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121 Cards in this Set
- Front
- Back
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What are the common disorders of the penis?
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Hypospadias
Epispadius Dorsal chordee Buried Penis Meatal Stenosis Phimosis Paraphimosis Priapism |
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What is hypospadias?
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The meatus of the penis does not lie at the tip but along the shaft. Causes the urine to come out
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What is chordee with dorsal hood?
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Congenital downward curvature of the penis due to a strand of connective tissue between the urethral opening and the glands.
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Chordee is often associated with ___
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hypospadias
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The most common direction of penile torsion is ____
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counterclockwise
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Penile torsion is believed to be due primarily to abnormal ___ ___ and not to any structural abnormalities of the ___.
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skin attachments; corpora
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ToF: penile torsion is associated with functional abnormalities.
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FALSE!!
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In order for treatment to be given for penile torsion the angle of rotation must be > than ___ degrees
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60
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Describe isolated penile torsion.
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Penile development and the orientation of the corporal bodies and
corpus spongiosum are usually normal, although the median raphe is often noted to run obliquely up the shaft of the penis toward the urethral meatus. |
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What is penile torsion?
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abnormal rotation of the glans and urethral meatus
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ToF: a buried penis is not normally developed?
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False!
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Where is a buried penis located?
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hidden beneath the suprapubic fat pad
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Why does buried penis occur?
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Consequence of the penile skin being inadequately anchored to the deep fascia of the penis
-penile skin can slide up over the top of the penis and leave the penis buried in the suprapubic fat pad |
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What is buried penis often associated with?
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Phimosis, congenital (10%) or acquire (18%-42)
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when does the initial phase of penile development occur?
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first 3 months of gestation
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Which hormone is responsible for penile growth?
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placental hCG during the first 3 months of gestation
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Beginning at 4 months up to 2 years old, what hormone is responsible for penile growth?
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testosterone
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Describe the production of fetal and neonatal testosterone.
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Stimulated by luteinizing hormone (LH), which is in turn regulated by the hypothalamic production of gonadotropin- releasing hormone (GnRH).
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Micropenis result from an ____ in penile growth sometime after the ___ week of gestation.
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interruption; fourteenth
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The minimum size of the penis at birth is ___
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2cm
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In micropenis, the penis is smaller than ___ standard deviations from he mean
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2
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What is the mean penis size in centimeters with one standard deviation.
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3.9cm +/- 0.8 cm
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What is the mean penis size in adults
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13.3 cm +/- 1.3 cm
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What is physiologic phimosis?
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Foreskin has not complete the normal separation from he epithelium o the glans penis
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Describe pathologic phimosis
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Foreskin can't be retracted after it has been previously retractable or when the foreskin cannot be retracted after puberty
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What is paraphimosis?
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foreskin is retracted and remains proximal to the glans penis
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What can paraphimosis cause?
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can constrict the penis and cause edema of the glans
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What is priapism?
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uncommon condition of prolonged penile erection
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What is priapism associated with?
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-spinal cord trauma
-sickle cell disease -leukemia -pelvic tumors or infection -penile trauma - |
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ToF: priapism is a urologic emergency?
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true
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What is a bifib scrotum?>
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The scrotum is separated into to places and is often associated with renal abnormalities
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ToF: meatal stenosis is a congenital problem?
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False: it is an acquired problem in bodys
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What occurs in meatal stenosis?
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Delicate meatal edges lose superficial epithelial lining and adhere to ventral side and pinpoint the meatus
-scarring and narrowing of the urethral meatus |
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What is the most common cause of meatal stenosis?
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occurs following hypospadias surgery, urethral instrumentation, and long term complication of circumcision.
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Meatal stenosis has been found to affect as many as __% of boys by age 4.
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10
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What is the clinical presentation of meatal stenosis?
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-Narrow, high velocity urinary stream
-UPward urinary stream -dysuria |
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What is the best way to examine the testes?
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Thetestisisbestexaminedby grasping it between the thumb and the first two digits.
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ToF: the testes are normally different sizes.
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False: normally the same size
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ToF: the epididymis is not usually palpable.
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FALSE: it should be a soft, smooth ridge posterolateral to the testes
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What are the disorders of the testes and the epididymis?
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-Varicocele
-Cryptorchidism -Ectopy -Torsion of the testes |
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What occurs in a meatal bridge?
