29. Congenital anomalies of the urethra.

Question 1

this the congenital anomalies of the urethra

Answer 1

• Hypospadia: external urethral meatus in lower position on ventral surface of penis
• Epispadia: external urethral meatus in lower position on dorsal surface of penis
  
  • ​rx = [Reconstructive surgery]
• External meatus stenosis: narrowing of the uretheral opening
  
  • rx mild = [Dilation]
  • rx severe = [Meatoplasty]
• Posterior urethral valve:
  
  • ​rx= [transurethral resection]

Question 2

what is hypospadia

what are the types of hypospadia and how are they classified

Answer 2

hypospadia is when the EAM is found in a lower position on the ventral surface of penis

• effects of hyposdia are
  
  • cosmetic, functional and physiological

types of hypospadias

• According to location of EAM
  
  • Glandular
  • Coronal
  • Penile: 1) proximal 2) midshaft 3)distal
  • Penoscrotal 1) proximal 2) distal
  • Perineal
• According to severity
  
  • ​Mild: glandular, coronal and disral
    
    • charac by no micropenis!! scrotal anomalies, & chordea
    • surgical indications: cosmetic reasons, not always indicated
  • Severe: proximal penile, penoscrotal, perineal
    
    • _​_charac by no scrotal anomalies!! w/ micropenis and chordea present
    • surgery: reconstruction w/in 6-18months
      
      • indications: cosmetic AND functional
        
        • ​func: can’t reproduce d/2 probs with erection and ejaculation

Question 3

surgical indications of mild hypospadia

Answer 3

surgical indications: cosmetic reasons, not always indicated

Question 4

what is the surgery and indications for surgery for severe hypospadia

Answer 4

• surgery: reconstruction w/in 6-18months
• indications: cosmetic AND functional
  
  • ​func: can’t reproduce d/2 probs with erection and ejaculation

Question 5

what is a posterior urethral valve

assoc w/ wolfian duct?

complications? kidneyx2? bladder? lungs?

youngs classification (3 types)

Answer 5

aka congenital obstructing posterior urethral membranes is the most common congenital obstructive urethral anomaly

pathology

• https://www.osmosis.org/learn/Posterior_urethral_valve#_=_

classification

type 1: most common - more ant integration of wolfian

• two mucosal folds extend anteroinferiorly from bottom of verumonatum and fuse anteriorly at lower level

type 2: rare

• mucosal folds extend along posterolateral urethral wall from ureteric orifice to verumontanum

type 3: Cobb’s collar- incomplete dissolution of urogenital membrane

• circular diaphragm with central opening in membranous urethra
• located below the verumontanum and occurs due to abnormal canalization of urogenital membrane

Question 6

how is posterior urethral valve trearted

Answer 6

Transurethral resection

https://www.google.com/search?q=Transurethral+resection&safe=off&sxsrf=ACYBGNTnDTE9hzsCU14AjfFgVWlgulcAMA:1579514172288&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjRt6Dp9JHnAhVvzsQBHYGYDnkQ_AUoAXoECBIQAw&biw=590&bih=559#imgrc=E_u2tuC3AQVF_M:

Question 8

treatment of epispadia

Answer 8

[Reconstructive surgery]

Question 9

treatment of external meatus stenosis

Answer 9

mild= Dilation

severe= Meatoplasty

Question 10

what is chordae

Answer 10

• fibrous tissue,*
• with any chordae micro penis and scrotal anomalies are common*
• • indicated for surgical correction based on functional issues*

medscape

• def: Chordee happens when the penis curves sharply up or down. It usually happens at the very end of the penis at the glans, or tip. usually seen durirng an erection
• can occur with hypospadias
• path:
  
  • penis are normally curved around the 10th week of pregnancy. If the child is born with a curved penis, this means that the tissues may have stopped developing around that time and remained curved
  • circumcision causing uneven fibrous scar tissue causing it to bend
• surgical correction by removal of fibrous tissue but this is if functional issues persist