Urology

Question 1

Where does the deep ring lie

Answer 1

1/2 between ASIS and PS then slightly up

Question 2

Where does the superficial ring lie

Answer 2

Superior and medial to pubic tubercle

Question 3

What is the anatomy of the inguinal canal

Answer 3

Anterior = external oblique
Floor = inguinal ligament
Posterior = transverse abdominas

Question 4

What are the contents of the inguinal canal

Answer 4

Vas deferens or round ligament
Testicular artery and vein
Genitofemoral nerve
Ilioinguinal nerve

Question 5

What are indications for orchidopexy (moving a testcile)

Answer 5

Fertility
Malignancy
Trauma
Torsion
Cosmesis

Question 6

What does orchidopexy do

Answer 6

Deals with patent PV

In adults have to insert a mesh as hernia due to wear and tear

Question 7

What is patent processes vaginalis

Answer 7

Descends with testis and closes of deep ring
If big = hernia
If small= hydrocele

Question 8

What is an indirect inguinal hernia

Answer 8

Through deep ring in children

Most common

Question 9

What causes

Answer 9

Patent PPV

Question 10

What is a direct inguinal hernia

Answer 10

Pushes through defect in abdominal wall

Question 11

How does inguinal hernia present

Answer 11

Groin swelling 
SEPARATE from testis
CANT get above
Can reduce
Comes back when stand up or cough

Question 12

What are symptoms if incarcerates

Answer 12

Red 
Pain
Swelling
Vomit
Bloating

Question 13

When are inguinal hernia common

Answer 13

Pre-term

Question 14

How do you Dx

Answer 14

USS

Question 15

When do you do urgent surgery and why

Answer 15

If <1 as high risk of incarceration and strangulation

Question 16

What do you do if >1

Answer 16

Elective surgery

Question 17

What do you do if incarcerated

Answer 17

Reduce and repair

Question 18

How does a hydrocele form

Answer 18

Peritoneal fluid through deep ring due to PPV

Question 19

How does hydrocele present

Answer 19

Scrotal swelling
Painless 
Can't separate as fluid all around
Transilluminate
CAN"T reduce
Can feel above
Decreases lying flat and gets worse through the day

Question 20

How do you Dx and Rx

Answer 20

USS
Conservative until 5
Usually resolves

Question 21

What is cryptorchidism

Answer 21

Any testis that cannot be manipulated into bottom 1/2 of the scrotum

• FH
• LBW
• Premature
• SGA

Question 22

What are types of Cryptorchidism

Answer 22

True - between kidney and inguinal
Ectopic - abnormal place
Retractile - can massage intro scrotum
Ascending - as grow ascends up

Question 23

When do you consider referral

Answer 23

3 months

Question 24

When do you treat

Answer 24

Surgery if haven’t dropped by age 1

Question 25

What are risks of undescended testis

Answer 25

Infertility Torsion Testicular cancer Psychological

Question 26

What are definite indications for circumcision

Answer 26

BXO - chronic scarring/. lichen sclerosis of foreskin | Can't retract

Question 27

What are other indications

Answer 27

Religion Phismosis Recurrent balantits Paraphismosis

Question 28

What ae advantages

Answer 28

Malignancy UTI STI Sexual

Question 29

What are disadvantages

Answer 29

Pain Bleeding Stenosis Fistula

Question 30

How do you treat phismosis

Answer 30

Physiological if <2 Will retract Steroid cream Don't force as cause a scar

Question 31

When do you treat

Answer 31

>2 | Recurrent UTI / balanaprosthitis

Question 32

When should you never circumcise

Answer 32

If hydrospadia | Risk of stricture

Question 33

What does BXO lead to

Answer 33

Phismosis Stenosis Pain on urination and sex

Question 34

What is a hydrospadia

Answer 34

Uretral meatus on distal ventral aspect - Difficulty urine - Difficult sex

Question 35

What is associated with hydrospadia

Answer 35

Upper tract anomaly Ambigious genitalia Cryptochodism

Question 36

How do you Dx

Answer 36

USS

Question 37

How do you treat

Answer 37

Surgery before 2

Question 38

What can cause an acute scrotum

Answer 38

``` Torsion testi Torsion appendix testi Epididymitis Orchitis Trauma Haematocele Incarceration ```

Question 39

How does it present

Answer 39

Sudden onset pain Swelling Red or blue Hard Lop sided / Retracted testis but can be normal Autonomic - N+V / unwell Asbsent cresmater but can be present - scratch inner thy

Question 40

What increases risk of torsion

Answer 40

Bell clapper deformity

Question 41

How do you Dx

Answer 41

If torsion - don't USS as no time | Straight to theatre and fix BOTH testis

Question 42

Orchitis

Answer 42

Mumps serology