GU Flashcards
what is phimosis?
inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis
what are causes of phimosis?
pathologic or physiologic
what do you do for a pt w/phimosis whose family does not desire circumcision?
bethamethasone cream
can you do circumcision in office?
yes if pt is <1 month old and 10 lbs
when do you do circumcision in OR?
if pt is >6 month
what is smegma?
collection of skin cells. provides natural lubricant btw glans and prepuce that if often trapped under preputial adhesions and mistaken for pus or infection
what is infection of glans and foreskin a/w uncircumcised penis?
balanoposthitis
is meatal stenosis a/w circumcised or uncircumcised?
circumcised
a concerned parent asks you about retracting the foreskin of her 1 yo uncircumcised boy every day in warm water to help with its retraction. what do you suggest?
Leave the foreskin ALONE! natural retraction btw 4-7 years of age.
what is paraphimosis?
retracted foreskin of an uncircumcised male that cannot be pulled back over the glans…ouch!
how do you treat paraphimosis?
- manual reduction in ED or office
2. surgical correction with DORSAL slit and circumcision
How can uncircumcised male prevent paraphimosis?
if they ALWAYS pull foreskin back over the glans after voiding
what is hypospadias?
opening of urethra is on the underside, VENTRAL aspect of penis , midshaft, or proximal at the peno-scrotal junction….hypo:under
bifid scrotum may be a/w what penile concern?
hypospadias
what do you recommend to parents of a new born w/ hypospadias?
surgical correction recommended prior to potty training to avoid voiding frustration!
what is the post op risk of hypospadias correction surgery?
urethrocutaneous fistula
congenital chordee is a/w what other penile abnormality?
hypospadias
what is congenital chordee?
latin for downward curvature of penis
parents present their child as “born partially circumcised”. what do you immediately think of?
congenital chordee
what are physical exam findings for chordee?
curvature of shaft with classic DORSAL HOOD presentation
what is tx for chordee?
surgical correction to straighten penis and then finish circumcision
would you do circumcision for a pt with hypospadias or chordee in OFFICE?
Nope. must refer to pediatric urology
what is testicular torsion?
twisting of spermatic cord
in what population do you see testicular torsion often?
- prenatally in newborns
2. adolescents –this is common!!!
you suspect testicular torsion in office. what do you do?
send to ED
why testicular torsion is an emergency?
testicular necrosis may happen secondary to decreases blood flow
you advise your pt with testicular torsion to go to ED immediately but you feel they are not very serious. what do you tell them to encourage them?
That he may lose his testicles if not surgically corrected < 8-12 hrs !!!!
what are clinical presentation of testicular torsion?
- acute onset
- SEVERE PAIN radiating to groin
- n/v is common
what do you find on PE of a pt suspecting testicular torsion?
testes are
- swollen
- discolored
- tender
- high-riding
- palpable twisted cord
what reflex test do you do when suspecting testicular torsion and what do you find?
cremasteric reflex which is absent in ipsilateral testes
when do you see a NEGATIVE prehn sign with no relief w/elevation?
testicular torsion
you ordered scrotal doppler u/s because you are suspecting ….?
testicular torsion
undescended testicles?
testicles do not descend to scrotal sac, normally fully descent by 6 month of age
retractile testes?
normally descended testes that move in and out of the base of the scrotum
what is the cause of retractile testes?
hyperactive cremasteric reflex
parents report normal scrotal sac and normal fullness in warm bath or while sleeping but not otherwise. what are you thinking of?
retractile testes
what are PE findings for retractile testes?
- cremasteric reflex noted
- can palpate and milk the testes down into scrotum
- pt assumes catcher position or sits cross-legged in warm tub and note palpable testes
what do you do when you dx a pt with retractile testes?
- reassurance: most descend fully by puberty
- clinically monitor: palpate on well child visits
- observe for ascending testes: cord structures do not grow as pt does
- refer to uro
what is cryptorchidism?
general term for TRUE pathological undescended testes
what are classifications of cryptorchidism?
- uni vs. bilateral
- real cryptorchidism vs. ectopic testes
- palpable vs. non-palpable
what are two most important risk a/w cryptorchidism?
- infertility
2. testicular cancer
Seminoma is a/w ?
cryptorchidism
what PE findings for cryptorchidism?
flat underdeveloped scrotum
inguinal hernia
hypospadias
when do you refer to Uro?
- testes not descended by 6 months of age
2. dx laparoscopy and surgical orchidopexy by 9-12 months of age
what is the most common bacterial cause of UTI in children?
E. coli in 60-80%
when do you order urine culture for UTI?
- in children with a high likelihood of UTI
2. if the dipstick shows + LE and/or + nitrites
what are the down sides of bag urine?
can’t avoid getting perineal vaginal wash in girl or contamination in uncircumcised boy
is bag urine suitable for culture?
Nope. neg r/o UTI but positive is likely to be false-positive (88% fp overall)
dx of UTI requires?
BOTH 1. positive culture AND 2. positive urinalysis
positive urinalysis
dipstick: + LE and/or + nitrite
microscopy: white blood cells +/- bacteria
what does + culture with - ua mean?
- contamination
- asymptomatic bacteruria
- ua not sensitive enough
what is LE?
leukocyte esterase produced from the breakdown of leukocytes.
is LE always indicative of infection?
Nope!. vaginitis/vulvitis can lead to inflammation without infection–>+LE
+ Nitrites?
much more predictive of UTI
a 6 yo female presents with dysuria, frequency, urgency, small-volume voids, lower abd pain, and mal-odor. what is your first thought?
UTI
Parents describe their 5 month old infant as irritable with poor appetite and occasional vomiting, and fever. what is your first thought?
UTI …maybe
what is the duration of treatment (abx) for UTI?
7-14 days
your pt is not responding to abx that you prescribed for UTI. What is your next action?
renal ultrasound to evaluate for perinephric abscess
what dx study can evaluate for hydronephrosis/hydroureter when suspecting obstruction or VUR?
renal ultrasound
what are indications to order radiologic studies?
- children <3 yrs w/first UTI
- males any age wit hfirst UTI
- kids w/recurrent UTI
- kids w/ recurrent UTI not responding to therapy
what do you check for in PE in a pt complaining of Nocturnal enuresis?
Boys: meatal stenosis
girls: labial adhesions
diurnal enuresis/ dysfunctional voiding is commonly seen with?
Hx of recurrent UTI/dysuria
routine ua screening for protein/heme IS RECOMMENDED for pediatric pts with …
HSP DM post infectious glomerulonephritis acute renal injury or failure sickle cell trait strong FH of renal dz
what is nephrotic syndrome?
MASSIVE renal PROTEIN LOSS.
what are some symptoms of nephrotic syndrome?
proteinuria
edema. hyperlipidemia
hypoalbuminemia
what are the DDX for painless hematuria?
glomerular dz post infec. glomerulonephritis benign familial/thin membrane dz HSP HUS
what do you need to r/o for painful hematuria?
direct injury to UT/
kidney/abd trauma
what are PE findings for painful hematuria?
flank/CVS pain or masses
ecchymosis
suprapubic pain
what are DDX for painful hematuria?
wilm's tumor bladder/kidney stone cystitis pyelonephritis urethritis
