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12. UroPed (1583) > EAU Pediatrics 2021 Rapid > Flashcards

EAU Pediatrics 2021 Rapid Flashcards

1
Q

Treatment for phimosis usually starts: ___

A

After two years of age or according to caregivers’ preference

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2
Q

Primary phimosis: conservative 1st line treatment with 80% success rate:

A

3rd generation corticoid ointment or cream

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3
Q

Offer ___ or ___ to treat primary symptomatic PHIMOSIS.

A

Corticoid ointment or cream

OR Circumcision

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4
Q

Treat primary phimosis in patients with ____.

A

recurrent urinary tract infection and/or with urinary tract abnormalities.

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5
Q

Circumcise phimotic patients in case of ___.

A

lichen sclerosus or scarred phimosis.

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6
Q

Treat paraphimosis by ___.

A

manual reposition and proceed to surgery if it fails.

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7
Q

Phimosis: Avoid retraction of ___.

A

asymptomatic preputial adhesions.

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8
Q

Classification of Undescended Testis

A

Palpable

  • Inguinal
  • Ectopic
  • Retractile

Non-palpable

  • Inguinal
  • Ectopic
  • Intraabdominal
  • Absent: (1) agenesis (2) vanishing
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9
Q

Unilateral NON-palpable testis –> EUA (always) –> PALPABLE

A

Standard orchidopexy

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10
Q

Unilateral NON-palpable testis –> EUA (always) –> NON-PALPABLE

A

Inguinal Exploration with possible lap

OR

Diagnostic Lap

  • Testis close to internal ring –> LAP or inguinal orchidopexy
  • Testis too high for orchidopexy –> Staged Fowler-Stephens procedure
  • Blind-ending spermatic vessels –> vanishing testis no further steps
  • Spermatic vessels enter inguinal ring –> inguinal exploration
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11
Q

An undescended testis justifies treatment early in life to ____.

A failed or delayed orchidopexy may increase ___.

The earlier the treatment, the ___.

A

avoid loss of spermatogenic potential.

the risk of testicular malignancy later in life.

lower the risk of impaired fertility and testicular cancer.

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12
Q

In unilateral undescended testis, fertility rate is ___ whereas paternity rate is ___.

A

fertility - reduced

paternity - NOT reduced

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13
Q

In bilateral undescended testes, fertility and paternity rates are ___

A

BOTH impaired.

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14
Q

The treatment of choice for undescended testis is ___.

There is no consensus on the use of ___.

A

surgical replacement in the scrotum.

hormonal treatment.

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15
Q

The palpable testis is usually treated surgically using ___.

A

an inguinal approach.

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16
Q

Do not offer ___ for retractile testes instead ___.

A

medical or surgical treatment

undertake close follow-up on a yearly basis until puberty.

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17
Q

Perform surgical orchidolysis and orchidopexy before the age of ___.

A

TWELVE months, and by EIGHTEEN months at the latest.

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18
Q

Evaluate male neonates with ___ for possible ____.

A

bilateral non-palpable testes

disorders of sex development.

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19
Q

Perform a ____ to locate an intra-abdominal testicle.

A

diagnostic laparoscopy

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20
Q

Hormonal therapy in unilateral undescended testes is ___ for future paternity.

A

of NO BENEFIT

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21
Q

Offer ___ treatment in case of bilateral undescended testes.

A

Endocrine treatment

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22
Q

Inform the patient/caregivers about the ___with an undescended testis in a post-pubertal boy or older and discuss ___.

A

increased risk of a later malignancy

removal in case of a contralateral normal testis in a scrotal position.

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23
Q

Testicular tumours in prepubertal boys have a ___.

A

lower incidence and a different histologic distribution 2a compared to the adolescent and adult patients.

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24
Q

In prepubertal boys up to 60-75% of testicular tumours are ___.

A

benign.

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25
Q

Testicular Tumors

___ should be performed to confirm the diagnosis.

A

High-resolution ultrasound (7.5 – 12.5 MHz), preferably a doppler ultrasound,

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26
Q

Testicular Tumors

___ should be determined in prepubertal boys with a testicular tumour before surgery.

A

Alpha-fetoprotein

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27
Q

Testicular Tumors

____, but not as an emergency operation.

A

Surgical exploration should be done with the option for frozen section

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28
Q

Testicular Tumors

Organ-preserving surgery should be performed in ___.

