Common Pediatric Disorders- Villanueva Flashcards
When is recommended time to do surgery for undescended testicles?
after 6 mo.
Reason for surgery of undescended testicle
Fertility (Same fertility if unilateral, but bilateral is 50% fertility) and cancer risk.
When is the best time in life to do a scrotal exam
At birth
Most reliable way to identify an undescended testicle
1) Physical exam **
2) MRI
3) Scrotal US with doppler
4) Scrotal US
5) CT scan
Non palpable testicle has compensatory _________ >1.8cm. When kid has non palpable testicle must do a _________?
Hypertrophy, laparoscopy
Most hernias in kids are ____________ while in adults they are _______
Indirect, direct
Risks of hernias in kids
1) Incarceration (Premature 40%, overall 12%)
2) <10% can be redced
3) Bowel necrosis and strangulation is rare
2 types of hydroceles
1) Communicating: risks 2% hernias 0% incarceration. 85% spontaneous resolution by 18 mos.
2) Non-communicating: risks=nil
Febrile UTI characteristics
1) Younger child
2) Temp >38.5
3) Sick, back pain
4) Usually anatomic problem present
5) Workup: Renal US and in some a VCUG
Non-febrile UTI characteristics
1) Older child
2) No fever
3) No constitutional symptoms
4) Usually has dysfunctional elimination syndrome with normal anatomy
5) Work-up: KUB, voiding diary
What has surgical of vesicoureteral reflux been proven to decrease
1) Febrile UTIs- No other things
Antibiotic prophylaxis after a UTI decreases the risk of recurrent UTI by…
8%- Antibiotics can causes resistance in bowel flora
Classification of Hydronephrosis (SFU)
SFU 0= Normal SFU 1= Black (urine) at renal pelvis SFU 2= If you see calyces SFU 3= see all calyces SFU 4= Complete obstruction
Which children require immediate eval of hydronephrosis after birth
1) boy, history of oligodramnios (little amniotic fluid), bilateral grade 2 hydro
2) Girl, bilateral ureteroceles
3) Boy, bilateral grade 2 or more hydro
The diagnosis and treatment of vesicoureteral reflux in an asymptomatic child with prenatal hydro and no history of UTIs:
Has no proven benefits
Immediate postnatal evaluation
Bladder outlet obstruction, bilateral obstruction (SFU 4)
What is Mag 3
For SFU 3 and 4. Radiotracer study to show blockage
Causes of TRUE fecal incontinence (3)
1) Myelomeningocele
2) Hirshprung disease
3) Anorectal malformations
Cause of PSEUDO-fecal Incontinence
Due to constipation
Treatment of Encopresis
1) Desimpaction
2) Maintenance
3) Lifelong disease
Daytime urinary incontenence- what should you do?
In older kids consider Renal US to rule out neurogenic bladder, valves, anatomic problems
RX: Constipation, timed voiding and double voiding regimen
-Anticholinergics? (relax bladder)
Monosymptomatic nocturnal enuresis treatment
1) General measures (Restrict fluids, go to bathroom before bed)
2) Medicines (Don’t cure, and only 30% effective and <10% cure rate)
3) Bedwetting alarm (80% success)
How are labial adhesions treated?
1) Observation
2) Estrogen cream
3) Break adhesion surgically
What is the recommended care of an uncircumcised penis from age 0 to age 8
Once the foreskin becomes retractable, teach children to retract their own foreskin during voiding or bathing
-Phimosis- cannot retract foreskin
Soft penile adhesions involves what anatomically? What treatment is needed?
Do not involve the circumcision.
Disappear on their own without treatment
Penile bridge involves what anatomically? What treatment is needed?
Usually involve circumcision. Require surgical treatment
Hypospadius
Dorsal hood. Hole on VENTRAL side
