Paed Urology Flashcards

1
Q

Who gets inguinal hernias?

A

Mostly boys

Bowel (girls can get ovaries in it as well)

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2
Q

How does an inguinal hernia present?

A

A groin swelling

Often ass with prematurity

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3
Q

Are inguinal hernias in kids direct or indirect?

A

Indirect

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4
Q

how do you manage an inguinal hernia?

A

If <1yr –> Urgent referral and repair as can incarcerate easily

If >1yr –> Elective referral and repair

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5
Q

What do you do if an inguinal hernia incarcerates?

A

Reduce and repair immediately as it can compress the vessels –> Death of testes

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6
Q

What’s the main reason you’ll see a scrotal swelling in an infant?

A

Hydrocele

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7
Q

What features of a swollen scrotum fit with hydrocele?

A
  • Painless
  • Bluish colour
  • Increases with crying, straining or in the evening (esp if walking)
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8
Q

How do you treat a hydrocele?

A

They’re very common in newborns and most spontaneously resolve so treat conservatively till ~5 then surgery

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9
Q

What could cause Cryptorchidism?

A

1) True absence of testes
2) Retractile - physiological response to cold
3) Ectopic
4) Ascending

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10
Q

What is an ascending teste?

A

In scrotum as a baby but 4-5yrs later it’s gone, possibly because body grows faster than spermatic cord –> testes pulled up into the canal

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11
Q

When we find undescended testes we do Orchidopexy, why?

A

1) Fertility
2) Malignancy
3) Trauma (more at risk if stuck in canal)
4) Torsion (more likely)
5) Cosmetic

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12
Q

What is the only absolute indication for a circumcision?

A

Balantitis Xerotica Obliterans

White scarring of foreskin

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13
Q

Who else might we circumcise?

A
  • Religious/cultural reasons
  • Balanoposthitis
  • to reduce UTI risk in high risk people with dilated urinary tracts/renal failure
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14
Q

What is the acute scrotum?

A

Acute onset swelling and/or pain of the scrotum

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15
Q

What could cause Acute Scrotum and at what age?

A

Testicular Torsion (neonates and 10+)

Torsion Appendix Testes (from infant to puberty)

Epididymitis (Neonates & 10+, never happens in kids)

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16
Q

how do we manage acute scrotum?

A

Unless you’re certain it’s not torsion do surgical exploration to repair.

As you only have 6-8hrs to recover the testes before permanent damage occurs

17
Q

What is hypospadias?

A

Urethral meatus on ventral aspect of penis

1) Anterior (commonest)
2) Middle
3) Posterior

Also ass with upper tract anomalies and ambiguous genitalia

18
Q

How do we investigate and manage hypospadias?

A

US if severe –> Surgical repair

19
Q

UTIs are common in kids, which ones do we investigate?

A
  • <6months old
  • Atypical bugs
  • Atypical presentation e.g. pyelonephritis
  • Recurrent UTI
20
Q

Define the presentation of a UTI?

A

Pure growth bacteria >10^5
Pyuria
Systemic Upset (fever, vomiting etc)

21
Q

What tests can we do when investigating UTIs?

A

US
Renography (MAG3 & DMSA)
MCUG (micturating Cystourethrogram)

22
Q

The main cause of abnormal/recurrent UTIs in kids is.?

A

Vesicoureteric Reflux

23
Q

What is the management for VUR?

A

Conservative e.g. voiding advice, managing constipation & fluids

Abx prophylaxis till age 4 (Trimethoprim)

Surgery:

  • STING (if mild/mod symptoms)
  • Ureteric Reimplantation