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CP3 SURGERY > UROLOGY - Penis and Testicles > Flashcards

UROLOGY - Penis and Testicles Flashcards

1
Q

What is Phimosis

A

Narrowing of the prepubital orifice

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2
Q

Causes phimosis (4)

A

Idiopathic
Congenital
BXO
Traumatic forcible retraction of foreskin

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3
Q

PS phimosis in children

A

Ballooning of the foreskin + poor stream during urination

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4
Q

PS phimosis in adults

A

Pain during intercourse + inability to retract foreskin

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5
Q

Tx phimosis

A

Circumcision

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6
Q

What is paraphimosis

A

Pulling a tight foreskin over glans, obstructing vv return- –> swollen, painful glans
Then cannot replace foreskin

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7
Q

Causes paraphimosis

A

After erection

Forgetting to replace foreskin after catheter

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8
Q

Tx paraphimosis

A

LA + P to glans

Or slitting foreskin dorsally

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9
Q

Prevention of recurrence paraphimosis

A

Circumcision

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10
Q

What is 50% of carcinoma of the penis associated with?

A

HPV 16/18

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11
Q

Who is > at risk of carcinoma penis

A

Smokers

Immunosuppressed

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12
Q

PS carcinoma of the penis

A

Persistent red patch on penis –> ulcer

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13
Q

What type of cell tends to be penile cancer

A

Squamous cell carcinoma

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14
Q

ix penile carcinoma?

A

Punch biopsy

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15
Q

Mx early penile carcinoma

A

Radiotherapy

Or penis preserving excision

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16
Q

Mx late penile carcinoma

A

Radical excision

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17
Q

What is priapism

A

Persistent erection of corpora cavernosum

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18
Q

Causes priapism (4)

A

Idiopathic (mostly)
Trauma
Sickle cell disease
Intracvernosal injections for impotence

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19
Q

Tx priapism

A 
Ice packs 
Alpha agonists 
Selective emobilization 
Aspiration of corpus cavernosum 
Surgical intervention
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20
Q

What is Peyronie’s disease

A

Upward curvature of penis when erect

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21
Q

What % of men are affected by Peyronies

A

Up to 3%

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22
Q

Cause Peyronies

A

Unknown

Potentially related to fibrous scarring post trauma

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23
Q

Tx Peyronies

A

Mx assoc depression

Surgical intervention

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24
Q

What is an ectopic testis

A

Testies that has strayed from its normal line of descent

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25
Q

Most common site of ectopic testis

A

Superior inguinal pouch

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26
Q

Mx ectopic testis

A

Orchidopexy @6m

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27
Q

What is an undescended tstis

A

Testis has stopped short of scrotum

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28
Q

Why does undescended testis occur

A

Local defect in devlopment

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29
Q

Mx undescended testis

A

orchidopexy @6m

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30
Q

What is retractile testes

A

Normal testes w/ XS cremasteric reflex

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31
Q

Tx retractile testes

A

No Tx

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32
Q

Complications of maldescent testes (4)

A

Defective spermatogenesis
Incr risk torsion
Incr risk malignancy
Incr risk indirect inguinal hernia

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33
Q

GO OVER APPROACH TO SCROTAL SWELLING

A

DO IT U POO

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34
Q

Cremasteric reflex + torsion

A

Absent

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35
Q

Phren’s sign

A

Scrotal elevation relieves pain in epididymitis

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36
Q

What is epididymal cyst due to?

A

Cystic degeneration of epididymal structures

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37
Q

What 2 conditions are epididymal cysts associated with?

A

PKD

CF

38
Q

Fl in epididymal cyst

A

Clear or milky

39
Q

Mx epidiymal cyst

A

Excise if signif Sx

40
Q

What is the most common cause of scrotal enlargement

A

Hydrocele

41
Q

What is a hydrocele

A

Excessive collection of serous fluid in tunica vaginalis

42
Q

Why do hydrocele’s occur (2)

A

Problem w/ absorbing fl

Or too much fl = being produced

43
Q

Congenital hydroceles

A

Assoc w/ hernia sac + patent processus vaginalis

44
Q

Mx congenital hydroceles

A

Most spontaneously resolve <1y

45
Q

Who gets 1’ hydroceles

A

Younger men

46
Q

What is a 2’ hydrocele

A

Fluids collecting due to underlying inflamm in epididymis/testes/ underlying cancer

