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Paediatric Surgery > Paediatric Urology > Flashcards

Paediatric Urology Flashcards

1
Q

From where do the urinary and genital systems develop

A

Intermediate mesoderm (common mesodermal ridge running along the posterior wall of the abdominal cavity)

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2
Q

What is the origin of the definitive kidney

A

Metanephros

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3
Q

Where is the ureter/renal pelvis derived

A

Mesonephric duct

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4
Q

Where is the collecting system of the kidney derived

A

Ureteric bud from the mesonephric duct

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5
Q

Where is the excretory system (e.g. glomeruli, tubules) of the kidney derived

A

Metanephric blastema

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6
Q

From where are the bladder (apart from the trigone) and urethra derived

A

Urogenital sinus (anterior part of the cloaca)

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7
Q

Where is the trigone of the bladder derived

A

Mesoderm

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8
Q

What sex is the default

A

Female

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9
Q

When do the gonads acquire male/female morphology

A

Week 7

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10
Q

Where in the testes is testosterone produced

A

Leydig cells

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11
Q

What happens to the medullary cords at puberty

A

Acquire a lumen to form the seminiferous tubules

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12
Q

What structure guides the descent of the testis

A

Gubernaculum

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13
Q

When do the testes reach A) the inguinal canal, and B) the external inguinal ring

A

A) 7 months

B) 8 months

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14
Q

When does the Processus Vaginalis close and what are the consequences of this not happening

A
  • 1 year

- Hydrocele or congenital inguinal hernia

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15
Q

What gives rise to the ovarian ligament

A

Gubernaculum

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16
Q

What gives rise to the round ligament

A

Uterovaginal canal (Gubernaculum)

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17
Q

What does the mesonephric duct contribute to the male genitalia

A
  • Epididymis
  • Vas deferens
  • Seminal vesicles
  • Ejaculatory ducts
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18
Q

From where are the Fallopian tubes derived

A

Paramesonephric ducts

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19
Q

Describe the development of the male external genitalia

A
  • Genital tubercle becomes the phallus
  • Urethral folds (of cloaca) become the penile urethra
  • Genital swellings form the scrotum
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20
Q

What is the result of failure of fusion of the urethral folds

A

Hypospadias

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21
Q

Describe the development of the female external genitalia

A
  • Genital tubercle forms the clitoris
  • Urethral folds do not fuse and become the labia minora
  • Genital swellings become labia majora
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22
Q

What is Potter Syndrome

A
  • Bilateral renal agenesis
  • Characteristic features of oligohydramnios and characteristic facial appearance
  • Pulmonary hypoplasia leads to stillbirth
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23
Q

In whom are lower pole renal vessels common

A

Children with pelviureteric obstruction

24
Q

What is the inheritance pattern of adult polycystic kidney disease

A

Autosomal dominant

25
Q

What is the inheritance patterns of infant polycystic kidneys

A

Recessive

26
Q

What are the associations of APKD

A
  • Cystic change in other organs e.g. liver, spleen, pancreas
  • Berry Aneurysms of the circle of Willis
  • Mitral valve prolapse
27
Q

What urological conditions is tuberous sclerosis associated with

A
  • Angiomyolipomata

- Polycystic kidneys

28
Q

Describe horseshoe kidney

A
  • Fusion of the inferior pole occurs before the kidneys have rotated along the long axis
  • The IMA prevents ascent
  • Ureter enters the bladder ectopically
29
Q

Describe uretrocele

A
  • Cystic dilatation of the intramural part of the ureter

- Commonly occurs in association with the upper-pole ureter of a duplex system

30
Q

Describe a retrocaval ureter

A
  • Abnormality in the development of the posterior cardinal vein
  • Ureter lies BEHIND vena cava
  • Compression of the ureter can occur between IVC and vertebrae
31
Q

What is the investigation of choice for assessing PUJ obstruction

A

MAG-3 scan will show delayed drainage of the kidneys

32
Q

When is surgery indicated in PUJ obstruction

A
  • Symptomatic
  • Increasing hydronephrosis on serial USS
  • Declining renal function
33
Q

When would nephrectomy be considered in PUJ obstruction

A

If the kidney is functioning poorly (<15% differential function)

34
Q

How is PUJ obstruction treated

A

Dismembered retroperitoneal (Anderson-Hynes) pyeloplasty

35
Q

Define vesicoureteric reflux

A

Abnormal backflow of urine from the bladder into the ureter and kidney

36
Q

Describe the pathophysiology of VUR

A
  • Shortened intramural course of ureter due to lateral displacement
  • Diminished function of VU junction
37
Q

Outline the 5 grades of VUR

A 
1 = reflux into ureter only, no dilatation 
2 = reflux into renal pelvis on micturition, no dilatation 
3 = mild/moderate dilatation of the ureter, pelvis, calyces 
4 = dilatation of the renal pelvis and calyces with moderate ureteral tortuosity 
5 = gross dilation with ureteral tortuosity
38
Q

What does VUR predispose to

A

Recurrent UTI

39
Q

How is VUR managed

A
  • Prophylactic antibiotics

- Surgery if progressive renal damage or breakthrough UTI

40
Q

What is the most common cause of bladder outlflow obstruction in boys

A

Posterior urethral valves

41
Q

Describe hypospadias

A

Urethral meatus opens onto the ventral surface of the penis (75% distally located)

42
Q

What is associated with hypospadias

A
  • Undescended testis
  • Inguinal hernia
  • Bifid scrotum
  • Chordae and renal and ureteric abnormalities
43
Q

When is surgery performed for hypospadias

A

Between 9 and 18 months

44
Q

How is hypospadias treated

A
  • Urethroplasty

- Penile reconstruction

45
Q

Define a retractile testis

A

Sits high in the scrotum or inguinal canal but can be milked into the scrotum and stays in the scrotum with minimal tension

46
Q

Define an undescended testis

A

During development the testicle has been arrested somewhere along the course of normal descent and does not reach the bottom of the scrotum by 3 months of age

47
Q

Define a maldescended/ectopic testis

A

Situated somewhere other than the usual course of descent

48
Q

What is the increase in risk of malignancy associated with Cryptochidism

A

10x

49
Q

When should orchidopexy be performed for undescended testis

A

Before 1 year (6-18 months)

50
Q

What structural abnormality are undescended testes typically associated with

A

Patent processus vaginalis

51
Q

What is indicated if the testis are impalpable

A

Laparoscopy

52
Q

Inheritance pattern of congenital adrenal hyperplasia

A

Autosomal recessive

53
Q

Features of Klinefelter syndrome (47 XXY)

A
  • Increased height
  • Mild learning disability
  • Gynaecomastia
  • Infertility
54
Q

Describe testicular feminisation

A
  • Chromosomally XY

- BUT present as females due to complete androgen insensitivity of the genitalia

55
Q

What gene codes for Wilm’s tumour

A

WT1 gene

56
Q

How are children <6 months of age investigated following UTI

A

USS 6 weeks post-UTI

57
Q

How are children aged 6 months to 3 years investigated following atypical UTI

A
  • USS

- DMSA scan

Paediatric Surgery (5 decks)

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