Paediatric urology

Question 1

A young girl, prior to puberty, presents with :

• Soreness
• Itching
• Erythema around labia
• Vaginal discharge
• Dysuria
• Constipation

What is the likely diagnosis and what will be seen on urine dipstick ?

Answer 1

Vulvovaginitis
Leukocytes but no nitrites

Question 2

when do most children get control of daytime and nightime urination

Answer 2

• Daytime : 2 yrs
• Nightime : 3-4 yrs

Question 3

How can nocturnal enuresis be classfied

Answer 3

• Primary : child has never been consistently dry at night
• Secondary : previously been dry at night for at least 6mnths

Question 4

Give 6 causes of primary nocturnal enuresis

Answer 4

• Variation in normal development
• Overactive bladder
• Fluids intake before bed
• Failure to wake
• Psychological distress
• Secondary causes : constipation, UTI, learning disability, cerebral palsy.

Question 5

How is nocturnal enuresis managed ?

Answer 5

• <5 = reassurance
• General advice : fluid intake, toielting patternsm reward schemes
• Enuresis alarm (needs to be trialed for at least 3 mnths)
• Desmopressin for short term control

Question 6

How does desmopressin work in the managed of nocturnal enuresis ?

Answer 6

• It is an analogue of vasopressin
• Reduces the volume of urine produced by the kidneys

Question 7

what is a cause of hydronephrosis in newborn boys ?

Answer 7

• Posterior urethral valve : tissue at the proximal end of the urethra causes obstruction to urine output

Question 8

In more mild cases, how does a posterior urethral valve present ?

Answer 8

Obstruction to outflow causes back pressure into the bladder, ureters and up to the kidneys.

• Difficulty urinating
• Weak urinary stream
• Chronic urinary retention
• Palpable bladder
• Recurrent urinary tract infections
• Impaired kidney function

Question 9

How does severe cases of a posterior urethral valve present ?

Answer 9

• Presents in the fetus as bilateral hydronephrosis and oligohydramnios
• Oligohydramnios leads to pulmonary hypoplasia with resp failure shortly after birth

Question 10

If not picked up on antenatal scnas, what investigations are done in a posterior urethral valve ?

Answer 10

• Abdo USS : enlarged, thickened bladder and bilateral hydronephrosis
• MCUG : Cshows the location of the extra urethral tissue and reflux of urine back into the bladder
  Cystoscopy : can also be used to ablate or remove the extra tissue = definitive management

Question 11

Explain the normal development of the testes

Answer 11

• Develop in the abdomen
• Migrate down through the inguinal canal and into the scrotum

Question 12

Give 5 RF for undescended testes

Answer 12

• Fx
• Low birth weight
• Small for gestational age
• Prematurity
• Maternal smoking during pregnancy

Question 13

When should a child with unilateral undescended testis be referred ?

Answer 13

• From around 3 mnths
• Seen by a urological surgeon by 6 mnths of age

Question 14

When should a child with bilateral undescended testes be referred

Answer 14

Reviewed by senior paediatrician within 24 hrs

Question 15

When should Orchidopexy for a unilateral undescended testis be performed

Answer 15

Around 1 yr of age

Question 16

What is hypospadias ?

Answer 16

Congenital condition where the urehtal meatus is displaced to the ventral side of the penis towards the scrotum

Question 17

Give 3 features of hypospadias

Answer 17

• Vventral urethral meatus
• Hooded prepuce
• Chordee (ventral curvature of the penis) in more severe forms

Question 18

what is essential to warn parents of children with hypospadias

Answer 18

it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure

Question 19

what is a hydrocele

Answer 19

Collection of fluid within the tunica vaginalis surrounding the testes

Question 20

What is a simple hydrocele

Answer 20

Non-communicating : caused by excessive fluid production within the tunica vaginalis

Question 21

What is a communicating hydrocele

Answer 21

• Occurs when the tunica vaginalis is connected with the peritoneal cavity via the processus vaginalis
• This allows fluid to flow from the peritoneal cavity into the hydrocele.

Question 22

what is seen on examination of a hydrocele

Answer 22

• Soft, smooth non tender swelling around one testes (usually anterior and below testicle)
• Swelling confined to scrotum : you can ‘get above’ the mass
• Transilluminate with light

Question 23

what imaging is used to confirm a hydrocele

Answer 23

USS

Question 24

when will a child wit hypospadias be referred to a specialist for possible surgery ?

Answer 24

12 mnths of age