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Varicocele
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Clx
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Soft scrotal mass (“bag of worms”)
· ⤵️ In supine position
· ⤴️ With standing/Valsalva maneuvers
Subfertility
Testicular atrophy
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US
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· Retrograde venous flow
· Tortuous, anechoic tubules adjacent to testis
· Dilation of pampiniform plexus veins
· Does not transluminate
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Tx
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Gonadal vein ligation (boys & young men with testicular atrophy)
Scrotal support & NSAlDs (older men who do not desire additional children)
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Testicular Cancer
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#
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Age 15-35
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RF
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FHx, cryptorchidism
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Germ cell (95%): seminomatous or nonseminomatous (embryonal carcinoma, yolk sac, choriocarcinoma, teratoma, mixed)
Sex cord-stromal tumors: Sertoli cell / Leydig cell
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Sx
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ⓤ painless testicular mass
Dull ache in lower abdomen
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Dx
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Examination: firm, ovoid mass
⤴️ tumor markers (AFP, ß-hCG, LDH)
Scrotal US
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Testicular Torsion
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#
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Most common in adolescents
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S/S
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· Testicular, inguinal, abdominal pain
· N/V
· Horizontal testicular lie with elevated testicle
· Absent cremasteric reflex
· Swollen, erythematous scrotum
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US
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No blood flow on scrotal with Doppler
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Tx
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· Surgical detorsion & fixation with exploration of the contralateral side
· Manual detorsion (if immediate surgery is not available)
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Testicular Hematoma
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Hx: TRAUMA
Sx: rapidly expanding hematoma
Complications: Compartment syndrome
Dx: US
Tx: Surgical Evacuation
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Indications for Cystoscopy
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Gross hematuria with no evidence of glomerular disease or infection
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Microscopic hematuria with no evidence of glomerular disease or infection but increased risk for malignancy
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Recurrent UTIs
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Obstructive sx w/ suspicion for stricture, stone
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Irritative sx w/o urinary infection
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Abnormal bladder imaging or urine cytology
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Emergencies
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Torsion
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Epididymitis
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· Acute spontanous pain
· Young
· Horizental lie
· Pain w/ elevation + no reflex
· Dx: US w/ Doppler (no blood flow)
· Tx: Bilateral Orchiopexy
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· Acute spontanous pain
· Young (gono & chlamydia) vs Old: E.coli
· vertical lie
· NO Pain w/ elevation
· FEVER
· Dx: US w/ Doppler (positive blood flow) –> UA + Urine Cx
· Tx: Abx (depends on age).
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Pyelo
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Prostatits
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· Sick pt
· FEVER, CHILLS
· FLANK Pain
· Dx: UA + Cx + US
· Tx: Hospitalize + IV Abx
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· Sick pt
· FEVER, CHILLS
· DRE: tender prostate
· NEVER EVER MY FUCKING BROTHER DO DRE AFTER Dx. (induces sepsis)
· Dx: UA + Cx + US
· Tx: IV Abx
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Fast HY Review 