Paediatric Urology Flashcards
What are the systemic signs of a paediatric urological problem?
fever, vomiting failure to thrive anaemia hypertension renal failure
What are the local signs of a paediatric urological problem?
pain changes in urine abnormal voiding mass visible abnormalities incidental
What are the antenatal signs of a paediatric urological problem?
asymptomatic
permits immediate postnatal assessment
How might an inguinal hernia present?
Bump on groin
Young child
Asymptomatic
Permits immediate postnatal assessment
How common are incarcerated hernias?
< 1 year 33% incarcerate
How are inguinal hernias managed?
< 1 year
- URGENT referral
- repair - no place for observation
> 1 year
-elective referral and repair
Incarcerated
-reduce and repair on same admission
How does hydrocele present?
SCROTAL swelling Very common in newborns Painless Increases with crying, straining, evening Bluish colour
How is hydrocele managed?
Conservative until 5 y/o
How may undescended testes (cryptorchidism) present?
Any testis that cannot be manipulated into the bottom half of the scrotum
- true undescended testis
- retractile testis
-(ascending testis)
What is orchidopexy?
A surgery to move a testicle that has not descended or moved down to its proper place in the scrotum
What are the indications for orchidopexy?
Fertility
-1% loss germs cells / month undescent……
Malignancy
- RR 3 x (probably intra-abdominal only)
- lifetime risk - <1%
Trauma
Torsion
Cosmetic
How may a normal non-retractile foreskin present?
“4 year old boy with non retractile foreskin”
“recurrent balanitis”
o/e “pinhole meatus”
How might BXO (Balinitis Xerotica Obliterans) present?
“14 year old boy with non retractile foreskin”
“struggling to pass urine”
o/e “scarred foreskin, narrow meatus”
What are the indications for circumcision?
Absolute:
Balanitis Xerotica Obliterans (BXO)
Relative:
balanoprosthitis
religious
UTI
What are the potential consequences of circumcision?
?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
What are the disadvantages of circumcision?
Painful Complications -bleeding -meatal stenosis -fistula -cosmetic
How might testicular torsion present?
“14 year old boy with 4 hour history of right sided testicular pain” o/e scrotum: -red -asymmetry -acutely tender to touch
How may appendix torsion testes present?
“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
What are the causes of acute scrotum in children?
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
Why investigate a UTI?
Prevent renal scarring
-reflux nephropathy and chronic renal failure
Prevent hypertension
NICE guideline on UTI……..
-all <6/12, atypical, recurrent
What is the definition of a UTI?
Pure growth bacteria > 105
Pyuria (white cells)
Systemic upset
-fever, vomiting
If a UTI has mixed growth bacteria, no pyuria and no systemic symptoms, what is it?
Less significant
What might you assess in history and examination of a UTI?
FH, bowel habit, voiding dysfunction
What can a US show in a UTI?
Number, size, position, shape, hydronephrosis
What are the 2 types of renography that can be used in UTI?
MAG3
DMSA
Both use 99mTc
What can the MAG3 show?
Drainage, function, reflux
What can the DMSA show?
Function, scarring
How may grades of vesicoureteral reflux (VUR) are there?
5
How is VUR managed?
Conservative
- voiding advice
- constipation
- fluids
Antibiotic prophylaxis
- until toilet trained?
- Trimethoprim (2mg/kg nocte)
STING
-mild/moderate with symptoms
Ureteric reimplantation
What is STING?
Teflon paste is injected into the bladder via a tube through the urethra, to modify the shape of the ureter
What is ureteric reimplantation?
Changes point where ureters join the bladder
What is hypospadias?
Urethral meatus on the ventral aspect of the penis
What are the 3 classifications of hypospadias?
Anterior (50%)
Middle (30%)
Posterior (20%)
What are the anomalies associated with hyospadias?
Upper tract
Ambiguous genitalia
What are the investigations carried out in hypospadias?
US
Karyotype only if severe
How is hypospadias managed?
One stage or 2 stages procedure
Reposition the urethral opening and, if necessary, straighten the shaft of the penis
