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Urology Tutorial for Student Doctors
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J L Probert BMedSci, DM, FRCS (Urol)
Preface
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------=_NextPart_01C92E58.844B0AC0
Content-Location: file:///C:/1EF64553/scrotalswellings_files/script.js
Content-Transfer-Encoding: quoted-printable
Content-Type: application/javascript; charset="us-ascii"
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parent.SldUpdated(GetSldId())
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g_origH=3Dsld.style.posHeight
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InitHLinkArray()
if( g_scaleInFrame||(IsWin("PPTSld") && parent.IsFullScrMode() ) )
document.body.scroll=3D"no"
_RSW()
if( IsWin("PPTSld") && parent.IsFullScrMode() )
FullScrInit();
=09
MakeSldVis();
ChkAutoAdv()
if( runAnimations )
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if( document.all("NSPlay") )
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setTimeout( "document.body.start()", sld.filters.revealtrans.duration * =
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SlideObj.filters.revealtrans.Apply()
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SlideObj.style.visibility=3D"visible"
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SlideObj.filters.revealtrans.Play()
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function MakeNotesVis()
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nObj =3D document.all.item("NotesObj")
parent.SetHasNts(0)
if( nObj ) {
nObj.style.display=3D""
parent.SetHasNts(1)
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return 1
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function ChkAutoAdv()
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if(SldHasTrans())
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AutoAdv()
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function AutoAdv()
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if(!IsWin("PPTSld") || !gUseSldTimings )return
var sld=3DGetCurSld()
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function GetObj(id)
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if(g_supportsPPTHTML) return document.all(id);
else return document.getElementById(id);
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function SldHasTrans() { return SlideObj.style.filter !=3D ""; }
function GetSldId() { return sId=3Dlocation.href.substring(location.href.la=
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function HideMenu() { if( frames["PPTSld"] && PPTSld.document.all.item("ctx=
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function IsSldOrNts() { return( IsWin("PPTSld")||IsWin("PPTNts") ) }
function SupportsPPTAnimation() { return( navigator.platform =3D=3D "Win32"=
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function SupportsPPTHTML()
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function _RSW()
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if( !g_supportsPPTHTML || IsNts() ||
( !g_scaleInFrame && (!IsWin("PPTSld") || !parent.IsFullScrMode()) ) )
return
var padding=3D0;
if( IsWin("PPTSld") && parent.IsFramesMode() ) padding=3D6
cltWidth=3Ddocument.body.clientWidth-padding
cltHeight=3Ddocument.body.clientHeight-padding
factor=3D(1.0*cltWidth)/g_origW
if( cltHeight < g_origH*factor )
factor=3D(1.0*cltHeight)/g_origH
newSize =3D g_origSz * factor
if( newSize < 1 ) newSize=3D1
s=3DSlideObj.style
s.fontSize=3DnewSize+"px"
s.posWidth=3Dg_origW*factor
s.posHeight=3Dg_origH*factor
s.posLeft=3D(cltWidth-s.posWidth+padding)/2
s.posTop=3D(cltHeight-s.posHeight+padding)/2
if( g_scaleHyperlinks )
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}
function _InitAnimations()
{
animRuntimeInstalled =3D ''+document.body.localTime !=3D 'undefined';
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g_animUseRuntime =3D g_showAnimation && animRuntimeInstalled && !(isFullSc=
