Medical brain notes 15

  PENIS Malformations of the penis  include epispadias and hypospadias. Both may be associ-ated with undescended testes.  Epispadias  is a urethral opening on the dorsal surface of the penis, while  hypospadias  is a urethral opening on the ventral surface. Both have an increased risk of urinary tract infection and infertility. Balanitis/balanoposthitis  is inflammation of the glans penis, and the glans and   foreskin, respectively. Causes include poor hygiene and lack of circumcision. Peyronie disease  is penile fibromatosis resulting in curvature of the penis during   erection Condyloma acuminatum  is a warty, cauliflower-like growth, with the causative   agents most frequently being HPV serotypes 6 and 11. Squamous cell carcinoma (SCC)  is uncommon in the United States, and is often   related to infection with HPV serotypes 16 and 18. There is an increased risk in uncircumcised males (multicentric carcinoma in situ...

  TESTES   Varicocele  is a dilated pampiniform venous plexus and internal spermatic vein, usu-ally on the left side. It may cause infertility. Clinically, it resembles a “bag of worms” superior to the testicle. Hydrocele  refers to fluid within the tunica vaginalis.   Spermatocele  is an epididymal cyst containing sperm. On physical examination it   transilluminates.   Epididymitis  presents with fever and gradual onset of scrotal pain.   •           Acute epididymitis that affects men age <35 is often caused by  N. gonorrhoeae  or  C. trachomatis .   •           Acute epididymitis that affects men age >35 is often caused by  E. coli  or  Pseu-domonas .   •           Chronic epididymitis can be caused by TB.   Orchitis  presents with sudden onset of...

  TESTICULAR CANCER   Testicular cancer  typically presents with a firm, painless testicular mass; nonsemi-nomatous tumors may present with widespread metastasis. Caucasians have a higher incidence than African Americans. Risk factors include:   •           Cryptorchidism (3–5 times increased risk)   •           Testicular dysgenesis (testicular feminization and Klinefelter syndrome)   •           Positive family history   Clinically, U/S typically shows a hypoechoic intratesticular mass. Serum tumor marker studies can be helpful in confirming the diagnosis. Treatment is radical orchiectomy and possible chemotherapy/radiotherapy. Staging includes examination of the surgically resected specimen, including a lymph node dissection, along with imaging studies and lab tests. Serum markers are used to monitor disease. • ...

  PROSTATE   Benign prostatic hyperplasia (BPH)  (also called nodular hyperplasia; glandular and   stromal hyperplasia) is extremely common. Androgens (dihydrotestosterone) play an important role in the pathogenesis, and the lesion is not premalignant. The inci-dence increases with age (age 60 is 70%; age 70 is 80%). BPH typically presents with the following:   •           Decreased caliber and force of stream   •           Trouble starting (hesitancy)/stopping the stream   •           Postvoid dribbling   •           Urinary retention   •           Incontinence   •           Urgency/frequency   •           Nocturia/dysuria...