Paediatric urology

Question 1

Nocturnal enuresis : Definition

Answer 1

• Involuntary discharge of urine in child > 5 years old
• Absence of congenital/acquired defects

Question 2

Nocturnal enuresis : Management

Answer 2

1. R/O underlying cause :T1 Diabetes or UTI
2. General advice : empty bladder regularly, rear systems

• First line tx : Enuresis alarm (señor pads that sense wetness)
• Second line : Desmopressin
  (usually for short term control or alarm is not effective)

Question 3

UTI in children : Investigations

Answer 3

Needs investigation - concern of possible underlying cause and damage to kidneys

I) ** < 6 months old **} First UTI which responds to treatment
* Arrange : US of kidneys < 6 weeks

II) > 6 months with UTI -
* Not for imaging if no atypical feature
* Atypical features are present such as ;

1 . Infective features;
* Systemically ill
* No response to Abx in 48 hours

2 . Renal features;
* Mass in abdominal/bladder
* U+Es deranges
* Poor urine form

Further investigations
1. Urine with microscopy and culture
2. Radioisotope scan : renal scars

Question 4

Vesicoureteric Reflux : Definition

Answer 4

1. Abnormal backflow of urine from the bladder into the ureter and kidney.
2. It is a relatively common abnormality of the urinary tract in children and predisposes to urinary tract infection (UTI),

Question 5

Vesicoureteric Reflux : Clinical features

Answer 5

1. Antenatal : Hydronephrosis
2. Recurrent childhood UTI -> Progress to Chronic pyelonephritis and result in renal scarring

Question 6

Vesicoureteric Reflux :Investigation

Answer 6

First line : Micturating cystourethrogram

Question 7

Cryptorchidism : Definition

Answer 7

• One or both of the testes fail to descend into the scrotum from the abdominal cavity during fetal development
• Most commonly unilateral

Question 8

Cryptorchidism : Management

Answer 8

• Unilateral
  1. 3 months - refer to urology
  2. Orchidopexy surgery
• Bilateral
  Urgent referral to paediatrician for genetic/endocrine Ix

Question 9

Cryptorchidism : Complication

Answer 9

1. Infertility
2. Torsion
3. Testicular cancer

Question 10

Nephrotic syndrome in children

Answer 10

1. Minimal change glomerulonephritis
2. Peak incidence 2-5 years