Paediatric Urology Flashcards

1
Q

Presentations of Paediatric Urological problems: what things may they present with systemically, locally, and antenatally?

A
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2
Q

Case:

9 month old boy

mum noticed lump in left groin at bath time

gone next morning

baby happy and feeding

Diagnosis?

A

inguinal hernia

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3
Q

what is an inguinal hernia and who does it occur in?

A

GROIN swelling (not in scrotum)

2% boys

boys 9:1 girls (due to association with descent of testes)

increase risk with prematurity

< 1 year 33% incarcerate! (can get stuck)

Bowel coming out and down the inguinal canal

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4
Q

what is the management of inguinal hernias?

A

management

< 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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5
Q

Case:

9 month old boy

mum noticed lump in left SCROTAL swelling at bath time. bluish colour

gone next morning

baby happy and feeding

Diagnosis?

A

hydrocele

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6
Q

what is a hydrocele? who does it occur in? and what does it cause?

A

SCROTAL swelling (History very important)

Fluid down into testicle instead of bowel

very common in newborns

painless - increases with crying, straining, evening

bluish colour

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7
Q

how do you manage hydroceles?

A

conservative until 5 yrs of age

Hernia management is surgery but for this its conservative as most go away

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8
Q

Groin swelling = ???

Scrotal swelling = ???

A

hernia

hydrocele

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9
Q

Case:

9 month old boy

mum noticed scrotum empty at bath time

normal neonatal discharge examination

baby happy and feeding

Diagnosis?

A

Possible undescended testes

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10
Q

what is Cryptorchidism (undescended testis)?

A

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

true undescended testis

retractile testis (comes down and goes back up again)

(ascending testis) – ones that are down but don’t keep up with growth

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11
Q

what is the incidence of cryptochidism

A

Testes don’t descent till 3rd trimester

Most of the ones undescended at birth will come down

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12
Q

what are indicaitons for Orchidopexy?

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

A

fertility (Operate to maintain fertility) - 1% loss germs cells / month undescent……

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

trauma

torsion

cosmetic

Longer you leave them the more damaged they become

Primary reason is to improve function

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13
Q

case:

“4 year old boy with non retractile foreskin”

“recurrent balanitis”

o/e “pinhole meatus”

Diagnosis?

A

Normal non retractile foreskin

Can argue phimosis

Normal development

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14
Q

Case:

“14 year old boy with non retractile foreskin”

“struggling to pass urine”

o/e “scarred foreskin, narrow meatus”

Diagnosis?

A

BXO – Balinitis Xerotica Obliterans

Bit older now so more of a problem

History is slightly different

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15
Q

what is Balanitis Xerotica Obliterans?

A

Scarring condition of the foreskin

Point of restriction is right at the end, hasn’t got bit on top like the other one did (normal non retractable foreskin)

White scarring at top

These wont get better

You can use steroid cream

At least 50% will get circumcision

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16
Q

circumcision - removal of foreskin

what are the indications?

A

absolute - Balanitis Xerotica Obliterans (BXO) (Only real indication in BXO as doesn’t really get better with anything else)

relative:

Balanoprosthitis – severe inflammation & infection of the glands in the shaft of penis – if need repeated antibiotics then may do circumision

religious

xTI – if a boy has a very dilated urinary tract, high risk urinary tracts

17
Q

Circumcision – what are the suggested advantages?

A

?UTI - x120 circs prevent 1 UTI

?malignancy - Penile cancer VERY rare – very low in population anyway

?sexual enhancement - ↑nerve endings in prepuce – doesn’t hold up

?AIDS / STD’s - Sub-Saharan Africa – it does reduce HIV but just use barrier contraception

Overall, minimal evidence of medical benefit

18
Q

what are the disadvantages of circumcision?

A

painful

complications - bleeding, meatal stenosis, fistula, cosmetic

? look different

19
Q

Case:

“14 year old boy with 4 hour history of right sided testicular pain”

o/e scrotum red, asymmetry, acutely tender to touch

Diagnosis?

A

Testicular torsion

Age and length of history is important here

20
Q

what is testicular torsion?

A

testical twists on spermatic cord (so one is higher thats why asymetry)

Acute event

Short period (6 hours) to salvage testis as they become ischaemic, testicular higher up as its shortens

Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. Testicular torsion is most common between ages 12 and 18, but it can occur at any age, even before birth

21
Q

Case:

“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?

A

Torsion Appendix Testis

22
Q

what is Torsion Appendix Testis?

A

Red swelling

Appendix testes is a embryological remnant sitting on top of epididymis, what would of been female parts

Twists and becomes ischaemic and necrotic and goes black and that’s the blue dot you can see

Torsion of the appendix testis is a twisting of a vestigial appendage that is located along the testicle. This appendage has no function, yet more than half of all boys are born with one. Although this condition poses no threat to health, it can be painful. Usually no treatment other than to manage pain is needed

23
Q

what is Acute Scrotum?

A

age related ….. Ish (older you are more likely a torsion but not absolute - More torsion as you get older and go through puberty as you get a bigger mass of testes so more likely to twist)

differential diagnosis:

  • torsion testis, torsion appendix testis,
  • RARELY epididymitis (get in new born babies with congenital abnormalities of the urinary tract)
  • trauma, haematocele, incarcerated inguinal hernia

if in doubt – explore (if you cant say it’s a torsion then explore)

6- 8 hours to recover testis

24
Q

why investigate UTI and who should you investigate?

A

why investigate UTI?

prevent renal scarring - reflux nephropathy and chronic renal failure

prevent hypertension

who to investigate?

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

25
Q

what is the definition of a UTI?

A

pure growth bacteria > 105

pyuria

systemic upset - fever, vomiting

mixed growth bacteria, no pyuria, no systemic symptoms - less significant

26
Q

how do you assess a UTI?

A

history and examination - FH, bowel habit, voiding dysfunction

ultrasound scan - number, size, position, shape, hydronephrosis

renography:

  • MAG3 - drainage, function, reflux
  • DMSA - function, scarring

icturating cystourethrogram (MCUG) (gold standard for picking up reflux)

27
Q

what is VUR and its grades?

A

Vesicoureteral reflux (VUR) is when the flow of urine goes the wrong way. This condition is more common among infants and young children

This can cause UTI – when urine goes back upto kidney

Grade 3 is where it gets more significant

28
Q

what is the management of VUR?

A

Conservative (initially) - voiding advice, constipation, fluids

antibiotic prophylaxis - ? until toilet trained?, Trimethoprim (2mg/kg nocte)

STING - mild/moderate with symptoms

ureteric reimplantation (much bigger procedure)

29
Q

what is Hypospadias?

A

zurethral meatus on the ventral aspect (under aspect) of the penis

Anterior is relatively minor

Hypospadias is a condition in which the opening of the urethra is on the underside of the penis instead of at the tip. The location of the opening can vary and can be anywhere from underneath the tip of the penis (more common) to the base of the penis (less common)

30
Q

Hypospadias - what are associated anomalies, investigations and management?

A

associated anomalies:

  • upper tract (unusual)
  • (ambiguous genitalia)

investigations - US, Karyotype only if severe

management - one stage or 2 stages procedure