Genitalia Flashcards
Are most disorders of the genitalia in childhood in boys or girls?
Boys
What are some inguinoscrotal disorders in boys?
Inguinal hernia
Hydrocele
Undescended testis
Varicocele
What causes an inguinal hernia?
They are almost always indirect and due to a patent processus vaginalis.
In which children are inguinal hernias more common and which side?
Much more frequent in boys and are particularly common in premature infants. They are more common on the right side
How do inguinal hernias usually present in children?
Intermittent swelling in the groin or scrotum on crying or straining. The groin swelling may become visible on raising the intra-abdominal pressure by gently pressing on the abdomen or asking the child to cough.
How do inguinal hernias present in infants?
An irreducible lump in the groin or scrotum. The lump is firm and tender. The infant may be unwell with irritability and vomiting.
How would you manage an inguinal hernia?
Most ‘irreducible’ hernias can be successfully reduced following opiod analgesia and sustained gentle compression. Surgery is delayed for 24-48 hours to allow resolution of oedema. If reduction is impossible, emergency surgery is needed
Why does an inguinal hernia need to be reduced quickly?
Because of the risk of strangulation of bowel and damage to the testis. A hernia associated with undescended testis should be operated early to minimise risks to the testis.
What is a hydrocele?
A patent processus vaginalis, which is sufficiently narrow to prevent formation of an inguinal hernia, may still allow peritoneal fluid to track down around the testis to form a hydrocele.
How do hydrocele’s present?
They are asymptomatic scrotal swellings, often bilateral and sometimes with a blueish discolouration. They may be tense of lax but are non-tender and transilluminate.
What might stimulate a presentation of a hydrocele?
Some are not evident at birth but present early in childhood after a viral or gastrointestinal illness.
How would you manage a hydrocele?
The majority resolve spontaneously as the processus continues to obliterate, but surgery is considered if it persists beyond 18-24 months of age..
What is undescended testis?
An undescended testis has been arrested along its normal pathway of descent. It can be unilateral or bilateral
In which infants is undescended testis more common?
Preterm infants, descent occurs through the third trimester and may continue into early infancy
How would you examine an undescended testis?
It should be carried out in a warm room, with warm hands and a relaxed child. The testis can then be brought down into a palpable position by gently massaging the contents of the inguinal canal towards the scrotum
How would you classify undescended testis?
Retractile - can be manipulated into the bottom of the scrotum without tensions but subsequently retracts
Palpable - can be palpated in the groin but cannot be manipulated into the scrotum
Impalpable - no testis can be felt on detailed examination
What investigations would you perform on an undescended testis?
US
Hormonal (in bilateral impalpable testes - the presence of testicular tissue is proven by rise in testosterone after IM injections of hCG)
Laparoscopy - used in impalpable testis
How would you treat undescended testis?
Surgical placement of the testis in the scrotum (orchidopexy) to correct infertility, increased risk of malignancy and cosmetic and psychological factors
What is a varicocele?
Varicosities of the testicular veins may develop in boys around puberty. They are usually on the left side and their is an association with subfertility
How do you treat varicocele?
Surgery to improve symptoms (dragging, aching), impaired testicular growth and, in later life, for infertility
What are some acute disorders of the scrotum?
Torsion of the testis
Torsion of the testicular appendage
Infection
When is testicular torsion most common?
In adolescents, but it may occur at any age, including the perinatal period
How does testicular torsion present?
The pain is not always centred on the scrotum but may be in the groin or lower abdomen. There may be a history of previous self-limiting episodes. Atypical presentation is not unusual
When should testicular torsion be treated?
Within 6-12 hour of the onset of symptoms for there to be a good chance of testicular viability.
How do you treat testicular torsion?
Surgical exploration is mandatory unless torsion can be excluded. Fixation of the contralateral testis is essential because there may be an anatomical predisposition to torsion.
What is torsion of the testicular appendage and when does it occur?
A hydatid of Morgagni is an embryological remnant found on the upper pole of the testis. Torsion of this appendage characteristically affects boys just prior to puberty
How does torsion of the testicular appendage present?
The pain may increase over 1 or 2 days and occasionally the touted hydatid can be seen or felt (the blue dot sign)
How would you treat torsion of the testicular appendage?
Surgical exploration and excision of the appendage leads to rapid resolution of the problem
What infection may cause an acute scrotum in infants and toddlers?
Viral or bacterial epididymo-orchitis or epididymitis
What are some abnormalities of the penis?
Hypospadias
Circumcision
Paraphimosis
What is hypospadias?
In the male fetus, urethral tubularisation occurs in a proximal to distal direction under the influence of fetal testosterone. Failure to complete this process leaves the urethral opening proximal to the normal meatus on the glans and this is termed hypospadias
What are the presenting features of hypospadias?
It may be solely cosmetic concerns but it may cause functional problems including an inability to micturate in a normal direction and erectile disformity
When is surgery for hypospadias performed?
Correction is often undertaken before 2 years of age, often as a single-staged operation.
Should infants with hypospadias be circumcised?
No, the foreskin if often needed for later reconstructive surgery
What physiological thing can a non-retractile foreskin often lead to?
Ballooning on micturition
What are some medical indications for circumcision?
Phimosis (inability to retract foreskin)
Recurrent balanoposthitis (redness and inflammation of the foreskin)
Recurrent UTIs
What is paraphimosis?
The foreskin becomes trapped in the retracted position proximal to a swollen glans. The foreskin can usually be reduced, but adequate analgesia is needed to achieve this.
What are some genital disorders in girls?
Inguinal hernias
Labial adhesions
Vulvovaginitis/vaginal discharge
What happens in inguinal hernias in girls?
Much less common than in boys. The ovary becomes incarcerated in the hernial sac and can be difficult to reduce.
What are the causes of vaginal discharge in young girls?
Infection (bacterial or fungal)
Specific irritants
Poor hygiene
Sexual abuse
