paediatric urology

Question 1

List the triad of hypospodias
(clinical presentation)

Answer 1

Ventral urethral meatus
Ventral chordee (penis curves sharply up or down)
Dorsal hood (lack of foreskin ventrally so its more dorsal)

Question 2

Outline the aetiology of hypospodias

Answer 2

-Non syndromic
Genetic factors
Endocrinopathy
Leydig cell dysfunction
Disorders of testosterone biosynthesis
Maternal exposure to
DDT
Progesterone during IVF

-Syndromic
Smith-Lemeli-Opitz
WAGR
Hand foot syndrome
Opitz G syndrome
13q deletion
Deny’s drash
Wolf- Hirshman

Question 3

what is the most common type of hypospodias

Answer 3

Distal
-glanular
-coronal
-subcoronal

Question 4

what is the medical management of phimosis

Answer 4

betamethazone cream applied to the penis

Question 5

list the clinical presentation of posterior urethral valve

Answer 5

Antenatal
Oligohydramnios
Dilated posterior urethra and bladder
Bilateral hydroureteronephrosis

Neonatal
Pulmonary hypoplasia  Respiratory distress
Severe early onset renal failure
High mortality, up to 45%

infants and older children
Difficulty voiding, urinary incontinence, UTI’s
Lifelong morbidity despite optimal treatment, 25 – 40% will progress to ESRD

Question 6

what are the pop off mechanisms in posterior urethral valve

Answer 6

(what protects the kidneys/ prevents devastation)

Unilateral reflux
Urinary ascites
Urinoma
Bladder diverticulum

Question 7

outline the management of puv

Answer 7

Resuscitation
Catheterization
Diagnosis with MCUG

Valve ablation or vesicostomy
Redo valve ablation 6 weeks later
Lifelong follow-up by nephrology
?Renal transplantation

Question 8

list the risk factors for renal scarring

Answer 8

Recurent febrile UTI’s
High grade reflux (Grade 4-5)
Child less than 1 year.
Underlying bladder bowel dysfunction

Question 9

ouline the neuropathic bladder classification and compare the two

Answer 9

Upper motor neuron (hyperreflexia)
High pressure
Poor compliance
Neurogenic detrusor overactivity

lower motor neuron
Low pressure
Good compliance
Atonic

Question 10

what are the clinical features of neuropathic bladder due to sacral agenesis

Answer 10

Examine the back:
AbN gluteal cleft
Lipoma
Tuft of hair
Pigmentation
Dimple

Question 11

which test would you do for paediatric pt with symptoms suggestive of both neuropathic bladder and bladder reflux

Answer 11

MCUG
Video-urodynamics
Renogram

Question 12

outline the management of neuropathic bladder

Answer 12

First line
Anticholinergics (oxybutin) +clean intermittent self catheterisation

Second line
Intravesical Botox injection

Third line
Bladder augmentation