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Pediatrics- Noelle > Urology > Flashcards

Urology Flashcards

1
Q

What gene causes sexual differentiation?

A

SRY gene

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2
Q

What needs to be functional for testosterone to become DHT

A

5 alpha reductase

Critical for normal male: DHT

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3
Q

What are the two most common forms of disorders of sexual development?

A

46 XX CAH- 95% have 21 hydroxylase enzyme deficiency

45X/46XY mixed gonadal dysgenesis

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4
Q

What do Leydig cells produce

A

Testosterone

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5
Q

What do Sertoli cells produce?

A

anti mullerian hormone

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6
Q

Name the 3 defects seen with hypospadias

A

Foreskin is incomplete ventrally
Urethral meatus not at tip of penis
Erections curved downward (AKA chordee)

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7
Q

Congenital hydronephrosis affects what percentage of pregnancies?

A

CH affects 1% of pregnancies (most common fetal anomaly)
no correlation between severity of congenital hydronephrosis and risk of VUR
positive correlation between severity of congenital hydronephrosis and risk of obstruction

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8
Q

What are the 4 most common causes of high grade congenital hydronephrosis?

A

PUV- posterior urethral valves
UVJO- ureterovesical junction obstruction
UPJO- ureteropelvic junction obstruction
High grade VUR

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9
Q

Congenital hydronephrosis and APD 7-10mm, when do they need ultrasound?

A

Within 1-3 months

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10
Q

Congenital hydronephrosis and APD >15mm, when do they need ultrasound?

A

Within 2 weeks

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11
Q

What are the signs of posterior urethral valves?

A 
Male
Keyhole sign
Distended, thick walled bladder
Bilateral hydronephrosis
Oligohydramnios
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12
Q

What are the recommendations for prevention of renal stones?

A

Increased fluid intake
Avoid excess salt intake
Normal calcium intake

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13
Q

Most common solid renal mass of infant <1 or antenatal?

A

congenital Mesoblastic nephroma- usually benign

Tx- complete surgical excision

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14
Q

Most common solid renal mass if >1

A

Wilms

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15
Q

Testicular torsion versus torsion of appendix testis

A 
Testicular torsion:
Pain: severe, sudden onset of severity
Nausea and vomiting: often
Testis position: +/-high riding
\+/- transverse lie
Testis tenderness: throughout
Cremasteric reflex: often absent
Blue dot sign: never

Torsion of appendix testis:
Pain: milk to severe, gradual onset
Nausea and vomiting: occasional
Testis position: normal
Testis tenderness: localized to upper pole
Cremasteric reflex: often present
Blue dot sign: rarely present but pathognomonic

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16
Q

Name 2 indications for VCUG

A

Assess for:

  1. VUR
  2. PUV
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17
Q

Name one disadvantage of Nuclear Cystogram

A

Does not assess for PUV

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18
Q

Which renal scan detects renal scarring?

A

DMSA- best for differential renal function

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19
Q

Mag3 lasix scan tells you what 2 things?

A

differential renal function
Obstruction
(kidney function and drainage)

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20
Q

Name 4 types of urodynamics

A
  1. Voiding calendar- two day home data collection of time and volume of voids. Provides urinary frequency and functional bladder capacity. Helpful to diagnose overactive bladder
  2. Post residual void- US bladder scanner. Assesses bladder emptying
  3. uroflowmetry (velocity curve of urinary system). Assesses for urethral obstruction.
  4. cystometry (invasive urodynamics)- assessment of relaxation/contraction of pelvic floor muscles during bladder filling and voiding. Assess for normal pelvic floor relaxation with voiding.
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21
Q

90% of urinary stones contain________ as a major constituent, and 60% are composed of _________

A

Nearly 90% of urinary stones contain calcium as a major constituent, and 60% are composed of calcium oxalate.

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22
Q

What do we use to treat kidney stones

A

Pain- NSAIDs
80-90% of stones <5mm will pass on their own
alpha adrenergic blocker (tamsulosin) may facilitate passage
Interventional treatment: reserved for large stones
lithotripsy
extracorpeal shock wave lithotripsy
percutaneous nephrostolithotomy

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23
Q

what are signs of low grade congenital hydronephrosis on ultrasound?

A 
minimal hydronephrosis
mild hydronephrosis
SFU grade 1 or 2
Calyces not dilated
APD <10mm
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24
Q

what are signs of high grade congenital hydronephrosis on ultrasound

A 
moderately severe hydronephrosis
severe hydronephrosis
dilated calyces
parenchymal thinning
SFU grade III or IV
APD >15mm
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25
Q

what is UPJO and how is it different from the other causes of significant CH

A

uretero-pelvic junction obstruction

significant hydronephrosis WITHOUT hydroureter

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26
Q

what is the postnatal management for suspected PUV (7)

A 
stabilize if respiratory issues
urgent postnatal RBUS
bladder decompression (catheter)
Serial serum creatinine levels
Confirmatory VCUG
consult nephrology (fluid, acid-base, electrolyte management)
consult urology (surgical management)
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27
Q

what is the main cause of acquired hydronephrosis? how does it present?

A

UPJ obstruction
presents with recurrent abdominal pain/flank pain
recurrent pyelonephritis
vomiting (+/- pain) after increased fluid intake

28
Q

what investigations would you do for UPJ obstruction

A

Initial: RBUS

If hydronephrosis then urology may confirm obstruction with diuretic renal scan

29
Q

what is the most common non-infectious cause of daytime incontinence?

A

idiopathic overactive bladder

30
Q

what are the treatment options for idiopathic overactive bladder?

