Paed Urology Flashcards
Male and female hernias - differences?
Indirect or direct - which is more common
Mostly boys- bowel
Girls can get ovaries in it as well
99% are indirect hernias
How does an inguinal hernia present? [1]
Increased risk of inguinal hernia with…
A groin swelling
Often associated with prematurity
How do you manage an inguinal hernia? [2]
If <1yr –> Urgent referral and repair as can incarcerate easily
If >1yr –> Elective referral and repair
What do you do if an inguinal hernia incarcerates? [2]
Reduce and repair immediately as it can compress the vessels –> Death of testes
What dx is likely if you see a scrotal swelling in an infant?
Hydrocele
What features of a swollen scrotum fit with hydrocele? [3]
How to investigate hydrocele on examination [2]
- Painless
- Bluish colour
- Increases with crying, straining or in the evening (esp if walking)
Transillumination - chinese lantern sign
How do you treat a hydrocele? [3]
Most spontaneously resolve so just observe till 5yo then surgery
Types of UDT [4]
1) True absence of testes
2) Retractile - physiological response to cold
3) Ectopic - superficial femoral pouch
4) Ascending
Ascending testes:
Presentation [1]
Etiology [2]
Documented normal at birth then present at 5-7yo with no testes
?Body grows faster than spermatic cord –> testes pulled up into the canal
Indications for orchidopexy [5]
1) Fertility
2) Malignancy
3) Trauma (more at risk if stuck in canal)
4) Torsion (more likely)
5) Cosmetic
What is an absolute indication for a circumcision? [1]
Balantitis Xerotica Obliterans
White scarring of foreskin
(Bullet vs sausage on lateral view)
Relative indications for circumcision [3]
- Religious/cultural reasons
- Balanoposthitis
- to reduce UTI risk in high risk people with dilated urinary tracts/renal failure
What is the acute scrotum? [1]
Acute onset swelling and/or pain of the scrotum
What are 2 causes of Acute Scrotum and at what age does each occur?
Testicular Torsion and epididymitis similar epidemiology - occurs in neonates and >10yo
Torsion Appendix Testes (increases in likelihood from infancy to puberty)
Management of acute scrotum [2]
when to leave it alone? [2]
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
Blue dot sign on examination – torsion of the appendix testis
(leave it alone!)
How do we investigate and manage hypospadias?
US if severe –> Surgical repair
UTIs are common in kids, which ones do we investigate? [4]
Whats the main aim of investigating
Aim: Prevent renal scarring
- <6m
- Atypical buds
- Atypical presentation e.g. pyelonephritis
- Recurrent UTI - more than 2 upper tract infections or more than 3 lower tract infections
Define the presentation of a UTI? [3]
Pure growth bacteria >10^5
Pyuria
Systemic Upset (fever, vomiting etc)
What tests can we do when investigating UTIs? [3]
US (do within 6 weeks following infection)
Renography (MAG3 & DMSA)
MCUG (micturating cystourethrogram)
The main cause of abnormal/recurrent UTIs in kids is [1]
Vesicoureteric Reflux
What warrants conservative tx [3]
What is the management for VUR?
Mixed growth bacteria, no pyuria, no systemic symptoms
Conservative e.g. voiding advice, managing constipation & fluids
Abx prophylaxis till age 4 (Trimethoprim)
Surgery:
- STING (if mild/mod symptoms)
- Ureteric Reimplantation
How is fertility affected in UDT?
Explain association between malignancy and UDT [2]
1% loss germ cells per month of undescent
RR 3 x (probably intra-abdominal only – severe cases)
Fixing does not reduce risk but makes cancer easier to detect
Hypospadias
Define [2]
Associated anomalies [2]
Ix [1]
proximally displaced urethral meatus on ventral aspect of penis
• Associated anomalies of upper tract, can be intersex (ambiguous genitalia)
• Investigations: US if severe
What is defined as recurrent UTI in children [3]
- > 2 episodes of upper urinary tract infection, or
- 1 episode of upper urinary tract infection plus >1 episode of lower urinary tract infection, or
- three or more episodes lower urinary tract infection.
Phimosis Ax [3] Symptoms [2] Mx [2] Complications
Ax: physiological, balanitis, balanoposthitis
Symptoms: non-retractile foreskin and or ballooning during micturition
Mx:
• <2y/o: physiological phimosis that will resolve in time with expectant mx and good hygiene
• >2y/o or recurrent balanoposthitis or UTI: circumcision
Complications: penile carcinoma
Unilateral undescended testis
Referral guidelines
Unilateral undescended testis NICE CKS (2020) now recommend referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age - Orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age
Bilateral undescended testes Management
Bilateral undescended testes
Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation
