Paediatric Urology

Question 1

presentations of paediatric urological problems: systemic

Answer 1

o Fever, vomiting
o Failure to thrive
o Anaemia
o Hypertension
o Renal failure

Question 2

presentations of paediatric urological problems: local

Answer 2

o Pain
o Changes in urine
o Abnormal voiding
o Mass
o Visible abnormalities
o Incidental

Question 3

presentations of paediatric urological problems: antenatal

Answer 3

o Asymptomatic

o Permits immediate postnatal assessment

Question 4

inguinal hernia epidemiology

Answer 4

groin swelling
2% boys
boys 9:1
99% indirect
increase risk with prematurity
<1 yr 33% incarcerate

Question 5

management of inguinal hernia

Answer 5

• < 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

Question 6

hydrocele features

Answer 6

• Scrotal swelling
• Very common in new-borns
• Painless
o Increases with crying, straining, evening
• Bluish colour
• Management
o Conservative until 5 years of age

Question 7

what is cryptorchism and types?

Answer 7

Any testis that cannot be manipulated into the bottom half of the scrotum.
• True cryptorchidism
• Retractile
• Ectopic
• (Ascending testis)

Question 8

indications for orchidopexy

Answer 8

• Fertility
o 1% loss germ cells/month undescended
• Malignancy
o RR 3 x (probably intraabdominal only)
o Lifetime risk < 1%
• Trauma
• Torsion
• Cosmetic

Question 9

absolute indications for circumcision

Answer 9

balantitis xerotica obliterans

Question 10

relative indications for circumcision

Answer 10

balanoprosthitis
religious
UTI

Question 11

suggested advantages of circumcision

Answer 11

• 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

Question 12

disadvantages of circumcision

Answer 12

• Painful
• Complications
o Bleeding
o Meatal stenosis
o Fistula
o Cosmetic
• Look different

Question 13

differential for acute scrotum

Answer 13

Torsion testis, torsion appendix testis, epididymitis

§ Trauma, haematocele, incarcerated inguinal hernia

Question 14

how long do you have to recover a testes?

Answer 14

6-8hr

Question 15

why do you investigate UTI in kids

Answer 15

prevent ranal scarring therefore relux nephropathy and chronic renal failure
prevent hypertension

Question 16

NICE recommends that all what UTIs are investigated?

Answer 16

<6.12
atypical
recurrent

Question 17

define UTI

Answer 17

• Pure growth bacteria > 105
• Pyuria
• Systemic upset
o Fever, vomiting

Question 18

assessment of UTI in children

Answer 18

• 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)

Question 19

management of VUR

Answer 19

• 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

Question 20

what is hypospadias?

Answer 20

where the urethral meatus is on the ventral aspect of the penis

Question 21

what is hypospadias associated with?

Answer 21

anomalies in the upper tract and ambiguous genitalia

Question 22

what must you not do in hypospadias?

Answer 22

circumcise