Paediatric Urology Flashcards
Hernia // Hydrocele // Cryptochortism // Circumcision // UTI // VUR // Testicular torsion // Hypospadias
What are the presentations of paediatric urological problems?
Systemic
Local
Antenatal
Systemic
- fever, vomiting
- failure to thrive
- anaemia
- hypertension
- renal failure
Local
- pain
- changes in urine
- abnormal voiding
- mass
- visible abnormalities
- incidental
Antenatal
- asymptomatic
- permits immediate postnatal assessment
What is a Hernia?
- Groin swelling
- Much more common in boys - due to inguinal canal formation
- Most are indirect - coming through inguinal canal.
- Higher risk in prematurity because of non descent of testes.
- Complication - incarceration??
What is the management of Hernia?
< 1 year
- URGENT referral - fax / phone
- repair - no place for observation
y> 1 year
- elective referral and repair
Incarcerated (this can cause testicular ischaemia)
- reduce and repair on same admission
What is a hydrocele?
Management?
- SCROTAL swelling
- very common in newborns
- painless
- increases with crying, straining, evening
- bluish colour
Conservative until 5 years of age.
What is Cryptorchidism?
Any testis that cannot be manipulated into the bottom half of the scrotum.
- true cryptorchidism
- (retractile testes are normal)
- ectopic
- (ascending testis) - just stays at same stage, doesn’t keep up with growth
What are indications for orchidopexy?
- fertility
- 1% loss germs cells / month undescent……
- malignancy
- RR 3 x (probably intra-abdominal only)
- lifetime risk - <1%
- trauma
- torsion
- cosmetic
What is circumcision?
Indications?
- removal of foreskin
- indications
- absolute
- Balanitis Xerotica Obliterans (BXO)
- relative
- balanoprosthitis
- religious
- UTI
- absolute
What are the disadvantages of circumcision?
- painful
- complications
- bleeding
- meatal stenosis
- fistula
- cosmetic
- look different
What are some differentials for an acute scrotum?
- torsion testis - twisting and loss of blood supply
- torsion appendix testis
- epididymitis
- Trauma, haematocoele, incarcerated inguinal hernia (these are uncommon)
There can often be a delay because boys are embarrassed to tell mother etc.
Why investigate UTI?
- Prevent renal scarring and hypertension.
- Investigate all <6/12, atypical, recurrent.
Definition of UTI?
SSx of UTI?
- pure growth bacteria > 105
- pyuria
- systemic upset
- fever, vomiting
- mixed growth bacteria, no pyuria, no systemic symptoms
- less significant
What are the important aspects of Assessing UTI in boys?
- history and examination
- FH, bowel habit, voiding dysfunction
- ultrasound scan
- number, size, position, shape, hydronephrosis
- renography
- MAG3 - drainage, function, reflux
- DMSA - function, scarring
- micturating cystourethrogram (MCUG - fill the bladder with dye.
What is the management of VUR?
- conservative
- voiding advice, constipation, fluids
- antibiotic prophylaxis
- ? until age 4
- Trimethoprim (2mg/kg nocte)
- ? until age 4
- STING
- mild/moderate with symptoms
- ureteric reimplantation
What is Hypospadias?
- Urethral meatus on the ventral aspect of the penis.
- classification
- Anterior (50%
- Middle (30%)
- Posterior (20%)
What are the investigations, management and associated anomalies?
- investigations:
- US if severe
- management
- DO NOT CIRCUMCISE
- one stage or 2 stages procedure
Associated anomalies
- upper tract abnormalities
- intersex (ambiguous genitalia)