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Urology > Children > Flashcards

Children Flashcards

1
Q

What is primary enuresis

A

The child has never been dry at night before

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2
Q

Nocturnal Enuresis definition

A

The child continues to involuntarily void beyond the age of anticipated control
For example bed wetting twice a month in a child of 5 years

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3
Q

Secondary enuresis

A

A recurrence of incontinence after the child has been dry for 6 months

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4
Q

What is the initial drug of choice in enuresis?

A

Desmopressin which is a vasopressin

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5
Q

How long does desmopressin work for?

A

7-10 hours after administration

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6
Q

Retractile Testis definition

A

Descended testis that have moved upwards by cremaster muscle spasm and can be massaged and it will drop again

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7
Q

Undescended Testes definition

A

These are testes that have not descended down the abdomen

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8
Q

Ectopic testes

A

This is when the testis has passed through the inguinal canal and has deviated away towards the outside of the scrotum

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9
Q

What are the 2 descents of the testes?

A
  1. Transabdominal descent

2. Inguinoscrotal descent

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10
Q

What is orchidopexy?

A

A surgical procedure where they move an undescended testicle into the scrotum and permanently fix it there

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11
Q

What usually happens at the 3 month mark to baby boys to help descend testes?

A

There is a surge of testosterone

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12
Q

What is prune belly syndrome always associated with?

A

Bilateral undescended Testes

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13
Q

What is the risk for undescended testes of becoming malignant?

A

5-10x more risk of malignancy

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14
Q

What is the treatment for UDT?

A
  1. Wait until 12-18 months
  2. Orchidopexy
  3. Hormone therapy(B-HCG and Gonadotropin releasing hormone)
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15
Q

What is the most common organism that causes UTI’s in children?

A

E coli

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16
Q

What ages is it common for children to have a UTI?

A

6 months

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17
Q

What are some of the common clinical signs of UTI in children?

A
  1. Fever (febrile convulsions)
  2. irritability
  3. Trouble feeding
  4. Diarrhoea and vomiting
  5. Jaundice
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18
Q

How do you collect urine from a child with possible UTI?

A
  1. Use a urine bag
  2. suprapubic catheter for complications getting an uncontaminated bag specimen
  3. Midstream urine specimen
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19
Q

What are the investigations for UTI in children?

A

First you do a dipstick and if leucocytes and nitrites are high then it is suggestive of a UTI
Then ensure you do a Ultrasound KUB and MCUG

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20
Q

What investigation is the gold standard for Vesico-ureteric Reflux?

A

MCUG

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21
Q

What investigation cannot be done until the UTI is treated?

A

MCUG

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22
Q

How long do you give the antibiotics for?

A

7-14 days

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23
Q

What prophylactic Antibiotics do you give?

A

You can use co-trimoxazole(bactrim)
or
Nitrofurantoin

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24
Q

When does the prepuce develop intra-uterinally?

A

12th-20th week

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25
Q

Give 4 medical indications for circumcision?

A
  1. Phimosis
  2. Parphimosis
  3. To reduce risk of penile cancer
  4. Reduce incidence of UTI in baby boys under 6 months
  5. Reduces incidence of HIV
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26
Q

Sensory innervation of the penis is supplied by?

A

Two dorsal nerves of the penis on either side of he midline

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27
Q

What anaesthesia do you use in infants prior to circumcision?

A
  1. Bupivicaine (1mg/kg) which lasts for 6 hours

2. Lignocaine (2mg/kg)

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28
Q

Define hypospadias

A

Abnormal opening of urethral meatus on the ventral aspect of the penis
Chordee-The curvature of the penis towards the ventral aspect of the penis

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29
Q

What other congenital anomalies is hypospadias associated with?

A
  1. Undescended testes

2. Inguinal hernias

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30
Q

What is a requirement for the development of the normal urethra?

A

You need DHT(dihydotestosterone) convrted testosterone by 5-alpha reductase

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31
Q

At what age does hypospadias surgery occur?

A

Around the age of 2

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32
Q

What are the most important factors for the hypospadias surgery?

A

To correct the chordee and straighten the penis

To reconstruct the urethra

33
Q

What is antenatal hydronephrosis?

A

5 mm AP diameter on ultrasound

34
Q

What is the most common cause of unilateral hydronephrosis?

A

Pelvic-ureteric junction obstruction

35
Q

What are some of the causes of bilateral hydronephrosis?

A

Bilateral Pelvic-ureteric junction obstruction
Bilateral VUR
Prune belly syndrome

36
Q

What is VUR?

A

This is defined as when the urine back-flows from the bladder up the ureters again

37
Q

What is primary VUR?

A

When the issue is a congenital one and is related to how the ureters enter the bladder(short submucosal tunnel)

38
Q

What is VUR associated with in children?

A

UTI

39
Q

What is the gold standard to diagnose VUR?

