EAU Pediatrics 2021 Rapid Flashcards
Treatment for phimosis usually starts: ___
After two years of age or according to caregivers’ preference
Primary phimosis: conservative 1st line treatment with 80% success rate:
3rd generation corticoid ointment or cream
Offer ___ or ___ to treat primary symptomatic PHIMOSIS.
Corticoid ointment or cream
OR Circumcision
Treat primary phimosis in patients with ____.
recurrent urinary tract infection and/or with urinary tract abnormalities.
Circumcise phimotic patients in case of ___.
lichen sclerosus or scarred phimosis.
Treat paraphimosis by ___.
manual reposition and proceed to surgery if it fails.
Phimosis: Avoid retraction of ___.
asymptomatic preputial adhesions.
Classification of Undescended Testis
Palpable
- Inguinal
- Ectopic
- Retractile
Non-palpable
- Inguinal
- Ectopic
- Intraabdominal
- Absent: (1) agenesis (2) vanishing
Unilateral NON-palpable testis –> EUA (always) –> PALPABLE
Standard orchidopexy
Unilateral NON-palpable testis –> EUA (always) –> NON-PALPABLE
Inguinal Exploration with possible lap
OR
Diagnostic Lap
- Testis close to internal ring –> LAP or inguinal orchidopexy
- Testis too high for orchidopexy –> Staged Fowler-Stephens procedure
- Blind-ending spermatic vessels –> vanishing testis no further steps
- Spermatic vessels enter inguinal ring –> inguinal exploration
An undescended testis justifies treatment early in life to ____.
A failed or delayed orchidopexy may increase ___.
The earlier the treatment, the ___.
avoid loss of spermatogenic potential.
the risk of testicular malignancy later in life.
lower the risk of impaired fertility and testicular cancer.
In unilateral undescended testis, fertility rate is ___ whereas paternity rate is ___.
fertility - reduced
paternity - NOT reduced
In bilateral undescended testes, fertility and paternity rates are ___
BOTH impaired.
The treatment of choice for undescended testis is ___.
There is no consensus on the use of ___.
surgical replacement in the scrotum.
hormonal treatment.
The palpable testis is usually treated surgically using ___.
an inguinal approach.
Do not offer ___ for retractile testes instead ___.
medical or surgical treatment
undertake close follow-up on a yearly basis until puberty.
Perform surgical orchidolysis and orchidopexy before the age of ___.
TWELVE months, and by EIGHTEEN months at the latest.
Evaluate male neonates with ___ for possible ____.
bilateral non-palpable testes
disorders of sex development.
Perform a ____ to locate an intra-abdominal testicle.
diagnostic laparoscopy
Hormonal therapy in unilateral undescended testes is ___ for future paternity.
of NO BENEFIT
Offer ___ treatment in case of bilateral undescended testes.
Endocrine treatment
Inform the patient/caregivers about the ___with an undescended testis in a post-pubertal boy or older and discuss ___.
increased risk of a later malignancy
removal in case of a contralateral normal testis in a scrotal position.
Testicular tumours in prepubertal boys have a ___.
lower incidence and a different histologic distribution 2a compared to the adolescent and adult patients.
In prepubertal boys up to 60-75% of testicular tumours are ___.
benign.
Testicular Tumors
___ should be performed to confirm the diagnosis.
High-resolution ultrasound (7.5 – 12.5 MHz), preferably a doppler ultrasound,
Testicular Tumors
___ should be determined in prepubertal boys with a testicular tumour before surgery.
Alpha-fetoprotein
Testicular Tumors
____, but not as an emergency operation.
Surgical exploration should be done with the option for frozen section
Testicular Tumors
Organ-preserving surgery should be performed in ___.
all benign tumours.
Testicular Tumors:
___ should only be performed in patients with a malignant tumour to exclude metastases.
Staging (MRI abdomen/CT chest)
Testicular Tumors:
___ should only be performed in patients with the potential malignant Leydig or Sertoli-cell-tumours to rule out lymph node enlargement.
Magnetic resonance imaging
Testicular Tumors:
Patients with a non-organ confined tumour should be ___.
Referred to paediatric oncologists post-operatively.
HYDROCELE
In the majority of infants, ___ is not indicated within the first twelve months due to the tendency for ___. Little risk is taken by initial observation as progression to hernia is rare.
surgical treatment of hydrocele
spontaneous resolution.
HYDROCELE
In the paediatric age group, an operation would generally involve ___
ligation of the patent processus vaginalis via inguinal incision.
HYDROCELE
In the majority of infants, ___ prior to considering surgical treatment.
observe hydrocele for twelve months
HYDROCELE
Perform early surgery if ___
there is suspicion of a concomitant inguinal hernia or underlying testicular pathology.
HYDROCELE
Perform a scrotal ultrasound in case of ___
doubt about the character of an intrascrotal mass.
