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Topic in urology
Clinical Medicine II
Question | Answer |
---|---|
Fluid-filled sac surrounding a testicle results in swelling of the scrotum | hydrocele |
When do thetestes descend | through the inguinal canal about 1m before birth |
What happens after the dedscent of the testes | processus vaginalis closes and testis is covered in what is now the tunica vaginalis |
What is a non-communicating hydrocele | the hydrocele does not communicate w/ the abd cavity |
Where is the fluid in a communicating hydrocele | anterior to the teste |
What does a communicating hydrocele associated w/ | indirect inguinal hernia |
What would an acute hydrocele result from | acute process in tunica vaginalis such as trauma, infection, tumor |
Sxs of hydrocele | USUALLY PAINLESS |
Dx of hydrocele | fluid filled sac, transillumination, cremasteric reflec intact,U.S.: r/o tumor |
Tx o f hydrocele | observation in infancy, surgical intervention if symptomatic (aspiration not appropriate by itself) |
Cystic swelling either of epididymis or of the rete testis | spermatocle |
Where does a spermatocele occur | above, behind, or separate from the testis |
Painless diverticulum of the epidydimis located b/w head of epidydmis and testes | spermatocele |
Tx spermatocele | surgically removed if painful or large enough to cause significant discomfort |
Are hydroceles, spermatoceles, and varicocels associated w/ infertility | only varicoceles |
Abnormal dialation of a vein w/I spermatic cord “bag of worms” | varicocles |
What are the venous plexus for R and L side | papiniform on the right→drains into internal spermativ viein then IVC, L drains into renal vein more acute angle |
Where do most of varicocles occur | L almost 100% R warrants further investigation |
Tx varicocele | surgery for relief of sxs, cosmetic? |
What is RARE before puberty | epididymitis |
Causes of epididymitis | reflux of urine or infections |
In men <35 and >35 what are the MC pathogens for infx | <35: N. gonorrhea, C trachomatis anal intercourse, many more >35: enterobacteriaceae and pseudomonas |
What s often found with epididymitis | 15-20% found with malignant lesions |
Pain relieved by elevation of the affected testes | prehn sign |
CP of epididymitis | painful palpation and prehn sign (painful, acute, only behind the teste) can do a UA/UC, aspiration |
Dx of epididymitis | clinical, gram stain of urethral secretions >5WBC leukocyte esterase on first-void sediment>10, radionuclide scan more accurate, US has 70% sensitivity: R/O torsion/tumor |
Tx for epididymitis | appropriate abx, anti-inflammatories, scrotal elevation to facilitate drainage, ice |
Does epididymitis cause infertility | (can: scarring) |
Abx tx <35mv>35 | <35: doxy 100mg bidx 10d consider adding ceftriazone 250mg x 1dose (N. gonorrhea, C> trachomatis) >35: TMP-SMX ds bid x10-14d (prostitis) cipro 500mg qd x10-14d enterbacteriacae, coliforms, enterococci |
Uncommon acute inflammation of the testes | orchitis (usually an extension associated w/ epididymitis |
Cause of orchitis | systemic infections: mups paramyxovirus MC |
Tx orchitis | scrotal support/elevation, hot/cold packs, abx if deemed appropriate, anti-inflammatory including prednisone, |
Does orchitis cause infertility | could yes + sterility |
Testicular maldescent | cryptorchidism |
When does it need surgical correction | indication if not resolved by one year of age (r/o rectractile physiologic cryptorchidism) |
Rotation of the testis and spermatocord | testicular torsion |
Tx testicular torsion | surgical emergency |
S/S testicular torsion | acute scrotal pain, N/V/ anorexia (d/t pain), trauma? Riding high testes, swelling, extreme tenderness, ABSCENT cremasteric reflex, prehn sign (does not), |
Dx of TT | US and radionuclide scan, if suspect emergent urology consult |
When does necrosis occur w/ 360 and 1080 degrees | 360: 12-24hrs, 1080: 2hrs |
How can we manually untwist the testicles | right clockwise, left counterclockwise, must f/u w/ orichidopexy |
Surgery to keep undescended teste down | orichidopexy |
