Term
| what are the most important modalities needed to make a dx in terms of disorders of the external genitalia? |
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Definition
| thorough inspection of the penis, palpation & ultrasound (US) of the scrotal contents (in that order) |
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Term
| what is the most common mass lesion w/in the scrotum? tx? |
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Definition
| hydrocele - which is an accumulation of fluid between the *visceral and parietal* layers of the tunica vaginalis (which wraps around the testicle itself or testicle + cord). tx: left alone and only treated w/sx if problematic |
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Term
| what does congenital hydrocele result from? |
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Definition
| persistence of peritoneal fluid w/in one or more *unobliterated segments of the process vaginalis that usually communicate w/the peritoneal cavity - requires sx (when the infant cries - the hydrocele will get larger). these are usually accompanied by inguinal hernia (or one will arise) which also requires sx. |
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Term
| what is the etiology of non-congenital hydroceles? |
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Definition
| reduction in reabsorption or an increase in production of a fluid by secreting membranes. can be *idiopathic, due to injury/infection, and more rarely - secondary to prostate/bladder/testicle CA. |
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Term
| what is found on physical examination for hydrocele? |
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Definition
| the involved side is large, has a sense of fluctuation (water balloon), can be soft to very firm, can be transilluminated, will not reduce in size unless it communicates (which if it does, a hernia is involved), and the testicle may not be palpable. |
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Term
| what is tx for hydrocele? |
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Definition
| mostly just observation (esp in children), if very large/uncomfortable - sx, and if the testicle is not palpable/at high testicular CA risk - sx is advised. no hydrocele is life-threatening or pre-malignant. |
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Term
| what is an inguinoscrotal hernia? |
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Definition
| an indirect hernia sac extending through the inguinal canal, down into the scrotum. these usually contain bowel, but may contain omentum/bladder. usually these reduce w/lying down - but occasionally if they are incarcerated/strangulated, sx would be urgent. the testicle and epididymis is usually palpable but an inguinoscrotal hernia does not translate well. |
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Term
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Definition
| a retention cyst at the head of the epididymis or aberrant tubules of the rete testes. spermatoceles will usually transilluminate and are separate from the testicle on palpation. spermatoceles are firm, usually non-tender, and about the size/shape of a marble. they contain spermatozoa and are only removed if painful. |
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Term
| what is a varicocele? what side are they seen more commonly on? |
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Definition
| a dilation of the internal/external spermatic and vassal veins w/in the scrotum due to an incompetency/absence of valves in the internal spermatic vein, allowing retrograde flow of blood. these are *more common on the L (L side empties into the renal vein at a 90 degree angle). |
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Term
| what might a varicocele of acute onset be due to? |
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Definition
| a retroperitoneal mass compressing the splenic vein - need to get a CT |
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Term
| how do varicoceles present? |
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Definition
| usually symptomatic - but may present as "heaviness/aching" in the scrotum. on palpation: "bag of worms" in the *upright position* |
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Term
| is varicocele the *most common cause of male infertility? |
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Definition
| yes - varicoceles are associated w/reductions in sperm motility/maturation due to rises in temperature. |
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Term
| when is tx for varicocele appropriate? |
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Definition
| in the context of discomfort/infertility |
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Term
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Definition
| this results from trauma to the testicle - producing a collection of blood between the *parietal and visceral* layers of the *tunica vaginalis. this is usually associated with ecchymosis (bruising) of the scrotum and if the testicles cannot be palpated US/sx is necessary. |
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Term
| how urgent is testicular torsion? |
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Definition
| testicular torsion is *extremely urgent (requires prompt dx/tx). >90% occur in the first 2 decades of life. |
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Term
| what characterizes intravaginal torsion? |
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Definition
| this is the most common form of torsion, where the testicle and cord twist *w/in the tunica vaginalis* - resulting from the combination of high insertion of the tunica on the cord and an abnormally long mesorchium OR failure of attachment of the epididymis to the posterolateral scrotal wall (bell clapper). |
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Term
| what characterizes extravaginal torsion? |
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Definition
| less common, this only happens in the neonatal period and 1st year of life. this will occur in fetus pre-delivery; testicle on examination is hard, non-tender, and gone by the time baby is born - *requires emergency surgery to save. |
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Term
| how does testicular torsion present? |
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Definition
| in any pt other than a neonate - *severe, sudden pain. exquisite tenderness on palpation which may refer along the cord to the groin/lower abdomen. this pain can subside spontaneously and be recurrent and may worsen to the point of n/v. the testicle/epididymis is engorged, enlarged, and high in the scrotum w/a thickened cord. |
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Term
| are UTI symptoms associated with testicular torsion? |
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Definition
