Inguino-scrotal Flashcards
common organisms that cause epididymoorchitis
N. gonorrhoea
Chlaymdia trachomatis
what is epispadias
urethral opening is on top of the penis/above the clitoris
complications of phimosis and paraphimosis
urinary obstruction
ballooning of the foreskin on micturition
treatment of balanitis
topical or systemic antibiotics
clinical presentation of testicular torsion in a baby
hard, painless, scrotal mass
clinical presentation of torsion of the testicular appendage
- gradual onset of testicular pain
no nausea
complications of hypospadias
difficulty direction urinary stream
infertility
poor sexual function
treatment of testicular torsion
surgery
what signs on examination points towards a varicocele
- feels like a bag of worms
- asymmetry - testes hanging at different positions
- no transillumination
- increases in size during Valsalva
- decreases in size if supine
what causes a hydrocele
peritoneal fluid tracks down a narrow but patent processus vaginalis into the scrotum causing swelling
3 complications of cryptorchidism
reduced fertility
increased malignancy risk
increased risk of testicular torsion
typical clinical presentation of testicular torsion in a pubescent
sudden onset testicular pain and swelling
+/- nausea and vomiting
(pain may be in the iliac fossa)
treatment of paraphimosis
external compression of the glans –> reduce the swelling –> push back through the constriction
which testicle is more likely to have a varicocele? L or R
left
what percentage of live births of boys have undescended testes
2%
risk factors for epididymoorchitis
- UTI
- instrumentation/catheterization
- reflux
- other abnormalities of the urinary tract
- immunocompromise
greatest risk factor for torsion of the testes
Bell-clapper deformity
difference between direct and indirect inguinal hernias
direct - through the external ring due to abdominal wall weakness
indirect - through the internal inguinal ring
when does descent of the testes usually start in utero
by 28 weeks
history presentation of a varicocele
asymptomatic or may have scrotal pain or heaviness
what signs on examination do you see for testicular torsion
- discolouration of the scrotum
- exquisitely tender testes
- swollen testis, riding high
- absent cremasteric reflex
what signs of examination tell you that a scrotal swelling is a hydrocele and not an inguinal hernia
- transilluminates
- can get above it
- no impulse on crying/straining
- does not empty with compression
3 components of hypospadias
- proximal meatus on the undersurface of the penis
- dorsal hood
- chordee
what is the common cause of balanitis
infected urine pools under the foreskin due to phimosis
what causes acquired undescended testis
result of the failure of elongation of the spermatic cord with age caused by the persistence of a fibrous remanent of the processes vaginalis
what signs on examination do you see for torsion of the testicular appendage
- focal tenderness at upper pole of testes, but testis itself can be palpated without pain
- blue dot sign
principles of management of epididymoorchitis
scrotal support, bed rest, ice
analgesia
alkalinisation of urine
antibiotics - ceftriaxone and doxycycine
what is a bell-clapper deformity
when the tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate
what is smegma
a collection of shed skin cells and skin secretions under the foreskin of a penis in young boys due to adherence of the foreskin to the glans in early childhood (up to 5)
most common age for torsion of the testicular appendage
under 11 years
what causes a varicocele
Dilation of the pampiniform venous plexus and the internal spermatic vein within the scrotum due to incompetent valves in the testicular veins
difference between phimosis and paraphimosis
- phimosis - inability to RETRACT foreskin over glans penis
- foreskin is caught behind the glans leading to oedema and the ability to REDUCE the foreskin
when should you do surgery for a varicocele
if there is:
- pain
- testicular atrophy/delayed growth of ipsilateral testes
treatment of phimosis
- mild-moderate = application of steroid ointment to the tight shiny part of the foreskin
- severe = circumcision
clinical presentation of a hydrocele
PAINLESS cystic swelling around the testis in the scrotum
pathophysiology of paraphimosis
when a tight foreskin is forcibly retracted –> forms a constricting ring around the coronal groove of the glans –> venous engorgement –> painful swelling of the glans –> unable to reduce foreskin over the swelling
clinical presentation of epididymoorchitis
- sudden onset bilateral scrotal pain and swelling
- fever
- purulent discharge
- secondary reactive hydrocoele
detail the urgency of surgery for inguinal hernias
more urgent the younger the child
typical age group for torsion of the testes
- babies
- >13 years (most commonly between the ages of 13-16)
