Pediatric Urology

Question 1

what is a majority of the peditric urologic concerns in children a result of

Answer 1

congenital anomalies or renal, ureteral or urethral tracts

Question 2

what is often accompanied with renal abnormalities in children

Answer 2

Ureteral abnormalities

Question 4

what are the most common types of stones with nephrolithiasis in children

Answer 4

calcium oxalate or calcium phosphate

m/c from hypercalciuria and hypocitraturia

Question 6

What type of stones is Lesch-nyhan syndrome associated with

Answer 6

Urate stones

Question 7

what is the treatment of nephrolithiasis in children

Answer 7

treat underlying problem of disease process
hydration
surgical removal if necessary

Question 9

when can hydronephrosis be detected in children

Answer 9

prenatal ultrasound

Question 11

where are the common obstruction areas with hydronephrosis in children

Answer 11

Ureteropelvic junction- proximal (UPJ-prox)
Ureterovesicular junction - distal (UVJ - distal)

Question 12

how is the diagnosis made of hydronephrosis in children

Answer 12

nuclear renal scan with furosemide (diuretic)

Question 13

What is VUR

Answer 13

Vesico-Ureteral Reflux
retrograde flow of urine from bladder up into ureter and even kidney

difficult to distinguish from hydronephrosis with US alone

Question 14

How is VUR diagnosed

Answer 14

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

Question 15

Who should obtain a renal US

Answer 15

all infants after first febrile UTI to screen for congenital abnormalities of GU system

Question 16

what procedure helps to reduce the risk of UTI in boys

Answer 16

Circumcision

Question 17

What is the most common pathogen with UTI

Answer 17

Fecal flora
(85% E. coli, also Klebsiella, etc)

Question 18

what is the presentation of newborns and infants with UTI

Answer 18

fever OR hypothermia
poor feeding
irritability
failure to thrive
vomiting
may note: strong or foul smelling urine

Question 19

what is the presentation of UTI in preschoolers

Answer 19

Abdominal or flank pain
vomiting
fever
frequency
dysuria
enuresis

Question 20

what is the presentation of UTI in school age children

Answer 20

more classic s/sx of cystitis or pyelonephritis

Question 21

what is seen on urinalysis with UTI

Answer 21

usually with pyruia, positive leukocyte esterase

Question 22

what is the treatment of UTI in < 3month olds who are febrile, toxic, dehydrate or septic

Answer 22

admission and given IV abx

Question 23

what are the antibiotics of choice for UTI treatment

Answer 23

amoxicillin, TMP-SMX or first gen cephalosporin for cystitis 7-10 days.

Question 24

how long should acute pyelonephritis be treated for

Answer 24

10-14 days

Question 25

what is repeated spontaneous voiding of urine during sleep, child > 5yo

Answer 25

enuresis

Question 26

what is primary noctural enuresis

Answer 26

disparity between bladder capacity and overnight urine production as well as failure to awaken in response to full bladder ## Footnote - strong genetic influence - constipation also associated

Question 27

What is associated with secondary nocturnal enuresis

Answer 27

problems including depression, anxiety, social phobias, conduct disorder and ADHD. somtimes considered "regressive" and more behavioral. can be a response to emotional trauma.

Question 28

what are the treatment options for enuresis

Answer 28

non-pharm: motivation, training, alarm, biofeedback pharmacoloic: kids > 7yo

Question 29

what are the pharmacologic options for enuresis

Answer 29

DDAVP (desmopressin) and Imipramine anticholinergic - 2nd line

Question 30

what is an anomaly caused by failure of tubularization and fusion of urethral groove - urethra opens to underside of penile shaft

Answer 30

hypospadias

Question 31

what is clinical presentation of phimosis

Answer 31

may be asymptomatic difficult urination ballooning of prepuce weak, think urinary stream recurrent balanitis

Question 32

what are the treatment options for phimosis

Answer 32

corticosteroid cream (short term) dorsal slit circumcision

Question 33

what is preputial skin trapped behind tight ring glands that becomes dematous

Answer 33

paraphimosis

Question 34

what is the first line treatment for paraphimosis

Answer 34

compression of devema and replacement of foreskin

Question 35

what is the treatment of cryptorchidism

Answer 35

surgical orchiopexy

Question 36

What is a emergency condition due to the rotation of testis and strangulation of blood supply

Answer 36

testicular torsion

Question 37

what are the symptoms of testicular torsion

Answer 37

acute scrotal pain and swelling nausea and vomiting

Question 38

how is testicular torsion diagnosed

Answer 38

PE and confirmed with color Doppler US

Question 39

what is the treatment of testicular torsion

Answer 39

immediate manual detorsion followed by surgical intervention

Question 40

when is testicular torsion most common to present | (age)

Answer 40

12-18 years old, second peak in infancy ## Footnote m/c in left testis

Question 41

What reflex is affected with testicular torsion

Answer 41

cremasteric relfex usually absent on affected side

Question 42

What is the treatment of epididymitis or orchitis

Answer 42

antibiotics in babies and sexually active males analgesics scrotal support not all cases require abx

Question 43

What is the medication treatment for epididymitis for sexually active males

Answer 43

ceftriaxone + doxycyline

Question 44

what are the complications of epididymitis if untreated

Answer 44

infertility worsening ascending infection

Question 45

what is the typical infection associated with Orchitis

Answer 45

mumps

Question 46

what is the treatment of penile adhesion

Answer 46

steroid cream vaseline (soften adhesion) watch and wait surgical lysis of adhesion (uncommon)

Question 47

What is the fusion of labia minora, complete or partial

Answer 47

labial adhesion

Question 48

what is thought to be the cause of labial adhesion

Answer 48

thought to be caused by low estrogen state and then possibly irritation resulting in re-epithelialization