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if( g_animUseRuntime ) {
collSeq =3D document.all.tags("seq");
if( collSeq !=3D null ) {
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gSldJumpIdx =3D numSlds;
if ( gSldJumpIdx >=3D 0 ) {
if ( gSldJumpIdx =3D=3D 0 )
gSldJumpIdx =3D 1;
var jumpTo =3D parseInt(gSldJumpIdx);
gSldJump =3D 0; gSldJumpIdx =3D "";
win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref )
}
}
}
function _KDH()
{
if( event.keyCode =3D=3D 8 ) {
event.returnValue =3D 0;
parent.GoToPrevSld();
}
}
function DocumentOnClick()
{
if( IsNts() || parent.HideMenu() ) return;
if( ( g_allowAdvOnClick && !parent.IsFramesMode() ) ||
(event && (event.keyCode=3D=3D32) ) )
parent.GoToNextSld();
}
var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""=
, g_bgSound=3D"",
g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser =
=3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1;
var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w=
indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va=
r g_animManager =3D null;
var g_animUseRuntime =3D false;
var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime;
var g_animMainSequence =3D null;
var ENDSHOW_MESG=3D"End of slide show, click to exit.", SCREEN_MODE=3D"Fram=
es", gIsEndShow=3D0, NUM_VIS_SLDS=3D42, SCRIPT_HREF=3D"script.js", FULLSCR_=
HREF=3D"fullscreen.htm";
var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO=
tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true
window.gPPTHTML=3DSupportsPPTHTML()
var gMainDoc=3Dnew Array(new hrefList("slide0001.htm",1,-1,1),new hrefList(=
"slide0004.htm",1,-1,1),new hrefList("slide0002.htm",1,-1,1),new hrefList("=
slide0003.htm",1,-1,1),new hrefList("slide0005.htm",1,-1,1),new hrefList("s=
lide0006.htm",1,-1,1),new hrefList("slide0007.htm",1,-1,1),new hrefList("sl=
ide0008.htm",1,-1,1),new hrefList("slide0009.htm",1,-1,1),new hrefList("sli=
de0014.htm",1,-1,1),new hrefList("slide0010.htm",1,-1,1),new hrefList("slid=
e0011.htm",1,-1,1),new hrefList("slide0012.htm",1,-1,1),new hrefList("slide=
0013.htm",1,-1,1),new hrefList("slide0015.htm",1,-1,1),new hrefList("slide0=
016.htm",1,-1,1),new hrefList("slide0017.htm",1,-1,1),new hrefList("slide00=
18.htm",1,-1,1),new hrefList("slide0019.htm",1,-1,1),new hrefList("slide002=
0.htm",1,-1,1),new hrefList("slide0021.htm",1,-1,1),new hrefList("slide0022=
.htm",1,-1,1),new hrefList("slide0023.htm",1,-1,1),new hrefList("slide0024.=
htm",1,-1,1),new hrefList("slide0025.htm",1,-1,1),new hrefList("slide0027.h=
tm",1,-1,1),new hrefList("slide0028.htm",1,-1,1),new hrefList("slide0029.ht=
m",1,-1,1),new hrefList("slide0030.htm",1,-1,1),new hrefList("slide0031.htm=
",1,-1,1),new hrefList("slide0032.htm",1,-1,1),new hrefList("slide0033.htm"=
,1,-1,1),new hrefList("slide0034.htm",1,-1,1),new hrefList("slide0035.htm",=
1,-1,1),new hrefList("slide0036.htm",1,-1,1),new hrefList("slide0037.htm",1=
,-1,1),new hrefList("slide0038.htm",1,-1,1),new hrefList("slide0039.htm",1,=
-1,1),new hrefList("slide0040.htm",1,-1,1),new hrefList("slide0041.htm",1,-=
1,1),new hrefList("slide0042.htm",1,-1,1),new hrefList("slide0043.htm",1,-1=
,1));
function FullScrInit()
{
g_allowAdvOnClick =3D GetCurSld().mAdvOnClk
document.body.style.backgroundColor=3D"black"
document.oncontextmenu=3Dparent._CM;
document.onkeydown =3D _KDH;
document.ondragstart=3DCancel
document.onselectstart=3DCancel
self.focus()
}
function Redirect( frmId )
{
var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId()
if(idx>=3D0) str=3Dstr.substr(1);
if( window.name !=3D frmId && ( sId !=3D str) ) {
obj =3D GetObj("Main-File")
window.location.href=3Dobj.href+"#"+sId
return 1
}
return 0
}
var MHTMLPrefix =3D CalculateMHTMLPrefix();
function CalculateMHTMLPrefix()
{
if ( document.location.protocol =3D=3D 'mhtml:') {
href=3Dnew String(document.location.href)
Start=3Dhref.indexOf('!')+1
