Paeds Renal + Urology Flashcards
1
Q
What is a UTI
A
infections anywhere along urethra, bladder, ureters and kidneys pathway
2
Q
What is cystitis
A
inflammation of the bladder
3
Q
What are symptoms of UTI in babies
A
Fever ** may be only sign
Lethargy
Irritability
Vomiting
Poor feeding
Urinary frequency
4
Q
What are symptoms of UTI in older infants and children
A
Fever
Abdominal pain, particularly suprapubic pain
Vomiting
Dysuria (painful urination)
Urinary frequency
Incontinence
5
Q
How is UTI investigated
A
clean catch urine sample or urine collection pad
urine dipstix
aspirate bladder
catheter
US
Micturating cystourethrogram
DMSA scan
6
Q
What findings on urine dipstick suggest UTI
A
Nitrites
Leukocytes
7
Q
which is more indicative of UTI leukocytes or nitrites
A
leukocytes
8
Q
How is UTI managed under 3 months
A
referred immediately to a paediatrician
start immediate IV antibiotics (e.g. ceftriaxone)
have a full septic screen, including blood cultures, bloods and lactate.
A lumbar puncture should also be considered.
9
Q
How is UTI managed over 3 months
A
Lower UTI = 3 days of Oral antibiotics can be considered if they are otherwise well.
Upper UTI = consider admission w IV Abx or oral ABx for 7-10 days
10
Q
What children with UTIs are followed up
A
All children under the age of 3 months
Children of any age who are systemically unwell
Children with recurrent UTI
11
Q
what is bacteriological criterion for UTI Diagnosis
A
10^5 organisms/ml of single bacteria on a CCU/MSU
12
Q
What are typical Abx choices for UTIs in children
A
Lower:
- Trimethoprim
- Nitrofurantoin
- Cefalexin
- Amoxicillin
Upper:
- cephalosporin
- co-amoxiclav
13
Q
what is the investigation all children under 6 months with their first UTI
A
abdominal ultrasound within 6 weeks, or during the illness if there are recurrent UTIs or atypical bacteria
14
Q
what is the investigation for children with recurrent UTIs
A
abdominal ultrasound within 6 weeks
15
Q
what is the investigation for children with atypical UTIs
A
an abdominal ultrasound during the illness
16
Q
How is renal damage assessed
A
DMSA (Dimercaptosuccinic Acid) Scan
injecting a radioactive material (DMSA) and using a gamma camera to assess how well the material is taken up by the kidneys
17
Q
what are causes of increases interstitial fluid
A
obstruction of Lymph drainage
obstruction of venous drainage
Lowered oncotic pressure - low albumin/protein
salt and water retention
18
Q
How does DMSA scan assess damange
A
Where there are patches of kidney that have not taken up the material, this indicates scarring that may be the result of previous infection.
19
Q
What is Vesico-ureteric reflux (VUR)
A
backflow of urine from the bladder into the ureter and kidney
found in around 30% of children who present with a UTI.
associated dilatation, clubbing
20
Q
What does Vesico-ureteric reflux (VUR) predisposes a patient to
A
developing upper urinary tract infections and subsequent renal scarring
21
Q
How is Vesico-ureteric reflux (VUR) diagnosed
A
micturating cystourethrogram (MCUG).
22
Q
How is Vesico-ureteric reflux (VUR) managed
A
Avoid constipation
Avoid an excessively full bladder
Prophylactic antibiotics
Surgical input from paediatric urology
23
Q
What is micturating Cystourethrogram (MCUG) used to investiagte
A
- atypical or recurrent UTIs in children under 6 months
- family history of vesico-ureteric reflux
- dilatation of the ureter on ultrasound
- poor urinary flow
24
Q
How does micturating Cystourethrogram (MCUG) work
A
catheterising the child, injecting contrast into the bladder and taking a series of xray films to determine whether the contrast is refluxing into the ureters.
Children are usually given prophylactic antibiotics for 3 days around the time of the investigation.
