Urology (5) (Misc) Flashcards

Question

management of fourniers gangrene

Answer 1

* STAT broad spectrum IV Abx * Surgical debridement of all affected (necrotic) tissue and subcutaneous tissue involved * SEPSIS 6

Answer 2

phimosis paraphimosis

Answer 3

* When prepuce cannot be fully retracted in adult * **Physiology phimosis:** normal non-retractability up to adolescence * **Pathological:** scarring, infection, inflammation

Answer 4

* In adulthood may be associated with other pathologies * Beware of the elderly with phimosis and balanitis

Answer 5

* Poor hygiene (build-up of smegma) * STDs * Penile cancer

Answer 6

* Pain on intercourse, splitting/bleeding * Balanitis (inflamed glans) * Posthitis (inflamed foreskin/prepuce) * Balanitis xerotica obliterans (BXO) * Urinary retention

Answer 7

* Topical corticosteroid therapy * Circumcision

Answer 8

Inability to pull forward a retracted foreskin over the glans penis * Painful constriction of the gland by the retracted prepuces proximal to the corona * As the paraphimosis remains, the **glans becomes increasingly oedematous** due to reduced venous return, leading to vascular engorgement of the distal penis and further oedema * Can lead to fourniers gangrene

Answer 9

* Phimosis- presence of tight constricting bands as part of the foreskin that prevents the retraction over the glans * Catheterisation esp in elderly (when you retract the foreskin and don’t put it back) * Penile cancer

Answer 10

* Needs reduction STAT * **Manual pressure** to the glans can aid to reduce oedema, squeezing gently but constantly, before applying force to the glans to reduce it into the prepuce (use of lubricant jelly as required). * Application of **dextrose-soaked gauze** to act as an osmotic effect, drawing fluid out of the glans, reducing the oedema present, and allowing for glans reduction as above. Similar technique for reducing oedema can be performed with ice packs * The “**Dundee Technique**” involves the use of needle punctures into the glans penis, squeezing the area to allow drainage of oedematous fluid, before attempting reduction of the glans, as discussed above * Occasionally dorsal slit may be necessary * Suitable analgesia

Answer 11

Abnormal mass or swelling within the scrotum- can be testicular or extra-testicular. * hydrocele * varicocele * epidiymal cyst * indirect inguinal scrotal hernia

Answer 12

Clinical features * Time of onset * Associated symptoms (pain) * Previous episodes * Inspection of lump * Size * Site * Shape * Symmetry * Skin changes * Scars * Palpating the lump (CAMPFIRE) * **_T_**enderness, **_T_**emperature, **_T_**ransillumination * **_C_**onsistency * **_A_**ttachments * **_M_**obility * **_P_**ulsation * **_F_**luctuation * **_I_**rreducibility * **_R_**egional lymph nodes, * the **_E_**dge.

Answer 13

* US of the scrotum * Biopsy not warranted – due to risk of seeding * Blood tests * LDH * AFP * Beta-hCG * Diagnosis is purely on clinical features, US and histopathological examination of testes following orchidectomy

Answer 14

* Extra-testicular * *A hydrocoele is an abnormal collection of peritoneal fluid between the **parietal and visceral layers of the tunica vaginalis** enveloping the testis*.

Answer 15

* **Congenital hydrocoeles** affect up to 3% of male neonates and generally ***regress spontaneously by one or two years of age.*** * No treatment is typically needed * Caused by a patent processus vaginalis requiring ligation to stop recurrence.

Answer 16

* hydrocoeles may be primary (idiopathic) or secondary due to trauma, infection, or malignancy. * Those presenting with a hydrocoele aged between 20-40yrs (or where the testis cannot be palpated) should undergo urgent ultrasound scan *

Answer 17

* They typically present\* as a painless fluctuant swelling that will transilluminate, either unilateral or bilateral. * Occasionally they can grow very large and cause discomfort when sitting and walking necessitating surgical management.

Answer 18

A hydrocele that doesn't disappear on its own might need to be **surgically removed**, typically as an outpatient procedure. The surgery to remove a hydrocele (hydrocelectomy) can be done under general or regional anesthesia. An incision is made in the scrotum or lower abdomen to remove the hydrocele

Answer 19

Abnormal dilatation of the pampiniform venous plexus within the spermatic cord Complications: infertility and testicular atrophy (increasing intra-scrotal temp) could be a sign of renal cancer

Answer 20

* Lump * Bag of worms * Dragging sensation * Disappears when lying flat * **Usually found on left hand side** * Spermatic vein drains directly into the left renal vein

Answer 21

* Semen analysis * Surgery: embolization by interventional radiologist and surgical approaches either open or laparoscopic approach for ligation

Answer 22

infertility and testicular atrophy (increasing intra-scrotal temp)

Answer 23

Benign fluid-filled sacs arising from the epididymis. They are common scrotal pathology and are classically seen in middle-aged men.

Answer 24

* Smooth fluctuant nodule, found above and separate from the testis that will transilluminate, often they are multiple. * The cysts rarely cause symptoms, have no association to malignancy, and generally do not need treatment.

Answer 25

In rare instances, they are very large or painful and therefore surgery may be required, but is best avoided in younger men as surgery may lead to infertility.

Answer 26

Inguinal hernia can pass into the scrotum via the deep inguinal ring, entering the inguinal canal initially at the internal ring (indirect hernia) or through Hesslebach’s triangle (direct hernia). Passing into the scrotum they run alongside the spermatic cord.

Urology (5) (Misc) Flashcards

(50 cards)