1.3 Developmental disorders of the urethra and the male genitalia

Question 1

what is Hypospadias?
cause?
how and when is it corrected?

Answer 1

Abnormal opening of penile urethra on ventral surface of penis due to failure of urethral folds to fuse

Corrected by surgery, ideally when child is 6-12 months old

Question 2

what anomalies Hypospadias is associated with?

Answer 2

Association of 3 anomalies:
- Abnormal ventral opening of the urethral meatus
- abnormal curvature of the penis
- abnormal distribution of foreskin with dorsally
present hood and ventral deficient foreskin.

Question 3

Etiology of Hypospadias?

Answer 3

• lack of testosterone production
• lack of androgen receptors
• lack of 5 alpha reductase

Question 4

Hypospadiasn Treatment? at what age?

Answer 4

Corrected by surgery, ideally when child is 6-12 months old
- Urethroplasty
- meatoplasty
- glanuloplasty

Question 5

what is Phimosis?

Answer 5

Inability to retract the foreskin to reveal the glans
due to adhesions existing between the prepuce and the glans (due to smegma accumulation).

Question 6

what is Failure of testicular development

Answer 6

• Can occur all along the developmental line
• Make sure it´s not cryptorchidism by doing laparoscopic inguinal/abdominal exploratory surgery

Question 7

what is Cryptorchidism?

Answer 7

The failure of descent of testis

Question 8

Cryptorchidism numbers? when should it descend

Answer 8

In 30% of boys born at 30 weeks

Most will descend within first 6 months

Question 9

how do you diagnose Cryptorchidism?

Answer 9

palpation in the inguinal canal and Imaging studies can assist.

Question 10

what is Hydrocele?

Answer 10

Common cause of scrotal swelling in infants
- - When processus vaginalis fails to close.
- More common in premature babies
- leads to Accumulation of peritoneal fluid.
- Most cases resolve spontaneously within 1 year

o requires Surgery to close if persisting

Question 11

what is varicocele?

Answer 11

Dilation and twisting of the pampiniform plexus greater than 2 mm

Question 12

varicocele which side mostly, age group and %

Answer 12

• Mostly left sided (because of the relation of the spermatic vein to the left renal vein (the spermatic vein opens at a sharp angle into the left renal vein). On the right side, the spermatic vein opens into the much larger inferior vena cava.)
• 12-20% of males
• 15-25 years

Question 13

varicocele symps?

Answer 13

• Infertility
• scrotal pain
• visible enlarged veins
• feeling of heaviness in the testicle.

Question 14

varicocele diagnosis and therapy?

Answer 14

Dx: US
th: Varicocelectomy

Question 15

what is Epispadias?
what is associated with

Answer 15

• Urethra ends in an opening on the upper aspect of the penis. due to faulty positioning of genital tubercle
• Noted as a component of the bladder and cloacal exstrophy.
  Associated with bladder exstrophy (‘exstrophy-epispadias complex
• It can cause incontinence.

Question 16

Epispadias th?

Answer 16

Reconstructive surgery

Question 17

what is Inconspicuous penis?

Answer 17

• A penis that appears to be small.
• Several enteties:
  1. Webbed penis
  2. conceal penis (buried, hidden)
  3. trapped penis.

Question 18

what is Megalourethra? why does it happen

Answer 18

Dilatation without stenosis, could be due to the lack of corpus cavernosum.

Question 19

Undescended testis classification by location

Answer 19

• upper scrotum,
• superficial inguinal pouch,
• inguinal canal,
• or abdomen

Question 20

Undescended testis increases risk of

Answer 20

testicular cancer
and subfertility

Question 21

If orchidopexy has failed, or an intra-abdominal testis is detected after puberty,
what should be performed

Answer 21

orchiectomy should be performed

Question 22

If the testis is palpable in the inguinal canal
what should be performed

Answer 22

orchidopexy

Question 23

Meatal stenosis

Answer 23

Narrow orifice at the tip of the glans
- Congenital or acquired (most commonly after circumcision

Question 24

Physiologic phimosis

Answer 24

results from adhesions between the epithelial layers of the
inner prepuce and glans.
These spontaneously dissolve with intermittent foreskin
retraction and erections, so that as child grows, physiologic phimosis resolves

Question 25

Pathologic phimosis

Answer 25

Pathologic phimosis is the inability to retract the foreskin after it was previously retractable or after puberty, usually due to distal scarring

Question 26

Indirect inguinal
hernia

Answer 26

Later presentation of patent processus vaginalis

• Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the groin