Paediatric urology Flashcards
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 ?
Vulvovaginitis
Leukocytes but no nitrites
when do most children get control of daytime and nightime urination
- Daytime : 2 yrs
- Nightime : 3-4 yrs
How can nocturnal enuresis be classfied
- Primary : child has never been consistently dry at night
- Secondary : previously been dry at night for at least 6mnths
Give 6 causes of primary nocturnal enuresis
- Variation in normal development
- Overactive bladder
- Fluids intake before bed
- Failure to wake
- Psychological distress
- Secondary causes : constipation, UTI, learning disability, cerebral palsy.
How is nocturnal enuresis managed ?
- <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
How does desmopressin work in the managed of nocturnal enuresis ?
- It is an analogue of vasopressin
- Reduces the volume of urine produced by the kidneys
what is a cause of hydronephrosis in newborn boys ?
- Posterior urethral valve : tissue at the proximal end of the urethra causes obstruction to urine output
In more mild cases, how does a posterior urethral valve present ?
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
How does severe cases of a posterior urethral valve present ?
- Presents in the fetus as bilateral hydronephrosis and oligohydramnios
- Oligohydramnios leads to pulmonary hypoplasia with resp failure shortly after birth
If not picked up on antenatal scnas, what investigations are done in a posterior urethral valve ?
- 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
Explain the normal development of the testes
- Develop in the abdomen
- Migrate down through the inguinal canal and into the scrotum
Give 5 RF for undescended testes
- Fx
- Low birth weight
- Small for gestational age
- Prematurity
- Maternal smoking during pregnancy
When should a child with unilateral undescended testis be referred ?
- From around 3 mnths
- Seen by a urological surgeon by 6 mnths of age
When should a child with bilateral undescended testes be referred
Reviewed by senior paediatrician within 24 hrs
When should Orchidopexy for a unilateral undescended testis be performed
Around 1 yr of age
What is hypospadias ?
Congenital condition where the urehtal meatus is displaced to the ventral side of the penis towards the scrotum
Give 3 features of hypospadias
- Vventral urethral meatus
- Hooded prepuce
- Chordee (ventral curvature of the penis) in more severe forms
what is essential to warn parents of children with hypospadias
it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure
what is a hydrocele
Collection of fluid within the tunica vaginalis surrounding the testes
What is a simple hydrocele
Non-communicating : caused by excessive fluid production within the tunica vaginalis
What is a communicating hydrocele
- 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.
what is seen on examination of a hydrocele
- 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
what imaging is used to confirm a hydrocele
USS
when will a child wit hypospadias be referred to a specialist for possible surgery ?
12 mnths of age
