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Pediatrics > Peds Urology > Flashcards

Peds Urology Flashcards

1
Q

cryptorchidism aka undescended testicle

A
  • 4:100
  • 75% will descend by 9 mo.
  • different types: palpable, nonpalpable, retractile
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2
Q

most specific test for undescended testicle

A

PE, not scrotal US or MRI/CT

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3
Q

palpable undescended testicle

A
  • felt usually in the inguinal canal

- needs surgical intervention

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4
Q

nonpalpable undescended testicle

A
  • nl testicle may lie inside the abdomen (lap pexy)
  • neonatal torsion (testicular atrophy)
  • testicle didn’t develop appropriately
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5
Q

retractile undescended testicle

A
  • testicle in nl position by has a strong cremaster reflex and can be hard to palpate
  • doesn’t need surg
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6
Q

hydrocele

A

fluid in scrotum or inguinal canal

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7
Q

communicating hydrocele

A
  • fluctuates in size
  • patent processus vaginalis allowing fluid to go b/w the scrotum and abdomen
  • needs surgical intervention
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8
Q

non communicating hydrocele

A
  • 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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9
Q

inguinal hernia

A

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

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10
Q

varicocele

A
  • dilation of the venous drainage of testicle (panpiniform venous plexus and internal spermatic vein)
  • “bag of worms”
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11
Q

S/s of varicocele

A
  • mostly asx

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

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12
Q

how does varicocele effect fertility

A

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

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13
Q

MC location of varicocele

A

left side d/t blood supply

  • left: renal vein
  • right: IVC

**this will be a test question

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14
Q

testicular torsion

A

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

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15
Q

hallmark presentation of testicular torsion

A

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

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16
Q

“bell clapper” deformity

A

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

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17
Q

torsed appendix testis

A
  • 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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18
Q

epidemiology of testicular torsion

A

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

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19
Q

essential time from onset of pain to intervene of testicular torsion

A

6 hrs

20
Q

dx and tx of testicular torsion

A
  • scrotal US w/ doppler to assess blood flow to testicle

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

21
Q

phimosis

A
  • physiologic phimosis: inability to fully retract the foreskin
  • all uncircumcised males are born with it
22
Q

tx of phimosis

A

diprolene cream and manual retraction

23
Q

paraphimosis

A
  • forcefully retracting the prepuce behind the sulcus of the glans
  • swelling, pain, and decreased blood flow
  • manual reduction on emergent basis or emergency circ
24
Q

three characteristics of hypospadias

A
  • location of meatus
  • chordee (bend)
  • dorsal hood (incomplete foreskin)
25
Q

tx of hypospadias

A
  • DO NOT perform circ if suspicion for hypospadias - refer

- surgical intervention at around 9-12 mo.

26
Q

labial adhesions

A
  • fusion of the labia minora
  • common in first 2 years of life
  • estrogen dependent
27
Q

tx of labial ahesions

A
  • only tx if symptomatic (urine pooling, post void dribbling, foul smelling urine, UTIs)
  • Estrogen cream
  • surgical lysis if severe
  • usually spontaneously resovle by puberty
28
Q

hydronephrosis

A
  • collection of retained fluid (urine) w/i the kidney’s collecting system
  • MC congenital condition detected on antenatal US
29
Q

causes of hydronephrosis

A
  • obstruction: stones
  • ureteropelvic junction obstruction
  • ureterovesicular junction obstruction
  • posterior urethral valves
  • refulex
  • nl variant
30
Q

grading system for hydronephrosis

A

SFU grading (1-4)

31
Q

multicystic dysplastic kidney

A
  • 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
32
Q

vesicoureteral reflux

A
  • 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
33
Q

how can you get secondary vesicoureteral reflux

A
  • high pressure bladder situations

- holding urine in dysfunctional elimination

34
Q

standard w/u for a “first time febrile UTI”

A
  1. RUS: if any abnormality is seen then proceed w/ a –>

2. VCUG

35
Q

VCUG

A
  • requires a cath in the bladder

- more specific for grading the level of VUR (100X more radiation than NCG)

36
Q

nuclear cystogram

A
  • requires cath
  • doesn’t give images to grade the VUR
  • may use a f/u study
37
Q

tx of vesicoureteral reflux

A
  • 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
38
Q

w/u for febrile UTI

A
  • RUS, VCUG
  • recommend cath specimen
  • DMSA scan to eval for cortical scarring and fxn
39
Q

urinary incontinence w/u

A
  • voiding diary
  • US
  • uroflow
  • post void residual
  • exam
40
Q

tx of urinary incontinence

A
  • 1st line is conservative: timed voiding, double voiding, increase water, voiding posture, hygiene, address constipation
  • meds, cystoscopy, VUDY
41
Q

nocturnal enuresis etiology

A
  • bladder capacity
  • increased urine production
  • sleep disorder
42
Q

tx of nocturnal enuresis

A
  • conservative: timed voids, double voids before bed, limiting fluids before bed,
  • meds: typically wait until 7yp to initiate DDAVP tx or other meds
43
Q

Wilm’s tumor

A
  • malignant renal tumor in young children

- avg. age: 3 yo

44
Q

presentation of wilm’s tumor

A
  • abdominal mass (lg, firm, unilateral)
  • HTN
  • hematuria
  • abdominal tenderness
45
Q

tx of wilms tumor

A

nephrectomy +/- radiation and chemo

Pediatrics (9 decks)

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