25
what pyelonephritis
inflammation of the kidney resulting from bacterial infection
the inflammation affects the renal pelvis (join between kidney and ureter) and parenchyma (tissue).
26
What are RF for pyelonephritis
- Female sex
- Structural urological abnormalities
- Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children)
- Diabetes
27
What is the MC causative organism for pyelonephritis
Escherichia coli
28
What type of bacteria is E. coli
gram-negative, anaerobic, rod-shaped bacteria
29
Other than E. coli what are causative organisms of pyelonephritis
Klebsiella pneumoniae (gram-negative anaerobic rod)
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candida albicans (fungal)
30
What are the triad of pyelonephritis symptoms
similar presentation to lower urinary tract infections (i.e. dysuria, suprapubic discomfort and increased frequency)
PLUS
- Fever
- Loin or back pain (bilateral or unilateral)
- Nausea / vomiting
31
How is pyelonephritis investigated
Urine dipstick --> nitrities, leukocytes & blood
Midstream urine (MSU) for microscopy, culture and sensitivity
Blood tests --> WBC and CRP
32
how is pyelonephritis managed
1st line Abx 7-10 days
- cephalosporin or co-amoxiclav
refer to hospital of sepsis suspect
33
What are the three tests for sepsis
Blood lactate level
Blood cultures
Urine output
34
What are the treatments tests for sepsis
- Oxygen to maintain oxygen saturations of 94-98% (or 88-92% in COPD)
- Empirical broad-spectrum IV antibiotics (according to local guidelines)
- IV fluids
35
What are two things to keep in mind in patients not responding to treatment for pyelonephritis
- Renal abscess
- Kidney stone --> obstructing the ureter, causing pyelonephritis
36
What can recurrent pyelonephritis lead to
scarring of the renal parenchyma, leading to chronic kidney disease (CKD).
It can progress to end-stage renal failure.
37
what is enuresis
'involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract'
38
what is nocturnal enuresis
Bed wetting
39
what is diurnal enuresis
Inability to control bladder function during the day
40
what is average age for children to get control of daytime and nighttime urination
- daytime urination by 2 years
- nighttime urination by 3 – 4 years.
41
what is primary nocturnal enuresis
where the child has never managed to be consistently dry at night.
42
What is the most common cause of primary nocturnal enuresis
variation on normal development
43
What are other causes of primary nocturnal enuresis
Overactive bladder
Fluid intake
Failure to wake
Psychological distress
44
What are secondary causes of primary nocturnal enuresis
- chronic constipation
- urinary tract infection
- learning disability
- cerebral palsy
45
What is the initial step in management of primary nocturnal enuresis
establish the underlying cause.
2 week diary of toileting, fluid intake and bedwetting episodes.
46
What does the management of primary nocturnal enuresis involves
- Reassure parents of children under 5 years that it is likely to resolve without any treatment
- Lifestyle changes: reduced fluid intake in the evenings, pass urine before bed and ensure easy access to a toilet
- Encouragement and positive reinforcement. Avoid blame or shame.
- Treat any underlying causes or exacerbating factors, such as constipation
- Enuresis alarms
- Pharmacological treatment
47
What is Secondary nocturnal enuresis
where a child begins wetting the bed when they have previously been dry for at least 6 months
48
What are causes of Secondary nocturnal enuresis
Urinary tract infection ** MC
Constipation ** MC
Type 1 diabetes
New psychosocial problems (e.g. stress in family or school life)
Maltreatment
49
What should always be considered in cases of Secondary nocturnal enuresis
abuse and safeguarding
50
What are two main types of Incontinence
Urge incontinence is an overactive bladder that gives little warning before emptying
Stress incontinence describes leakage of urine during physical exertion, coughing or laughing.
51
What are other causes of diurnal enuresis other than stress and urge incontinence
- Recurrent urinary tract infections
- Psychosocial problems
- Constipation
52
Name three medications for nocturnal enuresis
Desmopressin
Oxybutinin
Imipramine
53
What is Desmopressin
analogue of vasopressin (also known as anti-diuretic hormone).
