Uro odds and ends

Question 1

Renal trauma grading

Answer 1

Grade 1: contusion or non-enlarging subcapsular haematoma, but no laceration

Grade 2: superficial laceration 1 cm, without extension into the renal pelvis or collecting system a day no extravasation of urine.

Grade 4: laceration extends into renal pelvis or urinary extravasation

Grade 5: shattered kidney, avulsion of renal hilum with devascularisation of kidney due to hilar injury.

Question 2

Management of renal trauma

Answer 2

NB‼️ INITIAL MANAGEMENT OF RENAL TRAUMA IS GENERALLY CONSERVATIVE

Conservative mx: hospital admission, strict bed rest, monitor vitals, serial abdo exams, monitor macro haematuria and antibiotics

Indications for 🚫 haemodynamic instability, renal artery thrombosis

Question 3

Hypospadias:

Embryology, classification, clinical features and treatment.

Answer 3

Congenital, abnormal opening of urethral meatus on ventral aspect of penis, dorsal foreskin hood (incompletely fused prepuce) and chordee.
Urethra 8-15 weeks needs DHT via conversion of testosterone by 5 Alfa reductase ➡️ ventral urethral groove with urethral fold on each side➡️ folds meet in midline from prox to distal➡️ tubular urethra. Glandular urethra forms when ectodermal cord grows through glans to meet with fused urethral folds

Classification
Distal(65%) glandular, coronal, distal penile
Middle(15%) mid penile shaft
Proximal(20%) prox penile shaft, peno-scrotal, perineal

Clinical features
Urethral opening on ventral side, dorsal hood, chordee, spraying of urinary stream, proximal hypospadias + UDT= must screen for intersex

Treatment
NO CIRCUMCISION
want to allow normal micturition in standing position & vaginal ejaculation
Orthoplasty for chordee, urethral reconstruction @2years (distal hypospadias might not need surgery)

Question 4

Simple renal cyst

Answer 4

Common over 40/50 years
Gen unilateral, containing yellow serous fluid

U/S round or oval lesion, smooth outline and no internal echoes, clear posterior shadow enhancement.

CT: same density as water. No enhancements after contrast injection. As cysts are avascular

Question 5

Complicated renal cyst

Answer 5

On u/s: internal echoes, septa or irregular outline

Ddx: RCC, Wilms tumor, renal TB, hyatid cyst, cortical abscess, haematoma, urinoma

Question 6

Adult polycystic kidney disease

Answer 6

Autosomal dominant, bilateral in 95%
Cysts enlarge and destroy renal parenchyma by pressure atrophy➡️ CRF
Kidneys can be very large, over 10kgs
Asso conditions: berry aneurysms, mitral valve prolapse, diverticulosis of colon, cysts in liver spleen and pancreas

Question 7

Adult polycystic kidney disease presentation and management

Answer 7

Symptoms gen 40-60 years
Flank pain, UTI, symptoms of RF, hypertension, anaemia and palpable renal masses.
U/S better than IVP. CT is most accurate

Management: hpt mx, CRF medical mx dialysis and renal transplant. nephrectomy for pain, recurrent UTI or prior to transplant if kidneys very large
Genetic counseling as kiddies have 50% chance of inheriting

Question 8

Hydrocele definition and classification

Answer 8

Collection of fluid between visceral and parietal layers of tunica vaginalis

Congenital: communicating(patent processes vaginalis) hydrocele of cord
Aquired: primary(most common) due to decreased fluid absorption rela to lymphatics, can follow surgery for inguinal hernia or varicocele
Secondary to acute epididymitis, testicular tumor or torsion, Scrotal trauma or filariasis

Question 9

Hydrocele mx and ddx for painless scrotal swelling

Answer 9

Communicating hydrocele gen closes by 1/2 years surgery if it persists
Primary: aspiration and sclerotherapy (sodium tetra sulphate) or surgery (hydrocelectomy)

Hydrocele, spermatocele/epididymal cyst, varicocele, chronic epididymitis, TB epididymitis