A

MCUG

40
Q

What are the complications of VUR?

A

Renal failure
Hypertension due to renal scarring
Reflux nephropathy or chronic pyelonephritis

41
Q

What is secondary VUR?

A

This caused by some sort of obstruction

Bladder outflow obstruction or posterior urethral valve or neuropathic bladder

42
Q

What is the DMSA used to detect?

A

Renal scarring

43
Q

When do you do a post natal ultrasound when dealing with VUR?

A

At 1 and 6 weeks

44
Q

When do you do do a DMSA/MAG3 when dealing with VUR?

A

At 6 and 12 weeks

45
Q

What is the medical Rx of VUR?

A

We give low dose chemo-prophylaxis-nitrofurantoin or nalidixic acid

46
Q

What is the definition of a PUJ?

A

The obstruction at the junction between the ureter and the renal pelvis which results in restriction of urinary flow

47
Q

Which kidney is usually affected with PUJ?

A

The left kidney

48
Q

What is neonatal anuria?

A

The inability of the child to pass urine before the first 24 hrs of life

49
Q

If the baby has not passed urine within 24 hours what could be the cause?

A

Urinary retention or anuria

50
Q

What are the causes of anuria?

A

Bilateral renal agenesis or renal venous thrombosis

Or renal arterial thrombosis

51
Q

Causes of urinary retention include:

A

Bladder outlet obstruction
Posterior urethral valves
Magnesium sulphate in pregnancy to help with pre-eclampsia

52
Q

What is cloacal exstrophy?

A

Involves the bladder and the bowel

53
Q

What is bladder exstrophy?

A

It involves the bladder and the urethra exposed

54
Q

What is epispadias?

A

It involves the urethra being open on the dorsal aspect

55
Q

What are the clinical features of exstrophy?

A 
Undescended testes
Epispadias 
Bifid clitoris in girls 
Diastasis of pubic symphysis 
Penis is usually short and stubby
56
Q

Management of a child with bladder exstrophy

A

Urological emergency
Cover with plastic and transfer immediately for bladder closure+ orchidopexy+ urethral reconstruction and iliac osteomies

57
Q

What are the triad of abnormalities associated with prune belly syndrome?

A

Undesecended testes
Abnormal abdominal wall
Anomalies of the urogenital tract

58
Q

Babies with prune belly syndrome often present with:

A

Pulmonary hypoplasia- respiratory distress

59
Q

What are some of the special investigations associated with prune belly syndrome?

A

Ultrasound
MCUG
Urine culture and Urine MCS because of the high occurrence of UTI

60
Q

Management of babies with prune belly syndrome:

A

Treat with AB because of the UTI

Elective bilateral orchidopexy for the UDT

61
Q

What are the clinical features of posterior urethral valves on ultrasound?

A
  • oligohydroamnios
  • bilateral hydronephrosis
  • thickened bladder wall
62
Q

What is the surgical Rx for VUR?

A

ureterneocystostomy which has a 90% success rate

63
Q

What are the primary causes of PUJ obstruction?

A

Abberant development of ureteric/pelvic circular muscle
Abberant insertion of the ureter into the renal pelvis(higher than normal)
Abnoemal collagen folds
Extrinsic vessels occluding the ureters

64
Q

What is the best investigation for PUJ?

A

Ulrasound then MAG3/DMSA followed by IVP

65
Q

What are the clinical signs of PUJ?

A

Haematuria
UTI
Loin pain

66
Q

What are the complications of PUJ

A

Renal failure
Pyelonephritis
Calculi
Hypertension

67
Q

Mx of PUJ obstruction:

A

Conservative with AB and watch with U/S
If surgery is indicated then do:
pyeloplasty, balloon dilataion or nephrectomy

68
Q

What is the ratio of the ureter and the ureteric diameter/

A

5:1

69
Q

What is simple multicystic dysplastic kidney disease?

A

This is when it affects only one side of the kidney

70
Q

What is complex multicystic dysplastic kidney disease?

A

This is when it affects both kidneys

71
Q

Unilateral disease of MCDKD is associated with:

A

contralateral PUJ or VUR of the contralateral kidney

72
Q

In autosomal recessive polycystic kidney disease, the child dies from:

A

Respiratory distress

73
Q

What genes are associated with Polycystic Kidney Disease?

A

PKD1 and PKD2

74
Q

What is the incidence of nephroblastoma in children?

A

About 10-20%

75
Q

At what age does Wilms Tumour occur?

A

2-3 years old

76
Q

What do children with Wilms tumour present with?

A

AbdomInal mass, haematuria, hypospadias, UDT

77
Q

What is the treatment of Wilms tumour?

A

Nephrectomy, chemotherapy and radiotherapy

78
Q

What are the clinical presentations of children with neuroblastoma?

A 
systemically unwell
fever
abdominal mass
loss of weight
anaemia

Urology (10 decks)

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