Miss Rashmi Singh Consultant urological Surgeon. Men s Health Seminar Parkside Hospital November 2016

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1 Miss Rashmi Singh Consultant urological Surgeon Men s Health Seminar Parkside Hospital November 2016

2 Hernia Hydrocele Varicocele Infections Epididymal cyst Testicular Ca Miscellaneous Phimosis Paraphimosis Balanitis Frenulum Infective lesions SCROTAL PENILE

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4 Young males Anxious Media coverage Often feel normal anatomy e.g. epididymis Ask them to identify the lump Reassurance

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6 Benign Cystic degenerative change Palpable separate from and above testis 3 rd testis Contain clear fluid Easily confirmed on USS Post vasectomy - spermatocele Only excise if symptomatic Avoid surgery until completed family

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8 Separate and above testis Usually irreducible Risk of strangulation Refer general surgery

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10 Dilatation of pampiniform venous plexus Bag of worms Examine in standing position Aching classically at end of day Long periods of standing Found in 40% of infertile men Can impair testicular growth and spermatogenesis

11 Pain Impaired testicular growth in adolescents Potentially correctable factor in infertile couple Asymptomatic-no treatment Usually treated with radiological embolisation

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14 Collection of fluid within tunica vaginalis Benign Painless Usually secondary Paediatric-needs early repair Testis lies within hydrocele Testis often impalpable if large Transilluminable Excise only if symptoms/cosmesis Aspiration not recommended

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16 Infectious Tender Indurated, hard mass Beware diabetic abscess <35 chlamydia/gonorrhoea: doxycycline >35 E.coli: ofloxacin 14/7 plus NSAID Swelling make take 8-12 weeks to fully resolve

17 Aggressive necrotising fasciitis of perineum and genitalia Rare. Can be fatal Diabetics Immunosuppressed malnourished Elderly males Nursing home Indwelling catheters Recent instrumentation/ perineal surgery

18 Severe sepsis Painful, swollen, erythematous skin Bullae/necrotic skin Crepitus Offensive smell Urgent debridement and parenteral antibiotics

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21 Solid painless lump. Palpable within in body of testis Rarely Cough Headache Back pain Family history Undescended testis

22 USS gold standard Refer any solid intra-testicular lump under 2 week rule Staging CT Tumour markers: AFP/BHCG/LDH Sperm banking Inguinal orchidectomy/prosthesis 95% cure rates. 80% mets Highly radio/chemo sensitive

23 common in scrotal skin Smooth surface Fixed to skin

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25 Post scrotal surgery Vasectomy Hydrocele Conservative management Scrotal support Analgesia May take weeks to resolve High impact trauma Risk of testicular rupture Urgent us/refer A&E if unable to palpate whole testis Surgery to evacuate haematoma and debride/repair

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28 Emergency Tight foreskin cannot be pulled forward from retracted position After intercourse/self-retraction Constriction band Engorgement/swelling of penis Painful strangulation Urgent reduction Interval circumcision

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30 Benign Moist erythematous lesions Usually asymptomatic Well circumscribed Responds well to circumcision

31 Common skin conditions

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33 Lichen sclerosis White hyperkeratotic lesions Phimosis, stricture May be associated with future malignant change May need biopsy if no response to topical steroids, circumcision

34 Phimosis Recurrent Paraphimosis Balanitis BXO Failed frenuloplasty Lesions on foreskin of uncertain nature Not for religious indications

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36 Rare. Refer any suspicious lesion on 2 week pathway

37 Use USS when in doubt Solid lumps in body of testis need urgent referral Epididymo-orchitis- may take many weeks to settle Penile cancer extremely rare Refer any ulcers/suspicious lesions on glans early if no response to topical steroid

38 Miss Rashmi Singh Consultant Urological Surgeon