Revision - Urology Flashcards
Investigations in suspected UTI in children?
1) urine dipstick
2) MSU (‘clean catch’ sample) –> if unexplained temp ≥38
When should a urine sample be sent for in children?
All infants with an unexplained temp ≥38 degrees should have MSU sent <24h
What are next steps if leukocytes or nitrites are present on a urine dipstick?
Nitrites & leukocytes –> treat as UTI
Nitrites only –> treat as UTI
Leukocytes only –> don’t treat as UTI unless there is clinical evidence they have one
Neither –> UTI unlikely
Management of all infants <3 months with a suspected UTI (e.g. unexplained temp ≥38 degrees)?
Refer immediately to paediatrician
Management of children aged >3 months with lower UTI?
3 days oral abx
Management of children aged >3 months with upper UTI?
Consider admission for IV abx
If not admitted oral Abx such as cephalosporin or co-amoxiclav should be given for 7-10 days
When is an US indicated for UTIs in children?
1) <6m in children with their 1st UTI –> within 6w, during illness if atypical bacteria
2) All children with recurrent UTIs –> within 6w
3) All children with atypical UTIs –> during illness
When should children with atypical UTIs have an abdo US?
During the illness
When should children with recurrent UTIs have an abdo US?
Within 6w
What are some features of an atypical UTI?
1) non E.coli organism
2) failure to respond to treatment within 48h
3) raised creatinine
4) sepsis
5) abdo or bladder mass
6) poor urine flow
What is the definition of a ‘recurrent’ UTI?
1) ≥2 episodes of upper UTI
2) ≥3 episodes of lower UTI
3) 1 upper & 1 lower UTI
What information can an US give in UTIs?
1) renal size
2) renal calculi
3) hydronephrosis (indicates obstruction or severe reflux)
4) can identify most congenital abnormalities
What investigation can assess for damage from recurrent or atypical UTIs?
DMSA (Dimercaptosuccinic Acid) Scan
What does a DMSA scan involve?
Injecting a radioactive material (DMSA) and using a gamma camera to assess how well the material is taken up by the kidneys.
Where there are patches of kidney that have not taken up the material, this indicates scarring that may be the result of previous infection.
When is a DMSA scan done in UTIs?
4-6m after infection
What may a urine dipstick show in vulvovaginitis?
A urine dipstick may show leukocytes but NO nitrites.
This will often result in misdiagnosis as a urinary tract infection.
What may be recommended in severe cases of vulvovaginitis?
Oestrogen cream
At what age do most children get control of daytime urination?
2 years
At what age do most children get control of nighttime urination?
3-4 years
How long has a child been dry for previously in 2ary nocturnal enuresis?
At least 6m
What 3 medications may be indicated in enuresis?
1) desmopressin
2) oxybutynin
3) imipramine (TCA)
At what age is enuresis considered pathological?
≥5 y/o
Risk factors for enuresis?
boys
FH
sleep apnoea (30%)
obese children
What are 3 methods of collecting urnie sample from infant?
1) Bladder catheterisation (most common collection method for culture)
2) Bag collection
3) Suprapubic bladder aspiration (rarely used)
What investigations are required for UTI in children <6 months?
Typical infection:
- USS
Atypical/recurrent infection:
- USS
- DMSA
- MCUG
What investigations are required for UTI in children 6m-3y?
Typical: none
Atypical/recurrent:
- USS
- DMSA
What investigations are required for UTI in children >3y?
Typical: none
Atypical/recurrent: USS (+DMSA if recurrent)
Mx of VUR?
Prophylactic antibiotics to prevent infection
Surgical correction for severe/problematic reflux
