Genitalia Flashcards
What is pathophysiology for inguinal hernia?
patent processus vaginalis
intestine emerges from deep inguinal ring through inguinal canal (indirect)
Why are premature babies more likely to get inguinal hernia?
tissues are weaker and more friable
what is the presentation of an inguinal hernia?
lump in the groin (extends onto scrotum/labia)
asymptomatic
What is an incarcerated hernia?
hernia that cannot be reduced (irreducible)
what is a strangulated hernia
intestine in hernia becomes ischaemic
what is management of hernia
taxis (compression in line with inguinal canal) with good analgesia)
surgery (once oedema has settled and child is well)
what is a hydrocele
patent processus vaginalis that allows peritoneal fluid to track down the testes
What is the clinical difference between hydrocele and hernia
you can get above a hydrocele
hydrocele transilluminates
What is management of hydrocoele under 2 yrs
NOTHING
should resolve spontaneously
What is mx of hydrocele >2 years
surgical repair, laparoscopic exploration
what is a varicocoele
scrotal swelling due to dilated testicular veins
what side is varicocele most common on
LEFT
what is the clinical presentation of varicocele
feels like BAG OF WORMS
dull ache
how do you manage varicocele
conservative if asymptomatic
otherwise can use surgical ligation
what is bilateral undescended testes
cryptorchidism
why is bilateral impalpable testes a medical emergency
because the karyotype must be CHECKED to exclude disorders of sex development
what are risk factors for testicular torsion
undescended / bell clapper testes
what are differentials for testicular torsion
torsion of appendix testis
epididimo-orchitis
what is a medical cause of circumcision
balanitis xerotica obliterates
recurrent balanoposthitis
prophylaxis of UTI
if access to urethra is required regularly e.g. spina bifidA CATHETERISATION
what is phimosis
inability to retract foreskin/ ballooning of foreskin during micturition
how do you manage phimosis over / under 2 yo?
UNDER 2: physiological, should resolve with time (do NOT forcibly retract as it can cause scar formation)
OVER 2 + recurrent balanoposthitis/UTI: consider surgery
what is the only condition that can cause true phimosis
balanitis xerotica obliterans
what is balanitis xerotica obliterans
progressive scarring that extends onto glans, meatus and urethra
IT IS AN INDICATION FOR CIRCUMCISION
what is paraphimosis
retracted foreskin cannot be reduced
it is an EMERGENCY, as it may compromise blood supply to glans
How do you manage paraphymosis
manipulation with topical analgesia
puncture technique (perforating foreskin at multiple points to allow leakage of fluid)
surgical reduction, the circumcision
what is hypospadia
failure of develoipment of ventral tissues of pnis
what are three key features of hypospadia
ventral urethral meatus
ventral curvature of shaft of penis
hooded appearance of foreskin
how do you manage hypospadia
surgery of cosmetic / functional grounds
ideally boys will be able to pass urine in straight line while standing and have a straight erection
NO CIRCUMCISION BEFORE REPAIR, as skin is important for repair
How do you manage testicular torsion
Admit immediately to urology/paeds surgery
IV fluids, NBM, antiemetics, analgesia
Surgery within 4-6 hours to salvage the testicle: orchidectomy vs orchidopexy + fix contralateral testicle to the posterior wall
What is the medical term for underscended testes
cryptorchidism
what do you do if neonate presemnts with bilat undescended testes (and impalpable)
refer URGENTLY (24j)to senior paediatrician for genetic /endocrine testes
How do you manage unilat undescended testes
Birth: arrange review. at 6-8 weeks
6-8 weeks: arrange review in 3 months
3m:
- descended but retractile > review annually as risk of ascending testes
- one testis still undescended > refer to paeds for surgey BEFORE 6 MONTHS
What surgery is done for undescended palpable testes
Orchidopexy (placement of testis in scrotum)
Why must an orchidopexy be carried out
Cosmetic
Reduced risk of trauma and torsion
Fertility
Malignancy (increased risk if undescended)
What surgery is done for undescended NONPALPABLE tetes
laparoscopic inguinal surgical exploration
How do you manage labial adhesions
Topical steroids / oestrogens to lyse the adhesions