A

all benign tumours.

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29
Q

Testicular Tumors:

___ should only be performed in patients with a malignant tumour to exclude metastases.

A

Staging (MRI abdomen/CT chest)

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30
Q

Testicular Tumors:
___ should only be performed in patients with the potential malignant Leydig or Sertoli-cell-tumours to rule out lymph node enlargement.

A

Magnetic resonance imaging

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31
Q

Testicular Tumors:

Patients with a non-organ confined tumour should be ___.

A

Referred to paediatric oncologists post-operatively.

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32
Q

HYDROCELE
In the majority of infants, ___ is not indicated within the first twelve months due to the tendency for ___. Little risk is taken by initial observation as progression to hernia is rare.

A

surgical treatment of hydrocele

spontaneous resolution.

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33
Q

HYDROCELE

In the paediatric age group, an operation would generally involve ___

A

ligation of the patent processus vaginalis via inguinal incision.

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34
Q

HYDROCELE

In the majority of infants, ___ prior to considering surgical treatment.

A

observe hydrocele for twelve months

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35
Q

HYDROCELE

Perform early surgery if ___

A

there is suspicion of a concomitant inguinal hernia or underlying testicular pathology.

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36
Q

HYDROCELE

Perform a scrotal ultrasound in case of ___

A

doubt about the character of an intrascrotal mass.

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37
Q

HYDROCELE

Do not use ___ because of the risk for chemical peritonitis.

A

sclerosing agents

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38
Q

Child ≥ 5 years nocturnal enuresis

A 
Detailed questions for day-time symptoms
Physical exam and urinanalysis
2 days day-time voiding and drinking diary
2 weeks night-time urine production recording (= weight night-time diapers + morning first voided volume)
Upon indication • Urine
microscopy • Uroflow-
metry
• Ultrasound
• ENT referral • Psychologist
referral
 Supportive measures (not a treatment) (max 4 weeks) • Normaland regular drinking habits
• Regular voiding and bowel habits
• Monitor night-time production (weight diapers)
Child + caregivers seek a treatment
--Nocturnal enuresis wetting alarm treatment
with regular
follow-up
--desmopressin +/- anticholinergics

If no improvement (< 4 weeks) OR Lack of compliance +
Re-evaluate

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39
Q

Do not treat children ___ in whom spontaneous cure is likely.

A

less than five years of age

** inform the family about the involuntary nature, the high incidence of spontaneous resolution and the fact that punishment will not help to improve the condition.

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40
Q

Use___ to exclude day-time symptoms.

Perform a ___ to exclude the presence of infection or potential causes such as diabetes insipidus.

A

voiding diaries or questionnaires

urine test

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41
Q

Offer desmopressin +/- cholinergics in ___.

Offer ___ in motivated and compliant families

A

proven night-time polyuria: success rates of 70% can be obtained with desmopressin (DDAVP), either as tablets (200-400 μg), or as sublingual DDAVP oral lyophilisate

ALARM treatment: device that is activated by getting wet –> method of action is to repeat the awakening and therefore change the high arousal to a low arousal threshold when a status of full bladder is reached

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42
Q

Myelodysplasia

A

includes a group of developmental anomalies that result from defects in neural tube closure. Lesions include spina bifida aperta and occulta, meningocele, lipomyelomeningocele, or myelomeningocele. Myelomeningocele is by far the most common defect seen and the most detrimental.

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43
Q

MYELODYSPLASIA + NB: Neurogenic detrusor-sphincter dysfunction (NDSD) may result in ___

A

different forms of LUTD and 2a ultimately result in incontinence, UTIs, VUR, and renal scarring.

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44
Q

MYELODYSPLASIA + NB: In children, the most common cause of NDSD is ___

A

myelodysplasia (a group of developmental anomalies 2 that result from defects in neural tube closure).

