Urology / Renal Flashcards
Increased risk of cryptorchidism
Premature infants
Low birth weight
70% of cryptorchidism will:
Descend spontaneously
Complications of cryptorchidism
- Testicular cancer in both affected and unaffected testicle
- Infertility
- Testicular torsion
- Inguinal hernias
Management of cryptorchidism
- Orchiopexy - before 1 y/o
- Observation if < 6 months
- hCG or GNRH
- Orchiectomy if found later in life
Most cryptorchidism will descend by:
Rarely spontaneously descend after:
3 months
6 months
Most common cause of painless scrotal swelling
Hydrocele
Congenital hydrocele in infants usually close by ___________ and may not require treatment
1 year
A communicating hydrocele will be worse with:
Valsalva
Management of hydroceles
- Usually no tx needed
2. Surgical repair if persists after 1 year
Inability to retract foreskin over the glans
Phimosis
Management of phimosis
Not emergent
Circumcision
Foreskin becomes trapped behind corona of glans and forms right band, constricting penile tissues
Paraphimosis
Management of paraphimosis
- Manual Reduction: reduce edema with cool compresses or pressure dressing then gentle pressure
- Pharmacologic therapy: granulated sugar, injection of hyaluronidase
- Incision - dorsal slit
Spermatic cord twists and cuts off testicular blood supply due to congenital malformation which allows the testicle to be free floating in the tunica vaginalis causing it to twist on itself
Testicular torsion
If nausea/vomiting present in the setting of abrupt onset of scrotal or inguinal pain, suspect:
Torsion
Usually absent in epididymitis
Physical exam signs for testicular torsion
Negative Prehn’s sign
Negative cremasteric reflex
Blue dot sign at upper pole
Bell clapper deformity
Pain relief of scrotal elevation
Prehn’s sign
Diagnosis of testicular torsion
- Testicular doppler ultrasound - best initial
- Emergency surgical exploration require if US unable to exclude
- Radionuclide scan (not used frequently)
Management of testicular torsion
- Detorsion and orchiopexy within 6 hours and in obvious cases (testicle fixation in scrotum)
- Orchiectomy if testicle not salvageable
Distinct episodes of urinary incontinence while sleeping in children > 5 y/o in the absence of symptoms of infection
Enuresis
Management of enuresis
- Behavioral
- Enuresis alarm
- Desmopressin DDAVP (may cause hyponatremia)
- Tricyclic antidepressants
Abnormal urethral placement (proximal and ventral)
Hypospadias
Abnormal foreskin resulting in an incomplete closure around the glans leading to the appearance of a dorsal hooded prepuce, abnormal penile curvature
Hypospadias
Management of hypospadias
Urology referral and surgical correction
Due to incompetent or inadequate closure of the ureterovesical junction (UVJ) that contains a segment of the ureter within the bladder wall (intravesical ureter)
Vesicoureteral Reflux
Diagnosis of vesicoureteral reflux
- Contrast voiding cystourethrogram
- Radionuclide cystogram
- UA, serum creatinine, renal imaging
Management of vesicoureteral reflux
Spontaneous resolution
Complications of vesicoureteral reflux
Loss of renal parenchyma
May lead to decreased renal function
Immunologic inflammation of the glomeruli causing protein and RBC leakage into the urine
Glomerulonephritis
HTN, hematuria (RBC casts), dependent edema (proteinuria), and azotemia (nitrogen in blood) are hallmarks
Glomerulonephritis
Types of glomerulonephritis
- IgA Nephropathy (Berger’s Dz)
- Post Infectious
- Membranoproliferative/Mesangiocapillary
- Rapidly progressive
- Goodpasture’s dz
- Vasculitis
Most common cause of acute glomulonephritis
IgA nephropathy (Berger’s)
Glomerulonephritis that often affects young males within days (24-48 hours) after URI or GI infection
IgA nephropathy
Diagnosis of IgA nephropathy
IgA mesangial deposits on immunostaining
Management of IgA nephropathy
ACEI +/- corticosteroids
Glomerulonephritis that is most common after GABHS
Post infectious
Glomerulonephritis that classically presents as a 2-14 y/o boy with facial edema up to 3 weeks after Strep with scanty, cola-colored urine (hematuria and oliguria)
Post infectious glomerulonephritis
Diagnosis of post infectious glomerulonephritis
Increased antistreptolysin (ASO) titers, low serum complement Biopsy: hypercellularity, increased monocytes/lymphocytes, immune humps
Management of post infectious glomerulonephritis
Supportive, +/- antibiotics
Glomerulonephritis due to SLE, viral hepatitis (HCV, HBV)
Membranoproliferative/mesangiocapillary glomerulonephritis
Glomerulonephritis associated with poor prognosis (progresses to end stage renal failure within weeks/months)
Rapidly progressive glomerulonephritis (RPGN)
Crescent formation on biopsy
Rapidly progressive glomerulonephritis
Due to collapse of crescent shape of Bowman’s capsule
Management of rapidly progressive glomerulonephritis
Corticosteroids + cyclophosphamide
Two types of glomerulonephritis that only present with RPGN:
Goodpasture’s disease
Vasculitis
Glomerulonephritis with + anti-GBM antibodies
Goodpasture’s disease
Diagnosis of goodpasture’s disease
LInear IgG deposits
Management of goodpasture’s disease
High dose corticosteroids + cyclophosphamide + plasmapheresis
Glomerulonephritis that is characterized by lack of immune deposits and + ANCA antibodies
Vasculitis
Can either have p-ANCA or C-ANCA
Diagnosis of glomerulonephritis
- Urinalysis
- Increased BUN, creatinine
- Renal biopsy gold standard
Risk factors for cystitis
Sexual intercourse
Spermicidal use
Pregnancy
Most common etiology for cystitis
E. coli
Staph
Enterococci for indwelling catheters
Dysuria, increased frequency, urgency, hematuria, suprapubic discomfort
Acute cystitis
Fever and tachycardia, back/flank pain, + CVAT, n/v
Pyelonephritis
Diagnosis of cystitis/pyelonephritis
- Urinalysis
- Dipstick
- Urine culture
If urinalysis shows WBC casts
Pyelonephritis
Management of cystitis
- Pyridium
- Nitrofurantoin, ciproflox, bactrim, fosfomycin
- Pregnant: amoxicillin, augmentin
Management of pyelonephritis
Fluoroquinolones IV or PO aminoglycosides
