Pediatric Urology - Exam 3 Flashcards
What is the normal length of male genitalia? What is average? When does it begin to form? When is it completely covered by glans?
Normal length is 2.8cm - 4.2cm, with an average of 3.5cm
Develops beginning at 12 weeks gestation
Covers entire glans by 18-20 weeks
What does shallow rugae of the scrotum indicate? What does an empty scrotum indicate?
preterm infant
cryptorchidism
What is the age range for puberty in boys? What is average? What are the earliest sign of puberty?
9-14 years old
average 11.5
increase in testicular size and volume
What are later male signs of puberty?
pubic hair development and increase in penile length
What is considered male menarche?
Sperm in urine and nocturnal emissions occur close to end of puberty
What percentage of US males are circumscribed?
60-90% of males in the US are circumcised
When are circumcisions commonly performed? Why?
male child is between 1 and 10 days, at least 24 hours old
Infant should preferably be 24 hours old, this interval allows time for identification of other health issues that may take precedence over an elective circumcision
What are the 2 CI to circumcision? What is the strong caution?
unstable or significantly premature infants
penile abnormalities: hypospadia, chordee, concealed penis, large suprapubic fat pad
bleeding disorders is strong caution
What is chordee of the penis?
curvature of penis
What is hypospadias?
when the urethal meatus is not where it should be, usually on the posterior side of the penis
What are some benefits of circumcision?
easier genital hygiene
lower rates of UTIs during infancy
Decreased incidence of invasive penile cancer
Decreased incidence of VIRAL STDs
Decreased incidence of cervical cancer in female partners
Why does circumcision decrease incidence of viral STIs?
Variation may result from site of infection: gonorrhea/chlamydia infect urethra, while viral infections tend to involve the foreskin, where dendritic cells play a prominent role
What are the risks of circumcision?
procedure related risks
improper skin removal
bleeding/infection
glans injury
development of epidermal inclusion cysts
adhesions/scarring/skin bridge
What is the pain cocktail for a circumcision?
Local anesthesia by dorsal penile nerve block or circumferential ring block using 1% lidocaine without epinephrine or 4% lidocaine topical cream
______ is the blind technique for circumcision. What is sometimes the unintentional SE?
Mogen clamp
This type has an occasional amputation of the glans
What are the 2 circumcision techniques that allow for visualization of the glans? What are the major differences?
plastibell and gomco clamps
plastibell: plastic bell stays in place after the procedure
gomo clamps: bell shaped clamp is placed over glans during procedure while foreskin is cut but then removed at the end of the procedure
What is the post circumcision care? What should you NOT due?
Apply barrier ointment (vaseline) with diaper changes to the glans and the part of the diaper where glans would hit to reduce risk of adhesions, infection, or meatal stenosis for 2 weeks after procedure
The shaft skin should NOT be forcibly retracted
In an uncircumcised penis, how far does the redundant skin extend?
extends 1cm beyond glans
What is normal with regards to foreskin retraction in newborn males?
usually incomplete in most male infants at birth and retractability increases yearly!
90% by 3
92% by 6-7
99% by adolescence
What is the care of an uncircumcised penis? What should you NOT due?
Wash penis regularly non-irritant soap
May GENTLY retract foreskin with diaper changes and bathing to clean and dry beneath but need to replace foreskin after cleansing
Do NOT force retraction:
What is phimosis? Is it normal?
Phimosis-narrowing of the opening of the foreskin so that it CANNOT be retracted
Most phimosis is physiological at birth, most boys have physiologic phimosis: the inner surface of the foreskin is developmentally fused to the glans penis
______ foreskin becomes stuck behind the glans of the penis
paraphimosis
_____ inflammation of glans penis and the foreskin
Balanoposthitis
What am I? What is the tx?
smegma: (epithelial debris generated during desquamation) can sometimes be seen under the foreskin as pearls
tx: no intervention needed