Flashcards in GU Deck (63)
MC organisms involved in UTIs?
RF for UTIs?
VUR (vesicoureteral reflux)
urinary tract obstruction
poor perineal hygiene
S/s of UTI in new borns/infants?
nonspecific signs: fever, hypothermia, jaundice, poor feeding, irritability, vomiting, FTT, & sepsis
+/- strong, foul-smelling or cloudy urine
s/s of UTIs in pre-school children?
abd &/or flank pain, vomiting, fever, frequency, dysuria, urgency, or enuresis
CVA tenderness is unusual in young children
s/s of UTI in school aged children?
classic s/sx of cystitis: frequency, dysuria, & urgency
possibly pylonephritits: fever, vomiting, flank pain
Dx of UTI?
-Nitrite* (can be - in young children)
GOLD standard: urine culture of properly collected specimen
Tx for UTI
<3mo, septic, dehydrate:
ADMIT to hospital for IV abx
Older infants/children: empiric therapy
-Amoxicillin, TMP-SMX, 1st gen cephalosporin
What is vesicoureteral reflux (VUR)
Reflux of urine from bladder into the ureter/upper urinary tract
1% of newborns
increases up to 15%
Epidemiology of VUR?
White > Black
F > M
strong fam hx
What is primary VUR?
incompetent or inadequate closure of the ureterovesical junction (UVJ)
Due to a congenitally short intravesicular ureter
MC form of reflux
What is secondary VUR?
Due to an abnormally high voiding pressure in bladder which results in failure of the closure of UVJ during bladder contraction
Functional bladder obstruction (neurogenic bladder)
Anatomic dysfunction - Posterior urethral valves
s/s of VUR?
Prenatal: hydronephrosis on prenatal u/s
Postnatal: febrile UTI
Work up for prenatal VUR?
Prenatal hydronephrosis (on prenatal u/s):
unilateral: repeat ultrasound at 1wk of age
bilateral: repeat ultrasound + VCUG
work up for post natal VUR?
UTI: renal & bladder u/s
Febrile UTI: Voiding Cystourethrogram (VCUG)
Grading for VCUG reflux?
Grade 1 (reflex into ureter w/ no dilation) -->
Grade 4 (reflux w/ dilation of ureter & blunting of reflux calyces)
Tx for grade 1 and 2 VUR?
Monitor for spontaneous resolution (by age 5, 80% spontaneously resolve)
Consider prophylactic antibiotics
Tx for grade III to V VUR?
regardless of age antibiotic prophylaxis:
TMP-SMX (2mg/kg) or nitrofurantoin (1-2mg/kg)
DC when VUR resolves (spontaneously or surgically)
at risk for complications if left untreated
What is posterior urethral valves?
Obstructing membranous folds within the lumen of the posterior urethra
obstructs normal flow of urine
MC etiology of UT obstruction in newborn male
Dx of PUV?
Bilateral hydronephrosis, distended and thickened bladder
Failure to thrive, distended abdomen, poor urinary stream
Older boys: straining to urinate, UTIs, daytime & nocturnal enuresis
Dx- VCUG- dilated & elongated posterior urethra during the voiding phase
prenatal: experimental surg
post natal: correct electrolyte abn, foley cath, surg correction
FU post PUV tx?
Bladder dysfunction may require clean intermittent catheterization
Monitor for renal failure- significant risk despite early intervention: Renal transplant
Monitor for UTIs
What is considered daytime freq?
What is enuresis?
Repeated urination into clothing (day & nighttime) by a child > than 5y/o
diurnal enuresis = wetting while awake
Primary v. secondary nocturnal enuresis?
Primary = occurring in children who have NEVER been consistently dry though the night
Secondary = resumption of wetting after at least 6mo of dryness
s/s of enuresis?
child > 5yr (developmentally & chronologically)
at least 2x per week for 3 months
RF for nocturnal enuresis?
often associated w/ underlying constipation
runs in families
dx of nocturnal enuresis?
H&P: r/o anatomical abn, constipation
UA +/- culture
Tx of nocturnal enuresis?
limit liquids before sleep
awaken the child at night to bathroom
meds if others fail
What meds can be used for nocturnal enuresis?
Desmopressin Acetate (DDAVP)- synthetic analogue of the antidiuretic hormone (ADH) vasopressin
-can be Rx for short term periods
Imipramine- high risk ADEs