Revision - Cryptorchidism

Question 1

What are the 3 types of cryptorchidism?

Answer 1

1) True undescended testis

2) Ectopic testis

3) Ascending testis

Question 2

What % of cases of cryptochidism are bilateral?

Answer 2

25%

Question 3

Give 4 complications of undescended testes

Answer 3

1) psychological

2) infertility

3) testicular torsion

4) testicular cancer

Question 4

Risk factors for cryptorchidism?

Answer 4

1) Maternal smoking during pregnancy

2) Prematurity

3) Low birth weight

4) Having a first degree relative with cryptorchidism

5) Having other abnormalities of genitalia (i.e. hypospadias)

Question 5

With unilateral undescended testis, what is the management?

Answer 5

1) Watch and wait to see if they descend on their own by 6 months

2) Consider referral from around 3 months of age

3) Baby should ideally see a urological surgeon before 6 months of age

4) Orchidopexy –> majority of procedures are performed at around 1 year of age

Question 6

With bilateral undescended testes, what is the management?

Answer 6

Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation.

May be a presentation of CAH.

Question 7

What must be excluded in cases of bilateral undescended testes?

Answer 7

Hormonal causes such as androgen insensitivity syndrome or disorder of sex development must be excluded.

Question 8

What is the ventral side of the penis?

Answer 8

The underside

Question 9

Hypospadias vs epispadias?

Answer 9

Hypospadias –> uretheral meatus is displaced to the ventral side (towards the scrotum)

Epispadias –> urethral meatus is displaced to the dorsal side

Question 10

What are the 3 key features of hypospadias (although not all 3 are required for the condition)?

Answer 10

1) ventral opening of the urethral meatus

2) ventral curvature of the penis or “Chordee”

3) dorsal hooded foreskin

Question 11

What surgery is indicated in hypospadias?

Answer 11

urethroplasty (around the age of 1y/o)

Question 12

What is essential prior to hypospadias surgery?

Answer 12

It is essential that the child is NOT circumcised prior to the surgery as the foreskin may be used in the corrective procedure

Question 13

Location of fluid collection in a hydrocele?

Answer 13

Within the tunica vaginalis that surrounds the testes

Question 14

What are the 2 types of hydroceles?

Answer 14

1) communicating

2) non-communicating

Question 15

What are non-communicating (i.e. simple) hydroceles caused by?

Answer 15

Caused by excessive fluid production within the tunica vaginalis.

Question 16

What is a communicating hydrocele?

Answer 16

Where the tunica vaginalis around the testicle is connected with the peritoneal cavity via a pathway called the processus vaginalis.

This allows peritoneal fluid to travel from the peritoneal cavity into the hydrocele, allowing the hydrocele to fluctuate in size.

Question 17

Give some causes of a hydrocele

Answer 17

1) congenital (neonates & infants)

2) testicular torsion

3) testicular tumour

4) trauma

5) infection e.g. epididymo-orchitis

Question 18

Can you get ‘above’ the mass on examination in a hydrocele?

Answer 18

Yes - the swelling is confined to the scrotum

Question 19

When do infantile hydroceles usually resolve by?

Answer 19

1-2 y/o

Question 20

What is a key part of the treatment of balanitis?

Answer 20

Simple hygiene - improper washing under the foreskin and the presence of a tight foreskin can make balanitis worse

Question 21

What is a posterior urethral valve?

Answer 21

Where there is tissue at the proximal end of the urethra (closest to the bladder) that causes obstruction of urine output.

Occurs in newborn boys

Question 22

2 key complications of a posterior urethral valve?

Answer 22

1) hydronephrosis

2) UTIs

Question 23

How can SEVERE posterior urethral valve present?

Answer 23

1) bilateral hydronephrosis in the developing fetus

2) oligohydramnios –> this leads to underdeveloped fetal lungs (pulmonary hypoplasia) with respiratory failure shortly after birth

Question 24

What is a key complication of oligohydramnios?

Answer 24

Pulmonary hypoplasia

Question 25

What is the most common cause of scrotal pain in adults?

Answer 25

Epididymitis

Question 26

What is the epididymis?

Answer 26

Found at the back of each testicle.

Sperm are released from the testicle into the head of the epididymis.

The sperm travel through the head, then body, then tail of the epididymis.

Sperm mature and are stored in the epididymis.

Question 27

What are the 2 main functions of the epididymis?

Answer 27

1) Store sperm for maturation

2) Transport sperm to vas deferens

Question 28

What does the epididymis drain into?

Answer 28

Vas deferens

Question 29

What are the 4 most common organisms causing epididymo-orchitis?

Answer 29

1) Mumps

2) E. coli

3) Chlamydia

4) Neisseria gonorrhoea

Question 30

What is the most common cause of epididymo-orchitis in men <35 y/o?

Answer 30

Most likely due to a sexually transmitted pathogen:

Chlamydia trachomatis
Neisseria gonorrhoeae

Question 31

What is the most common cause of epididymo-orchitis in men >35 y/o?

Answer 31

Infection is most likely due to a non-sexually transmitted gram-negative enteric organism causing UTIs:

1) E. coli
2) Pseudomonas spp

Send MSU for microscopy and culture

Question 32

What other organ can mumps affect?

Answer 32

Pancreas –> pancreatitis

Question 33

What is the key differential for epididymo-orchitis?

Answer 33

Testicular torsion (emergency!)

Question 34

What 3 features makes an STI organism more likely as a cause of epididymo-orchitis?

Answer 34

1) Age <35

2) Increased number of sexual partners in the last 12 months

3) Discharge from the urethra

Question 35

What are the 2 critical side effects of quinolones (e.g. ciprofloxacin)?

Answer 35

1) tendon rupture (notably achilles)

2) lower seizure threshold

Question 36

What is the most common cause of ambiguous genitalia in newborns?

Answer 36

Congenital adrenal hyperplasia

Question 37

Do seminomas or non-seminoma testicular tumours have a better prognosis?

Answer 37

Seminomas

Question 38

In suspected epididymo-orchitis in young males likely due to an STI, what abx can be given whilst waiting for sexual health screen results?

Answer 38

Ceftriaxone IM single dose + oral doxycycline for 10-14 days

Question 39

When is the cremasteric reflex usually preserved in testicular torsion?

Answer 39

when the torsion affects the appendage only