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YR5 Specialties > Paeds genitalia > Flashcards

Paeds genitalia Flashcards

1
Q

What is epididimo-orchitis?

A

inflammation +/- infection of the epididymis +/- testes resulting in pain + swelling.

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2
Q

Give 3 symptoms of epididimo-orchitis

A

UNIlateral testicular pain + swelling
+/- discharge
+/- dysuria

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3
Q

What is the most common cause of epididimo-orchitis in boys vs >14s?

A

Boys: urine refluxing into the vas deferens or UTI
>14s: STI, UTI, Mumps

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4
Q

What must be excluded when a patient presents with symptoms of epididimo-orchitis?

A

Testicular torsion

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5
Q

What sign is positive in epididimo-orchitis?

A

Prehn’s sign
Reduced pain when affected hemiscrotum is elevated

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6
Q

What investigations are performed for epididimo-orchitis?

A

Urinalysis + culture
NAAT of urethral swab for Chlamydia/ Gonorrhoea

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7
Q

What investigation can be used if history and physical examination cannot exclude torsion in suspected epididimo-orchitis?

A

Duplex USS scrotum

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8
Q

What is the treatment for epididimo-orchitis depending on suspected source?

A

UTI: Levofloxacin
STI: Ceftriaxone + Doxycycline

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9
Q

What is a hydrocele?

A

accumulation of fluid within the tunica vaginalis
Results in a scrotal swelling.

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10
Q

What are the 2 types of hydrocele?

A

communicating: patency of processus vaginalis allowing peritoneal fluid to drain into the scrotum.
non-communicating: excessive fluid production within the tunica vaginalis

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11
Q

Which type of hydrocele is commonly seen in newborn males?

A

Communicating
clinically apparent in 5-10%
usually resolve within first few months of life

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12
Q

Give 5 signs of hydrocele

A

Soft, non-tender swelling of hemi-scrotum.

Usually anterior to + below the testicle

Swelling confined to scrotum, you can get ‘above’ the mass on examination

Transilluminates with pen torch

Testis may be difficult to palpate if the hydrocele is large

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13
Q

What investigations are required for hydroceles?

A

Clinical Dx
USS if uncertainty or underlying testis can’t be palpated/ in adults to r/o tumour

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14
Q

What is the management of hydrocele?

A

Infantile hydroceles repaired if not spontaneously resolved at 1-2y

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15
Q

What is hypospadias?

A

congenital abnormality of the penis
3/1000 male babies
genetic element: further male babies 5-15% risk

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16
Q

What condition is hypospadias seen to be associated with in around 10% of boys?

A

Cryptorchidism

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17
Q

What 4 features characterise hypospadias?

A

Ventral urethral meatus
Hooded prepuce
Chordee (ventral curvature of the penis)
Urethral meatus may open more proximally in more severe variants (75% of openings are distally located)

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18
Q

What is the management for hypospadias?

A

Refer to specialist services
Corrective surgery at ~12-18m
AVOID circumcision: as foreskin may be used in the corrective procedure
If very distal disease, no tx may be needed.

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19
Q

What is paraphimosis?

A

inability to pull forward a retracted foreskin over the glans penis.
Urologic emergency

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20
Q

What is phimosis?

A

Inability to retract foreskin

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21
Q

What are the signs/ symptoms of paraphimosis?

A

progressive pain + swelling in glans/ distal prepuce
(constricting foreskin functions as a tourniquet)

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22
Q

Why is paraphimosis an emergency?

A

Untreated it can lead to penile ischaemia + worsening infection, inc. Fournier’s gangrene

23
Q

What is the management for phimosis?

A

NORMAL in babies + young boys
Most boys’ foreskins don’t retract before 5y
Foreskin may bulge/ balloon when they pee

24
Q

What is the management for paraphimosis?

A

Manual reduction after applying LA jelly as a lubricant + to relieve pain.
Difficult cases: dorsal slit should be made in the foreskin
Circumcision once oedema + inflammation have resolved.

25
Q

What reduction techniques may be used for paraphimosis?

A

Dextrose-soaked gauze/ ice pack to act as an osmotic effect, drawing fluid out of the glans, reducing oedema present

“Dundee Technique”: needle punctures into glans penis, squeezing the area to allow drainage of oedematous fluid, before attempting reduction

26
Q

What 6 symptoms may arise in phimosis?

A

Swelling + tenderness
Pain when peeing or a weak flow of pee
Haematuria
Frequent UTIs
Bleeding/ thick discharge from under foreskin/ unpleasant smell– signs of infection (balanitis)
Painful erections

27
Q

If symptomatic, what is the management for phimosis?

