6.2.7. Neonatology - Common Post-Natal Problems - Genito-Urinary

Question 1

What are the 4 Major Classifications of the Neonatal Genito-Urinary System Disorders?

Answer 1

1. Renal Pelvis Dilatation
2. Female Genitalia
3. Male Genitalia
4. Ambiguous Genitalia

Question 2

What is the Worry with Renal Pelvis Dilatation?

Answer 2

Renal Damage from Vesico-Ureteric Reflux

Note - This is a Common Finding Antenatally

Question 3

When are the Scans for Renal Pelvis Dilatation?

Answer 3

1. Birth

2. 6 Weeks

Question 4

What are the Common Problems of Female Genitalia?

Answer 4

1. Skin Tags
2. Urinary Meatus
3. Clitoral Enlargement in Preterm Infants
4. Vaginal Bleeding - Pseudo-Menstruation

Question 5

What is a Mucosal Skin Tag?

Answer 5

A Fold / Continuation of the Mucosa from the Vaginal Wall

Note - No Action is Required, it will shrink and disappear within the 1st week

Question 6

What are the Features of Pseudo-Menstruation?

Answer 6

1. Normal
2. Withdrawal of Maternal Hormones
3. 48 Hours to 6 Days

Question 7

What are the Common Neonatal Male Genitalia Problems?

Answer 7

1. Undescended Testes
2. Micropenis
3. Hypospadias
4. Chordee
5. Torsion
6. Hydroceles
7. Inguinal Hernias

Question 8

What are the Types of Undescended Testes?

Answer 8

1. Retractile
2. Palpable
3. Impalpable

Question 9

What is the Treatment of Undescended Testes?

Answer 9

1. Requires Follow-Up

2. Referal for Surgery by Age 1-2 years old

Question 10

What are the Features of Micropenis?

Answer 10

1. < 2.5cm Term
2. Refer if Worried / Seems Small
   Note - 90% Term Boys between 2.4cm and 5.5cm

Question 11

What is Hypospadias?

Answer 11

Proximally Displaced Urethral Meatus

Question 12

What are the Different Ratings of Hypospadias?

Answer 12

1st Degree - Urethral Meatus opens on the Underside of the Glans Penis
2nd Degree - Urethra Opens on the Shaft
3rd Degree - Urethra Opens on the Perineum

Question 13

What is Hypospadias Associated with?

Answer 13

1. Chordee

2. Undescended Testes

Question 14

What is Chordee?

Answer 14

Ventral Curvature of the Penis

Question 15

What are the Features of Torsion?

Answer 15

1. Uncommon
2. Require Treatment within 6 hours for Testes to Remain Viable
3. Hard Tender Testis
4. Sometimes Blueish Discolouration
5. Most Neonatal Cases Testis is already Necrotic
6. Urgent Surgical Referal

Question 16

What are the Features of Hydroceles?

Answer 16

1. Frequent Finding in Newborn
2. Important (on Palpation) to identify the Testicles as Separate Entities from the Hydrocele - Transillumination
3. Common (In contrast to Inguinal Hernia)
4. Cannot be Reduced as Fluid is an Enclosed Space
5. No Treatment is Required

Question 17

What are the Features of Hernias?

Answer 17

1. They are Common
2. They are Reducible
3. Irreducible may Strangulate
4. Early Referal for Paediatric Surgery

Question 18

What are the Different Types of Ambiguous Genitalia?

Answer 18

1. Clearly Indeterminate Sex
2. Apparent Male
3. Apparent Female

Question 19

What are the Features of an Apparent Male Ambiguous Genitalia?

Answer 19

1. Bilateral, Non-Palpable Testes - in Full Term Newborn
2. Separation of the Scrotal Sacs with Hypospadius
3. Hypospadius Concomitant with Undescended Testicle

Question 20

What are the Features of an Apparent Female Ambiguous Genitalia?

Answer 20

1. Clitoral Hypertrophy
2. Foreshortened Vulva with Single Opening
3. Inguinal Hernia containing a Solid Mass - Likely to be a Gonad

Question 21

What Investigations are done for Ambiguous Genitalia?

Answer 21

1. Serum Electrolytes / Glucose
2. Chromosome Analysis
3. Pelvic / Abdominal Ultrasound - Determine Pelvic Structures
4. 17-Hydroxyprogesterone
5. Serum for Testosterone