Hypospadias 1:500 newborns urethral meatus opens on the ventral side of the penis,proximal to the glans may be associated w...
Hypospadias
- 1:500 newborns
- urethral meatus opens on the ventral side of the penis,proximal to the glans
- may be associated with chordee (ventral curvature of penile shaft),undescended testicles, inguinal hernia
- if severe, distinguish from ambiguous genitalia, and ruleout other GU abnormalities
- do not circumcise; foreskin used for surgical repair
Epispadias
o urethral meatus opens on the dorsum of the penis,at points along the glans and shaft
Phimosis
- inability to retract prepuce (persistent > 3 years of age)
- may be congenital or a consequence of inflammation
- if it is severe, requires circumcision or surgical enlargement of opening
Cryptorchidism
- arrested descent of testicles in natural path to scrotum (prepubic > ext inguinal ring > inguinal canal > abdominal)
- common (30%) in premies, 3-4% of full term babies
- most descend by 3 months; no spontaneous descent at > 1 year old
- sequelae: trauma (inguinal testes), torsion, malignancy (40x risk),infertility
- Differential: retractile, ectopic, atrophic testes, intersex state
- undescended testes: may palpate in inguinal canal but unable to milk down into scrotum
- retractile testes: parents may have seen them in scrotum, can milk them down with warm hands/warm room
- Investigations
• HCG stimulation test to induce descent, serum testosterone, U/S, CT, surgical exploration, karyotype - Treatment
• orchidoplexy by age 2 years, HCG sometimes tried
