Pediatric Urology Flashcards
What are the three types of cryptochism?
undescended testicles, retractile testicles, and ascending testicles.
When are undescended testicles most common?
at birth, they are more common in premature or low weight births.
What is the recommended time to do surgery if they do not descend?
after 6 months but before 12-24 months.
boys and bilateral normal testis and boys with unilateral UDT have the (same or different) risks of fertility
the same (both have 90%). bilateral udt has 50%.
do retractile or ascending testis have associated cancer or fertility risks?
not shown
When is the best time in life to do a scrotal exam?
birth.
What is the most reliable way of diagnosing a UDT?
physical exam (current says you can use MRI or U/S also)
When should a PCP order a scrotal US for UDT?
never (according to lecture)
What might you expect to see for a non palpable testicle?
compensatory hypertropy > 1.8cm usually indicates the other testicle is dead. There may be a risk of cancer in the testiulcar nubbin, and a higher risk of torsion in a solitary testicle.
What is the mandatory procedure in a child with a non palpable testicle?
laparoscopy
What are the risks associated with hernias?
incarceration, strangulation and bowel necrosis
what is a hydrocele?
it is a fluid filled sac surrounding a testicle that results in swelling of the scrotum. it is common in newborns and most disappear without treatment. it is not painful most of the time.
what are the two types of hyrdoceles?
communication (sac open and fluid passes to and from abdominal cavity, higher risk of hernias. most resolve by 18 months) and non communicating (sac closes)
compare a febrile UTI vs a non febrile UTI
febrile: younger, temp >38.5, sick, back pain, anatomic problem, workup = renal us and VCUG
non febrile: older, no fever, dysfunctional elimination, normal anatomy, workup: KUB, voiding diary
what is the workup for a febrile UTI?
renal us and vcug
what is the workup for a non febrile UTI
KUB and voiding diary
What is hydronephrosis?
dilation of the kidney, specifically the renal pelvis (where urine is produced)
What can cause hydronephrosis?
anatomic abnormality, variant of normal, or an obstruction are most common
how is hydronephrosis classified?
grade 0-4
Which children require immediate evals of hydronephrosis after birth?
boy, history of oligodraminos, bilateral grade 2 hydro
girl, bilateral ureteroceles
boy, bilateral grade 2 or more hydro
Who should get a VCUG for hydronephrosis?
grade 2 or more
Who should get a Mag 3 for hydronephrosis?
grade 3 or 4
Between incontinence and encopresis, which should be treated first?
encopresis because constipation could be the underlying cause to both
What is psuedofecal incontinence?
due to constipation
Treatment of encopresis involves?
desimpaction, maintenince (stool softener with schedule potty time), and this can last for 6 months
Daytime urinary incontinence in older kids, you need to order what?
renal us to r/o neurogenic bladder, valves, or anatomic problems.
How do you treat daytime incontinence?
constipation relief, and time voiding, or double voiding.
what is mono symptomatic nocturnal enuresis?
the brain and the bladder are not communicating about when each needs to go.
What is the treatment for monsymptomatic nocturnal enuresis?
general measures: pee before bed, limit fluids
medications: not very helpful
bedwetting alarm: only help about 1/2 the time.
What is the recommend care of the uncircumcised penis from age 0 to age 8.
once the foreskin becomes retractable, teach children to retract their own foreskin during voiding and bathing.
For labial adhesions, what are the treatment options?
observatiogn, estrogen cream or surgical lysis
What is phimosis?
you cannot retract the foreskin all the way back. there is physiological and pathological
What is the difference between physio and patho phimosis?
physio= ring is supple, patho= ring is thick and inflammed
Distinguish between soft penile adhesions and the penile bridge?
soft= do not involve the circumcision, disappear on their own without treatment. penile = involve circumsicion, require lysis.
This is indicated in a child with significant hypospadius, which results in outflow abnormalities and likely sexual dysfunction
referral to a surgeon
