Surgery Marrow Pg 317-326 (Urology)

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Questions and Answers

What is the most important prognostic factor for testicular tumors?

Stage of tumor (correct)

Size of the tumor

Age of the patient

Type of tumor

Stage I non-seminomatous tumors have a 50% rate of subclinical metastasis.

True

What treatment is generally recommended for Stage II testicular tumors?

BEP chemotherapy

In Stage III, treatment typically involves BEP chemotherapy followed by _______ and possible metastasectomy.

RPLND Signup and view all the answers

Match the stages with their appropriate treatments:

Stage I = BEP chemotherapy Stage II = BEP chemotherapy Stage III = BEP chemotherapy + RPLND ± metastasectomy Signup and view all the answers

What is the most common vessel involved in hemorrhage during post-operative complications in urology?

Frenular vessel Signup and view all the answers

Chordee formation is a common complication after urological procedures.

True Signup and view all the answers

What is the primary method of management for paraphimosis before considering surgery?

Conservative management using Xylocaine jelly Signup and view all the answers

In paraphimosis, the foreskin forms a __________ ring around the penis.

constriction Signup and view all the answers

Match the following steps of the dorsal slit procedure to their descriptions:

Step 1 = Prepuce held in artery forceps and stretched Step 2 = Dorsal incision made up to the corona Step 3 = Circumferential incision in preputial skin Step 4 = Remaining edges sutured with dissolvable sutures Signup and view all the answers

What is the primary cause of the bend in Peyronie's Disease?

Calcific deposition in corpora Signup and view all the answers

Priapism is defined as a prolonged erection lasting more than 6 hours.

False Signup and view all the answers

Name two clinical features commonly associated with Peyronie's Disease.

Difficulty during intercourse, Retroperitoneal Abrosis Signup and view all the answers

High flow priapism can be secondary to __________ injury.

spinal Signup and view all the answers

Match the causes of priapism with their types:

Sickle cell anaemia = Low flow/ischemic priapism Trauma = High flow Papaverine injection = High flow Venous blockade = Low flow/ischemic priapism Signup and view all the answers

Which treatment involves the use of collagenase clostridium histolyticum?

Intra lesional injection Signup and view all the answers

Priapism is always a painful condition.

False Signup and view all the answers

What is the common term for a prolonged erection due to venous blockade?

Low flow/ischemic priapism Signup and view all the answers

What is the recommended treatment for symptomatic phimosis in individuals over 6 years of age?

Circumcision Signup and view all the answers

Lymph nodes are commonly associated with infections and are evaluated using FNAC.

True Signup and view all the answers

What is the margin requirement for a tumour that is away from the root of the penis?

0.5 cm Signup and view all the answers

The commonest cause of death in relation to lymph nodes is due to erosion of __________ vessels.

femoral/iliac Signup and view all the answers

Match the following treatments or diagnostic techniques to their purposes:

5-FU = Topical chemotherapy for Bowen disease Cisplatin = Chemotherapy for primary tumors FNAC = Evaluating enlarged lymph nodes Radiotherapy = Treatment for cancer Signup and view all the answers

Which type of penile cancer is most common and involves a mutation in the $p53$ gene?

Squamous cell carcinoma Signup and view all the answers

High-flow priapism is treated by shunt surgery.

False Signup and view all the answers

What condition affects the glans and is characterized by reddish papules and a sunburn-like appearance?

Erythroplasia of Queyrat Signup and view all the answers

The presence of _______ in biopsy samples indicates keratin pearls in diagnosing penile cancer.

keratin pearls Signup and view all the answers

Match the following clinical features with their corresponding conditions:

Bowen's disease = Affects the shaft Genital warts = Caused by HPV Buschke-Lowenstein tumor = Slow-growing tumor Leukoplakia = White patches on mucous membranes Signup and view all the answers

What is the most common congenital urogenital anomaly?

Hypospadias Signup and view all the answers

Chordee is characterized by an upward bending of the penis.

False Signup and view all the answers

At what age is surgical intervention for hypospadias typically performed?

6 to 12 months Signup and view all the answers

The ________ opening in hypospadias is placed ventrally.

urethral Signup and view all the answers

Match the following principles of hypospadias repair with their descriptions:

Orthoplasty = Correction of chordee Urethroplasty = Resection and tubularization of the urethra Glanuloplasty = Reconstruction of the glans Skin cover = Providing coverage with existing skin Signup and view all the answers

Which section of the male urethra is the shortest and least distensible?

