Genitalia

Question 1

Hydrocoele

Answer 1

<2y = most resolve spont. by 2, reassure providing no evidence of pathology
2-11 = open repair, laparscopic investigation, bilat. repair, if abdiminscrotal may been abdo incision
11-18 =
- idiopathic: observation, surgery if uncomfortable
- after varicocelectomy: conservative Mx, surgery if doesnt resolve
filiarial-related: complete excision of tunica vaginalis

Question 2

Varicocoele

Answer 2

Conservative in asymptomatic

occlusion of veins achieved by surgical ligation

Question 3

Undescended Testes <3m

Answer 3

If possible disorder of sexual dev, urgent r/v to senior paed within 24hr (?genetic/endocrine testing)
If undescended bilat. - same
If unilat.:
-r/v at 6-8wks of life
- at that r/v if still undescended exmine at 3m
- at 3m:
-both des. then no action
- if both in scrotum but one or both retractive annual FU
- if still undes. refer to paed surg <6m age

Question 4

Orchidopexy

Answer 4

Cosmetic
reduce risk of trauma/torsion
fertility (esp bilat)
malignancy (increased risk in undes)
Ideally at 1yr age
in 10% of impalpable testis they have regressed in dev and are absent

Question 5

Testicular torsion

Answer 5

Ix: Doppler USS (dont delay exploratory surgery if high sus.)
presentation within 6hrs has best testicular survival outcome
Manual detorsion if no surgery within 6hrs
Supportive: pain, anti-emetics

Question 6

Non-neonatal Testicular torsion

Answer 6

Immediate urological consult
orchidectomy/pexy decision made
also fix contralat. testis

Question 7

Neonates testicular torsion

Answer 7

born w/torsion - is surgery necessary? risk of anaes.

born w/normal - urgent exploration

Question 8

Torsion of appendix testis

Answer 8

scrotal exploration and excision of appendage often necessary as cant be reliably diff. from testicular torsion
if mild Sx consertive Mx

Question 9

Epididymo-orchitis

Answer 9

Sx relief: bedrest, scrotal elevation
IV unwell: IV abx  + fluids
Eradicate infection:
- gonoccal or chlam. = ceftriaxone and doxy
- enteric = quinolone
- mumps = supportive
Preventing Cx:
- prompt Rx
possible Cx: abcess, infertility, chronic pain

Question 10

Paraphimosis

Answer 10

manipulation w/topical analgesia (ice pack, compression, osmotic agents)
puncture technique (multiple in foreskin to allow oedema drain
surgical reduction + circumcision

Question 11

Hypospedias

Answer 11

Surgery not mandatory
perform on functional/cosmetic grounds
ultimate aim: control urinate standing and straight erection
NB. do NOT circumcise boys w/hypospedias as is needed for repair

Question 12

Labial adhesions

Answer 12

topical steroids or oestrogens