Urology Flashcards
What is the difference between primary and secondary enuresis?
Primary - the child has never been dry
Secondary - the child has previously been dry and is now not continent
When would be expect the child to become continent of urine?
3-5 years
What are some likely causes of enuresis?
Lack of attention to bladder stimulation - behavioural Detrusor instability Bladder neck weakness Neuropathic bladder (irregular, thick walls - associated with spina bifida), Distension at presentation, abnormal perineal sensation, anal tone and sensory loss UTI Diabetes Constipation Ectopic urethra causing dribbling
How should we investigate a child with enuresis?
Urine dip (UTI, nitrites, leucocytes, glucose, ketones)
Assess concentrating ability - osmolality on early morning sample
USS of the renal tract
What % of 5 and 10 year olds are not dry by night and who is it more common in?
6% 5yos and 3% 10yos not dry by night. This problem is twice as common in boys and esp those who have a first degree relative who struggled with enuresis (always ask)
What are some common causes of secondary enuresis?
Diabetes
Emotional upset (abuse, bereavement)
UTI
What are some organic causes of enuresis?
UTI
Constipatio + fecal impaction - can press on bladder and limit its capacity
How should enuresis be managed?
Counselling really important - tell parents there is no quick fix and might take time.
- ADVICE - plenty of fluids during day but then none 90mins before bed. Encourage to sit on loo just before bed (no caffeine, energy drinks)
- Start charts
- Enuresis alarm - explain how to use
- Desmopressin can be used for short term relief e.g. sleep overs or holidays
How does the occurrence of UTIs change over a child’s life and what problems might UTIs in childhood expose you to?
More common as the child gets older (any UTI in <6m should warrant investigation)
UTIs can spread to upper tract and cause pyelonephritis and scarring of the kidneys - this can expose to HTN and CKD later in life
Who should have their urine tested for infection? How is this done
ALL children with unexplained fever
Can be done with a dip but this can be hard - in young children you can attach a bag within their nappy to collect urine and then dip this
How would an infant with a urine infection present?
NON-SPECIFIC Fever Vomiting Lethargy or irritability Poor feeding/FTT Jaundice (UTI can cause jaundice in neonate) Septicaemia Offensive urine Febrile convulsions
How will older children present with a UTI?
More classical symptoms Dysuria Lower abdo pain Frequency Fever Lethargy, anorexia Haematuria Offensive, cloudy urine Enuresis
If nitrites and leucocytes are both positive on dip what does this suggest?
Confirms infection
If nitrites are positive and leucocytes are negative what does this suggest?
Could possibly be infection - send for microscopy
If the leucocytes are positive and the nitrites are negative on dip what does this suggest?
Infection still possible - urine might not have been in bladder for long enough to have nitrites (this is why early morning samples are best
Send for microscopy
What are the most common organisms causing UTI in childhood?
In nearly all it is the bowel flora (E.coli and klebsiella proteus)
In the newborn the most common method of spread is haematogenous
How should children <3m old be managed if they have a UTI?
Refer to paediatrics for urinalysis, abx, and KUBUSS within 6 weeks
How should a child older than 3m with UTI be managed?
3 day courses trimethoprim, nitrofurantoin or amoxicillin
7-10 day course if pyelonephritis
Encourage good fluid intake and safety net
