Paed Urology

Question 1

Who gets inguinal hernias?

Answer 1

Mostly boys

Bowel (girls can get ovaries in it as well)

Question 2

How does an inguinal hernia present?

Answer 2

A groin swelling

Often ass with prematurity

Question 3

Are inguinal hernias in kids direct or indirect?

Answer 3

Indirect

Question 4

how do you manage an inguinal hernia?

Answer 4

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

If >1yr –> Elective referral and repair

Question 5

What do you do if an inguinal hernia incarcerates?

Answer 5

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

Question 6

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

Answer 6

Hydrocele

Question 7

What features of a swollen scrotum fit with hydrocele?

Answer 7

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

Question 8

How do you treat a hydrocele?

Answer 8

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

Question 9

What could cause Cryptorchidism?

Answer 9

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

one or both of the testes fail to descend from the abdomen into the scrotum.

Question 10

What is an ascending teste?

Answer 10

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

Question 11

When we find undescended testes we do Orchidopexy, why?

Answer 11

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

Question 12

What is the only absolute indication for a circumcision?

Answer 12

Balantitis Xerotica Obliterans

White scarring of foreskin

Question 13

Who else might we circumcise?

Answer 13

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

Question 14

What is the acute scrotum?

Answer 14

Acute onset swelling and/or pain of the scrotum

Question 15

What could cause Acute Scrotum and at what age?

Answer 15

Testicular Torsion (neonates and 10+)

Torsion Appendix Testes (from infant to puberty)

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

Question 16

how do we manage acute scrotum?

Answer 16

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

Question 17

What is hypospadias?

Answer 17

opening of the urethra is on the underside of the penis instead of at the tip

Urethral meatus on ventral aspect of penis

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

Also ass with upper tract anomalies and ambiguous genitalia

Question 18

How do we investigate and manage hypospadias?

Answer 18

US if severe –> Surgical repair

Question 19

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

Answer 19

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

Question 20

Define the presentation of a UTI?

Answer 20

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

Question 21

What tests can we do when investigating UTIs?

Answer 21

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

Question 22

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

Answer 22

Vesicoureteric Reflux

Question 23

What is the management for VUR?

Answer 23

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

Abx prophylaxis till age 4 (Trimethoprim)

Surgery:

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