Paediatric Urology Flashcards
Presentations of Paediatric Urological problems: what things may they present with systemically, locally, and antenatally?
Case:
9 month old boy
mum noticed lump in left groin at bath time
gone next morning
baby happy and feeding
Diagnosis?
inguinal hernia
what is an inguinal hernia and who does it occur in?
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
what is the management of inguinal hernias?
management
< 1 year = URGENT referral , repair - no place for observation
> 1 year = elective referral and repair
incarcerated - reduce and repair on same admission
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?
hydrocele
what is a hydrocele? who does it occur in? and what does it cause?
SCROTAL swelling (History very important)
Fluid down into testicle instead of bowel
very common in newborns
painless - increases with crying, straining, evening
bluish colour
how do you manage hydroceles?
conservative until 5 yrs of age
Hernia management is surgery but for this its conservative as most go away
Groin swelling = ???
Scrotal swelling = ???
hernia
hydrocele
Case:
9 month old boy
mum noticed scrotum empty at bath time
normal neonatal discharge examination
baby happy and feeding
Diagnosis?
Possible undescended testes
what is Cryptorchidism (undescended testis)?
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
what is the incidence of cryptochidism
Testes don’t descent till 3rd trimester
Most of the ones undescended at birth will come down
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
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
case:
“4 year old boy with non retractile foreskin”
“recurrent balanitis”
o/e “pinhole meatus”
Diagnosis?
Normal non retractile foreskin
Can argue phimosis
Normal development
Case:
“14 year old boy with non retractile foreskin”
“struggling to pass urine”
o/e “scarred foreskin, narrow meatus”
Diagnosis?
BXO – Balinitis Xerotica Obliterans
Bit older now so more of a problem
History is slightly different
what is Balanitis Xerotica Obliterans?
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