Urology š¤¢ Flashcards
What is the CLASSIC timeline of hemolytic uremic syndrome?
Prodrome with BLOODY diarrhea, vomiting, and abdominal pain
Followed by the classic TRIAD:
- Hemolytic anemia
- Thrombocytopenia
- Acute Kidney Injury
Which one requires emergency treatment:
Phimosis or Paraphimosis
Paraphimosis
What disease:
Throat, bloat, coke
Post infectious glomerulonephritis
Throat: happens after GAS pharyngitis
Bloat: edema (periorbital or peripheral)
Coke: urine looks like coke
What is this:
Inability to retract foreskin
Phimosis
If you suspect a UTI, what labs do you need to order?
Urinalysis
Culture and sensitivities
What will you see in the urinalysis of someone with post-infectious glomerulonephritis?
Cola colored
RBC too numerous to count
RBC Casts (PATHOGNOMIC for GN)
How do you treat Pathologic phimosis?
Stretching exercises (gently pulling it back QID)
Topical steroid
Circumcision (last resort)
Is a vesicoureteral reflux common?
Yes. 1% of newborns have it, and 30-45% of children with UTIs have it
What will you see in the Urinalysis if your patient has UTI?
Bacteriuria
Pyuria
Leukocyte esterase (from breakdown of WBC)
Nitrite (produced by G- rods)
What is this:
Abnormal penile curvature
Chordee
Is it really obvious when a child has a horseshoe kidney?
No, usually asymptomatic
Maybe they have pain, infection or obstruction
What is this:
āRetracted foreskin in an uncircumcised male that cannot be returned to its natural positionā
Paraphimosis
What is the most common renal malignancy in kids?
Wilms Tumor
(Risk increases if you have a horseshoe kidney_
Is red urine always hematuria?
No, it may be from eating beets, pyridium, or food dyes
A thorough history is KEY
How do you collect a urine specimen from a child who is NOT potty trained?
Catheterized specimen
Do NOT use a bag collection
What is chordee?
Abnormal penile curvature
How do you treat physiologic phimosis?
You donāt treat it
If your pt is struggling with nocturnal enuresis and he gets invited to a sleepover and is worried hell wet the bed, what is a good option?
DDAVP/Desmopressin
SHORT term
What is the classic tetrad of āImmunoglobulin A Vasculitis Henoch-Schonlein Purpura?ā
- Abdominal pain
- Maculopapular rash usu on legs
- Joint pain usu knees and ankles
- Renal involvement
What are some of the downsides to a Voiding Cystourethrogram?
Invasive
Radiation
Catheter
Cost
Discomfort
MANY cases of vesicoureteral reflux will go away on their own
What is the problem with using DDAVP/Desmopressin for nocturnal enuresis?
It is effective short term, but has a high relapse rate
What is the first line imaging study for following up in a UTI (in patients for whom it is indicated)
Renal and Bladder Ultrasound (RBUS)*****
What are you thinking:
Hereditary glomerulonephritis affecting collagen proteins in kidneys, eyes, and ears
Alport Syndrome
What is the range of grades for vesicoureteral reflux?
***
Grade 1(mild)-5(severe) **************
IMPORTANT
What are the benefits of circumcsion?
UTI less likely
Some STIs less likely
Penis cancer less likely
Inflammation/dermatoses less likely
What is the most common bacteria in UTI?
E. Coli 80% of the time
Others are klebsiella, proteus, enterococcus, Staph aureus
True or False:
Circumcision leads to sexual dissatisfaction and breast feeding failure
False
Though it is true that Babby may not BF for 24 hrs after the procedure
What is cryptorchidism?
The scrotum is missing a testicle and it hasnāt descended bony 4 moths of age
What might make you suspect that a child has a vesicoureteral reflux?
- seeing hydronephrosis on a prenatal ultrasound
- a child with a febrile UTI
Do AAP guidelines recommend routine screening UA in asymptomatic, healthy patients?
No
What are the 4 main characteristics of NephrOtic Syndrome?
- NephrOtic range prOteinuria
- HypOalbuminemia
- O shaped face (edema)
- Hyperlipidemia (dOnut blOOd)
If a child has had 1 febrile UTI, when should they get a voiding Cystourethrogram?
If they also have one of these:
- any anomaly on RBUS
- Temp >102.2 and pathogen other than E. coli
- poor growth
- HTN
In testicular torsion:
After _____ hours, the testis is 100% viable
After _____ hours, the testis is 20% viable
After ____ hours, the testis is 0% viable
4-6 hours=100%
12 hours= 20%
24 hours= 0%
What might cause foamy urine?
