Pediatric Urology Flashcards
normal length of neonatal male genitalia
2.8 - 4.2cm, avg 3.5cm
Neonatal male genitalia begins developing at ___ weeks gestation
12
Covers entire glans by 18-20 weeks
how should a normal neonatal male genitalia look like
Normal scrotum-fully developed, with deep rugae and testes bilaterally
Shallow rugae is indicative of?
NEONATAL MALE GENITALIA
preterm infant
Empty scrotum is indicative of ?
NEONATAL MALE GENITALIA
cryptorchidism
what age does puberty start for boys?
9-14 yrs, avg 11.5 yrs
earliest and latest sign of puberty for boys?
- Earliest sign: increase in testicular size and volume
- Later: pubic hair development and increase in penile length
what is male menarche
- Sperm in urine and nocturnal emissions occur close to end of puberty
Penile Enlargement occurs at what tanner stages?
2-5
when is Elective circumcision done?
- done only in healthy, stable infants
- 1-10 days old - preferably 24 h old
- allows to find other health issues that may take precedence over an elective circumcision
circumcision CIs
- Unstable or significantly premature
- penile abnormalities
- Bleeding disorders - only a relaive CI; need further eval
benefits of circumcision
- Easier hygiene
- less UTIs during infancy
- dec in invasive penile CA
- dec in viral STDs (HSV, HPV, HIV; no change in gonorrhea or chlamydia)
- Dec incidence of cervical CA in female partners
narrowing of the opening of the foreskin so that it can not be retracted
Phimosis
foreskin becomes stuck behind the glans of the penis
Paraphimosis
inflammation of glans penis and the foreskin
Balanoposthitis
risks of circumcision
- Procedure related risks (.2% risk)
- Improper skin removal (too much/little)
- Bleeding
- Infection
- Pain
- Glans injury (including amputation)
- Development of epidermal inclusion cysts
- Adhesions and scarring
- Skin bridges
anesthesia for circumcision?
- dorsal penile nerve block
- circumferential ring block
1% lidocaine NO EPI or 4% topical lidocaine
which clamp is the blind technique for circumcision
mogen clamp - has occasional amputation of glans
what are the two techniques that allow for visulization of glans during circumcision
- Plastibell- clamp stays in place
- gomco clamps- clamp removed at end of procedure
post-circumcision care
- barrier ointment
- shaft skin should not be forcibly retracted
- Vaseline with diaper changes to glans and part of diaper where glans would hit
- 2 weeks
- Foreskin
- Redundant Skin
- 1cm beyond glans
- Provides protection to urethral meatus and glans penis
uncircumcised penis
how does retraction of penis change throughout the years?
- Retractability increases yearly
- By age 1: 50% of uncircumcised boys have retractile foreskins
- 90% by age 3
- 92% by age 6 to 7
- 99% by adolescence
what is physiologic phimosis
the inner surface of the foreskin is developmentally fused to the glans penis
Most phimosis is physiological
epithelial debris generated during desquamation is seen under the foreskin as pearls, what is the intervention?
none needed
Accumulation of smegma