Urology Flashcards
What is the first investigation to do for congenital urinary obstruction?
US
What are the x2 functional assessments that can be done in the setting of urinary obstruction?
- DMSA
- MAG3 (gold standard)
What is the most common cause of congenital urinary obstruction?
UPJ
What x2 investigations do you do for PUV?
- US
- Voiding cystourethrography
What x2 complications from intra-uterine environment for neonates with PUV?
- pulmonary hypoplasia
- renal insufficiency
What is the concern for paraphimosis?
emergency because can lead to gangrene
Best timing for hypospadias correction
6-18 months
How to treat phimosis?
- Betamethasone cream 0.1% BID x2 weeks on then off x4 cycles, need to retract foreskin
- Circumcision
What APD measurement of the kidney would be consider “high grade” for congenital hydronephrosis?
> 15 mm
Most common cause of urinary obstruction in children
UPJ
What x2 things can VCUG detect?
- PUV (in males only)
- VUR
What is the important indication for renal scans that other imaging modalities cannot provide?
Differential renal function
Difference between DMSA vs MAG3
- Both provide functional information
- DMSA = renal scarring
- MAG3 = filtration + drainage
All grades of congenital hydronephrosis carry a 10-15% risk of what?
VUR
4 most common causes of high grade congenital hydronephrosis
- UPJ obstruction
- UVJ obstruction
- VUR
- PUV
What is the APD measurement in low grade congenital hydronephrosis?
<10mm
When should you do the first post-natal RBUS for (a) low grade vs (b) high grade congenital hydronephrosis?
(a) first 1-3 months
(b) first 2 weeks
Most common cause of acquired hydronephrosis
UPJ obstruction
Investigations for acquired hydronephrosis
- RBUS
- Diuretic renal scan (MAG3)
Typical presentation of acquired hydronephrosis
- Recurrent abdo pain + flank pain
- Recurrent pyelo
- Emesis/pain following increased fluid intake
Clues on prenatal US to suggest PUV
- Male
- Oligohydramnios
- Bilateral hydronephrosis
- Distended, thick-walled bladder
- Keyhole sign
Post-natal management if PUV
- Stabilize respiratory
- Decompress bladder
- Check Cr
- Urgent RBUS + confirmatory VCUG
- Consult nephro + urology
What is the most common non-infectious cause of daytime urinary incontinence?
Overactive bladder
What are x2 scary things you want to make sure are not present in setting of overactive bladder?
- Signs of spinal dysraphism / sacral agenesis (aka caudal regression syndrome)
- Bladder outlet from scarred phimosis or meatal stenosis
