Male genital and hernias Flashcards
Prepubertal boys
1.5 to 2 cm in length
Post puberty
4 to 5 cm
Wrinkles the skin
Dartos muscle
Draw scrotum toward abdomen
Cremaster muscle
cloaks the anterior two thirds of the testis
Parietal layer
lines the adjacent scrotum
Visceral layer
If the peritoneal lining remains an open channel to the scrotum it can give rise to an
indirect inguinal hernia
The parietal and visceral layers form a potential space for the abnormal fluid accumulation
hydrocele
ejaculatory duct
2.5 cm long
Formed when the vas deferens merges with the seminal vesicle
Ejaculatory duct
The left testicular vein empties into the _________.
left renal vein
The right
testicular vein empties into the _________.
inferior vena cava
develop at the internal inguinal ring, where the spermatic cord exits the abdomen.
Indirect inguinal hernias
arise more medially due to weakness in the floor of the inguinal canal and are associated with straining and heavy lifting.
Direct inguinal hernias
are more likely to
present as emergencies with bowel
incarceration or strangulation.
Femoral hernias
Most common, all ages, both sexes. Often in children; may occur in adults.
Indirect inguinal hernias
Less common. Usually in men older than 40 yrs; rare in women.
Direct inguinal hernias
Least common. More common
in women than in men
Femoral hernias
Above inguinal ligament, near its midpoint (the internal inguinal ring).
Indirect inguinal hernias
Above inguinal ligament, close to the pubic tubercle (near the external inguinal ring).
Direct inguinal hernias
Below the inguinal ligament; appears more lateral than an inguinal hernia. Can be hard to differentiate from lymph nodes.
Femoral hernias
Often into the scrotum. The hernia comes down the inguinal canal and touches the fingertip.
Indirect inguinal hernias
Rarely into the scrotum. The hernia bulges anteriorly and pushes the side of the finger forward.
Direct inguinal hernias
Never into the scrotum. The inguinal canal is empty.
Femoral hernia
suggest
lice (crabs) or sometimes scabies in
the pubic hair.
Pubic or genital excoriations
is a tight prepuce that cannot
be retracted over the glans
Phimosis
is a tight prepuce that, once retracted,
cannot be returned. Edema ensues.
Paraphimosis
Is inflammation of the glans;
Balanitis
is inflammation of the
glans and prepuce.
balanoposthitis
is a congenital ventral
displacement of the meatus on the
penis
Hypospadias
Profuse yellow discharge signals
gonococcal urethritis
scanty white or
clear discharge signals
nongonococcal
urethritis
Induration along the ventral surface
of the penis suggests a ______ or possibly a _______.
urethral stricture
carcinoma
Tenderness in the indurated area suggests
_______ from a
urethral stricture.
periurethral inflammation
There may be dome-shaped white or yellow
papules or nodules formed by occluded follicles filled with keratin debris of desquamated
follicular epithelium.
Epidermoid cysts
A poorly developed scrotum on one or
both sides suggests
cryptorchidism
Erythema and mild excoriation point
to ________, not uncommon in
this moist area
fungal infection
the primary site of lymph node
involvement in testicular cancer
inferior vena
cava
The vas deferens, if ________, may feel thickened or
beaded.
chronically
infected
A cystic structure in the
spermatic cord suggests a _____________.
hydrocele
of the cord
A bulge near the external inguinal
ring suggests a _________
direct inguinal hernia
A bulge near the internal inguinal ring
suggests an ______________
indirect inguinal hernia
Experts note that distinguishing the
type of hernia is difficult, with sensitivity and specificity of _______,
and ______.
74% to 92%
93%
A hernia is _________ when its
contents cannot be returned to the
abdominal cavity.
incarcerated
A hernia is
________ when the blood supply
to the entrapped contents is
compromised
strangulated
A congenital displacement of the urethral meatus to the inferior
surface of the penis. The meatus may be subcoronal, midshaft,
or at the junction of the penis and scrotum (penoscrotal).
Hypospadias
Pitting edema may make the scrotal skin taut; seen in heart
failure or nephrotic syndrome.
Scrotal Edema
Palpable, nontender, hard plaques are found just beneath the
skin, usually along the dorsum of the penis. The patient
complains of crooked, painful erections.
Peyronie Disease
A nontender, fluid-filled mass within the tunica vaginalis. It transilluminates, and the examining fingers can palpate above the mass within the scrotum
Hydrocele
An indurated nodule or ulcer that is usually nontender. Limited almost completely to men who are not circumcised, it may be masked by the prepuce. Any persistent penile sore is suspicious
Carcinoma of the penis
Usually an indirect inguinal hernia that comes through the
external inguinal ring, so the examining fingers cannot get
above it within the scrotum.
Scrotal Hernia
Small firm testes usually
≤2 cm suggest _____________.
Klinefelter syndrome
refers to gravity-mediated varicose veins of the
spermatic cord, usually found on the left. It feels like a soft
“bag of worms” in the spermatic cord above the testis, and if
prominent, appears to distort the contours of the scrotal skin.
Varicocele
