Reproductive 2 Flashcards
(25 cards)
What is hypospadias?
Common congenital malformation with incorrect positioning of the urethral meatus due to failure of urethral folds and foreskin to fuse on ventral penis
The meatus may be located centrally (penile shaft), anteriorly/distally (glans/corona), or posteriorly/proximally (scrotum or perineum)
How may hypospadias present?
Abnormal foreskin - dorsal hood
Ventral penile curvature
Two meatal openings
Proximal hypospadias are associated with bifid scrotum and penoscrotal transposition
Associated with inguinal hernias and cryptorchidism
What is the management of hypospadias?
Significant displacement or symptomatic micturition may need surgery:
- Reconstruction of urethra, penis and scrotum at 6 months of age (urethroplasty / orthoplasty)
Severe cases require two stage repair with correction of penile curvature first followed by urethroplasty at least 6 months later
What are some complications of hypospadias repair?
Urethral fistula
Meatal stenosis
Urethral diverticulum
UTI
What is meatal stenosis?
Stenosis of the opening of the urethra at the external meatus
What is urethral diverticulum?
Distinct outpouching of the urethral mucosa that most frequently leads to dribbling, dysuria and dyspareunia
What is contraindicated in hypospadias?
Circumcision
What is cryptorchidism?
Failure of one or both testicles to descend to their natural position in the scrotum
What are possible variations of cryptorchidism?
Inguinal
Intra-abdo
Ascending
What is the management of cryptorchidism?
Surgery between 6-18 months
Orchidopexy - exposure and fastening of the testicle to the scrotum
If non-palpable, potentially therapeutic open or laparoscopic orchidopexy
What is acute abdomen?
Severe abdominal pain lasting for ≤ 5 days
List some genitourinary causes of an acute abdomen
Ruptured ectopic
Ovarian torsion
Testicular torsion
Acute pyelonephritis
How would a ruptured ectopic present (symptoms)?
Sudden severe lower abdo pain
Vaginal bleeding or amenorrhoea (or symptoms of pregnancy)
Lower abdo guarding / tenderness
Tachycadia
What signs may be noted on exam of a ruptured ectopic?
Cervical motion tenderness Closed cervix Enlarged uterus Lower abdo guarding / tenderness Hypotension Tachycardia
What investigations are diagnostic of a ruptured ectopic?
β-hCG
Transabdo / transvaginal US
What may a transabdo / transvaginal US
Free fluid in hepatorenal recess (pouch or Morison) or in recto-uterine pouch (pouch of douglas)
Emtpy uterine cavity
Thickened endometrial lining
Adnexal mass
Tubal ring sign (shows trophoblastic tissue = early pregnancy)
What could a sudden onset of unilateral lower abdo or pelvic pain in a woman suggest? What other feature may be present?
Ovarian torsion
N&V
Unilateral iliac fossa tenderness
What investigations should be done for ovarian torsion?
Pelvic / transvaginal US
Pelvic CT with IV contrast
What is fat necrosis of the breast?
Nonsuppurative inflammatory lesion affecting breast adipose tissue
How does fat necrosis of the breast present?
Irregularly defined and dense breast mass
Generally periareolar
Causes skin retraction, erythema or ecchymosis
What investigations may be done for fat necrosis of the breast?
Mammogram +/- US
What may be the shown on mammogram of fat necrosis of the breast?
Fluid filled cyst
Course rim calcification
If there is doubt about the findings on mammogram / US of fat necrosis of the breast, what should be performed? Why may you be alarmed?
May mimic breast cancer
Do biopsy
What does biopsy show on fat necrosis of the breast?
Foam cells
Multinucleatued giant cells
Hemosiderin (iron storage complex)
Chronic inflammation
