Surgery + WRAP UP

Question 1

What is the definition of phimosis and paraphimosis?

Answer 1

Phimosis - adhesion of foreskin to glans after 3years

Paraphimosis - irreducible retraction of foreskin beyond glans

Question 2

What are the signs and symptoms of an inguinal hernia?

Answer 2

Intermittent swelling in groin/scrotum
Tenderness worse at end of day
Relieved by lying down/pressing on it
Palpable impulse with coughing/straining
Abdominal fullness
Danger signs: hardness, tenderness, oedematous, vomiting - usually indicates incarceration

Question 3

What investigations are required for a suspected hernia?

Answer 3

Physical examination is usually sufficient

Can do and ultrasound +/- CT

Question 4

What are some complications of hernias?

Answer 4

Strangulation –> ischaemia

Incarceration

Question 5

What is a hydrocele and how do they appear?

Answer 5

Collection of fluid within the processus vaginalis producing swelling in scrotum, caused by incomplete obliteration of PV (thinner = hydrocele (fluid), thicker = hernia (bowel))
Caused by non-closure of processus vaginalis - communicating hydrocele
OR imbalance in fluid production/absorption (inflammation, tumours, trauma) - non-communicating

Question 6

What are the clinical features of a hydrocele?

Answer 6

Painless swelling in scrotum, can get above it
Transilluminates
Can palpate testes inside
Scrotum is smooth

Question 7

What are the two different types of undescended testes?

Answer 7

Retractable - normally descended but exaggerated cremasteric reflex
Maldescended - arrested descent (found in normal pathway) or ectopic (deviated from normal pathway)

Question 8

What is the pathophysiology commonly causing testicular torsion?

Answer 8

Inadequate fixation of testes to tunica vaginalis –> allows testes to rotate and occlude vascular supply
“Bell clapper” deformity - testes transverse lie

Question 9

What are the clinical features of testicular torsion?

Answer 9

Sudden onset testicular pain and swelling
Occasional N&V, sometimes fever
Pain may be in iliac fossa, pain may lessen as the testicle dies
Discoloured scrotum
Riding high, abnormal lie (transverse)
Cremasteric reflex absent

Question 10

What are the different causes of a testis not present in the scrotum?

Answer 10

Maldescended testes - true undescended: arrested along normal path
Ectopic
Retractile testes: overactive cremaster reflex
Hypoplastic: testicular agenesis

Question 11

Is undescended testes more common in left or right?

Answer 11

Right (left comes down first)

Question 12

How do you determine whether an absent testis is retractile or truly undescended?

Answer 12

Can it be milked downwards
Upon release does it spring back upwards straight away (undescended) or remain in the scrotum until cremasteric kicks in (retractile)

Question 13

What is the treatment for retractile testis?

Answer 13

Nothing

Overactive cremaster reflex reduces with age

Question 14

What are the complications of persistent cryptorchidism?

Answer 14

Infertility
Increased risk of testicular cancer
Torsion
Hernia

Question 15

What is the management for cryptorchidism?

Answer 15

Surgery at 6mo

Karyotype

Question 16

What kind of deformity predisposes males to testicular torsion?

Answer 16

Bell clapper deformity - where testes lay horizontally rather than vertically

Question 17

How does testicular torsion present in neonates?

Answer 17

Usually testes is already dead

Painless, discoloured (blue or black), swollen

Question 18

What is the treatment for testicular torsion?

Answer 18

Immediate surgery!
Detort in 6hrs can save
>24 hours cannot save

Question 19

What is torsion of a testicular appendage?

Answer 19

Twisting of remnants of mullerian or wolffian ducts
You can have the ‘blue dot sign’ (necrotic appendage)
Less painful, cremasteric reflex is intact

Question 20

What causes indirect hernias?

Answer 20

Failure of obliteration of processus vaginalis - abdominal contents can now enter the sac

Question 21

Are direct hernias more likely to present on the left or right side?

Answer 21

RIGHT

Left comes down first

Question 22

What is the management for inguinal hernias?

Answer 22

Surgical correction - inguinal hernias to not spontaneously heal
- Usually explore other wise as well

Question 23

What is the treatment for hydrocele?

Answer 23

Nothing - will resolve by 12mo

>2 years - surgery

Question 24

What are the clinical features of hypospadias?

Answer 24

Urethral meatus opens ventral side of penis shaft