Pediatric Urology Flashcards
what is a majority of the peditric urologic concerns in children a result of
congenital anomalies or renal, ureteral or urethral tracts
what is often accompanied with renal abnormalities in children
Ureteral abnormalities
what are the most common types of stones with nephrolithiasis in children
calcium oxalate or calcium phosphate
m/c from hypercalciuria and hypocitraturia
What type of stones is Lesch-nyhan syndrome associated with
Urate stones
what is the treatment of nephrolithiasis in children
treat underlying problem of disease process
hydration
surgical removal if necessary
when can hydronephrosis be detected in children
prenatal ultrasound
where are the common obstruction areas with hydronephrosis in children
Ureteropelvic junction- proximal (UPJ-prox)
Ureterovesicular junction - distal (UVJ - distal)
how is the diagnosis made of hydronephrosis in children
nuclear renal scan with furosemide (diuretic)
What is VUR
Vesico-Ureteral Reflux
retrograde flow of urine from bladder up into ureter and even kidney
difficult to distinguish from hydronephrosis with US alone
How is VUR diagnosed
VCUG (voiding cystourethrogram)
contrast instilled in bladder via a catheter, xr taken while pts bladder is being filled and child voids to check for reflux
Who should obtain a renal US
all infants after first febrile UTI to screen for congenital abnormalities of GU system
what procedure helps to reduce the risk of UTI in boys
Circumcision
What is the most common pathogen with UTI
Fecal flora
(85% E. coli, also Klebsiella, etc)
what is the presentation of newborns and infants with UTI
fever OR hypothermia
poor feeding
irritability
failure to thrive
vomiting
may note: strong or foul smelling urine
what is the presentation of UTI in preschoolers
Abdominal or flank pain
vomiting
fever
frequency
dysuria
enuresis
what is the presentation of UTI in school age children
more classic s/sx of cystitis or pyelonephritis
what is seen on urinalysis with UTI
usually with pyruia, positive leukocyte esterase
what is the treatment of UTI in < 3month olds who are febrile, toxic, dehydrate or septic
admission and given IV abx
what are the antibiotics of choice for UTI treatment
amoxicillin, TMP-SMX or first gen cephalosporin for cystitis
7-10 days.
how long should acute pyelonephritis be treated for
10-14 days
what is repeated spontaneous voiding of urine during sleep, child > 5yo
enuresis
what is primary noctural enuresis
disparity between bladder capacity and overnight urine production as well as failure to awaken in response to full bladder
- strong genetic influence
- constipation also associated
What is associated with secondary nocturnal enuresis
problems including depression, anxiety, social phobias, conduct disorder and ADHD.
somtimes considered “regressive” and more behavioral.
can be a response to emotional trauma.
what are the treatment options for enuresis
non-pharm: motivation, training, alarm, biofeedback
pharmacoloic: kids > 7yo
what are the pharmacologic options for enuresis
DDAVP (desmopressin) and Imipramine
anticholinergic - 2nd line
what is an anomaly caused by failure of tubularization and fusion of urethral groove - urethra opens to underside of penile shaft
hypospadias
what is clinical presentation of phimosis
may be asymptomatic
difficult urination
ballooning of prepuce
weak, think urinary stream
recurrent balanitis
what are the treatment options for phimosis
corticosteroid cream (short term)
dorsal slit
circumcision
what is preputial skin trapped behind tight ring glands that becomes dematous
paraphimosis
what is the first line treatment for paraphimosis
compression of devema and replacement of foreskin
what is the treatment of cryptorchidism
surgical orchiopexy
What is a emergency condition due to the rotation of testis and strangulation of blood supply
testicular torsion
what are the symptoms of testicular torsion
acute scrotal pain and swelling
nausea and vomiting
how is testicular torsion diagnosed
PE and confirmed with color Doppler US
what is the treatment of testicular torsion
immediate manual detorsion
followed by surgical intervention
when is testicular torsion most common to present
(age)
12-18 years old, second peak in infancy
m/c in left testis
What reflex is affected with testicular torsion
cremasteric relfex usually absent on affected side
What is the treatment of epididymitis or orchitis
antibiotics in babies and sexually active males
analgesics
scrotal support
not all cases require abx
What is the medication treatment for epididymitis for sexually active males
ceftriaxone + doxycyline
what are the complications of epididymitis if untreated
infertility
worsening ascending infection
what is the typical infection associated with Orchitis
mumps
what is the treatment of penile adhesion
steroid cream
vaseline (soften adhesion)
watch and wait
surgical lysis of adhesion (uncommon)
What is the fusion of labia minora, complete or partial
labial adhesion
what is thought to be the cause of labial adhesion
thought to be caused by low estrogen state and then possibly irritation resulting in re-epithelialization
