paediatric urology Flashcards by Evie withington

presentation of paediatric urological problems

systemic:

fever, vomiting
FTT
anaemia
HT
renal failure

local:

pain
changes in urine
abnormal voiding
mass
visible abnormalities
incidental

antenatal:

asymptomatic
permits immediate postnatal assessment

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what does this hx suggest:

9mth old male
lump in left groin noticed which was then gone the next morning
baby happy and feeding

inguinal hernia

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features of inguinal hernia

GROIN swelling

2% boys will have one at some point during life

boys 9: 1 girls

increased risk with prematurity

if <1yr old: 33% incarcerate

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management of inguinal hernia

<1y/o:

URGENT referral
repair - no place for observation

>1y/o:

elective referral and repair

incarcerated:

reduce and repair on same admission

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what happens in an inguinal hernia

loop of bowel comes down through defective inguinal canal

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what does this hx suggest:

9mth old male
lump in left scrotal swelling, bluish colour
gone the next morning
baby happy and feeding

hydrocele

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hydrocele features

SCROTAL swelling

very common in newborns

painless - increases w/ crying, straining, evening

bluish colour

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management of hydrocele

conservative until 5y/o

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what does this hx suggest:

9mth old male
scrotum empty
normal neonatal discharge examination
baby happy and feeding

possible undescended testes

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what is cryptorchidism

undescended testis
any testis that cannot be manipulated into the bottom half of the scrotum

can be either:

true undescended testis
retractile testis - normal, very vigorous cremasteric reflex
ascending testis - don’t keep up w/ growth

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why are the testis in the scrotum

enzymes in the testis that produce sperm work at 33 degrees

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incidence of cryptorchidism

roughly proportional to age

premature babies - very high risk (testes don’t normally descend until 3rd trimester)

the majority will resolve
if still undescended by 1yr - needs intervention

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indications for orchiodopexy in cryptorchidism

improve fertility - 1% loss germ cells per month undescended
risk of malignancy - relative risk 3x (probably intra-abdo only), lifetime risk <1%
trauma
torsion
cosmetic

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what does this hx indicate:

4y/o male w/ non-retractile foreskin
recurrent balanitis
o/e: pinhole meatus

normal non-retractile foreskin

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normal non-retractile foreskin

area of tightness is just off the tip

not tight and not obstructing

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what does this hx indicate:

14y/o male w/ non-retractile foreskin
struggling to pass urine
o/e: scarred foreskin, narrow meatus

BXO: balanitis xerotica obliterans

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balanitis xerotica obliterans

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point of constriction of foreskin is very tight

‘bullet like’ penis

white scarring when looking at the tip

management of balanitis xerotica obliterans

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steroid cream - dermovate

50% will end up needing circumcision

circumcision - indications

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removal of foreskin

absolute: BXO
relative: balanoprosthitis, religious, UTI (recurrent, abnormal anatomy)

what is balanoprosthitis

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severe inflammation and infection of glans penis and shaft

recurrent

advantages of circumcision

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UTI - 120 circs prevent 1 UTI
?malignancy - penile cancer is very rare
?sexual enhancement - increased nerve endings in prepuce
?AIDS/STD’s - sub-saharan africa

overall minimal evidence of medical benefit

disadvantages of circumcision

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painful
complications: bleeding, meatal stenosis, fistula, cosmetic
?look different

what does this hx suggest:

14y/o male w/ 4hr hx of R sided testicular pain
o/e: red scrotum, asymmetry, acutely tender to touch

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testicular torsion - until proven otherwise

why is testicular torsion important

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testicle twists on the spermatic cord

cuts off blood supply

testicles become gradually ischaemic

~6hrs time frame to salvage the testis

appearance of testicular torsion

as it twists it tends to shorten and is usually higher up than the other side VERY TENDER

what does this hx suggest * 14 y/o m w/ 4hr hx R sided testicular pain * o/e: scrotum red, NO asymmetry, blue spot seen, tender to touch

torsion appendix testis

what is the appendix testis

embryological remnant that sits on top of the epididymis

what is torsion appendix testis

appendix testis teists and becomes necrotic → blue spot visible on skin

what does diagnosis of acute scrotum depend on

semi age related DDx: * torsion testis, torsion appendix testis * rarely epididymitis - has been misdiagnosed in cases of testicular torsion * unusual: trauma, haematocele, incarcerated inguinal hernia * if in doubt - explore * do not miss testicular torsion, only way to avoid losing testis/rule out torsion is to explore

why do we investigate UTI in children

* prevent renal scarring - reflux nephropathy and chronic renal failure * prevent HT

when to investigate UTI in children

all \<6/12 atypical recurrent

definition of UTI

pure growth of bacteria \>10⁵ pyuria systemic upset - fever vomiting mixed growth bacteria, no pyuria, no systemic Sx - less significant

assessment of UTI

hx and exam - FHx renal problems, bowel habit, voiding dysfunction USS to check kidneys - number, size, position, shape, hydronephrosis renography - * MAG3 - drainage, function, reflux * DMSA - function, scarring micturating cystourethrogram (MCUG) - unpleasant, avoid where possible

grades of vesicoureteric reflux

1. urine going into ureter 2. into kidney w/ no dilation of renal tract 3. more significant: dilation 4. dilated calyces 5. massively significant: massive reflux, gross hydronephrosis, dilated and torturous ureter

what is grade 5 VUR associated with

almost always some form of dysplasia of the kidney

management of VUR

**conservative:** voiding advice, avoid constipation, fluids **abx prophylaxis:** best treatment if diagnosed young - continue until toilet trained, trimethoprim (2mg/kg nocte) **surgical:** STING (mild/moderate VUR w/ Sx), submucosal teflon injection under ureter to stop reflux, effective; ureteric reimplantation (high grade reflux, much bigger operation) - take ureter out and put it back in a different place w/ a tunnel to stop reflux

what is hypospadias

urethral meatus on ventral aspect of penis

classification of hypospadia

anterior - relatively minor, cosmetic rather than functional issue middle - more of an issue, usually requires surgery posterior - very severe, challenging to fix

associated anomalies w/ hypospadias

upper tract - unusual, not routinely checked for ambiguous genitalia - often severe hypospadias, undescended testis

investigations for hypospadias

US karyotye only if severe

management of hypospadias

anterior - single stage procedure more severe - 2 stage procedure * important to straighten penis as part of surgery * difficulty urinating * ability to have penetrative intercourse

paediatric urology Flashcards

(41 cards)