Paediatric Urology Flashcards
What are some systemic presentations of paediatric urological problems?
- fever, vomiting
- failure to thrive
- anaemia
- hypertension
- renal failure
What are some local symptoms of paediatric urological problems?
- pain
- changes in urine
- abnormal voiding
- mass in pelvis
- visible abnormalities
- incidental
What are antenatal presentations of paediatric urological problems?
- asymptomatic
- permits immediate postnatal assessment
How does inguinal hernia present?
groin swelling out of deep inguinal ring
What do we mean when we say a hernia is ‘incarcerated’?
it cannot be reduced back to where it originated
How would hernia be managed if the child was less than a year old?
urgent referral and repair because the hernia is more likely to be incarcerated
How would hernia be managed if the child was more than a year old?
elective referral and repair
What is hydrocele and what generally causes it in children?
- painless scrotal swelling
- fluid leaking through the processes vaginalis
What can worsen hydrocele?
increases with crying, straining and in the evening
How would hydrocele be managed?
conservative until 5 years of age
What is cryptorchidism?
any testis that cannot be manipulated into the bottom half of the scrotum
True cryptorchidism?
the testes have not descended at all
Retractile cryptorchidism.
can manipulate the testis to come down but will bounce back after a few seconds
Ectopic cryptorchidism.
testis descend into wrong place e.g. thigh
Ascending testis.
- have been in scrotum at birth but not later on
- can be due to cord of testis not growing properly and so lifting them up
What is circumcision?
removal of foreskin
What is an absolute indication for circumcision?
Balanitis Xerotica Obliterans - a scarring condition of the foreskin that can lead to urinary retention
What are some relative indications for circumcision?
- balanoprosthitis
- religious
- UTI
What are disadvantages of circumcision?
- painful
- complications such as bleeding, mental stenosis, fistula, cosmetic
If a child presents with n acute scrotum (painful scrotum), what would you include in the differential diagnosis?
- testicular torsion***
- torsion appendix testis**
- epididymitis*
- trauma
- haematocoele
- incarecerated inguinal hernia
In what age group is testicular torsion common?
12-14 year olds
How much time do you have to save the testicle in testicular torsion?
6-8 hours from time of twist
What is torsion appendix testis?
when an appendage to the testis (most likely a remnant from embryological development) gets twisted and causes pain
What sign on examination might suggest testicular torsion?
transverse lie of testicle
