Genital surgical disease

Phimosis
Phimosis(/fmoss/or/famoss/),
from theGreekphimos(["muzzle"]),
is a condition in males
foreskincannot be fully retracted over the
glans penis.
The term may also refer toclitoral
phimosisin women, whereby theclitoral
hoodcannot be retracted, limiting
exposure of theglans clitoridis.

Embryology
At birth, the inner layer of the
foreskinis sealed to theglans penis.
This attachment forms "early in fetal
development and provide[s] a
protective cocoon for the delicate
developing glans.
The foreskin is usually nonretractable in infancy and early
childhood.

 The tip of the foreskin is too narrow to pass

over theglans penis. This is normal in children
and adolescents.
2. The inner surface of the foreskin is fused
with the glans penis. This is normal in children
and adolescents but abnormal in adults.
3. Thefrenulumis too short to allow complete
retraction of the foreskin (a condition called
frenulum breve).

 Lichen sclerosus et atrophicus(thought to be

the same condition asbalanitis xerotica
obliterans) is regarded as a common (or even
the main)[21]cause of pathological phimosis.[\
chronic inflammation (such asbalanoposthitis
),
repeatedcatheterization, or forcible foreskin
retraction.[23]
untreated diabetics due to the presence of
glucose in their urine

 Physiologic phimosis, common in

boys 10 years of age and younger, is
normal, and does not require
intervention.Non-retractile foreskin
usually becomes retractable during
the course ofpuberty.

treatment

Treatment
Nonsurgical
Topicalsteroidcreams such asbetamethasone,
mometasone cortisone
Stretching of the foreskin can be accomplished
manually, with balloons[27]or with other tools.
Thetissue expansionpromotes the growth of
new skin cells to permanently expand the
narrowpreputial ringthat prevents retraction.
Beaug treatment - several hundred adolescents
with unusual masturbation advised them to
masturbate in the normal way

Surgical methods
Circumcisionis sometimes performed for
pathological phimosis, and is effective.
Dorsal slit(superincision) is a single
incision along the upper length of the
foreskin from the tip to the corona,
exposing the glans without removing any
tissue.
Ventral slit (subter incision)
Preputioplasty, in which a limited dorsal slit
done

complications
The most acute complication is
paraphimosis. In this condition, the glans
is swollen and painful, and the foreskin is
urinary retention
carcinoma of the penis.

Post operative complications.

Connection with HIV

Hydrocele
Ahydrocele(Br English:hydrocoele)
denotes apathologicalaccumulation
ofserous fluidin abody cavity.

Embryology
theprocessus vaginalis. Normally, the
communication between the processus
vaginalis and the peritoneum is obliterated,
and the
tunica vaginalisis the tissue that remains
overlying the testis and theepididymis.
Congenital hydrocele results when the
processus vaginalis remains patent,
allowing fluid from the peritoneum to
accumulate in the scrotum.

Diagnosis

A hydrocele feels like a small fluidfilled balloon inside thescrotum.

It is smooth, and is mainly in front
of the testis. Hydroceles vary
greatly in size.
Hydroceles are normally painless
and harmless.
Large hydroceles cause discomfort
because of their size.

problems
A hydrocele testis is not
generally thought to affect
fertility
Cosmesis
Mechanical problems in
micturition and intercourse
Infection(pyocele)
Trauma(Haematocele)

Treatment
If the hydrocele is not surgically
removed, it may continue to grow
aspiration, is less invasive but
recurrence rates are high.
Sclerotherapy, the injection of a
solution following aspiration done
repeatedly as the hydrocele recurs.
Fertility

Treatment
hydrocelectomy.
There are two surgical techniques available for
hydrocelectomy.
Hydrocelectomy with Excision of the
Hydrocele Sac:I
Incision of the hydrocele sac after complete
mobilization of the hydrocele.
edges are sewn together behind the spermatic
cord(Winkelmann's or Jaboulay's technique)
excision of the hydrocele sas is useful for large or
thick-walled hydroceles and multilocular hydroceles.

 The edge of the hydrocele sac is over

sewn for haemostasis (von Bergmann
's technique
Hydrocele Surgery with Plication
of the Hydrocele Sac:
The hydrocele is opened with a small
skin incision without further
preparation. The hydrocele sac is
reduced (plicated) by suture
Hydrocele surgery: Lord's technique.