Reproductive organ pathology in children

Question 1

On which side are indirect inguinal hernia more common, and why?

Answer 1

The R side, due to later descent of the R testies

Question 2

When should children be operated on for indirect inguinal hernias?

Answer 2

Within a few weeks of Dx because the risk of incarceration is high (but this risk lessens after 1y/o)

Question 3

What is the name of the procedure that corrects inguinal hernias?

Answer 3

Surgical herniotomy

Question 4

Where does fluid accumulate in a hydrocele?

Answer 4

Tunica vaginalis

Question 5

What are the 2 types of hydrocele?

Answer 5

1) Communicating/congenital

2) Non-communicating

Question 6

What causes congenital hydroceles?

Answer 6

A processus vaginalis that remains patent

Question 7

What causes a non-communicating hydrocele?

Answer 7

They are found secondary to trauma, testicular torsion, or epididymitis

Question 8

What is the usual management for hydroceles?

Answer 8

12-24 months of ‘watchful waiting’ due to a tendency for spontaneous regression

Question 9

What are the types of torsion?

Answer 9

1) Congenital testicular torsion
2) Testicular torsion outside the perinatal period
3) Torsion of the testicular or epididymal appendage

Question 10

In what type of torsion might you see ‘blue dot sign’?

Answer 10

Torsion of the testicular epididymal appendage

Question 11

When is Prehn’s sign negative?

Answer 11

Testicular torsion

Question 12

When is Prehn’s sign +ve?

Answer 12

Epididymitis

Question 13

What is Prehn’s sign?

Answer 13

Relief of pain on lifting the scrotum above the pubic symphysis

Question 14

When does testicular torsion tend to occur?

Answer 14

During sport/physical activity

Question 15

What does easing pain tend mean with regard to testicular torsion?

Answer 15

Necrosis setting in, rather than resolution

Question 16

In testicular torsion, how do the testes appear O/E?

Answer 16

1) In the ‘bell-clapper position’
2) Oedematous
3) Tender
4) Retracted upwards
5) +/- erythema of the scrotal skin
6) Absence of the cremasteric reflex

Question 17

What is the spinal root of the cremasteric reflex?

Answer 17

L1/L2

Question 18

How is testicular torsion usually Dx?

Answer 18

USS with colour Doppler

Question 19

How is testicular torsion managed?

Answer 19

De-torsion (either manually or surgically)
Bilateral orchidopexy
(Orchidectomy is the testicle is no longer viable)

Question 20

What are the complications of testicular torsion?

Answer 20

INFARCTION - which can cause 1) atrophy; 2) infection; 3) cosmetic deformity; 4) Sub/infertility

Question 21

What is epidydimoorchitis usually caused by in children?

Answer 21

UTI

Question 22

What is epidydimoorchitis usually caused by in teenagers?

Answer 22

Gonorrhea/chlamydia

Question 23

What is the commonest congenital abnormality?

Answer 23

Cryptochiadism

Question 24

What are the complications of cryptochiadism?

Answer 24

1) Decreased fertility rate (but same paternity rate as boys with bilaterally descended testes)
2) 20x more likely to develop a testicular malignancy

Question 25

What are the differentials for bilateral absence of testes at birth?

Answer 25

1) Anorchia

2) CAH