11. Surgical 3 Flashcards
What is wrong with the meatus? What are the two yellow lumps? How old is the boy?
There are two openings in the meatus - the patient has a degree of duplication of the urethra.
The yellow lumps are deposits of smegma, which is peeling skin and secretions accumulating between the foreskin and the glans,
boy - 1-3 yrs when the foreskin begins to separate and smegma occurs
Is smegma dangerous?
No, it merely tells you the age of the boy (1-3+) - separation of foreskin from the glans
What is this? What is happening?
When does it occur and how is it treated?
Balanitis.
Bowel organisms (eg E coli) have colonised the space between the foreskin and glans and are multiplying in the retained glans, causing superficial ulceration.
occurs when the foreskin is separating from the glans (1-5 years)
Treated with topical antiseptic and occasionally systemic abx
What is this (red, swollen, painful penis)?
When does it occur?
How is it treated?
Is recurrence common?
Diagnosis is paraphimosis, a mechanical problem with the foreskin compressing the shaft after retraction and causing congestion of glans.
There is no infection.
It occurs just after the foreskin has separated from the glans - 1-5 y.o
It is treated by compressing the glans until it can be pushed back inside the foreskin (usually with anaesthetics)
Recurrence not usual.
What’s going on here?
Phimosis (congenital narrowing of foreskin so it cannot be retracted) after poor circumcision where foreskin has been cut too short, causing secondary buried penis- the glans has retracted inside the foreskin and the foreskin has closed over the glans, causing phimosis with obstruction of urinary flow
What’s going on here? What causes it and what is the treatment?
How could it be prevented?
Ballooning of foreskin durign micturition cuased by phimosis.
Causes of phimosis: 2ndary to poor circumsion, trauma, recurrent infection under foreskin during phase of separation.
Treatment: emergency circumcision to relieve urinary tract obstruction.
Prevention: good perineal hygiene in babies/toddlers - displace E coli from under foreskin
Diagnosis?
When does it occur?
Diagnosis = meatal ulcer which will lead to meatal stenosis if not treated quickly with protective vaseline/ointment.
Common after neonatal circucision, as removal of foreskin exposes glans and meatus to trauma
how did this happen
ulcerated glans penis - during circumcision foreskin torn free> trauma to glandular epithelium> ulceration of glans> 2ndary infection by E coli
cause of this?
Bleeding after circumcision due to inadequate haemostasis.
also - inadequate removal of outer foreskin
Is this hypospadias?
When is a dx of hypospadias acceptable at birth?
No, this baby should be invx/tx for disorders of sex development.
Dx of hypospadias at birth is acceptable when the scrotum is fused and contains 2 testes, and there is confirmation of no global abnormality of hormone function or testicular dev
What is hypospadias?
A congenital condition where the meatus is not at the tip of the glans but on the underside of the glans and at any point along it.
These patients may also have ‘chordee’ - penis curving downward, especially when the meatus is more proximal.
What abnoramlities are visible?
proximal urethral opening, in coronal groove, with a blind ending pit at the site where the urethra should open.
The foreskin is also abnormal - it does not cover the ventral surface of the glans - “dorsal hood”
The scrotum is normal and contains two testes- unlikely to be DSD
What abnormalities are visible and is this important/needing to be fixed?
Deficinecy of ventral tissues on the penis around the urethra >bend in the shaft “chordee” . Erection would be painful or impossible.
It does require surgery for adult sexual function
What is wrong here?
Penis has an abnormal foreskin which is all on the ventral side- ‘ventral hood’
The glans is not ocnical but flat, and the penile shaft is furhter from the scrotum than normal
= epispadias, a rare anomaly of closure of the anterior lower abdominal wall- urethra opens on upper/dorsal aspect of penis
Diagnosis?
Epispadias - open urethral gutter on dorsal surface, ventral hood
What is this?
Bladder extrophy, the most severe variant of the epispadius- extrophy spectrum. issues of bladder and sexual function
Diagnosis?
Mucosa protruding from anus - shape is annular, consistent with rectal prolapse rather than rectal polyp.
Also no obvious natal cleft so possibility of spina bifida
What is this? What causes it and does it need surgery?
umbilical hernia - failure of umbilical ring to close after involution of umbilical cord,
Usually closes spontaneously by 2 y.o, only surgery after then. Risk of incarceration in infants is very low as umbilical ring is round with smooth edges. (risk goes up with age, pregnancy and obesity)
What is this? Is it dangerous?
it is not a hernia - it is an inclusion dermoid cyst - a few skin cells have been trapped during closure of the skin defect at the umbilicus after involution of the cord stump.
not dangerous - simple excision