End=3Dhref.lastIndexOf('/')+1
if (End < Start)
return href.substring(0, Start)
else
return href.substring(0, End)
}
return '';
}
function GetTags(base,tag)
{
if(g_supportsPPTHTML) return base.all.tags(tag);
else return base.getElementsByTagName(tag);
}
function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP=
refix+GetHrefObj( gCurSld ).mNtsHref ) }
function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() }
function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() }
function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() }
function SetHasNts( fVal )
{
if( gHasNts !=3D fVal ) {
gHasNts=3DfVal
UpdNavPane()
}
}
function ToggleOtlText()
{
gOtlTxtExp=3D!gOtlTxtExp
UpdOtlPane()
}
function ClearMedia()
{
if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0;
}
function FullScreen()
{
if ( PPTSld.g_animUseRuntime )
PPTSld.document.body.pause();
ClearMedia();
var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF =
: FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref;
if(PPTNav.event.ctrlKey) {
var w =3D (window.screen.availWidth * 1.0) / 2.0
var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW
win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top=
=3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h );
if( win.document.body && PPTSld.g_animUseRuntime )
win.document.body.PPTSldFrameset=3Dwindow;
}
else
{
win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" );
if( win.document.body && PPTSld.g_animUseRuntime )
win.document.body.PPTSldFrameset=3Dwindow;
}
}
function ToggleVNarration()
{
rObj=3DPPTSld.document.all("NSPlay")
if( rObj && !PPTSld.g_animUseRuntime ) {
if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) )
rObj.Play()
else if( rObj.playState =3D=3D 2 )
rObj.Pause()
else
return;
}
else if( PPTSld.g_animUseRuntime )
{
narObj =3D PPTSld.document.all("narrationID")
if( narObj )
narObj.togglePause()
}
}
function GetCurSldNum()
{
obj=3DGetHrefObj(gCurSld)
if( obj.mOrigVis =3D=3D 1 )
return obj.mSldIdx
else
return gCurSld
}
function GetNumSlds()
{
if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 )
return GetSldList().mNumVisSlds;
else
return GetSldList().mList.length
}
function GetSldNum( href )
{
for(ii=3D0; ii 1 )
PopSldList();
else if( !IsFramesMode() ) {
if( gLoopCont )
GoToFirst()
else
EndShow()
}
}
function GoToPrevSld()
{
ii=3DgCurSld-1
if( ii > 0 ) {
obj=3DGetHrefObj(ii)
while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) )
obj=3DGetHrefObj(--ii)
if( ii =3D=3D 0 ) ii=3D1
GoToSldNum(ii)
}
}
function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) }
function GoToLast()
{
ii=3DGetSldList().mList.length
if( ii !=3D gCurSld )
GoToSld( GetHrefObj(ii).mSldHref )
}
function GoToSldNum( num )
{
if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue
obj =3D GetHrefObj( num )
obj.mVis=3D1
gPrevSld=3DgCurSld
gCurSld =3D num;
PPTSld.location.replace(MHTMLPrefix+obj.mSldHref)
if( IsFramesMode() ) {
UpdNavPane(); UpdOtlPane(); UpdNtsPane()
}
}
function GoToSld( href )
{
if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue
GetHrefObj( GetSldNum(href) ).mVis=3D1
PPTSld.location.replace(MHTMLPrefix+href)
}
function SldUpdated( id )
{
if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return
gPrevSld=3DgCurSld
gCurSld=3DGetSldNum(id)
if( IsFramesMode() ) {
UpdNavPane(); UpdOtlPane(); UpdNtsPane()
}
}
function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) }
function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO=
bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) }
function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) }
function CloseWindow() {
if( HideMenu() ) return;
var event =3D PPTSld.event;
if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D=
=3D32 || event.type=3D=3D"click" ) )
window.close( self );
CatchNumKeys( self, event );
}
function Unload() { gIsEndShow=3D0; }
function SetupEndShow() {
gIsEndShow=3D1;
PPTSld.document.body.scroll=3D"no";
