Pnp Pa Penis

Front 1

hypospadias

Back 1

**abnormally palaced meatus

**can cause infertility

Front 2

chordee w/ dorsal hood

Back 2

**crooked penis

• congenital downward curvature due to strand of connective tissue b/w urethral opening and the glands

• a/w hypospadias

Front 3

penile torsion

Back 3

• abnormal rotation of glands & urethral meatus

• most often counterclockwise

• not a/w functional abnormalities

• treatment reserved for rotation >60°

Front 4

buried penis

Back 4

• normally developed

• hidden beneath suprapubic fat pad; common in obese patients

• consequence of penile skin being inadequately anchored to deep fascia of penis

• a/w phimosis

Front 5

What is the best way to measure a buried penis?

Back 5

• use 10cc syringe

• OR push down suprapubic fat

Front 6

micropenis

Back 6

**results from interruption of penile growth after 14th week gestation

• first 3 months of gestation- initial phase of penile development resultss from hCG

• 4 mos-2 yrs- penis size (+) from testosterone

assessment--

• must stretch penis for length

• penis smaller than 2SD

• minimum of 2cm @ birth

• 1 inch @ one year f/u

Front 7

harriet lane

Back 7

**measured when flacid & stretched

Front 8

physiologic v. pathologic phimosis

Back 8

physiologic--

• foreskin has not complete normal separation from epithelium of glans penis

• treatment can include hydrocortisone

pathologic--

• can't be retracted after it has ben previously retractable

• OR when foreskin cannot be retracted after puberty

Front 9

paraphimosis

Back 9

• foreskin is retracted & remains in proximal of glands penis & can't be pulled forward

• can constrict penis & cause edema of the glans

Front 10

priaprism

Back 10

**prolonged penile erection; >4 hours

a/w--

• spinal cord trauma

• sickle cell disease

• leukemia

• pelvic tumor or infection

• penile tumor

Front 11

T/F. Priaprism is a urological emergency.

Back 11

True; needle is placed in corporal body to drain blood

Front 12

meatal stenosis

Back 12

**scarring & narrowing of urethral meatus

• delicate meatal edges lose superficial epithelial lining

• occurs following hypospadias surgery, urethral instrumentation, & circumcision

• narrow, high velocity urinal stream

• dysuria

Front 13

cathing boys

Back 13

1 yr- 5 french

1-6 yrs- 8 frnch

Front 14

testes assessment

Back 14

• stand to side

• ask patient to hold own penis

• explain procedure

• examine by grasping b/w thumb and first two digits

• epipdidymis should be palpable, soft, w/ smooth ridge posterolateral to testes

• testes should be same size

Front 15

vericoceles

Back 15

• usually L sided & not painful

• not found in children < 9 y/o

• if R sided, usually bilateral

• a/w elevated temp in scrotum & testes

• hallmark of testicular damage is testicle atrophy

Front 16

grading of vericocele

Back 16

**patient should be standing

• subclinical- not palpable or visible even w/ valsalva maneuver; demonstrable on dobbler

• grade 1- can only be palpable when patient valsalvas

• grade 2- nonvisible but palpable

• grade 3- palpable vericocele feels like bag of worms; visible distention

Front 17

testicular torsion

Back 17

• more common in newborn & early stages of puberty

• can occur perinatally if entire testis complex has not yet fused to scrotum >> testis, spermatic cord, and vaginalis twist en bloc

• need surgery; ER/OR within 4 hours

clinical presentation--

• erythema/blue discoloration of scrotum >> apears as asymptomatic swelling

• severe pain; can resolve spontaneously

• n/v

• child may c/o lower abdominal or inguinal pain due to embarassment

Front 18

cause of testicular torsion

Back 18

• bell clapper deformity caused by peritoneal investiture of testis lying on cord

• abnormal insertion of tunica vaginalis >> spermatic cord can twist

Front 19

testicular torsion diagnosis

Back 19

if suspect >> perform cremasteric reflex (-) >> urology will order US

Front 20

torsion of testicular appendages

Back 20

• more common in school age; 7-12 y/o

• appendix testes is mullerian duct remnant located @ superior pole of testes; when it becomes twisted >> similar to spermatic cord torsion

clinical presentation--

• mild to moderate gradual pain

• cremasteric reflex intact

• affected testicle is tender @ top superior pole

• blue dot sign

• as pain increases, physical findings become less specific

Front 21

urethritis

Back 21

**inflammation of urethra w/o concurrent bladder infection

Front 22

epididymitis

Back 22

prepubertal boys--

• a/w urinary tract anomaly

• if w/ UTI >> renal/bladder sonogram & bladder cystourethrogram to r/o structural problems

adolescents & young adults--

• r/t sexual activity

• does not present w/ UTI

Front 23

urethral stricture

Back 23

fibrotic narrowing of urethra caused by scarring

Front 24

bladder outlet obstruction

Back 24

• diminished force & caliber of urinary stream

• results from trauma or untreated/severe urethral infection

Front 25

cryptochidism

Back 25

**testicular maldescent

**testes usually descend into scrotum @ 36 weeks; if not descended by 1 year >> refer

risk groups--

• first born

• C-section

• low birth weight

• toxemia pregnancy

• hypospadia

• congenital subluxation of hip

• winter

Front 26

true v. ectopic cryptorchidism

Back 26

• risk of malignancy/infertility if left in abdomen

• examine in warm environment

• milk testes

Front 27

cryptorchid v. ectopic testes

Back 27

cryptorchid--

• descent arrested b/w normal pathway in its original abdominal location and scrotal position

ectopic--

• diverted from normal pathways

• gubernaculum testes has abnormal insertion point, e.g. suprapubic, penile, femoral, perineal, contralateral position

Front 28

cryptochidism hormones

Back 28

hCG IM, RSH, LH, and testosterone

>>if no increase in testosterone, no testes

Front 29

hernias

Back 29

• common in males, R side, premies

• iguinal & femoral hernias require surgery

Front 30

iguinal hernia

Back 30

due to failure of processus vaginalis to obliterate >> bowel forced into scrotum >> surgical repair

PE--

• suspect if child c/o intermittent groin swelling

• crying/older child raising arms >> prominent lump

• palpate testes

• put arms over head

Front 31

hydrocele

Back 31

• accumulation of peritoneal fluid inside patent process vaginalis

• a/w iguinal hernias

• transillumination reveals homogeneous glow w/o shadows

• usually resolves by one year

Front 32

communicating v. noncommunicating hydrocele

Back 32

communicating hydrocele--

• communicates w/ fluids of abdominal cavity

noncommunicating hydrocele--

• may be present @ birth or develop years later for no reason

• usually remains the same size, very slow growth

• needs surgical repair

Front 33

T/F. If varicocele is painful, patient should be reffered to urology.

Back 33

True

Front 34

examining the vagina

Back 34

two positions--

• supine frog leg

• knee chest

• pull down and out

• no speculum needed unless unknown bleeding; speculum reserved for sexually active

• physiological hymenal changes r/t pubertal development

• look @ anal area

• 2 openings; vaginal & urethral