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Genitalia Flashcards

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1
Q

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

A

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

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2
Q

What sort on inguinal hernias do children get?

A

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

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3
Q

In whom are inguinal hernias more common?

A

Boys and preterm infants

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4
Q

Which side do inguinal hernias typically occur on?

A

Typically on the right side

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5
Q

How do inguinal hernias usually present?

A

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

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6
Q

How else can inguinal hernia present?

A

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

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7
Q

Can “irreducible” hernias be reduced

A

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

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8
Q

What to do if hernia can’t be reduced

A

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

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9
Q

Surgery to treat inguinal hernia

A

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

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10
Q

What is a hydrocele?

A

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

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11
Q

Presentation of hydrocele symptomwise

A

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

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12
Q

Presentation of hydrocele time wise

A

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

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13
Q

Management of hydrocele

A

Most go automatically

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

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14
Q

What is cryptorchidism?

A

Undescended testes

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15
Q

Incidence of undescended testes

A

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

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16
Q

When are undescended testes more common?

A

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

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17
Q

What can occur post birth with undescended testes?

A

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

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18
Q

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

A

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

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19
Q

Examination of undescended testes?

A

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

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20
Q

What is retractile testes?

A

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

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21
Q

What is palpable testes?

A

Can be palpated in groin but cannot be manipulated into scrotum

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22
Q

What is impalpable testes?

A

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

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23
Q

Investigations for undescended testes?x 3

A

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

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24
Q

Management of undescended testes?

A

Surgical placement of testis in scrotum - orchidopexy

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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

Paediatrics (16 decks)

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