Urology Quiz on Testicular Conditions
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Questions and Answers

What is a common complication of cryptorchidism?

  • Increased testosterone levels
  • Inguinal hernias (correct)
  • Decreased risk of germ cell tumors
  • Improved fertility rates

    • What is the most common type of testicular malignancy?

  • Leydig cell tumor
  • Sertoli cell tumor
  • Seminoma (correct)
  • Non-seminoma germ cell tumor

    • Which type of hydrocele is characterized by the presence of peritoneal fluid in the tunica vaginalis?

  • Hematocele
  • Communicating hydrocele (correct)
  • Spermatocele
  • Noncommunicating hydrocele

    • What is a key histological feature of seminomas?

    <p>Fried egg appearance of cells</p> Signup and view all the answers

    Which statement about embryonal carcinoma is true?

    <p>It may secrete β-hCG due to syncytiotrophoblast tissue.</p> Signup and view all the answers

    What is the recommended treatment for cryptorchidism if the testes do not descend spontaneously?

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

    Which type of tumor does not typically transilluminate?

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

    What is the primary risk factor associated with germ cell tumors in young men?

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

    What type of hydrocele may become bloody due to conditions such as infection or trauma?

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

    What is the role of androgens in the prostate?

    <p>Stimulates production of prostatic fluid</p> Signup and view all the answers

    What is a significant symptom of acute prostatitis?

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

    Which treatment is primarily used for managing symptoms of Benign Prostatic Hyperplasia (BPH)?

    <p>5α-reductase inhibitors</p> Signup and view all the answers

    What is the most common form of cancer in men?

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

    What does an elevated PSA level indicate?

    <p>Potential prostate cancer</p> Signup and view all the answers

    What characterizes chronic abacterial prostatitis?

    <p>Symptoms without identifiable bacteria</p> Signup and view all the answers

    Which category of drugs works by causing smooth muscle relaxation in BPH treatment?

    <p>α1-blockers</p> Signup and view all the answers

    What histological feature is commonly associated with BPH?

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

    What is the function of Leuprolide in prostate cancer treatment?

    <p>Suppresses pituitary FSH/LH release</p> Signup and view all the answers

    Which of the following is a common consequence of untreated BPH?

    <p>Urinary tract infections</p> Signup and view all the answers

    The Gleason score is used for:

    <p>Grading prostate cancer cells</p> Signup and view all the answers

    What is the primary function of the tunica albuginea in penile anatomy?

    <p>Provides structural support to the corpora cavernosa</p> Signup and view all the answers

    Which of the following is NOT a symptom of Peyronie Disease?

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

    What characterizes the ischemic type of priapism?

    <p>It results from lack of blood flow to the penis</p> Signup and view all the answers

    Which medication is known to be contraindicated with phosphodiesterase 5 inhibitors due to the risk of hypotension?

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

    What is a common risk factor for squamous cell carcinoma of the penis?

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

    Which condition is characterized by difficult venous outflow, potentially leading to penile tissue ischemia?

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

    What is a potential complication of untreated testicular torsion?

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

    Which type of hydrocele features accumulation of fluid adjacent to the testicle?

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

    What is a characteristic ultrasound finding in varicocele?

    <p>Dilated veins resembling a 'bag of worms'</p> Signup and view all the answers

    Which of the following treatments is typically used for Peyronie's disease?

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

    Which mechanism primarily causes erection during physiological processes?

    <p>Smooth muscle relaxation</p> Signup and view all the answers

    What is the most common cause of ischemic priapism?

    <p>Veno-occlusion from sickle cell anemia</p> Signup and view all the answers

    What condition presents with soft, cauliflower-like lesions and is caused by papillomavirus?

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

    What typically characterizes a spermatocele?

    <p>Large cyst located at the head of the epididymis</p> Signup and view all the answers

    What characteristic distinguishes seminoma from other germ cell tumors?

    <p>Painless mass with no transillumination</p> Signup and view all the answers

    Which condition is most associated with a testicular mass in children?

    <p>Yolk sac tumor</p> Signup and view all the answers

    What is the primary treatment option for noncommunicating hydrocele in adults?

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

    Which tumor marker is associated with seminomas?

    <p>Beta-human chorionic gonadotropin</p> Signup and view all the answers

    What does a 'fried egg' appearance in histology indicate?

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

    What defines the composition of a mixed germ cell tumor?

    <p>A combination of different germ cell tumor types</p> Signup and view all the answers

    Which anatomical location is most common for extragonadal germ cell tumors in adults?

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

    What histological feature helps to differentiate embryonal carcinoma from seminoma?

    <p>Necrotic tissue present</p> Signup and view all the answers

    Which symptom is most commonly associated with acute prostatitis?

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

    What is the primary action of 5α-reductase inhibitors in the treatment of BPH?

