Pediatric Urology Flashcards
Nearly all urologic concerns in children are the result of what?
Congenital anomalies of the renal, ureteral, or urethral tracts
What public health problem is leading to an increased incidence of nephrolithiasis in children?
What type of stones are most common in pediatric patients?
Childhood Obesity
Calcium oxalate or calcium phosphate
What are some predisposing factors or concurrent diagnoses lead to kidney stones?
- Lesch-Nyhan Syndrome
- Recurrent UTI’s (struvite stones)
- Paralysis/Immobolization (such as spina bifida)
What is the treatment of nephrolithiasis in children?
- Treat underlying problem or disease
- Optimize hydration
- Surgical removal can be performed
How is Vesico-Ureteral Reflux (VUR) diagnosed?
VCUG (voiding cystourethrogram)
Are UTI’s normal in infants?
No, a renal ultrasound should be done in all infants after a first febrile UTI to screen for congenital abnormalities
What is the treatment for VUR Grade I-III?
What is the treatment for VUR Grade IV-V?
Low grade VUR often resolve spontaneously over time
Prophylactic antibiotics (Bactrim or Nitrofurantoin)
Severe reflux may require surgical repair
What can reduce the risk of UTI’s in boys?
Circumcision
What is the most common pathogen of pediatric UTI’s?
- **E.Coli **
- Klebsiella
- Proteus
- Gram Negative and some Enercoccocus
What is the presentation of UTI in newborns or infants?
- Fever or Hypothermia
- Poor feeding
- Irritability
- Failure to thrive
- Vomiting
- May note foul smelling urine
What is the presentation of UTI’s in school aged children?
What about preschoolers?
- More classic s/sx of cystitis or pyelonephritis
Abdominal or flank pain, vomiting, fever, dysuria
What are the antibiotic treatments for UTI?
What is the duration of treatment?
- Amoxicillin
- TMP-SMX
- 1st Generation Cephalosporin
7-10 days, no short treatments
What is enuresis?
What are the types?
Is it more common in males or females?
Repeated spontaneous voiding of urine during sleep, child > 5 years old
Primary and Secondary enuresis
Males
Is there a strong genetic association of primary nocturnal enuresis?
Yes!!
Why is enuresis more common in sickle cell patients?
They are unable to concentrate their urine well due to scaring and they are also encouraged to drink a lot of fluids to prevent pain crises
What are some pharmacologic treatments for enuresis?
How old must the child be to start therapy?
- Desmopressin and imipramine (DDAVP)
- Anticholinergics (second line)
Age 7 or older
Do you want to circumcise an infant with suspected hypospadias?
No, the reconstruction typically uses the foreskin so want to preserve until surgery
Can phimosis be physiologic?
Yes, normal finding in newborns
What are distinguishing features of a pathologic phimosis from physiologic?
- History of cracking and bleeding with retraction
- Indurated, scarred, whitened skin at tip of prepuce
- Narrowest part is most distal
- Painful erections
What is the first line treatment of paraphimosis in kids?
Compression of edema and replacement of foreskin
What is the diagnosis of cryptorchidism?
What is the treatment?
What is the risk with cryptorchidism?
Diagnosis by examination, sometimes US or laparoscopy
Surgical orchiopexy
Testicular cancer and infertility
What is the first line treatment of testicular torsion in kids?
How is testicular torsion confirmed?
Immediate manual detorsion followed by surgical intervention
Doppler ultrasonagraphy
What deformity predisposes testis to twisting?
Bell-clapper deformity: anomalous development of tunica vaginalis and spermatic cord
What reflex is usually absent in testicular torsion?
When may you see “Blue dot sign”
Cremasteric reflex
Infarcted are is blue in testicular torsion
What way should you manually detorse the testes?
Testes usually rotate inward, detorsion is rotation in outward direction (like opening a book)
What co-occuring infection typically presents with orchitis?
Mumps
What is the treatment for orchitis?
Supportive care if viral or after mumps infection: truly supportive care (elevate scrotum)
Abx is only used if infection is confirmed to be bacterial
What is the treatment for penile adhesions?
- Steroid cream
- Vaseline
- Watch and wait
- Surgical lysis of adhesions (uncommon)
What is the thought behind the cuase of labial adhesions?
Can they spontaneously resolve?
Low estrogen state and then possibly irritation resulting in re-epitheliazation
Yes
If labial adhesions do not resolve spontaneously, what are some treatment options?
- Topical estrogen
- Vaseline
