- dilation of the venous drainage of testicle (panpiniform venous plexus and internal spermatic vein) - "bag of worms"

- mostly asx - picked up on well child exam or by patient if adolescent

Peds Urology Flashcards by Kathleen McKenzie

cryptorchidism aka undescended testicle

4:100
75% will descend by 9 mo.
different types: palpable, nonpalpable, retractile

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most specific test for undescended testicle

PE, not scrotal US or MRI/CT

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palpable undescended testicle

felt usually in the inguinal canal

- needs surgical intervention

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nonpalpable undescended testicle

nl testicle may lie inside the abdomen (lap pexy)
neonatal torsion (testicular atrophy)
testicle didn’t develop appropriately

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retractile undescended testicle

testicle in nl position by has a strong cremaster reflex and can be hard to palpate
doesn’t need surg

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hydrocele

fluid in scrotum or inguinal canal

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communicating hydrocele

fluctuates in size
patent processus vaginalis allowing fluid to go b/w the scrotum and abdomen
needs surgical intervention

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non communicating hydrocele

non fluctuating
thought to be related to delayed closure of processus vaginalis, trapping fluid in scrotum
often resolve spontaneously
in older kids/ adults: trauma and infection can cause it

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inguinal hernia

-outpouching of abdominal contents through a weakness in the inguinal canal

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varicocele

dilation of the venous drainage of testicle (panpiniform venous plexus and internal spermatic vein)
“bag of worms”

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S/s of varicocele

mostly asx

- picked up on well child exam or by patient if adolescent

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how does varicocele effect fertility

40% of infertile males are found to have varicocele but it doens’t always cause infertility

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MC location of varicocele

left side d/t blood supply

left: renal vein
right: IVC

**this will be a test question

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testicular torsion

-twisting of the testicle resulting in a strangulation of the blood supply

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hallmark presentation of testicular torsion

sudden, severe, one-sided testicular pain (+/- hydrocele)

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“bell clapper” deformity

congenital condition where the testes hang in the scrotum and can “swing” which allows for easy twisting or free rotation

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torsed appendix testis

a mullerian duct remnant that is attached to the superior pole of testicle
can twist upon itself and cause testicular pain

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epidemiology of testicular torsion

-peaks in neonate w/i the first few days of life and then again in 12-18 yos

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essential time from onset of pain to intervene of testicular torsion

6 hrs

dx and tx of testicular torsion

scrotal US w/ doppler to assess blood flow to testicle

- surgical intervention: detorsion and orchiopexy of both testes; orchiectomy

phimosis

physiologic phimosis: inability to fully retract the foreskin
all uncircumcised males are born with it

tx of phimosis

diprolene cream and manual retraction

paraphimosis

forcefully retracting the prepuce behind the sulcus of the glans
swelling, pain, and decreased blood flow
manual reduction on emergent basis or emergency circ

three characteristics of hypospadias

location of meatus
chordee (bend)
dorsal hood (incomplete foreskin)

tx of hypospadias

- DO NOT perform circ if suspicion for hypospadias - refer | - surgical intervention at around 9-12 mo.

labial adhesions

- fusion of the labia minora - common in first 2 years of life - estrogen dependent

tx of labial ahesions

- only tx if symptomatic (urine pooling, post void dribbling, foul smelling urine, UTIs) - Estrogen cream - surgical lysis if severe - usually spontaneously resovle by puberty

hydronephrosis

- collection of retained fluid (urine) w/i the kidney's collecting system - MC congenital condition detected on antenatal US

causes of hydronephrosis

- obstruction: stones - ureteropelvic junction obstruction - ureterovesicular junction obstruction - posterior urethral valves - refulex - nl variant

grading system for hydronephrosis

SFU grading (1-4)

multicystic dysplastic kidney

- congenital nonfunctioning kidney - surgery only necessary if increase in size or causes elevation in BP - need: RUS, VCUG, and DTPA-NRS - f/u w/ annual RUS until stable then PRN

vesicoureteral reflux

- retrograde flow of urine from the bladder up the ureter and towards the kidney - happens when "one way valve" is immature - most commonly is congenital at fetal development - F>M

how can you get secondary vesicoureteral reflux

- high pressure bladder situations | - holding urine in dysfunctional elimination

standard w/u for a "first time febrile UTI"

1. RUS: if any abnormality is seen then proceed w/ a --> | 2. VCUG

VCUG

- requires a cath in the bladder | - more specific for grading the level of VUR (100X more radiation than NCG)

nuclear cystogram

- requires cath - doesn't give images to grade the VUR - may use a f/u study

tx of vesicoureteral reflux

- observational: tx dysfunctional elimination habits, prophylax abx, yearly voiding studies - deflux injections: inject bulking agents in ureteral orifice - open reimplantation: reimplant ureter into bladder wall

w/u for febrile UTI

- RUS, VCUG - recommend cath specimen - DMSA scan to eval for cortical scarring and fxn

urinary incontinence w/u

- voiding diary - US - uroflow - post void residual - exam

tx of urinary incontinence

- 1st line is conservative: timed voiding, double voiding, increase water, voiding posture, hygiene, address constipation - meds, cystoscopy, VUDY

nocturnal enuresis etiology

- bladder capacity - increased urine production - sleep disorder

tx of nocturnal enuresis

- conservative: timed voids, double voids before bed, limiting fluids before bed, - meds: typically wait until 7yp to initiate DDAVP tx or other meds

Wilm's tumor

- malignant renal tumor in young children | - avg. age: 3 yo

presentation of wilm's tumor

- abdominal mass (lg, firm, unilateral) - HTN - hematuria - abdominal tenderness

tx of wilms tumor

nephrectomy +/- radiation and chemo