Congenital:
Hypospadias: It may have other associated anomalies also. Children with this anomaly have abnormal placement of urethral orifice on the undersurface of penis and downward curvature of penis. Both anomalies are corrected in single surgery in most of the cases. Surgical reconstruction should be complete before school going age.
Epispadias : In this condition urethral orifice is on the upper surface of penis with upward curvature of penis. Management is by surgery and is usually staged.
Vaginal agenesis: In most of these patients uterus is rudimentary or absent. Most of the times condition is diagnosed at the time of puberty. Reconstruction of vagina is preferably done approximately one to two years before marriage is planned. Usually it is done by transferring split skin graft from thigh to the site of neo-vagina.
Ambiguous genitalia,
Chordee without hypospadias – In these children urethral opening is at the tip of penis but penis is curved downward. Cause of the problem is shortening of urethra along with presence fibrous tissue arround it. Management is by surgery and it is usually done in single stage.
Acquired:
  • Urethral stricture
  • Fistula
  • Penile or vaginal reconstruction -
  • Lymphoedema (Penis, Scrotum & Limbs) 33a, 34a, 35a, 36a, 37a
Apart from artery and vein our circulatory system consists of lymphatic vessels that run approximately parallel to blood vessels in superficial plane. These minute vessels start as blind conduits in peripheral areas. Main role of these is to carry away proteins and other substances that can’t be reabsorbed in venous capillaries. Approximately 2-4 lt. of lymph is carried in blood stream by these lymphatics daily. Lymph nodes are clustered in certain parts of the body in the path of lymphatics and act as filter for lymph.
Water along with certain nutrients, O2 and small amounts of plasma proteins are continuously filtered away from arterial capillaries in tissues and substances to be excreted are similarly taken back by venous capillaries. Plasma proteins and other large molecules that can’t be taken back by venous capillaries, seek its way through lymphatics. Blockage in the path of lymphatics by any means leads to stagnation of these lager molecules in peripheral tissues with consequent water accumulation and hence lymph edema. This may be congenital (absence of development or insufficiency) or acquired due to trauma, burn, infection, malignancy, radiotherapy etc. Substances that can’t be taken back because of this blockage or insufficiency, get pooled up in subcutaneous tissues and lead to swelling. It’s rich in plasma protein that forms coagulum, may act as substrate for thriving of bacteria and itself may lead to chronic tissue inflammation. Person gets repeated infections due to increased susceptibility that further accelerates lymphatic blockage and it may become a vicious cycle.
Causes
  • Congenital- Though congenital it may not manifest clinically for a variable age. It may be apparent in early childhood, after puberty or even in adulthood depending on severity of blockage
  • Acquired
  • Bacterial infection (Filariasis)
  • Malignancy-Surgical excision or Radiotherapy
  • Trauma, burn injury leading to extensive skin loss.
Treatment
  • Rest, Limb elevation
  • Physical decongestion by mechanical Methods, massage and elastic pressure garments
  • Surgery in selected cases
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