Pain over the upper pole of the testis, nl testicular orientation, pain, blue appearing lesion over upper pole | appendix testes torsion |
Tx ATT | analgesics |
When does testicular malignancy peak | 20-40 years, |
What is testicular malignancy associated w/ | epididymitis, epidiymorchitis may delay dx, |
Two major groups of germ cell tumors | seminoma and seminomatous |
What arises from epithelial cells | carcinoma |
Arises from connective tissues and are often named for the specific type of tissue | sarcoma |
What increases testes malignancy chance | cryptorchidism (10-40fold), abdominal testis: siminoa,orchiplexy: non semino |
What a lab findings w/ malignancy | AFP and beta-human chorionic gonadotropin |
Imaging for examination | US and CT |
Tx testicular malignancy | beam radiation, surgery, platinum-based chemo |
Inflammation of the prostate | prostatitis |
Prostadynia | pain in the prostate |
Causes of prostatitis | ascending urethral infx d/t meatalinoculation, reflux of infected urine, invasion of colonic bacteria, |
Sxs of ABP | acute febrile illness, perineal pain, ↑ urinary frequency, dysuria, urgency, nocturia |
Stranger signs with CBP | penile pain, pain w/ ejaculation, hematospermia, scrotal pain, perianal pain |
Inflammatory bp | similar to CBP, tx w/ NSAIDS? |
Tx ABP <35 | doxy 100mg bid x 10d (ceftriaxone 250mg IM x1) |
Tx ABP >35 | cipro 500mg bid or TMP-STXbid x 10-14d |
Tx CBP | cipro 500 mg bid x28days |
BPH | hyperplasia of the prostatic epithelium |
Sxs with BPH | dysuria, nocturia, urgency, sxs of bladder outlet obstruction, weak stream and post-void dribbling |
Txof BPH | testosterone and dihydrotestosterone control |
What may be elevated d/t BPH | PSA (prostatic specific antigen) |
Will cancer develop if casterated before puberty | no need testosterone to devlope this |
When does prostate cancer show up | (RARE) before 50 |
What type of cancer is prostate cancer most often | 95% adenocarcinomas |
Where are MC mets of prostate cancer | pelviclymph nodes and skeleton, visceral mets, lungs, liver, adrenal glands |
Causes of urethritis | NGU: chlymydia trachomatis, caffeine, spermatocides, lotions, soaps,condoms |
NGU definition | urethral discharge/dysuria AND urethral inflammation w/ mucopurulent discharge or leukocytes |
S/s of NGU | mucoid or watery discharge common, dysuria, 42% asymptomatic |
Tx urethristis | abx, metronidazole (sxs persist and trichamonas) ↓ caffeine, avoid irritants |
Inflammation of the glans penis | blanitis |
What does balanitis sometimes associate w/ | posthitis (inflammation of foreskin), poor hygiene |
Smegma | glandular secretions |
Cause of balanitis | candida, (circumcision prevent recurrances) |
Foreskin too tight to retract | phyimosis, hygiene issues and sex fxn issues |
Too tight to get back over the glans | paraphimosis, may need emergent relief |
RF’s for penile cancer | HPV, smoking, tx of penile psoriatic lesions w/ psoralen and ultraviolet radiation, |
Persistent inability to obtain or maintain sufficient rigidity of the penis to allow satisfactory sexual performance | erectile dysfunction (subjective data) |
Causes of failure to iniciate erection | endocrinologic, psychogenic, neurogenic |
Failure to fill the erection | ateriogenic |
Failure to store blood for an erection | venoocclusive dysfunction |
Vasculogenic E.D causes | atherosclerotic dz, DM, excessive outflow |
Neurogenic E.D causes | spinal cord lesions, MS peripheral neuropathy, pelvic surgery |
Endocrinologic causes E.D. | testosterone leves, prolactin excess (suppress libido) |
Diabetic E.D. causes | primarily secondary to vascular and nero complications of DM, ↓ Nitric oxide in endothelial tissues |
Causes of performance anxiety | loss of attraction, relationship conflict, depression, sexual inhibition, fear of STD, preggo, commitment |
Two casues of psychogenic E.D. | performance anxiety, excess sympathetic tone |
Medication causes E.D> | diuretics, antiHTN, hormones, antidepressants, H2 blockers, ETOH, cocain, THC |
Tx E.D. | oral phosphodiesterase type 5 inhibitors (tadalafil, sildenafil, vardenafil) |