Pediatric urology

Question 1

Wilm’s tumor

Answer 1

malignant kidney tumor in children

Question 2

WAGR

Answer 2

wilms
aniridia
GU abnormalities
retardation (mental)

Question 3

Beckwith- Wiedemann syndrome

Answer 3

• hemihypertrophy
• abdominal wall hernias
• newborn hypoglycemmia
• Wilms tumor

Question 4

Wilms versus neuroblastoma

Answer 4

Wilms:
renal flank mass
hematuria and HTN

Neuroblastoma:
adrenal or PS ganglia mass
often crosses midline on imaging
does not cause hematuria

Question 5

Urethral displacement

Answer 5

epispadias- opening on the dorsum of the penis, rare, associated with extrophy of bladder

hypospadias- meatus along ventral surface

foreskin may be distorted

Treatment:
surgical correction
no circumcision, as the foreskin should be saved
ok to stop circumcision halfway through- this is a cosmetic issue and can be corrected

complications: infertility
urethrocutaneous fistula can be a complication of hypospadias repair

Question 6

Nocturnal enuresis

Answer 6

• cannot be diagnosed until 5yo
• treatment usually delayed until the child is at least 7 yo
• usually non-pathologic

Treatment:

• toilet training if not yet attempted
• motivational therapy (star charts)
• restrict fluids before bed (with a compensatory increase in daytime fluids)
• nighttime chaperone to the toilet or scheduled wakening to void using alarm clock
• enuresis alarm in bed for classic conditioning (this is most effective long-term therapy)
• oral desmopressin (DDAVP)

Question 7

Secondary enuresis

Answer 7

sometimes this is a normal relapse period

can be indicative of an underlying psychiatric issue

common in CPS children

Question 8

cryptorchidism

Answer 8

undescended testicles

inguinal canal mc place, along with empty scrotal sac

Treatment: testicle should be brought into the scrotum by 6-12 months

• exogenous hCG
• surgical orchiopexy reduces risk of testicular cancer

complications:
infertility
increased risk of testicular cancer

Question 9

Posterior urethral valves

Answer 9

MC obstructive urethral lesion in infants and newborns

Abnormal tissue folds in distal prostatic urethra, act as obstruction

This diagnosis may be suspected when you see a distended bladder in utero, b/l hydronephrosis, as well as maybe oligohydramnios

Voiding cystourethrogram confirms the diagnosis:
dilated posterior urethra distal to the valves, sail shape seen at the valve

Treatment:
Foley catheter or vesicostomy (opens the bladder to lower abd skin until baby is old enough for surgery)
Cystoscopically ablate the valves

Suspect delayed diagnosis in male child who is incontinent beyond appropriate age, or develops UTI. VCUG to evaluate for posterior urethral valve

Question 10

MC presenting symptom in child with Wilm’s tumor

Answer 10

palpable flank mass