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45
Q

MYELODYSPLASIA + NB: Bladder sphincter dysfunction correlates poorly with ___

A

the type and level of the spinal cord lesion. 2a Therefore, urodynamic and functional classifications are more practical in defining the extent of the pathology and in guiding treatment planning.

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46
Q

MYELODYSPLASIA + NB: Children with neurogenic bladder can have disturbances of ___

The main goals of treatment are ___

A

bowel function as well as urinary function 2a which require monitoring and, if needed, management.

prevention of urinary tract deterioration and achievement of 2a continence at an appropriate age.

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47
Q

MYELODYSPLASIA + NB: Injection of ____ in children who are refractory to anticholinergics, has been shown to have beneficial effects on clinical and urodynamic variables.

A

botulinum toxin into the detrusor muscle

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48
Q

MYELODYSPLASIA + NB: Urodynamic studies should be performed in ___ to estimate the risk for the upper urinary tract and to evaluate the function of the detrusor and the sphincter.

A

every patient with spina bifida as well as in every child with high suspicion of a neurogenic bladder

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49
Q

MYELODYSPLASIA + NB: In all newborns with myelodysplasia, intermittent catheterisation (IC) should be started ___

A

soon after birth.

*** In those with a clear underactive sphincter and no overactivity starting IC may be delayed. If IC is delayed, closely monitor babies for urinary tract infections, upper tract changes (US) and the lower tract (UD).

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50
Q

MYELODYSPLASIA + NB: Start early anticholinergic medication in the newborns with ___

A

suspicion of an overactive detrusor.

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51
Q

MYELODYSPLASIA + NB: The use of ____ is an alternative and a less invasive option in children who are refractory to anticholinergics in contrast to bladder augmentation.

A

suburothelial or intradetrusoral injection of onabotulinum toxin A

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52
Q

MYELODYSPLASIA + NB: Treatment of faecal incontinence is important ___. Treatment should be started with ___. If not sufficient transanal irrigation is recommended, if not practicable or feasible, a ___

A

to gain confidence and independence.

mild laxatives, rectal suppositories as well as digital stimulation

Malone antegrade colonic enema (MACE)/Antegrade continence enema (ACE) stoma should be discussed.

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53
Q

MYELODYSPLASIA + NB: Ileal or colonic bladder augmentation is recommended in patients with___.

A

therapy resistant overactivity of the detrusor, small capacity and poor compliance, which may cause upper tract damage and incontinence

** The risk of surgical and non- surgical complications and consequences outweigh the risk of permanent damage of the upper urinary tract +/- incontinence due to the detrusor.

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54
Q

MYELODYSPLASIA + NB: In patients with a neurogenic bladder and a weak sphincter, ____should be offered.

A

a bladder outlet procedure

** It should be done in most patients together with a bladder augmentation.

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55
Q

MYELODYSPLASIA + NB: ___ should be offered to patients who have difficulties in performing an IC through the urethra.

A

Creation of a continent cutaneous catheterisable channel

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56
Q

MYELODYSPLASIA + NB: A life-long follow-up of ___should be available and offered to every patient. Addressing sexuality and fertility starting before/during puberty should be offered.

A

renal and reservoir function

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57
Q

MYELODYSPLASIA + NB:

Urinary tract infections are common in children with neurogenic bladders, however, only ___ should be treated.

A

symptomatic UTIs

58
Q

UPJO/UVJO:
In children diagnosed with antenatal hydronephrosis, ____ were shown to
be at higher risk of developing UTI.

A

non-circumcised infants (LE: 1a), children diagnosed with high-grade hydronephrosis (LE: 2) and hydroureteronephrosis (LE: 1b)

59
Q

UPJO/UVJO: Include ___ in post-natal investigations.

A

serial ultrasound (US) and subsequent diuretic renogram and sometimes voiding cystourethrography

60
Q

UPJO/UVJO: Offer ___ to the subgroup of children with antenatal hydronephrosis who are at high risk of developing urinary tract infection like ____, respectively.

A

continuous antibiotic prophylaxis

uncircumcised infants, children diagnosed with hydroureteronephrosis and high- grade hydronephrosis

61
Q

UPJO/UVJO: Decide on surgical intervention based on the ___

A

time course of the hydronephrosis and the impairment of renal function.

