Urology Flashcards
At which grade VUR do you provide Abx prophylaxis against UTI?
Grade 4 and 5
Or urological anomaly
Discuss w/ urology or nephro
T or F: all febrile UTI < 2 should get prophylactic ABX.
False.
All < 2 = U/S
If Grade 4-5 VUR and starting Abx- what do you start? + for how long?
Septra (Trimethoprim/ Sulfamethoxazole)
OR nitrofurantoin
1/4-1/3 of daily total tx dose
Max 3-6 mon.
If abN persist then prophylaxis R/A at that time (as increased risk of resistance w/ time)
6 mon. old w/ gr 2 reflux on one side. What do you? Start Abx? Monthly urine studies? Repeat VCUG x 6 mo?
Repeat VCUG in 6 mo.
Child on prophylaxis (Septra) found to have organism resistant to Septra AND nitrofurantoin. What do you do? Switch Abx prophylaxis, d/c, monthly urine ?
D/C prophylaxis.
w/ consult w/ uro +/- nephro
- Broader Abx breed resistance
When do you do a VCUG in relationship to pt w/ UTI?
< 2
US findings suggest VUR, selective anomaly or obstructive uropathy
or < 2 y.o. but 2nd UTI!
What is VUR?
Vesicoureteral reflux
= retrograde flow of urine from bladder to ureter + kidney
Is paediatric VUR usually congenital or acquired?
Congenital.
1/3 of siblings have VUR too; but no longer screen!
what is primary VUR?
congenital incompetence of valvular mech of vesicoureteral junction
T or F: VUR often resolve or improve w/ growth?
True.
- mean age of resolution= 6y.o.
- higher grade, b/l, older = less likely to resolve
What is the optimal method of dx VUR?
VCUG
= radionuclide cystogram
Should siblings of kids with VUR have U/S or VCUG?
Royal College- we no longer screen for sibling VUR (30% risk).
American: do U/S
- if abnormalities in cortex, size, asymmetry, UTI = VCUG
List primary and secondary aetiologies for VUR?
Primary:
- valve incompetence (AD),
- malformation (ureteral duplication)
- Assoc. w/ UPJ obstruction
Secondary:
1. neuropathic bladder (i.e. myelomeningocele)
How do you treat VUR?
Observation
- timed voiding
- no constipation
- increase fluid
- bladder emptying
- look for UTI
Grade 4-5: prophylactic Abx
Sx option
5 mon. with UTI. 2 indications for prophylaxis. 2 indications for urology referral.
Prophylaxis and Referral=
- Grade 4 or 5 VUR
- abN kidney or urinary tract structure on US
- Recurrent UTI in < 2 y.o.
Way to detect renal scarring: IV pyelography, nuclear scan (DMSA), renal excretion scan (MAG-3), VCUG?
Renal nuclear scan (DMSA)
List 5 causes of antenatal hydronephrosis:
- Transient hydronephrosis
- Ureteropelvic junction obstruction (UPJ)
- VUR (Vesicoureteral reflux)
- Megaureter
- Multicystic dysplastic kidney (MCDK)
- Posterior Urethral valve (PUV)
Describe Prune Belly Syndrome
Rare
AR; not sex link but M>F
Neo: oligohydraminos, pul hypoplasia
GI: lax lg abdo w/ thin wall where can see loops
GU: kidney dysplasia, VUR, undescended testis
Triad:
Abdo muscle deficient + B/L cryptorchidism + GU anomalies (due to severe urethral obstruction)
Prognosis depend on pul hypoplasia + renal hypoplasia
High risk UTI
1/3= ESRD
Which is consistent with Prune Belly Syndrome:
- PUV
- Progression to ESRD
- Sex linked
- Polyhydraminos
progression to ESRD
- VUR common not PUV
- M dominant but AR NOT sex linked
- oligohydraminos and pul hypoplasia!
What is the triad in prune belly syndrome?
Abdo muscle deficient
+ GU anomalies (due to severe urethral obstruction)
+ B/L cryptorchidism
T or F: most undescended at birth complete descend within first 3-4 months?
True
Name one RF for cryptorchidism
Prematurity
-30% of prem M
When should you do Sx for Cryptorchidism?
< 2y.o.
Ideally < 1; Nelson’s say 9-15 months.
Refer congenital unilateral non palpable or palpable undescended testis:
4-12 months