Urology/Renal Flashcards
What is the most common genitourinary defect in boys?
Cryptorchidism
Which side is more commonly affected in Cryptorchidism in infant boys?
Right side is more common
A mother is concerned about her infant boy with cryptorchidism. When do you tell her the testicle will most likely descend?
Within the first year of life
The majority descend within 3 months
When is surgery indicated for cryptorchidism?
- If the testes has not descended within a year
- An Orciopexy is performed
What are 2 sequelae of cryptorchidism?
- Increases risk of testicular cancer
2. infertility
What is a sequelae of a hydrocele?
incarcerated hernia
When is surgery for a hydrocele indicated?
If it is not resolved by 6 months
T or F: It is common to have some level of hydrocele at birth.
True
What does a “patent processes vaginalis” mean?
Means there is a communication between the abdominal cavity and the scrotum–allowing fluid to move between the two
How long do the testicles maintain an intra-abdominal position?
Until about 7-9 months gestation, at this time, they descend through the inguinal canal
Where does the processus vaginalis end?
In the scrotum
When the glans penis is strangulated by an inflamed foreskin that cannot be placed back, what is this called?
Paraphimosis: TRUE MEDICAL EMERGENCY
How do you manage paraphimosis?
- Place the penis is sugar water/sugar: acts like an osmotic to decrease swelling
- STAT consult to pedi urology for emergency circumcision
What is phimosis?
Narrowing of the prepuce orifice
A 4 year old boy with a narrowed prepuce orifice tells his mother he is in pain. –what is the appropriate management?
Topical Betamethasone cream BID for 6 weeks WITH a 6-8 week f/u
- 85% resolve with the steroid
- remaining 15% need a circumcision
A 12 y/o male is in the office with testicular pain. The patient is in so much pain he has omitted twice. On PE, you see an edematous and erythematous scrotum, with an absent cremasteric reflex on the side of the affected testicle. When examining the patient, you notice a high riding, horizontal testicle. What is the next appropriate step?
- Scrotal U/S + doppler
- Emergent orchiopexy by urology
How can you differentiate between a Testicular torsion and a torsion on the testicular appendix?
A torsion of the testicular appendix will have -a present cremasteric reflex
- a vertical lying testicle
- and the “blue dot” sign
What is the most common urologic complaint?
Enuresis
Are females or males more commonly affected by Diurnal enuresis?
Females are more affected
Are females or males more commonly affected by nocturnal bedwetting?
Males are more commonly affected
How much should a child be drinking?
1 oz/ 2lbs of body weight
What is dysfunctional elimination syndrome?
Urinary retention is ALWAYS coupled with constipation (until proven otherwise)
What is hypospadias?
Congenital disorder of the urethra where the urinary opening is not at the usual location on the head of the penis
What are the different classifications of hypospadias?
“Go Call Patty Sue!”
- Glanular
- Coronal mid shaft
- Penoscrotal
- Scrotal
What is hypospadias thought to result from what?
A failure of the urinary channel to completely tubularize to the end of the penis; the actual cause is unknown
What is the most common associated defect with hypospadias?
Cryptorchidism
A 3 month old male infant is brought in by his parents whose concern is their sons “spraying” urine stream. On PE, you notice a chordee. What is the most likely diagnosis?
Hypospadias
What is the management for hypospadias?
- surgical repair between 6-12 months of age
- hold off on circumscision
What are the Grades I and II of Vesicourethral Reflux?
Grade I: reflux into a non-dilated ureter
Grade II: reflux into the renal pelvis and calyces without dilatation
What are the Grades III and IV of Vesicourethral Reflux?
Grade III: Mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices
Grade IV: dilation of the renal pelvis and calyces with moderate urethral tortuosity
What is Grade V of Vesicourethral Reflux?
Gross dilation of the ureter, pelvis, and calyces; ureteral tortuosity; loss of papillary impressions
How do you diagnose Vesicourethral Reflux?
VCUG
How do you treat Vesicourethral Reflux?
- Main goal is to protect the kidneys*
- Prevent UTIs
- This may mean prophylactic abx in children too young to potty train
T or F: In pediatrics, a urine culture must always be obtained?
True
What is the difference between older children with cystitis and infants and young children?
- Infants and young children: fever without any other obvious source; no focal complaints
- older children: NO FEVER; may actually complain about suprepubic tenderness. fullness, dysuria, frequency and/hesitancy
If a child <3 has a UTI, what is the next appropriate step?
warrants a VCUG and renal U/S
If a child >3 has a UTI, what are some common etiologies?
- Poor hygiene during toiling
- Bubble baths
- Dysfunctional Elimination Syndrome*
What is the treatment for Cystitis?
Augmenting Bacterium However, due to resistance: Cefuroxime, Cephalexin, or Ceftriaxone can be used
< 1yr: child needs parenteral abx like Ceftrixone (maybe admission)
1-2 yrs: parenteral is still likely needed; IM Ceftriaxone can be given w/ parents consent w/o admission
> 3yrs: PO abx are adequate
In children > 3 yrs, what is the most common cause of cystitis?
DES
Best tx is prevention, encourage child to void every 2 hrs
What is your initial diagnosis based on the following:
- “very ill” appearing child
- fever higher than 102 degrees
- positive UA/cultures
Pyelonephritis
What test/study should you do to confirm your diagnosis?
- “very ill” appearing child
- fever higher than 102 degrees
- positive UA/cultures
CT is the gold standard
RUS is also useful with less radiation risk
What is the treatment for this patient?
- “very ill” appearing child
- fever higher than 102 degrees
- positive UA/cultures
- Augmentin
- Bacterium
However, due to resistance:
-Cefuroxime,
-Cephalexin,
or Ceftriaxone can be used
< 1yr: child needs parenteral abx like Ceftrixone
1-2 yrs: parenteral is still likely needed; IM Ceftriaxone can be given w/ parents consent w/o admission
> 3yrs: PO abx are adequate
*Admission is generally needed to ensure abx compliance!
