Surgery - Genitalia Flashcards
What are the clinical features of a hernia?
presents as a lump in the groin which may extend into the scrotum or labia
may be asymptomatic may be irreducible causing pain
infant may be irritable and vomit
What are the consequences of incarceration (risk of hernia)?
lump becomes irreducible causing pain and sometimes intestinal obstruction or damage to testes (strangulation)
risk of incarceration is higher in infants than older children
What is the management of an inguinal hernia?
most can be reduced by gentle compression with good analgesia
surgery can then be planned if reduction not possible
emergency surgery is required because of the risk of compromise to bowel/testis
What are the different causes of ‘the acute scrotum’?
testicular torsion epididymo-orchitis idiopathic scrotal oedema incarcerated hernia torted epididymal cyst torted hydatid of margani
What are the clinical features of testicular torsion?
very painful redness and oedema of scrotal skin pain may be localised to groin or lower abdomen
What is testicular torsion?Why is it an emergency?
torsion of the spermatic cord
occlusion of the blood vessels will affect viability of the testis unless prompt action is taken
What is torted hydatid of Morgagni?
a small embryological remnant at the upper pole of testis
presentation similar to testicular torsion
pain less severe usually and longer history
What is a totted epididymal cyst?
small smooth fluid filled swelling that slowly develops often painless but testicle can ache more common in middle age
What is epididymo-orchitis?
inflammation of the epididymis and/or the testes usually due to infection
What is balantis?
skin irritation on the head of the penis symptoms:
sore itchy smelly penis
redness and swelling build up of thick fluid pain when peeing
How is balantis treated?
clean penis daily with water or steroid cream or ointment for irritation
anti fungal cream or tablets for yeast infection
antibiotics for infection
What is BXO?
balantis xerotica obliterans
chronic progressive disease leads to phimosis and urethral stenosis affects both urinary and sexual function
Are non retractible foreskins normal?
in most cases this is physiologically normal
What is a hydrocele?
same underlying anatomy as a hernia but the process vaginalis although patent is not sufficiently wide to form an inguinal hernia can resolve spontaneously or surgery considered if doesn’t resolve after 2 years
What is an undescended testicle?
testes is impalpable or is found in the inguinal region and never made it to scrotum
What is an ascended testicle?
impalpable or found in the inguinal region and never made it to the scrotum
What is a retractile testicle?
a testicle that can be brought down into the scrotum without any difficulty
Why do the testes need to be located in the scrotum?
optimal function
potential for malignancy if not in scrotum
difficult to examine for potential torsion/malignancy
trauma caused by compression if in inguinal canal
cosmoses - people don’t want to be different
fertility - optimum for spermatogenesis if in scrotum
How are undescended testes managed?
Orchidopexy - surgical placement of the testis in the scrotum should be performed before the age of 1 as outcomes are better at a younger age
What are the medical reasons for circumcision?
BXO causing true phimosis
recurrent balanoposthitis casuing refractory symptoms
prophylaxis if recurrent UTIs
if access to urethra is required reliably for intermittent catheterisation (e.g. in spina bifida)
Potential complications after circumcision?
post op bleeding
infection
meatal stenosis
rare - urethral fistula
What are labial adhesions?
fusion of the labia minora can cause local irritation to girls
translucent area of flimsy tissue between the labia
How are label adhesions managed?
topical corticosteroids or oestrogen can help lyse adhesions
formal division can be done but only under exceptional circumstances as recurrence rate high
What is a varicocele and how does it present?
scrotal swelling comprising of dilated testicular veins symptomatic or may cause dull ache examination - ‘bag of worms’ and bluish colour
What are the risks of varicocele?
testicle atrophy
infertility
