Urology Flashcards
Where does the deep ring lie
1/2 between ASIS and PS then slightly up
Where does the superficial ring lie
Superior and medial to pubic tubercle
What is the anatomy of the inguinal canal
Anterior = external oblique Floor = inguinal ligament Posterior = transverse abdominas
What are the contents of the inguinal canal
Vas deferens or round ligament
Testicular artery and vein
Genitofemoral nerve
Ilioinguinal nerve
What are indications for orchidopexy (moving a testcile)
Fertility Malignancy Trauma Torsion Cosmesis
What does orchidopexy do
Deals with patent PV
In adults have to insert a mesh as hernia due to wear and tear
What is patent processes vaginalis
Descends with testis and closes of deep ring
If big = hernia
If small= hydrocele
What is an indirect inguinal hernia
Through deep ring in children
Most common
What causes
Patent PPV
What is a direct inguinal hernia
Pushes through defect in abdominal wall
How does inguinal hernia present
Groin swelling SEPARATE from testis CANT get above Can reduce Comes back when stand up or cough
What are symptoms if incarcerates
Red Pain Swelling Vomit Bloating
When are inguinal hernia common
Pre-term
How do you Dx
USS
When do you do urgent surgery and why
If <1 as high risk of incarceration and strangulation
What do you do if >1
Elective surgery
What do you do if incarcerated
Reduce and repair
How does a hydrocele form
Peritoneal fluid through deep ring due to PPV
How does hydrocele present
Scrotal swelling Painless Can't separate as fluid all around Transilluminate CAN"T reduce Can feel above Decreases lying flat and gets worse through the day
How do you Dx and Rx
USS
Conservative until 5
Usually resolves
What is cryptorchidism
Any testis that cannot be manipulated into bottom 1/2 of the scrotum
- FH
- LBW
- Premature
- SGA
What are types of Cryptorchidism
True - between kidney and inguinal
Ectopic - abnormal place
Retractile - can massage intro scrotum
Ascending - as grow ascends up
When do you consider referral
3 months
When do you treat
Surgery if haven’t dropped by age 1
What are risks of undescended testis
Infertility
Torsion
Testicular cancer
Psychological
What are definite indications for circumcision
BXO - chronic scarring/. lichen sclerosis of foreskin
Can’t retract
What are other indications
Religion
Phismosis
Recurrent balantits
Paraphismosis
What ae advantages
Malignancy
UTI
STI
Sexual
What are disadvantages
Pain
Bleeding
Stenosis
Fistula
How do you treat phismosis
Physiological if <2
Will retract
Steroid cream
Don’t force as cause a scar
When do you treat
> 2
Recurrent UTI / balanaprosthitis
When should you never circumcise
If hydrospadia
Risk of stricture
What does BXO lead to
Phismosis
Stenosis
Pain on urination and sex
What is a hydrospadia
Uretral meatus on distal ventral aspect
- Difficulty urine
- Difficult sex
What is associated with hydrospadia
Upper tract anomaly
Ambigious genitalia
Cryptochodism
How do you Dx
USS
How do you treat
Surgery before 2
What can cause an acute scrotum
Torsion testi Torsion appendix testi Epididymitis Orchitis Trauma Haematocele Incarceration
How does it present
Sudden onset pain
Swelling
Red or blue
Hard
Lop sided / Retracted testis but can be normal
Autonomic - N+V / unwell
Asbsent cresmater but can be present - scratch inner thy
What increases risk of torsion
Bell clapper deformity
How do you Dx
If torsion - don’t USS as no time
Straight to theatre and fix BOTH testis
Orchitis
Mumps serology