It reduces the volume of urine produced by the kidneys. It is taken at bedtime with the intention of reducing nocturnal enuresis.
54
What oxybutinin
anticholinergic medication that reduces the contractility of the bladder.
It can be helpful where there is an overactive bladder causing urge incontinence.
55
What is Imipramine
tricyclic antidepressant.
It is not clear how it works, but it may relax the bladder and lighten sleep.
56
What is AKI
rapid drop in kidney function, diagnosed by measuring the serum creatinine.
Acute kidney injury is most common in acutely unwell patients (e.g., infections or following surgery).
57
What is criteria for diagnosing AKI
- Rise in creatinine of more than 25 mm/L in 48 hours
- Rise in creatinine of more than 50% in 7 days
- Urine output of less than 0.5 ml/kg/hour over at least 6 hours
58
What are RF for predispose developing AKI
- Older age (e.g., above 65 years)
- Sepsis
- CKD
- Heart failure
- Diabetes
- Liver disease
- Cognitive impairment (leading to reduced fluid intake)
- Medications (e.g., NSAIDs, gentamicin, diuretics and ACE inhibitors)
- Radiocontrast agents (e.g., used during CT scans)
59
What are pre renal causes of AKI
MC - Insufficient blood supply (hypoperfusion) to kidneys
- Dehydration
- Shock (e.g., sepsis or acute blood loss)
- Heart failure
60
What are renal causes of AKI
intrinsic disease in the kidney
- Acute tubular necrosis
- Glomerulonephritis
- Acute interstitial nephritis
- Haemolytic uraemic syndrome
- Rhabdomyolysis
61
What are post renal causes of AKI
obstruction to the outflow of urine away from the kidney, causing back-pressure into the kidney and reduced kidney function
- Kidney stones
- Tumours (e.g., retroperitoneal, bladder or prostate)
- Strictures of the ureters or urethra
- Benign prostatic hyperplasia (benign enlarged prostate)
- Neurogenic bladder
62
what is acute tubular necrosis
refers to damage and death (necrosis) of the epithelial cells of the renal tubule
MC of AKI
63
What are two causes of damage to kidney cells
Ischaemia due to hypoperfusion (e.g., dehydration, shock or heart failure)
Nephrotoxins (e.g., gentamicin, radiocontrast agents or cisplatin)
64
What can be seen on urinalysis for acute tubular necrosis
Muddy brown casts
65
How long does recovery from acute tubular necrosis take
1-3 weeks
66
what is Acute interstitial nephritis
acute inflammation of the interstitium (the space between the tubules and vessels).
67
What is cause of acute interstitial nephritis
- Drugs (e.g. NSAIDs or antibiotics)
- Infections (e.g., E. coli or HIV)
- Autoimmune conditions (e.g., sarcoidosis or SLE)
68
What is Nephritis
inflammation within the nephrons of the kidneys
69
What does Nephritis cause
- Haematuria: invisible or visible amounts of blood in the urine
- Proteinuria: although less than in nephrotic syndrome
- Oliguria (significantly reduced urine output)
- Fluid retentions
70
What are two most common causes of Nephritis in children
post-streptococcal glomerulonephritis and IgA nephropathy (Berger’s disease).
71
What precipitates post-streptococcal glomerulonephritis
occurs 1 – 2 WEEKS after a β-haemolytic streptococcus infection, such as tonsillitis caused by Streptococcus pyogenes
72
what is pathophysiology of post-streptococcal glomerulonephritis
immune complex (IgG, IgM and C3) deposition in the glomeruli and cause inflammation.
