Paediatric Urology

Question 1

What is cryptorchidism?

Answer 1

Failure of testicular descent into the scrotum

Question 2

What are the types of cryptorchidism?

Answer 2

True undescended testis
Ectopic testis
Ascending testis

Question 3

What is a true undescended testis?

Answer 3

Testis is absent from the scrotum but lies along the line of testicular descent

Question 4

What is an ectopic testis?

Answer 4

Testis is found away from the normal path of descent

Question 5

What is an ascending testis?

Answer 5

Where a testis previously found in the scrotum undergoes a secondary ascent

Question 6

What are risk factors for cryptorchidism?

Answer 6

Prematurity
Low birth weight
Other genitalis abnormalities
FHx

Question 7

Where do you palpate in suspected cryptorchidism?

Answer 7

Scrotum

Along inguinal canal

• if found, can it be moved into scrotum
• if yes = retractile testis

Question 8

How is bilateral cryptorchidism +/- ambiguous genitilia managed?

Answer 8

Refer to paediatrician - ?CAH

Question 9

How is cryptorchidism managed?

Answer 9

At birth - wait until 6-8 weeks
6-8 weeks - if still undescended, re-examine at 3 months
3 months 
- retractile = annual follow up 
- undescended = refer to surgery

Question 10

What are the complications of cryptorchidism?

Answer 10

Testicular cancer
Testicular torsion
Infertility

Question 11

What is phimosis?

Answer 11

Inability to retract the foreskin

Question 12

What causes phimosis?

Answer 12

From birth there are adhesions between prepuce and glans that breakdown over time

Question 13

What age is the first foreskin retraction normally?

Answer 13

10

Question 14

What is the physiological appearance of phimosis?

Answer 14

‘Pouting’ appearance

Question 15

What is the pathological appearance of phimosis?

Answer 15

BXO

Question 16

What does BXO stand for?

Answer 16

Balanitis xerotica obliterans

Question 17

What is BXO?

Answer 17

Keratinisation of the tip of the foreskin causing scarring so prepuce remains non-retractile

Question 18

What are the features of BXO?

Answer 18

Ballooning of foreskin on micturition

Scarring of urethral meatus

• irritation
• dysuria
• local infection

Question 19

What is seen on examination in BXO?

Answer 19

White fibrotic scarred tip of prepuce

Question 20

How is BXO managed?

Answer 20

Circumcision

Question 21

What are complications of circumcisions?

Answer 21

Bleeding
Infection
Swelling

Question 22

What are complications of BXO?

Answer 22

Meatal stenosis
Phimosis
Erosions of glans/prepuce

Question 23

What is a hydrocele?

Answer 23

Patency of tunica vaginalis allowinf peritoneal fluid to drain into the scrotum

Question 24

What age does a hydrocele normally resolve by?

Answer 24

1 year

Question 25

What is hypospadias?

Answer 25

Congenital defect causing the urethral meatus to be located at an abnormal site on the ventral side of penis

Question 26

What are risk factors for hypospadias?

Answer 26

Low/high maternal age Low birth weight FHx

Question 27

What are the features of hypospadias?

Answer 27

Ventral opening of urethra Ventral curvature of penis / chordee Dorsal hooded foreskin

Question 28

How is hypospadias managed?

Answer 28

Urethroplasty

Question 29

What can cause an acute painful scrotum?

Answer 29

Testicular torsion Torted hydatid of Morgagni Trauma Epidymo-orchitis

Question 30

What is the hydatid of Morgagni?

Answer 30

Small embryological remnant at upper pole of testis