GU Problems of Infancy Flashcards
Etiology and History of Hernias
Etiology: Patent process vaginalis
*Associated with pre-term infants or family history
History: ‘lump’ with straining or crying, subsides at rest (waxes and wanes)
PE of Hernia (4)
- Palpate testes first
- Extend arms over head, crying- visible
- Reduce it
- If cannot reduce call surgery!
Hydrocele Etiology
Intra-abdominal fluid leakage through a patent inguinal ring (water bubble)
Hydrocele Presentation (4)
- Appears like a “water balloon” - bulging scrotum
- Testes not palpable
- Soft, nontender
- Transilluminate (this is the key finding; it will light up with transillumination)
Hernia and Hydrocele Differentials (4)
- Undescended/retractile testicle
- Varicocele
- Epididymitis
- Tumor, soft tissue swelling
Hernia vs. Hydrocele
Hydroceles are soft non-tender and non-reducible; feel and look like water balloon and will light up with transillumination
Hernias are firm and reducible
Hernia management (2)
- Incarcerated inguinal hernia needs surgical repair; if it does not reduce then it needs to go to surgery otherwise risk of peritonitis
- Can be accompanied by a hydrocele
Hydrocele Management (2)
- Spontaneous resolution by 1 year
2. If not, surgical repair
Undescended Testes (3)
- AKA - Cryptorchidism
- One of the most common conditions of the male endocrine glands
- Most common genital condition at birth
Undescended Testes Evaluation (5)
- Obtain gestational history at initial evaluation; earlier gestational age=increased risk
- Palpate testes for quality and position at each well child visit
- Refer infants with cryptorchidism, present at birth, who do not have spontaneous descent by 6 months to surgery (URO/PEDIATRIC)
- Bilateral undescended testes, non-palpable should be referred for genetic testing
- Endocrine/genetics for sexual development if bilateral with severe hypospadias
Ambiguous Genitalia Evaluation (2)
- Do not perform ultrasound or other imaging prior to referral – these do not assist in decision making
- Do not use hormonal therapy to induce testicular descent – low response rates and lack of evidence to support
Undescended Testes Treatment (3)
- In absence of spontaneous descent by 6 months surgery should be performed within the next year
- Providers should counsel boys with a history of cryptorchidism (neither testicle descended) or monorchidism (only 1 testicle within the scrotum) and parents on long-term risks
- Educate about infertility and cancer risks due to increased risk of these things with undescended testes
Hypospadias (6)
- Opening of the urethra is on the underside of the penis
- 1 in 300 males
- Grading
- Refer to urology
- Surgical repair
- No circumcision clearance
Epispadias (5)
- Defect in the urethra
- Often occurs with bladder exstrophy
- Shorter than normal urethra with opening on the dorsal aspect
- Short and flat penis that may curve upward
- Bladder control problems
Ambiguous Genitalia (7)
- Not obvious
- 1 in 4,500 newborns
- Associated with disorders of sexual development (DSD)
- Do not differentiate until clear
- May need hormones or surgery
- Controversial and evolving management
- Parents choice
- Child’s choice - Healthy baby but can’t identify the sex; need to do work-up of sending in chromosomes
- Make decision and parents will decide if the baby will have surgery to look physically like a female or look physically like a male