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Contrast enhanced CT or IVU is useful in elucidating tubular ectasia or medullary calcifications found in medullary sponge kidney. Other anomalies previously mentioned may require ultrasound, CT, and MRI to diagnose parenchymal disease in addition to contrast studies such as IVU, retrograde pyelography or cystography to evaluate the ureters and bladder. Management Asymptomatic simple cystic disease requires no further study or treatment. Symptomatic distension of the renal capsule, obstruction of the collecting system or infection may warrant percutaneous treatment, sclerosis or even laparoscopic or open operative excision. The complications of medullary sponge kidney, including calculus formation and infection, require management. Hypercalciuria associated with the disease induces stone formation, and thus thiazides or inorganic phosphates are effective for lowering hypercalciuria and limiting stone formation. Phosphate administration may increase the risk of infectious stone development in the presence of urease-producing bacteria. Therefore, if phosphates are used, frequent urinary cultures should be performed to ensure absence of an asymptomatic infection. Long-term antibiotic prophylaxis may be required to prevent these infections. Aeromedical considerations Many of the cystic and congenital abnormalities are disqualifying for aviation duties. Simple cystic disease is compatible with flight as long as the cysts do not result in mechanical compromise to the kidney, collecting system or renal vasculature. It is important to differentiate cystic abnormalities from renal tumours. Medullary sponge kidney is of aeromedical significance because of the disease complications. Pyelonephritis and nephrolithiasis are common, with potential sequelae including septicaemia and renal failure in symptomatic patients. For these reasons, it is disqualifying for aviation duties. Effective use of the drugs listed above decreases complications and increases the chance of resuming aviation duties. Autosomal recessive polycystic kidney disease expresses itself early; if an applicant is asymptomatic, the disease is of little aeromedical importance. Adult polycystic kidney disease may threaten the safety of flight and so should only be considered with limitation to multicrew operations. Any aeromedical disposition of an applicant or aviator with polycystic kidney disease should be done in consultation with a specialist and the medical assessor of the licensing authority. Although some States require two functioning kidneys for medical certification, an individual may have no risk of complications in an aviation environment with a single kidney. Normal renal function studies, absence of symptoms, and no evidence of infectious, obstructive or congenital disease are signs of a good prognosis. In such cases, unilateral agenesis and hypoplasia are of no clinical significance and are not at increased risk to interfere with aviation duties. In summary, symptoms of the above diseases that could impair flying performance include flank pain, urinary urgency, frequency, dysuria, fever and malaise. Subtle decline of mental clarity and general health may also occur and will require regular follow-up examinations of those who continue to fly. SCROTAL PROBLEMS Disease processes/ clinical features ICAO Preliminary Unedited Version — November 2009 III-6-13 The scrotum is a loose sac containing the testes, the epididymides, and the spermatic cord. Dermatological conditions, endocrinopathies, infection, vascular problems, malignancy, and other diseases may arise in the scrotum and its contents. Testicular examination should reveal a firm, rubbery, ovoid structure. Diminished testicular size suggests hypogonadism. Elevation of the testis in the hemiscrotum may indicate torsion or malignancy, especially if palpable masses are present. In the setting of these findings, the latter diagnosis should be suspected until proven wrong. Hernias may present as a scrotal finding. Gentle pressure with the physician’s index finger, causing invagination of the scrotum anterior to the testicle and spermatic cord up to the internal ring, may reveal this and other pathology. Valsalva manoeuvres7 may assist with this diagnosis, and it may also be useful in finding a varicocele. This finding is noted by the presence of a dilated, tortuous spermatic vein within the hemiscrotum. Another diagnostic tool is transillumination: a cystic scrotal mass will transilluminate whereas a solid one will not pass light. Diagnosis The most common physical finding in the testes is a mass. Painless, firm masses that clearly arise from the testis are malignant until proven otherwise. Solid extratesticular masses tend to be benign but www.aero.cn 航空翻譯 www.aviation.cn 本文鏈接地址：Manual of Civil Aviation Medicine 2
