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17th European Urology Residents Education Programme > Paediatric urology > Flashcards

Paediatric urology Flashcards

1
Q

How common is congenital urogenital anomalies on prenatal ultrasounds?

A

up to 2%

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2
Q

What is the most common urogenital anomoly that is discovered on prenatal ultrasounds?

A

60% is hydronephrosis

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3
Q

How common is UPJ obstruction?

A

1:1500

males 2:1 females in newborn

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4
Q

Differential diagnosis with hydronephrosis in newborns:

A 
UPJ problems 43%
VUR (vesicourethral reflux) 24%
Megaureter 12%
PUV (posterior urethral valves) 11%
Duplex systems 10%
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5
Q

What carachterises Megaurethers?

A

More often males
More on the left side

Can be caused by obstruction and/or reflux

Is primary or secondary (PUV, neurogenic bladder)

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6
Q

If a hydronephrosis is not an obstruction, what else can it be a sign of?

A

VUR (vesicourethral reflux)

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7
Q

What information is needed from the antenatal ultrasound if a hydronephrosis is discovered?

A 
Laterality, grade of dilatiation, echogenicitiy of the kidney
With or without a dilated urether
Bladder volume and emptying
Sex of child
Amniotic fluid volume
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8
Q

What is a VCUG?

A

Voiding CystoUrethroGram

Gold standard for imaging the bladder and urethra

Can detect:
Vesicoureteral reflux
urethral valves 
ureteroceles
diverticula
neurogenic bladder
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9
Q

What is a MAG3?

A

Type of Dynamic Renography

shows:
blood flow to the kidney
renal clearance
drainage function

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10
Q

When should UPJ obstruction be operated?

A 
Decreased renal function <40% on affected side
Increasing hydronephrosis
Manifesting symptoms
Poor drainage
grade III and IV dilatation
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11
Q

What are the goals in diagnosing and treating UPJ obstruction?

A

Perserve renal function

Less:
UTI
Pain
Hematuria
Urolithiasis
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12
Q

What share of megaurethers will resolve spontaneously?

A

85%

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13
Q

When should a megaurether be surgically corrected?

A

Progression in dilatation
Deterioration of renal function
Symptomatic

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14
Q

What is more common, a complete duplex system or a partial?

A

Partial

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15
Q

What other conditions are a duplex collecting system associated with?

A

Ectopic urether

Ureterocele

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16
Q

What are the most common sites for an ectopic urether?

A

Males: posterior urethra

Females: bladder neck, urethra, vagina

more common in girls

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17
Q

What is a ureterocele?

A

Malformation characteried by pseudo-cystic dilatation of the distal, intravesical portion of urethra

are often a source of obstruction

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18
Q

How common are ureteroceles?

A

1:4000

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19
Q

How common are ureteroceles in duplex systems?

A

80% are found in upper pole urether

20% in single systems

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20
Q

How common are bilateral ureteroceles?

A

10%

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21
Q

What is the ratio boys:girls in the prevalence of ureteroceles?

A

1:4-7

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22
Q

What is a Posterior Urethral Valve?

A

Obstructing membranous fold within the lumen of the posterior urethra

23
Q

What is the most common urinary obstruction that affects newborn boys?

A

Posterior Urethral Valve (PUV)
1: 5000-8000 live births

is lifethreatening
35% renal insufficiency despite optimal treatment

24
Q

How do you treat PUV and what is the result?

A

Shunting
Fetal valve ablation

bladder decompression
restoration of amniotic fluid
lungs can expand
restoration of surfactant
no benefit for renal function
25
Q

At what age is the foreskin most often retractable?

A

90% at 3 years old

26
Q

How many boys still have physiological fimosis at 17?

A

1%

27
Q

How do you treat secondary fimosis?

A

Stereoid creme (class III-stereoids, twice daily 39 days)
Dorsal slit
Circumcision

28
Q

What are the medical indications for circumcision?

A

Congenital urinary tract malformation to reduce risk for UTI
Secondary phimosis with recurrent UTI
BXO (balanitis xerotica obliterans)

29
Q

What is the NNT to prevent UTI for circumcisions?

A

111

therefore not justified as a routine

30
Q

What are the contraindications for circumcision?

A

acute infection
congenital anomalies
bleeding disorders

31
Q

What is the complication rate for circumcision?

A

0,2-5%

32
Q

What is the incidence of hypospadias?

A

1:300 newborn boys

33
Q

In hypospadias, how many are distal and how many are proximal?

A

Distal 80%

proximal 20%

34
Q

What factors are associated with hypospadias?

A

Mainly unknown

low birth weight
young and older mothers
vegeterian diet during pregnancy
IVF
some genetic disorders
disorders of sexual differentation
35
Q

What are the indication for surgical correction of hypospadias?

A

Straighten the penis
Enable standing voiding
Enable normal sexual function
Meatal stenosis correction

cosmetic- foreskin reconstruction

36
Q

What is the most prevalent procedure for correcting hypospadias?

A

Tubularised incised plate
if proximal, two stage procedure

with buccal or skin behind the ear
(important, skin without hair)

37
Q

What are longtime complications after hypospadia surgery?

A

urethrocutaneous fistula 7-25%

Stricture/stenosis 5-15%

38
Q

What is Epispadias?

A

Defect in the dorsal wall of the urethra

together with incontinence and small penis size

39
Q

What is the incidence of epispadias?

A

1: 120 000 male births

40
Q

How do you define a micropenis?

A

stretched penis length < 2,5 SD of age specific length

41
Q

What other conditions are micropenises associated with?

A 
Hypogonadism 
PAIS
Chromosomal abberations
-Klinefelter's syndrome
-Prader- Willis syndrome
Idiopathic
42
Q

What other investigations should be conducted on a patient with a micropenis?

A

Karyotype
Hormonal analysis
hCG stimulations test
Paediatric endocrinologist

43
Q

When is surgical intervention varranted for a hydrocele?

A

If persistent >12 months

44
Q

Differential diagnoses for acute onset scrotal masses:

A 
Torsion
Trauma
Abscess
Orchitis
Epididymnitis
45
Q

Differential diagnoses for non-acute onset scrotal masses:

A 
Hydrocele
Hernia
Spermatocele
Varicocele
Neoplasia
46
Q

What is the most common age for testicular torsion?

A

12-20 years

47
Q

What is the difference between regular testicular torsion and Neonatal testicular torsion?

A

Neonatal testicular torsion can be extravaginal

48
Q

What are the most common viral causes for epididymo-orchitis in children?

A

Adenovirus

Mumps

49
Q

What is Acute Idiopathic scrotal edema?

A

Inflammation, tenderness and swelling of scrotal skin
can extend to the perineum & abdomen

age 2-10
non-tender testis
spntanous resolution <72 hours
UL -thickening of scrotal skin

Colud be an allergic reaction

50
Q

How common is cryptorchidism?

A

3% at birth

1% at 1 year

51
Q

How often is cryptochidism bilateral?

A

30%

52
Q

How often is the testicle palpable in cryptochidism?

A

80%

53
Q

How often is the testicle absent in cryptochidism?

A

of those that are not palpable 20% are without testicle

54
Q

When should cryptiochidism be corrected?

A

Before 1 year of age

17th European Urology Residents Education Programme (17 decks)

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