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Professional Skills Urology Core Module Trustin Domes.

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Presentation on theme: "Professional Skills Urology Core Module Trustin Domes."— Presentation transcript:

1 Professional Skills Urology Core Module Trustin Domes

2 Outline Brief Anatomy of Scrotum and Prostate Physical Examination: CVA, Scrotum and DRE Case Scenarios – LUTS – Hematuria – Upper and lower urinary tract obstruction – Scrotal Masses/Pain

3 Anatomy of Scrotal Contents Vessels: – Testicle has 3 arterial blood supplies: Testicular artery Cremasteric artery Deferential artery – Pampiniform venous plexus Lymphatics Nerves Cremasteric muscle/fascia Vas deferens

4 Anatomy of Scrotal Contents Vas is the most posterior component of spermatic cord Tunica vaginalis surrounds the anterior 2/3 rd of the testicle and creates a potential space for hydroceles and hematoceles

5 Clinical Anatomy of the Prostate Verma S, Rajesh A AJR 2011;196:S1-S10

6 Prostate Anatomy Peripheral Zone = 85% of prostate cancer originate in this zone, therefore are detected on DRE Transition Zone = site of benign prostatic hyperplasia

7 CVA and Ballottement If CVA tenderness think: - Renal colic - Pyelonephritis - Significant renal trauma - Renal vascular occlusion If you can ballot the kidney think: - Large renal mass - Polycystic kidney disease - Severely hydronephrotic kidney

8 Physical Examination of the Scrotum Best to examine the man in both the supine and upright positions – Helps to demonstrate conditions that change with position: hernias and varicoceles Bimanual examination of each testicle, adenxa and spermatic cord – Testicular size, consistency, masses, tenderness Normal testis size 16-20 cc (2 x 4 cm) – Examine cord upright (+/- valsalva) to assess for presence of vas deferens, inguinal hernia and varicocele

9 Cremasteric Reflex Reflex elicited by stroking the medial thigh causes an ipsilateral contraction of the cremasteric muscle (bringing the testicle closer to the external inguinal ring) Reflex tests L1-L2 (genitofemoral nerve responsible for afferent and efferent limbs) Typically absent in testicular torsion – Negative predictive value of over 90%

10 Transillumination Important to help differentiate solid from fluid-filled masses Hydroceles and spermatoceles will transilluminate, other scrotal masses typically WILL NOT Hydrocele

11 Varicoceles Dilated veins of the paminiform plexus Predominant left-sided (98%) Isolated right-sided varicocele may be caused by a retroperitoneal – NEED abdominal imaging Varicocele grading: – Grade I: palpable only with valsalva – Grade II: easily palpable without valsalva – Grade III: large, visible through scrotal skin Grade III: “bag of worms”

12 Digital Rectal Examination Comment on: Prostate Size Symmetry Consistency Tenderness Nodules Rectal/Anal Masses Rectal Tone

13 Prostate size 25 cc150 cc Average prostate size is approximately 25 cc in men older than 50 years How many finger-breadths across? Can you get to the top (base)?

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