Hypospadias, Hydrocele, Cryptorchidism Ricci pp. 1562-1565; 1585

Hypospadias Urethral meatus underneath the glans or penis rather than midline. Problems with directing urinary stream, deposition of sperm, and self-esteem. Requires surgical reconstruction using foreskin. Children with hypospadias should not be circumcised.

Manifestations Meatus not midline Unusual urinary stream Look for chordee which causes pulling of shaft May have other conditions such as inguinal hernia, cryptorchidism, or hydrocele

Hypospadias

Chordee

Surgical Management The surgeon will use a small piece of foreskin or tissue from another site to create a tube that increases the length of the urethra. Extending the length of the urethra will allow it to open at the tip of the penis.

Surgical Management During surgery, the surgeon may place a catheter in the urethra to make it hold its new shape. The catheter may be sewn or fastened to the head of penis to keep it in place. It will be removed 1 - 2 weeks after surgery.

Hypospadias Repair

Postop Management Postop urinary stent or drainage tube TACCO drainage from tube and check patency Make sure penis is in upright position to avoid stress on urethral incision Check pressure dressing on penis Double diapering to allow for separation of urine and stool (p. 1563) and decrease chance of infection Antibiotics, antispasmodics, pain meds

Parental Education Catheter care Teach how to irrigate if mucus plug occurs S/S of infection No tub baths Quiet play No straddling activities

Hydrocele Fluid in scrotal sac Sac looks larger Sac is translucent Usually resolves spontaneously

Hydrocele

Hydrocele

Pathophysiology A hydrocele can develop in the womb. Normally, the testicles descend from the abdominal cavity into the scrotum. A sac (processus vaginalis) accompanies each testicle, allowing fluid to surround the testicles.

Pathophysiology In most cases, each sac closes and the fluid is absorbed. However, if the fluid remains after the sac closes, the condition is known as a noncommunicating hydrocele. Because the sac is closed, fluid can't flow back into the abdomen. Usually the fluid gets absorbed within a year.

Pathophysiology In some cases, however, the sac remains open. With this condition, known as communicating hydrocele, the sac can change size or, if the scrotal sac is compressed, fluid can flow back into the abdomen.

Surgical Repair If fluid does not reabsorb, surgery may be necessary.

Cryptorchidism Either one or both testicles have not descended during the 7th month of gestation. May be mechanical, hormonal, chromosomal, or enzymatic. If left untreated, can lead to sterility and testicular cancer.

Risk Factors and Manifestations Prematurity First-born child Cesarean birth LBW Hypospadias Exam reveals either one or no testicles in scrotal sac

Cryptorchidism

Locations of Undescended Testicles

Surgical Management An orchiopexy is the term for surgical correction An incision is made into the abdomen, the site of the undescended testicle, and another is made in the scrotum (A). The testis is detached from surrounding tissues (B) and pulled out of the abdominal incision attached to the spermatic cord (C). The testis is then pulled down into the scrotum (D) and stitched into place (E).

Orchiopexy