Urogenital Development

Question 1

What is this describing?

Collection of peritoneal fluid in the scrotum which enters through a patent processus vaginalis (5% of newborn boys).

Answer 1

Hydrocele

Question 2

What is this a presentation of?
Painless fluctuant scrotal swelling, can be uni/bilateral, non-tender, irreducible, transilluminates, can ‘get above it’.

Answer 2

Hydrocele

Question 3

What is the management of hydrocele?

Answer 3

1. Most resolve within a few months (observe in <2 year olds).
2. If it persists beyond age 2 - surgical repair (communicating hydrocele)
3. Excellent prognosis, rarely recur.
4. In adolescents - most commonly idiopathic and non-communicating - observe/surgery

Question 4

What is this describing?
One/both testes not palpable in scrotum (80% unilateral), usually resulting from failure of normal descent of testes during third trimester.

Answer 4

Cryptorchidism (undescended testes)

Question 5

What is the management for cryptorchidism?

Answer 5

1. Initially conservative, most descend spontaneously, refer by 6 months if not.
2. If not fully descending by 1 year, orchidopexy (reposition and fixate) due to risk of infertility and malignancy.

Question 6

What is renal agenesis?

Answer 6

Failure to develop one or both kidneys.

Question 7

What are the clinical features of renal agenesis?

Answer 7

Oligohydramnios, pulmonary hypoplasia

Question 8

How is renal agenesis diagnosed?

Answer 8

Prenatal USS

Question 9

What is the management for renal agenesis?

Answer 9

1. Bilateral - poor prognosis, death due to respiratory insufficiency.
2. Unilateral - normal life, monitor kidney growth and function and blood pressure.

Question 10

What are duplex kidneys?

Answer 10

Normal anatomical variant, duplication of pelvicalyceal and ureteric systems.

Question 11

What are the clinical features of duplex kidneys?

Answer 11

1. Asymptomatic, incidental finding

2. Recurrent UTIs - prone to hydronephrosis and vesicoureteric reflux

Question 12

How are duplex kidneys diagnosed?

Answer 12

Renal USS

Question 13

What is the management of duplex kidneys?

Answer 13

1. No management if asymptomatic

2. Children with recurrent UTIs - prophylactic antibiotics

Question 14

Where is a horseshoe kidney normally found and why?

Answer 14

1. Pelvis

2. Iliac vessels prevent upwards migration during foetal development

Question 15

What are the clinical features of a horseshoe kidney?

Answer 15

1. Many are asymptomatic

2. Obstructive uropathy, renal infections

Question 16

How is a horseshoe kidney diagnosed?

Answer 16

Renal USS showing that kidneys are too medial and lower pole is too long.

Question 17

What is this describing?

Dilation of the renal collecting system as a consequence of blockage/reflux at positions along the urinary tract.

Answer 17

Hydronephrosis

Question 18

What are the causes of hydronephrosis?

Answer 18

1. Obstruction at pelviureteric junction/VUJ or bladder neck

2. Reflux at the VUJ

Question 19

What are the clinical features of hydronephrosis?

Answer 19

Usually asymptomatic

Question 20

How is hydronephrosis diagnosed?

Answer 20

1. Identified on antenatal USS or USS for recurrent UTIs

2. Determine underlying cause by micturating cystourethrography

Question 21

What are posterior urethral valves?

Answer 21

Congenital abnormality where a membrane develops in the posterior neck of the urethra in the region of the prostate, obstructing the flow of urine from the bladder.

Question 22

Which gender is more affected by posterior urethral valves?

Answer 22

Males, females are not affected.

Question 23

What is this a presentation of?
Dribbling of urine and poor urinary stream, enlarged bladder, bilateral hydronephrosis secondary to obstruction and reflux, recurrent UTIs.

Answer 23

Posterior urethral valves

Question 24

How are posterior urethral valves diagnosed?

Answer 24

USS scan, micturating cystourethrography

Question 25

What is the management for posterior urethral valves?

Answer 25

Catheter and surgical ablation of the valve

Question 26

What is this describing?
Backward flow of urine from the bladder into the ureters and towards the kidneys, dilation of the renal tract. Affects girls more commonly than boys, frequently familial.

Answer 26

Vesicoureteric reflux

Question 27

What causes vesicoureteric reflux?

Answer 27

Anatomical anomalies at the VUJ or secondary conditions (e.g. posterior urethral valves).

Question 28

What are the clinical features of vesicoureteric reflux?

Answer 28

1. Recurrent UTIs/pyelonephritis

2. Recurrent infections lead to scarring of kidney (reflux nephropathy)

Question 29

How is vesicoureteric reflux diagnosed?

Answer 29

1. Either detected following investigations for an antenatal diagnosis of hydronephrosis or following a UTI in an infant.
2. Severity of reflux graded (I-V)
3. Micturating cystourethrography

Question 30

What is the management for vesicoureteric reflux?

Answer 30

1. Prophylactic antibiotics (trimethoprim at night)
2. Most children grow out of problem
3. Surgery if recurring UTIs/severe reflux/scarred kidneys

Question 31

What is this describing?
Opening of the urethra is not in its usual position at the tip of the penis. It is located anywhere along the ventral aspect. Leads to a proximal displaced urethral meatus.

Answer 31

Hypospadias

Question 32

What are the clinical features of hypospadias?

Answer 32

1. 80% are mild - meatus at glans
2. 15% are on the shaft
3. 5% in scrotum/perineum

Question 33

What should be avoided in hypospadias and why?

Answer 33

1. Circumcision

2. Foreskin may be required for corrective surgery