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56 Cards in this Set
- Front
- Back
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cryptorchidism
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sigsn- hypoplastic, hypopigmented, poorly rugated, empty scrotum.
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management of cryptorchidism
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most undescended testes will descend spontaneously during first 6 months of life. Testes that don't descend by age 6 months rare descend spontaneously, so do orchiopexy- to improve fertility and testicular growth. Reduces risk of testicular torsion b/c attached to scrotal wall. risk of testicular cancer is decreased but not gone.
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risk factors for chryptorchidism
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premature, small for gestational age ,weight < 2.5kg, exposure to pesticides DES in utero, genetics, neural tube defect
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KEEP GOING
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KEEP GOING! |
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genital lesions: pearly penile papules
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normal variant. Rows of flesh colored dome topped or filiform papules aound corona of glanz penis.
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condyloma acuminata
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genital warts- MOST COMMON STD in S. caused by HPV virus. See skin lesions verrucous or flat
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gonococcal urethritis
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get urethral discharge and dysuria wtihin 2-7 days of exposure to infected partner. Can get dysuria, polyuria,
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herpes ! HSV infection
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get vesicles- can dev into painful pustules and ulcers that crust in 4-15 days. Urethritis is common complaint- associated w/ dysuria and mucoid discharg
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management of infertility
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male factor causes 20% cases - do semen analysis for concentration, motility, morphology. Other cause can be anovulation - can check serum progesterone and proclatin and sample endometrium. . After can do hysterosalpingogram to look for anatomic abnormalities
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signs of epididymitis
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mild-moderate scrotal pain + swelling + tenderness. No urination sxs. UA normal. Prehn side usually positive (dec pain with testicular elevation)
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cause of epididymitis
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most common is Chlamydia
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testicular torsion
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sudden severe pain. Get high riding testes on affected side. Cremasteric reflex is GONE. Do doppler U/S !
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orchitis
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bacterai like mumps infection. Get fever, severe scrotal pain and swelling
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testicular tumor
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painless scrotal mass
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varicocele
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dull scrotal pain improved by lying down. Bag of worms feel. Usually left sided or bilateral
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cryptorchidism risks
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higher risk of testicular cancer. Dec after surgery but still high
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causes of erectile dysfunction- psychologic
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have normal night and morning erections- indicate intact vascular and neurologic supply to penis. Optimal androgen leve. Rule out physiologic cause. Due to anxiety!
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causes of erectile dysfunction- physiologic causes
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ie DM- get poor glycemic control, vasculopathy, neuropathy, meds.
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klinefelter syndrome
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have higher risk of breast cancer.
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evaluation of painless scrotal swelling
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must eval for testicular cancer. Get scrotal U/S. cystic/fluid filled lesions are unlikely to be cancer .if lesion is suspicious, get CT abd/pelvis to look forretroperitoneal nodes , and measure afp, bHCG. Radical inguinal orchiectomy gives accurate diagnosis
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result of untreated varicocele
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testes are in pampiniform plexus of vessels that reduce temperature of scrotum. If plexus dilates, temperature increases, seminiferous tubules will atrophy :(
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hydrocele
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collection of fluid in potential space in tunica vaginalis- can be congenital (patent processus vaginalis) or acquired from epididymitis etc.
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features of varicoceles
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often affects L side b/c L spermatic vein etners L renal vein at 90deg angle. R spermatic vein drains direct to IVC. If someone has bilateral varicocele, need to look for IVC obstruction that coculd be causing it. So get an abdominal CT to look for obstruction
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BPH treatment
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TURP- transurethral resection of prostate can result in retrograde ejaculation as complication.
