urinary problems in pediatrics Flashcards
day time urinary continence by age…
4
daytime and night time continence by age…
5
an infant voids approx ___ times per day
20 (small voided volumes and incomplete bladder emptying)
increased daytime frequency = voiding ___ or more times during waking hours
8
decreased daytime frequency= voiding ___ or less
3
abnormal frequent small voids in a previously toilet-trained kid (with NO evidence of polyuria or uti)
pollakiuria
T/F intermittent stream is normal physiologic pattern in kids <3y.o
TRUE
- voiding stream of urine that occurs in several discrete bursts rather than the normal continuous stream
polyuria= urine output exceeding __L/m2
2 L/m^2 in kids and 3L in adults
primary enuresis
80% of cases
involuntary urination in kids who has never established continence for more than 6 months
secondary enuresis
20% of cases
resumption fo enuresis after at least 6 mo of continence
monosymptomatic enuresis
aka uncomplicated enuresis
enuresis without lower urinary tract symptoms other than nocturia
no hx of bladder dysfunction
nonmonosymptomatic enuresis
enuresis with lower urinary tract symptoms:
- incr/decr voiding frequency
- daytime wetting, urgency, hesitancy
- straining, weak, intermittent stream
- posturination dribbling, holding maneuvers
- sensation of incomplete emptying
lower abd or genital discomfort
nocturnal enuresis= discrete episodes of urinary incontinence during sleep in kids > ___ yo
5
causes of monosymptomatic nocturnal enuresis
- detrusor over-activity
- disturbed sleep
- psychologic (bx)
- neuropsych (intellectual disability, low self-esteem, adhd)
when would you get a renal US and VCUG (voiding cystourethrogram)
- kids with significant daytime complaints
- uti that hasnt been evaluated
- signs of structural urologic abnormalities
US helpful to determine
post-void residual volume
bladder wall thickness
abd xray for…
to determine presence and extent of stool retention
MRI for…
kids with lower lumbosacral spine abnormality
abnormal neuro exam of the perineum and lower extremities
kids who have BOTH bladder and bowel symptoms are described as ___
bowel and bladder dysfunction
complex/ complicated enuresis
overactive bladder
abnormal bladder contraction during the filling phase
[
2nd MC bladder dysfunction (nocturnal enuresis is #1)
main symtom= URGENCY
girl with h/o never gaining urinary control prob has ___
ectopic ureter
anatomic cause of dysfunctional voiding
duplex collecting system
t/f boys with ectopic ureter is always proximal to the external urethral sphincter
TRUE
this is why males w ectopic ureter dont present with incontinence
posterior urethral valves (PUV)
obstructing membranous folds within the lumen of the posterior urethra
obstructs bladder outlet
results from disruptions in male embryologic urethral development
MC cause of chronic renal dz d/t urinary tract obstruction
how are PUVs diagnosed?
prenatal US
as kids: UTI
- presumptive diagnosis w VCUG, confirmation by cystoscopy
PUV can lead to ___-
vesicoureteral reflux
vesicoureteral reflux
voiding against closed sphincter increases bladder pressure
what does a urinalysis measure?
leaukocyte esterase (from neutrophils)
nitrites (gram-neg bacteria)
both can be detected by color change on dipstick test
what test is used to definitively diagnose UTI?
urine culture
what is the test of choice to establish vesicoureteral reflux
VCUG
- voiding cystourethrogram/ renal scintigraphy
involved catheterization to fill the bladder with a radioopaque or radioactive liquid and recoridng images during voiding
