Paediatric Urology Flashcards
Presentations of Paediatric Urological problems: systemic
- fever, vomiting
- failure to thrive
- anaemia
- hypertension
- renal failure
Presentations of Paediatric Urological problems: local
- pain
- changes in urine
- abnormal voiding
- mass
- visible abnormalities
- incidental
Presentations of Paediatric Urological problems: Antenatal
- asymptomatic
- permits immediate postnatal assessment
lump in left groin, ale, gone next morning, baby is happy.. diagnosis?
inguinal hernia
Features of an inguinal hernia?
- who is at most risk of them?
GROIN
- boys
- prematurity
management of inguinal hernias? <1 year
< 1 year
URGENT referral
repair - no place for observation
management of inguinal hernias? >1 year
elective referral and repair
- 9 month old boy
- mum noticed lump in left SCROTAL swelling at bath time. -bluish colour
- gone next morning
baby happy and feeding - Diagnosis?
hydrocele
what is hydrocele?
when are they worse?
SCROTAL swelling
very common in newborns
- increases with crying, straining, evening
management of hydrocele?
conservative until 5 yrs of age
- 9 month old boy
- mum noticed scrotum empty at bath time
- normal neonatal discharge examination
- baby happy and feeding
diagnosis?
Possible undescended testes
Incidence of Cryptorchidism - who is at risk?
premature babies
- testes don’t descend until the 3rd trimester
Indications for Orchidopexy?
- for fertility
- reduces risk of malignancy
- trauma
- torsion
- cosmetic
4 year old boy with non retractile foreskin
- recurrent balanitis
o/e “pinhole meatus”
diagnosis?
Normal non retractile foreskin
- pull it forward, not tight or obstructing
- 14 year old boy with non retractile foreskin”
- “struggling to pass urine”
- o/e “scarred foreskin, narrow meatus”
diagnosis?
BXO – Balinitis Xerotica Obliterans
-scarring condition
intervention and treatment of BXO
dermovate - topically
- ultrapotent steroid
- Circumcision
balanoprosthitis is recurrent?
infection of the foreskin and shaft
- needs antibiotics
Circumcision – suggested advantages
- reduces risk of UTI
- penile cancer is rare
- reduces AIDS/std’s
Circumcision - disadvantages
- painful
- complications
- bleeding
- meatal stenosis
- fistula
- cosmetic
14 year old boy with 4 hour history of right sided testicular pain”
o/e scrotum red, ASYMMETRY, acutely tender to touch
Diagnosis?
Testicular torsion
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
diagnosis???
Torsion Appendix Testis
Acute scrotum, differentials?
- torsion testis,
- torsion appendix testis,
- RARELY epididymitis
- trauma, haematocele, incarcerated inguinal hernia
what does renal scarring cause?
- reflux nephropathy and chronic renal failure
- hypertension
UTI - when/who to investigate?
<6 months
- atypical symptoms /bug or history
- recurrent UTUI
what is the definition of UTI?? + symptoms
- pure growth bacteria > 10’5
- pyuria
- systemic upset (fever, vomiting)
- pus cells in samples?
assessment of UTI - history and examination
FH, bowel habit ,voiding dysfunction?
assessment of UTI - investigations
further? - when is this indicated?
ultrasound scan
(number, size, position, shape, hydronephrosis)
micturating cystourethrogram (MCUG) >1 year old
renogram
MAG3 - drainage, function, reflux
DMSA - function, scarring
(younger patients)
gold standard test to pick up reflux (UTI)?
micturating cystourethrogram (MCUG)
management of VUR? -CONSERVATIVE
voiding advice, constipation, fluids
management of VUR? -antibiotic prophylaxis
keep it on until toilet trained?
Trimethoprim (2mg/kg nocte)
management of VUR? - operation
- if it is high grade what can you do
STING
ureteric reimplantation
- take ureter out, fix it, close the bladder
what is Hypospadias?
3 types?
urethral opening on the underside of the penis
- Anterior (50%)
- Middle (30%) - operation
- Posterior (20%) - most severe form
Hypospadias associated anomalies?
- upper tract
- (ambiguous genitalia) -is it defo a boy or girl?
Hypospadias - investigations
US, Karyotype only if severe
Hypospadias - management
one stage or 2 stages procedure