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testicualar cancer
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most common solid malignancy in males under age 35. presents as painless mass
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if u/s shows suspicious lesion for testicular cancer …
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then get CT abd/pelvis and CXR . Also check bHCG and AFP. (HCG up in pure seminomas, both in nonseminomas)
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Eval for ED
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can be caused by peripheral artery disease- if pt has atherosclerotic risk factors (DM, smoking, hLd) and claudicatio nsxs ie butt and thigh pain while walking, do diagnostic testing - ABI, cardiac stress test
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Leriche syndrome
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triad- lower extremity claudication, dec femoral pulses, erectile ddysfunction
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Ankle brachial index
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<0.9 iss sensitive/specific fo PAD. If someone had 3 + atherosclerotic risk factors, screen for cardiovascular disease before treating the sexual dysfunction
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treatment for ED
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PDE-5 inhibitors (sildenafil, vardenafil, tadalafil).
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prostate cancer
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in most ppl, progresses very slowly, so people likley die from other causes.
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PSA test
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nonspecific. High false positive rate. Can treat with high rate of complications.
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treatment for prostate cancer
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radical prostatectomy or radiation tx
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complicaions of tx of prostate ca
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ED< incontinence, bowel dysfunction
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prostatitis
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boggy, tender, edematous prostate.
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tx of prostatitis
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check UA and Ucx. Pyuria and poitive culture- guide tx
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do prostaste massage?
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No. can cause bacteremia. No benefit
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nonbacterial prostatitis
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get >20 WBC/hpf in prostate secretions, bt no bacteria in culture. Inflammatory disorder. No hx of UTI
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acute prostatitis
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fever, chills, dysuria, perineal pain, cloudy urine, dysuria, tender prostate,
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chronic bacterial prostatitis
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complication of acute prostatitis- subtle. Get dysuria and polyuria without signs of prostatitis.
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how to tx nonbacterial prostatitis
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Sitz bath and anti-inflammatory meds
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side effect of sildenafil (viagra)
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causes blue-green color vision. Wait 6 hours before flying plane
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Scrotal pain= work up
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is it pain predominant (testicular torsion, appendix testes torsion, epididymitis) o r swelling predominant (hydrocele , varicocele, spermatocele, testicular cancer).
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cremasteric relfex
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testes elevate with inner thigh stroke. Absent in testicular torsion. Usually normal in epididymitis. Gone in torsion.
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eval for testicular torsion
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get doppler U/S to eval for torsion. Will need urology to surgically detorse and do orchiopexy on both testes
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hydrocele
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do transillumination test- see cystic fluid between parietal and visceral layers of tunica vaginalis that can increase in size or not.
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epididymitis eval
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check UA. Urethral swab
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eval for blunt testicular trauma: mild
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minimal pain/swelling. Rest, ice, briefs, NSAIDs, f/u in 48 hrs
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eval for blunt testicular trauma: moderate
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scrotal U/S. if normal, treat as mild. If abnormal- consult surgery. Look for dec blood flow
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eval for blunt testicular trauma: severe
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abnormal exam- look for scrotal hematoma, testicular compression, hematocele, testicular rupture, torsion etc. get U/S and surgical consult
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if suspect urethral injury- see blood at ti of meatus
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do retrograde urethrogram to look.
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priapism
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painful erection that can become veno-occlusive, acidotic and anoxic and ischemic. Can be due to sickle cell, neurogenic problem, trauma, medication (trazodone)- get alpha adrenergic blocade . Lasts >3hours. Emergency. Need urologic consult b/c can damae corpora and cause impotence . tx- ice paick. meds to inc venous outflow. 1st line med- alpha adrenergic agonist like epinephrine or phenylephrine to bring it down
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TURP complications
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retrograde ejaculation (Dry), hyponatremia- uses 20-30L of iso-osmotic flush without Na. can get absorbed into circulation via prostatic veins thus make Na drop, causing sxs. Look for osmolal gap
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causes of transient elevated PSA
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urinary retention, mild prostate inflammation, infection, urologic procedure, DRE, recent ejaculation
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persistent PSA elevation
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BPH, prostate Ca, prostatitis
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if PSA is mildly elevated
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repeat in 2-6 weeks to see if ti normalized. If persistently elevated, do further investigation
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