Urology Flashcards
What are some symptoms of UTI in infants?
Fever Vomiting Lethargy/irritability Poor feeding/faltering growth Jaundice Offensive-smelling urine Febrile seizure
What are some symptoms of UTI in children?
Dysuria, Frequency and Urgency Abdo pain/loin tenderness Fever +/- Rigors Lethargy and Anorexia Vomiting and Diarrhoea Haematuria Offensive-smelling urine Febrile seizure Bed wetting
How can a clean catch urine sample be obtained from infants?
Sample pot
In-and-out Catheter
Bag on Perineum once perineum has been cleaned
When must a urine sample from children be cultured?
Immediately or refridgerate to prevent contamination
Why are children pre-disposed to develop UTIs?
Bowel flora can easily enter the urethra
They may have incomplete bladder emptying
What are some of the common causative organisms of UTIs in children?
E. Coli
Pseudomonas
Strep. Faecalis
Which factors in children may lead to incomplete bladder emptying?
Infrequent voiding Vulvitis Incomplete micturition with residual volumes Obstruction from a loaded rectum Neuropathic bladder Vesicoureteric Reflux
What is Vesicoureteric Reflux?
Ureters are displaced laterally, meaning they enter the bladder directly. This can give severe reflux leading to renal pelvis dilatation and intra-renal reflux
What is the risk with prolonged Vesicoureteric reflux?
Can lead to intra-renal scarring giving CKD and HTN
At what age should all UTIs in children be investigated?
<6m of age
Which features of a UTI in children >6m suggest an atypical cause that warrants investigation?
Seriously ill Poor urine flow Abdominal/bladder mass Raised serum creatinine Failure to respond to suitable antibiotics within 48h Infection with atypical organism
What is some general advice parents can be given to reduce the risk of their child developing a UTI?
Stay hydrated Use potty more often - time sessions Empty the bladder completely - encourage double voiding Proper wiping - front to back Avoid constipation Avoid tight-fitting underwear No bubble baths
How should a confirmed UTI be managed in a child <3m?
Admit for Parental Abx, Microscopy and culture
How should a confirmed Upper UTI/Pyelonephritis be managed in a child >3m?
Cefalexin
Co-Amoxiclav
How should a Lower UTI be managed in a child >3m?
Trimethoprim
Nitrofurantoin
When do children commonly present with Nephrotic syndrome?
2-5y
What three features are usually found in Nephrotic Syndrome?
Hypoalbuminaemia
Proteinuria
Oedema
What are some causes of Nephrotic Syndrome in children?
Minimal Change Disease - Most common cause in children Focal Segmental Glomerulosclerosis HSP Diabetes Infection
How should Nephrotic Syndrome be managed?
High Dose Steroids - Prednisolone
Low salt diet
Diuretics for oedema
Albumin infusions if severe hypoalbuminaemia
What are some potential complications of Nephrotic Syndrome in children?
Hypovolaemia
Thrombosis
Infection
Acute/Chronic renal failure
What is Nocturnal Enuresis?
Bed wetting at night
What are some causes of Primary Nocturnal Enuresis in children?
Variation on normal development Overactive bladder Excess fluid intake prior to bedtime Failure to wake due to deep sleep Psychological distress
What is Primary Nocturnal Enuresis?
Child has never been dry at night
How can Primary Nocturnal Enuresis be managed?
Reassurance that it will resolve without treatment Reduce fluid intake in the evenings Pass urine before bed Avoid blame or shame, no punishment Treat any underlying cause Enuresis alarms Pharmacological treatment
What is Secondary Nocturnal Enuresis?
Child begins wetting the bed when they have been previously dry for at least 6m
What are some potential causes of Secondary Nocturnal Enuresis?
UTI Constipation T1DM New psychosocial problems Maltreatment
How should secondary nocturnal enuresis be managed?
Treat the underlying cause
What is an Enuresis Alarm?
A device that makes a noise at the first sign of bed wetting, waking the child and stopping them from urinating
Which medication can be used to reduce nocturnal enuresis?
Desmopressin - ADH analogue reducing volumes of urine
Which medication can be used to treat nocturnal enuresis due to an overactive bladder?
Oxybutinin - Anticholinergic that reduces contractility of the bladder
What is a Wilms tumour?
A specific tumour of the kidney found in children, usually under 5y
What are some symptoms a Wilms’ tumour may present with?
Abdominal pain Haematuria Lethargy Fever Hypertension Weight loss Parents notice the mass in the abdomen
How is a Wilms’ tumour diagnosed?
USS of the Abdo
CT/MRI
Biopsy of the tumour
How is a confirmed Wilms’ tumour managed?
Surgical excision of the tumour along with the affected kidney - Nephrectomy
What is a Posterior Urethral valve?
Tissue at the proximal end of the urethra causes obstruction of urine output. Occurs in newborn boys
How can a Posterior Urethral valve present?
Difficulty Urinating Weak urinary stream Chronic urinary retention Palpable bladder Recurrent UTIs Impaired kidney function
What are the possible consequences of a Posterior
Urethral Valve in utero?
Bilateral Hydronephrosis
Oligohydramnios
Pulmonary Hypoplasia
Which investigations are appropriate for a suspected Posterior Urethral valve?
Abdominal USS - Enlarged bladder and bilateral hydronephrosis
MCUG - Shows location of tissue and extent of reflux
Cystoscopy - Can be curative too
How is a confirmed Posterior Urethral valve managed?
Ablation via cystoscopy
