ERA UNIVERSITY / ERA COLLEGE OF NURSING

LESSON PLAN ON- CONGENITAL MALFORMATIONS

SUBMITTED TO: SUBMITTED BY

Firoz mam Ms. Shreya Sinha
Assistant Professor MSc. Nursing 1st Year
Era College of Nursing

Submitted on- 28 / 06 / 2021

 LESSON PLAN

 Subject : Medical Surgical Nursing

 Topic : Congenital Malformations (Male Reproductive System)
 Group : BSc. Nursing 2nd year students
 Size : 80 students
 Duration : 1 hour
 Date of presentation : 28 June 2021
 Place : BSc Nursing 2nd Year Classroom
 Name of student teacher : Ms. Shreya Sinha
 Name of the supervisor : Firoz mam
 Method of teaching : Lecture cum discussion
 Previous knowledge : The students are having basic knowledge regarding Congenital malformations.
General Objective:-
At the end of the class the students will gain knowledge regarding Congenital malformations. The students intellectual skills regarding
Congenital malformations will be increased, students will have positive attitude towards the management of Congenital malformations and
they will be able to provide the competent care to those suffering from Congenital malformations of male reproductive system.

Specific objective- At the end of the class the students will be able to-:
 Introduce Congenital malformations.
 Define Congenital malformations.
 Describe the types of congenital malformations of male reproductive system.
Sr.N TIME SPECIFIC CONTENT TEACHING A.VAIDS EVALAUTION
O OBJECTIVE LEARNING
ACTIVITY

1- 1min Self Self-Introduction:- -------------- -------- ------------

-Introduction Myself Shreya Sinha student from M. Sc. Nursing 1st year

2- 1min Announcemen Announcement of Topic:- ------------ ----------- ------------

t of the topic I am going to present the topic on “Congenital malformations.”

3- 2min Introduce Introduction: Teacher activity- PPT What is

Congenital Congenital malformations of the male reproductive system may Lecture cum Congenital
malformations. be the result of a clear disturbance in one stage of embryonic discussion. malformation?
development. There are extremely wide anatomical variations
and a large number of combinations of congenital Students activity-
malformations of the male genital tract. Listening.

4- 2min Define Definition Teacher activity- PPT What is the

Congenital Congenital malformations of the male genital tract is defined as Lecture cum definition of
malformations. deviations from normal anatomy resulting from embryonic mal discussion. Congenital
development of the genital tract. malformations?
Students activity-
Listening

5- 50min Describe the Congenital malformations in male genital tract: Teacher activity- PPT What are the
types of The congenital malformations in male genital tract are- Lecture cum types of
congenital  Phimosis discussion. congenital
malformations  Exstrophy of bladder and urethra malformations of
of male  Undescended testis (Cryptorchidism) Students activity- male
reproductive  Ambiguous genitalia Listening reproductive
system.  Hypospadiasis system?
 Epispadiasis

PHIMOSIS
Phimosis is the inability to withdraw the narrowed penile
foreskin behind the glans penis. It may appear as a tight ring or
“rubber band” of foreskin around the tip of the penis,
preventing full retraction.

Types:
Phimosis is divided into two forms-
1) Physiological Phimosis- almost all boys have a non-
retractile foreskin at birth. The inner foreskin is attached
to the glans. Foreskin adhesions break down and form
smegma pearls (white cysts under the foreskin), which
are then extruded. The foreskin does not retract before
the age of 2 years. The process of retractility is
spontaneous and does not require manipulation. This is
known as physiological phimosis.

2) Pathological Phimosis- It results from enthusiastic

attempts to retract foreskin in physiological phimosis
causing microtears, infection, and bleeding with
secondary scarring. Poor hygiene and recurrent balanitis
(infection of glans penis), posthisis (inflammation of
foreskin), or both could lead to difficulty in retraction of
foreskin and consequent true phimosis or pathological
phimosis.
Etiology:
 Congenital defect
 Yeast infection
 Poor hygiene
 Genetic
 Due to loss of skin elasticity and infrequent urination.
 Forceful retraction of the foreskin over the glans penis.

Clinical Features:
In physiologic phimosis-
 Non retractability of the foreskin.
 Ballooning during urination.

