Peds Uro

Question 1

congenital vesicoureteral reflux predisposes children to?

Answer 1

pyelonephritis, scarring

Question 2

side effects of long-term vesicoureteral reflux and scarring

Answer 2

decreased renal function, ESRD, HTN, decreased growth

Question 3

the (younger/older) the child, the faster the lower reflux resolves

Answer 3

younger

Question 4

treating only symptomatic UTIs in kids with VU reflux results in?

Answer 4

continued scarring (bad tx option) for the 20% of kids whose kidneys scar

Question 5

resolution rate of unilateral VU reflux

Answer 5

almost always resolves within 5 years

Question 6

goals of tx of VU reflux

Answer 6

prevent renal injury, tx pyelonephritis, decrease morbidity and hospitalization

Question 7

medical tx for VU reflux

Answer 7

ABX to keep urine sterile (sterile reflux does not cause scarring); reflux can resolve

Question 8

why would someone get surgical tx of VU reflux?

Answer 8

reduce ABX, reduce complications/morbidity, noncompliance with medical therapy, immediate solution

Question 9

outcomes: surgical vs. medical management of VU reflux

Answer 9

no difference in cystitis, HTN, renal growth; surgical decreases pyelo by 2.5X, prevents late scars seen with medical?

Question 10

surgical options for VU reflux

Answer 10

open reimplant of ureter (pull valve into bladder) or ureteral injection to shrink size of hole

Question 11

you need to salvage a twisted testicle within?

Answer 11

6 hours

Question 12

PE findings of testicular torsion

Answer 12

erythema, edema, loss of cremasteric reflex

Question 13

diagnosis of torsion when you want to be 100% sure its not that

Answer 13

doppler ultrasound

Question 14

weaknesses of nuclear scan of testes

Answer 14

increased erythema can cause false negative, infant scrotum is too small

Question 15

posterior urethral valves result in?

Answer 15

dilation of the prostatic urethra + massive reflux, renal dysplasia, risk for sepsis

Question 16

posterior urethral valves are usually diagnosed?

Answer 16

prenatally (thickbladder, hydrop, oligohydramnios)

Question 17

initial management of posterior urethral valves

Answer 17

1. decompression with foley cath, 2. ABX, 3. fluid + electrolyte support, then get a repeat U/S + VCUG

Question 18

surgical tx of posterior urethral valve

Answer 18

cut valve leaflet, leave tissue in place