Paediatric Urology Flashcards
What are some systemic presentations of paediatric urological problems?
- fever, vomiting
- failure to thrive
- anaemia
- hypertension
- renal failure
What are some local symptoms of paediatric urological problems?
- pain
- changes in urine
- abnormal voiding
- mass in pelvis
- visible abnormalities
- incidental
What are antenatal presentations of paediatric urological problems?
- asymptomatic
- permits immediate postnatal assessment
How does inguinal hernia present?
groin swelling out of deep inguinal ring
What do we mean when we say a hernia is ‘incarcerated’?
it cannot be reduced back to where it originated
How would hernia be managed if the child was less than a year old?
urgent referral and repair because the hernia is more likely to be incarcerated
How would hernia be managed if the child was more than a year old?
elective referral and repair
What is hydrocele and what generally causes it in children?
- painless scrotal swelling
- fluid leaking through the processes vaginalis
What can worsen hydrocele?
increases with crying, straining and in the evening
How would hydrocele be managed?
conservative until 5 years of age
What is cryptorchidism?
any testis that cannot be manipulated into the bottom half of the scrotum
True cryptorchidism?
the testes have not descended at all
Retractile cryptorchidism.
can manipulate the testis to come down but will bounce back after a few seconds
Ectopic cryptorchidism.
testis descend into wrong place e.g. thigh
Ascending testis.
- have been in scrotum at birth but not later on
- can be due to cord of testis not growing properly and so lifting them up
What is circumcision?
removal of foreskin
What is an absolute indication for circumcision?
Balanitis Xerotica Obliterans - a scarring condition of the foreskin that can lead to urinary retention
What are some relative indications for circumcision?
- balanoprosthitis
- religious
- UTI
What are disadvantages of circumcision?
- painful
- complications such as bleeding, mental stenosis, fistula, cosmetic
If a child presents with n acute scrotum (painful scrotum), what would you include in the differential diagnosis?
- testicular torsion***
- torsion appendix testis**
- epididymitis*
- trauma
- haematocoele
- incarecerated inguinal hernia
In what age group is testicular torsion common?
12-14 year olds
How much time do you have to save the testicle in testicular torsion?
6-8 hours from time of twist
What is torsion appendix testis?
when an appendage to the testis (most likely a remnant from embryological development) gets twisted and causes pain
What sign on examination might suggest testicular torsion?
transverse lie of testicle
Why would you investigate UTI?
- prevent renal scarring
- prevent hypertension
Who would you investigate with a UTI?
- atypical UTI
- recurrent UTI
- all children less than 6 months old with UTI
What growth of bacteria defines a UTI?
pure growth bacteria >10 to power of 5
What symptoms are there of UTI?
- pyuria
- systemic upset e.g. fever, vomiting
How would you assess a UTI?
-history and examination ask abut family history, bowel habit (constipation), voiding dysfunction -US number of kidneys? size, position, shape, hydronephrosis -renography MAG3 DMSA -micturating cystourethrogram
What is MAG3?
a type of demography that looks at the drainage, function and reflux in the kidney
What is DMSA?
a type of demography looking at function, scarring of kidney (area of kidney not being perfused will show up)
What is the purpose of a micturating cystourethrogram?
look for reflux in kidney
How is kidney reflux graded? (vesicoureteric reflux VUR)
1-5
1- reflux does not extend past the ureters
2-reflux extends to the kidney
3-reflux extends to kidney with some dilatation
4-reflux extends to kidney with moderate dilatation
5-reflux extends to kidney with extensive dilatation
How is vesicoureteric reflux managed?
- conservative i.e. voiding advice, constipation, fluids
- antibiotic prophylaxis for grade 3 and above (trimethoprim)
- STING for mild/moderate with symptoms
- ureteric reimplantation
What are hypospadias?
when the urethral meatus is on the ventral aspect of the penis
How are hypospadias classes and what is the most common?
- anterior(most common-50%)
- middle
- posterior (at scrotum)
What management is there for hypospadias?
one stage or 2 stage procedure to move urethral meatus to tip of penis
