Urology Flashcards
What is the appearance of a hernia?
Groin swelling
In which gender are hernias most common?
Boys
What are most of the hernias in kids?
Indirect (i.e. they go through the deep inguinal ring)
How do you manage hernias?
If <1y urgent repair (as 33% will incarnate), after 1y elective repair (as less likely to incarnate)
What does incarnation of a hernia mean?
It becomes strangulated/obstructed
What is the appearance of a hydrocele?
Bluish scrotal swelling that transilluminates
It is painless, but increases in size with crying, straining and is bigger in the evening due to gravity
How do you manage hydrocele?
Conservative until 5y
What is cryptorchidism?
Undescended testes
Testes that cannot be manipulated into the bottom half of the testes
What are the different types of cryptorchidism?
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
Why is it important that the testes are in the scrotum?
To maintain 34 degrees optimal temperature for spermatogenesis
What are the indications for orchidoplexy?
Infertility - 1% loss/month UD Malignancy (although probably due to being abnormal testes in first place) Trauma Torsion Cosmesis
What is circumcision?
Removal of foreskin
What are the indications for circumcision?
Absolute - balanitis Xerotica obliterans (white scarring of foreskin)
Relative - UTI (abnormal tract), religious, balanoprosthitis
What are the disadvantages of circumcision?
Pain, complications (bleeding, urethral meatal stenosis, fistula, cosmetic)
What are the reasons for acute scrotum?
Testicular torsion, torsion appendix testis (blue dot), epididymitis, trauma, haematocele, incarcerated inguinal hernia
What is management of acute scrotum?
If in doubt - explore
How long will it take a testis to die after in torts?
6-8h
Why is it important to investigate UTIs?
To prevent renal scarring which may lead to reflux nephropathy, chronic renal failure and HTN
When should you investigate UTIs?
If under 6m, recurrent or atypical (e.g. pyelonephritis with sepsis or klebsiella)
Define UTI?
Pure growth bacteria >10^5 + pyuria + systemic symptoms (fever, nausea)
How do you assess UTIs?
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
How do you manage UTIs?
Voiding advice, Rx constipation, trimethoprime (2mg/kg nocte), STING (mild-mod), ureteric re-implantation (big op)
What are hypospadias?
Urethral meatus on ventral aspect of penis (can be ant, mid, posterior) May be assoc with ambigious genitalia,
How do you investigate hypospadias?
USS if severe
What is important to remember in hypospadias?
DO NOT CIRCUMCISE
