GU Problems Flashcards
define hydrocele
an abnormal collection of fluid within the remnants of the processus vaginalis around the testes
describe a simple hydrocele
accumulation of fluid within the tunica vaginalis
in neonates is simply congenital but in adults, occurs due to trauma, torsion or tumour formation
describe a communicating hydrocele
persistence of the processus vaginalis to allow peritoneal fluid to communicate freely with scrotal portion of the processus
describe a non-communicating hydrocele
occurs due to imbalance between secretion and reabsorption of fluid
risk factors of hydroceles
younger age FH of hydroceles connective tissue disorder low birth weight trauma
clinical features of hydroceles
non-tender smooth enlargement of the scrotum
often transilluminates
investigations of hydroceles
US of scrotum
management of hydroceles in infants < 6mnths
watchful waiting as should self-resolve
indication for surgical management of hydroceles in infants
unresolved >12mnths
excessive discomfort
compromised scrotal skin
suspect underlying pathology
management of hydroceles in adolescents
reassurance and monitoring but if large and uncomfortable, consider surgery
management of hydroceles in asymptomatic adults
observation
management of hydroceles in symptomatic adults
aspiration and surgery
define testicular torsion
an event in which tissues around the testicles are not sufficiently attached, causing twisting around the spermatic cord which obstructs blood flow
describe intravaginal testicular torsion
torsion occurring secondary to lack of normal fixation of the posterior lateral aspect of the testes to tunica vaginalis
describe extravaginal testicular torsion
torsion of both the spermatic cord and tunica vaginalis together
clinical features of testicular torsion
sudden onset unilateral testicular pain causing swollen erythematous appearance
nausea and vomiting
signs of testicular torsion
high rising scrotum
unilateral absence of cremaster reflex
no pain relief on testicle elevation (-ve prehn’s sign)
management of testicular torsion
expedited surgical exploration and orchidoplexy
define varicocele
a scrotal swelling consisting of an abnormal collection of dilated veins of the pampiniform plexus of spermatic cord
describe subclinical and Grade I varicoceles
subclinical: detect only on Doppler US
Grade I: small and detected only on Valsalva manoeuvre
describe Grade II and Grade III varicoceles
Grade II: moderate size and palpable without Valsalva
Grade III: large size and visible through scrotal skin
clinical features of varicoceles
painless scrotal swelling
scrotum feels like “bag of worms”
feelings of scrotal heaviness
investigations of varicoceles
colour Doppler studies
thermography
sperm counts
management of subclinical or Grade I varicoceles in adolescent and adults
no treatment and annual examinations + sperm counts (in adults)
management of Grade II and Grade III varicoceles in adolescent and adults
refer to urology
common scrotum affected in varicocele cases
left
define phimosis
inability of the foreskin to retract over the glans penis due to tightness of the foreskin
clinical features of phimosis
issues retracting foreskin painful erections poor urine stream ballooning of foreskin of micturition recurrent balanitis
management of phimosis in patients < 2yrs
reassurance
advise against forceful retraction
advise good hygiene
management of phimosis in patients >2yrs
topical corticosteroid (e.g. Betamethasone) vertical incision
define paraphimosis
an inability of retracted foreskin to return to its original anatomical location due to glans penis swelling
clinical features of paraphimosis
unmoveable foreskin
swelling and pain of the penis
discolouration of the penis
conservative management of paraphimosis
gradual manual reduction using topical or local anaesthetic
surgical management of paraphimosis
dorsal slit reduction therapy
last resort of phimosis and paraphimosis management
circumcision
define cryptorchidism
an incomplete descent of one or both testes from the abdomen through the inguinal canal, causing absence from the scrotum
risk factors of cryptorchidism
FH of undescended testes low birth weight preterm delivery endocrine disorder maternal smoking
clinical features of cryptorchidism
lack of testes or a testicle within the scrotum
investigations of cryptorchidism
bloods (FBC, TFTs and serum testosterone)
pelvic and abdominal US
management of bilateral cryptorchidism
urgent referral to paeds for endocrine and genetic testing
if still not present at 3mnths: referral for surgery by 6mnths
management of unilateral cryptorchidism
review at 6-8wks
if still not present:
review at 3mnths
if still not present:
referral for surgery by 6mnths
surgical method of choice in cases of cryptorchidism
orchidoplexy
common complications of cryptorchidism
testicular torsion
infertility
testicular cancer
