Urology

Question 1

What is the appearance of a hernia?

Answer 1

Groin swelling

Question 2

In which gender are hernias most common?

Answer 2

Boys

Question 3

What are most of the hernias in kids?

Answer 3

Indirect (i.e. they go through the deep inguinal ring)

Question 4

How do you manage hernias?

Answer 4

If <1y urgent repair (as 33% will incarnate), after 1y elective repair (as less likely to incarnate)

Question 5

What does incarnation of a hernia mean?

Answer 5

It becomes strangulated/obstructed

Question 6

What is the appearance of a hydrocele?

Answer 6

Bluish scrotal swelling that transilluminates

It is painless, but increases in size with crying, straining and is bigger in the evening due to gravity

Question 7

How do you manage hydrocele?

Answer 7

Conservative until 5y

Question 8

What is cryptorchidism?

Answer 8

Undescended testes

Testes that cannot be manipulated into the bottom half of the testes

Question 9

What are the different types of cryptorchidism?

Answer 9

True
Retractile - loose to pull down, sit there for a few s and spring back up (this is normal)
Ascending - cord from which testes dangles doesn’t grow relative to rest of body –> testes move up into abdomen
Ectopic - not where they should be, e.g. both on one side

Question 10

Why is it important that the testes are in the scrotum?

Answer 10

To maintain 34 degrees optimal temperature for spermatogenesis

Question 11

What are the indications for orchidoplexy?

Answer 11

Infertility - 1% loss/month UD
Malignancy (although probably due to being abnormal testes in first place) 
Trauma 
Torsion 
Cosmesis

Question 12

What is circumcision?

Answer 12

Removal of foreskin

Question 13

What are the indications for circumcision?

Answer 13

Absolute - balanitis Xerotica obliterans (white scarring of foreskin)

Relative - UTI (abnormal tract), religious, balanoprosthitis

Question 14

What are the disadvantages of circumcision?

Answer 14

Pain, complications (bleeding, urethral meatal stenosis, fistula, cosmetic)

Question 15

What are the reasons for acute scrotum?

Answer 15

Testicular torsion, torsion appendix testis (blue dot), epididymitis, trauma, haematocele, incarcerated inguinal hernia

Question 16

What is management of acute scrotum?

Answer 16

If in doubt - explore

Question 17

How long will it take a testis to die after in torts?

Answer 17

6-8h

Question 18

Why is it important to investigate UTIs?

Answer 18

To prevent renal scarring which may lead to reflux nephropathy, chronic renal failure and HTN

Question 19

When should you investigate UTIs?

Answer 19

If under 6m, recurrent or atypical (e.g. pyelonephritis with sepsis or klebsiella)

Question 20

Define UTI?

Answer 20

Pure growth bacteria >10^5 + pyuria + systemic symptoms (fever, nausea)

Question 21

How do you assess UTIs?

Answer 21

Hx/Ex - constipation, voiding habits
USS - kidney no, size, location, shape, hydronephrosis
MAG3 (function, reflux, drainage)
DMSA (scarring, function)
MCGU - catheterise, insert dye, watch for reflux, v unpleasant

Question 22

How do you manage UTIs?

Answer 22

Voiding advice, Rx constipation, trimethoprime (2mg/kg nocte), STING (mild-mod), ureteric re-implantation (big op)

Question 23

What are hypospadias?

Answer 23

Urethral meatus on ventral aspect of penis (can be ant, mid, posterior) May be assoc with ambigious genitalia,

Question 24

How do you investigate hypospadias?

Answer 24

USS if severe

Question 25

What is important to remember in hypospadias?

Answer 25

DO NOT CIRCUMCISE