    <p>Inhibit dihydrotestosterone (DHT) production</p> Signup and view all the answers

    What is the Gleason score used to evaluate in prostate cancer?

    <p>Tumor grade and differentiation</p> Signup and view all the answers

    Which of the following is a potential risk associated with chronic abacterial prostatitis?

    <p>Chronic pelvic pain</p> Signup and view all the answers

    What type of chemotherapy drug is Flutamide?

    <p>A competitive androgen receptor inhibitor</p> Signup and view all the answers

    What laboratory test is often performed to help diagnose prostate cancer?

    <p>Prostate-specific antigen (PSA) test</p> Signup and view all the answers

    What type of lesions are characteristic of metastatic prostate cancer spread?

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

    Which condition can lead to complete obstruction of urinary flow as a rare complication of BPH?

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

    What is a common symptom of chronic bacterial prostatitis?

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

    How is prostate cancer typically diagnosed?

    <p>Transrectal ultrasound-guided biopsy</p> Signup and view all the answers

    What is the primary risk factor for the development of squamous cell carcinoma of the penis?

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

    Which process occurs during the detumescence phase of penile physiology?

    <p>Contraction of smooth muscles</p> Signup and view all the answers

    What is a common treatment for Peyronie disease that reduces inflammation?

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

    What characterizes ischemic priapism?

    <p>Lack of blood inflow</p> Signup and view all the answers

    What histological feature is typically associated with condylomata acuminata?

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

    Which of the following is NOT a treatment option for ischemic priapism?

    <p>Oral phosphodiesterase inhibitors</p> Signup and view all the answers

    What is a common cause of testicular torsion in adolescent males?

    <p>Abnormal attachment of the tunica vaginalis</p> Signup and view all the answers

    What is the recommended management for a patient with a suspected varicocele?

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

    What is the main physiological function of phosphodiesterase 5 (PDE5) inhibitors in treating erectile dysfunction?

    <p>Increase cGMP levels</p> Signup and view all the answers

    What symptom is typical of a penile fracture?

    <p>Audible snap sound</p> Signup and view all the answers

    Which condition is characterized by the accumulation of fluid in the tunica vaginalis?

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

    What is the main purpose of conducting a Varicocelectomy?

    <p>To relieve venous obstruction</p> Signup and view all the answers

    What condition can potentially lead to infertility due to increased temperature in the scrotum?

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

    What type of priapism generally results from vascular accidents such as sickle cell anemia?

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

    Study Notes

    Penile Anatomy

    • The penis has three cavernous bodies (corpora).
    • The corpora cavernosa are two large spongy tissue beds.
    • The corpus spongiosum is a smaller spongy tissue bed, surrounding the urethra.
    • The tunica albuginea is a white connective tissue that surrounds the corpus cavernosa.
    • Buck's fascia covers all three erectile structures.

    Penis Physiology

    • Key structures include arterioles and corpora.
    • In a flaccid penis, cavernosal arterioles have high tone, leading to reduced blood flow.
    • Erection (tumescence) involves smooth muscle relaxation, increasing blood flow into the corpora cavernosa, causing them to swell (sinusoids).
    • Veins/venules are compressed, decreasing outflow.
    • High inflow and low outflow result in increased intracorporeal pressure.
    • Detumescence (loss of erection) is caused by smooth muscle contraction and increased venous outflow, making the corpora shrink.

    Peyronie Disease

    • Characterized by abnormal tunica albuginea, an acquired disorder.
    • Likely results from trauma in a susceptible individual.
    • Leads to localized fibrosis of the tunica albuginea.
    • Symptoms include pain, nodule formation, and abnormal curvature during erection.
    • Erectile dysfunction often accompanies the condition.
    • Treatment includes Pentoxifylline, a phosphodiesterase inhibitor, which can reduce inflammation and prevent collagen deposition. Injection or oral administration is possible.

    Penile Fracture

    • Results from rupture of the tunica albuginea, often associated with urethral damage.
    • Caused by blunt trauma.
    • A clinical finding is an audible snap, followed by pain, swelling, and ecchymosis (bruising).

    Priapism

    • Characterized by a persistent erection lasting more than 2-4 hours, not associated with sexual activity.
    • Ischemic priapism (95% of cases) is due to a lack of penile blood outflow, leading to tissue ischemia.
    • Non-ischemic (high-flow) priapism involves a fistula between arteries and the corpus cavernosum, often following trauma.

    Ischemic Priapism Etiology

    • Failure of cavernosal outflow
    • Two common causes: sickle cell disease and certain drugs.
    • Veno-occlusion (blocked veins) is another underlying factor.
    • Certain drugs (e.g., antipsychotics, antidepressants, alpha blockers, erectile dysfunction drugs) can contribute.

