1.3 Developmental disorders of the urethra and the male genitalia Flashcards
what is Hypospadias?
cause?
how and when is it corrected?
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
what anomalies Hypospadias is associated with?
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.
Etiology of Hypospadias?
- lack of testosterone production
- lack of androgen receptors
- lack of 5 alpha reductase
Hypospadiasn Treatment? at what age?
Corrected by surgery, ideally when child is 6-12 months old
- Urethroplasty
- meatoplasty
- glanuloplasty
what is Phimosis?
Inability to retract the foreskin to reveal the glans
due to adhesions existing between the prepuce and the glans (due to smegma accumulation).
what is Failure of testicular development
- Can occur all along the developmental line
- Make sure it´s not cryptorchidism by doing laparoscopic inguinal/abdominal exploratory surgery
what is Cryptorchidism?
The failure of descent of testis
Cryptorchidism numbers? when should it descend
In 30% of boys born at 30 weeks
Most will descend within first 6 months
how do you diagnose Cryptorchidism?
palpation in the inguinal canal and Imaging studies can assist.
what is Hydrocele?
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
what is varicocele?
Dilation and twisting of the pampiniform plexus greater than 2 mm
varicocele which side mostly, age group and %
- 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
varicocele symps?
- Infertility
- scrotal pain
- visible enlarged veins
- feeling of heaviness in the testicle.
varicocele diagnosis and therapy?
Dx: US
th: Varicocelectomy
what is Epispadias?
what is associated with
- 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.
Epispadias th?
Reconstructive surgery
what is Inconspicuous penis?
- A penis that appears to be small.
- Several enteties:
1. Webbed penis
2. conceal penis (buried, hidden)
3. trapped penis.
what is Megalourethra? why does it happen
Dilatation without stenosis, could be due to the lack of corpus cavernosum.
Undescended testis classification by location
- upper scrotum,
- superficial inguinal pouch,
- inguinal canal,
- or abdomen
Undescended testis increases risk of
testicular cancer
and subfertility
If orchidopexy has failed, or an intra-abdominal testis is detected after puberty,
what should be performed
orchiectomy should be performed
If the testis is palpable in the inguinal canal
what should be performed
orchidopexy
Meatal stenosis
Narrow orifice at the tip of the glans
- Congenital or acquired (most commonly after circumcision
Physiologic phimosis
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
Pathologic phimosis
Pathologic phimosis is the inability to retract the foreskin after it was previously retractable or after puberty, usually due to distal scarring
Indirect inguinal
hernia
Later presentation of patent processus vaginalis
- Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the groin
