Hernias and genital disorders

Question 1

Hernias

Answer 1

As a rule, inguinal and femoral hernias should be referred urgently for early surgery to avoid high risk of strangulation.

Surgery is usually not required for umbilical hernia since 95% resolve spontaneously by 2–3 yrs.

Question 2

Sites of common hernias

Answer 2

Question 3

Hydroceles

Answer 3

90% resolve spont. by 18 mths

if persistent >2 yrs, refer with a view to surgery.

Question 4

Hypospadias

Answer 4

Look for other GUT abnormalities.

Refer ASAP if child not producing good urinary stream.

Otherwise refer by 6 mths with view to surgery at ~12 mths.

Never circumcise.

Question 5

Foreskin and circumcision

Answer 5

If not circumcised in neonatal period, circumcision is best performed under GA after 6 mths

• following counselling and with consent of both parents.

Question 6

Phimosis

Answer 6

Real phimosis is uncommon

almost all cases of tight foreskin with narrowing of preputial orifice resolve naturally

Question 7

Paraphimosis

Answer 7

This usu. occurs in older boys 8–12 yrs when penis is erect.

The foreskin is retracted, swollen and painful.

Urgent reduction should be attempted.

Follow-up circumcision is usu. recommended.

Question 8

The ‘buried’ penis

Answer 8

The penis looks small or the foreskin quite huge and tight.

There is failure of skin fixation at the base of penis ± excessive fat pad.

It does not often resolve spont.

Early surgical referral is advisable.

Question 9

Undescended testes

Answer 9

Testes can still descend up to 3 mths after birth.

Refer by 6 mths with a view to correction between 9–12 mths but definitely before 2 yrs

Question 10

Fused labia (labial agglutination)

Answer 10

This is due to adhesions acquired from perineal inflammation (vulvovaginitis).

No treatment is recommended if the child can void readily

• —allow natural healing to occur.

Some prefer separation of the adhesions under appropriate anaesthesia.