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Term
| how soon does irreversible destruction occur w/testicular torsion? |
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Definition
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Term
| what should be in the ddx for testicular torsion? |
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Definition
| epididymitis and epididymo-orchitis, which if the pt is negative for abnormal urinalyses, fever, etc - can be r/o |
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Term
| what is the tx for testicular torsion? |
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Definition
| pain management, manual detorsion and then prompt surgical detorsion *B/L* (b/c usually a deficiency of the detaching mechanisms of both testicles) |
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Term
| what are the 2 testicular appendages of clinical significance? what may happen to them? tx? |
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Definition
| the appendix testes (attached to tunica albuginea & located on superior anterior aspect of testes) and appendix epididymis (located on the anterior aspect of the epididymis globus major). either may be subject to torsion and produce a sudden onset of mod-severe pain, usually located to site of twisted appendage (only point tenderness). the pain should leave spontaneously w/in 1 wk, tx only needs to be supportive if dx assured (since they are vestigial - no problem if they die off) |
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Term
| what is the difference between acute epididymis, epididymo-orchitis & orchitis? |
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Definition
| acute epididymis will always become epididymo-orchitis if not treated. orchitis only occurs with systemic viral disease (like the mumps). all are commonly associated w/fever and usually start as mild discomfort in the lower abdomen and within the scrotum -> progressing to severe pain, mostly in the scrotum. |
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Term
| what characterizes incidence of epididymo-orchitis? |
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Definition
| epididymo-orchitis is usually preceded by urethritis ( age 40); often also associated w/large prostates. |
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Term
| how does epididymo-orchitis present? what needs to be r/o? |
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Definition
| at first, the epididymis is swollen and tender - followed by enlargement and tenderness of the entire testicle w/in 3 days. pyuria is usually present (but not w/viral orchitis) as is elevated WBC. testicular torsion/tumors need to be r/o. |
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Term
| what is tx for epididymo-orchitis? what is the sequence of resolution? |
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Definition
| ice, elevation, scrotal support, analgesics, antibx (broad spec, cipro) - but if pyuria not present, viral etiology is likely. *the pain will resolve first, followed by a reduction in size/induration* |
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Term
| what is the worst case scenario for epididymo-orchitis? |
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Definition
| progression to abscess and loss of a testicle |
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Term
| is swelling w/testicular CA painful? |
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Definition
| no - but it can produce secondary inflammation, hydroceles, or hematoceles |
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Term
| what is the most reliable imaging study for testicular CA? |
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Definition
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Term
| how should the primary testicular tumor be removed? |
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Definition
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Term
| what is effective in tx of metastatic testicular CA? |
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Definition
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Term
| can pts die of necrotizing fasciitis of the scrotum? |
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Definition
| yes, this is a medical emergency and can often affect DM pts |
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Term
| what is urinary (urethral) extravasation usually due to? how is it diagnosed? tx? |
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Definition
| blunt/penetrating trauma usually causes it. it is diagnosed via retrograde urethrogram and treated w/insertion of cystotomy tube. |
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Term
| what are common dermatoses of the scrotum? |
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Definition
| tinea cruris, eczema, monilia, lice, folliculitis, hemangiomas |
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Term
| what are most penile CA? who are they usually found in? where does it met? |
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Definition
| SCC - almost exclusively found in uncircumcised males (why foreskin needs to be retracted) and mets through the lymph system. |
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Term
| what is peyronie's disease? tx? |
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Definition
| abnormal dorsal or ventral curvatures of the erect penis which present w/pain and difficulty w/vaginal penetration/poor erection due to a fibrous plaque of the dorsal or ventral tunica albuginea. can regress spontaneously or require surgery; often is not responsive to other treatments. |
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Term
| what is priapism? how does it present? how is it treated? |
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Definition
| prolonged painful erection, NOT related to sexual stimulation most commonly caused by *intracavernous injection of vasoactive agents for impotency (other causes include leukemia, sickle cell disease, pelvic tumors, trauma, and prolonged stimulation). *this is a urologic emergency* - if it isn’t reduced, permanent fibrosis/impotency will occur. on physical exam: tense corpora cavernosa, *soft glans and soft corpora spongiosum* tx: intracorporal adrenergic injection irrigation, shunts, exchange transfusions for sickle cell disease, chemo for leukemia |
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Term
| what is phimosis and paraphimosis? |
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Definition
| phimosis: a condition where the foreskin cannot be retracted due to stenosis. paraphimosis: retracted foreskin cannot be reduced and progressive swelling occurs - *urologic emergency* |
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Term
| what can cause scrotal edema? |
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Definition
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