Genitalia Disorders Flashcards
(16 cards)
Epididymo-orchitis admit to hospital if
Diabetes
Immunocompromised
Epididymo-orchitis management
Urgent assessment by sexual health specialist
Supportive - scrotal elevation
IV antibiotics and fluids needed if systemically unwell
Gonorrhoea or chlamydia - IM ceft and PO dox without waiting for results
Other - PO dox
Enteric - quinolone
STI epididymo-orchitis features
Under 35
More than one sexual partner in past year
Urethral discharge
Gonorrhoeal epididymo-orchitis features
Previous infection
Purport urethral discharge
MLM
Black ethnicity
Enteric organisms associated with UTI epididymo-orchitis features
Over 35
Low risk sexual history
History of penetrative anal sex
Recent catheterisation
Congenital hydrocele management
<2 yrs
Self limiting so observation unless bowel palpable in groin or not resolved by 1-2 years
Hydrocele of 2-11 management
If persists beyond 2 years - open repair
Otherwise laparoscopic
Hydrocele of 11-18 management
Idiopathic - observation, surgery if large or uncomfortable
Hydrocele after varicocelectomy - conservative, surgery if do not resolve
Filarial related (parasitic infection) - complete excision of tunica vaginalis
Hypospadias management
Surgery not mandatory - can be functional or cosmetic after 3 months
Aim is to allow boys to pee in a straight line and have a straight erection
Boys should not be circumcised before repair
10% associated with cryptorchidism
Paraphimosis feature
Foreskin of uncircumcised penis is retracted and left behind the glans penis, leading to vascular engorgement and oedema of distal glans
Paraphimosis management
With ischaemia or necrosis - emergency surgery
Acute without ischaemia or necrosis - manipulation with analgesia, if failed refer to urology for puncture technique, lastly surgical and circumcision
Chronic without ischaemia or necrosis - surgical, then circumcision
Testicular torsion presentation
Swollen, tender testis retracted upwards
Cremasteric reflex lost (stroke inner thigh, testis pulled up towards inguina)
Negative Prehn’s sign (elevating testis does not alleviate pain as opposed to epididymitis)
Testicular torsion management
Emergency surgical exploration
Morphine sulphate and odansetron supportive, other testicle fixed to posterior wall
Manual de-torsion if surgery not available in 6 hours
Crytorchidism urgent referral if
Possibility of disorder of sexual development - within 24 hours
Bilateral undescended at birth - within 24 hours
Bilateral undescended at 6-8 weeks - within 2 weeks
Unilateral cryptorchidism management
At birth - arrange review at 6-8 weeks
At 6-8 weeks - if both descended no further action, if unilateral re-examine at 4-5 months
At 4-5 months - if both descended no further action, if both in scrotum but one or two retractable advise annual follow up (risk of ascending testes), if still undescended refer to surgeon by 6 months
Cryptorchidism management
Surgery
Palpable - orchidopexy
Non-palpable - laparoscopic inguinal surgical exploration with subsequent orchidopexy (by 12 months) /orchidectomy (by 18 months)
