Paediatric Urology

Question 1

What are the presentations of paediatric urological problems?

Systemic

Local

Antenatal

Answer 1

Systemic

• fever, vomiting
• failure to thrive
• anaemia
• hypertension
• renal failure

Local

• pain
• changes in urine
• abnormal voiding
• mass
• visible abnormalities
• incidental

Antenatal

• asymptomatic
• permits immediate postnatal assessment

Question 2

What is a Hernia?

Answer 2

• Groin swelling
• Much more common in boys - due to inguinal canal formation
• Most are indirect - coming through inguinal canal.
• Higher risk in prematurity because of non descent of testes.
• Complication - incarceration??

Question 3

What is the management of Hernia?

Answer 3

< 1 year

• URGENT referral - fax / phone
• repair - no place for observation

y> 1 year

• elective referral and repair

Incarcerated (this can cause testicular ischaemia)

• reduce and repair on same admission

Question 4

What is a hydrocele?

Management?

Answer 4

• SCROTAL swelling
• very common in newborns
• painless
• increases with crying, straining, evening
• bluish colour

Conservative until 5 years of age.

Question 5

What is Cryptorchidism?

Answer 5

Any testis that cannot be manipulated into the bottom half of the scrotum.

• true cryptorchidism
• (retractile testes are normal)
• ectopic
• (ascending testis) - just stays at same stage, doesn’t keep up with growth

Question 6

What are indications for orchidopexy?

Answer 6

• fertility
  
  • 1% loss germs cells / month undescent……
• malignancy
  
  • RR 3 x (probably intra-abdominal only)
  • lifetime risk - <1%
• trauma
• torsion
• cosmetic

Question 7

What is circumcision?

Indications?

Answer 7

• removal of foreskin
• indications
  
  • absolute
    
    • Balanitis Xerotica Obliterans (BXO)
  • relative
    
    • balanoprosthitis
    • religious
    • UTI

Question 8

What are the disadvantages of circumcision?

Answer 8

• painful
• complications
  
  • bleeding
  • meatal stenosis
  • fistula
  • cosmetic
• look different

Question 9

What are some differentials for an acute scrotum?

Answer 9

• torsion testis - twisting and loss of blood supply
• torsion appendix testis
• epididymitis
• Trauma, haematocoele, incarcerated inguinal hernia (these are uncommon)

There can often be a delay because boys are embarrassed to tell mother etc.

Question 10

Why investigate UTI?

Answer 10

• Prevent renal scarring and hypertension.
• Investigate all <6/12, atypical, recurrent.

Question 11

Definition of UTI?

SSx of UTI?

Answer 11

• pure growth bacteria > 105
• pyuria
• systemic upset
• fever, vomiting
• mixed growth bacteria, no pyuria, no systemic symptoms
• less significant

Question 12

What are the important aspects of Assessing UTI in boys?

Answer 12

• history and examination
  
  • FH, bowel habit, voiding dysfunction
• ultrasound scan
  
  • number, size, position, shape, hydronephrosis
• renography
  
  • MAG3 - drainage, function, reflux
  • DMSA - function, scarring
• micturating cystourethrogram (MCUG - fill the bladder with dye.

Question 13

What is the management of VUR?

Answer 13

• conservative
  
  • voiding advice, constipation, fluids
• antibiotic prophylaxis
  
  • ? until age 4
    
    • Trimethoprim (2mg/kg nocte)
• STING
  
  • mild/moderate with symptoms
• ureteric reimplantation

Question 14

What is Hypospadias?

Answer 14

• Urethral meatus on the ventral aspect of the penis.
• classification
  
  • Anterior (50%
  • Middle (30%)
  • Posterior (20%)

Question 15

What are the investigations, management and associated anomalies?

Answer 15

• investigations:
  
  • US if severe
• management
  
  • DO NOT CIRCUMCISE
• one stage or 2 stages procedure

Associated anomalies

• upper tract abnormalities
• intersex (ambiguous genitalia)