cryptorchidism, hydrocele, varicocele, hypospadias, phimosis, paraphimosis Flashcards
1
Q
what does a non-rugated scrotum indicate
A
- preterm birth
- full term males have scrotal rugations
2
Q
cryptorchidism
A
- testicle(s) do not descend from abdomen to scrotum
3
Q
testes descent phases
A
- transabdominal phase- INSL3 dependent
- inguinoscrotal phase- androgen dependent
4
Q
in what phase do testicles usually fail to descend
A
- phase 2- inguinoscrotal phase
5
Q
layers of inguinal canal
A
- from in -> out
- peritoneum
- subserous fascia
- transversalis
- transverse abdominus
- internal oblique
- external oblique
6
Q
what is the job of the gubernaculum
A
- anchor down the testicles in the scrotum
7
Q
risk factors for cryptorchidism
A
- low birth weight
- prematurity
8
Q
causes of cryptorchidism
A
- abnormal hypothalamic- pituitary- gonadal axis
- gubernaculum not firmly attachedto scrotum
9
Q
clinical manifestations of cryptorchidism
A
- 20-30% of pts have nonpalpable testes*- cremaster “very active”
- most transabd testes found within few cm of internal ring
10
Q
sequelae of cyrptorchidism
A
- infertility
- testicular cancer- even if cryptorchidism has been surgicaly fized
- often assoc with inguinal hernias due to patent processus vaginalis
11
Q
guidelines for cryporchidism treatment
A
- if someone looks like a boy but has no testicles assume girl until proven otherwise- urgent referral
- palpate testes at each well child visit
- refer if testes dont descend at 6 mo
- PCP dont perform US or other imaging
- no hormonal tx
- surgery within 1 year if no descent at 6 mo
- counsel about long term risks
12
Q
when to refer for cryptorchidism
A
- no spontaneous descent by 6 mo
- unilat cryptorchidism + hypospadias
- no testicles
13
Q
treatment for cryptorchidism
A
- watch and wait until 6 mo if otherwise healthy
- orchiopexy- “tie down” testicles into scrotum
14
Q
hydrocele
A
- swelling in scrotum due to collection of fluid
- pediatric hydroceles are usually congenital within first year of life
- most adult hydroceles are acquired
15
Q
noncommunicating hydrocele
A
- due to trauma or inflammatory conditions
- common in adults
16
Q
communicating hydrocele
A
- due to patent processus vaginalis
- usu discovered in infancy
17
Q
si/sx of hydrocele
A
- scrotal swelling- persistent vs transient (communicating)
- possibly pain in older pts
- infertility
- mainly no sx other than swelling
18
Q
PE/ imaging for hydrocele
A
- standard GU exam
- transilluminate the scrotum*- should glow bright red if hydrocele
scrotal US to assess for neoplasm or other causes
19
Q
treatment for hydroceles in kids
A
- non-communicating- observe until 1-2 years old, consider surgery if persistent
- communicating- surgery
20
Q
treatment for hydroceles in teens
A
- r/o
- surgery
- can observe if small
21
Q
treatment for hydroceles in adults
A
- r/o pathology
- surgery
22
Q
varicocele
A
- dilation of pampiniform plexus in spermatic cord
- occurs in 40% of infertile men
- very common and usually not pathologic
23
Q
what side is varicocele more commonly found?
A
- LEFT
- if right need to consider pathology
24
Q
si/sx of varicocele
A
- usually asymptomatic
- vary in size
- “bag of worms”
25
PE for varicoceles
- fullness of spermatic cord
- should do PE in upright position
- may disappear in supine
- "bag of worms"
26
diagnosis for varicoceles
- clinical dx
| - may get scrotal US
27
grade I varicocele
- small
| - palpable only with valsalva
28
grade II varicocele
- medium
- palpable at rest without valsalva
- invisible
29
grade III varicocele
- easily visible
30
treatment for varicocele
- generally only treat if concerned for infertility
- infertility reversible after surgery
- can do embolization
31
hypospadias
- opening of penis on ventral surface/ back side of penis
| - one of the most common birth defects
32
what are the risk factors for hypospadias
- low birth weight
33
treatment for hyospadias
- maybe nothing- depends on where opening is
- DONT circumcise- use skin for repair
- surgical repair usu at 6-12 months, may need to be pretreated with testosterone
34
phimosis
- inability to fully retract penile foreskin
- normal in infants and kids
- not normal in adults but not necessarily pathologic
35
causes of phimosis
- normal anatomy
- foreskin opening too small
- foreskin fused to penis
- penile frenulum too short
36
treatment indications for phimosis
- urinary problems
- sexual dysfunction
- hx of paraphimosis
- hygiene issues
37
treatment for phimosis
- manual stretching
- steroid creams- causes skin thinning
- circumcision
38
pharaphimosis
- foreskin gets retracted and cannot be pulled over glans penis
- swelling of foreskin -> threatens or results in vascular compromise of penis
- urological emergency
39
si/sx of paraphimosis
- penile pain
- swelling of foreskin and/or penile head
- signs of distress
- if prolonged ischemia can have autoamputation
40
treatment of paraphimosis
- urologic emergency**
- can try gentle retraction of foreskin IF there is time
- if severe may need bedside emergency dorsal slit
- circumcision= ultimate treatment
41
seminal vesicle
- responsible for 70-85% of fluid that becomes semen
- fluid is alkaline
- unites with vas deferens to form 2 ejaculatory ducts
42
vas deferens
- aka ductus deferens
- 2 ducts connect L and R epididymis to ejaculatory ducts
- collects with other fluids from seminal vesicles and prostate
- contracts during ejaculation to propel sperm forward
43
epididymis
- connects testes to vas deferens
| - stores sperm for 2-3 mo while they mature
44
testes
- produce sperm and androgens
| - primary reproductive organs in males
45
what is the denonvillier's fascia
- lays between prostate and rectum
| - prevents prostate Ca from regularly penetrating rectum
46
zones of prostate
- transition zone
- central zone
- peripheral zone
