GU

Question 1

Evaluation of testicular mass

Answer 1

US is best

• can delineate btwn neoplasm and nonmalignant process
• should be BILATERAL bc b/l disease occurs in 2-4% of patients even if obvious mass is not palpated

Tumor markers

• LDH
• b-hCG (choriocarnioma, seminoma)
• AFP (yolk sac cells)

Testicular cancer

• most common btwn 15-34
• RF: FHx testicular cancer, personal hx of cryptorchidism, gonadal dysgenesis, Klinefelters, HIV

Question 2

Proximal Hypospadias (towards shaft/scrotum) + Cryptorchidism should be evaluated for what?

Answer 2

Disorders of sexual development 
XX virilization 
XY undervirilization
mixed gonadal dysgenesis
Congenital adrenal hyperplasia*** 

Pelvic ultrasound
Karyotype
Serum electrolytes and 17OH level

Question 3

Epididymitis

Answer 3

Unilateral pain and swelling in scrotum
Scrotal erythema

+ Dysuria, Increased Freq, Urethral discharge, Fever

PE: normal lie of testes, + cremasteric reflex (vs. testicular torsion)
Phren sign - pain improves when testes is elevated

• *Prepubertal: postviral**
• enterovirus, adenovrius, myocoplasma
• rarely e coli

Sexually active adolescents:

• chlamydia, neisseria
• also viruses, mycobacteria, e coli

Can spread to orchitis (infection of the testes)

Question 4

Orchitis

Answer 4

infectious or inflammatory disorder involving the testis, which may occur due to

• extension of epididymitis
• hematogenous spread of a systemic bacterial infection, - sequelae of a viral infection

Chlamydia and Neisseria

Question 5

Torsion

Answer 5

Classic symptoms of testicular torsion include sudden onset of severe, unrelenting scrotal pain, often with associated nausea and/or vomiting.

Physical examination findings of testicular torsion include enlargement/swelling of the hemiscrotum, tenderness of the testicle, loss of the cremasteric reflex, and transverse lie of the testis on the affected side.

Any boy with acute scrotal pain, regardless of age, must be presumed to have testicular torsion until proven otherwise.

It is essential that a testicular examination be conducted in any boy with abdominal pain, because testicular torsion can manifest solely with abdominal pain.

Testicular torsion is a true surgical emergency. All boys with suspected testicular torsion should be emergently referred for urologic consultation and scrotal ultrasonography.

Question 6

Torsion of Appendix Testes

Answer 6

• pain is gradual, increasing over a period of 1–2 days.
• most common cause of acute testicular pain in boys 7–14 years of age
• tender mass on the upper pole of the testis, which is sometimes visible on careful examination of the scrotal skin as a “blue dot” (the “blue dot sign”)
• Tx: rest and NSAIDS

VS.
epididymitis - usually has UTI sx or in adolescents STI
spermatocele - asymptomatic

Question 7

Testes usually descend by?

Answer 7

6 months! Refer to GU for orchiopexy at that time.

Question 8

Priaprism treatment

Answer 8

• Pts with sickle cell
• Has potential to lead to permanent impotence due to ischemia and fibrosis in the corpus cavernosa of the penis

Tx:
Supportive: IV hydration and pain medication
If > 4-5 hours: Intracavernous injection of phenylephrine

Question 9

Treatment of Urethral Prolapse

Answer 9

Topical estrogen cream, applied twice daily following a sitz bath, often leads to resolution within 2–4 weeks

Question 10

Spermatocele

Answer 10

• painless, fluid-filled epididymal cyst that contains nonviable sperm.
• distinct from the testis and typically transilluminates.

Painless and of no clinical consequence.

Surgical incision is indicated only to relieve associated discomfort.

Question 11

Hydroceles

Answer 11

If present > 1 year of age -> refer to Peds Uro

Could be inguinal hernia.

Question 12

Silk glove sign

Answer 12

AKA thickened processus vaginalis

Sign of an inguinal hernia
- spermatic cord sliding between the hernia sac and the processus vaginalis. When the layers of the hernia sac are palpated sliding over each other, it mimics the feeling of a silk glove.