Paediatric Urology

Question 1

How do urological problems present in children?

Answer 1

Systemic: fever, vomiting, failure to thrive, anaemia, HTN, renal failure

Local: pain, changes in urine, abnormal voiding, mass, visible abnormalities, incidental

Antenatal: asymptomatic, permits immediate post natal assessment

Question 2

How are hernias and hydroceles managed in children?

Answer 2

Hernia: groin swelling
- management: <1 yr = urgent referral and repair, >1yr = elective referral and repair, incarcerated = reduce and repair on same admission

Hydrocele: scrotal swelling

• common in newborns, painless, bluish colour
• management is conservative until 5yo

Question 3

How do you approach a child with undescended testis?

Answer 3

Types: true cryptorchidism, retractile, ectopic

Indications for orchidopexy: fertility, malignancy, trauma, torsion, cosmetic

Question 4

How do you diagnose and investigate UTI in children?

Answer 4

Investigate to prevent renal scarring and hypertension (all <6/12, atypical, recurrent)

Presentation
Pure growth bacteria >10*5, pyuria, systemic upset eg fever, vomiting
Mixed growth, no pyuria, no systemic symptoms = less significant

Assessment

• history and exam
• USS
• renography eg MAG3, DMSA
• mictursting cystourethrogram (MCUG)

Question 5

How are penoscrotal conditions including hypospadia and acute scrotum recognised?

Answer 5

Acute scrotum: pain in the scrotum

• Dx: torsion testis, torsion appendix testis, epididymitis (rarer: trauma, haematocele, incarcerated inguinal hernia).
• Urgent surgery to prevent ischaemic damage (6-8hours to salvage testis!)

Hypospadia: urethral meatus is on ventral aspect of penis

• can have associated anomalies
• can US if severe
• do not circumcise. One stage or 2 stages procedure

Question 6

How is vesicoureteral reflux managed?

Answer 6

Conservative: voiding advice, constipation, fluids

Antibiotic prophylaxis: ?until age 4, trimethoprim

STING: mild/moderate with symptoms (

Ureteric reimplantation