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Flashcards in Genitalia Deck (62)
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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