Common surgical problems in children - part 2

Question 1

What is the clinical presentation of idiopathic scrotal oedema ?

Answer 1

• Unilateral (90% of the time) or bilateral erythema seen on the scrotum
• Sometimes the erythema is seen to spread to the perineum or inguinal region
• Swelling of scrotum

Question 2

What is phimosis ?

Answer 2

It is the inability of the foreskin to be retracted behind the glans penis in uncircumcsied males

Question 3

At what age does phimosis become abnormal ?

Answer 3

Above the age of 4 as it is normal before then

Question 4

What is the management plan for phimosis ?

Answer 4

Usually resolves on its own but if it shows no signs of resolving then:

• First line - give steroid cream e.g. bethamethosone
• Second line - surgery if this doesn’t work

Question 5

What is paraphimosis ?

Answer 5

A urologic emergency in which the retracted foreskin of an uncircumcised male cannot be returned to its normal anatomic position

Question 6

What are some of the complications of paraphimosis ?

Answer 6

Gangrene and amputation of the glans penis

Question 7

What is the management of paraphimosis ?

Answer 7

• Squeeze the fluid out of the foreskin and pull it back over the glans penis, may need to give pain relief
• If this doesn’t work may need to make a slit in the foreskin to relieve pressure

Question 8

What is hypospadias ?

Answer 8

Combination of 3 problems:

• The hole through which urine passes (meatus) is not at the tip of the penis
• The foreskin is gathered at the back of the penis with none at the front
• The penis may be bent when stiff.

Question 9

How is hypospadias treated ?

Answer 9

With surgery

Question 10

What is a hydrocele ?

Answer 10

The accumulation of serous fluid in a body sac.

Question 11

What are the signs/symptoms of a hydrocele testis ?

Answer 11

Swelling of the teste

Can be transilluminated with light

You can feel above the swelling

Question 12

What is one of the ways you can differentiate a hydrocele testis from a hernia ?

Answer 12

You can feel above the swelling

Question 13

How do undescended testicles commonly present ?

Answer 13

Commonly present with emptiness in the scrotum and often the undescended testicle(s) are palpated in the inguinal canal

Question 14

What is the management of undecended testicles ?

Answer 14

If not dedescended by first 6 months of life then often a surgical procedure called orchidopexy to move them down