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Paediatrics > Paediatric Urology > Flashcards

Paediatric Urology Flashcards

1
Q

What are the systemic signs of a paediatric urological problem?

A 
fever, vomiting 
failure to thrive
anaemia
hypertension
renal failure
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2
Q

What are the local signs of a paediatric urological problem?

A 
pain
changes in urine  
abnormal voiding
mass
visible abnormalities
incidental
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3
Q

What are the antenatal signs of a paediatric urological problem?

A

asymptomatic

permits immediate postnatal assessment

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4
Q

How might an inguinal hernia present?

A

Bump on groin
Young child
Asymptomatic
Permits immediate postnatal assessment

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5
Q

How common are incarcerated hernias?

A

< 1 year 33% incarcerate

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6
Q

How are inguinal hernias managed?

A

< 1 year

  • URGENT referral
  • repair - no place for observation

> 1 year
-elective referral and repair

Incarcerated
-reduce and repair on same admission

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7
Q

How does hydrocele present?

A 
SCROTAL swelling
Very common in newborns
Painless
Increases with crying, straining, evening
Bluish colour
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8
Q

How is hydrocele managed?

A

Conservative until 5 y/o

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9
Q

How may undescended testes (cryptorchidism) present?

A

Any testis that cannot be manipulated into the bottom half of the scrotum

  • true undescended testis
  • retractile testis

-(ascending testis)

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10
Q

What is orchidopexy?

A

A surgery to move a testicle that has not descended or moved down to its proper place in the scrotum

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11
Q

What are the indications for orchidopexy?

A

Fertility
-1% loss germs cells / month undescent……

Malignancy

  • RR 3 x (probably intra-abdominal only)
  • lifetime risk - <1%

Trauma

Torsion

Cosmetic

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12
Q

How may a normal non-retractile foreskin present?

A

“4 year old boy with non retractile foreskin”
“recurrent balanitis”
o/e “pinhole meatus”

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13
Q

How might BXO (Balinitis Xerotica Obliterans) present?

A

“14 year old boy with non retractile foreskin”
“struggling to pass urine”
o/e “scarred foreskin, narrow meatus”

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14
Q

What are the indications for circumcision?

A

Absolute:
Balanitis Xerotica Obliterans (BXO)

Relative:
balanoprosthitis
religious
UTI

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15
Q

What are the potential consequences of circumcision?

A 
?UTI	
-120 circs prevent 1 UTI		
?malignancy
-Penile cancer VERY rare
?sexual enhancement
-↑nerve endings in prepuce 
?AIDS / STD’s
-Sub-Saharan Africa

Overall, minimal evidence of medical benefit

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16
Q

What are the disadvantages of circumcision?

A 
Painful
Complications
-bleeding 
-meatal stenosis
-fistula
-cosmetic
17
Q

How might testicular torsion present?

A 
“14 year old boy with 4 hour history of right sided testicular pain” 
o/e scrotum:
-red
-asymmetry
-acutely tender to touch
18
Q

How may appendix torsion testes present?

A 
“14 year old boy with 4 hour history of right sided testicular pain” 
o/e scrotum:
-red
-NO Asymmetry
-blue spot seen
-tender to touch
19
Q

What are the causes of acute scrotum in children?

A 
Age related ….. ish
Differential diagnosis
-torsion testis
-torsion appendix testis
-RARELY epididymitis

Also:

  • trauma
  • haematocele
  • incarcerated inguinal hernia

If in doubt - explore
6- 8 hours to recover testis

20
Q

Why investigate a UTI?

A

Prevent renal scarring
-reflux nephropathy and chronic renal failure

Prevent hypertension

NICE guideline on UTI……..
-all <6/12, atypical, recurrent

21
Q

What is the definition of a UTI?

A

Pure growth bacteria > 105
Pyuria (white cells)
Systemic upset
-fever, vomiting

22
Q

If a UTI has mixed growth bacteria, no pyuria and no systemic symptoms, what is it?

A

Less significant

23
Q

What might you assess in history and examination of a UTI?

A

FH, bowel habit, voiding dysfunction

24
Q

What can a US show in a UTI?

A

Number, size, position, shape, hydronephrosis

25
Q

What are the 2 types of renography that can be used in UTI?

A

MAG3
DMSA

Both use 99mTc

26
Q

What can the MAG3 show?

A

Drainage, function, reflux

27
Q

What can the DMSA show?

A

Function, scarring

28
Q

How may grades of vesicoureteral reflux (VUR) are there?

A

5

29
Q

How is VUR managed?

A

Conservative

  • voiding advice
  • constipation
  • fluids

Antibiotic prophylaxis

  • until toilet trained?
  • Trimethoprim (2mg/kg nocte)

STING
-mild/moderate with symptoms

Ureteric reimplantation

30
Q

What is STING?

A

Teflon paste is injected into the bladder via a tube through the urethra, to modify the shape of the ureter

31
Q

What is ureteric reimplantation?

A

Changes point where ureters join the bladder

32
Q

What is hypospadias?

A

Urethral meatus on the ventral aspect of the penis

33
Q

What are the 3 classifications of hypospadias?

A

Anterior (50%)
Middle (30%)
Posterior (20%)

34
Q

What are the anomalies associated with hyospadias?

A

Upper tract

Ambiguous genitalia

35
Q

What are the investigations carried out in hypospadias?

A

US

Karyotype only if severe

36
Q

How is hypospadias managed?

A

One stage or 2 stages procedure

Reposition the urethral opening and, if necessary, straighten the shaft of the penis

Paediatrics (37 decks)

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