In pathologic phimosis-
 Pain
 Skin irritation
 Local infections
 Bleeding
 Dysuria
 Hematuria
 Frequent episodes of urinary tract infections
 Preputial pain
 Painful erection and intercourse
 Weak urinary stream
 Enuresis urinary retention

Diagnostic evaluation:
 History collection
 Physical examination
 A swab from the foreskin area to rule out bacterial
infections
  Urine culture
 Blood test

Management:
Management depends on age of child, type of non retraction,
severity of phimosis.
 Reassurance- Parents should be reassured on normalcy
of the condition in that age group. They should be
taught how to keep the foreskin and its undersurface
clean and hygienic. Normal washing with lukewarm
water and gentle retractions duting bathing and urination
makes the foreskin retractile over time.
 Topical corticosteroid therapy- The most common
corticosteroids used are hydrocortisone 2.5%,
betamethasone 0.05%, triamcinolone 0.01%, and
fluticasone propionate 0.05%. The ointment is massaged
into the affected areas twice daily for 6-8 weeks along
with manual stretching/ retraction twice daily.
 Surgery- Circumcision or surgical removal of foreskin
is usually performed. Other procedures may be needed,
including dorsal incision of the foreskin, release of
adhesions, divisions, of a short frenulum and
meatoplasty.

EXSTROPHY OF BLADDER AND URETHRA

Bladder exstrophy is a rare congenital malformation of the
bladder and urethra in which the bladder is turned inside out.

Clinical features:
 Absent anterior bladder wall and exposed bright red
posterior bladder.
  Seepage of urine onto the posterior bladder.
 Constant urine odor and skin excoriation.
 Ulcer of bladder mucosa
 Infection
 A flattened puborectal sling
 Separation of the pubic symphysis
 Shortening of the pubic ramii.
 External rotation of the pelvis.
 Females frequently have a displaced and narrowed
vaginal orifice, a bifid clitoris, and divergent labia.

Treatment:
 Modern staged repair of exstrophy (MSRE)- The
initial step is closure of the abdominal wall, often
requiring a pelvic osteotomy. At approximately 6
months of age, the patient then undergoes repair of the
epispadiasis after testosterone stimulation. Finally,
bladder neck repair usually occurs around the age of 4-5
years.
 Complete primary repair of exstrophy (CPRE)- The
bladder closure is combined with an epispadiasis repair,
in an effort to decrease costs and morbidity.

Nursing Management:
 Teach the parents to keep the bladder area clean, cover
it with sterile petrolatum gauze to prevent infection and
ulceration of mucosa.
 Apply a bland ointment around the bladder area to
protect against draining urine.
 Change the diaper frequently.
  Clean the stool immediately to prevent contamination.
 Avoid straining of stool to prevent rectal prolapse.
 Provide loose clothing to avoid pressure on the bladder
wall.
 Avoid immersing the infant during bath to prevent
contamination of bladder wall.
 Collect urine sample from the opening of the bladder
with a medicine dropper or a syringe.
 Provide routine postoperative care.
 Keep the abdominal dressing clean and dry.
 Prevent kinking of any drainage tubing,
 Teach the parents to identify signs of infection or other
complications.
 Reassure the parents with adequate information.
 Involve the parents in child care.

UNDESCENDED TESTIS (CRYPTORCHIDISM)

Cryptorchidism is derived from the greek word kryptos,
meaning hidden and, orchis, meaning testicle. Undescended
testes or cryptorchidism is the developmental defect
characterized by failure of one or both testes to descend through
the inguinal canal into the scrotum.
The testes begin their descent from abdominal
cavity between 32 and 36 weeks of gestation.
Etiology:
 Idiopathic
 Severely premature infants
 Environmental chemicals
 Diabetes and obesity in the mother
 Hypopituitarism
 Exposure to regular alcohol consumption during
 pregnancy.
 Family history of undescended testicle
 Associated syndrome- Down syndrome, Prader-willi
syndrome.

Clinical features:
 Testes not palpable in scrotum.
 Cremasteric reflex- The testes is pulled up from scrotum
into the inguinal canal or abdomen while examining in
cold room and testes can be coaxed back to scrotum by
sliding the fingers from the inguinal ring towards the
neck of the scrotum. This is possible in retracted testes
but not with undescended testes.

