Urology/renal Flashcards
Cryptorchidism
Testicle not in scrotum by 4 mo
Cryptorchidism tx
Most descend spontaneously by 3-4 mo
If not palpable or atrophic → exploratory surg at 6-12 mo
Orchioplexy at 6-12 mo ↓ risk of torsion and subfertility
tx for Cystitis
Admit for infants < 2 months, immunocompromised, vomiting, inability to tolerate orals, lack of outpatient f/u, and failure of outpatient therapy
Ages 2-13 year→ 2nd or 3rd generation cephalosporin, add amoxicillin if suspecting enterococcal infection
Age > 13→Septra or cephalosporin
First episode in uncomplicated female should be treated 5-7 days
Young children, male adolescents, and children with recurrent, febrile, or complicated cystitis should be treated for 7-14 days
Renal bladder US indicated for first febrile UTI in kids under 2 who did not have normal prenatal screening US, for kids of any age with recurrent UTIs, and kids of any age with UTI, poor growth, HTN, or FH of renal disease
VCUG indicated for evaluation of possible reflux in kids of any age with > 2 febrile UTIs
Length for tx for Cystitis
First episode in uncomplicated female should be treated 5-7 days
Young children, male adolescents, and children with recurrent, febrile, or complicated cystitis should be treated for 7-14 days
Tx for Enuresis
High rate of spontaneous resolution by 15 yo
Behavioral changes: regular voiding and emptying bladder before bedtime, no fluids after 6pm
Rewards for voiding before bedtime, working up to rewards for staying dry overnight
Enuresis alarms for wetting > twice per week
Desmopressin for children with nocturnal polyuria and normal bladder capacity who have failed alarm trials
Paraphimosis
Inability to return foreskin over the glans from a retracted position
May present w/ swelling and tenderness of penis and band of circumferential tissue
Paraphimosis tx
Pain control, ↓ local swelling, manually return the foreskin over the glans
Phimosis
Inability to retract the freskin over the glans penis
May balloon with urination
Phimosis tx
Reassurance and hygiene education
Most resolve spontaneously
Topical steroids and manual stretching loosen the phimotic ring
Circumcision
Hypospadias presentation
Two urethral openings with second blind ending at nrml position
Dorsal hooded prepuce
Abnrml penile curvature
Difficulty controlling urine direction
Hypospadias tx
No intervention or surgical repair at 6-18 mo depending on severity
Avoid circumcision bc foreskin is used later in surg
Vesicourethral reflux
Retrograde flow of urine from bladder to ureter and renal pelvis
Graded on scale of 1-5 depending on extent of dilation of ureter
Vesicourethral reflux w/u
VCUG during w/u for UTI
Prenatal US can show hydronephrosis and should get f/u US postnataly w/ wo w/p VCUG
Vesicourethral reflux tx
Goal is to prevent pyelonephritis and kidney inj
Watchful waiting, abx pphx, surgical correction
DMSA scans to determine renal fn
Medical and surg mgmt >2-3 yo
Surg if UTI not responsive to abx
Vesicourethral reflux complications
Predisposes to pylonephritis by facilitating transport of bacteria from bladder to upper urinary tract
Poststreptococcal Glomerulonephritis (PSGN) presentation
Occurs following GAS pharyngitis of skin infection (impetigo)
Edema, gross hematuria, HTN, +/- proteinuria
Poststreptococcal Glomerulonephritis (PSGN) tx
Supportive
Monitor for HTN and pulm edema→ Na and water restriction, loop diuretics if needed
Dialysis
Microscopic hematuria usually resolves in 3-6 mo
Proteinuria cis slower and cah still be present up to 10 yrs alter
Membranoproliferative Glomerulonephritis
Nephrotic sundrome, nephritic syndrome, microscopic hematuria +/- proteinuria
Membranoproliferative Glomerulonephritis tx
Treat underlying cause if present
Poor prognosis esp in pts w. nephrotic syndrome, ↑ CK, HTN or RPGN on renal bx → CKD
No definitive therapy but some pts respond to steroid
Membranoproliferative Glomerulonephritis w/u
Renal bx → tram track pattern
Serum complement levels often low
Testicular torsion presentation
Twisting of testicle on vascular pedicle
Acute pain, erythema and swelling of scrotum, N/V
Absent cremasteric reflex, testicle elevated ro lies horizontally
Testicular torsion w/u
Visualization in surg
Doppler US → ↓ or absent bloodflow, perigonadal fluid, Δ in gonadal location or size
Testicular torsion tx
Torsion is surgical emergency
Surg detorsion → fixation in scrotum (orchiopexy) or removal of testicle (orchiectomy)
Testicular torsion epi
MC in boys 12-18 yo
Can occur in utero and in neonates
