genito-urinary Flashcards
Symptoms of balanitis
- redness and itchiness of glans penis
- often assoc with non-retractile foreskin (preputial adhesions)
- dysuria
- urethral discharge
What are the causes of balanitis
allergy
chlamydia
gonnorhea
syphillus
What is the management of balanitis
1% hydrocortisone cream for 1-2 weeks
miconidazole cream if confirmed candida
clean penis with luke warm water
Avoid soaps and bubble baths
What happens if you have chronic balanitis
Balanitis xerotic obliterans
What are the indications for circumcision following balanitis
recurrent infection
lichen sclerosis
persistent phimosis
Which commensal organism that can cause balanitis doesn’t always need treating
group B strep
When should you refer a child with balanitis
- uncertainty with dianogsis
- persistent or recurrent balanitis which is not responding to management
- suspected lichen sclerosus and/or persistent phimosis — refer to a paediatric urologist or surgeon for consideration of circumcision.
What is phimosis
non-retractile foreskin
natural separation occurs around 5YO
What is the most common congenital defect of the penis
hypospadius
What is hypospadius
- urethral meatus on the ventral aspect of the penis or scrotum, dorsal winged prepuce (foreskin), and ventral curvature of the penis (chordee)
- foreskin incompletly formed ventrally
Which children with hypospadius should be referred to surgeons
all of them!!!
What other congenital anomalies can hypospadius be associated with
- inguinal hernia
- cryptorchidism,
- other abnormalities of the renal tract.
What is the management of hypospadius
Surgery ~1YO by urologist/plastic surgeon
- do not have child circumcised pre-operatively as can be used as a graft if needed
What are the main complications of surgery to corret hypospadius
- fistula
- stenosis
- dehiscence
What is a uretorecele
abnormal outpouch of the ureter into the bladder
predisposes children to recurrent UTIs
Can cause obstruction
What does the presence of absolute incontinence suggest
structural anomaly
What is a duplex kidney with ectopic ureter
2 ureters are coming from one kidney. In an ectopic, one ureter sits below the neck of the bladder leading to lack of control of micturition
What is vesicoureteric reflux
abnormal flow of urine from your bladder back up the tubes (ureters) that connect your kidneys to your bladde
What is the investigation of choice to look for vesicoureteric reflux
micturating cystography - is invasive and requires catheterisation
What is DMSA scintigraphy
- gold standard for detecting renal parenchymal defects
- uses technetium
- isotope is concentrated in the proximal renal tubules; its distribution correlates with functioning renal tissue
WHat is tortid hydatid of Morgagni
torsion of the appendix teste - presents with upper pole testicular pain
What are the featurs of tortid hydatid of Morgagni
- upper pole testicular pain
- present cremasteric reflex
- blue dot sign
- absence of nausea and vomiting
What is the management of tortid hydatid of Morgagni
- analgesia
- scrotal support
- bed rest
- usually 5-10 days
- surgery if ongoing pain/doubt of diagnoses
What is idiopathic scrotal oedema
- self limiting
- scrotal swelling and erythema
- no epidydimal or teste involvement
- <10YO
- resolves 3-10 days
What is the triad of nephrotic syndrome
oedema
heavy proteinurea >1g/m/day
hypoalbuminaemia
What investigations should you do if qureying nephrotic syndrome
- urine dip
- electrolytes and albumin
- protein-createnine ratio rarely done in children
What is the role of protien:creatine ratio in nephrotic syndrome
quantifies the amount of protein in urine
what would be considered typical findings in a child with nephrotic syndrome
- 1 - 10 years
- normal BP
- normal renal function
- no macroscopic haematuria
do you need to do a renal biopsy in a child with clinic triad of nephrotic syndrome
No - if fit triad, treat with steroids, those who respond in 4 weeks are 90% likely to have minimal change disease
Who gets a renal biopsy in minimal change disease
atypical features
- <1
- macroscopic haematuria
- high BP
- abnormal renal function
what is the most likely histology in typical nephrotic syndrome in children
minimal change
what is the most likely histology in atypical nephrotic syndrome in children
focal segmental glomerulonephritis
Non-pathological causes of proteinuria
- transient proteinurea
- fever induced
- exercise induced
- UTI
- postural proteinurea
Pathological causes of proteinuria
- nephrotic syndrome
- glomerulonephritis
- CKD
- tubular interstitial disease
What are the main complications of nephrotic syndrome in children
- hypovolaemia! may look overloaded but intravascularly deplete
- infection
- thromboembolism
Signs of intravascular depletion
- cool peripheries
- increased core-peripheral temp gap (>2 degrees)
- tachycardia
Why are you at risk of thromboembolism with nephrotic syndrome
- reduced levels of anti-thrombin 3 as its being lost in urine
- this creates a pro-thrombotic state
where is the most common sites of clot formation in a child with nephrotic syndrome
- renal blood vessels
- sagittal sinus venous system
how does renal vessel thrombosis present
- macroscopic haematuria
- abdo pain
How does sagittal venous sinus thrombosis present
- worsening unremitting head ache
- opthalmic issues
What is the management of thromboembolism
- urgent imaging - renal US vs CT head
- anti-coagulation
Risk factors of sagital venous sinus thrombosis in children
- Pro-coagulant
- Sickle cell anemia
- Chronic hemolytic anemia
- Beta-thalassemia major
- Heart disease.
- Iron deficiency
- Certain infections
- Dehydration
- Head injury
- For newborns, a mother who had certain infections or a history of infertility
Causes of haematuria
- UTI
- glomerulonephritis
- UT stones
- trauma
- renal tract injury
- PCKD
- Renal vein thrombosis
- Arteritis
- Haematological disorder
- drugs - cyclophosphamide
- exercise induced
- fictitious
post infectious causes of glomerulonephritis
- bacterial - streptococcal/staphylococcalaureus/mycoplasma/pneumoniae salmonella
- viral: herpes/EBV/varicella/CMV
- fungi:candida, aspergillus
- parasitic:toxoplasma, malaria, schistosomiasis
Non-infectious causes of glomerulonephritis
- membraneoproliferative glomerulonephritis
- Iga nephropathy
- Subacute bacterial endocarditis
- Alports syndrome
- Systemic disease - SLE