Diagnostic evaluation:
 Ultrasonography
 CT scan
 MRI

Management:
Since spontaneous descend is unusual after 1 year of age, the
optimum time for treatment is 1=2 years of age. Two types of
management are used. If the testes is below the external
inguinal ring, hormonal therapy with human chorionic
gonadotropin 250, 500, and 1000 units for 1 year, 1-5 year and
beyond 5 years, respectively are given twice a week for 5-6
weeks. If the testes is located inside the inguinal ring or in
ectopic position, orchiopexy is done. Contamination of
operative site is prevented by careful cleansing of stool and
urine. The traction attachment, which retains the testes in the
scrotum is removed after 5-7 days of surgery.
 AMBIGUOUS GENITALIA
Ambiguous genitalia (also known as atypical genitalia) is a
birth defect of sex organs that makes it unclear whether an
affected newborn is a girl or boy. This condition occurs
approximately once in every 4500 births. The baby seems to
have a mixture of both female and male parts- e.g., they may
have both vulva and testicles.

Etiology:
 Androgen insensitivity syndrome
 Congenital adrenal hyperplasia (CAH)
 Sex chromosome disorders- instead of having either XX
or XY sex chromosomes, a baby may have a mixture of
both (‘mosaic’ chromosomes); or specific genes on the
Y chromosome may be inactive; or one of the X
chromosomes may have a tiny Y segment attached to it.
 Maternal factor: An androgen-secreting tumor during
pregnancy.

Types:
 The baby has ovaries and testicles, and the external
genitals are neither clearly male nor female.
 The baby has ovaries and a penis-like structure or
phallus.
 The baby has undescended testes and external female
genitals including a vulva.
Clinical features:
Babies who are genetically female (with two X chromosomes)
may have-
 An enlarged clitoris, which may resemble a small penis.
 Closed labia, or labia that include folds and resemble a
scrotum.
 Lumps that feel like testes in the fused labia.

Babies who are genetically male (with one X and one Y

chromosome) may have-
 Hypospadiasis
 An abnormally small penis with the urethral opening
closer to the scrotum.
 The absence of one or both testicles in what appears to
be the scrotum.
 Undescended testicles and an empty scrotum that has
the appearance of a labia with or without a micropenis.

Diagnostic evaluation:
 History collection
 Physical examination
 Karyotyping
 Ultrasonography
 X-rays
 Hormonal assay
 Treatment:
 Parental counselling
 Surgery: An overly large clitoris may be trimmed, or a
fused vulva separated or undescended testicles relocated
into the scrotum.
 Hormone therapy

6- 1min ----- ----- -----

SUMMARY:
The term congenital malformation in male reproductive
system refers to a variety of structural disorders of the
reproductive tract that occur while the child is growing in the
womb. In this condition, we have seen about the introduction
of congenital malformation, definition, types of congenital
malformations in male reproductive system.
7- 1min ----- ---- ------
CONCLUSION:
Congenital malformations of genital tract are deviations from
normal anatomy resulting from embryonic mal development of
the male genital tract. Modern surgical techniques have
significantly reduced complication rates.
 BIBLIOGRAPHY

Book Referrences:
 Chintamani, Mani Mrinalini, “Lewis’s Medical Surgical Nursing” 2nd Edition, US Editors.
 Dutta Parul, “Textbook of Pediatric Nursing”, 4th Edition.
 McKinney Slone Emily, “Textbook of Maternal-Child Nursing”, Saunders Elsevier, Third Edition.
 Pal Panchali, “Textbook of Pediatric Nursing” Paras Medical Publisher, New Delhi.
 Suddarth’s & Brunner, “Textbook of Medical Surgical Nursing” 13th Edition, Wolters Kluwer.

Net Referrences:

 https://www.slideshare.net/mohamedjammal9/congenital-malformations-of-genital-organs
 https://www.slideshare.net/SantoshKumari11/reproductive-tract-anomalies-80135050
 https://www.slideshare.net/vahithaarun/congenital-abnormalities-of-reproductive-system

Journal Referrences:

 https://academic.oup.com/aje/article/187/4/656/4857204?login=true
 https://www.researchgate.net/publication/323243738_Congenital_Abnormalities_of_the_Male_Reproductive_System_and_Risk_
of_Autism_Spectrum_Disorders
 https://embryology.med.unsw.edu.au/embryology/index.php?title=Genital_System_-_Abnormalities&redirect=no/