Urology/renal

Question 1

Cryptorchidism

Answer 1

Testicle not in scrotum by 4 mo

Question 2

Cryptorchidism tx

Answer 2

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

Question 3

tx for Cystitis

Answer 3

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

Question 4

Length for tx for Cystitis

Answer 4

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

Question 5

Tx for Enuresis

Answer 5

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

Question 6

Paraphimosis

Answer 6

Inability to return foreskin over the glans from a retracted position

May present w/ swelling and tenderness of penis and band of circumferential tissue

Question 7

Paraphimosis tx

Answer 7

Pain control, ↓ local swelling, manually return the foreskin over the glans

Question 8

Phimosis

Answer 8

Inability to retract the freskin over the glans penis

May balloon with urination

Question 9

Phimosis tx

Answer 9

Reassurance and hygiene education

Most resolve spontaneously

Topical steroids and manual stretching loosen the phimotic ring

Circumcision

Question 10

Hypospadias presentation

Answer 10

Two urethral openings with second blind ending at nrml position

Dorsal hooded prepuce

Abnrml penile curvature

Difficulty controlling urine direction

Question 11

Hypospadias tx

Answer 11

No intervention or surgical repair at 6-18 mo depending on severity

Avoid circumcision bc foreskin is used later in surg

Question 12

Vesicourethral reflux

Answer 12

Retrograde flow of urine from bladder to ureter and renal pelvis

Graded on scale of 1-5 depending on extent of dilation of ureter

Question 13

Vesicourethral reflux w/u

Answer 13

VCUG during w/u for UTI

Prenatal US can show hydronephrosis and should get f/u US postnataly w/ wo w/p VCUG

Question 14

Vesicourethral reflux tx

Answer 14

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

Question 15

Vesicourethral reflux complications

Answer 15

Predisposes to pylonephritis by facilitating transport of bacteria from bladder to upper urinary tract

Question 16

Poststreptococcal Glomerulonephritis (PSGN) presentation

Answer 16

Occurs following GAS pharyngitis of skin infection (impetigo)

Edema, gross hematuria, HTN, +/- proteinuria

Question 17

Poststreptococcal Glomerulonephritis (PSGN) tx

Answer 17

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

Question 18

Membranoproliferative Glomerulonephritis

Answer 18

Nephrotic sundrome, nephritic syndrome, microscopic hematuria +/- proteinuria

Question 19

Membranoproliferative Glomerulonephritis tx

Answer 19

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

Question 20

Membranoproliferative Glomerulonephritis w/u

Answer 20

Renal bx → tram track pattern

Serum complement levels often low

Question 21

Testicular torsion presentation

Answer 21

Twisting of testicle on vascular pedicle

Acute pain, erythema and swelling of scrotum, N/V

Absent cremasteric reflex, testicle elevated ro lies horizontally

Question 22

Testicular torsion w/u

Answer 22

Visualization in surg

Doppler US → ↓ or absent bloodflow, perigonadal fluid, Δ in gonadal location or size

Question 23

Testicular torsion tx

Answer 23

Torsion is surgical emergency

Surg detorsion → fixation in scrotum (orchiopexy) or removal of testicle (orchiectomy)

Question 24

Testicular torsion epi

Answer 24

MC in boys 12-18 yo

Can occur in utero and in neonates

Question 25

Hydrocele

Answer 25

Transilluminates on both sides of scrotum

Soft, NT

Tolerates feeds

Area of “swelling” typically involves only the scrotum

Question 26

Hydrocele tx

Answer 26

Elective repair as clinically indicated