X hits on this document

Word document

Pediatric Surgery (Pg 68-81) - page 30 / 33

127 views

0 shares

0 downloads

0 comments

30 / 33

Winter procedure – needle biopsy of corpora allowing communication to spongiosum --> draining blood

o

High flow: injury to vasculature  --> increased blood flow 2* vascular fistula

Corporal blood gas: low flow PO2 low; high flow PO2 high

Tx with embolizing vascular fistula

Phimosis: firbotic contracture of foreskin – prohibiting retraction of prepuce.

o

poor hygiene; DM.  Tx w/ improved hygiene and circumcision

Paraphimosis: mild prepuce contracture --> constricting band over coronal sulcus

o

Urologic EMERGENCY – compress glans and retract prepuce

o

if above fails --> incision of constriction.  Followed by circumcision

Peyronies Dz:

o

Scarring of tunica albuginea --> plaques on dorsal penile surface

o

Penile curvature --> sexual incapacitation

o

Immature phase: painful erection, progressive curvature, indurated plaque

SURGERY CONTAINDICATED DURING THIS PHASE

Vit E and Potaba or colchicine --> resolve spontaneously

o

If medical management fails – can correct curvature with surgery

o

Last resort = penile prosthesis!

Circumcision and Dorsal Slit:

Most common operation on males in US

Contraindications: myelodyplasia, hypospadias

newborn: no anesthesia just sugar  Adults: anesthesia  (is this ethical?)

procedure:

o

hemostats to crush ---> dorsal slit of foreskin (can stop here)

o

ventral incision made ---> redundant prepuce removed circumferentially after coronal sulcus viewed

o

mucosa and cutaneous surfaces approximated w/ absorbable sutures

Urethra:

Anatomy: Posterior = prostatic (transitional epi) + membranous urethra

Anterior = everything else – pseudostrat to stratified columnar

Paired bulbourehtral glands secrete preejac into bulbous urethra

Glands of Littre – secrete preejac into penile urethra

Female – urethra 4cm long.  Prox 1/3 = transitional rest = strat squamous

o

Periurethral glands of skene – empty into distal urethra

Trauma: usually blunt

o

Urethral injury suspected w/ blood @ meatus, inability to void, penile edema + ecchymosis

o

Eval: radiograph before catheterization

o

Tx: extravasation limited by Bucks fascia – urethral cath or suprapubic cystostomy

Urethral disruption: suprapubic tube x 3 mos ---> reconstruction

Malignant Dz:

o

Male urethral ca: rare!  >60y/o  80%= SCC

Tx: distal: partial -->total penectomy.  Proximal: urethrectomy + cystoprostatectomy

Document info
Document views127
Page views127
Page last viewedSun Jan 22 04:11:52 UTC 2017
Pages33
Paragraphs1668
Words11129

Comments