GU Flashcards
Inability to retract foreskin
phimosis
At what age can you physiologic ability to retract foreskin
Birth(4%)
10yo(50%)
12yo(99%)
Pathologic causes of retractable foreskin
- Early forcible retraction
* Fibrosis secondary to infection
Sxs of phimosis
- Inability to retract foreskin after previously being retractable
- Painful erection
- Bleeding/irritation
- Dysuria
- Recurrent infections
Tx phimosis
- Stretching exercises
- Topical corticosteroid
- Circumcision
Phimosis pt educ
- Dont retract 6mo
- Clean w/ mild soap & water
- Return foreskin to natural position
Retracted foreskin in uncircumcised male that can’t be returned to natural position
Paraphimosis (EMERGENT)
Pathophys of paraphymosis
Entrapment -> impaired venous flow -> engorgement -> arterial compromise
Causes of paraphimosis
- Forcible retraction
- Infection/inflammatin
- GU procedure
- Sexual activity/trauma
Sxs paraphimosis
- Swelling
- Pain
- Irritability (infant)
Exam findings paraphimosis
- Edema & tenderness of glans
- Painful swelling of retracted foreskin
- shaft unaffected
- color change if ischemia present
Tx paraphimosis
- Manual reduction
* Surgical intervention by urology
Surgical removal of foreskin
Circumcision
6 step circumcision procedure that leaves glans exposed during recovery
Gomco
3 step circumcision procedure that leaves plastic covering on glans during recovery
Plastibell (preferred by moms)
Congenital ventral displacement of urethra (looks like it is sucked back in)
Hypospadias
When is hypospadias Dx made
New born exam
Exam findings
- Abn foreskin
- Abn penile curvature (chord)
- Second opening
Further eval for hypospadias/chordee
- Family Hx
- Normal penile length (2.5-3.5cm)
- Check for penile curvature
- Look for disorders of sexual devt
Tx Hypospadias/Chordee
- Urology (surgical repair at 6mo)
* DONT CIRCUMCISE DURING NEW BORN PERIOD
Testes not within scrotum and hasn’t spontaneously descended by 4mo
Cryptorchidism
Cryptorchidism increases risk of
- Testicular torsion
- Subfertility (correct by 1yo)
- Testicular cancer
Cryptorchidism terminology
- Absent (agenesis/atrophy)
- Undescended (stopped short along path)
- Retractile (overactive cremasteric reflex)
- Ascending testes
- Ectopic
Clinical presentation of cryptorchidism
Absent uni/bilat testicle w/ flat scrotum
Cryptorchidism exam
- Check if unilat/bilat
* Check if testicle is palpable in canal (watch and wait)
Cryporchidsm Tx
- Spontaneous decent 6mo
- Refer if;
- non-palpable undescended testes
- Ascending testes beyond infancy
- Atrophic testis
- Difficulty differentiating bt undescended, retractile, ectopic
Twisting of spermatic cord due to poorly anchored testicle -> vascular compromise
Testicular torsion (EMERGENT)
Peak incidence of testicular torsion
Neonatal period, puberty
Neonatal testicular torsion
Extravaginal
Testicular torsion Sxs
- Abru and tept onset of severe scrotal pain (may radiate)
- Constant pain
- Nausea & vomiting
Exam findings of testicular torsion
- Edematous erythematous scrotum
- Slightly elevated & tender
- Absent cremasteric reflex
- Negative Prehn’s sign (relief of pain when you elevate scrotum)
Dx Testicular torsion
- Hx and physical
* Doppler ultrasound (confirmatory test)
