II Lecture Chapter 20 Short Answer: Testicular and Penile Surgery pp 442

What are the three stages of hypospadias repair?

1) Glanuplasty: involves meatoplasty 2) Chordee: release of chordee to straighten the penis 3) Urethroplasty: reconstruction of the urethra

What type of dressing is used postoperatively for a hydrocelectomy?

A fluff dressing is applied and for adult patients a scrotal support (jockstrap) is placed to keep the dressing in place and to keep light pressure on the surgical site to aid in preventing postoperative scrotal edema.

What is the cause of a hydrocele? How is the tissue layer secured to prevent a recurrence of the hydrocele?

A hydrocele is an abnormal accumulation of serous fluid around the testis contained within the tunical vaginalis. The fluid buildup is often the result of trauma or infection.

If the patient is Jewish, what else may need to be done for a circumcision?

Accommodations may need to be made to allow a Rabbi into the OR.

What area of the penis is filled to create an artificial erection?

Artificial erection is accomplished by injecting 0.9% saline into the corpus cavernosum to fill both corporal bodies.

What is the most common diagnosis for a circumcision at birth or later?

Circumcision is the removal of the prepuce. It is performed at the parents request, sometimes for religious reasons. It is performed to treat phimosis. Phimosis is the inability to retract the prepuce over the glans penis. It is attributed to a thin band of skin at the openings of the foreskin. Phimosis can be infantile or adult. It can be a painful condition that is often treated by performing a circumcision.

place the layers of the scrotum to the testicle in the correct order

Epidermis Dermis Subcutaneous tissue Dartos muscle External spermatic fascia Cremastric fascia Internal spermatic fascia Tunica vaginalis,

Compare and describe the difference between a hypospadias and epispadias.

Hypospadias and epispadias is a congenital condition of the urethra. Hypospadias: The urethral opening occurs on the underside (ventral) of the penis, anywhere along the penile shaft, on the corona, or on the perineum of the male or in the vagina of the female. The degree of chordee is determined by how proximal the urethral opening is located. Chordee is caused by fibrous bands that extend from the urethral opening to the tip of the glands. Epispadias is the developmental absence of the anterior wall of the urethra somewhere on the dorsum of the penis. Three types of epispadias: Banalic: dorsum Penile: shaft Penopubic: proximal ends

What is the normal incision site for an orchiopexy?

Inguinal oblique incision is made by using the #15 knife blade The inguinal canal is exposed by continuing the incision into the external oblique aponeurosis. The gubernaculum testis is dissected free from its attachments up to the level of the internal inguinal ring.

When a penile implant is inserted, it is essential that the implant is protected. What is done to protect the implant?

The surgical technologist should either establish an area on the back table for the implant or set up a separate Mayo stand. The implant must not come into contact with towels or drapes to avoid lint; additionally, the surgical team should thoroughly wash off the powder from gloves.

Describe the dilation process for insertion of the prosthesis.

The surgical technologist should help the surgeon in stating the size of the Hegar dilator when handing it to the surgeon; this will help the surgeon to remember to stop with the dilator that is 1 mm larger than the diameter of the implant.

Describe the dilation process for insertion of the implant.

The surgical technologist should help the surgeon in stating the size of the dilator when handing it to the surgeon; this will help the surgeon to remember to stop with the diameter that is 1 mm larger than the diameter of the implant. The needle is grasped with a needle holder and pulled through the glans, thus pulling the inflatable rod up into position for insertion. The suture is unthreaded from the Keith needle so it can be used for the next inflatable rod.

What is often associated with cryptorchidism?

This disorder is commonly associated with premature birth and often accompanied by an inguinal hernia.

Define "torsion." Why is a considered an emergency procedure?

Torsion of the testicle is a twisting of the spermatic cord that causes extreme pain. The spermatic cord contains the blood vessels that supply the testicles; twisting may reduce or obstruct the blood flow to the testicle, producing ischemia or necrosis. Immediate reduction must occur or the testicle may be permanently compromised.

What is used to accomplish a circumcision?

Placement of a bell-shaped device called a Plastibell over the glans (another device called the the Gomco is also frequently used). The foreskin is then pulled taut over the bell and the second part of the instrument is then placed over the foreskin and connected to the base of the bell. The device is tightened, trapping the skin in position. This serves a dual purpose: it compromises the blood supply to the foreskin and provides a protective surface for the surgeon to move the scalpel along as the foreskin is excised. The clamp is removed and sutures are placed if necessary. A frenulectomy (the removal of a frenulum, a small fold of tissue that prevents an organ in the body from moving too far) may be performed at this time. A nonadherent dressing is loosely applied to the distal penis allowing for urination and preventing irritation by the diaper. The parents should be instructed on how to care for the wound. Pain medication if needed may be administered if needed in the form of rectal suppository or oral liquid. Complete wound healing is expected within 7 to 10 days and no further care is necessary.

Describe the reason(s) for removal of both testicles. What additional care is needed if it is necessary to remove both testicles?

Radical orchiectomy, performed for testicular cancer, is the removal of the entire contents of the hemiscrotum, tunica vaginalis, and spermatic cord. If both testicles are removed, the patient will be required to be on testosterone hormone therapy for a lifetime.

What will be removed and what incision is used in a simple orchiectomy? A radical orchiectomy?

Radical orchiectomy, performed for testicular cancer, is the removal of the entire contents of the hemiscrotum, tunica vaginalis, and spermatic cord. Simple orchiectomy is the removal of the testicle and epididymis. Using a #15 knife blade, the surgeon makes an anterolateral scrotal incision. The incision is made through all layers of the scrotum and tunica vaginalis to expose the testicle. The testicle and spermatic cord are brought out through the incision. The surgeon incises the spermatic cord above the testicle. The structures within are identified and dissected free, and each section is doubly clamped, cut, and ligated with 0 or 1-0 nonabsorbable suture. The testicle is now free and removed.

Describe testicular cancer. What is done to treat it?

Testicular cancer is often first noticed during bathing or self examination. This aggressive type of cancer usually affects men between the ages of 20 and 40. Infants with cryptorchidism are at a higher risk for developing testicular cancer. Pain is not evident in the early stages of the disease.

Describe the preparation and use of the inserter for the implant.

The surgeon uses the Furlow inserter to measure the corporeal length. 3-0 absorbable sutures are placed along the incision of the tunica and tagged with mosquito clamps. The implant package is opened. The surgeon places a suture through a Keith needle and the needle is placed into the groove of the Furlow inserter. The Furlow inserter is is placed through the corporal tunnel and the plunger at the end of the inserter is pushed to puncture the glans with the Keith needle.