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Topic in urology

Clinical Medicine II

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)
Created by: becker15
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