PPTSld.document.onkeypress=3DCloseWindow;
PPTSld.document.onclick=3DCloseWindow;
PPTSld.document.oncontextmenu=3D_CM;
}
function EndShow()
{
if( IsFramesMode() ) return
if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue
doc=3DPPTSld.document
var dir =3D doc.body.dir
if( dir !=3D "rtl" ) dir =3D "ltr";
doc.open()
doc.writeln(' 0) {
PushSldList(sldList,fEnd);
gCurSld =3D 1;
}
else
if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue
}
function PushSldList(arr,fEnd) {
var ii =3D gSldStack.length;
gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd);
GoToSld( gSldStack[ii].mList[0].mSldHref );
}
function PopSldList() {
if (gSldStack[gSldStack.length-1].fEndShow)
EndShow()
else {
gCurSld =3D gSldStack[gSldStack.length-1].mCurSld;
gSldStack[gSldStack.length-1] =3D null;
gSldStack.length--;
var sldList =3D gSldStack[gSldStack.length-1];
GoToSld( sldList.mList[gCurSld - 1].mSldHref );
}
}
var custShowList=3Dnew Array();
function ImgBtn( oId,bId,w,action )
{
var t=3Dthis
t.Perform =3D _IBP
t.SetActive =3D _IBSetA
t.SetInactive=3D _IBSetI
t.SetPressed =3D _IBSetP
t.SetDisabled=3D _IBSetD
t.Enabled =3D _IBSetE
t.ChangeIcon =3D null
t.UserAction =3D action
t.ChgState =3D _IBUI
t.mObjId =3D oId
t.mBorderId=3D bId
t.mWidth =3D w
t.mIsOn =3D t.mCurState =3D 0
}
function _IBSetA()
{
if( this.mIsOn ) {
obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 )
obj.style.posTop=3D0
}
}
function _IBSetI()
{
if( this.mIsOn ) {
obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 )
obj.style.posTop=3D0
}
}
function _IBSetP()
{
if( this.mIsOn ) {
obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 )
obj.style.posLeft+=3D1; obj.style.posTop+=3D1
}
}
function _IBSetD()
{
obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 )
obj.style.posTop=3D0
}
function _IBSetE( state )
{
var t=3Dthis
GetObj( t.mBorderId ).style.visibility=3D"visible"
if( state !=3D t.mIsOn ) {
t.mIsOn=3Dstate
if( state )
t.SetInactive()
else
t.SetDisabled()
}
}
function _IBP()
{
var t=3Dthis
if( t.mIsOn ) {
if( t.UserAction !=3D null )
t.UserAction()
if( t.ChangeIcon ) {
obj=3DGetObj(t.mObjId)
if( t.ChangeIcon() )
obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth
else
obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth
}
t.SetActive()
}
}
function _IBUI( clr1,clr2,nextState )
{
var t=3Dthis
SetBorder( GetObj( t.mBorderId ),clr1,clr2 )
obj=3DGetObj( t.mObjId )
obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj=
.style.posTop
t.mCurState=3DnextState
return obj
}
function TxtBtn( oId,oeId,action,chkState )
{
var t=3Dthis
t.Perform =3D _TBP
t.SetActive =3D _TBSetA
t.SetInactive=3D _TBSetI
t.SetPressed =3D _TBSetP
t.SetDisabled=3D _TBSetD
t.SetEnabled =3D _TBSetE
t.GetState =3D chkState
t.UserAction =3D action
t.ChgState =3D _TBUI
t.mObjId =3D oId
t.m_elementsId=3D oeId
t.mIsOn =3D 1
}
function _TBSetA()
{
var t=3Dthis
if( t.mIsOn && !t.GetState() )
t.ChgState( gHiliteClr,gShadowClr,0,0 )
}
function _TBSetI()
{
var t=3Dthis
if( t.mIsOn && !t.GetState() )
t.ChgState( gFaceClr,gFaceClr,0,0 )
}
function _TBSetP()
{
if( this.mIsOn )
this.ChgState( gShadowClr,gHiliteClr,1,1 )
}
function _TBSetD()
{
this.ChgState( gFaceClr,gFaceClr,0,0 )
this.mIsOn =3D 0
}
function _TBSetE()
{
var t=3Dthis
if( !t.GetState() )
t.ChgState( gFaceClr,gFaceClr,0,0 )
else
t.ChgState( gShadowClr,gHiliteClr,1,1 )
t.mIsOn =3D 1
}
function _TBP()
{
var t=3Dthis
if( t.mIsOn ) {
if( t.UserAction !=3D null )
t.UserAction()
if( !t.GetState )
return
if( t.GetState() )
t.SetPressed()
else
t.SetActive()
}
}
function _TBUI( clr1,clr2,lOffset,tOffset )
{
SetBorder( GetObj( this.mObjId ),clr1,clr2 )
Offset( GetObj( this.m_elementsId ),lOffset,tOffset )
}
function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle=
ft }
function SetBorder( obj, upperLeft, lowerRight )
{
s=3Dobj.style;
s.borderStyle =3D "solid"
s.borderWidth =3D 1
s.borderLeftColor =3D s.borderTopColor =3D upperLeft
