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.

    <p>RPLND</p> Signup and view all the answers

    Match the stages with their appropriate treatments:

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

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

    <p>Frenular vessel</p> Signup and view all the answers

    Chordee formation is a common complication after urological procedures.

    <p>True</p> Signup and view all the answers

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

    <p>Conservative management using Xylocaine jelly</p> Signup and view all the answers

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

    <p>constriction</p> Signup and view all the answers

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

    <p>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</p> Signup and view all the answers

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

    <p>Calcific deposition in corpora</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>Difficulty during intercourse, Retroperitoneal Abrosis</p> Signup and view all the answers

    High flow priapism can be secondary to __________ injury.

    <p>spinal</p> Signup and view all the answers

    Match the causes of priapism with their types:

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

    Which treatment involves the use of collagenase clostridium histolyticum?

    <p>Intra lesional injection</p> Signup and view all the answers

    Priapism is always a painful condition.

    <p>False</p> Signup and view all the answers

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

    <p>Low flow/ischemic priapism</p> Signup and view all the answers

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

    <p>Circumcision</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>0.5 cm</p> Signup and view all the answers

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

    <p>femoral/iliac</p> Signup and view all the answers

    Match the following treatments or diagnostic techniques to their purposes:

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

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

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    High-flow priapism is treated by shunt surgery.

    <p>False</p> Signup and view all the answers

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

    <p>Erythroplasia of Queyrat</p> Signup and view all the answers

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

    <p>keratin pearls</p> Signup and view all the answers

    Match the following clinical features with their corresponding conditions:

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

    What is the most common congenital urogenital anomaly?

    <p>Hypospadias</p> Signup and view all the answers

    Chordee is characterized by an upward bending of the penis.

    <p>False</p> Signup and view all the answers

    At what age is surgical intervention for hypospadias typically performed?

    <p>6 to 12 months</p> Signup and view all the answers

    The ________ opening in hypospadias is placed ventrally.

    <p>urethral</p> Signup and view all the answers

    Match the following principles of hypospadias repair with their descriptions:

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

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

    <p>Membranous urethra</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>MCU (micturating cystourethrogram)</p> Signup and view all the answers

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

    <p>corpus cavernosum</p> Signup and view all the answers

    Match the parts of the male urethra with their characteristics:

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

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

    <p>Suprapubic catheterization</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>Buccal mucosal graft</p> Signup and view all the answers

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

    <p>guide wire</p> Signup and view all the answers

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

    <p>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</p> Signup and view all the answers

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

    <p>Eggplant-shaped deformity</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>Surgery</p> Signup and view all the answers

    The posterior urethral valves can cause __________ in male children.

    <p>hydronephrosis</p> Signup and view all the answers

    Match the types of posterior urethral valves with their descriptions:

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

    Which surgical technique is used for mid hypospadias repair?

    <p>Snodgrass procedure</p> Signup and view all the answers

    Ectopia vesicae typically has a good prognosis.

    <p>False</p> Signup and view all the answers

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

    <p>Inability to pass urine</p> Signup and view all the answers

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

    <p>pelvic fracture</p> Signup and view all the answers

    Match the clinical features to the type of urethral injury:

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

    What is one of the complications associated with ectopia vesicae?

    <p>All of the above</p> Signup and view all the answers

    Identify one clinical feature of ectopia vesicae.

    <p>Urine dribbling from bladder</p> Signup and view all the answers

    Strictures are a potential complication of urethral injuries.

    <p>True</p> 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.

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