Urinary Flashcards
Cryptorchidism treatment
Orchidopexy before 2yrs
Refer to surgeons at 3m and should be seen before 6m
Testicular torsion Rx
Surgical exploration within 6h
What should parents be told about hypospadias?
Do not circumcise as foreskin used to repair if severe
What is defined as secondary enuresis?
Was achieved before for 6m
three reasons for enuresis
Inability to wake when bladder full
Bladder overactive
High nocturnal urine output
When do most children achieve day and night continence?
3-4yrs
What % have achieved day time continence by 4 yrs
95%
What % have achieved day time continence by 2.5yrs
50%
What % have achieved night time continence by 5yrs
95%
What % have achieved night time continence by 10yrs
97-98%
Boys or girls slower to achieve continence?
Boys
What are some organic reasons for enuresis
Constipation
DM
UTI
Spina bifida
Ectopic ureter
What investigations and examination done in enuresis
Ask about fluid intake, stress, access to toilet, diet
Examine abdo, genitalia, spine, neuro, growth
BP
Urine sample- glycosuria, protein, infection, osmolality
?Renal USS or AXR
Management enuresis for >5yo
Star chart
Alarm
What is second line management enuresis, or for older child
Drugs- desmopressin (ADH analogue)
Oxybutinin (anticholinergic)
TCA (imipramine)- last line
management enuresis <5yo
Reassure as not all children have achieved yet. Advice easy access to toilet at night ?potty, empty bladder before bed, not too much fluid before bed
If child >5 has daytime Sx management enuresis?
Refer
Secondary enuresis where to manage?
If something can be done in PC e.g. constipation, UTI then there, otherwise refer to secondary care
What syndrome predisposes children to infections, thrombosis and hyperlipidaemia, and presents with oedema
Nephrotic syndrome
Age group nephrotic syn
2-5y
Triad in nephrotic syn
Proteinuria (>1g/m2/24hr) leads to hypoalbuminuria (<25g/L) and oedema
80% nephrotic synd caused by?
Minimal change glomerulonephritis
90% nephrotic synd responds to
High dose oral steroids
Should child UTI be investigated?
Yes for cause or renal damage
80% childhood UTI caused by
E coli
Predisposing factors to UTI
Incomplete emptying (infrequent or hurried voiding, constipation obstructing or neuropathic bladder)
Vesicoureteric reflex
Poor hygiene
Preferred way of sampling urine
Clean catch, if not pad
Management UTI
<3m refer to paeds
> 3m and upper- 7-10 days oral Abx or admit
> 3m and lower- 3 days Abx PO
Recurrent- consider Abx prophylaxis
What can occur 7-14 days following a group A beta-haemolytic Streptococcus infection?
Post-strep glomerulonephritis
caused by immune complex (IgG, IgM and C3) deposition in the glomeruli
4 important causes of glomerulonephritis
Post-strep
HSP
IgA nephropathy
Alport syndrome
Advice for vulvovaginitis
Loose clothes
Not too much soap
