Reproductive organ pathology in children Flashcards
On which side are indirect inguinal hernia more common, and why?
The R side, due to later descent of the R testies
When should children be operated on for indirect inguinal hernias?
Within a few weeks of Dx because the risk of incarceration is high (but this risk lessens after 1y/o)
What is the name of the procedure that corrects inguinal hernias?
Surgical herniotomy
Where does fluid accumulate in a hydrocele?
Tunica vaginalis
What are the 2 types of hydrocele?
1) Communicating/congenital
2) Non-communicating
What causes congenital hydroceles?
A processus vaginalis that remains patent
What causes a non-communicating hydrocele?
They are found secondary to trauma, testicular torsion, or epididymitis
What is the usual management for hydroceles?
12-24 months of ‘watchful waiting’ due to a tendency for spontaneous regression
What are the types of torsion?
1) Congenital testicular torsion
2) Testicular torsion outside the perinatal period
3) Torsion of the testicular or epididymal appendage
In what type of torsion might you see ‘blue dot sign’?
Torsion of the testicular epididymal appendage
When is Prehn’s sign negative?
Testicular torsion
When is Prehn’s sign +ve?
Epididymitis
What is Prehn’s sign?
Relief of pain on lifting the scrotum above the pubic symphysis
When does testicular torsion tend to occur?
During sport/physical activity
What does easing pain tend mean with regard to testicular torsion?
Necrosis setting in, rather than resolution
In testicular torsion, how do the testes appear O/E?
1) In the ‘bell-clapper position’
2) Oedematous
3) Tender
4) Retracted upwards
5) +/- erythema of the scrotal skin
6) Absence of the cremasteric reflex
What is the spinal root of the cremasteric reflex?
L1/L2
How is testicular torsion usually Dx?
USS with colour Doppler
How is testicular torsion managed?
De-torsion (either manually or surgically) Bilateral orchidopexy (Orchidectomy is the testicle is no longer viable)
What are the complications of testicular torsion?
INFARCTION - which can cause 1) atrophy; 2) infection; 3) cosmetic deformity; 4) Sub/infertility
What is epidydimoorchitis usually caused by in children?
UTI
What is epidydimoorchitis usually caused by in teenagers?
Gonorrhea/chlamydia
What is the commonest congenital abnormality?
Cryptochiadism
What are the complications of cryptochiadism?
1) Decreased fertility rate (but same paternity rate as boys with bilaterally descended testes)
2) 20x more likely to develop a testicular malignancy
What are the differentials for bilateral absence of testes at birth?
1) Anorchia
2) CAH
