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
Signs + symptoms of overactive bladder
- No neurological anomales
- Frequency (>8 times per day)
- Urgency
- Urge incontinence
- Urine holding postures
- Small functional bladder capacity
- Commonly associated with recurrent cystitis
- Associated with constipation
First and second line treatment of overactive bladder
1) Timed voiding, treat constipation + UTIs
2) Anti-cholinergics
Types of ureteric duplication + associated risks
- Complete = ureters do not merge –> associated with UVJ obstruction + VUR
- Partial = ureters merge before entering the bladder
When to refer a patient with a duplex kidney?
If febrile UTI + UVJO + VUR
Most common example of a renal fusion anomaly
Horseshoe kidney
Conservative tx for renal stones
- Fluids
- Analgesics
- Alpha blockers (tamsulosin)
Prevention of Ca oxalate stones
- Increase fluids
- Normal dairy intake
- Decrease salt intake
- Add citrus to diet
First x2 steps in work of patient with ?renal stones
- RBUS
- If confirmatory needed: CT KUB
Types of hydrocele - characteristics of each
- Communicating = congenital defect, risk of indirect hernia
- Non-communicating = could be part of resolution of communicating, can be reactive (secondary to infection, tumor, inflammation, trauma)
When should you refer a communicating hydrocele?
If no resolution by 18 months
At what age would you consider referral for circumcision for non-retractile foreskin (aka physiological phimosis)?
> 10 years old
What to think about if non-retractile foreskin with thick/blanched skin?
Lichen sclerosis
Complication of circumcision that can be prevented by application of petroleum jelly
Meatal stenosis
What are x2 possible benefits of circumcision?
- Decreased STI transmission
- Decreased rate of penile cancer
What is the best management plan for VUR I-III which is identified following a single febrile UTI?
Observation alone
Dx if daytime urinary incontinence with leaks with increased abdo pressure
Stress incontinence
Dx if daytime urinary incontinence - with continuous leaking/dribbling
Ectopic ureter
Most common renal “solid” abdo mass for fetuses, neonates, and infants?
Congenital mesoblastic nephroma
50% risk of Wilms Tumor with what x2 syndromes?
- WAGR
- Denys Drash Syndromes
If you see blueberry muffin rashs what malignancy would this make you think of?
-Neuroblastoma skin mets
What do you think of with a midline mass in a newborn?
PUV
Best treatment for buried penis
Weight loss