Proteinuria
What are the two types of circumcision ?
Gomco- a can opener?!? Seriously have no idea what this is about and Iām done looking at that picture
Plastibell-putting a tube around it and tying it tight until the tissue dies ?!?!?
How do you treat testicular torsion
Immediate urology consult
Surgical detorsion and fixation (orchiopexy) of BOTH testes so it doesnt happen again
If imaging is needed for evaluation of UTI, what is the first line study?
Renal and Bladder ultrasound (RBUS)
What is this:
āRetracted foreskin that cannot be returned top natural positionā
Paraphimosis
What are the causes of paraphimosis?
Forceful retraction
Infection
Inflammation
Procedures
Trauma
When retracting the foreskin, what should you do if you are met with any resistance
Stop
What is the test of choice to detect VUR (vesicoureteral reflux)
Voiding cystourethrogram (VCUG)
What is the most common type of renal fusion?
Horseshoe kidney
What are you thinking:
Proteinuria, hypoalbuminemia, edema, hyperlipidemia
NephrOtic syndrome
What is the most effective LONG term therapy for nocturnal enuresis?
Enuresis alarms
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What condition may accompany Hypospadias?
Chordee
What are you thinking:
Bloody diarrhea, hemolytic anemia, thrombocytopenia, AKI
Hemolytic uremic syndrome
Will the cremasteric reflex be intact in testicular torsion?
No
What is nocturnal enuresis?
Bedwetting in kids 5 or older
What is this:
āTorsion (twisting) of the spermatic cord due to a poorly anchored testicleā
Testicular Torsion
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If a child of any age has had 2 or more febrile UTIs, what imaging study needs to be done?
Voiding Cystourethrogram
What ages are males most likely to get testicular torsion?
Puberty (12-18 yrs) 90%
Neonatal period 10%
Cryptorchidism may increase the risk for what?
Testicular torsion
Subfertility
Testicular Cancer
What is the most common location for undescended testis?
Suprascrotal
What is a condition that may accompany Epispadias?
Bladder exstrophy- bladder sticks out of their abdomen!!!!!!!!
Does everyone agree on the best way to treat vesicureteral reflux?
No, there is controversy regarding the optimal management.
- watchful waiting
- low dose prophylactic antibiotics (most common)
- surgical correction (grades 4 or 5)
What is the difference between Epispadias and Hypospadias?
Epispadias- urethral opening is on dorsal side of penis
Hypospadias- urethra is on ventral side of penis
Is a horseshoe kidney the only problem a kid might have?
No, 33-50% of patients with horseshoes also have another urological or genital abnormality.
Also increased risk for a Wilms tumor
What is this:
āNuclear medicine scan using radioisotope dimercaptosuccinic acid (DMSA) to detect acute pyelonephritis and renal scarringā
Renal scintigraphy
What does the American Academy of Pediatrics say about circumcision?
Benefits outweigh the risks, but theyāre not great enough to recommend routine circumcision for all newborn boys.
The final decision should be left to the parents.
What lab tests need to be considered in a patient with cola colored urine and decreased renal function 2 weeks after a sore throat?
ASO (Antistreptolysin Ab) titer
Complement
What are the 5 possible reasons for cryptorchidism?
- Absent testis- they just donāt have one
- Undescended testis- stopped short along normal descent
- Retractile testes- overactive cremasteric reflex pull it back inside
- Ascending testis- ?
- Ectopic testis- lives somewhere else
What will you see in the blood results of someone with posit-infectious glomerulonephritis?
+ ASO (Antistreptolysin Ab) Titer ****
High creatinine
Low complement
What is the most common bacteria to cause UTI?
E. coli
What is Alport Syndrome?
An inherited disease caused by genetic mutations in collagen proteins
- glomerular disease
- deafness
- visual disturbances
What is the name of the surgery that is done when someone has testicular torsion?
Orchiopexy (detorsion and fixation)
What are the risks of circumcision?
Procedure related complications
Bleeding, infection, urethral complication, inadequate skin removal
What kinds of things can cause proteinuria?
Nephrotic syndrome***
Lupus
Diabetes
Glomerulonephritis
Benign- fever, hypovolemia, exercise
If your patient has costoverterbal tenderness, what diagnosis should you be thinking of?
UTI
Is it OK to forcibly retract the foreskin at any age?
No never
What is the confirmatory test of choice in testicular torsion?
Doppler US
What is this:
āRenal disease causing massive renal protein loss in urineā
NephrOtic syndrome
Will Prehnās sign be positive or negative in testicular torsion?
