paediatric urology Flashcards
presentation of paediatric urological problems
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
what does this hx suggest:
- 9mth old male
- lump in left groin noticed which was then gone the next morning
- baby happy and feeding
inguinal hernia
features of inguinal hernia
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
management of inguinal hernia
<1y/o:
- URGENT referral
- repair - no place for observation
>1y/o:
- elective referral and repair
incarcerated:
- reduce and repair on same admission
what happens in an inguinal hernia
loop of bowel comes down through defective inguinal canal
what does this hx suggest:
- 9mth old male
- lump in left scrotal swelling, bluish colour
- gone the next morning
- baby happy and feeding
hydrocele
hydrocele features
SCROTAL swelling
very common in newborns
painless - increases w/ crying, straining, evening
bluish colour
management of hydrocele
conservative until 5y/o
what does this hx suggest:
- 9mth old male
- scrotum empty
- normal neonatal discharge examination
- baby happy and feeding
possible undescended testes
what is cryptorchidism
- 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
why are the testis in the scrotum
enzymes in the testis that produce sperm work at 33 degrees
incidence of cryptorchidism
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
indications for orchiodopexy in cryptorchidism
- 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
what does this hx indicate:
- 4y/o male w/ non-retractile foreskin
- recurrent balanitis
- o/e: pinhole meatus
normal non-retractile foreskin
normal non-retractile foreskin
area of tightness is just off the tip
not tight and not obstructing
what does this hx indicate:
- 14y/o male w/ non-retractile foreskin
- struggling to pass urine
- o/e: scarred foreskin, narrow meatus
BXO: balanitis xerotica obliterans