Urology in kids (including UTI)

Question 1

Name 5 symptoms/signs of a UTI

Answer 1

Fever, irritability, poor feeding, vomiting, loin/abdo pain, increased frequency and dysuria

Question 2

Name 4 risk factors for a UTI

Answer 2

Age (higher in infancy)
Gender (female&raquo_space; male)
Uncircumcised (but only for first 3 months)
Vaginal intercourse
Vesico-ureteric or urethrovesicular reflux
Constipation

Question 3

Name 4 ways of diagnosing a UTI

Answer 3

Need a clean urine specimen to do urinanalysis/MCS on:

MSU (if they can void on request)
Clean catch method (if unable to void on request but generally well)
SPA (if unable to void on request and high index of suspicion)
Catheter sample (if SPA fails)

Question 4

Go through management of UTI

Answer 4

Antibiotics - usually Trimethoprim (oral), or IV gent and benpen if really severe (+ fluid resus if shocked)

Question 5

What is a Ddx of an infant with fever + bacteria in urine? Should you do any other tests except for urinanalysis/MCS on an infant presenting like this?

Answer 5

Might have asymptomatic bacteruria + infection elsewhere (like meningitis - should still do an LP if under 3 months)

Question 6

What are the 3 main congenital malformations of the urinary tract? Which is the most severe?

Answer 6

Posterior urethral valve - causes obstruction at level of bladder neck = hydronephrosis of both kidneys and ureters (worst!)
Ureterovesical junction obstruction - obstruction at point where ureter meets bladder = hydronephrosis of unilateral kidney and ureter
Pelviureteric junction obstruction - obstruction at point where ureter leaves renal pelvis = hydronephrosis of unilateral kidney (least severe)

Question 7

What is the biggest complication of a urological obstruction?

Answer 7

Chronic, recurrent infection

Question 8

Name 3 aspects of treating urological obstructions (depending on severity)

Answer 8

Antibiotic prophylaxis
Stents
Surgery