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Pediatric Surgery (Pg 68-81) - page 31 / 33

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Female Urethra ca: only GU malignancy F>M.

fungating papillary mass, bleeding

local extension --> vagina, bladder common

noninvasive distal: Squamous CC; Tx w/ urethrectomy

Promximal or panureteral involvement:  Tx w/ Chemo + Rad + Excision

Urethral Strictures: usually caused by straddle injury

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Obstructive voiding --> UTI

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Eval: if catheter cannot pass:  Eval w/ retrograde urethrogram +voiding cystourethrogram.  If cath passes, no stricture

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Tx: short discrete stricture: dilation.

Long/recurrent stricture – open urethral reconstruction (cure rate 98%)

Congenital Disorders:

Posterior Urethral Valves:

Paired folds of mucosa from prostatic -->membranous urethra which cause obstruction

Dx: usually by antenatal US, or by poor urinary stream

Tx: Catheter or supapubic tube until can endoscopically ablate the valves

Hypospadias: 1 in 300 incidence.  External urethra on ventral surface

Classified by loc’n: perineal, penoscrotal, shaft, etc.

Corpus spongiosum turns into fibrous bands distally causing ventral penile curvature

Perineal hypospadias may be difficult to assign gender

Tx: usually before age 2.  Stop curvature; bridge urethral gap

Infectious Dz:

Gonooccal Urethritis: incubation period 2-14d. N.gonorrhae

Yellow discharge, dysuria, itching, frequency

25% asymptomatic reservoirs

Dx: swab of urethra culture in Thayer Martin Medium (maybe oral/anal swabs too)

Tx: Ceftriaxone if suspicion

Non-Gon Urethritis: dysuria, frequency, itching, clear/white discharge

Chlamydia = most common

Dx: urethral swab

Tx: azithromycin

If Urethritis, treat for both Gon and Non Gon w/ a combo of Azithro + Ceftriaxone

Testes: mesoderm, descend by gubernacular ligament in the 8th month of gestation

Cremaster muscle = internal oblique extension

Congenital Disorders:

Cryptorchidism: nonpalpable testicle – high incidence w/ premies

Anorchia: prenatal torsion, rarely agenesis; usually unilateral:  2nd testicle hypertrophies to compensate and normal fertility and hormones:

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if bilaleral: hormone replacement starting @ puberty

Retractile: overactive cremaster muscle; usually descend @ puberty

Undescended: usually just inside internal inguinal ring

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HCG stimulation --> increased testosterone but if not, intersexuality questioned

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