Pediatric Urology

Question 1

Nearly all urologic concerns in children are the result of what?

Answer 1

Congenital anomalies of the renal, ureteral, or urethral tracts

Question 2

What public health problem is leading to an increased incidence of nephrolithiasis in children?

What type of stones are most common in pediatric patients?

Answer 2

Childhood Obesity

Calcium oxalate or calcium phosphate

Question 3

What are some predisposing factors or concurrent diagnoses lead to kidney stones?

Answer 3

• Lesch-Nyhan Syndrome
• Recurrent UTI’s (struvite stones)
• Paralysis/Immobolization (such as spina bifida)

Question 4

What is the treatment of nephrolithiasis in children?

Answer 4

• Treat underlying problem or disease
• Optimize hydration
• Surgical removal can be performed

Question 5

How is Vesico-Ureteral Reflux (VUR) diagnosed?

Answer 5

VCUG (voiding cystourethrogram)

Question 6

Are UTI’s normal in infants?

Answer 6

No, a renal ultrasound should be done in all infants after a first febrile UTI to screen for congenital abnormalities

Question 7

What is the treatment for VUR Grade I-III?

What is the treatment for VUR Grade IV-V?

Answer 7

Low grade VUR often resolve spontaneously over time

Prophylactic antibiotics (Bactrim or Nitrofurantoin)

Severe reflux may require surgical repair

Question 8

What can reduce the risk of UTI’s in boys?

Answer 8

Circumcision

Question 9

What is the most common pathogen of pediatric UTI’s?

Answer 9

• **E.Coli **
• Klebsiella
• Proteus
• Gram Negative and some Enercoccocus

Question 10

What is the presentation of UTI in newborns or infants?

Answer 10

• Fever or Hypothermia
• Poor feeding
• Irritability
• Failure to thrive
• Vomiting
• May note foul smelling urine

Question 11

What is the presentation of UTI’s in school aged children?

What about preschoolers?

Answer 11

• More classic s/sx of cystitis or pyelonephritis

Abdominal or flank pain, vomiting, fever, dysuria

Question 12

What are the antibiotic treatments for UTI?

What is the duration of treatment?

Answer 12

• Amoxicillin
• TMP-SMX
• 1st Generation Cephalosporin

7-10 days, no short treatments

Question 13

What is enuresis?

What are the types?

Is it more common in males or females?

Answer 13

Repeated spontaneous voiding of urine during sleep, child > 5 years old

Primary and Secondary enuresis

Males

Question 14

Is there a strong genetic association of primary nocturnal enuresis?

Answer 14

Yes!!

Question 15

Why is enuresis more common in sickle cell patients?

Answer 15

They are unable to concentrate their urine well due to scaring and they are also encouraged to drink a lot of fluids to prevent pain crises

Question 16

What are some pharmacologic treatments for enuresis?

How old must the child be to start therapy?

Answer 16

• Desmopressin and imipramine (DDAVP)
• Anticholinergics (second line)

Age 7 or older

Question 17

Do you want to circumcise an infant with suspected hypospadias?

Answer 17

No, the reconstruction typically uses the foreskin so want to preserve until surgery

Question 18

Can phimosis be physiologic?

Answer 18

Yes, normal finding in newborns

Question 19

What are distinguishing features of a pathologic phimosis from physiologic?

Answer 19

• History of cracking and bleeding with retraction
• Indurated, scarred, whitened skin at tip of prepuce
• Narrowest part is most distal
• Painful erections

Question 20

What is the first line treatment of paraphimosis in kids?

Answer 20

Compression of edema and replacement of foreskin

Question 21

What is the diagnosis of cryptorchidism?

What is the treatment?

What is the risk with cryptorchidism?

Answer 21

Diagnosis by examination, sometimes US or laparoscopy

Surgical orchiopexy

Testicular cancer and infertility

Question 22

What is the first line treatment of testicular torsion in kids?

How is testicular torsion confirmed?

Answer 22

Immediate manual detorsion followed by surgical intervention

Doppler ultrasonagraphy

Question 23

What deformity predisposes testis to twisting?

Answer 23

Bell-clapper deformity: anomalous development of tunica vaginalis and spermatic cord

Question 24

What reflex is usually absent in testicular torsion?

When may you see “Blue dot sign”

Answer 24

Cremasteric reflex

Infarcted are is blue in testicular torsion

Question 25

What way should you manually detorse the testes?

Answer 25

Testes usually rotate inward, detorsion is rotation in outward direction (like opening a book)

Question 26

What co-occuring infection typically presents with orchitis?

Answer 26

Mumps

Question 27

What is the treatment for orchitis?

Answer 27

Supportive care if viral or after mumps infection: truly supportive care (elevate scrotum)

Abx is only used if infection is confirmed to be bacterial

Question 28

What is the treatment for penile adhesions?

Answer 28

• Steroid cream
• Vaseline
• Watch and wait
• Surgical lysis of adhesions (uncommon)

Question 29

What is the thought behind the cuase of labial adhesions?

Can they spontaneously resolve?

Answer 29

Low estrogen state and then possibly irritation resulting in re-epitheliazation

Yes

Question 30

If labial adhesions do not resolve spontaneously, what are some treatment options?

Answer 30

• Topical estrogen
• Vaseline