Paediatric Urology Flashcards
Symptoms of paediatric urological problems
Systemic - fever, vomiting, failure to thrive, anaemia, hypertension, renal failure
Local - pain, changes in urine, abnormal voiding, mass, visibile abnormalities, incidental finding
Antenatal presentation of urological problems
Typically assymptomatic
Post natal assessment
Ratio of hernia in boys to girls
9 to 1
What percentage of hernias are indirect?
99%
Origin of hernia in boys versus girls
Boys - bowel
Girls - ovary
Difference between direct and indirect hernia
Indirect through the inguinal canal
Direct - through posterior wall of inguinal canal
Hernia managment
Sugery - mesh repair
Hernia truss if unfit in older patients
Location of inguinal canal
Above inguinal ligament
Superficial ring anterior to pubic tubercle
Deep ring approximately 1.5-2cm above the half way point between the anterior superior iliac spine and the pubic tubercle
Floor of inguinal canal
External oblique aponeurosis
Inguinal ligament
Lacunar ligament
Roof of inguinal canal
Internal oblique
Transversus abdominis
Anterior wall of inguinal canal
Ecternal oblique aponeurosis
Posterior wal of inguinal canal
Transversalis fascia
Conjoint tendon
Lateral to inguinal canal
Internal ring
Fibres of internal oblique
Medial of inguinal canal
External ring
Conjoint tendon
Contents of inguinal canal in male
Spermatic cord
Ilioinguinal nerve
Coverings of spermatic cord
External spermatic fascia
Cremasteric fascia
Internal spermatic fascia
From which tissue is the external spermatic fascia continuous
External oblique aponeurosis
Contents of inguinal canal in female
Round ligament of uterus
Iioinguinal nerve
Presentation of hernia
Lump in groin
Child may have vomited
Complications of hernia
Bruising, wound infection
Chronic Pain
Recurrence
What is hydrocele?
Accumulation of fluid in tunica vaginalis
Scrotal swelling
Features of presentation of hydrocele in children
Swelling - confined to scrotum
No pain
Increases with crying, straining and in the evening
Bluish colour
2 types of hydrocele
Communicating and non-communicating
Difference between communicating and non-communicating hydrocele
Communicating - patency -flow of peritoneal fluid
Non-communicating - excess fluid production in tunica vaginalis
Which type of hydrocele is most common in newborn males?
Communicating
A hydrocele can develop secondary to
Epididymoorchitis
Testicular torsion
Testicular tumours
Management of infantile hydrocele
Conservative until age 5
What is cryptorchidism?
Failure to manipulate any testis into bottom half of scrotum
3 groups of cryptorchdism
True undescended testis
Ectopic
Ascending testis
What is true undescended testis?
where testis is absent from the scrotum but lies along the line of testicular descent
What is ascending testis?
where a testis previously identified in the scrotum undergoes a secondary ascent out of the scrotum.
What pulls the testis from abdomen to scrotum during embryological development?
Gubernaculum
Risk factors for cryptorchidism
Prematurity
Low birth weight
Other genitalia abnormalities (hypospadias)
First degree relative with cryptorchidism
What needs to be clarified in history of cryptorchidism?
Has testis ever been seen or palpated within the scrotum
Sites of true undescended testis
Abdominal
Inguinal
Suprascrotal
Sites of ectopic testis
Prepenile
Femoral
Cryptorchidism may be a presentation of which other condition?
Congenital Adrenal Hyperplasia
How is congenital adrenal hyperplasia managed?
High dose sodium chloride therapy
Glucose montioring
Steroid replacement
Indications for orchidopexy
Fertility Malignancy Torsion Trauma Cosmetic
Absolute indication for circumcision
Balanitis Xerotica Obliterans
What is Balanitis Xerotica Obliterans
Keratinisation of tip of foreskin causes scarring and prepuce is non-retractile
Clinical features of balanitis xerotica obliterans
Ballooning of foreskin during micturition
Scarring of urethral meatus - dysuria, irritation, haematuria, local infection
Relative indications for circumcision
Balanoprosthitis
Religious
UTI
Complications of circumcision
Bleeding
Meatal stenosis
Fistula
Cosmetic
Differential diagnosis of acute scrotum
Torsion testis
Torsion appendix testis - blue dot sign
Epididymitis
Causes of acute scrotum
Trauma
Haematocele
Incarcerated inguinal hernia
Definition of UTI
Pure growth bacteria
Pyuria
Systemic upset -fever, vomiting
Management of vesicoureteric reflux
Conservative - voiding advice, constipation, fluids
Antibiotic prophylaxis - trimethoprim 2mg/kg nocte
STING - subureteral teflon injection
Ureteric reimplantation
What is hypospadia?
Urethral meatus on ventral aspect of penis
Occurs due to arrested development
Classification of hypospadias
Anterior
Middle
Posterior
Anterior occurs in 50%
Glandular Coronal Shaft - distal, middle, proximal Scrotal Perineal
3 features for diagnosis
Do not need all 3
Urethral meatus on ventral aspect
Ventral curvature - Chordee
Dorsal hooded foreskin
Differential diagnosis of hypospadia
Important to exclude Disorder of Sex Development (DSD)
Associated with unilateral or bilateral undescended testis
What condition must not be missed with hypospadias and abnormalities in female genitalia?
Congenital Adrenal Hyperplasia
Investigations for hypospadias
Ultrasound if severe
Karyotype
Urea and Electrolytes
Endocrine tests
Management of hypospadias
DO NOT CIRCUMCISE
Ureoplasty
Meatus brought to glans of penis, chordee corrected,
Dorsal foreskin can be circumcised or reconstructed
Complications of hypospadias
Bleeding Infection Bladder spasms Meatal or urethral stenosis Urethral fistula