= AKI
73
When is diagnosis of post-streptococcal glomerulonephritis considered
evidence of recent tonsillitis caused by streptococcus
74
How is post-streptococcal glomerulonephritis investigated
**immunology - anti-streptolysin antibody titre & low C3**
urine dipstick
urinalysis
throat swab
75
How is post-streptococcal glomerulonephritis managed
majority supportive
Fluid balance
correction of other imbalances
antihypertensive medications and diuretics if complications (oedema and hypertension)
Abx for strep infection - penicillin
76
How are IgA nephropathy and post-strep glomerulonephritis differentiated
IgA = 1-2 days after + macroscopic haematuria
Post Strep = 1-2 weeks + proteinuria + lower complement levels
77
what is IgA nephropathy
Mesangial deposition of IgA immune complexes in the nephrons of the kidney causes inflammation
IgA vasculitis
78
How condition does IgA nephropathy have a degree of overlap with
Henoch-Schonlein Purpura
79
what is shown in a renal biopsy of IgA nephropathy
- IgA & complement deposits on the basement membrane
- glomerular mesangial proliferation
80
How is IgA nephropathy managed
minimal proteinuria and a normal glomerular filtration rate (GFR)
* no treatment needed, other than follow-up to check renal function
persistent proteinuria & a normal or only slightly reduced GFR
* initial treatment is with ACE inhibitors
falling GFR or failure to respond to ACE inhibitors
* immunosuppression with corticosteroids
81
WHat is Henoch-Schonlein Purpura (HSP)
IgA mediated small vessel vasculitis.
Inflammation occurs in the affected organs due to IgA deposits in the blood vessels.
82
what triggers HSP
haematuria proteinura
acute nephritis
renal impairment
hypertension
83
what are 4 classic features of HSP
* palpable purpuric rash (with localized oedema) over buttocks and extensor surfaces of arms and legs
* abdominal pain
* polyarthritis
* features of IgA nephropathy may occur e.g. haematuria, renal failure
84
What should be monitored in HSP
blood pressure and urinanalysis
85
what is Nephrotic syndrome
the basement membrane in the glomerulus becomes highly permeable, resulting in significant proteinuria.
86
What is the classic triad of Nephrotic syndrome
Low serum albumin (< 25 g/l)
High urine protein content (>3+ protein on urine dipstick)
Oedema
87
what are symptoms of Nephrotic syndrome
frothy urine, generalised oedema and pallor.
88
What are signs of Nephrotic syndrome
- Deranged lipid profile, with high levels of cholesterol, triglycerides and low density lipoproteins
- High blood pressure
- Hyper-coagulability, with an increased tendency to form blood clots
- predisposition to infection (due to loss of immunoglobulins)
89
What are initial investigation for nephrotic syndrome
urine dipstick
90
What is MC of Nephrotic syndrome in children
minimal change disease
90% of cases in children under 10
peak incidence btwn 2 and 5 years of age
91
what intrinsic kidney disease can cause Nephrotic syndrome
Focal segmental glomerulosclerosis
Membranoproliferative glomerulonephritis
92
What systemic illness can cause Nephrotic syndrome
Henoch schonlein purpura (HSP)
Diabetes
Infection, such as HIV, hepatitis and malaria
93
What does biopsy for minimal change disease show on light microscope
no change
94
What does ECM show for minimal change disease
- diffuse loss of podocyte foot processes
- vacuolation
- appearance of microvilli.
95
What does urinalysis for minimal change disease show
small molecular weight proteins and hyaline casts.
