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Y3 paediatrics > paediatric urology > Flashcards

paediatric urology Flashcards

1
Q

presentation of paediatric urological problems

A

systemic:

  • fever, vomiting
  • FTT
  • anaemia
  • HT
  • renal failure

local:

  • pain
  • changes in urine
  • abnormal voiding
  • mass
  • visible abnormalities
  • incidental

antenatal:

  • asymptomatic
  • permits immediate postnatal assessment
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2
Q

what does this hx suggest:

  • 9mth old male
  • lump in left groin noticed which was then gone the next morning
  • baby happy and feeding
A

inguinal hernia

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3
Q

features of inguinal hernia

A

GROIN swelling

2% boys will have one at some point during life

boys 9: 1 girls

increased risk with prematurity

if <1yr old: 33% incarcerate

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4
Q

management of inguinal hernia

A

<1y/o:

  • URGENT referral
  • repair - no place for observation

>1y/o:

  • elective referral and repair

incarcerated:

  • reduce and repair on same admission
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5
Q

what happens in an inguinal hernia

A

loop of bowel comes down through defective inguinal canal

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6
Q

what does this hx suggest:

  • 9mth old male
  • lump in left scrotal swelling, bluish colour
  • gone the next morning
  • baby happy and feeding
A

hydrocele

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7
Q

hydrocele features

A

SCROTAL swelling

very common in newborns

painless - increases w/ crying, straining, evening

bluish colour

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8
Q

management of hydrocele

A

conservative until 5y/o

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9
Q

what does this hx suggest:

  • 9mth old male
  • scrotum empty
  • normal neonatal discharge examination
  • baby happy and feeding
A

possible undescended testes

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10
Q

what is cryptorchidism

A
  • undescended testis
  • any testis that cannot be manipulated into the bottom half of the scrotum

can be either:

  • true undescended testis
  • retractile testis - normal, very vigorous cremasteric reflex
  • ascending testis - don’t keep up w/ growth
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11
Q

why are the testis in the scrotum

A

enzymes in the testis that produce sperm work at 33 degrees

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12
Q

incidence of cryptorchidism

A

roughly proportional to age

premature babies - very high risk (testes don’t normally descend until 3rd trimester)

  • the majority will resolve
  • if still undescended by 1yr - needs intervention
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13
Q

indications for orchiodopexy in cryptorchidism

A
  • improve fertility - 1% loss germ cells per month undescended
  • risk of malignancy - relative risk 3x (probably intra-abdo only), lifetime risk <1%
  • trauma
  • torsion
  • cosmetic
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14
Q

what does this hx indicate:

  • 4y/o male w/ non-retractile foreskin
  • recurrent balanitis
  • o/e: pinhole meatus
A

normal non-retractile foreskin

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15
Q

normal non-retractile foreskin

A

area of tightness is just off the tip

not tight and not obstructing

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16
Q

what does this hx indicate:

  • 14y/o male w/ non-retractile foreskin
  • struggling to pass urine
  • o/e: scarred foreskin, narrow meatus
A

BXO: balanitis xerotica obliterans

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17
Q

balanitis xerotica obliterans

A

point of constriction of foreskin is very tight

‘bullet like’ penis

white scarring when looking at the tip

18
Q

management of balanitis xerotica obliterans

A

steroid cream - dermovate

50% will end up needing circumcision

19
Q

circumcision - indications

A

removal of foreskin

  • absolute: BXO
  • relative: balanoprosthitis, religious, UTI (recurrent, abnormal anatomy)
20
Q

what is balanoprosthitis

A

severe inflammation and infection of glans penis and shaft

recurrent

21
Q

advantages of circumcision

A
  • UTI - 120 circs prevent 1 UTI
  • ?malignancy - penile cancer is very rare
  • ?sexual enhancement - increased nerve endings in prepuce
  • ?AIDS/STD’s - sub-saharan africa

overall minimal evidence of medical benefit

22
Q

disadvantages of circumcision

A
  • painful
  • complications: bleeding, meatal stenosis, fistula, cosmetic
  • ?look different
23
Q

what does this hx suggest:

  • 14y/o male w/ 4hr hx of R sided testicular pain
  • o/e: red scrotum, asymmetry, acutely tender to touch
A

testicular torsion - until proven otherwise

24
Q

why is testicular torsion important

A

testicle twists on the spermatic cord

cuts off blood supply

testicles become gradually ischaemic

~6hrs time frame to salvage the testis

25
Q

appearance of testicular torsion

A

as it twists it tends to shorten and is usually higher up than the other side

VERY TENDER

26
Q

what does this hx suggest

  • 14 y/o m w/ 4hr hx R sided testicular pain
  • o/e: scrotum red, NO asymmetry, blue spot seen, tender to touch
A

torsion appendix testis

27
Q

what is the appendix testis

A

embryological remnant that sits on top of the epididymis

28
Q

what is torsion appendix testis

A

appendix testis teists and becomes necrotic → blue spot visible on skin

29
Q

what does diagnosis of acute scrotum depend on

A

semi age related

DDx:

  • torsion testis, torsion appendix testis
  • rarely epididymitis - has been misdiagnosed in cases of testicular torsion
  • unusual: trauma, haematocele, incarcerated inguinal hernia
  • if in doubt - explore
    • do not miss testicular torsion, only way to avoid losing testis/rule out torsion is to explore
30
Q

why do we investigate UTI in children

A
  • prevent renal scarring - reflux nephropathy and chronic renal failure
  • prevent HT
31
Q

when to investigate UTI in children

A

all <6/12

atypical

recurrent

32
Q

definition of UTI

A

pure growth of bacteria >105

pyuria

systemic upset - fever vomiting

mixed growth bacteria, no pyuria, no systemic Sx - less significant

33
Q

assessment of UTI

A

hx and exam - FHx renal problems, bowel habit, voiding dysfunction

USS to check kidneys - number, size, position, shape, hydronephrosis

renography -

  • MAG3 - drainage, function, reflux
  • DMSA - function, scarring

micturating cystourethrogram (MCUG) - unpleasant, avoid where possible

34
Q

grades of vesicoureteric reflux

A
  1. urine going into ureter
  2. into kidney w/ no dilation of renal tract
  3. more significant: dilation
  4. dilated calyces
  5. massively significant: massive reflux, gross hydronephrosis, dilated and torturous ureter
35
Q

what is grade 5 VUR associated with

A

almost always some form of dysplasia of the kidney

36
Q

management of VUR

A

conservative: voiding advice, avoid constipation, fluids

abx prophylaxis: best treatment if diagnosed young - continue until toilet trained, trimethoprim (2mg/kg nocte)

surgical: STING (mild/moderate VUR w/ Sx), submucosal teflon injection under ureter to stop reflux, effective; ureteric reimplantation (high grade reflux, much bigger operation) - take ureter out and put it back in a different place w/ a tunnel to stop reflux

37
Q

what is hypospadias

A

urethral meatus on ventral aspect of penis

38
Q

classification of hypospadia

A

anterior - relatively minor, cosmetic rather than functional issue

middle - more of an issue, usually requires surgery

posterior - very severe, challenging to fix

39
Q

associated anomalies w/ hypospadias

A

upper tract - unusual, not routinely checked for

ambiguous genitalia - often severe hypospadias, undescended testis

40
Q

investigations for hypospadias

A

US

karyotye only if severe

41
Q

management of hypospadias

A

anterior - single stage procedure

more severe - 2 stage procedure

  • important to straighten penis as part of surgery
    • difficulty urinating
    • ability to have penetrative intercourse

Y3 paediatrics (45 decks)

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