s.borderBottomColor=3D s.borderRightColor =3D lowerRight
}
function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] }
function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() }
function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() }
function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() }
function BtnOnUp()
{
b=3DGetBtnObj()
if( b !=3D null )
b.Perform()
else
Upd()
}
function GetNtsState(){ return parent.gNtsOpen }
function GetOtlState(){ return parent.gOtlOpen }
function GetOtlTxtState(){ return parent.gOtlTxtExp }
function NtsBtnSetFlag( fVal )
{
s=3Ddocument.all.item( this.m_flagId ).style
s.display=3D"none"
if( fVal )
s.display=3D""
else
s.display=3D"none"
}
function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S=
etActive() }
function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S=
etInactive() }
function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S=
etPressed() }
function _BSetA_BorderImg()
{
b =3D gBtnArr[this.mBorderId]
if( b !=3D null && this.mIsOn && !b.GetState() ) {
obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 )
obj.style.posTop=3D0
}
}
function _BSetI_BorderImg()
{
b =3D gBtnArr[this.mBorderId]
if( b !=3D null && this.mIsOn && !b.GetState() ) {
obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 )
obj.style.posTop=3D0
}
}
var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"=
THREEDFACE"
var gBtnArr =3D new Array()
gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan=
e,GetOtlState )
gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt=
lPane,GetOtlState )
gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN=
tsPane )
gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg;
gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg;
gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.=
ToggleNtsPane,GetNtsState )
gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To=
ggleNtsPane,GetNtsState )
gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n=
b_prevBorder",30,parent.GoToPrevSld )
gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n=
b_nextBorder",30,parent.GoToNextSld )
gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent=
.FullScreen )
gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa=
rent.FullScreen,null )
gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border;
gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border;
gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent=
.FullScreen,null )
gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border;
gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border;
gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice=
","nb_voiceBorder",18,parent.ToggleVNarration )
gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT=
xt","nb_otlTxtBorder",23,parent.ToggleOtlText )
gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts"
gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag
gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState
var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr=
row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval"
function ShowMenu()
{
BuildMenu();
var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y=
=3DPPTSld.event.clientY+doc.scrollTop
m =3D PPTSld.document.all.item("ctxtmenu")
m.style.pixelLeft=3Dx
if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) )
m.style.pixelLeft=3Dx-m.scrollWidth
m.style.pixelTop=3Dy
if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) )
m.style.pixelTop=3Dy-m.scrollHeight
m.style.display=3D""
}
function _CM()
{
if( !parent.IsFullScrMode() ) return;
if(!PPTSld.event.ctrlKey) {
ShowMenu()
return false
} else
HideMenu()
}
function BuildMenu()
{
if( PPTSld.document.all.item("ctxtmenu") ) return
var mObj=3DCreateItem( PPTSld.document.body )
mObj.id=3D"ctxtmenu"
mObj.style.visibility=3D"hidden"
var s=3DmObj.style
s.position=3D"absolute"
s.cursor=3D"default"
s.width=3D"120px"
SetCMBorder(mObj,"menu","black")
