Urology

Question 1

Short term complications of UTI

Answer 1

Sepsis, renal abscess, AKI

Question 2

Long term complications of UTI

Answer 2

Renal scarring, recurrent infection, impaired renal function, hypertension, ESRD, preeclampsia

Question 3

UTI testing in acutely ill children: age and appropriateness of testing

Answer 3

1) Any child on antibiltics already: test (for UTI)
2) < 3 months: test
3) 3 to 24 months: fever + high risk: test
4) > 24 months: girl/uncircumcised boy with sx: test

Question 4

Criteria to diagnose UTI in children

Answer 4

Pyuria (LE on UA or WBC on microscopy)

And

Significant bacterial growth on culture:

1) suprapubic aspiration: 10- 50,000 cfu
2) bladder catheterizatio: 1000 to 50,000 cfu
3) midstream clean catch: 10,000 to 100,000

Question 5

When to get KUB US and voiding cystourethrogram (VCU) in peds?

Answer 5

1) atypical UTI: KUB US—if abnormal— VCU
2) < 24 months first UTI: KUB US—if abnormal— VCU
3) < 24 months recurrent UTI: VCU
4) > 24 months recurrent UTI: KUB US—if abnormal— VCU

Question 6

Antibiotics in UTI peds: dosage and max

Amoxicillin/ Augmentin

Cefixime

Cefuroxime axetil

Cephalexin

Nitrofurantoin

Bactrim

Answer 6

Amoxicillin/ Augmentin:
25 to 50 mg/kg/day TID, max: 500 mg/dose

Cefixime
8 mg/kg/day Qday, max: 400 mg/dose

Cefuroxime axetil
20 to 30 mg/kg/day BID, max: 500 mg/dose

Cephalexin
50 to 100 mg/kg/day BID to QID, max: 500 mg/dose

Nitrofurantoin
5 to 7 mg/kg/day QID, max: 100 mg/dose

Bactrim < 24 months
6/30 to 12/60 mg/kg/day BID, max: 160 mg/dose (of TMP

Bactrim > 24 months
8/40 mg/kg/day BID, max: 160 mg/dose (of TMP)

Question 7

Chronic urinary retention

Answer 7

PVR volume greater than 300 ml on 2 separate occasions and lasting 6 months

Question 8

Suprapubic catheter advantage

Answer 8

Improve patient comfort
Decrease bacteriuria
Decrease need for catheterization for up to 14 days

silver alloy coated and abx impregnated catheters not advantageous

Question 9

Alpha blocker — catheter?

Answer 9

In urinary retention, initiate alpha blocker at time of catheter insertion or at least before removal— improve successful voiding trial

(After catheter insertion, continous void for 3 days then remove and voiding trial)

Question 10

MCC of urinary retention

Answer 10

BPH

Question 11

MCC (2) of iatrogenic urinary retention

Answer 11

Postop

• Risk with older age and prescence of UTI sx
• preop alpha blocker decreased risk

Meds:
Anticholinergics (MCC): block parasymp to detrusor- impair contractility

Alpha adrenergic: increase tone in prostate and bladder neck

CCB: reduce smooth muscle contractility in bladder

NSAIDS: inhibit prostaglandin synthesis- decrease detrusor contractility