Paediatrics Surgery Flashcards
What are the three groups of cryptorchidism?
True undescended testes - absent in scrotum but lies along line of testicular descent
Ectopic testes - testes is found away from normal path
Acscending testes - previously in scrotum but secondary ascent out of scrotum
What are some risk factors for cryptorchidism?
Prematurity
Low birth weight
Other abnormalities e.g. hypospadias
First degree relative with cryptorchidism
What are some differentials for cryptorchidism?
Normal retractile testes - seen intermittently in scrotum (pulled to base with minimal traction)
True undescended testes - along normal decent pathway (cannot be manipulated to base of scrotum)
Ectopic - not on normal pathway
What is the management of cryptorchidism?
If DSD suspected, undescended testes with ambiguous genetalia or hypospadias = urgent referral to senior paediatrician within 24 hours (access to paediatric endocrinology and urology) - risk of salt losing crisis (requiring NaCl and gluclose monitoring)
No imaging modality = benefit in diagnosis (USS and MRI = low sensitivity)
Long term management
Birth = review at 6-8 weeks
6-8 weeks = if unilateral then reexamine at 3 months
3 months = retractive (annual follow-up) undescended ( refer for intervention)
What intervention options are there in cryptorchidism?
Locate an impalpable testis = examination under anaesthesia followed by laparoscopy (may find atrophic testes or absent testing with blind ending vas and testicular vessels)
If palpable = open orchidopexy via groin incision
If intra-abdominal = 2 stage Fowler-Stephens procedure (testicular vesses ligated = collateral vessel development then second stage bringing testis down 2 months later)
What are some surgical complications of cryptorchidism?
Surgical = infection, bleeding, wound dehiscence (long term = testicular atrophy, re-ascent)
Undescended testes = impaired fertility (testes are 2-3oC warmer effecting spermatogenesis), testicular cancer (2-3 times more common - increases if orchidopexy done after puberty), torsion (higher risk in undescended)
How does the foreskin (prepuce) change after birth?
Birth = adhesions between prepuce and glans (gradually break down - by 10 can retract foreskin)
What is balanitis xerotica obliterans?
Keratinisation of the tip of the foreskin causes scaring (prepuce remains non-retractile)
What is the history of balanitis xerotica obliterans?
Ballooning of foreskin during micturition
Scarring of urethral meatus causes irritaion, dysuria, haematuria and local infection
What is the management of BXO?
Circumcision (histopathology to confirm diagnosis)
What are the complications of BXO?
Circumcision complications = bleeding, infection, swelling
Untreated complications = meatal stenosis, phimosis, erosions of glans and prepuce (extended to urethra)
What is hypospadias?
Congenital defect causing urethral meatus to be located at an abnomal site, underside of penis
What are the 3 key features of hypospadias?
- Vental opening of the urethral meatus
- Ventral curvature of penis “chordee”
- Dorsal hooded foreskin
Label the following:
What could present as hypospadias and unilateral undescended testes?
Congenitala adrenal hyperplasia (can lead to salt wasting)