var iObj=3DCreateItem( mObj )
SetCMBorder( iObj, "threedhighlight","threedshadow" )
iObj.style.padding=3D2
CreateMenuItem( iObj,sNext,M_GoNextSld,M_True )
CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld )
CreateSeparator( iObj )
CreateMenuItem( iObj,sEnd,M_End,M_True )
mObj.style.visibility=3D"visible"
}
function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa=
lue=3Dfalse }
function Highlight() { ChangeClr("activecaption","threedhighlight") }
function Deselect() { ChangeClr("threedface","menutext") }
function Perform()
{
e=3DPPTSld.event.srcElement
if( e.type=3D=3D"menuitem" && e.IsActive() )
e.Action()
else
PPTSld.event.cancelBubble=3Dtrue
}
function ChangeClr( bg,clr )
{
e=3DPPTSld.event.srcElement
if( e.type=3D=3D"menuitem" && e.IsActive() ) {
e.style.backgroundColor=3Dbg
e.style.color=3Dclr
}
}
function M_HasPrevSld() { return( parent.HasPrevSld() ) }
function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() }
function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();=
PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() }
function M_True() { return true }
function M_End() { window.close( self ) }
function CreateMenuItem( node,text,action,eval )
{
var e=3DCreateItem( node )
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Scrotal Swellings
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•This
tutorial has been designed to be interactive within the
•lim=
its of
Powerpoint presentations
•
•To =
get the
most out of it you should read up the subject first
•
•If =
you
haven’t managed that at least have a textbook beside
•you=
during
the tutorial so that you can look up the answers
•
•The=
marks
available for each section are shown in orange
•
•Sug=
gestions
for further reading are shown in green
Introduction
•This
tutorial has been designed to take you through some of the
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•com=
moner
conditions which can cause a swelling in the scrotum
•
•The=
most
important thing to remember about a swelling arising from
•either the =
scrotum
or its contents is that:
•
•On examination it is possible to get above the swelling
•
•If =
you
can’t get above the swelling then that suggests that the pathology&#=
13;
•has
originated from the groin. So before we get started write down as
•man=
y causes
as you can think of for a swelling in the groin or scrotum
•whi=
ch you cannot get above.
•
•The answers=
are on
the next slide.
Common
Causes of a Lump in the Groin / Scrotum Which You Cannot Get Above
Inguinal Hernia
Femoral Hernia
Enlarged Inguinal Lymph Nodes
Saphena Varix
Femoral Artery Aneurysm
Lipoma
<=
span
lang=3DEN-GB style=3D'color:#FF9900;mso-color-index:4'>6 marks=
Now let’s move on to scrotal sw=
ellings.
Again, write
down as many causes of a scrotal swel=
ling
which
you can g=
et above
and then review the list on the
next slide.
Common
Causes of Scrotal Swellings Which You Can Get =
Above=
Hydrocele
Epididymal Cyst
Varicocoele
Epididymo-orchitis
Testicular Tumour
<=
span
lang=3DEN-GB style=3D'color:#FF9900;mso-color-index:4'>5 marks=
We are now going to go through each of
the
conditions on the list.
The tutorial will ask you a series of
questions in each
case and you can then review the answ=
ers on
the
slides which follow.
Hydrocele<=
/div>
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•1 Define a hydrocele
•2 What is the underlying
pathology?
•3 How might you classify the
causes?
4What might a patient with a hydrocele
complain of?=
3;
•5 What are the important findi=
ngs to
elicit on examin=
ation?
•6 Name 3 methods of treatment<=
/span>
Hydrocele 2
•Definition:=
•
•“A
hydrocele is a collection of fluid within the tunica vaginalis” 1 mark
•
•You
should read up on the embryology of testicular
•descent
to appreciate how the tunica vaginalis is
•formed
Pathogenesis of
Hydrocele
The fluid collects because of an imba=
lance
between
production and absorption.
