GU Flashcards
Testicular torsion is most common at what age?
Adolescence 12- 16 yrs
Torsion of hydatid of Morgagni is AKA? Common age of presentation
AKA torsion of testicular appendage
Usually pre pubertal males
Note: blue dot sign - tender nodule with blue discoloration on the upper pole of the testis
Blue dot sign is seen in what pathology?
Torsion of testicular appendage
Torsion of testicular appendage require surgical intervention T/F
F - if diagnosis is clear not indication for surgery, symptoms should resolve w/in 48 hrs
Management of a hydrocele?
If < 2 yrs reassurance only, 95% will resolve by 2 yrs old
If > 2 yrs old ligation of processus vaginalis
Mgmt of priapism?
Mgmt is different for ischaemic vs non ischaemic
Ischaemic is painful and non ischaemic is not
Ischaemic is an emergency - needs surgery consult. Tc ice pack, oral analgesia and cavernous phenylephrine and aspiration if there for > 4 hrs
What is the only absolute medical indication for circumcision?
BXO (balantitis xerotica obliterans)
Note: as 10% of cases will have narrowing of urethra and hence urethral calibration is also indicated.
Other relative indications: recurrent paraphimosis, posterior urethral valves or high grade VUR (due to abnormal tract/increase risk UTIs)
Balantitis xerotica obliterans vs phimosis
BXO - thickened non retractile foreskin, it does not evert and is scarred. Leads to a pin hole opening
Phimosis: non retractile foreskin, mild erythema, ballooning of foreskin on micturition and white debris
What is the mgmt of phimosis in a baby?
Reassurance; foreskin in only retractable in 1% of babies at birth; only 1% of 16 yrs old will have a foreskin that is non retractable
Presence of pus cell in the urine of a pt who has recently been started on a new medication.
Acute interstitial nephritis
Common meds: beta lactams, sulphonamides, rifampicin, ethambutol, erythromycin
What is the mgmt of a chronic ovarian cyst > 5cm?
Ovary sparing cystectomy
At 5cm or greater there is a risk of torsion
According to NICE guidelines in a child over 3 yrs old what is the appropriate duration of treatment with oral abx for cystitis?
3 days
NB: pyelonephritis is 7-10 days
In hypospadias where does the urethra open?
Ventrally just before the glans
Other features: a chordee (tilt ventrally) and hooded foreskin
Note: epispadias is much less common and is an opening on the dorsal side
What is the mgmt of the lack of a palpable testis?
Normal up until 6 months
After 6 months should have a diagnostic laparoscopy and possibly the first stage if orchidopexy.
NB: no form of imaging is reliable enough to determine whether a testes is present or not
Vesicoureteric reflux is most accurately diagnosed by a DMSA scan T/F
F - DMSA scan is the best investigation to look for renal scars
Micturating cystography is used for diagnosis
Most vu reflux spon resolves the age of 3 yrs T/F
F - most resolves by 5 yrs
Of children who present to the hospital with a UTI about what % have VUR?
30 - 40%
Umbilicus draining in a infant, differentiate patent vitellointestinal remnant from urachal sinus
Patent vitellointestinal remnant - more likely to drain pus or intestinal contents
Patent urachal sinus - as is bladder, more likely to drain clear
Do USS to investigate these
Causes of secondary hyperoxaluria?
Overall it is due to fat malabs –> short gut, Crohns, CF and pancreatitis
Can lead to oxalate stones
In a patient with a UTI and a large renal stone what is the most likely type of stone?
Struvite (mix of Mg, ammonium, phos and ca due to proteus)
Can cause a large stag horn calculus and renal impairment
Are uric acid stones radio opaque or lucent?
Lucent
Note: radio opaque = ca, struvite and cystine stones
In a patient with grade V VUR when is surgery indicated?
- Anyone > 5 yrs old
- 1-5 years old if bilateral (even if no scarring)
- 1-5 years old with scarring
Note: if unilateral and no scarring in 1-5 yr old no surgery, only antibiotic prophylaxis
Features of an atypical UTI
Poor urine flow Abdo and/or bladder mass Positive culture of non- E coli organism Raised Cr Signs of sepsis Failure to respond to appropriate antibiotic treatment within 48hrs
Note: according to NICE guidelines any children with any feature of atypical UTI need ultrasound
What is the definition of recurrent UTIs
3 or more lower UTIs
OR 2 or more of UTIs of which at least one is upper
Note: prophylactic antibiotics rec for recurrent UTIs
When a patient is having a MCUG for VUR work up what preperation need to be undertaken before hand?
Patient should be started on prophylactic abx orally for 3 days with the MCUG being done on the 2nd day
What is the incidence of hypospadias?
1 in 300 live male births
How does detrusor instability typically present?
Urge incontinence , due to spon contraction of the bladder muscle
Clinical presentation of ureterocele?
- Recurrent cystitis
- Renal outflow obstruction which can lead to renal failure
Note: can also have no symptoms
Hydrocoele vs varicocoele
Hydrocoele - acute onset, can be post traumatic, transilluminates
Varicocoele - chronic onset, “bag of worms” consistency
Relief of pain following elevation of the scrotum is present in what pathology?
Epididymititis. It is known as Prehn sign
Note: this is usually absent in torsion
Where does a Gardner duct cyst develop?
Where does a Skene duct cyst develop?
Gardner: Anteriolateral aspect of the superior vagina
Skene: Around the urethral opening
Gold standard investigation for Asherman syndrome?
Hysteroscopy or sonohysterography
What is the tx of varicocele?
Observation only
Note: surgical correction if persistent severe testicular pain; testicular growth retardation or arrest over a 6-12 month period of observation; volume disparity of over 2mm between testes or if present in a solitary testes
Which side is varicocele more common?
Left
A varicocele in a pre adolescent boy needs a work up. T/F
T - due to association with malignancy (Wilms or neuroblastoma) or obstructive uropathy
No work up needed in adolescent
What is paraphimosis?
Inability place the retracted foreskin back to its anatomical position
Note: Foreskin retracted past the coronal sulcus may
become edematous, making the replacement of the foreskin over the glans more difficult. Reduction is emergent and may require sedation
Balanitis vs balanoposthitis?
Balanitis: inflammation of the glans penis only
Balanoposthitis: inflammation of the glans penis and foreskin
In an infant with a weak urine stream what needs to be considered?
If male infant posterior urethral vales
Lifetime risk of testicular cancer is increased in those with an undescended testicle, the risk is present in both testicles T/F
T - the risk of malignancy is increased in both testes even if only one is undescended
Silk glove sign on exam is associated with what pathology?
Inguinal hernia
