Paediatric Urology Flashcards

Hernia // Hydrocele // Cryptochortism // Circumcision // UTI // VUR // Testicular torsion // Hypospadias

1
Q

What are the presentations of paediatric urological problems?

Systemic

Local

Antenatal

A

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
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2
Q

What is a Hernia?

A
  • 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??
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3
Q

What is the management of Hernia?

A

< 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
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4
Q

What is a hydrocele?

Management?

A
  • SCROTAL swelling
  • very common in newborns
  • painless
  • increases with crying, straining, evening
  • bluish colour

Conservative until 5 years of age.

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5
Q

What is Cryptorchidism?

A

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
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6
Q

What are indications for orchidopexy?

A
  • fertility
    • 1% loss germs cells / month undescent……
  • malignancy
    • RR 3 x (probably intra-abdominal only)
    • lifetime risk - <1%
  • trauma
  • torsion
  • cosmetic
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7
Q

What is circumcision?

Indications?

A
  • removal of foreskin
  • indications
    • absolute
      • Balanitis Xerotica Obliterans (BXO)
    • relative
      • balanoprosthitis
      • religious
      • UTI
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8
Q

What are the disadvantages of circumcision?

A
  • painful
  • complications
    • bleeding
    • meatal stenosis
    • fistula
    • cosmetic
  • look different
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9
Q

What are some differentials for an acute scrotum?

A
  • 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.

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10
Q

Why investigate UTI?

A
  • Prevent renal scarring and hypertension.
  • Investigate all <6/12, atypical, recurrent.
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11
Q

Definition of UTI?

SSx of UTI?

A
  • pure growth bacteria > 105
  • pyuria
  • systemic upset
  • fever, vomiting
  • mixed growth bacteria, no pyuria, no systemic symptoms
  • less significant
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12
Q

What are the important aspects of Assessing UTI in boys?

A
  • 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.
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13
Q

What is the management of VUR?

A
  • conservative
    • voiding advice, constipation, fluids
  • antibiotic prophylaxis
    • ? until age 4
      • Trimethoprim (2mg/kg nocte)
  • STING
    • mild/moderate with symptoms
  • ureteric reimplantation
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14
Q

What is Hypospadias?

A
  • Urethral meatus on the ventral aspect of the penis.
  • classification
    • Anterior (50%
    • Middle (30%)
    • Posterior (20%)
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15
Q

What are the investigations, management and associated anomalies?

A
  • investigations:
    • US if severe
  • management
    • DO NOT CIRCUMCISE
  • one stage or 2 stages procedure

Associated anomalies

  • upper tract abnormalities
  • intersex (ambiguous genitalia)
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