62
Q

UPJO/UVJO: Offer surgical intervention in case of a ___

A

n impaired split renal function due to obstruction or a decrease of split renal function in subsequent studies and increased anteroposterior diameter on the US, and grade IV dilatation as defined by the Society for Fetal Urology.

63
Q

UPJO/UVJO: Offer pyeloplasty when ureteropelvic junction obstruction has been ___

A

confirmed clinically or with serial imaging studies proving a substantially impaired or decrease in function.

64
Q

UPJO/UVJO: Do not offer surgery as a standard for ___ since the spontaneous remission rates are as high as 85%.

A

primary megaureters

**Ureterovesical junction (UVJ) obstruction is an obstructive condition of the distal ureter as it enters the bladder, commonly called a primary obstructive megaureter. Megaureters are the second most likely cause of pathological neonatal hydronephrosis.

65
Q

Ureteropelvic junction (UPJ) obstruction is defined as

A

impaired urine flow from the pelvis into the proximal ureter with subsequent dilatation of the collecting system and the potential to damage the kidney.

It is the MOST COMMON pathological cause of neonatal hydronephrosis

66
Q

VUR: Inform parents of children with vesicoureteric reflux (VUR) that ___

Do not screen ___ since there is no added value in screening for VUR.

A

siblings and offspring have a high prevalence of VUR.

older toilet-trained children

    • Use renal ultrasound (US) for screening of sibling(s).
    • Use voiding cystourethrography if there is evidence of renal scarring on US or a history of urinary tract infection.
67
Q

VUR: There is no evidence that correction of ___ offers a significant benefit.

A

persistent low-grade reflux (grades I-III) without symptoms and normal kidneys

68
Q

VUR: Surgical correction should be considered in ___.

There is no consensus about the timing and type of surgical correction.

The outcome of open surgical correction is better than endoscopic correction for ___

whereas satisfactory results can be achieved by endoscopic injection for ___.

A

patients with persistent high-grade reflux (grades IV/V)

higher grades of reflux

lower grades

69
Q

VUR: Initially treat all patients diagnosed within the first year of life with ___

Offer immediate, parenteral antibiotic treatment for ___

A

continuous antibiotic prophylaxis, regardless of the grade of reflux or presence of renal scars.

febrile breakthrough infections.

70
Q

VUR: Offer ___ to patients with frequent breakthrough infections.

A

definitive surgical or endoscopic correction

71
Q

VUR: Offer___ to patients with persistent high-grade reflux and ___for lower grades of reflux.

A

open surgical correction

endoscopic correction

72
Q

VUR: Initially manage all children presenting at ___ conservatively.

Offer surgical repair to children above the age of one presenting with ___

A

age one to five years

high-grade reflux and abnormal renal parenchyma.

73
Q

VUR: Offer close surveillance without antibiotic prophylaxis to ___

A

children presenting with lower grades of reflux and without symptoms.

74
Q

VUR: Ensure that a detailed investigation for the presence of___is done in all and especially in children after toilet-training.

A

lower urinary tract dysfunction (LUTD)

** If LUTD is found, the initial treatment should always be for LUTD.

75
Q

STONES:

MAP stones on analysis

A

Urine CS - if urease producing bacteria – surgery/SWL, antibiotics

76
Q

STONES:

Uric acid stones

A

Check urine pH, uric acid levels
Acidic urine
Hyperuricosuria
Hyperuricemia

TX: Alkali replacement - K citrate
Allopurinol (10 mg/kg)
Low purine diet

77
Q

STONES:

Cystine

A

Urine pH
Urine cystine level
- If with cystinuria

High fluid intake
K citrate (3-4 mEq/kg/d)
Mercaptopropiyonilglycine 10-15 mg/k/d
Penicillamin 30 mg/kg/d

78
Q

STONES:

CaOx-CaPO

A

CHECK:
Urine and blood: pH, Ca, uric acid, PO, CaOxCitrateMgUricAPhos

pH>5.5: investigate for RTA

pH <5.5

  • -Hypercalciuria: K citrate, normal Ca, low sodium, HCTZ
  • -Hyperoxaluria: Regular Ca diet, low oxalate diet; K citrate, pyrodixine
  • -Hyperuricosuria: K citrate, allopurinol
  • -Hypocitraturia: K citrate

