Revision - Urology

Question 1

Investigations in suspected UTI in children?

Answer 1

1) urine dipstick

2) MSU (‘clean catch’ sample) –> if unexplained temp ≥38

Question 2

When should a urine sample be sent for in children?

Answer 2

All infants with an unexplained temp ≥38 degrees should have MSU sent <24h

Question 3

What are next steps if leukocytes or nitrites are present on a urine dipstick?

Answer 3

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

Question 4

Management of all infants <3 months with a suspected UTI (e.g. unexplained temp ≥38 degrees)?

Answer 4

Refer immediately to paediatrician

Question 5

Management of children aged >3 months with lower UTI?

Answer 5

3 days oral abx

Question 6

Management of children aged >3 months with upper UTI?

Answer 6

Consider admission for IV abx

If not admitted oral Abx such as cephalosporin or co-amoxiclav should be given for 7-10 days

Question 7

When is an US indicated for UTIs in children?

Answer 7

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

Question 8

When should children with atypical UTIs have an abdo US?

Answer 8

During the illness

Question 9

When should children with recurrent UTIs have an abdo US?

Answer 9

Within 6w

Question 10

What are some features of an atypical UTI?

Answer 10

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

Question 11

What is the definition of a ‘recurrent’ UTI?

Answer 11

1) ≥2 episodes of upper UTI

2) ≥3 episodes of lower UTI

3) 1 upper & 1 lower UTI

Question 12

What information can an US give in UTIs?

Answer 12

1) renal size

2) renal calculi

3) hydronephrosis (indicates obstruction or severe reflux)

4) can identify most congenital abnormalities

Question 13

What investigation can assess for damage from recurrent or atypical UTIs?

Answer 13

DMSA (Dimercaptosuccinic Acid) Scan

Question 14

What does a DMSA scan involve?

Answer 14

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.

Question 15

When is a DMSA scan done in UTIs?

Answer 15

4-6m after infection

Question 16

What may a urine dipstick show in vulvovaginitis?

Answer 16

A urine dipstick may show leukocytes but NO nitrites.

This will often result in misdiagnosis as a urinary tract infection.

Question 17

What may be recommended in severe cases of vulvovaginitis?

Answer 17

Oestrogen cream

Question 18

At what age do most children get control of daytime urination?

Answer 18

2 years

Question 19

At what age do most children get control of nighttime urination?

Answer 19

3-4 years

Question 20

How long has a child been dry for previously in 2ary nocturnal enuresis?

Answer 20

At least 6m

Question 21

What 3 medications may be indicated in enuresis?

Answer 21

1) desmopressin

2) oxybutynin

3) imipramine (TCA)

Question 22

At what age is enuresis considered pathological?

Answer 22

≥5 y/o

Question 23

Risk factors for enuresis?

Answer 23

boys
FH
sleep apnoea (30%)
obese children

Question 24

What are 3 methods of collecting urnie sample from infant?

Answer 24

1) Bladder catheterisation (most common collection method for culture)

2) Bag collection

3) Suprapubic bladder aspiration (rarely used)

Question 25

What investigations are required for UTI in children <6 months?

Answer 25

Typical infection:
- USS

Atypical/recurrent infection:
- USS
- DMSA
- MCUG

Question 26

What investigations are required for UTI in children 6m-3y?

Answer 26

Typical: none

Atypical/recurrent:
- USS
- DMSA

Question 27

What investigations are required for UTI in children >3y?

Answer 27

Typical: none

Atypical/recurrent: USS (+DMSA if recurrent)

Question 28

Mx of VUR?

Answer 28

Prophylactic antibiotics to prevent infection

Surgical correction for severe/problematic reflux