Hernias and Urology

Dr Mit Shah FY1

 Learning objectives

This session will cover:

Abdominal hernias
Differential diagnoses for scrotal lumps
Causes of haematuria
Acute urinary retention
Cancers testes, prostate
Prostate hyperplasia
Urinary calculi
Testes maldescent and torsion
Phimosis, paraphimosis and balanitis
Background
 Hernias
Abnormal protrusion of a viscus

Through the wall of the cavity that normally contains it.

Enclosed in a hernial sac.

Types of abdominal hernias:

Inguinal
Femoral
Incisional
Epigastric
Spigelian
 Understanding Inguinal
Canal
Inguinal canal represents an oblique passage taken
by the testis and spermatic cord (round ligament in
females)
 Inguinal Canal

Downwards and medially

4 cm long

Parallel and superior to inguinal ligament

Indirect and Direct inguinal
hernias
 How to clinically diagnose
inguinal hernias?

1. Can you get above it?

No (inguinoscoral hernia).

2. Next palpate over the superficial ring. Is there a cough

impulse? If yes this is a hernia.
3. Is the hernia reducible?
4. Is it direct or indirect? Palpate the deep ring with your
hand while the hernia is reduced and ask the patient to
cough.
Hernia will not appear if it is indirect
Hernia will appear if it is direct
 Management of
inguinal hernias
Elective
Open surgery
Laparoscopic repair
Often now done under local anaesthetic and as
day-case procedures

Urgent
Femoral hernias

Emergency
Strangulated hernias
 Hernias

Complications:
Strangulation
Bowel obstruction
Bowel ischaemia and necrosis
 Scrotal lumps

Write down differential diagnoses:

 Examination of the
scrotal lump

1. Can you get above it?

Yes

2. Is it part of the testis, or separate?

3. Is it cystic or solid?
Part and cystic hydrocele (will transilluminate)
Part and solid tumour, orchitis, granuloma
Separate and cystic Epididymal cyst
Separate and solid Epididymitis or orchitis
Ureteric calculi
Prostate Ca
Testicular Ca
Testes maldescent
and torsion
 Cases
Junior doctor scenarios
Clinical problem solving
Application of knowledge
 Case 1

50 year old Egyptian man presents to AAU

with haematuria.
What is you initial assessment and
management of this patient?
What is the most likely diagnosis given he is
from Egypt?
What investigations will he need?

Management?
 Haematuria

Types:
Visible
Non-visible

Other causes:
 Case 2

60 year old man on care of the elderly ward

admitted with pneumonia. Nursing staff call
the on-call evening FY1 report he has not
passed urine all day.
What is your approach to this patient?

Investigations?

Treatment?
 Urinary retention

Acute vs chronic

Causes of chronic urinary retention

Causes of acute urinary retention

Investigations

Management
 Case 3

The next day you are called by the nurse for

the same patient. The patient is
complaining of pain in his penis.
You examine and see this:

What is this condition and why

has the patient got it?
What is the treatment?
 Phimosis,
paraphimosis and
balanitis
Questions?