Paediatric Urology Flashcards
What populations are most affected by inguinal hernias?
Boys > girls 9:1
Increased incidence in premature babies
What is the difference in presentation between an inguinal hernia and a hydrocele?
Inguinal hernia = groin swelling
Hydrocele = scrotal swelling
What is the management of inguinal hernias?
In infants (<1 year)- urgent referral for repair
>1 year- elective referral and repair
Strangulated/incarcerated- reduce and repair on same admission
How do hydroceles present?
Very common in newborns
Scrotal swelling
Painless
Can be bluish
How are hydroceles managed?
Cause no harm so left to recede and do so spontaneously
Can operate if not receded by 5
What is the definition of cryptorchidism?
Cryptorchidism refers to any testis that cannot be manipulated into the bottom half of the scrotum
What are the four kinds of cryptorchidism? Describe each
True cryptorchidism
Retractile- sits high but can be pulled into scrotum, should be left alone
Ectopic- descend incorrectly
Ascending testis- don’t progress with growth and gradually get pulled out of scrotum. Will have normal examination at birth but will have undescended testes appearance by 4/5
When is incidence of cryptorchidism higher?
In light or premature babies
What are the indications for orchidopexy in cryptorchidism?
Fertility Malignancy Trauma Torsion Cosmetic
What are the absolute and relative indications for circumcision?
Absolute: -Balanitis xerotica obliterans (BXO)- scarring condition of foreskin, circumcision only treatment Relative: -Balanoprosthitis -Religious -UTI risk
What are the disadvantages of circumcision?
Painful Complications: -Bleeding -Meatal stenosis -Fistula -Cosmetic
What are the differential diagnoses for an acute scrotum?
Torsion testes
Torsion appendix testes (embryological remnant (hydatid) becomes torted. Pain is referred to testes as it does not have it’s own nerve. Can be operated on if very painful but will die off on its own in a few days)
Epididymitis
Trauma (only significant if pain onsets directly after trauma and persists)
Haematocele
Incarcerated inguinal hernia
In what age groups are torsion testes and torsion appendix testes most common?
Torsion testes- 10-15+
Torsion appendix testes- 6-15
When should UTI be investigated?
In those <6 months
Atypical causative organism
Recurrent
What are the aims of UTI investigation?
To prevent renal scarring and hypertension.