96
How is minimal change disease managed
High dose corticosteroids (i.e. prednisolone) for 4 weeks and then gradually weaned over the next 8 weeks
97
Other than steroids how is nephrotic syndrome managed
Low salt diet
Diuretics may be used to treat oedema
Albumin infusions may be required in severe hypoalbuminaemia
Antibiotic prophylaxis may be given in severe cases (penicillin V)
Immunisations
98
What is alternative to steroids in steroid resistant children for Nephrotic syndrome
ACE inhibitors and immunosuppressants such as cyclosporine, tacrolimus or rituximab
99
What are complications of Nephrotic syndrome
Hypovolaemia (oedema and low BP)
Thrombosis
high cholesterol
Infection - peritonitis
AKI or CKD
Relapse
100
What are features that can accompany AKI
Rash
Fever
Flank pain
Eosinophilia
101
How is AKI investigated
Urinalysis assesses for protein, blood, leucocytes, nitrites and glucose:
US of Urinary tract for obstruction
102
what does Leucocytes and nitrites in urine suggest
infection
103
what does Protein and blood and nitrites in urine suggest
acute nephritis (but can be positive in infection)
104
what does glucose and nitrites in urine suggest
diabetes
105
how can AKI be prevented
Avoiding nephrotoxic medications where appropriate
Ensuring adequate fluid intake (including IV fluids if oral intake is inadequate)
Additional fluids before and after radiocontrast agents
106
How is AKI treated
- IV fluids for dehydration and hypovolaemia
- Withhold medications that may worsen the condition (e.g., NSAIDs and ACE inhibitors)
- Withhold/adjust medications that may accumulate with reduced renal function (e.g., metformin and opiates)
- Relieve the obstruction in a post-renal AKI (e.g., insert a catheter in a patient with prostatic hyperplasia)
- Dialysis may be required in severe cases
107
Are ACE inhibitors nephrotoxic
incorrect
ACE inhibitors should be stopped in an acute kidney injury, as they reduce the filtration pressure.
However, ACE inhibitors have a protective effect on the kidneys long-term.
They are offered to certain patients with hypertension, diabetes and chronic kidney disease to protect the kidneys from further damage.
108
What are complications of AKI
- Fluid overload, heart failure and pulmonary oedema
- Hyperkalaemia
- Metabolic acidosis
- Uraemia (high urea), which can lead to encephalopathy and pericarditis
109
what is CKD
chronic reduction in kidney function sustained over three months.
It tends to be permanent and progressive.
110
What causes CKD
Diabetes
Hypertension
Medications (e.g., NSAIDs or lithium)
Glomerulonephritis
Polycystic kidney disease
111
How does CKD present
most asymptomatic
Fatigue
Pallor (due to anaemia)
Foamy urine (proteinuria)
Nausea
Loss of appetite
Pruritus (itching)
Oedema
Hypertension
Peripheral neuropathy
112
What is estimated glomerular filtration rate (eGFR) based on
based on the serum creatinine, age and gender
113
what is glomerular filtration rate
the rate at which fluid is filtered from the blood into Bowman’s capsule
114
How is Proteinuria quantified in CKD
urine albumin:creatinine ratio (ACR).
115
what can Haematuria indicate
infection
malignancy (e.g., bladder cancer)
glomerulonephritis
kidney stones.
116
How is CKD investigated
estimated glomerular filtration rate (eGFR
Proteinuria
Haematuria
Renal US
117
What investigations can be ordered to ID RF for CKD
Blood pressure (for hypertension)
HbA1c (for diabetes)
Lipid profile (for hypercholesterolaemia)
118
What is CKD diagnoses criteria
Over 3 months of
- Estimated glomerular filtration rate (eGFR) is sustained below 60 mL/min/1.73 m2 (G score)
- Urine albumin:creatinine ratio (ACR) is sustained above 3 mg/mmol (A Score)
119
what are units of eGFR
mL/min/1.73 m2
120
what are units for ACR
mg/mmol
121
What is Accelerated progression in eGFR
sustained decline in the eGFR within one year of either 25% or 15 mL/min/1.73 m2.
122
What are complications of CKD
Anaemia
Renal bone disease
Cardiovascular disease
Peripheral neuropathy
End-stage kidney disease
Dialysis-related complications
123
What is the Kidney Failure Risk Equation
to estimate the 5-year risk of kidney failure requiring dialysis.
