GU/GYNE Flashcards
The inability to retract the foreskin over the glans penis is known as ___
Phimosis
What are the three etiologies of phimosis?
Congenital, balanitis, poor hygiene
What is the time course of congenital phimosis?
90% experience natural separation by age 3. It is considered normal for the foreskin to adhere to the glans until around age 6
Ok so phimosis is considered normal until age 6! Unless …
Unless urination results in ballooning of the foreskin at any age – this is abnormal
How does phimosis typically present?
Limitation and pain when attempting to retract the foreskin
What investigations are needed to diagnose phimosis?
None! Diagnosed based on history and physical
How do we manage phimosis?
Proper hygiene
Topical corticosteroids
Dorsal slit
Circumcision
10% of males that are not circumcised as newborns require circumcision as adults due to complications of phimosis and balanitis. What is a key risk factor for this?
Uncircumcised males with diabetes
If phimosis is the inability to retract the foreskin, then what is paraphimosis?
Paraphimosis is when the retracted foreskin cannot be returned to its normal position
True or false, routine circumcision is recommended in male infants.
False
What are some benefits of circumcision?
Decreased rates of UTIs and penile cancer. Decreased incidence of cervical cancer in female partners. Decreased HIV incidence of HIV infection in heterosexual men
What are risks of circumcision?
Procedural complications – bleeding, infection, phimosis, urinary retention, etc.
What are the top three causes of inguinal masses in children?
1 enlarged lymph node, followed by hernias and hydroceles
The prevalence of inguinal hernias in newborns is 1-4 in 100.
True or false, surgical correction is recommended.
True! The risk of incarceration is 60% in the first 6 months of life if hernia is left untreated
What is the most significant risk factor for hernias in babies?
Preterm birth (reported in 30% of babies weighing less than 1000 g at birth)
Inguinal masses can occur anywhere along the inguinal canal to the scrotum or labia. What are some differentials for an inguinal canal mass?
Enlarged lymph node, retractile testis, an ovary or a synovial cyst
Inguinal masses can occur anywhere along the inguinal canal to the scrotum or labia. What are some differentials for an inguinal ring mass?
Testis or ovary, or an inguinal hernia
Inguinal masses can occur anywhere along the inguinal canal to the scrotum or labia. What are some differentials for a scrotal mass?
Hernia, hydrocele, varicocele, trauma, testicular pathology
Inguinal masses can occur anywhere along the inguinal canal to the scrotum or labia. What are some differentials for a labial mass?
Trauma, ectopic ovary, mixed gonadal tissue, Bartholin cyst
Non-acute inguinal masses have a slow onset and are not painful – what are some differentials to consider for non-acute masses?
Lymphadenopathy, a retractile testis, hydrocele, hernia, varicocele, tumor, ectopic ovary
Acute inguinal masses have a sudden onset and are associated with pain – what are some differentials?
Epididymitis, orchitis, testicular torsion, traumatic hematoma, lymphadenitis, incarcerated hernia
Diagnostics to consider with an inguinal mass?
CBC (if suspecting infection)
Urine C&S/culture (if suspecting epididymitis, orchitis, STI)
US
Describe what is happening in testicular torsion
Twisting of the testicle causes venous occlusion and engorgement as well as arterial ischemia and infarction
How does testicular torsion present?
Sudden onset severe unilateral scrotal pain, swelling of scrotal sac, high position of the testicle, abnormal cremasteric reflex, negative Phren’s sign.
Pain may radiate to the lower abdomen/groin, may have N/V, scrotum may be indurated and erythematous, reactive hydrocele may occur
May report intermittent periods of testicular pain before torsion