Urology Flashcards
How can paediatric urology problems present systemically?
- Fever, vomiting
- Failure to thrive
- Anaemia
- Hypertension
- Renal failure
How can paediatric urology problems present locally?
- Pain
- Changes in urine
- Abnormal voiding
- Mass
- Visible abnormalities
- Incidental
How can paediatric urology problems present antenatally?
- Seen on scan
- Foetus will be asymptomatic
- Permits immediate postnatal assessment
What is the epidemiology of inguinal hernias?
- 2% boys
- M:F 9:1
- 99% direct
- Increase with prematurity
- <1 year 33% incarcerate
How do inguinal hernias present?
GROIN swelling
How are inguinal hernias managed in the <1 years?
- URGENT referral by phone
- Repair: no place for observation
How are inguinal hernias managed in the >1 years?
Elective referral and repair
How are inguinal hernias treated in they are incarcerated?
Reduce and repair on same admission
How do hydroceles present?
- SCORAL swelling
- Painless
- Increases with crying, straining and in the evening
- Bluish colour
Who are hydroceles very common in?
New-borns
How are hydroceles managed?
Conservative until 5 years of age
What is cryptorchidism?
Any testis that cannot be manipulated into the bottom half of the scrotum
What are the types of cryptorchidism?
- True cryptorchidism
- Retractile
- Ectopic
- Ascending testes
Why are the testis located in the scrotum?
To keep the sperm cool for viability
What is the incidence of cryptorchidism?
- 0.8-1%
- Much more common in babies under 2kg
What are the indications for ochidopexy?
- Fertility preservation
- Malignancy prevention
- trauma
- Torsion
- Cosmetic
What is orchidopexy?
Fixation of testis into the scrotum
What is circumcision?
Removal of the foreskin
What are the absolute indications for circumcision?
Balanitis xerotica obliterans
What are the relative indications for circumcision?
- Balanoprosthitis
- Religious reasons
- UTI
What are the suggested advantages of circumcision?
- UTI prevention
- Malignancy prevention
- Sexual enhancement (increased nerve endings in prepuce)
- AIDS/STDs
- Overall no medical benefit
What are the disadvantages of circumcision?
- Painful
- Complications
- Looks different
What are the possible complications of circumcision?
- Bleeding
- Meatal stenosis
- Fistula
- Cosmetic
What is the differential diagnosis for the acute scrotum?
- Torsion testis
- Torsion appendix testis
- Epididymitis
- Trauma, haematocele, incarcerated inguinal hernia
If in doubt, explore the scrotum
How long are the testis viable in an acute scrotum?
6-8 hours
Why are UTIs investigated?
Prevent renal scarring
-Reflux nephropathy and CKD
Prevent hypertension
Who is investigated for UTI?
All 6/12, atypical and recurrent
How is a UTI defined?
Pure growth of >10^5 with pyuria and systemic upset
Mixed growth bacteria with no pyuria or systemic upset is less significant
How are UTIs assessed?
History and examination
-FH, bowel habit, voiding dysfunction
Ultrasound scan
-Number, size, position, shape, hydronephrosis
Renography
- MAG3 - drainage, function, reflux
DMSA- function, scarring
Micturating cystourethrogram (MCUG)
How is VUR managed?
Conservative
-Voiding advice, constipation, fluids
Antibiotic prophylaxis
- ? Until age 4
- Trimethoprim (2mg/kg nocte)
STING
-Mild/moderate with symptoms
Ureteric reimplantation
What is hypospadias?
Urethral meatus on the ventral aspect of the penis
How is hypospadias classified?
- Anterior 50%
- Middle 30%
- Posterior 20%
What are the associated anomalies of hypospadias?
- Upper tract abnormalities
- Intersex
How is hypospadias investigated?
- Clinical examination
- US if severe
How is hypospadias managed?
DO NOT CIRCUMCISE
-One stage or 2 stage surgical procedure
