Surgery - Genitalia

Question 1

What are the clinical features of a hernia?

Answer 1

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

Question 2

What are the consequences of incarceration (risk of hernia)?

Answer 2

lump becomes irreducible causing pain and sometimes intestinal obstruction or damage to testes (strangulation)
risk of incarceration is higher in infants than older children

Question 3

What is the management of an inguinal hernia?

Answer 3

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

Question 4

What are the different causes of ‘the acute scrotum’?

Answer 4

testicular torsion 
epididymo-orchitis 
idiopathic scrotal oedema 
incarcerated hernia 
torted epididymal cyst 
torted hydatid of margani

Question 5

What are the clinical features of testicular torsion?

Answer 5

very painful redness and oedema of scrotal skin pain may be localised to groin or lower abdomen

Question 6

What is testicular torsion?Why is it an emergency?

Answer 6

torsion of the spermatic cord

occlusion of the blood vessels will affect viability of the testis unless prompt action is taken

Question 7

What is torted hydatid of Morgagni?

Answer 7

a small embryological remnant at the upper pole of testis
presentation similar to testicular torsion
pain less severe usually and longer history

Question 8

What is a totted epididymal cyst?

Answer 8

small smooth fluid filled swelling that slowly develops often painless but testicle can ache more common in middle age

Question 9

What is epididymo-orchitis?

Answer 9

inflammation of the epididymis and/or the testes usually due to infection

Question 10

What is balantis?

Answer 10

skin irritation on the head of the penis symptoms:
sore itchy smelly penis
redness and swelling build up of thick fluid pain when peeing

Question 11

How is balantis treated?

Answer 11

clean penis daily with water or steroid cream or ointment for irritation
anti fungal cream or tablets for yeast infection
antibiotics for infection

Question 12

What is BXO?

balantis xerotica obliterans

Answer 12

chronic progressive disease leads to phimosis and urethral stenosis affects both urinary and sexual function

Question 13

Are non retractible foreskins normal?

Answer 13

in most cases this is physiologically normal

Question 14

What is a hydrocele?

Answer 14

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

Question 15

What is an undescended testicle?

Answer 15

testes is impalpable or is found in the inguinal region and never made it to scrotum

Question 16

What is an ascended testicle?

Answer 16

impalpable or found in the inguinal region and never made it to the scrotum

Question 17

What is a retractile testicle?

Answer 17

a testicle that can be brought down into the scrotum without any difficulty

Question 18

Why do the testes need to be located in the scrotum?

Answer 18

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

Question 19

How are undescended testes managed?

Answer 19

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

Question 20

What are the medical reasons for circumcision?

Answer 20

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)

Question 21

Potential complications after circumcision?

Answer 21

post op bleeding
infection
meatal stenosis
rare - urethral fistula

Question 22

What are labial adhesions?

Answer 22

fusion of the labia minora can cause local irritation to girls
translucent area of flimsy tissue between the labia

Question 23

How are label adhesions managed?

Answer 23

topical corticosteroids or oestrogen can help lyse adhesions
formal division can be done but only under exceptional circumstances as recurrence rate high

Question 24

What is a varicocele and how does it present?

Answer 24

scrotal swelling comprising of dilated testicular veins symptomatic or may cause dull ache examination - ‘bag of worms’ and bluish colour

Question 25

What are the risks of varicocele?

Answer 25

testicle atrophy

infertility