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Paediatrics > Genital > Flashcards

Genital Flashcards

1
Q

Migration of the testis physiology

A

Originates on posterior abdominal wall
Testosterone acts on peripheral tissues
Migration guided by mesenchymal gubernaculum
Layers are collected from abdominal wall and guided through inguinal canal

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2
Q

Scrotal contents

A

Testis
Vas
Blood vessels

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3
Q

Labial content

A

Attachment of the round ligament of the uterus

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4
Q

Features inguinal hernia

A

Common
Risk factor: prematurity
Persistently patent processus vaginalis
Emerges through deep inguinal ring through inguinal canal (indirect)
Lump in the groin which may extend to the scrotum or labium
Asymptomatic and intermittent
Thickened cord structure palpable in the groin

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5
Q

Features of strangulated hernia

A

Tender lump
Irritability
Vomiting
Greater risk in infants

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6
Q

Mx Hernias

A

Most successfully reduced by taxis
Surgery planned for time when oedema has settled and child is well
Emergency surgery required if strangulated
Surgery: ligation and division of processes vaginalis (hernial sac)
Surgery performed >3m old

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7
Q

Feature hydrocele

A 
Asymptomatic
Sometimes appear blue
Testis still papable
Hydrocele is separate from testis
-differentiates from hernia
Transilluminates
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8
Q

Mx hydrocele

A

Resolves spontaneously: patent vaginalis closes

Surgery is persisting beyond 2y

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9
Q

Features varicocele

A

Scrotal swelling
Dilated varicose testicular veins (bag of worms)
Common in boys, especially at puberty
Due to valvular incompetence
Commoner on left : drainage of gondal vein into renal vein (catecholamine from left adrenal)
Dull ache
Bluish colour
Testis may be smaller or softer than normal

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10
Q

Mx Varicocele

A

Conservative if asymptomatic
Occlusion of gonadal vein by surgical ligation
-laparoscopic through groin
-radiological embolisation

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11
Q

Features undescended testis

A

5% newborn term infants but more common in preterm
Most resolve by 3 months (1% still undescended)
Identified on routine examination of the newborn

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12
Q

Testis examination for undescended testis

A

Warm room and warm hands
Testis felt in scrotum or delivered by gentle pressure along inguinal canal
May be palpable or impalpable

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13
Q

Location of undescended testis

A

Groin
Below the external inguinal ring, outside scrotum (ectopic)
impalpable: in abdomen or absent

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14
Q

Mx bilateral undescended testis

A

Karotype to exclude disorders of sex development

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15
Q

Features retractile testis

A

Can be manipulated into the scrotum with ease and without tension
Action of the cremaster muscle pulls up the testis
More prominent when warm and relaxed

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16
Q

Mx Undescended testis

A

Referral by 3m, surgical appt by 6m
Procedure performed at 1y
Surgical placement of testis in the scrotum (orchidopexy)
-groin approach
-opening inguinal canal and mobilising testis

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17
Q

Functions of orchidopexy

A

Cosmetic with possible testis prosthesis when older
Reduced risk of torsion and trauma
-lying transversely on attachment to spermatic cord (clapper ball testis)
Fertility
Malignancy

18
Q

Features Torsion of the Testis

A 
Typically post-pubertal boys
Can occur at any age
Very painful
Redness and odema of scrotal skin
Pain localised to groin or abdomen
19
Q

Mx Torsion of the testis

A

Must be treated within hours
Surgical exploration is mandatory
Fixation of contralateral testis
Testicular loss in delay (esp. perinatal torsion)

20
Q

Features torsion of appendix testis

A 
Hydatid or Margani is Mullerian remnant located in upper pole of testis
Affects pre pubertal boys
More common than testis torsion
Pain evolves over days
Blue dot is pathognomonic
21
Q

Mx Appendix testis torsion

A

Surgical exploration and excision of appendix (in case of torsion)
If proven- control pain with analgaesia

22
Q

Features Epidiymitis

A

Inflammed epidiymis
Commoner in infants and small children
Associated with pre-exciting urological or rectal malformation
Small hydrocele and swollen testis

23
Q

Mx epidymitis

A

Usually surgical exploration in case of torsion
US of flow pattern allows differentiation from torsion
Pus sent for microbiology
Empirical antibiotics

24
Q

Features idiopathic scrotal oedema

A

Redness and swelling
Extending beyond scrotum into the thigh, perineum and surapubic area
Testis normal and non-tender

25
Q

Mx idiopathic scrotal oedema

A

Analgesia and review

26
Q

Red Flag Vaginal discharge

A

Blood vaginal discharge
dDx: vaginal rhabdomyosarcoma
Rare
Occurs in pre-school girls

27
Q

Features labial adhesions

A

Fusion of the labial minora
Can cause local irritation
Usually adequate orifice for passage of urine
Transluscent/bluish flimsy tissue between labia

28
Q

Mx labial adhesions

A

Non required
Topical corticosteroids or oestrogens may lyse lesions
Re-adhesion is common
Formal division of adhesions undertaken rarely

29
Q

Features true obstruction of vagina

A

Rare
Primary amenorrhea in adolescents
Cyclical abdo or pelvic pain
Bulging introitus that appears blue (imperforate hymen)
No imperforate hymen: problem of vaginal canalisation

30
Q

Mx imperforate hymen

A

Hymenectomy under anaesthesia

31
Q

Features normal foreskin retraction

A

Does not retract in infancy
50% non-retractile at 1y
Sub-preputial smegma: lump growing under foreskin
Ballooning of foreskin: incomplete lysis of preputial adhesions

32
Q

Features balanoposthitis

A 
Extensive redness
Sore prputial opening
Purulent discharge
Occurs 3% of boys
Peak incidence 3y
33
Q

Mx balanoposthitis

A

Anibiotics

Topical corticosteroids

34
Q

Features non-retractile foreskin

A

Preputial opening does not evert on retraction of the foreskin
Most commonly caused by balanitis (progressive scarring)

35
Q

Indications for circumscision

A

Balanitis causing true phimosis
Recurrent balanoposthitis causing refractory symptoms
Prophylaxis as UTI
Access required for intermittent catherterisation
Possible protection against HIV and HPV

36
Q

Cx circumcision

A 
Post-op bleeding (2%)
Infection in the skin margin
Ulceration of exposed granular skin
Meatal stenosis (most common in Hx balanitis)- require subsequent surgery
Urethral fistula
37
Q

Features paraphimosis

A 
Usually post-pubertal boys
Retracted foreskin not reduced easily
Ring of narrower skin
Glans swelling 
Compromise to glans blood supply
38
Q

Mx paraphimosis

A

Surgical emergency
Reduction of foreskin surgically under GA
Circumcision in balanitis

39
Q

Features Hypospadius

A

Common (1/200)
Failure of development of ventral tissue of penis
Ventral urethral meatus
Ventral curvature of shaft of the penis (more apparent on errection)
Hooded appearance of foreskin (deficiency of ventral skin)

40
Q

Mx hypospadius

A

Surgery not indicated if penis and urinary stream are straight
function or cosmetic indications
Surgery performed within 2-3y of life
Cannot be circumcised before repair incase prepuce is required for repair

41
Q

Cx hypospadius surgery

A

Breakdown of repair

Meatal narrowing

42
Q

Location of hypospadius

A

Glanular (Most common)
Coronal
Midshaft
Penoscrotal

Paediatrics (22 decks)

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