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Paediatrics > Paediatric Urology > Flashcards

Paediatric Urology Flashcards

1
Q

Symptoms of paediatric urological problems

A

Systemic - fever, vomiting, failure to thrive, anaemia, hypertension, renal failure

Local - pain, changes in urine, abnormal voiding, mass, visibile abnormalities, incidental finding

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2
Q

Antenatal presentation of urological problems

A

Typically assymptomatic

Post natal assessment

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3
Q

Ratio of hernia in boys to girls

A

9 to 1

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4
Q

What percentage of hernias are indirect?

A

99%

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5
Q

Origin of hernia in boys versus girls

A

Boys - bowel

Girls - ovary

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6
Q

Difference between direct and indirect hernia

A

Indirect through the inguinal canal

Direct - through posterior wall of inguinal canal

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7
Q

Hernia managment

A

Sugery - mesh repair

Hernia truss if unfit in older patients

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8
Q

Location of inguinal canal

A

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

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9
Q

Floor of inguinal canal

A

External oblique aponeurosis
Inguinal ligament
Lacunar ligament

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10
Q

Roof of inguinal canal

A

Internal oblique

Transversus abdominis

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11
Q

Anterior wall of inguinal canal

A

Ecternal oblique aponeurosis

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12
Q

Posterior wal of inguinal canal

A

Transversalis fascia

Conjoint tendon

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13
Q

Lateral to inguinal canal

A

Internal ring

Fibres of internal oblique

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14
Q

Medial of inguinal canal

A

External ring

Conjoint tendon

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15
Q

Contents of inguinal canal in male

A

Spermatic cord

Ilioinguinal nerve

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16
Q

Coverings of spermatic cord

A

External spermatic fascia
Cremasteric fascia
Internal spermatic fascia

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17
Q

From which tissue is the external spermatic fascia continuous

A

External oblique aponeurosis

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18
Q

Contents of inguinal canal in female

A

Round ligament of uterus

Iioinguinal nerve

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19
Q

Presentation of hernia

A

Lump in groin

Child may have vomited

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20
Q

Complications of hernia

A

Bruising, wound infection
Chronic Pain
Recurrence

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21
Q

What is hydrocele?

A

Accumulation of fluid in tunica vaginalis

Scrotal swelling

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22
Q

Features of presentation of hydrocele in children

A

Swelling - confined to scrotum
No pain
Increases with crying, straining and in the evening
Bluish colour

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23
Q

2 types of hydrocele

A

Communicating and non-communicating

24
Q

Difference between communicating and non-communicating hydrocele

A

Communicating - patency -flow of peritoneal fluid

Non-communicating - excess fluid production in tunica vaginalis

25
Q

Which type of hydrocele is most common in newborn males?

A

Communicating

26
Q

A hydrocele can develop secondary to

A

Epididymoorchitis
Testicular torsion
Testicular tumours

27
Q

Management of infantile hydrocele

A

Conservative until age 5

28
Q

What is cryptorchidism?

A

Failure to manipulate any testis into bottom half of scrotum

29
Q

3 groups of cryptorchdism

A

True undescended testis
Ectopic
Ascending testis

30
Q

What is true undescended testis?

A

where testis is absent from the scrotum but lies along the line of testicular descent

31
Q

What is ascending testis?

A

where a testis previously identified in the scrotum undergoes a secondary ascent out of the scrotum.

32
Q

What pulls the testis from abdomen to scrotum during embryological development?

A

Gubernaculum

33
Q

Risk factors for cryptorchidism

A

Prematurity
Low birth weight
Other genitalia abnormalities (hypospadias)
First degree relative with cryptorchidism

34
Q

What needs to be clarified in history of cryptorchidism?

A

Has testis ever been seen or palpated within the scrotum

35
Q

Sites of true undescended testis

A

Abdominal
Inguinal
Suprascrotal

36
Q

Sites of ectopic testis

A

Prepenile

Femoral

37
Q

Cryptorchidism may be a presentation of which other condition?

A

Congenital Adrenal Hyperplasia

38
Q

How is congenital adrenal hyperplasia managed?

A

High dose sodium chloride therapy
Glucose montioring
Steroid replacement

39
Q

Indications for orchidopexy

A 
Fertility
Malignancy
Torsion
Trauma
Cosmetic
40
Q

Absolute indication for circumcision

A

Balanitis Xerotica Obliterans

41
Q

What is Balanitis Xerotica Obliterans

A

Keratinisation of tip of foreskin causes scarring and prepuce is non-retractile

42
Q

Clinical features of balanitis xerotica obliterans

A

Ballooning of foreskin during micturition

Scarring of urethral meatus - dysuria, irritation, haematuria, local infection

43
Q

Relative indications for circumcision

A

Balanoprosthitis
Religious
UTI

44
Q

Complications of circumcision

A

Bleeding
Meatal stenosis
Fistula
Cosmetic

45
Q

Differential diagnosis of acute scrotum

A

Torsion testis
Torsion appendix testis - blue dot sign
Epididymitis

46
Q

Causes of acute scrotum

A

Trauma
Haematocele
Incarcerated inguinal hernia

47
Q

Definition of UTI

A

Pure growth bacteria
Pyuria
Systemic upset -fever, vomiting

48
Q

Management of vesicoureteric reflux

A

Conservative - voiding advice, constipation, fluids
Antibiotic prophylaxis - trimethoprim 2mg/kg nocte
STING - subureteral teflon injection
Ureteric reimplantation

49
Q

What is hypospadia?

A

Urethral meatus on ventral aspect of penis

Occurs due to arrested development

50
Q

Classification of hypospadias

A

Anterior
Middle
Posterior

Anterior occurs in 50%

Glandular
Coronal
Shaft - distal, middle, proximal
Scrotal
Perineal
51
Q

3 features for diagnosis

A

Do not need all 3
Urethral meatus on ventral aspect
Ventral curvature - Chordee
Dorsal hooded foreskin

52
Q

Differential diagnosis of hypospadia

A

Important to exclude Disorder of Sex Development (DSD)

Associated with unilateral or bilateral undescended testis

53
Q

What condition must not be missed with hypospadias and abnormalities in female genitalia?

A

Congenital Adrenal Hyperplasia

54
Q

Investigations for hypospadias

A

Ultrasound if severe
Karyotype
Urea and Electrolytes
Endocrine tests

55
Q

Management of hypospadias

A

DO NOT CIRCUMCISE
Ureoplasty
Meatus brought to glans of penis, chordee corrected,
Dorsal foreskin can be circumcised or reconstructed

56
Q

Complications of hypospadias

A 
Bleeding
Infection
Bladder spasms
Meatal or urethral stenosis
Urethral fistula

Paediatrics (10 decks)

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