A
  1. Treat constipation (diet/PEG 3350)
    Treat UTI
    observation is an option if not bothersome to family/child
    timed voiding (Every 1.5-2h)
  2. Anticholinergics (oxybutinin, tolteridine, solifenacin)
31
Q

what is a duplex kidney?

A

kidney with 2 renal pelvises

32
Q

what are patients with horseshoe kidney at risk of?

A

Increased risk of UPJO (only relevant if hydronephrosis)

33
Q

what is the first line investigation for renal stones?

A

renal ultrasound

34
Q

what investigation will most reliably identify small stones?

A 
CT KUB (if confirmation required after ultrasound)
but not first line
35
Q

what are some dietary measures for treating kidney stones?

A

increased fluid intake** (dilutes urine and prevents urinary solutes from crystallizing)
decrease sodium intake **
normal dietary calcium **
citrus juice contains citrate which is a urinary inhibitor of stone formation

36
Q

what is a hydrocele? how do you diagnose?

A

fluid around or adjacent to the testis
generally asymptomatic
diagnose with transillumination

37
Q

what is the risk associated with having a hydrocele? when should you refer?

A

risk is development of indirect hernia

allow up to age 18 months for resolution before referral

38
Q

why would you do an U/S for hydrocele (4)

A

to confirm scrotal testis (>6mo age)
to differentiate from inguinal hernia
to rule out testis tumor (adolescent age)
when it is associated with scrotal pain NYD

39
Q

what is the initial investigation for palpable abdominal mass?

A

abdominal ultrasound

- to differentiate solid from cystic masses

40
Q

what is the treatment for congenital mesoblastic nephroma?

A

complete surgical excision

41
Q

what 2 congenital syndromes are associated with wilm’s tumor

A

50% risk of wilms tumor with
Denys Drash
WAGR

42
Q

does the CPS recommend newborn male circumcision?

A

NO!

increased risk of STI transmission and penile cancer does not justify recommendaton of routine circumcision

43
Q

how can meatal stenosis be prevented following newborn circumcision?

A

apply petroleum jelly to the glans for up to 6 mo following circumcision

44
Q

what can be used to hasten retraction of foreskin and release adhesions?

A

topical steroids

45
Q

what are indications for surgical consultation for circumcision (4)

A

scarred phimosis
recurrent balanoposthitis
recurrent UTIs
delayed retraction of the foreskin >10 yo

46
Q

what investigation should be done after first febrile UTI? when should VCUG be considered?

A

RBUS

VCUG is reserved for those with an abnormal RBUS or if they have a 2nd febrile UTI

47
Q

what is VUR

A

retrograde flow of urine from the bladder to the kidneys

asymptomatic, low grade VUR does not require intervention

48
Q

what should you tell boys to do when collecting a midstream urine

A

retract retractable foreskins as contamination is very common

49
Q

what is cystitis

A

bacteruria resulting in local “bladder” symptoms only (voiding symptoms/suprapubic or lower back pain)

50
Q

what antibiotics should be used for prophylaxis for UTI

A

septra
nitrofurantoin
- used for no more than 3-6 months
- switch antimicrobials if urine culture shows resistant organism
- if urine shows resistance to both antibiotics then consider stopping prophylaxis rather than using broad spectrum antimicrobials

51
Q

DDx painful scrotal swelling (6)

A 
testicular torsion
incarcerated inguinal hernia
trauma
epididymitis
torsion of appendix testis
intermittent testicular torsion (torsion- detorsion)
52
Q

DDx painless scrotal mass (6)

A

tumor- firm
varicocele- bag of worms
noncommunicating hydrocele- fluid filled/transilluminates
spermatocele- localized cyst/transilluminates
reducible inguinal hernia
local insect bite

53
Q

what abnormality is associated with testicular torsion?

A

bell clapper deformity

54
Q

what are the most common testicular tumors

A

95% germ cell tumors- seminomas and non seminomas

55
Q

what is the most common malignant testicular germ cell tumor in prepubertal children

A

yolk sac tumor (high AFP)

although teratoma is more common

56
Q

what workup should be done for testicular tumor?

A

Ultrasound
Tumor markers (AFP, bHCG)
Chest x-ray
CT abdo, pelvis and chest for staging

57
Q

what is the treatment for testicular tumor

A

orchiectomy +/- RPLND (retroperitoneal lymph node dissection) +/- chemo, radiation

58
Q

what is testicular microlithiasis

A

uncommon condition where small clusters of calcium form in the testicles (seen on ultrasound)
- do not need further imaging but should be instructed in testicular self examination, exception = DSD

59
Q

what should be on the differential for an undescended testis?

A

retractile testis- most common!

60
Q

what is the most sensitive method for determining volume discrepancy between testes?

A

ultrasound

15-20% reduction in volume (hypotrophy) of a testis with varicocele is common

61
Q

what is the ideal time for repair of hypospadias?

A

between 6-12 months

62
Q

what is the treatment for primary phimosis

A

corticosteroid cream (betamethasone 0.1% for 6 weeks)

63
Q

what are some benefits of circumcision (4)

A

prevention of penile cancer
reduces UTI
reduces STI (HIV)
reduced balanitis, phimosis

64
Q

what are some complications of neonatal circumcision

A 
hemorrhage
wound infection
glans injury
urethrocutaneous fistula
inadvertent circumcision of neonate with hypospadias
65
Q

what is the treatment of testicular torsion

A

Treatment is prompt surgical exploration and detorsion.
If the testis is explored within 6 hr of torsion, up to 90% of the gonads survive.
Following detorsion, the testis is fixed in the scrotum with nonabsorbable sutures, termed scrotal orchiopexy, to prevent torsion in the future.
The contralateral testis should also be fixed

Pediatrics- Noelle (28 decks)

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