Revision - Cryptorchidism Flashcards
What are the 3 types of cryptorchidism?
1) True undescended testis
2) Ectopic testis
3) Ascending testis
What % of cases of cryptochidism are bilateral?
25%
Give 4 complications of undescended testes
1) psychological
2) infertility
3) testicular torsion
4) testicular cancer
Risk factors for cryptorchidism?
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)
With unilateral undescended testis, what is the management?
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
With bilateral undescended testes, what is the management?
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.
What must be excluded in cases of bilateral undescended testes?
Hormonal causes such as androgen insensitivity syndrome or disorder of sex development must be excluded.
What is the ventral side of the penis?
The underside
Hypospadias vs epispadias?
Hypospadias –> uretheral meatus is displaced to the ventral side (towards the scrotum)
Epispadias –> urethral meatus is displaced to the dorsal side
What are the 3 key features of hypospadias (although not all 3 are required for the condition)?
1) ventral opening of the urethral meatus
2) ventral curvature of the penis or “Chordee”
3) dorsal hooded foreskin
What surgery is indicated in hypospadias?
urethroplasty (around the age of 1y/o)
What is essential prior to hypospadias surgery?
It is essential that the child is NOT circumcised prior to the surgery as the foreskin may be used in the corrective procedure
Location of fluid collection in a hydrocele?
Within the tunica vaginalis that surrounds the testes
What are the 2 types of hydroceles?
1) communicating
2) non-communicating
What are non-communicating (i.e. simple) hydroceles caused by?
Caused by excessive fluid production within the tunica vaginalis.
What is a communicating hydrocele?
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.
Give some causes of a hydrocele
1) congenital (neonates & infants)
2) testicular torsion
3) testicular tumour
4) trauma
5) infection e.g. epididymo-orchitis
Can you get ‘above’ the mass on examination in a hydrocele?
Yes - the swelling is confined to the scrotum
When do infantile hydroceles usually resolve by?
1-2 y/o
What is a key part of the treatment of balanitis?
Simple hygiene - improper washing under the foreskin and the presence of a tight foreskin can make balanitis worse
What is a posterior urethral valve?
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
2 key complications of a posterior urethral valve?
1) hydronephrosis
2) UTIs
How can SEVERE posterior urethral valve present?
1) bilateral hydronephrosis in the developing fetus
2) oligohydramnios –> this leads to underdeveloped fetal lungs (pulmonary hypoplasia) with respiratory failure shortly after birth
What is a key complication of oligohydramnios?
Pulmonary hypoplasia
What is the most common cause of scrotal pain in adults?
Epididymitis
What is the epididymis?
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.
What are the 2 main functions of the epididymis?
1) Store sperm for maturation
2) Transport sperm to vas deferens
What does the epididymis drain into?
Vas deferens
What are the 4 most common organisms causing epididymo-orchitis?
1) Mumps
2) E. coli
3) Chlamydia
4) Neisseria gonorrhoea
What is the most common cause of epididymo-orchitis in men <35 y/o?
Most likely due to a sexually transmitted pathogen:
Chlamydia trachomatis
Neisseria gonorrhoeae
What is the most common cause of epididymo-orchitis in men >35 y/o?
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
What other organ can mumps affect?
Pancreas –> pancreatitis
What is the key differential for epididymo-orchitis?
Testicular torsion (emergency!)
What 3 features makes an STI organism more likely as a cause of epididymo-orchitis?
1) Age <35
2) Increased number of sexual partners in the last 12 months
3) Discharge from the urethra
What are the 2 critical side effects of quinolones (e.g. ciprofloxacin)?
1) tendon rupture (notably achilles)
2) lower seizure threshold
What is the most common cause of ambiguous genitalia in newborns?
Congenital adrenal hyperplasia
Do seminomas or non-seminoma testicular tumours have a better prognosis?
Seminomas
In suspected epididymo-orchitis in young males likely due to an STI, what abx can be given whilst waiting for sexual health screen results?
Ceftriaxone IM single dose + oral doxycycline for 10-14 days
When is the cremasteric reflex usually preserved in testicular torsion?
when the torsion affects the appendage only
