module 5 Flashcards
(45 cards)
Phimosis/paraphimosis - Dx
a tight pinpoint opening of the foreskin with minimal ability to retract the foreskin; foreskin flat and effaced;
paraphimosis: retracted foreskin that cannot be reduced to normal position. On exam edema and bluish discoloration of the glans penis
phimosis - management
normal cleansing with gentle stretching of the foreskin until resistance is felt.
circumcision is indicated if urinary obstruction or infection is present.
Can apply 0.5% betamethasone twice daily for 2-4 weeks
Hydrocele - history and clinical findings
intermittent or constant bulge or lump in the scrotum,
scrotal size increased with activity and decreases with rest,
overlying skin may be tense,
no distress or vomiting
Hydrocele - PE
asymmetry/scrotal mass notes, swelling is usually unilateral,
testes descended, cremasteric mass present
slightly blue tinged, does not reduce
Hydrocele - Management
Noncommunicating hydrocele - no tx indicated unless uncomfortable or has persists for >1yr, fluid will absorb
Communicating: no tx unless persists for >1yr, then surgical intervention is required
cryptorchidism
testis that does not reside in or cannot be manipulated into the scrotum (undescended testicle)
retractile tesis
testis is out of the scrotum, but can be brought into the scrotum and remain there
Gliding testis
testis can be brought into the scrotum, but returns to high position once released
Ectopic testis
tesis that lies outside of the normal line of descent
Ascended tesis
tesis has fully descended, but has spontaneously reascended and lies outside the scrotum
cryptorchidism - history and risk factors
Testis that doesn’t reside in and cannot be manipulated into the scrotum. Family History, risk factors: prematurity, hypospadias, congenital hip subluxation, low birth weight, Down Syndrome, Klinefelter, other congenital endocrine, chromosomal, or intersex disorder
Trapped testis
testis that is dislocated after herniorrhaphy
cryptorchidism - management
goal= improve fertility outcome, decrease malignancy risk, and minimize psychological stress.
Surgical intervention 9-15 months old;
surgery at 6 months if orchiopexy is performed with skilled surgeon and anesthesiologist;
if testes remain undescended, refer to urologist at 6 mo
testicular torsion - Dx
UA is usually normal, pyuria and bacteriuria indicate UTI, epididymitis, or orchitis; doppler ultrasound or testicular flow scan if doppler u/s WNL and time allow
testicular torsion - PE
ill appearing and anxious, gradual, progressive swelling (unilateral),
“blue dot sign”,
elevation of testes worsens pain,
cremasteric reflex is absent on side with torsion
testicular torsion - management
surgical emergency
occasionally manual reduction can be done, but surgery should follow within 6-12 hours
Epididymitis - Dx
UA (pyuria and occasional bacteria may be present); CBC (elevated WBC count); urethral cx and gram stain; STI testing;
u/s to differentiate btn torsion;
If tests are neg, refer to urology
Epididymitis - Management
symptom relief and tx of causative organism
Scrotal or inguinal hernia Dx
Family Hx
swelling in inguinal area/scrotum that comes and goes and increases with crying.
Silk glove sign (a sensation of two surfaces rubbing against each other while one palpates the spermatic cord as it crosses the pubic tubercle.)
U/S
Scrotal or inguinal hernia Managment
attempt to reduce it, and refer to surgeon or urologist within 1-2 weeks; inguinal hernias do not self resolve.
If not reducible or ischemia, hospitalize patient;
Varicocele diagnosis
benign enlargement or dilation of testicular veins, painless, “bag of worms”; usually on left side,
may experience a dull ache or feeling of heaviness; collapses while lying and enlarges with the valsalva manuever;
U/S
Varicocele Management
grade I: u/s monitoring every 12 mo. If pain or change should be reported; grade II or III: refer to urologist or surgeon. Also refer if right sided or bilateral, testicular growth becomes retarded, or pain
Hypospadias diagnosis
urethral meatus is on the underside of the penis. Family hx; report of unusual direction of urine stream; other findings - inguinal hernia, or undescended testicle.
Hypospadias PE
dorsally hooded foreskin. It is essential to visualize the urethral meatus (pull downward and outward); described as glanular, coronal, subcoronal, penoscrotal, or scrotal AND distal (most common), mid penile, or proximal