A

Topical steroids: soften foreskin
Abx if balanitis
Circumcision/ small cuts in the tip of the foreskin so it can be pulled back more easily (Preputioplasty)

28
Q

What is balanitis?

A

inflammation of the glans penis, usually due to infection that may be bacterial or fungal

29
Q

What is balanitis?

A

inflammation of the glans penis, usually due to infection that may be bacterial or fungal

30
Q

How should balanitis be treated?

A

Hygiene, inc. under foreskin (if not fixed) with saline washes
Short course Topical 1% hydrocortisone
If fungal: topical clotrimazole
If bacterial: flucloxacillin PO 7d

31
Q

What is testicular torsion?

A

twisting of the spermatic cord + its contents

32
Q

Describe the epidemiology of testicular torsion

A

Peak in neonatal period + 13-16y

33
Q

List 3 complications of testicular torsion

A

Testicular atrophy, ischaemia, + necrosis.
Sub-/infertility
Torsion of contralateral testis (40% risk if fixation of contralateral side not performed)

34
Q

Give 4 signs and symptoms of testicular torsion

A

Acute, severe unilateral scrotal pain + swelling
Pain may radiate to groin or lower abdo pain.
N+V
Tender testis retracted upwards. Skin may be reddened

35
Q

Which signs are positive in testicular torsion?

A

Pitting at testicular base: Ger +ve
Abnormally elevated: Deming +ve
Horizontal lie: Brunzel +ve

36
Q

Which signs are negative in testicular torsion?

A

No pain relief on elevation: Prehn’s -ve
No nodule: Blue-dot -ve
Loss of/ abnormal cremasteric reflex

37
Q

When is the blue dot sign seen?

A

Testicular appendix
Blue nodule 2-3mm

38
Q

What is the cremasteric reflex?

A

Stroking superior medial thigh stimulates
immediate contraction of cremaster muscle, elevating the testis on the side that has been stimulated.

39
Q

What is the management of testicular torsion?

A

Urgent surgical exploration
Analgesia + anti-emetics
Cord + testis untwisted + bilateral orchidopexy
If testis non-viable: orchidectomy

40
Q

Within what timeframe must surgical intervention be performed in testicular torsion?

A

6h

41
Q

What is cryptorchidism?

A

congenital absence of 1 or both testes in the scrotum due to a failure of the testes to descend during development.

42
Q

Give 4 risk factors for cryptorchidism

A

Prematurity
LBW
Having other abnormalities of genitalia (i.e. hypospadias)
1st degree relative with cryptorchidism.

43
Q

When is screening for cryptorchidism performed?

A

Within 72h of birth
At 6-8w check

44
Q

If there are bilateral undescended testes at birth, what is the management?

A

Urgent paediatric review within 24h for endocrine/ genetic testing
If disorder of sexual development excluded, + testis not present by 4-5m, ensure referral to be seen by urologist by 6m

45
Q

How should a unilateral undescended testicle at birth be managed?

A

At birth: review at 6-8w

At 6-8w: if fully descended, no further action. If unilateral, re-examine at 3m

At 3m, ensure referral to be seen by urologist by 6m.
If testis is retractile, advise annual follow up (due to risk of ascending testis).
If undescended, refer to paediatric surgery/ urology for definitive intervention

46
Q

When should definitive intervention for cryptorchidism be performed?

A

Before 12 months
(Orchidopexy)

47
Q

Name 2 syndromes associated with cryptorchidism

A

Prader willi
Kallmann’s

48
Q

Why should orchidopexy for cryptorchidism not be performed before 6m? And why should it be performed before 10y?

A

Not before 6/12 as testes may descend spontaneously during the first few months of life
Before 10y may protect against increased risk of testicular cancer a/w cryptorchidism.

49
Q

Give 3 complications of cryptorchidism

A

Increased risk of testicular torsion
Infertility (mainly if bilateral)
Increased risk testicular cancer

50
Q

What is labial fusion?

A

Partial labial fusion of the labia minora
Usually develops at 1-2y (cause unknown)
Common benign condition
Often resolves by puberty

51
Q

What is the management of labial fusion?

A

Asymptomatic: Reassure + f/u
Symptomatic: 4-6w topical oestrogen

52
Q

What symptoms can labial fusion cause?

A

Irritation
Terminal dribbling
Increased risk UTI

53
Q

What is a hydrocele?

A

Collection of fluid within tunica vaginalis

54
Q

What management is required for a hydrocele?

A

Often resolves spontaneously by 2y

YR5 Specialties (27 decks)

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