Paediatric Urology Flashcards
What is an inguinal hernia?
protrusion of a viscus through the inguinal canal - get groin swelling
incidence of inguinal hernia
2% boys : 9:1
99% indirect
increased risk with prematurity
reducible hernia
can push back into original cavity
irreducible/ incarcerated hernia
unable to push back into original cavity
obstructed hernia
bowel contents unable to pass through hernia
strangulated hernia
blood supply of contents is occluded
management of inguinal hernia
Surgery
<1 year URGENT referral - repair
> 1 year elective referral and repair
management of incarcerated inguinal hernia
reduce and repair on same admission
What is hydrocele ?
SCROTAL swelling
like hernia but just the fluid gets through
hydrocele is very common in
newborns
symptoms of hydrocele
painless
increases with crying, straining , evening
management of hydrocele
conservative until 5 yrs of age - usually just gets better
What is Cryptorchidism
any testis that cannot be manipulated into the bottom half of the scrotum
crypto = hidden - orchid = Testis
true cryptorchidism
undescended
retractile cryptorchidism
can pull down - without any tension - when they go up like in the cold they go all the way up again
just leave this type
ectopic cryptorchidism
not in the right place
Ascending crytorchidism
down but down keep up with growth - gradually pulled up
incidence of cryptorchidism
increased risk in prematurity
absolute indications for circumcision
Blanitis Xerotica Obliterans (BXO)
Acute Scrotum means
testicular pain
differential diagnosis of acute scrotum
torsion testis, torsion appendix testis, epididymitis
how many hours do you have to recover the testis?
6-8
why investigate UTI?
prevent renal scarring
reflux nephropathy and chronic renal failure
prevent hypertension
who to investigate when they have a UTI
all <6/12, atypical, recurrent
definition of UTI
pure growth bacteria > 10^5
pyuria
systemic upset
fever, vomiting
incidence of UTI
boys> girls in infancy then other way round after 1
increased incidence with vesicouteric reflux and structural abnormalities
symptoms of UTI infants
often non - specific - fever, poor feeding , vomitting
symptoms of UTI older child
dysuria, haematuria, suprapubuic/ loin tenderness
Investigations for UTI
urine dipstick - leucocytes +/- nitrites/ blood
positive urine culture
when does UTI require imaging?
recurrent/ atypical
or in infant < 6 months
what imaging can be done for UTI
renal USS
micturating cystourethrogram MAG3 + DMSA = renography
treatment of UTI
appropriate anitbiotics
consider prophylactic AntiBs in high risk children
complications of UTI
calyces dilatation, renal scarring, chronic renal failure
conservative management of VUR
voiding advice, constipation, fluids
drug treatment of VUR
antibiotic prophylaxis
until age 4
trimethoprim
Surgical treatment of VUR
STING
what is hypospadias?
urethral meatus on the ventral aspect of the penis
associated anomalies with hypospadias
upper tract
ambiguous genitalia
management of hypospadias
surgical reconstruction
DO NOT CIRCUMCISE
