Inguinal, hydrocele, varicocele, torsion Flashcards
Inguinal hernia brief:
- Protrusion of abdominal contents through the inguinal canal.
- Almost always indirect due to a patent processes vaginalis
- More common in boys + premature infants
- More common on the right side.
Clinical presentation of inguinal hernia?
1) Intermittent lump in groin/scrotum - may become visible on pressing abdominal or asking child to cough (raising abdominal pressure)
2) Inreducible lump in groin or scrotum
3) Infant may be unwell with irritability and vomiting
Management of inguinal hernia?
1) Opioid analgesia and sustained gentle compression
2) If reduction is impossible, emergency surgery is required because of the risk of strangulation of the bowel or damage to the testis.
What is a hydrocele?
- Patent processus vaginalis - allows peritoneal fluid to track down around the testes to form a hydrocele.
- Asymptomatic scrotal swellings, often bilateral and sometimes with a bluish discolouration.
- Transilluminate
- Not always present at birth but present in early childhood after viral/GI illness.
Tx: Majority
Presentation and treatment of hydrocele? Dx?
1) Asymptomatic scrotal swellings
2) Often bilateral and sometimes with a bluish discolouration.
- Not always present at birth but present in early childhood after viral/GI illness.
- Transilluminate
- Usually resolves spontaneously, surgery considered if it persists beyond 18-24 months
Varicocele brief:
- Vaircosites of the the testicular veins may develop in boys after puberty.
- Usually on the left side, dragging, aching, impaired testicular growth, infertility (in later life)
- Surgery by laparoscopy or radiological embolisation to obliterate testicular veins.
What is undescended testes (cryptorchism) ?
- When one or both tests are not present within the dependant portion of the scrotal sack and have instead been arrested along their normal pathway of descent.
- More common in preterm infants - testicular descent occurs in the third trimester.
- Testicular descent may continue during early infancy.
Classification of undescended testis?
- Rectractile - can be manipulated into the bottom of the scrotum without tension but then retracts.
- Palpable - palpable in the groin but cannot be manipulated into the scrotum.
- Impalpable - no testes can be felt on detailed examination.
Ddx: Female with congenital adrenal hypoplasia
Diagnosis of undescended testis?
- Ultrasound - done in children with bilateral impalpable testes (verify)
- Hormonal - bilateral impalpable testes - rise in serum testosterone in response to IM HCG
- Exploratory laparoscopy - investigation OF CHOICE for impalpable testes.
Treatment of undescended testes?
- Surgical placement of the testis in the scrotum (orchidoplexy):
1) Increases fertility (optimum spermatogenesis requires testis to be in scrotum below room temp)
2) Reduces risk of malignancy
3) Cosmetic reasons
Testicular torsion - UROLOGOCIAL EMERGENCY?
- Urological emergency caused by the twisting of the testicle by the spermatic cord causing vasculature constriction and time-sensitive ischaemia/necrosis of testicular tissue.
- Can occur at any age most commonly 13-15yrs.
- MUST BE RELIEVED WITHIN 6-12 hours for a good chance of testicle viability.
RF of testicular torsion?
1) Bell-clapper deformity (testes not anchored properly)
2) Trauma
3) Undescended testes
Clinical presentation of testicular torsion?
- SUDDEN ONSET pain in groin or lower abdomen
- Nausea and vomiting
- Atypical - no pain
O/E: - Swollen, tender testes retracted upwards
- Reddened skin
- NO relief of pain upon elevation of scrotum
Ddx: Epididymitis, varicocele, hydrocele
Diagnosis of testicular torsion?
- Examine testes + surgical exploration mandatory unless it can be exluded
- Doppler ultrasound looking at flow in the testicular blood vessels
Treatment of torsion?
- Surgical correction of torsion within 6-12 hours to ensure viability - contralateral fixation of other testes since there may be an anatomical predisposition to torsion (Bell Clapper Testes)