Membranous urethra Signup and view all the answers

The penile urethra is the longest portion of the male urethra.

True Signup and view all the answers

What diagnostic procedure involves the insertion of dye into the bladder to assess the proximal urethra?

MCU (micturating cystourethrogram) Signup and view all the answers

The structure that is widely known for its erectile tissues in the penis is the __________.

corpus cavernosum Signup and view all the answers

Match the parts of the male urethra with their characteristics:

Prostatic urethra = Most distensible Membranous urethra = Shortest portion Bulbar urethra = Bends Penile urethra = Narrowest portion Signup and view all the answers

What is the first management step for a patient with a complete urethral tear?

Suprapubic catheterization Signup and view all the answers

A partial urethral tear should be managed with immediate Foley's catheter insertion.

False Signup and view all the answers

What is the most common graft used in the management of long, complete urethral strictures?

Buccal mucosal graft Signup and view all the answers

For short, incomplete strictures, the procedure typically involves the use of a ______________.

guide wire Signup and view all the answers

Match the following types of urethral strictures with their respective management techniques:

Short, incomplete stricture = Optical internal urethrotomy Short, complete stricture = Resection and end-to-end anastomosis Long, complete stricture = Resection and grafting Buccal mucosal graft = Barbagli's technique Signup and view all the answers

What is the most common clinical feature associated with a fracture shaft of the penis?

Eggplant-shaped deformity Signup and view all the answers

Pain and swelling are not symptoms of a fracture shaft of the penis.

False Signup and view all the answers

What is the first-line management option for a fracture shaft of the penis?

Surgery Signup and view all the answers

The posterior urethral valves can cause __________ in male children.

hydronephrosis Signup and view all the answers

Match the types of posterior urethral valves with their descriptions:

Type 1 = Mucosal folds from verumontanum Type 2 = Rare variant Type 3 = Cobb's Collar appearance Signup and view all the answers

Which surgical technique is used for mid hypospadias repair?

Snodgrass procedure Signup and view all the answers

Ectopia vesicae typically has a good prognosis.

False Signup and view all the answers

What is a common complication of both anterior and posterior urethral injuries?

Inability to pass urine Signup and view all the answers

Injury to the prostatic membranous urethra is typically secondary to ________.

pelvic fracture Signup and view all the answers

Match the clinical features to the type of urethral injury:

Bulbar = Direct trauma/straddle injury Prostatic Membranous = Secondary to pelvic fracture Penile = Superficial perineal hematoma Posterior Urethral = High riding prostate on DRE Signup and view all the answers

What is one of the complications associated with ectopia vesicae?

All of the above Signup and view all the answers

Identify one clinical feature of ectopia vesicae.

Urine dribbling from bladder Signup and view all the answers

Strictures are a potential complication of urethral injuries.

True Signup and view all the answers

Study Notes

Testicular Disorders Stage III

Stage III testicular cancer involves bulky lymph nodes or distant metastasis.
Despite the presence of metastasis, aggressive treatment increases survival chances.
Treatment includes BEP chemotherapy followed by retroperitoneal lymph node dissection (RPLND) and radiotherapy, with potential metastasectomy.

Non-Seminomatous Tumors

Occur predominantly in the first and second decades of life.
Carry a worse prognosis compared to seminomatous tumors.
Approximately 50% of Stage I non-seminomatous tumors have subclinical metastasis.
The tumor stage is the most important prognostic factor for both seminomatous and non-seminomatous testicular cancers.
Treatment options are dependent on the stage of the cancer.

Peyronie's Disease

Characterized by calcific deposits in the corpora cavernosa of the penis.
Causes bending of the penis towards the plaque, particularly noticeable during erection.
Can lead to difficulty during intercourse.
Associated conditions include retroperitoneal fibrosis and Dupuytren's contracture.
The disease progresses through active and stabilization phases.
Diagnosis is based on clinical examination and medical imaging.
Treatment options include collagenase clostridium histolyticum injection (Xiaflex), Nesbit's procedure, or excision of the plaque with a bovine pericardial patch.

Priapism

Prolonged erection lasting more than four hours.
Erections exceeding six hours increase the risk of ischemia and necrosis.
Classified into high-flow and low-flow (ischemic) priapism.
Penile blood gas analysis and angiography assist in determining the cause and location of the blockage.

Post-op Complications

Common complications following urological procedures include hemorrhage, infection, and chordee formation.

Paraphimosis

Occurs when the foreskin forms a constricting ring around the penis.
Leads to penile swelling and pain.
Management involves conservative measures with xylocaine jelly, followed by dorsal slit surgery if conservative measures fail.

