Paediatric Urology

Question 1

Inguinal hernia presentation and management

Answer 1

• groin swelling

Management:
- < 1 year old: URGENT referral, repair - no place for observation
- > 1 year old: elective referral and repair
- incarcerated: reduce and repair on same admission

Question 2

hydrocoele presentation and management

Answer 2

presentation:
- scrotal swelling
- painless
- increases with crying, straining, evening
- bluish colour

management:
- conservative until 5 years of age

Question 3

what is Cryptorchidism?

Answer 3

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

Question 4

indications for orchidopexy in the case of cryptorchidism

Answer 4

• fertility: 1% loss germs cells/month undescended
• malignancy: RR 3x (probably intra-abdo only), lifetime risk < 1%
• trauma
• torsion
• cosmetic

Question 5

what are the indications for circumcision?

Answer 5

• absolute: Balanitis Xerotica Obliterans (BXO)
• relative: balanoprosthitis, religious, UTI

Question 6

advantages and disadvantages of circumcision

Answer 6

advantages: minimal evidence of medical benefit

disadvantages:
- painful
- complications: bleeding, meatal stenosis, fistula, cosmetic

Question 7

difference between presentation of testicular torsion and torsion appendix testes?

Answer 7

testicular torsion
- scrotum red
- asymmetry
- acutely tender to touch

torsion appendix testes
- scrotum red
- NO asymmetry
- blue spot seen
- tender to touch

Question 8

vesico-ureteric reflux management

Answer 8

• conservative: voiding advice, constipation, fluids
• Abx prophylaxis: until toilet trained? trimethoprim (2mg/kg nocte)
• STING: mild/moderate with symptoms
• ureteric reimplantation