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Flashcards in Genitalia Deck (62):
1

What process of development can lead to predisposition to development of inguinal hernia or hydrocele?

The processus vaginalis is the tongue of peritoneum that precedes the migrating testis through the inguinal canal - normally it becomes obliterated after birth but sometimes this fails and the predisposition occurs

2

What sort on inguinal hernias do children get?

Indirect normally always because due to the patent processus vaginalis - therefore comes through inguinal canal

3

In whom are inguinal hernias more common?

Boys and preterm infants

4

Which side do inguinal hernias typically occur on?

Typically on the right side

5

How do inguinal hernias usually present?

Intermittent swelling in groin on crying or straining
Can make it visible by raising intra-abdominal pressure - by placing hand on abdomen or asking them to cough

6

How else can inguinal hernia present?

Can also present as irreducible lump in groin or scrotum, which is firm and tender
This child can be unwell with irritability and vomiting

7

Can "irreducible" hernias be reduced

Most can be reduced with opoid analgesia and gentle compression
Then delay surgery for 24-48 hours to allow oedema to go down

8

What to do if hernia can't be reduced

Surgery is required as emergency because otherwise bowel can strangulate and can also damage the testis

9

Surgery to treat inguinal hernia

Ligation and division of hernial sac (processus vaginalis) via inguinal skin crease incision
Usually done as day case

10

What is a hydrocele?

If processus vaginalis is too narrow to allow bowel through to form an inguinal hernia then fluid can still track down it and go around testis to form hydrocele

11

Presentation of hydrocele symptomwise

Asymptomatic scrotal swelling. Usually bilateral and may be bluish
Can be tense or lax but non-tender and transilluminate

12

Presentation of hydrocele time wise

Some are evident at birth but some present in early childhood following viral or GI illness
Most will resolve spontaneously when PV continues to obliterate

13

Management of hydrocele

Most go automatically
Consider surgery if still present beyond 18-24 months of age

14

What is cryptorchidism?

Undescended testes

15

Incidence of undescended testes

4% of term male infants will have unilateral or bilateral undescended testes

16

When are undescended testes more common?

Preterm infants because descent through inguinal canal occurs in 3rd trimester

17

What can occur post birth with undescended testes?

Can continue to descend during early infancy and by 3 months of age 1.5% incidence

18

What can occur to a testes which was fully descended at birth?

Can ascend back into an inguinal position during childhood - will have late presentation of undescended or "ascended" testes

19

Examination of undescended testes?

In a warm room with warm hands - it is possible to bring testes into a palpable position by gently massaging contents of inguinal canal down

20

What is retractile testes?

Can be brought down but will be pulled back up into inguinal region by cremasteric muscle
With age testes will permenantly reside in scrotum

21

What is palpable testes?

Can be palpated in groin but cannot be manipulated into scrotum

22

What is impalpable testes?

No testis can be felt on examination - can be in inguinal canal, intra-abdominal or absent

23

Investigations for undescended testes?x 3

Ultrasound
Hormonal - testicular tissue if present will produce rise in serum testosterone after IM injection of HCG
Laparoscopy

24

Management of undescended testes?

Surgical placement of testis in scrotum - orchidopexy

25

Reasons for orchidopexy?

Fertility and malignancy risk
Also psychological

26

Fertility after orchidopexy?

After unilateral undescended testes is close to normal
But reduced to 50% if bilateral palpable undescended testes
If bilateral impalpable undescended testes - usually sterile

27

Malignancy after orchidopexy?

Risk is greatest for bilateral undescended testes - greatest risk for intraabdominal
Early orchidopexy for unilateral undescended testes reduces risk to almost normal

28

What is a varicocele?

Variscosities of testicular veins which can develop around puberty

29

Where are varicoceles normally?

On the left

30

Association of varicoceles

Associated with reduced fertility

31

When do you treat varicocele

If symptoms of dragging/aching, if impaired testicular growth or if infertility

32

Treatment of varicocele?

Obliteration of testicular veins by conventional surgery, laparoscopy or radiological embolisation

33

Causes of acute scrotal symptoms x5

Testicular torsion
Torsion of testicular appendage
Viral/bacterial epididymo-orchitis or epididymitis
Idiopathic scrotal oedema
Incarcerated inguinal hernia

34

When is testicular torsion most common?

In adolescents but can occur at any age

35

Presentation of testicular torsion

Pain - not always in scrotum but may be in groin or lower abdomen
Can get atypical presentation therefore suspect in any boy/young pain with inguinal/lower abdominal pain

36

Time for treatment of testicular torsion

Must be treated within 6-12 hours of onset to maintain testicular viability

37

Management of testicular torsion

Surgery with fixation of contralateral testis because can be anatomical predisposition to torsion - such as bell clapper testis where testis is not anchored properly

38

What sort of testis is associated with increased risk of torsion

Undescended testes - also at risk of confusion with incarcerated hernia

39

What is torsion of testicular appendage

Torsion of the hydratid of Morgagni which is an embroyological remnant on upper pole of testes

40

When does torsion of testicular appendage typically occur?

It typically occurs in boys just before puberty due to rapid enlargement of hydratid in response to hormones

41

Presentation of torsion of testicular appendage

Pain may increase over 1-2 days and occasionally torted hydratid can be seen or felt (blue dot sign)

42

Management of torsion of testicular appendage

Surgical exploration and excision of appendage

43

What can epididymitis be associated with

UTI

44

Presentation of idiopathic scrotal oedema

Painless bilateral scrotal swelling and redness in pre-school children

45

What is hypospadias?

Failure of urethral tubularisation leading to urethral opening not being in normal position on glans but instead being located proximally

46

Features of hypospadias?

Ventral urethral meatus
Hooded dorsal foreskin
Chordee - ventral curvature of penis shaft most apparent on erection (only marked in more severe forms)

47

Incidence of hypospadias

Common congenital abnormality
1 in 200 boys

48

Surgery for hypospadias

Often done before 2 years of age to correct penis for cosmetic and functional reasons

49

Foreskin retraction in developing penis

At birth foreskin is adherent to the glans
Adhesions separate over time making the foreskin eventually more mobile and retractable
At 1 year - 50% have non-retractable
At 4 years - 10% have non-retractable
At 16 years - 1%

50

Circumcision recommendations

Not recommended anywhere as routine neonatal procedure - only a few medical indications

51

3 medical indications for circumcision

Phimosis
Recurrent balanoposthitis
Recurrent UTI

52

What is phimosis?

Inability to retract foreskin - pathological not physiological
Will have whitish scarring of foreskin

53

What causes phimosis?

Localised skin disease known as balanitis xerotica obliterans - can also cause meatal stenosis

54

Age of phimosis?

Rare before age 5

55

What is balanoposthitis?

Redness and inflammation of foreskin and glans, sometimes with purulent discharge

56

Management of balanoposthitis?

If occurs once, common and can be treated with warm baths and antibiotics
If recurrent - uncommon and circumcision may be indicated

57

When is circumcision indicated with UTI

If upper urinary tract problems complicated by recurrent UTI's

58

What other than surgery can be used to help irritractable foreskin?

Topical corticosteroids to the prepuce to facilitate retraction

59

What is paraphimosis

Foreskin trapped in retracted position proximal to a swollen glans

60

Management of paraphimosis

Adequate analgesia to help reduce foreskin
Problem not usually recurrent

61

What are labial adhesions

Adhesions of labia minora in midline

62

Management of labial adhesions

If asymptomatic can be left alone and will often lyse spontaneously
If perineal soreness or urinary irritation - topical oestrogen 2x day for 1-2 weeks