Урология - Hydronephrosis
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Clinical features
HISTORY
Age. – It is more commonly seen in young adults.
Climate. – It is more frequent and more troublesome in hot climates.
Type of individual. – Tall, thin men are more often affected than short and fat individuals.
SYMPTOMS
1.Small and symptomless varicocele occur in
1/4th of normal men.
2.When the vein become large, they may cause a vague, dragging sensation and pain in the scrotum or groin.
3.A few patients may present with subfertility.
Bilateral varicocele particularly can cause oligospermia and subfertility.
Local examinations
This condition should always be examined in the standing posture, as the varicocele disappears as the patient lies down.
On palpation the dilated veins typically feel like a ‘bag of worms’.
In long standing cases the testis becomes smaller and softer than its of the opposite side.
Treatment
1.Conservative treatment. No treatment is required unless the varicocele is thought to contribute to infertility or is painful or so
large as to disturb the patient.
2. Operative treatment.
Indications for operation are:
Varicocele is painful and is worrying the patient.
The varicocele is so big as to disturb the patient.
When varicocele contributes to infertility.
Surgical ligation
Operation of Ivanicevitch
Operation of Palomo
Operation of Yakovenko
Phimosis
When the orifice of prepuce (foreskin) is too small to permit its normal retraction over the glans penis, the condition is called phimosis.
In children upto 3 years the prepuce is normally adherent to the the glans penis, so that retraction of the prepuce may be difficult.
Etiology
1. Congenital
In these cases the prepucial orifice is narrow since birth.
In extreme cases the prepucial sac balloons out when the patient micturates and a weak thin stream of urine flows.
2. Acquired
Inflammatory
Phimosis may result from scarring following long standing inflamation of the glans (balanitis) or of the prepuce (posthitis) or a combination of both (balanoposthitis).
Traumatic
Occasionally a vigorous trauma to the prepuce may cause prepucial fibrosis resulting in narrowing of the opening of the prepuce.