Genital Flashcards
(42 cards)
Migration of the testis physiology
Originates on posterior abdominal wall
Testosterone acts on peripheral tissues
Migration guided by mesenchymal gubernaculum
Layers are collected from abdominal wall and guided through inguinal canal
Scrotal contents
Testis
Vas
Blood vessels
Labial content
Attachment of the round ligament of the uterus
Features inguinal hernia
Common
Risk factor: prematurity
Persistently patent processus vaginalis
Emerges through deep inguinal ring through inguinal canal (indirect)
Lump in the groin which may extend to the scrotum or labium
Asymptomatic and intermittent
Thickened cord structure palpable in the groin
Features of strangulated hernia
Tender lump
Irritability
Vomiting
Greater risk in infants
Mx Hernias
Most successfully reduced by taxis
Surgery planned for time when oedema has settled and child is well
Emergency surgery required if strangulated
Surgery: ligation and division of processes vaginalis (hernial sac)
Surgery performed >3m old
Feature hydrocele
Asymptomatic Sometimes appear blue Testis still papable Hydrocele is separate from testis -differentiates from hernia Transilluminates
Mx hydrocele
Resolves spontaneously: patent vaginalis closes
Surgery is persisting beyond 2y
Features varicocele
Scrotal swelling
Dilated varicose testicular veins (bag of worms)
Common in boys, especially at puberty
Due to valvular incompetence
Commoner on left : drainage of gondal vein into renal vein (catecholamine from left adrenal)
Dull ache
Bluish colour
Testis may be smaller or softer than normal
Mx Varicocele
Conservative if asymptomatic
Occlusion of gonadal vein by surgical ligation
-laparoscopic through groin
-radiological embolisation
Features undescended testis
5% newborn term infants but more common in preterm
Most resolve by 3 months (1% still undescended)
Identified on routine examination of the newborn
Testis examination for undescended testis
Warm room and warm hands
Testis felt in scrotum or delivered by gentle pressure along inguinal canal
May be palpable or impalpable
Location of undescended testis
Groin
Below the external inguinal ring, outside scrotum (ectopic)
impalpable: in abdomen or absent
Mx bilateral undescended testis
Karotype to exclude disorders of sex development
Features retractile testis
Can be manipulated into the scrotum with ease and without tension
Action of the cremaster muscle pulls up the testis
More prominent when warm and relaxed
Mx Undescended testis
Referral by 3m, surgical appt by 6m
Procedure performed at 1y
Surgical placement of testis in the scrotum (orchidopexy)
-groin approach
-opening inguinal canal and mobilising testis
Functions of orchidopexy
Cosmetic with possible testis prosthesis when older
Reduced risk of torsion and trauma
-lying transversely on attachment to spermatic cord (clapper ball testis)
Fertility
Malignancy
Features Torsion of the Testis
Typically post-pubertal boys Can occur at any age Very painful Redness and odema of scrotal skin Pain localised to groin or abdomen
Mx Torsion of the testis
Must be treated within hours
Surgical exploration is mandatory
Fixation of contralateral testis
Testicular loss in delay (esp. perinatal torsion)
Features torsion of appendix testis
Hydatid or Margani is Mullerian remnant located in upper pole of testis Affects pre pubertal boys More common than testis torsion Pain evolves over days Blue dot is pathognomonic
Mx Appendix testis torsion
Surgical exploration and excision of appendix (in case of torsion)
If proven- control pain with analgaesia
Features Epidiymitis
Inflammed epidiymis
Commoner in infants and small children
Associated with pre-exciting urological or rectal malformation
Small hydrocele and swollen testis
Mx epidymitis
Usually surgical exploration in case of torsion
US of flow pattern allows differentiation from torsion
Pus sent for microbiology
Empirical antibiotics
Features idiopathic scrotal oedema
Redness and swelling
Extending beyond scrotum into the thigh, perineum and surapubic area
Testis normal and non-tender