IF Elevate serum PTH + hypercalcemia = hyperparathyroidism surgical treatment

79
Q

STONES:

Most common complications from SWL in children

A
  • renal colic;
  • transient hydronephrosis;
  • dermal ecchymosis;
  • UTI;
  • formation of Steinstrasse;
  • sepsis;
  • rarely, haemoptysis.
80
Q

STONES:

In children with ___, antibiotic prophylaxis to decrease infectious complications is not recommended

A

sterile pre-operative urine cultures

81
Q

STONES:
Staghorn stones

Pelvis > 20 mm

A

PCNL
Open/SWL

PCNL
MicroPerc/Open

82
Q

STONES:
Pelvis < 10 mm

Pelvis 10-20 mm

A

SWL
RIRS/PCNL/MicroPerc

SWL
PCNL/RIRS

83
Q

STONES:

Lower pole calyx

A

PCNL

SWL/Open

84
Q

STONES:

Kidney < 10 mm

A

SWL

RIRS/PCNL/MicroPerc

85
Q

STONES

Kidney > 10 mm

A

PCNL

RIRS PCNL Microperc

86
Q

STONES
Upper ureteral stones

Lower ureteral stones

A

SWL
SWL/Microperc

URS
PCNL/URS/Open

87
Q

STONES

Bladder

A

Endoscopic
SWL/Open

**Open is easier and with less operative time with large stones

88
Q

DSU
Asymptomatic
No VUR or VUR low grade

A

Observation

89
Q

DSU
Asymptomatic
High grade VUR or multiple infections

A

Bladder surgery or endoscopic

90
Q

DSU
Symptomatic with NO VUR
No/poor function

A

Intravesical endoscopic decompression
OR
Ectopic upper pole partial nephrectomy

91
Q

DSU
Symptomatic or severe hydroureteroneprhsosi or obstruction
VUR or no VUR with good function

A

Ectopic – upper to lower tract anastomosis

OR Intravesical endoscopic decompression

92
Q

DSU

___ are associated with complete renal duplication, but they also occur in a 1 single system.

A

Ureterocele and ectopic ureter

93
Q

DSU
Management includes a conservative approach, endoscopic decompression, partial nephroureterectomy, or complete primary reconstruction. Choice of treatment will depend on:

A
  • clinical status of the patient (e.g., urosepsis);
  • patient age;
  • function of the upper pole;
  • presence of reflux or obstruction of the ipsilateral or contralateral ureter;
  • presence of bladder neck obstruction caused by ureterocele;
  • intravesical or ectopic ureterocele;
94
Q

DSU

Ureterocele: DIAGNOSIS

A

Use ultrasound (US), radionuclide studies (mercaptoacetyltriglycine (MAG3)/dimercaptosuccinic acid (DMSA)), voiding cystourethrography (VCUG), magnetic resonance urography, high-resolution magnetic resonance imaging (MRI), and cystoscopy to assess function, to detect reflux and rule out ipsilateral compression of the lower pole and urethral obstruction.

95
Q

DSU

Ureterocele: Treatment

A

Select treatment based on symptoms, function and reflux as well on surgical and parenteral choices: observation, endoscopic decompression, ureteral re-implantation, partial nephroureteretomy, complete primary reconstruction. Offer, early endoscopic decompression to patients with an obstructing ureterocele.

96
Q

DSU

Ectopic ureter: Diagnosis

A

Use US, DMSA scan, VCUG or MRI for a definitive diagnosis.

97
Q

DSU

Ectopic ureter: Treatment

A

Treatment In non-functioning moieties with
recurrent infections, heminephro-ureterectomy
is a definitive solution. Ureteral reconstruction (ureteral re-implantation/ureteroureterostomy/ ureteropyelostomy and upperpole ureterectomy) are other therapeutic option especially in cases in which the upper pole has function worth preserving.

