Urology Quiz

Prostatic cancer typically arises from the posterior lobe and on the periphery. This is why it is often asymptomatic as it does not compress the urethra producing no urinary symptoms at an early stage. The prostate is located anterior to the rectum. Thus, on digital rectal exam (DRE), a mass can be felt as the posterior and peripheral region is affected.

Usually, they are not biopsied as there is a high risk of seeding the scrotum. Instead, investigations include a scrotal ultrasound and blood tests for tumour markers.

Testicular torsion is usually seen in adolescents and presents as sudden pain in the scrotum. On physical examination, the cremasteric reflex may be absent. It is caused by the twisting of the spermatic cord containing the pampiniform plexus, vas deferens and testicular artery. The blood supply is impaired leading to congestion and necrosis of the testicle. It is a surgical emergency.

Most frequently occur in young men with either Klinefelter syndrome or cryptorchidism. Cryptorchidism is the failure of the testicle to descend into the scrotum. Klinefelter syndrome: a chromosomal abnormality (47 XXY) leading to dysgenesis of seminiferous tubules causing testicular atrophy, gynecomastia, infertility and eunuchoid body shape.

Condyloma acuminatum is characterized by the growth of benign genital warts. On histology, there will be koilocytic change. This condition is caused by HPV type 6 or 11. Infection with HPV is also a risk factor for development of squamous cell carcinoma of the penis.

Varicoceles are caused by the dilation of the spermatic vein due to increased venous pressure. It is usually left-sided because there is an elevated resistance to flow on the left side as the left gonadal vein drains into the left renal vein compared to the right which drains into the inferior vena cava. Sometimes it is associated with a left-sided renal cell carcinoma. It causes scrotal enlargement in adults with a classic ‘bag of worms’ appearance. It can lead to infertility due to the increased temperature.

Metastasis commonly involves the lumbar spine in late stages of the cancer creating osteoblastic lesions on the bone. It presents as lower back pain. Serum alkaline phosphatase (ALP) will be raised as well as prostatic specific antigen (PSA).

Seminoma fits this description. It is the most common testicular tumour. It is malignant, metastasises late, responds to radiotherapy and has an excellent prognosis with appropriate and timely management.

Priapism is a prolonged and painful erection of the penis. Sickle cell disease, trauma and medications for erectile dysfunction (e.g. sildenafil) are all potential causes of this condition. It requires prompt treatment to prevent ischaemia. Treatment options include phenylephrine injection, surgical decompression and corporal aspiration.

Cryptorchidism is a condition in which one or both of the testes fail to descend from the abdomen into the scrotum. Testicles are formed in the abdomen and descend into the scrotum during fetal development. Affected individuals have an increased risk of developing germ cell tumours and infertility.

Hypospadias occurs due to failure of the urethral folds to fuse, resulting in an abnormal opening of the urethra on the inferior/ventral surface of the penis.

Epispadias is the condition associated with an opening of the urethra on the superior/dorsal surface of the penis, and it is linked with bladder exstrophy.

Yolk sac tumour is the most common testicular tumour in boys. An elevated AFP and Schiller Duval bodies (resemble glomerulus) are important features to differentiate from the other types of testicular tumours.

The Gleason grading system is used to categorise prostate adenocarcinoma and focusses on architecture of the tumour.