Kidney and urological disorders

Varicocele

A varicocele is dilated pampiniform veins, usually on the left, felt as a 'bag of worms' with dull aching worse on standing, and a preventable cause of male infertility and testicular atrophy. Confirm with Doppler ultrasound and semen analysis; use scrotal support and analgesia, and varicocelectomy for abnormal semen, atrophy or chronic pain.

Fournier's gangrene

Fournier's gangrene is rapidly progressive necrotising fasciitis of the perineum and genitals. Resuscitate with IV fluids and oxygen, perform urgent surgical debridement, and give IV ceftriaxone, gentamicin and metronidazole with analgesia and wound care.

Male urinary incontinence

Male urinary incontinence is involuntary leakage of urine. Start with bladder training and pelvic floor exercises, use oxybutynin or tolterodine for urgency, adjusting for kidney or liver impairment, and reserve surgery for refractory cases.