Paediatric Urology Flashcards
presentations of paediatric urological problems: systemic
o Fever, vomiting o Failure to thrive o Anaemia o Hypertension o Renal failure
presentations of paediatric urological problems: local
o Pain o Changes in urine o Abnormal voiding o Mass o Visible abnormalities o Incidental
presentations of paediatric urological problems: antenatal
o Asymptomatic
o Permits immediate postnatal assessment
inguinal hernia epidemiology
groin swelling 2% boys boys 9:1 99% indirect increase risk with prematurity <1 yr 33% incarcerate
management of inguinal hernia
• < 1 year o Urgent referral – fax/phone o Repair – no place for observation • > 1 year o Elective referral and repair • Incarcerated o Reduce and repair on same admission
hydrocele features
• Scrotal swelling • Very common in new-borns • Painless o Increases with crying, straining, evening • Bluish colour • Management o Conservative until 5 years of age
what is cryptorchism and types?
Any testis that cannot be manipulated into the bottom half of the scrotum. • True cryptorchidism • Retractile • Ectopic • (Ascending testis)
indications for orchidopexy
• Fertility o 1% loss germ cells/month undescended • Malignancy o RR 3 x (probably intraabdominal only) o Lifetime risk < 1% • Trauma • Torsion • Cosmetic
absolute indications for circumcision
balantitis xerotica obliterans
relative indications for circumcision
balanoprosthitis
religious
UTI
suggested advantages of circumcision
• UTI o 120 to prevent 1 UTI • Malignancy o Penile cancer very rare • Sexual enhancement o Increased nerve endings in prepuce • AIDS/STDs o Sub-Saharan Africa • Overall, no evidence of medical benefit
disadvantages of circumcision
• Painful • Complications o Bleeding o Meatal stenosis o Fistula o Cosmetic • Look different
differential for acute scrotum
Torsion testis, torsion appendix testis, epididymitis
§ Trauma, haematocele, incarcerated inguinal hernia
how long do you have to recover a testes?
6-8hr
why do you investigate UTI in kids
prevent ranal scarring therefore relux nephropathy and chronic renal failure
prevent hypertension
NICE recommends that all what UTIs are investigated?
<6.12
atypical
recurrent
define UTI
• Pure growth bacteria > 105
• Pyuria
• Systemic upset
o Fever, vomiting
assessment of UTI in children
• History and examination o Fh, bowel habit, voiding dysfunction • Ultrasound scan o Number, size, position, shape, hydronephrosis • Renography o Mag3 - drainage, function, reflux o Dmsa - function, scarring • Micturating cystourethrogram (mcug)
management of VUR
• Conservative o Voiding advice, constipation, fluids • Antibiotic prophylaxis o ? Until age 4 o Trimethoprim (2mg/kg nocte) • STING o Mild/moderate with symptoms • Ureteric reimplantation
what is hypospadias?
where the urethral meatus is on the ventral aspect of the penis
what is hypospadias associated with?
anomalies in the upper tract and ambiguous genitalia
what must you not do in hypospadias?
circumcise
