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UTI and Genitourinary Surgery - Coggle Diagram
UTI and Genitourinary Surgery
Cryptorchidism
Undecended Testis
Incidence
Term -> 3%-6%
Preterm -> 30%
6 Months -> 1%
Bilateral
10-25%
6% bilateral
Types
Palpable testis 80%
Ectopic
Retractile
Ascending testis
Inpalpable testis 20%
Intraabdominal or Canalicular: 50-60%
Abscent: 20%
Vanishing testis: 30%
Pathogenesis
Undescended testis are intrinsicly abnormal at birth
Associated Malformations
Epididymal anomalies
Abnormal ductal fusion
Flimsy attachment of hea of epididymis to testis
Complete separation or atresia of epididymis and atresia of the vas
Management
Palpable
Elective inguinal orchidopexy at 3months
Impalpable
Laparoscopy
Visualised in abdomen: Testis brought into scrotum
Blind ending vas and vessels / small testicular remnant → Implies tortion: Removal
Vas and vessel entering inguinal canal: groin exploration
Hypospadias
Incidence
1/150 - 300
Common with increasing incidence
Types
Glanular
Coronal
Subcoronal
Distal penile
Midshaft
Proximal penile
Penoscrotal
Scrotal
Perineal
Abnormalities
Abnormal position of urethral opening
Hooded foreskin
Chordee
Epidemiology
2x increase since 1968
White males
Familial
80% distal
Management
Surgery
Correction of penile curvature (chordee)
Reconstruction of urethra (urethroplasty)
Reconstruction / removal of foreskin
Phimosis
Phimosis is a narrowing of the opening of the foreskin,
preventing its full retraction
Diagnosis
After 2 yrs - all infants have narrow foreskin
Circumcision
Absolute indications
Balantis Xerotica Obliterans
Megaprepuce
UTI in presence of balanitis / phismosis
Relative Indications
Cultural
Phismosis / balanitis
Vesicoureteric Reflux
?
Most will grow out of it
Treatment
Antibiotic prophylaxis
STING
Ureteric reimplatation
UTI
Diagnosis
Gold Standard: MSU Midstream urine clean catch MC&S
Dipstick is 40% accurate
↑WCC
Symptomatic (temperature / vomiting)
Renal angle pain - pyelonephritis
Management
Treat infection then start investigating
Imaging
Renal Ultrasound
MCUG (micturating cystourethrogram)
DMSA
First UTI
50% have underlying pathology
At time of toilet training
Any UTI under 1 y/o -> Investigate
Under 1 yr female - monitor with further MSU
Over 1yr male and symptomatic - Investigate
Structural Causes
Vesicoureteric Relfux
Prophylactic abx
PUJ / VUJ Obstruction
Anderson-Hynes pyeloplasty
Renal damage
Under 6 months
Grade III-V reflux
Testicular Torsion
Management
Surgical emergency
Exploration!!!
Time sensitive - aim under 6 hrs
DDx
Tosion cyst of Morgagni - 2/3 of the time
Females
Imperforate hymen
Labial adhesions
Ovarian cysts
Newborn
Pubertal
Ovarian teratoma / cystadenoma
Ovarian torsion
