genitalia Flashcards
in pregnancy, which hormone influences testicle descent in boys?
anti-Mullerian hormone
what is the usual cause of an inguinal hernia in children (boys and girls)?
- patent processus vaginalis
- it’s meant to close in the womb after genital development
a) which sex is more likely to develop an inguinal hernia?
b) which side?
a) males
b) right
presentation of an inguinal hernia?
- intermittent groin/scrotal swelling
- appears on crying or straining
- infants might have vomiting too
how to confirm an inguinal hernia on examination?
- apply pressure to the abdomen by pressing on it
- ask the child to cough
management of inguinal hernia?
- surgical
- hernial sac is ligated and divided
why is an inguinal hernia operation on a boy an emergency?
left untreated it will strangulate the testis
cause of a hydrocoele?
patent processus vaginalis
presentation of a hydrocoele?
- asymptomatic scrotal swelling
- bilateral
- bluish discolouration (sometimes)
- non-tender
- transilluminate
age group for hydrocoeles?
- usually at birth
- in infants, appear post-infectious
management of hydrocoele?
- most resolve w/o intervention
- surgery if persistent > 18 months of age
what is a varicocoele made up of?
- dilated (varicose) testicular veins
age demographic of varicocoeles?
teenage boys
which side is more likely to develop a varicocoele?
left (because L gonadal vein drains into the L renal vein)
presentation of a varicocoele?
- most are asymptomatic
- dull ache
- O/E: bluish, “bag of worms” feeling, testis is smaller / softer than usual
management of a varicocoele?
- conservative if asymptomatic
- otherwise surgical ligation
a) aetiology of undescended testis?
b) what does it increase the risk of?
a) testis gets arrested along normal path of descent embryologically
b) testicular torsion
around which age do most undescended testis resolve themselves by?
- 3 months
- only 1% persist past this
risk factor for undescended testis?
prematurity
when would undescended testis usually be picked up?
examination of the newborn (NIPE)
a) which investigation is done for bilateral, impalpable testes?
b) why?
a) karyotyping
b) to rule out disorders of sex development
what causes retractile testis?
overaction of the cremasteric muscle reflex
management of undescended testis?
orchidopexy
where is the risk of malignancy in an undescended testis higher?
- bilateral
- intra-abdominal
when should orchidopexy be perfomed?
before / around 1 year of age, in undescended testis
a) what is the main genital emergency for boys?
b) which age?
a) testicular torsion
b) pre-pubescent
presentation of testicular torsion?
- painful
- red, oedematous scrotal skin
- pain may localise to groin / lower abdomen
management of testicular torsion?
- EMERGENCY !!!!
- must be surgically fixed within 4 hours
- fix the contralateral testis so this doesn’t get torsion too
