Andrology
Core concepts
Andrology overlaps with male infertility and sexual dysfunction, but the examinable core is the scrotum, the testis, testosterone and the penis as an organ.
Scrotal pathology: know testicular torsion (bell-clapper deformity, acute painful scrotum, surgical emergency), epididymo-orchitis, testicular tumour, hydrocele, varicocele, and spermatocele. Trap: treating a painful acute scrotum in a young man as epididymitis without excluding torsion; and forgetting that a varicocele that appears suddenly in an older man, or is right-sided and non-reducing, warrants imaging of the retroperitoneum.
Testosterone: know the difference between total and free testosterone, the need for two morning samples, and that testosterone replacement is contraindicated in men with untreated prostate cancer or active breast cancer, and is relatively contraindicated in men with a high haematocrit or uncontrolled heart failure. Trap: diagnosing hypogonadism on a single afternoon total testosterone.
Penis: Peyronie's disease (plaque, curvature, and the fact that it is not simply "a bent penis"), priapism (low-flow vs high-flow; low-flow is a compartment syndrome and needs aspiration plus intracavernosal phenylephrine), and penile fracture (surgical repair).
Male contraception and vasectomy: know that vasectomy is not immediately effective, and that post-vasectomy semen analysis is required.
Worked rule of thumb
A 24-year-old with sudden severe testicular pain and a normal urinalysis: treat as torsion until proven otherwise - Doppler ultrasound must not delay exploration. The trap answer is "reassure and treat for epididymitis".
Exam traps
- Missing torsion because the urinalysis is normal.
- Diagnosing hypogonadism on one sample or at the wrong time of day.
- Forgetting the retroperitoneal work-up for a new varicocele in an older man.
- Confusing low-flow and high-flow priapism management.