47
Q

Ix hydrocele

A

USS

48
Q

Mx troublesome hydrocele

A

Excision

49
Q

What is a varicoele

A

Varicosities/dilation of pampiniform plexus, most commonly on the left

50
Q

What % of men have a varicoele

A

10%

51
Q

PS varicoele

A

Pt complains of dragging sensation + ache

Bag of worms on palp

52
Q

Varicoele + infertility

A

assoc w/ reduced spermatogenesis + subfertility

53
Q

Which testicle > likely to have varicoele + why

A

L

Because L renal v drains at right angle vs R testicular vv which drains obliquely into IVC

54
Q

Mx varicoele

A

Reassurance

55
Q

What is the most common solid malignancy in men aged 15-44

A

Testicular tumour

56
Q

RF testicular cancer (4)

A

Underscended/ectopic testes
Infertility
Hypospadia
F/PHx

57
Q

What are the 2 main types of testicular tumours

A

Seminomas

Non-seminomatous germ cell tumours

58
Q

What are the 3 types of NSGCT’s

A

Teratomas
Yolk sac tumours
Choriocarcinomass

59
Q

Where do seminomas arise from

A

Cells of seminiferous tubules

60
Q

What age groups - seminomas

A

30-40y/o

61
Q

Macroscopic appearance seminoma

A

solid appearance

62
Q

Where does teratoma arise from

A

Totipotent germ cells

63
Q

What age group - teratoma

A

20-30y/o

64
Q

Macroscopic appearance teratoma

A

Cystic

65
Q

Spread testicular cancer

A

Lymphatic –> para-aortic nodes

Blood bourne - lungs + liver

66
Q

PS testicular cancer (5)

A 
Painless lump in testes 
Hydrocele 
Haematospermia 
Sx mets 
Rarely - gynaecomastia
67
Q

Ix testicular cancer

A

Scrotal USS
Tumour markers
CT CAP

68
Q

Tumour markers NSGCT’s (2)

A

Prod AFP

Some prod bHCG

69
Q

Tumour markers Seminomas (2)

A

Never prod AFP

10% prod bHCG

70
Q

Mx testicular tumours

A

Orchidectomy
+/- retroperitoneal LN dissection
Sperm banking

71
Q

post surgery Tx seminomas

A

post sugrical radiotherapy

72
Q

post surgery Tx NSCGTs

A

post surgical chemotherapy

73
Q

What is testicular torsion usually due to

A

Congenital abnormality

74
Q

What age does testicular torsion tend to PS in

A

12-18y/o

75
Q

Sx tsticular torsion

A

Sudden onset severe pain groin/lower abdo T10

+/- vom

76
Q

O/E testicular torsion

A

Unilateral hot swollen tender testes

Absent cremasteric reflex

77
Q

DDx testicular torsion (4 )

A

Epididymitis
Torsion of testicular appendage
Mumps
Cancer

78
Q

Salvage rate if op’d on within 6hrs testicular torsion

A

80%

79
Q

PS torsion testicular appendage

A

< painful that torsion

Small blue nodule visible under scrotum

80
Q

What is Epididymo-orchitis

A

Acute infection arising due to ascending infection via vas deferens

81
Q

Causes epididymo-orchitis (4)

A

Gonococcal/non-gonococcal urethritis
UTI/E.coli
Mumps
TB

82
Q

PS epididymo-orchitis (4)

A

Painful swelling of epididymis
+/- 2’ hydrocele
Hx discharge/dyusria
+ves Phren’s test

83
Q

Ix epididymo-orchitis

A

1st catch urine MCS + STI sscreen

USS

84
Q

Tx epididymo-orchitis

A

6w cipro

Analgesia + scrotal support

85
Q

PS acute bacterial prostatitis (5)

A 
Fever/rigors
Perianal pain
Difficulty voiding 
UTI Sx 
Pain on ejaculation
86
Q

PR - acute bacterial prostatitis

A

Tender + enlarged

87
Q

Def impotence

A

Inability to achieve, or sustain an erection for sexual intercourse

88
Q

Causes impotence (9)

A 
Neurogenic 
Vascular (HTN/aa disease)
DM
Pit failure 
Alochol 
Anti-HTN
Oestrogens 
Tranqs
Psychogenic
89
Q

Ix importence

A

Hx
Exam
Urine dip
Hormone screen

90
Q

Tx impotence

A 
Tx med/hormonal cause 
Stop smoking/reduce alc intake 
Sildenafil 
PEG1 injection 
Vacuum condom
91
Q

C/I sildenafil

A

If on HoTN drugs

CP3 SURGERY (19 decks)

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