    Ischemic Priapism Treatment

    • Urologic emergency due to hypoxia and acidosis of penile blood.
    • Can lead to permanent erectile dysfunction or penile necrosis.
    • Treatment options include corporal aspiration, intracavernosal phenylephrine injection, and surgical intervention.

    Condylomata Acuminata

    • Anogenital warts caused by papillomavirus (types 6 and 11).
    • Characterized by soft, tan, cauliflower-like lesions.
    • Can appear on the penis, vulva, and perianal area.
    • May cause rectal bleeding.
    • Treatment involves chemical agents or surgical therapy, and the condition does not lead to cancer.

    Histology of Condylomata Acuminata

    • Microscopically, a characteristic feature is perinuclear clear vacuolization (koilocytosis).

    Squamous Cell Carcinoma

    • A rare penile malignancy arising from squamous skin cells in the glans or shaft.
    • Primarily affects older men (mean age ~60).
    • Uncommon in the US and Europe, but relatively prevalent in Africa, Asia, and South America.
    • Risk factors include uncircumcision and HPV infection; smoking may also be a contributing factor.

    Squamous Cell Carcinoma Risk Factors

    • Uncircumcised penis.
    • Reduced exposure to carcinogens with circumcision.
    • High-risk HPV infections (types 16 and 18)
    • Smoking.

    Squamous Cell Carcinoma Pre-malignant Lesions

    • In situ carcinoma: no basement membrane invasion, often presenting as whitish plaques (leukoplakia) on the shaft.
    • Bowen disease: gray-white plaque, often on the shaft.
    • Erythroplasia of Queyrat: dark red lesion, usually on the glans.
    • Bowenoid papulosis: multiple red-brown papules.

    Erectile Dysfunction

    • Inability to achieve or maintain an erection.
    • Often associated with psychological factors, as well as conditions like heart disease, hypertension (HTN), diabetes, obesity, certain medications, smoking, alcoholism, and sleep apnea.

    Phosphodiesterase 5 Inhibitors

    • Medications (e.g., sildenafil, vardenafil, tadalafil) inhibiting PDE5.
    • Increasing levels of cyclic GMP (cGMP) results in smooth muscle relaxation, improving blood flow.
    • Uses include erectile dysfunction, pulmonary hypertension, and benign prostatic hyperplasia (BPH).
    • Side effects include vision problems (temporary blue vision), headache, flushing, and priapism.
    • Contraindicated in patients taking nitrates (like nitroglycerin) as this can cause life threatening hypotension.

    Scrotal Disorders

    • This section focuses on various conditions involving the scrotum. Individual disorders like testicular torsion, varicocele, hydrocele, spermatocele, and cryptorchidism are discussed below.

    Testicular Torsion

    • The testicle rotates within the scrotum, twisting the spermatic cord, which contains blood vessels (arteries and veins).
    • The torsion compresses the veins, causing impaired venous outflow; artery flow continues, this leads to engorgement and infarction (tissue death) of the testicle.
    • Clinical presentation can include a painful, swollen testicle and the absence of the cremaster reflex.
    • Treatment necessitates urgent surgical intervention (detorsion or orchiopexy).

    Testicular Torsion Neonatal Form & Adult Form

    • Neonatal torsion occurs in the first 30 days after birth, often when the testes are not fully secured to the scrotum.
    • Adult torsion is seen in boys aged 12 to 18. Anatomic defects like the bell clapper deformity may cause increased mobility and twisting of the testicle.

    Varicocele

    • Dilated veins of the pampiniform plexus in the spermatic cord, typically seen on the left side.
    • It's often caused by obstruction of venous blood flow. Left spermatic vein is longer with the risk of compression between the aorta and the superior mesenteric artery ("nutcracker effect").
    • Clinical presentation may include scrotal pain and swelling.
    • Diagnosis is made by ultrasound.
    • Potentially associated with infertility.

    Hydrocele

    • Accumulation of fluid in the tunica vaginalis, a sac surrounding the testicle.
    • Newborns sometimes experience a communicating form, where peritoneal fluid enters the tunica vaginalis; this often resolves on its own by the first year.
    • Adults may have a noncommunicating hydrocele that is often idiopathic.
    • Symptoms include scrotal swelling. The fluid can be visualized (transilluminated) by light.

    Spermatocele

    • A cystic mass typically located at the head of the epididymis.
    • Typically not associated with pain and is usually diagnosed through physical exam.
    • Easily differentiated from an underlying testis mass by ultrasound.

    Cryptorchidism

    • Undescended testes; can be unilateral or bilateral.
    • Can be located in the abdominal cavity or inguinal canal.
    • Potential complications include reduced sperm count, increased risk of germ cell tumors, and increased risk of testicular torsion.
    • Treatment includes watchful waiting, with orchiopexy to relocate the undescended testes if necessary.