124
When should a patient be referred to a renal specialist
* eGFR less than 30 mL/min/1.73 m2
* Urine ACR more than 70 mg/mmol
* Accelerated progression (a decrease in eGFR of 25% or 15 mL/min/1.73 m2 within 12 months)
* 5-year risk of requiring dialysis over 5%
* Uncontrolled hypertension despite four or more antihypertensives
125
What medications slow progression of CKD
ACE inhibitors (or angiotensin II receptor blockers)
SGLT-2 inhibitors (specifically dapagliflozin)
126
What medications reduce the risk of complications of CKD
Exercise, maintain a healthy weight and avoid smoking
Atorvastatin 20mg for primary prevention of cardiovascular disease (in all patients with CKD)
127
What management to treat metabolic acidosis
Oral sodium bicarbonate
128
What management to treat anaemia
iron and erythropoietin
129
What management to treat renal bone disease
Vitamin D, low phosphate diet and phosphate binders
130
what does management of end-stage renal disease involve
Special dietary advice
Dialysis
Renal transplant
131
When is short-term dialysis indicated
A – Acidosis (severe and not responding to treatment)
E – Electrolyte abnormalities (particularly treatment-resistant hyperkalaemia)
I – Intoxication (overdose of certain medications)
O – Oedema (severe and unresponsive pulmonary oedema)
U – Uraemia symptoms such as seizures or reduced consciousness
132
What is long-term dialysis indicated
End-stage renal failure
133
What are two options for long-term dialysis
Haemodialysis
Peritoneal dialysis
134
What is Haemodialysis
4 hours a day, three days per week.
Blood is taken out of the body, passed through the dialysis machine, and pumped back into the body. The blood passes along a series of semipermeable membranes inside the dialysis machine.
135
what are two options of longer term access for Haemodialysis
Tunnelled cuffed catheter
Arteriovenous fistula
136
what is AV fistula
artificial connection between an artery and a vein.
It bypasses the capillary system and allows blood to flow under high pressure from the artery directly into the vein
This provides a permanent, large, easy-access blood vessel with high-pressure arterial blood flow
137
What are options for AV fistula
- Radiocephalic fistula at the wrist (radial artery to cephalic vein)
- Brachiocephalic fistula at the antecubital fossa (brachial artery to cephalic vein)
- Brachiobasilic fistula at the upper arm (less common and a more complex operation)
138
what are complications of an AV fistula
Aneurysm
Infection
Thrombosis
Stenosis
STEAL syndrome
High-output heart failure
139
what is Peritoneal dialysis
Uses the peritoneal membrane to filter the blood.
A special dialysis solution containing dextrose is added to the peritoneal cavity
Ultrafiltration occurs from the blood, across the peritoneal membrane, into the dialysis solution.
The dialysis solution is replaced, taking away the waste products that have filtered out of the blood.
140
what are two types of Peritoneal dialysis
Continuous ambulatory peritoneal dialysis (CAPD) - dialysis always in peritoneal cavity
Automated dialysis - overnight
141
What are complications of Peritoneal dialysis
- Bacterial peritonitis (infections in the high-sugar environment are common and serious)
- Peritoneal sclerosis (thickening and scarring of the peritoneal membrane)
- Ultrafiltration failure (the dextrose is absorbed, reducing the filtration gradient, making ultrafiltration less effective)
- Weight gain (due to absorption of the dextrose)
- Psychosocial implications
142
What is Hypospadias
congenital condition
the opening of the urethra is abnormally displaced to the ventral side (underside) of the penis
143
What is Epispadias
the opening of the urethra is displaced to the dorsal side (top side) of the penis
144
when is Hypospadias diagnosed
examination of the newborn.
145
How is Hypospadias managed
Do not circumsise until indicates ok
referral to specialist
mild = no treatment required
surgery at 3-4 months
surgery to correct position and straighten penis
146
What are complications of Hypospadias
Difficulty directing urination
Cosmetic and psychological concerns
Sexual dysfunction
147
What is Haemolytic uraemic syndrome
thrombosis in small blood vessels triggered by shiga toxins from E.coli 0157 or shigella
148
Who does Haemolytic uraemic syndrome commonly affect and what increases the risk of developing HUS
following an episode of gastroenteritis.
