Surgery of the Penis and Prepuce Flashcards
What is hypospadia?
A rare developmental abnormality affecting the male genitalia which is the result of the foetal urogenital fold failing to fuse
Where is the urethral opening in hypospadia?
more ventral and caudal to normal, which can be anywhere along its length
How do we classify hypospadia? Examples (5)
The location of the urethral opening is used to classify hypospadias and as such it can be described as glandular, penile, scrotal, perineal or anal.
Most common breed affected by hypospadia?
Boston terrier
What is the effect of hypospadia on the penis and prepuce?
ncomplete on the ventral aspect, underdeveloped and/or abnormal
Term used to describe irritation of the penis and preputial lining.
balanoposthitis
Differentials for hypospadia. (5)
Hermaphroditism
Pseudohermaphroditism
Trauma
Urethral fistula
Penile hypoplasia
When is diagnostic imaging needed in hypospadia?
useful to identify other congenital or developmental abnormalities in affected individuals.
What does hypospadia treatment depend on?
Classification and degree affected?
What is the medical management aims of hypospadia?
Attempts to manage urine scalding and irritation medically with barrier creams/ointments and daily preputial flushing with physiologic saline can be made.
When is surgery NOT required in hypospadia cases?
Where the external urethral orifice remains near the cranial end of the penis
What surgical approach might be needed to be taken in hypospadia?
reconstruction or amputation/excision of the penile defect may be necessary in combination with appropriate urethrostomy surgery.
What is recommended in cases of hypospadia for major deficits that involve the urethra, prepuce and penis?
Excision of the penile remnants and urethrostomy is recommended.
What age for surgical approach of hypospadia in pediatric patients?
Delay until 8 weeks due to GA considerations
Which area of the penis bleeds profusely if wounded?
Cavernous tissue
What trauma of penis can lead to a deviation?
of os penis
What swelling might occur If a penile wound is deeper and causes disruption to the penile urethra, urine leakage or extravasation can occur? (2)
diffuse periputial or inguinal swelling.
What imaging is useful to determine urethral involvement in a wound?
Contrast studies
What are the risks of penile wound healing without intervention? (4)
- Fistula formation
- Persistent haemorrhage urine extravasation
- Infection
- Stricture
If a penile wound involves the urethra, without complete transection, what can be done and for how long?
Passing a urinary catheter and keeping this in place for 5-7 days
If trauma has caused urethra transection, what approach should be taken?
urethral anastomosis or a more caudal urethrostomy will be required.
If a urethral catheter cannot be placed following trauma; what can be placed?
Tube cystotomy
How can penile wounds be closed?
- layer
- material
- needle
tunica albuginea
- Absorbable monofilament suture material
- Swaged on, taper point needle. 1.5-0.7 metric sizes are appropriate (4-0 to 6-0).
Steps for a penile amputation.
- Retract the prepuce and place a temporary tourniquet around the penis, caudal to the affected area.
- A V-shaped incision is made on the lateral aspect of the penis through the tunica albuginea and the cavernous tissue.
- Cut the os penis as far caudally as is feasible
- Transect the urethra 1-2 cm distal to the penile transection and incise along the length to spatulate the remaining end.
- Suture the urethral mucosa to the tunica albuginea using monofilament absorbable sutures.
- Shorten the prepuce so that exteriorisation of the distal portion of the remaining penis is possible.