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the child has a duplicate stream when they urinate
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What is the name of the reflex that is elicited when the HCP runs her thumb up the inner thigh towards to the groin and the testes move upward
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Cremisteric reflex
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Varicoceles are common in males with ___sided varicoceles approaching __-% of all adult males
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left; 85
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ToF: varicocele has been linked to infertility.
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TRUE: 1/3 of all males evaluated for infertility have a varicocele
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ToF: Varicocele are a common finding in young boys?
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False! Not seen under age 9
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If a varicocele is found on the right side, what should occur?
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It should then be bilateral
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What must a child under 9 be worked up for if a varicocele is found?
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pelvic tumor
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A palpable ___ sided varicocele occur in __% to __% of all cases
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left; 85-90
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Clinically, the varicoocele is associated with elevated ___ in the scrotum and testes
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temperature
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What is the hallmark of testicular damage in the adolescent with varicocele?
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testicular atrophy
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Describe a grade 3 varicocele.
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while standing: Palpable varicocele feels like a bag of worms- visible distention: (Palpable and visible at rest)
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if a varicocele is not visible but palpable, what is its grade?
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22
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If the patient performs a valsalva maneuever and a varicocele is felt, what is the grade
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grade 1
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A varicocele that is Not palpable or visible even with Valsalva maneuver but domonstrable on Doppler is said to be in the __ stage
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subclinical
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What is a hydrocele?
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colleciton of fluid around the testicle
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When is testicular torsion most common?
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during the newborn period or early stages of puberty
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Of all the cases of testicular torsion, 2/3s occur in ages __ to __
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12 to 18
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Testicular torsion is caused by a deformity in the __ __ and the testicles lack a normal attachment to the __ __
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bell clapper; tunica vaginalis
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What is the intravaginal torsion?
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the testes hang freely due to the deformity of the bell-clapper ang the thus the spermatic cord can twist within the tunica vaginalis
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What causes extravaginal torsion?
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Testicular torsion that occurs perinatally if the entire testis complex has not yet fused to the scrotum.
-the testis, spermatic cord and tunica vaginalis twist en bloc. |
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What is the clinical presentation of extravaginal torsion?
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asymptomatic swelling of the scrotum.
-erythema or bluish discoloration of the scrotum is also frequently seen |
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ToF: the cremasteric reflex is not affect in testicular torsion?
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FALSE: it disappears
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What are the key history points found for a child with general testicular torsion?
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Severe pain of abrupt onset Nausea and vomiting
Child may complain of lower abdominal pain or inguinal pain due to embarrassment History of acute pain which resolved spontaneously may indicate testicular torsion that has resolved |
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the incidence of torsion of testicular appendage is more common in prepubertal boys ages __ to ___
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7 to 12
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The appendix testes is a ___ ___ remnant located at the ___ pole of the testes
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mullerian duct; superior
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The epididymal appendix is located on the head of the epididymis is a ___ ___remnant
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wolffian duct
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What caues testicular torsion of the appendage occur?
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When either appendage (appendix testes and/or epididymal appendix) becomes twisted the testicle will produce similar to spermatic cord torsion
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Describe the pain associated with torsion of the testicular appendage?
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milde to moderate pain that gradually develops over a few days
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___% of the normal boys from 30 months to __ years with torsion of the testicular appendage had an intact cremasteric relfex.
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100!!!; 12
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The affected testicle in torsion of the testicular appendage is tender at the ____
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top of the superior pole
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What is the blue dot sign? WHat is it a symptom of>
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small bluish discoloration of over the superior pole of the testicle.
Is common in torsion of the testicular appedage |
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ToF: as the pain of torsion of the testicular appendage increases, the physical findings become more specific.
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FALSE! they become less because the scrotum swelling increases
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What is the common treatment for torsion of the testicular appendage?
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Testicular elevation and rest
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What is urethritis?
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Inflammatory process of the urethra without a concurrent bladder infection that is usually but not always caused by sexually transmitted microorganism
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The most common cause of the urethritis is ___
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Sexually transmitted microorganism: chlamydia or gonorrhea
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ToF: epididymitis in adolescents usually presents with a UTI
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FALSE
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What is the common cause of epididymitis?
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usually related to sexual activity and seen in adolescents and young adults
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ToF: in prepubertal boys, epididymitis is almost always associated with urinary tract anomaly?
