Random Peds Urology Flashcards
What are differentials for a patient with continuous incontinence?
bladder bowel dysfunction, ectopic ureter, neurogenic bladder
What is constellation of prune belly syndrome?
loss of abdominal musculature, UDT, urinary tract abdnomalities (megaureters, open bladder neck)
What types of posterior urethral valves?
two types
Type 1 - leaflets from distal veru and fuse midline just prox to external
Type III - transverse flat distal to veru, with small hole in middle
treated by endoscopy, holmium or cold knife - incise 5, 7, and 12 o clock as needed
after PUV, still see hydroureteronephrosis, what do you do?
just observe
What can develop after PUV?
in young boys - they develop detrusor hyperreflexia with decreased bladder and compliance
in older boys - myogenic failure + nephrogenic DI (concentrating problem) - enuresis
boys will have poor bladder sensation - which can lead to upper tract deterioration + urinary incontinence (day + night)
treated with cic, anticholinergics, a1 blockers, continuous foley at night, TIMED VOIDING
small percentage need augment w/ creation of continent catheterizable channel (RARELY PERFORMED)
Pets w/ renal mass, differentials?
Wilms Tumor
Neuroblastoma
Congenital Mesoblastic Nephroma (tx with nephrectomy)
less likely: AML, RCC
ordering of images for peds:
RBUS > CT
metastatic imaging: chest CT (esp for Wilms - main met site) (all others depending on suspicion)
Clinical presentation of Wilms?
hematuria, palpable mass, HTN
HEALTHY (compared to sickly neuroblastoma)
What treatment works well with Wilms?
Chemo (also add on XRT for post surgery)
Consider NAC vs AC
If unresectable, use chemo
if bilateral, chemo first
vincristine, dactinomycin, doxorubicin,
what is staging for Wilms?
I - kidney, no spillage
II - extra capsular penetration
III - spillage, residual in abdomen
IV - mets
V - bilateral
what are risk factors for recurrence?
spillage, poor histology, residual disease
What is normal newborn Cr?
0.2-0.4
When is MCDK intervened upon
Only for mass effect
How is bladder volume calculated?
(Age (0 months for first year) + 2) X 30
What are causes of urinary retention in a toddler?
neurogenic bladder
ureterocele with ball valve
What is best imaging for an ectopic ureter?
MR uro gram
But other options are cystoscopy with vaginoscopy - and use of dyes
RBUS
