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Clin Med III > cryptorchidism, hydrocele, varicocele, hypospadias, phimosis, paraphimosis > Flashcards

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

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2
Q

cryptorchidism

A
  • testicle(s) do not descend from abdomen to scrotum
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3
Q

testes descent phases

A
  • transabdominal phase- INSL3 dependent

- inguinoscrotal phase- androgen dependent

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4
Q

in what phase do testicles usually fail to descend

A
  • phase 2- inguinoscrotal phase
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5
Q

layers of inguinal canal

A
  • from in -> out
  • peritoneum
  • subserous fascia
  • transversalis
  • transverse abdominus
  • internal oblique
  • external oblique
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6
Q

what is the job of the gubernaculum

A
  • anchor down the testicles in the scrotum
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7
Q

risk factors for cryptorchidism

A
  • low birth weight

- prematurity

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8
Q

causes of cryptorchidism

A
  • abnormal hypothalamic- pituitary- gonadal axis

- gubernaculum not firmly attachedto scrotum

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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
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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
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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
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12
Q

when to refer for cryptorchidism

A
  • no spontaneous descent by 6 mo
  • unilat cryptorchidism + hypospadias
  • no testicles
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13
Q

treatment for cryptorchidism

A
  • watch and wait until 6 mo if otherwise healthy

- orchiopexy- “tie down” testicles into scrotum

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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
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15
Q

noncommunicating hydrocele

A
  • due to trauma or inflammatory conditions

- common in adults

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16
Q

communicating hydrocele

A
  • due to patent processus vaginalis

- usu discovered in infancy

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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
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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
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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
Q

PE for varicoceles

A
  • fullness of spermatic cord
  • should do PE in upright position
  • may disappear in supine
  • “bag of worms”
26
Q

diagnosis for varicoceles

A
  • clinical dx

- may get scrotal US

27
Q

grade I varicocele

A
  • small

- palpable only with valsalva

28
Q

grade II varicocele

A
  • medium
  • palpable at rest without valsalva
  • invisible
29
Q

grade III varicocele

A
  • easily visible
30
Q

treatment for varicocele

A
  • generally only treat if concerned for infertility
  • infertility reversible after surgery
  • can do embolization
31
Q

hypospadias

A
  • opening of penis on ventral surface/ back side of penis

- one of the most common birth defects

32
Q

what are the risk factors for hypospadias

A
  • low birth weight
33
Q

treatment for hyospadias

A
  • 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
Q

phimosis

A
  • inability to fully retract penile foreskin
  • normal in infants and kids
  • not normal in adults but not necessarily pathologic
35
Q

causes of phimosis

A
  • normal anatomy
  • foreskin opening too small
  • foreskin fused to penis
  • penile frenulum too short
36
Q

treatment indications for phimosis

A
  • urinary problems
  • sexual dysfunction
  • hx of paraphimosis
  • hygiene issues
37
Q

treatment for phimosis

A
  • manual stretching
  • steroid creams- causes skin thinning
  • circumcision
38
Q

pharaphimosis

A
  • foreskin gets retracted and cannot be pulled over glans penis
  • swelling of foreskin -> threatens or results in vascular compromise of penis
  • urological emergency
39
Q

si/sx of paraphimosis

A
  • penile pain
  • swelling of foreskin and/or penile head
  • signs of distress
  • if prolonged ischemia can have autoamputation
40
Q

treatment of paraphimosis

A
  • urologic emergency**
  • can try gentle retraction of foreskin IF there is time
  • if severe may need bedside emergency dorsal slit
  • circumcision= ultimate treatment
41
Q

seminal vesicle

A
  • responsible for 70-85% of fluid that becomes semen
  • fluid is alkaline
  • unites with vas deferens to form 2 ejaculatory ducts
42
Q

vas deferens

A
  • 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
Q

epididymis

A
  • connects testes to vas deferens

- stores sperm for 2-3 mo while they mature

44
Q

testes

A
  • produce sperm and androgens

- primary reproductive organs in males

45
Q

what is the denonvillier’s fascia

A
  • lays between prostate and rectum

- prevents prostate Ca from regularly penetrating rectum

46
Q

zones of prostate

A
  • transition zone
  • central zone
  • peripheral zone

Clin Med III (26 decks)

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