Penile Cancer Management

Different management options for penile cancers depend on the extent of the tumor and its location.
Early stage tumors are treated with topical therapy (5-FU cream) and lasers.
More advanced tumors require surgical excision with margins ranging from 0.5 cm to total amputation.
Chemotherapy involving 5-FU and cisplatin can be used as an adjunct to surgery.

Phimosis

Inability to retract the foreskin.
Physiological phimosis is common in children under six years old and considered normal.
Symptomatic phimosis occurs when retraction is impossible after six years of age and can lead to recurrent UTIs, balanoposthitis, hydronephrosis, and foreskin ballooning.
Management involves circumcision.

Congenital Urogenital Disorders

Hypospadias is the most common congenital urogenital anomaly, characterized by ventral displacement of the urethral opening.
Associated with micropenis and undescended testis.

Hypospadias Clinical Features

Clinical features include downward-directed urine stream, chordee (downward penile bending), and potential infertility.

Hypospadias Management

Repair involves a multi-stage procedure addressing the chordee, urethra, glans, and skin cover.
Circumcision should be avoided, as the foreskin is used for reconstruction.
Surgery is typically performed between six and twelve months of age.

Urethral and Penile Disorders

Urethral injuries are classified as anterior or posterior.
Anterior injuries typically involve the bulbar or penile urethra, often resulting from direct trauma or straddle injuries.
Posterior injuries primarily affect the prostatic-membranous urethra and often result from pelvic fractures.

Fracture Shaft of Penis

Occurs due to trauma to the erect penis, causing tears in the corpora cavernosa and tunica albuginea.
Clinical features include a popping sound, pain, swelling, and an eggplant-shaped penile deformity.
Management involves surgical repair and drainage of the hematoma.

Other Penile Disorders

Posterior urethral valves are a congenital condition in males that can lead to hydronephrosis.
Vesicoureteral reflux (VUR) can be diagnosed through micturating cystourethrogram (MCU), which reveals a keyhole defect.

Urethral and Penile Anatomy

The female urethra is short (3-4 cm) compared to the male urethra (18-21 cm).
The male urethra is divided into prostatic, membranous, bulbar, and penile segments.

Investigation

RGU (retrograde urethrogram) is used to delineate the distal urethra in cases of urethral trauma.
MCU (micturating cystourethrogram) is used to visualize the proximal urethra and diagnose VUR.

Ectopia Vesicae

Ectopia vesicae is a complex congenital defect involving deficiencies in the anterior abdominal wall and bladder wall, leading to exposure of the bladder.
Carries a poor prognosis and often involves multiple associated abnormalities.

Urethral Trauma: Anterior vs. Posterior

Anterior urethral injuries are common in the bulbar and penile urethra and usually caused by direct trauma or straddle injuries.
Posterior urethral injuries affect the prostatic-membranous urethra and are often associated with pelvic fractures.

Management

The management of urethral injuries depends on the severity and location of the injury.
Patients with complete tears may require a suprapubic catheterization.
Partial tears can be managed with urethral catheterization.
Urethral strictures are managed using endoscopic procedures, resection and anastomosis, or grafting.

Stricture Management

Short, incomplete strictures can be managed using a guide wire and optical internal urethrotomy (OLU) or visual internal urethrotomy (VIU).
Short, complete strictures require resection and end-to-end anastomosis.
Long, complete strictures require resection and grafting, with buccal mucosal grafts being commonly used.

Prognosis

The prognosis of urethral and penile disorders depends on the type of condition, severity, and treatment.
Urethral strictures can lead to recurring UTIs, hydronephrosis, and kidney damage if not treated.
Untreated penile cancers can spread to the lymph nodes and distant metastasis.
Hypospadias can cause fertility issues if left untreated.
Ectopia vesicae carries a poor prognosis and often leads to multiple associated health complications.

Diagram Descriptions

The text includes various diagrams illustrating different aspects of the reproductive and urinary systems, including urethral injuries, surgical procedures, and anatomical structures.
These diagrams are designed to provide visual aid and improve understanding of the discussed topics.
The diagrams show detailed anatomical structures, procedures, and clinical presentations of various conditions.
Each diagram contains labels and arrows to guide the reader and highlight important features for understanding the related concepts.

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Description

Explore the complexities of testicular disorders, including Stage III testicular cancer, non-seminomatous tumors, and Peyronie's Disease. Understand their treatment options and prognostic factors. This quiz delves into the nuances of these urological conditions.