Antibiotics and anti-motility medication (e.g., loperamide) used to treat gastroenteritis increase the risk of HUS.
149
What is classic triad for Haemolytic uraemic syndrome
Microangiopathic haemolytic anaemia
Acute kidney injury
Thrombocytopenia (low platelets)
150
How does Haemolytic uraemic syndrome present
Diarrhoea is the first symptom, which turns bloody within 3 days
Around a week after the onset of diarrhoea
- Fever
- Abdominal pain
- Lethargy
- Pallor
- Reduced urine output (oliguria)
- Haematuria
- Hypertension
- Bruising
- Jaundice (due to haemolysis)
- Confusion
151
How is Haemolytic uraemic syndrome investigated
Stool culture is used to establish the causative organism.
152
Haemolytic uraemic syndrome managed
medical emergency
- Hypovolaemia (e.g., IV fluids)
- Hypertension
- Severe anaemia (e.g., blood transfusions)
- Severe renal failure (e.g., haemodialysis)
153
What are structures of urinary track
- Kidneys
- Ureters
- Bladder (with the detrusor muscle)
- Urethra
- Internal urethral sphincter (smooth muscle under autonomic control)
- Prostate (in males)
- External urethral sphincter (skeletal muscle under voluntary control)
154
From outside in what are structures of the kidney
- Cortex
- Medulla
- Pyramids and columns
- Major and minor calyx (pleural: calyces)
- Renal pelvis
- Pelviureteric junction (PUJ)
- Ureter
155
What is hydronephrosis
swelling of the renal pelvis and calyces in the kidney
156
How is obstructive uropathy diagnosed
ultrasound of KUB
157
What are common causes of upper urinary tract obstruction?
Kidney stones
Tumours
Ureter strictures
Retroperitoneal fibrosis
Bladder cancer
Ureterocele
158
What are common causes of lower urinary tract obstruction?
Benign prostatic hyperplasia
Prostate cancer
Bladder cancer
Urethral strictures
Neurogenic bladder
159
How is upper urinary tract obstruction managed
nephrostomy used to bypass an obstruction
160
How is lower urinary tract obstruction managed
urethral or suprapubic catheter used to bypass an obstruction
161
What are complications of obstructive uropathy
- Pain
- Acute kidney injury (post-renal)
- Chronic kidney disease
- Infection
- Hydronephrosis
- Urinary retention and bladder distention
- Overflow incontinence of urine
162
What is intravenous urogram
x-ray with IV contrast collecting in the urinary tract
163
What are Undescended Testes
testes have not made it out of the abdomen by birth
aka cryptorchidism
164
Where may undescended testes be palpable from
inguinal canal
165
What do undescended testes in older children or after puberty hold a higher risk of
torsion, infertility and testicular cancer.
166
what are RF for undescended testes
Family history of undescended testes
Low birth weight
Small for gestational age
Prematurity
Maternal smoking during pregnancy
167
How are undescended testes managed before 6 months
Watching and waiting is appropriate in newborns. In most cases the testes will descend in the first 3 – 6 months
168
How are undescended testes managed after 6 months
should be seen by a paediatric urologist.
Orchidopexy (surgical correction of undescended testes) should be carried out between 6 and 12 months of age.
169
when may testes retract back into inguinal canal
when it is cold or the cremasteric reflex is activated
170
What is Orchiopexy
correcting the position of the testicles and fixing them in place
171
What is Orchidectomy
removing the testicle) if the surgery is delayed or there is necrosis
172
What are examination findings for testicular torsion
Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicular lie (often horizontal)
Rotation, so that epididymis is not in normal posterior position
173
What can delay in treatment for testicular torsion lead to
increases the risk of ischaemia and necrosis of the testicle, leading to sub-fertility or infertility.
174
what is testicular torsion
twisting of the spermatic cord with rotation of the testicl
urological emergency
175
What is bell-clapper deformity
the fixation between the testicle and the tunica vaginalis is absent.