1 mar=
k
The tuni=
ca
vaginalis normally produces around
0.5ml of=
fluid a
day.
Common Causes of
Hydrocele
Congenit=
al Patent
processus vaginalis (PPV)
Acquired=
Idiopathic
Tumour
Trauma
Infection
5 mar=
ks
Hydrocele
History & Examination
History: A painless swelling in the scrotum.
Onset
may be gradual or sudden.
Examination: A scrotal swelling which you can get above
The
testis cannot be palpated separate to the
swelling
The
lump transilluminates
5 Mar=
ks
Hydrocele Investi=
gation
Because one of the caus=
es of a
hydrocele is testicular
tumour, it is important=
to
arrange a scrotal ultrasound
to rule out this as an
underlying pathology
Hydrocele Treatmen=
ts
Include:
•<=
/span>Conservative management if the hydroc=
ele is
small and causi=
ng
little in the way of symptoms
•<=
/span>Aspiration +/- injection of a scleros=
ing
agent
•<=
/span>Surgery: Ligation of PPV in children
• Jaboulay
• Lords 5 marks
•Both
the Jaboulay and the Lords procedure involve incising
•the
tunica vaginalis to allow the hydrocele fluid to be
•absorbed
by the scrotal lymphatics. Read up the procedures in
•a
surgical textbook to understand the techniques.
Epididymal Cyst
1 What
is an epididymal cyst?
2 What
might the patient complain of?
3 List
three important findings on examination.
4 How
are epididymal cysts treated?
Epididymal
Cyst Definition
“ A cystic swelling arising fro=
m the
epididymis”
1 Mar=
k
Epididymal
Cyst History & Examination
History: Painless scrotal swelling
Onset
usually gradual
Examination: Scrotal swelling which you can get above
<=
/div>
Testis
palpable separate from the lesion
The
cyst transilluminates
5 Mar=
ks
The
transilluminated appearance of the cyst is classically
describe=
d as a
“Chinese Lantern”
Epididymal
Cyst Management
Simple surgical excision of the cyst&=
#13;
1 Mar=
k
Aspirati=
ng will
not work because the cyst is
multiloc=
ulated
As for
hydroceles, conservative management is
perfectly
reasonable if the patient is asymptomatic
Varicocoele
1 Define
a varicocoele
2 What
local symptoms might a patient complain of?
•3 Describe the common signs on
physical examin=
ation
4 Why
is it important to image the kidneys?
5 Describe
the two main methods of non-conservative management?Varicocoele Defin=
ition
“A varicocoele is a dilatation =
of the
veins of the
pampiniform plexus”
=
1 Mar=
k
Varicocoele
Symptoms & Signs
Symptoms: Scrotal swelling
Far
more common on left than on right
Dragging
/ aching sensation in the groin / scrotum
Signs: Scrotal swelling which you can get above
=
Swelling
feels like a “Bag of worms”
4 Mar=
ks
Significance of
Varicocoele
•A left
sided-varicocoele may arise as a result of
•obs=
truction
to venous drainage caused by a renal
•tum=
our
•
•The=
refore
all patients with a varicocoele should
•und=
ergo
imaging (usually ultrasound) of their
•kidneys
=
;
•
• 1 Mark
Varicocoele:
Methods of Treatment
The two main methods are:
=
1 Surgical
ligation
2 Embolisation
under X-Ray control
2 Mar=
ks
Epididymo-Orchiti=
s
1 What
is epididymo-orchitis?
2 List
the symptoms and signs
3 How
is the condition treated?
Definition of
Epididymo-Orchitis
“An inflammation of the tissues=
of the
epididymis
and testis”
1 Mar=
k
The commonest cause of =
this is
infection. You need
to know some of the com=
moner
causative organisms.
Read up on these.
Symptoms & Si=
gns
•Symptoms: Painful scrotal swelling
=
;
•
•Signs: A scrotal swelling which you=
can
get above and
which is
• - hot
• - tender
• - erythematous
<=
/div>
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•
• 5 Marks
Treatment<=
/div>
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An appropriate broad-spectrum antibio=
tic is
used, such as
ciprofloxacin.
