GU

Question 1

When is enuresis not normal?

Answer 1

when child is older than 7 yrs, and they have been dry for 6 months

Question 2

Management of Enuresis?

Answer 2

Enuresis- Management
• Urinalysis-if abnormal –> renal ultrasound, vesicoureterogram
• Family counseling- do not punish child, but child should take some responsibility - remove sheets, etc.
• Conditioning therapies - alarm triggered when child wets the bed
Meds: DDAVP

Question 3

UTI suspected?

Answer 3

children <2 hospitalized
- UA: (suggestive)
leukocyte esterase, nitrates, blood
Urine culture is mandatory for diagnosis:
clean catch (older girls/ circumcised males)
positive = 50,000 - 100,000 CFU/mL
straight cath
positive = >10,000

Question 4

When do you do further studies for a UTI and what are they?

Answer 4

children 2 - 24 month first febrile 
• Any child with complicating factors: GU defects, neurogenic bladder dysfunction, family hx, HTN 
• Boys of any age 
• Febrile infants
• Recurrent UTIs any age

Renal and bladder ultrasonography (RBUS)
&
if abnormal, odd bacteria + high fever, growth or HTN, >2 febrile UTI
»»> voiding cystourethrogram (VCUG) is the test of choice to establish the presence and degree of VUR.

Question 5

Management of vesicoureteral reflux?

Answer 5

grade I - II = no prophylactic abx unless non-verbal or BBD
> grade III = abx prophylaxis (bactrim) Trimethoprim/sulfamethoxazole { > 2 mo only}

Question 6

pharm therapy for UTI

Answer 6

10 to 14 days
Increasing rates of resistance to Bactrim
• Cephalosporins –> Second & third generations cephalosporins more effective (e.g., cefixime)
• Fluorquinolones (e.g.,Cipro) are effective against E.
o coli but should not be used as first line treatment in younger children (AAP) because safety in children is still under study
o Ciprofloxacin may cause joint damage in children.
• Aminoglycosides also a good first line treatment for UTI (e.g., gentamycin, amikacin)

Question 7

Cryptorchidism

Answer 7

(Undescended Testicle)
• Need to differentiate from retractile testis
• May descend spontaneously in first 3 months of life, particularly in premature infant
• Refer to pediatric urology for repair, if not descended by 1 year
• Long-term monitoring for cancer (40x more)

Question 8

Hypospadias

Answer 8

urethral opening on ventral side of penis
• Postpone circumcision until surgical repair
• Management: referral to pediatric urology for surgical repair between 6-12 months
- mild cases are cosmetic

Question 9

Hydrocele

When to refer?

Answer 9

• Fluid trapped in scrotum when processus vaginalis does not close or closes late (painless scrotal swelling)
• Most resolve spontaneously during the first year of life
•Treatment: first year = supportive
• Referral when
• – Persists after 12 months of life
• – Bowel present in scrotum; ie does not transilluminate (inguinal hernia)
– increases in size,
– causes PAIN

Question 10

when can you fully retract foreskin?

Answer 10

10 yrs

Question 11

unilateral acute painful swelling of scrotum, no urinary symptoms, no systemic symptoms. occurring in 10 - 20 yr males

what is it? test you could do?

Answer 11

Testicular Torsion - twisting and strangulation of the spermatic cord (EMERGENCY - surgical intervention in 6 - 12 hours to save)

Prehn’s sign - lifting the testis does not relive pain
(prehn +)
absent cremasteric reflex

Question 12

Acute Glomerulonephritis

Answer 12

• Result of an immune process that injures the glomeruli of the kidney
• Most often develops 8-14 days after a strep infection
S&S– hematuria, proteinuria, tea colored urine, lethargy, abdominal pain, headache, vomiting, azotemia, hypertension
• Edema (peripheral) – peri- orbital edema is where you first see it, HTN, gross hematuria, oliguria –> hospitalization

DX: • Urinalysis- Hematuria, high specific gravity >1.020 and low PH (acidic)
o +Leukocytes, +protein
Blood: BUN and creatinine may be increased
o ASO (antistreptolysin O) titer may be increased- increased when exposed to strep within the last 6 weeks
throat cultures

Question 13

Azotemia

Answer 13

– Azotemia is a medical condition characterized by abnormal levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood

Question 14

Acute Glomerulonephritis treatment?

Answer 14

• Bedrest during acute phase –> Not necessary if BP and UOP is normal
• BP should be taken at home (if not possible child should be seen in the office)
• May require antihypertensives- without treatment –> seizures
• Daily weight at home
• Water restriction not necessary unless UOP is significantly decreased- may need to restrict water in relation to urinary output

Treatment-AGN
Diuretics may be useful (Lasix) to decrease fluid overload and edema
Nutrition-regular diet unless BP is elevated- may require low sodium diet
Antibiotics-may be necessary if it is determined that strep infection is present
• Prognosis-98% fully recover; a few patients may develop chronic renal failure