    Testicular Tumors

    • A general category encompassing various tumor types.
    • Testicular malignancy often mirrors ovarian cancers in pattern but lacks common epithelial cancers.
    • Germ cell tumors and sex cord-stromal tumors are the primary classifications. Germ cell tumors are further subdivided.

    Germ Cell Tumors

    • Highly malignant tumors derived from cells of the germ line, always capable of metastasis.
    • Usually a mixture of several subtypes.
    • Seminomas, embryonal carcinomas, yolk sac tumors, and chorocarcinomas among other types.
    • 5-year survival rate is generally high (~95%).

    Seminoma

    • The most common germ cell tumor, usually having a uniform appearance (homogeneous mass).
    • Generally appears grey-white, without hemorrhage or necrosis.
    • May secrete beta-hCG.
    • Diagnosis may use tumor markers, like placental alkaline phosphatase.
    • Treatment is focused on surgery +/− chemotherapy or radiation.

    Embryonal Carcinoma

    • A component of mixed germ cell tumors.
    • Can be distinguished from seminoma by the presence of necrosis and hemorrhage.
    • Usually includes syncytiotrophoblast tissue and produces beta-hCG. (Tumor marker)

    Yolk Sac Tumor

    • Most frequent germ cell tumor in children under age 3.
    • Originates from extraembryonic yolk sac cells.
    • Characterized by Schiller-Duval bodies microscopically, along with glomerular-like structures.

    Choriocarcinoma

    • A rare but potentially aggressive germ cell tumor, often following a normal or molar pregnancy.
    • It's characterized by the presence of syncytiotrophoblast and cytotrophoblast cells.
    • Secretion of hCG (human chorionic gonadotropin) is a diagnostic indicator; it may also produce gynecomastia.
    • May cause aggressive hematogenous spread throughout lungs, liver, and bone, often compared to its placental counterpart.

    Teratoma

    • Includes cells from all three germ layers (ectoderm, endoderm, and mesoderm).
    • Commonly presents as a large mass composed of neural tissue, muscle, cartilage, or other elements.
    • Found often in young children and adults.

    Mixed Germ Cell Tumors

    • Usually a combination of two or more germ cell tumor types; for example, seminomas plus embryonal carcinomas.
    • Often show a poorer prognosis compared to those with single-subtype tumors.

    Leydig Cell Tumor

    • A non-germ cell tumor originating from interstitial cells of Leydig.
    • Presents as a golden brown mass with Reinke crystals.
    • These tumors produce androgens and estrogens and may result in sexual precocity or gynecomastia (breast development in boys).

    Sertoli Cell Tumor

    • Often a benign tumor of Sertoli cells.
    • Usually do not produce hormones.

    Testicular Lymphoma

    • Relatively uncommon testicular tumor; often presents as a mass.
    • Can involve the testes as part of diffuse large B-cell lymphoma.

    Extragonadal GCTs

    • Occur in various sites outside the gonads, most commonly the anterior mediastinum in adults.
    • Can develop in children in the sacrococcygeal and intracranial regions.
    • Often arise from germ cell migration failures

    Prostate

    • A gland located anterior to the rectum, surrounding the urethra.

    Acute Prostatitis

    • Acute inflammation often bacterial, usually in older men.
    • Typically involves common urinary pathogens like E. coli.
    • Characterized by fever, chills, malaise, dysuria, frequency, and cloudy urine.
    • On digital rectal exam, the prostate is often swollen, tender and boggy.

    Chronic Prostatitis

    • Chronic symptoms (pain, difficulty voiding) of prostatic inflammation, often with no identified bacteria.

    BPH (Benign Prostatic Hyperplasia)

    • Age-related condition causing enlargement (hyperplasia) of prostate stromal and epithelial tissue.
    • Leads to urinary obstruction (partial or complete), with symptoms like hesitancy, frequency, and dribbling.

    Prostate Adenocarcinoma

    • Most frequent prostate cancer type.
    • Occurs in older men (>50), and is more common in African Americans. It's often found in the peripheral zone. A nodule on physical exam may occur.
    • Diagnosed through prostate biopsies guided by imaging, including transrectal ultrasound (TRUS).
    • Screening with prostate-specific antigen (PSA) levels might identify the condition.

    Prostate Cancer Metastasis

    • Prostate cancer can spread hematogenously to the spine and other regions, often leading to bone pain and elevated levels of serum alkaline phosphatase. Deposition of new bone (osteoblastic) may occur, as opposed to bone breakdown (osteolytic).

    Prostate Cancer Treatment

    • Treatment strategies include surgery, competitive androgen receptor inhibitors, including Flutamide, and GnRH agonists such as Leuprolide. These medications suppress hormone production or block receptor function.

    PSA (Prostate-Specific Antigen)

    • An androgen-regulated protein commonly found in semen, elevated levels are associated with BPH and prostate cancer, thus, used in screening (controversial).

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