98
Q

Findings in a newborn suggesting the possibility of DSD

A

APPARENT MALE
Severe hypospadias associated with bifid scrotum Undescended testis/testes with hypospadias
Bilateral non-palpable testes in a full-term apparently male infant

APPARENT FEMALE
Clitoral hypertrophy of any degree, non-palpable gonads
Vulva with single opening
Indeterminate
Ambiguous genitalia
99
Q

DSD

Investigations

A

Blood analysis: 17-hydroxyprogesterone, electrolytes, LH, FSH, TST, cortisol, ACTH Urine: adrenal steroids
Karyotype
Ultrasound
Genitogram
hCG stimulation test to confirm presence of testicular tissue Androgen-binding studies
Endoscopy

100
Q

DSD

Do not delay diagnosis and treatment of any neonate presenting with ___

A

ambiguous genitalia since salt-loss in a 46XX CAH girl can be fatal.

101
Q

PUV/UUT + renal insufficiency

Diagnose posterior urethral valves (PUV) initially by

A

ultrasound but a voiding cystourethrogram (VCUG) is required to confirm the diagnosis.

102
Q

PUV/UUT + renal insufficiency

Assess split renal function by ___

A

dimercaptosuccinic acid scan or mercaptoacetyltriglycine (MAG3) clearance. Use serum creatinine as a prognostic marker.

103
Q

PUV/UUT + renal insufficiency: Vesico-amniotic shunt antenatally is :___

A

NOT recommended to improve renal outcome.

104
Q

PUV/UUT + renal insufficiency: Offer ___after bladder drainage and stabilisation of the child.

A

endoscopic valve ablation

105
Q

PUV/UUT + renal insufficiency: Offer suprapubic diversion for bladder drainage if : ___

A

the child is too small for valve ablation.

106
Q

PUV/UUT + renal insufficiency: Offer a ____ if bladder drainage is insufficient to drain the upper urinary tract and the child remains unstable.

A

high urinary diversion

107
Q

PUV/UUT + renal insufficiency: Monitor ___ life-long, in all patients.

A

bladder and renal function

108
Q

Urachal remnants originate from failure of the obliteration of the ALLANTOIS, resulting in a urachal anomaly such as: ____ (4)

A

(1) urachal sinus, (2) urachal cyst, (3) vesico-urachal diverticulum, and (4) patent urachus

109
Q

URACHAL REMNANTS

Urachal remnants with no epithelial tissue : __

A

carry little risk of malignant transformation.

110
Q

URACHAL REMNANTS

___ urachal remnants can safely be managed non- operatively.

A

Asymptomatic and non-specific atretic

111
Q 
URACHAL REMNANTS
Urachal remnants (URs) \_\_\_ should also be observed non-operatively since they tend to resolve spontaneously.
A

incidentally identified during diagnostic imaging for non-specific symptoms

112
Q

URACHAL REMNANTS

A ____, may be viewed as physiological.

A

small urachal remnant, especially at birth

113
Q

URACHAL REMNANTS
Urachal remnants in patients younger than ___ are likely to resolve with non-operative management.

Follow-up is necessary only when symptomatic for___

A

6 months

6 to 12 months.

114
Q

URACHAL REMNANTS

Surgical excision of urachal remnants solely as a preventive measure against later malignancy appears to have ___

A

minimal support in the literature.

115
Q

URACHAL REMNANTS

Only ___ should be safely removed by open or laparoscopic approach.

A

symptomatic URs

116
Q

URACHAL REMNANTS

A __ is only recommended when presenting with febrile UTIs.

A

VCUG

117
Q

PENILE RARE CONDITIONS

A 
Epidermal inclusion cysts
Mucoid cyst of the penis
Median raphe cysts
Smegmal cysts or smegmal pearls
Dermoid cyst
118
Q

PENILE VASCULAR LESIONS
Haemangiomas

pyogenic granulomas: benign outgrowths of cutaneous capillary vessels formed usually from chronic irritation

A

develop rapidly at birth and involute slowly

Propranolol is currently first line treatment for infantile haemangiomas, the exact mechanism of action is unknown but can include inhibition of angiogenesis, vasoconstriction among others

The dose is in the range of 1.5-2.5 mg/kg, which needs to be continued for 12 to 18 months and then tapered through active or passive weaning to reduce risk of rebound growth

119
Q

PENILE VASCULAR LESIONS

Glomus tumors

A

primarily congenital arteriovenous shunts that develop from thermo-regulatory glomus bodies (fast- flow vascular malformations).

symptomatic at presentation or may have symptoms such as priapism, palpitation and perineal pain.

benign and treated either with laser, sclerotherapy or surgical excision.

