W139 Testes Flashcards
Testicular tumour symptoms
painless lump, irregular. late presentation can include cough and back pain
Testicular tumour common cancer types
seminomas and teratomas
testicular tumour investigations
USS testicle
serum tumour marker a-fetoprotein and b-hcg
chest xray,
CT scan of abdominal and pelvis (to stage)
testicular tumour management?
orchidectomy with histology
radiotherapy- Mets below diaphragm
chemotherapy- wide spread Mets
sperm banking
prostate carcinoma symptoms?
bladder flow obstruction
pain due to bone metastases
irregular prostate on PR
asymptomatic
prostate cancer type?
adenocarcinoma
prostate cancer investigation?
trans-rectal USS
PASS test
endo-rectal MRI for staging
prostate cancer management if microscopic?
watch and wait
prostate cancer management if NOT microscopic?
radical prostatectomy
radiotherapy
synthetic LH analogues if Mets present
bilateral orchidectomy
benign prostate enlargement symptoms
nocturnal peeing - nocturia
urine frequency
delay in urine initiation
enlarged but smooth prostate on PR
if bladder outflow obstruction- similar to adenoma
Benign prostate enlargement investigations?
serum electrolytes and renal USS to rule out renal damage
serum PSA- can be elevated but must check for adenoma
benign prostate enlargement mild symptom management?
watch and wait
benign prostate enlargement moderate to severe management?
selective a1-adrenoreceptor antagonists eg. tamulosin
or
5a reductase inhibitors
suprapubic catheter if needed
what does tamulosin do?
relax smooth muscle and helps urination
what do 5a reductase inhibitors do?
block testosterone to DHT, to slow prostatic growth
what is giant condylomata?
hideous warty growth on penis/ ball area
rare aggressive verrucous carcinoma
giant condylomata investigation?
biopsy for histology
giant condylomata management?
chemotherapy
IFN treatment
surgical excision (best choice)
what is balanitis?
inflammation of gland penis
symptoms of balanitis?
inflamed, non retractable foreskin ulceration foul smelling discharge dysuria impotence
balanitis investigations?
blood urine test for diabetes
Swansea for.microscopy (culture and sensitivity to drugs)
if STI potential is high refer to GUM
balanitis treatment
hydrocortisone if dermatitis
antibiotics if infective
if recurrent then circumcision
what is phimosis?
foreskin of penis can’t be pulled back past glans
phimosis investigation?
diagnosis on examination and history only
phimosis treatment?
topical steroids (bethamethasone)
stretch foreskin with balloons
circumcision
slit in foreskin
what on earth is ‘lichen sclerosis et atrophicus’?!
whitish thickening of foreskin which can’t be retracted
tbh sounds pretty similar to phimosis. blehhh
what does lichen sclerosis et atrophicus biopsy show?
hyperkeratosis and sclerosis (it’s ball in the name!)
lichen sclerosis et atrophicus management?
topical steroids
good hygiene
wtf is paraphimosis? and main symptom?
EMERGENCY
Foreskin trapped behind glans and can’t be reduced. Stops blood flow.
PAIN
paraphimosis causes?
severe malhandling of penis
also psoriasis and eczema
paraphimosis management?
prevented by bringing foreskin back to normal position quickly. simples.
manual.manipulation first
then dorsal slit (ouch)
then circumcision
what is Peyronie’s disease?
chronic inflammation of tunica albuginea
lol you get it from sexual trauma
penile cancer symptoms?
redness/rash bad discharge pain growth/sore bleeding
penile cancer type?
95% squamous cell carcinoma
HPV, hiv and genital warts strongly related
penile cancer investigations?
biopsy blood test (for what?)
penile cancer treatment?
surgery- laser, wide, macro, circumcision
radiotherapy
chemotherapy
what is cryptorchidism?
absence of one or both testes from scrotum at birth
ie. undescended testes
crptorchidism investigation?
test cremaster retraction (put something cold on scrotum, does it pull up?)
pelvis USS or MRI
cryptorchidism management?
watch and wait if young
orchiopexy surgery
sometimes hcg injections
sebaceous cyst on scrotum symptoms?
painless or painful to touch
may or may not have pus
lol
treatment of sebaceous ball cyst?
surgical removal
or watch and wait
what is fourniers gangrene?
EMERGENCY
Necrotising fasciitis of the ball/ genital area
grim grim grim
testicular torsion symptoms?
PAIN in groin and lower abdomen
nausea and vom
pyrexia
swelling and redness
what is testicular torsion?
EMERGENCY
spermatic cord twists and cuts off blood supply
oh noooo
testicular torsion investigations?
decreased cremasteric reflex
physical.exam
Doppler USS if in doubt
treatment of testicular torsion?
manual rotation of simple
or
SURGERY EMERGENCY
what is an epidydimal cyst?
a faux third testicle
contains serous liquid
usually painless
what is a varicocoele?
enlargement of venous plexus of scrotum
what is a varicocoele?
enlargement of venous plexus of scrotum
varicocoele symptoms?
drag like ache
visible enlarged veins-bag of worms
which testicle is usually affected by varicocoele of unknown cause?
the left due to anatomy- testicular vein and renal vein connect at 90 degrees on this side
varicocoele treatment?
surgery
embolisation- obstruct gonadal vein so drainage occurs through collaterals
what causes inguinal hernia?
failure of embryonic closure of the deep inguinale ring once testes has passed through
or
weakening in wall
what is a spermatocele?
retention of cyst in a tubule of the rete testis with sperm in it
painless, smooth mass
haematocoele what is it?
blood.in tunica vaginalis.
does NOT transilluminator apparently
symptoms of epididymitis?
pain swelling warmth dysuria discharge pyrexia
epidydimitis causes?
Chlamydia most common
then gonorrhea
also ecoli/ cmv