HYDROCELE
Do not use ___ because of the risk for chemical peritonitis.
sclerosing agents
Child ≥ 5 years nocturnal enuresis
Detailed questions for day-time symptoms Physical exam and urinanalysis 2 days day-time voiding and drinking diary 2 weeks night-time urine production recording (= weight night-time diapers + morning first voided volume) Upon indication • Urine microscopy • Uroflow- metry • Ultrasound • ENT referral • Psychologist referral
Supportive measures (not a treatment) (max 4 weeks) • Normaland regular drinking habits • Regular voiding and bowel habits • Monitor night-time production (weight diapers)
Child + caregivers seek a treatment --Nocturnal enuresis wetting alarm treatment with regular follow-up --desmopressin +/- anticholinergics
If no improvement (< 4 weeks) OR Lack of compliance +
Re-evaluate
Do not treat children ___ in whom spontaneous cure is likely.
less than five years of age
** inform the family about the involuntary nature, the high incidence of spontaneous resolution and the fact that punishment will not help to improve the condition.
Use___ to exclude day-time symptoms.
Perform a ___ to exclude the presence of infection or potential causes such as diabetes insipidus.
voiding diaries or questionnaires
urine test
Offer desmopressin +/- cholinergics in ___.
Offer ___ in motivated and compliant families
proven night-time polyuria: success rates of 70% can be obtained with desmopressin (DDAVP), either as tablets (200-400 μg), or as sublingual DDAVP oral lyophilisate
ALARM treatment: device that is activated by getting wet –> method of action is to repeat the awakening and therefore change the high arousal to a low arousal threshold when a status of full bladder is reached
Myelodysplasia
includes a group of developmental anomalies that result from defects in neural tube closure. Lesions include spina bifida aperta and occulta, meningocele, lipomyelomeningocele, or myelomeningocele. Myelomeningocele is by far the most common defect seen and the most detrimental.
MYELODYSPLASIA + NB: Neurogenic detrusor-sphincter dysfunction (NDSD) may result in ___
different forms of LUTD and 2a ultimately result in incontinence, UTIs, VUR, and renal scarring.
MYELODYSPLASIA + NB: In children, the most common cause of NDSD is ___
myelodysplasia (a group of developmental anomalies 2 that result from defects in neural tube closure).
MYELODYSPLASIA + NB: Bladder sphincter dysfunction correlates poorly with ___
the type and level of the spinal cord lesion. 2a Therefore, urodynamic and functional classifications are more practical in defining the extent of the pathology and in guiding treatment planning.
MYELODYSPLASIA + NB: Children with neurogenic bladder can have disturbances of ___
The main goals of treatment are ___
bowel function as well as urinary function 2a which require monitoring and, if needed, management.
prevention of urinary tract deterioration and achievement of 2a continence at an appropriate age.
MYELODYSPLASIA + NB: Injection of ____ in children who are refractory to anticholinergics, has been shown to have beneficial effects on clinical and urodynamic variables.
botulinum toxin into the detrusor muscle
MYELODYSPLASIA + NB: Urodynamic studies should be performed in ___ to estimate the risk for the upper urinary tract and to evaluate the function of the detrusor and the sphincter.
every patient with spina bifida as well as in every child with high suspicion of a neurogenic bladder
MYELODYSPLASIA + NB: In all newborns with myelodysplasia, intermittent catheterisation (IC) should be started ___
soon after birth.
*** In those with a clear underactive sphincter and no overactivity starting IC may be delayed. If IC is delayed, closely monitor babies for urinary tract infections, upper tract changes (US) and the lower tract (UD).
MYELODYSPLASIA + NB: Start early anticholinergic medication in the newborns with ___
suspicion of an overactive detrusor.
MYELODYSPLASIA + NB: The use of ____ is an alternative and a less invasive option in children who are refractory to anticholinergics in contrast to bladder augmentation.
suburothelial or intradetrusoral injection of onabotulinum toxin A
MYELODYSPLASIA + NB: Treatment of faecal incontinence is important ___. Treatment should be started with ___. If not sufficient transanal irrigation is recommended, if not practicable or feasible, a ___
to gain confidence and independence.
mild laxatives, rectal suppositories as well as digital stimulation
Malone antegrade colonic enema (MACE)/Antegrade continence enema (ACE) stoma should be discussed.
MYELODYSPLASIA + NB: Ileal or colonic bladder augmentation is recommended in patients with___.
therapy resistant overactivity of the detrusor, small capacity and poor compliance, which may cause upper tract damage and incontinence
** The risk of surgical and non- surgical complications and consequences outweigh the risk of permanent damage of the upper urinary tract +/- incontinence due to the detrusor.
MYELODYSPLASIA + NB: In patients with a neurogenic bladder and a weak sphincter, ____should be offered.
a bladder outlet procedure
** It should be done in most patients together with a bladder augmentation.
MYELODYSPLASIA + NB: ___ should be offered to patients who have difficulties in performing an IC through the urethra.
Creation of a continent cutaneous catheterisable channel
MYELODYSPLASIA + NB: A life-long follow-up of ___should be available and offered to every patient. Addressing sexuality and fertility starting before/during puberty should be offered.
renal and reservoir function