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TRUE
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What is the recommendation for any episode of epididymitis and UTI in males
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Investigation: renal/bladder sonogram and a voiding cystourethrogram to rule out structural problems
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What are fibrotic narrowings of the urethra caused by scarring?
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Urethral strictures
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What occurs with bladder outlet obstruction?
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diminished force and caliber of the urinary stream
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What are the major causes of the urethral strictures and bladder outlet obstruction?
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trauma or untreated or severe urethral infections
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what is cryptorchidism?
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condition of testicular maldescent
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What baby boys are found to more commonly suffer from cryptorchidism?
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First born
C-section Toxemia of pregnancy Hypospadia Congenital subluxation of hip Low birth weight Winter |
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ToF: cryptorchidism is not a common disorder?
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FALSE!
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__% of full terms males have cryptorchidism.
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3
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Up to 30% of the __ week preemies have cryptorchidism.
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30
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At what age do the testes usually descend by?
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6 months
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Why must the HCP ensure that the testes descend in a timely manner?
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There is a risk of malignancy and infertility if they are left in the abdomen
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How should a HCP get the testes into the scrotum?
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Milk testis from above internal inguinal canal downward. Some are retractile and can be milked into scrotum.
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What can occur with the testes of boys after the 7th month?
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they travel from the abdomen through the inguinal ring
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What causes the testes to move from the abdomen through the inguinal ring after the 7th month?
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the endocrinologic effect on the gubernaculum testis
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What is the gubernaculum?
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A fetal ligament that connects the testes and the scrotal sac
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In cryptocrchidism, the __ receptor on the gubernaculum and __ nerve are interrupted in some way.
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androgen; genitofemoral
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What is an A cryptorchid testis?
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A testis whose descent has been arrested between the normal pathway in its original abdominal location and scrotal position
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A testicle that has been diverted from a normal pathway to a location outside that which a normal testis travels is called an __ ___
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ectopic testes
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In an ectopic testes, the gubernaculum has an abnormal insertion point that may be in the ...
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-suprapubic
-penile -femoral -perineal -least common contralateral position |
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What the the preferred treatment for patient with no testes?
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-hCG IM for 4 days, RSH, LH and testosterone before day 4.
-if no increase in testosterone, there are no testes --> refer to surgery |
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What is the common age range to find male cancer of the testes>
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15- 35
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ToF: hernias are common.
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TRUE
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What is the incidence of hernias?
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10-20: 1000 live births
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Which sex has the highest incidence of hernias?
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Males > females 6:1
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Which side is the most common to find hernias>
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Right side: 44-70%
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What % of hernias become incarcerated?
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12-17
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ToF: All inguinal hernias must get referred, even without incarceration.
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TRUE
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Inguinal hernia should be suspected in a child who has a history of __ ___ ___
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intermittent groin swelling.
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WHat are the history findings for an inguinal hernia?
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“Lump” is seen when
crying Comes and goes |
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Inguinal hernias are due to failure of the ...
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failure of processus vaginalis to obliterate
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ToF: umbilical hernias are almost always benign
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TRUE
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• Normally the testicle is situated in a sac that surrounds the testicles called the ___ ___
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'processus vaginalis
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What is a hydrocele?
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Accumulation of peritoneal fluid inside patent process vaginalis
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What % of newborns are have hyrdocele?
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6
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ToF: hydroceles always occur with a hernia
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FALSE: can occur ALONE or with a herina
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How can a hydrocele be seen?
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Transilluminationrevealsa homogeneous glow without shadows
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When, if ever, does a hydrocele resolve?
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by 1 year
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What causes a communicating hydrocele
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failure of the processus vaginalis (the thin membrane that extends through the inguinal canal and descends into the scrotum) to close completely during prenatal development.
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IF the processus vaginalis remains open, there is a potential for both a __ and a __ to develop
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hernia and hydrocele
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What type of hydrocele might be present at birth or develop years later for no reason, has slow growth and may need surgical repair?
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non-communicating hydrocele
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What are the important aspects to examine for a female child in the genital exam?
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Examine in two different positions
No speculum needed unless unknown bleeding Be aware of physiological hymenal changes related to pubertal development Look at anal area |
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where in relation to the testes does a non-communicating hydrocele occur?
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above the testes
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What is the best position to examine a young girl's genital area?
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Supine-knee to chest position with underwear still on.
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