1 Mar=
k
Bonus Questions:
1 What
class of antibiotic does ciprofloxacin belong
to?
2 What
is the mode of action of ciprofloxacin?
Ciprofloxacin
This is a fluoroquinolone antibiotic&=
#13;
1 Mar=
k
It acts by inhibiting an enzyme calle=
d DNA
gyrase in
reproducing bacteria. This is one of =
the
enzymes
responsible for unwinding DNA during
replication
1 Mar=
k
End of Part One
That concludes this part of the tutor=
ial,
which has
taken you through benign scrotal
swellings
Go and have a cup of tea and then com=
e back
to
cover testicular tumours=
Testicular Tumour=
s
Urology Scrotal Swelling Tut=
orial Part 2
Classification
of Testicular Tumours
You might sensibly start classifying
testicular tumours into benign and
malignant. In fact benign solid tumou=
rs of
the testis are extremely rare.
The classification of malignant tumou=
rs is
complicated by the fact that
there are different classification sy=
stems
used in the UK and USA and
consequently it’s easy to get c=
onfused
if you read textbooks from the
different countries.
So don’t read anything now. Go to the next few slides to see how these
tumours are classified and how the sy=
stems
work in the two countries
It Starts Off Qui=
te
Easily
You can divide them into:
=
1 Germ
Cell Tumours
2 Other
tumours, the commonest of which is lymphoma,
which is the commonest testicular
malignancy in the older patient. We won’t
be saying any more about theseStill Quite Easy<=
/span>
Germ cell tumours can be divided into=
1 Seminomas
(we’ll talk about these in a bit)
2 Non-seminomatous
germ cell tumours
The
classification of these is where confusion
sometimes arises. A summary <=
/span>=
is
on the next slideClassification
of Non-Seminomatous Germ
Cell Tumours
But Remember
40% of
testicular tumours are mixed, i.e. they
have both
seminomatous and non
seminomat=
ous
elements
Questions
1 What
is the peak age incidence of seminomas?
2 What
is the peak age incidence of non-seminomatous
germ cell tumours (NSGCTs)?
•3 What are the symptoms & =
signs
of a testicular tumour?=
4 What
investigations are required?
5 What
surgery is usually necessary?
6 What
other therapeutic options exist for seminomas
& NSGCTs?Peak Age Incidence
Seminomas=
40 years
NSGCTs 30 years
2 Marks
Symptoms & Signs
Symptoms: Painless
scrotal swelling
Chance
discovery
Testis
feels “heavier”
Signs: Scrotal
swelling which you can get above
The
lump is craggy & does not transilluminate
May
be associated with hydrocele <=
/span>
May
have palpable liver due to metastases
5 Marks (one each for any 5 of the points)
Investigations
•Radiology: Ultrasound of testis
• CT of abdomen to assess
spread
• Chest X Ray for metastases&=
#13;
•Blood Tests: AFP (alpha foeto-protein)
• b-hCG (human chorionic
• gonadotrophin)
<=
/div>
• LDH (lactate dehydrogenase)
• 6 Marks
•The
blood tests are known as tumour markers. Read up on
•th=
ese.
You should be able to define them and say how they
•are
used. You should also read up on how these tumours
•sp=
read.
Surgery
•An inguinal orchidectomy=
is
performed 1 Mark
•
•i.e. the testis is taken out through an incision in
the
•groin
•
•This is because the lymphatic drainage of the testis is
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•to the para-aortic nodes. An incision in the scrotum
•risks spreading the tumour to the superficial inguinal
•lymph nodes which drain the scrotal skin
Other Treatments
If the tumour has metastasised, other options for&=
#13;
treatment include:
Radiotherapy for seminoma
Chemotherapy for NSGCTs 2 Marks
Sometimes a combination of the two is required
How Did You Do?
Add up yo=
ur
marks - the total is out of 70
Repeat the
tutorial later on to see if your mark
has impro=
ved
' + ENDSHOW_MESG + '
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tes![](3D"buttons.gif")