120
Q

Penile neurofibroma

A

extremely rare lesion arising from perineural and Schwann cells, and occurs usually with evidence of systemic neurofibromatosis or von Recklinghausen syndrome

reated successfully with complete excision

121
Q

Penile malignant schwanomas

A

secondary to malignant transformation of benign neurofibromas have been reported in boys with a strong family history of neurofibromatosis

require long-term follow-up due to risk of recurrence, new tumour formation and malignant transformation.

122
Q

Fibrosarcoma of the penis

A

rare and those occurring on the penis are even rarer in the paediatric age-group.

Surgical intervention has a favourable prognosis

123
Q

___ are the commonest paediatric penile lesions followed by vascular malformations and neurogenic lesions.

A

Cystic penile lesions

124
Q

___ patients require long-term follow-up due to risk of recurrence, new tumour formation 3 and malignant transformation.

A

Neurofibroma

125
Q

___ are rare and require excision in order to differentiate between benign and malignant neoplasms.

A

Mesenchymal tumours

126
Q

Treatment of penile cystic lesions is by ___

A

total surgical excision, it is mainly indicated for cosmetic or symptomatic (e.g. infection) reasons.

127
Q

___ is currently the first-line treatment for infantile haemangiomas.

A

Propranolol

128
Q

___ is the first-line treatment for penile lymphedema.

A

Conservative management

129
Q

In symptomatic cases or in patients with functional impairment, ___ may become necessary for penile lymphedema.

A

surgical intervention

130
Q

TRAUMA: Offer surgical intervention in case of ___

A

haemodynamic instability and a Grade V renal injury.

131
Q

TRAUMA: Diagnose suspected ureteral injuries by ___

A

retrograde pyelogram.

132
Q

TRAUMA: Manage ureteral injuries ___, using internal stenting or drainage of an urinoma, either percutaneously or via a nephrostomy tube.

A

endoscopically

133
Q

TRAUMA: Use ___to diagnose suspected bladder injuries.

A

retrograde cystography

134
Q

TRAUMA: Manage extra-peritoneal bladder ruptures conservatively with ___

A

a transurethral catheter left in place for seven to ten days.

135
Q

TRAUMA: Do not delay treatment of intra-peritoneal bladder ruptures by ___

A

surgical exploration and repair as well as post-operative drainage for seven to ten days.

** Post-operative drainage with a suprapubic tube is mandatory.

136
Q

Urethral trauma:

A transurethral catheter should only be inserted if ___.

A

there is a history of voiding after the traumatic event, and if a rectal and pelvic examination, as described above, has not suggested a urethral rupture.

137
Q

Urethral trauma:

Perform ____ to determine the position of the prostate.

A

A rectal examination

138
Q

Manage posterior urethral disruption by either: ___

A
  • primary reconstruction;
  • primary drainage with a suprapubic catheter alone and delayed repair;
  • primary re-alignment with a transurethral catheter.
139
Q

Pediatric pre-operative fasting times

A

Minimum fasting hours for ingested material

Clear liquids 1 hour
Breast milk 4 hours
Light meal 6 hours

140
Q

Pedia PREOP:

Use ___ solutions in hospitalised children because they are at high risk of developing hyponatraemia.

A

isotonic

141
Q

Assess the baseline and daily levels of ___ in every child who receives intravenous fluids, especially in ___ regardless of the type of solution chosen since there is an increased risk of electrolyte abnormalities in children undergoing such surgery.

A

serum electrolytes, glucose, urea and/or creatinine

intestinal surgery (e.g. ileal augmentation),

142
Q

PEDIA LAP

Use lower intra-abdominal pressure: ___ during laparoscopic surgery in infants and smaller children.

A

6-8 mmHg

12. UroPed (1583) (13 decks)

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