Negative
This is the test where elevating the scrotum relieves the pain. Works for epididymitis, but not testicular torsion
What is the second line treatment for nocturnal enuresis if educational and motivational therapy arenāt enough?
DDAVP/Desmopressin (synthetic ADH)
Is paraphimosis an emergency?
YES, possible ischemia and tissue death
Does the pain of testicular torsion come on suddenly or gradually?
SUDDENLY
What are the acute symptoms of post-infectious glomerulonephritis?
Cola-colored urine
Edema (kidneys not removing waste/fluid)
High BP
Renal insufficiency
How badly does testicular torsion hurt?
Constant pain so bad it makes them throw up
What is microscopic hematuria?
A urine sample that has >3 RBCs per hpf
??
What are the contraindications for circumcision ?
Unstable infant
Congenital penile anomalies (hypospadias, chordee)- you want the foreskin intact so the urologist can use that skin when making a surgical repair
How should you clean the foreskin?
Mild soap and water
Return to natural position after cleaning *******!!!
What are the management options for vesicoureteral reflux?
Surveillance
Prophylactic Abx
Surgery
What infection may occur 1-2 wks after infection with group A Ī²-hemolytic strep?
Post-infectious glomerulonephritis
What is the confirmatory test of choice to diagnose testicular torsion?
Doppler ultrasound
Will show you position of the testes and if there is blood flow
What is the difference between Physiologic Phimosis and Pathologic Phimosis?
Physiologic- normal state where the foreskin adheres to the glans. Baby was born this way and it will loosen up over time
Pathologic- canāt retract foreskin due to scarring/fibrosis secondary to infection or inflammation
What is it called when the urethra is displaced dorsally?
Epispadias
When a circumcision is done in a medical setting, is anesthesia used?
Yes
What is the most common cause of Pathologic phimosis?
A caregiver trying to FORCE the foreskin to retract which causes adhesions and scarring
Should we give antibiotics to patients with hemolytic uremic syndrome
No
What is the first line therapy for nocturnal enuresis?
Educational/motivational therapy:
Pee before bed
Donāt drink water right before bed
Sticker charts
Enuresis alarms
What kind of symptoms will a very young child with a UTI have?
NON specific
Fever may be only sx
Vomiting, irritability, poor appetite
What kinds of signs will older children have with a UTI?
Classic UTI symptoms:
Painful urination
Frequency
Urgency
Abdominal/back/flank pain
Suddenly wetting their pants
Why is testicular torsion a medical emergency?
Risk of vascular compromise
Is nocturnal enuresis common?
YES
15% of all 5 year olds do it
What is it called when the urethra is displaced ventrally?
Hypospadias
What is this:
āRetrograde flow of urine from the bladder into the upper urinary tract, usually due to inadequate closure of ureterovesicular junctionā
Vesicureteral Reflux (VUR)
What do you need to do if you discover that your patient has a horseshoe kidney?
Ultrasound
Serum creatinine
VCUG (if they have a UTI)
If their creatinine is normal and they have no hydronephrosis, you donāt have to do anything else. If they are, you need to more scans
How do you treat UTI?
3-10 days of abx. Start with empiric treatment then adjust according to C&S.
Empiric options:
Cephalosporin (Cephalexin/Cefdinir)
Amoxicillin-resistance increasing
Augmentin-resistance increasing
Bactrim-resistance increasing
How do you treat Immunoglobulin A Vasculitis Henoch-Schonlein Purpura?
Supportive care
Symptoms will spontaneously resolve
Should you do a follow up Urinalysis and C&S after treating a UTI?
No, donāt need to repeat it since you got a culture
How is paraphimosis treated?
Pain control
Timely, Manila reduction in office or ED
Surgical intervention
What is this:
The inability to retract the foreskinā
Phimosis
What should you do if your patientās UA was positive for MICROSCOPIC hematuria and theyāre otherwise asymptomatic?
Repeat the UA in 2-3 weeks.
3-4% of children will have small amounts of blood in their UA
Who needs a Renal and Bladder Ultrasound (RBUS) in their follow up after a UTI?
<2 yrs old with first febrile UTI
Recurrent UTI
FH of renal/urologic disease, poor growth, or HTN
Do not respond to antibiotic therapy
What should you do next if you diagnose a baby with hypospadias and/or chordee?
Check for palpable testes- make sure this isnāt a Disorder of Sexual Development
Refer to Urology
Do NOT circumcise them**
What bacteria is associated with hemolytic uremic syndrome?
Shiga toxin producing E. Coli
