Paediatric Urology Flashcards
(23 cards)
What populations are most affected by inguinal hernias?
Boys > girls 9:1
Increased incidence in premature babies
What is the difference in presentation between an inguinal hernia and a hydrocele?
Inguinal hernia = groin swelling
Hydrocele = scrotal swelling
What is the management of inguinal hernias?
In infants (<1 year)- urgent referral for repair
>1 year- elective referral and repair
Strangulated/incarcerated- reduce and repair on same admission
How do hydroceles present?
Very common in newborns
Scrotal swelling
Painless
Can be bluish
How are hydroceles managed?
Cause no harm so left to recede and do so spontaneously
Can operate if not receded by 5
What is the definition of cryptorchidism?
Cryptorchidism refers to any testis that cannot be manipulated into the bottom half of the scrotum
What are the four kinds of cryptorchidism? Describe each
True cryptorchidism
Retractile- sits high but can be pulled into scrotum, should be left alone
Ectopic- descend incorrectly
Ascending testis- don’t progress with growth and gradually get pulled out of scrotum. Will have normal examination at birth but will have undescended testes appearance by 4/5
When is incidence of cryptorchidism higher?
In light or premature babies
What are the indications for orchidopexy in cryptorchidism?
Fertility Malignancy Trauma Torsion Cosmetic
What are the absolute and relative indications for circumcision?
Absolute: -Balanitis xerotica obliterans (BXO)- scarring condition of foreskin, circumcision only treatment Relative: -Balanoprosthitis -Religious -UTI risk
What are the disadvantages of circumcision?
Painful Complications: -Bleeding -Meatal stenosis -Fistula -Cosmetic
What are the differential diagnoses for an acute scrotum?
Torsion testes
Torsion appendix testes (embryological remnant (hydatid) becomes torted. Pain is referred to testes as it does not have it’s own nerve. Can be operated on if very painful but will die off on its own in a few days)
Epididymitis
Trauma (only significant if pain onsets directly after trauma and persists)
Haematocele
Incarcerated inguinal hernia
In what age groups are torsion testes and torsion appendix testes most common?
Torsion testes- 10-15+
Torsion appendix testes- 6-15
When should UTI be investigated?
In those <6 months
Atypical causative organism
Recurrent
What are the aims of UTI investigation?
To prevent renal scarring and hypertension.
How is UTI defined?
Pure growth bacteria > 10^5 + pyuria + systemic upset (fever, vomiting).
How is UTI assessed in children?
History + examination
Ultrasound scan
Renography- MAG3, DMSA
Micturating cystourethrogram
How is vesico-ureteric reflux graded?
Grade I- urine reflux into ureter only
Grade II- urine reflux into ureter and renal pelvis
Grade III- urine reflux into ureter and renal pelvis resulting in mild swelling
Grade IV- urine reflux into ureter and renal pelvis resulting in moderate swelling
Grade V- urine reflux into ureter and renal pelvis resulting in severe swelling and twisting/distortion of the ureter
How is vesico-ureteric reflux managed?
Conservative- voiding advice, constipation prophylaxis, fluids
Antibiotic prophylaxis- trimethoprim until 4 years old
Submucosal Teflon injection (STING)- if mild/moderate/symptomatic
Surgical ureteric reimplantation
What is hypospadias?
Hypospadias is when the urethral meatus is present on the ventral aspect of the penis
What is the incidence of each type of hypospadias and how does severity vary?
50% anterior
30% middle
20% posterior
Severity worsens the closer the meatus is to the base of the penis
What are the possible associations with hypospadias?
Upper tract abnormalities
Ambiguous genitalia
What is chordee?
Chordee is a bend in the penis that occurs with erection due to scarring
