Paediatric urology

Question 1

How common is congenital urogenital anomalies on prenatal ultrasounds?

Answer 1

up to 2%

Question 2

What is the most common urogenital anomoly that is discovered on prenatal ultrasounds?

Answer 2

60% is hydronephrosis

Question 3

How common is UPJ obstruction?

Answer 3

1:1500

males 2:1 females in newborn

Question 4

Differential diagnosis with hydronephrosis in newborns:

Answer 4

UPJ problems 43%
VUR (vesicourethral reflux) 24%
Megaureter 12%
PUV (posterior urethral valves) 11%
Duplex systems 10%

Question 5

What carachterises Megaurethers?

Answer 5

More often males
More on the left side

Can be caused by obstruction and/or reflux

Is primary or secondary (PUV, neurogenic bladder)

Question 6

If a hydronephrosis is not an obstruction, what else can it be a sign of?

Answer 6

VUR (vesicourethral reflux)

Question 7

What information is needed from the antenatal ultrasound if a hydronephrosis is discovered?

Answer 7

Laterality, grade of dilatiation, echogenicitiy of the kidney
With or without a dilated urether
Bladder volume and emptying
Sex of child
Amniotic fluid volume

Question 8

What is a VCUG?

Answer 8

Voiding CystoUrethroGram

Gold standard for imaging the bladder and urethra

Can detect:
Vesicoureteral reflux
urethral valves 
ureteroceles
diverticula
neurogenic bladder

Question 9

What is a MAG3?

Answer 9

Type of Dynamic Renography

shows:
blood flow to the kidney
renal clearance
drainage function

Question 10

When should UPJ obstruction be operated?

Answer 10

Decreased renal function <40% on affected side
Increasing hydronephrosis
Manifesting symptoms
Poor drainage
grade III and IV dilatation

Question 11

What are the goals in diagnosing and treating UPJ obstruction?

Answer 11

Perserve renal function

Less:
UTI
Pain
Hematuria
Urolithiasis

Question 12

What share of megaurethers will resolve spontaneously?

Answer 12

85%

Question 13

When should a megaurether be surgically corrected?

Answer 13

Progression in dilatation
Deterioration of renal function
Symptomatic

Question 14

What is more common, a complete duplex system or a partial?

Answer 14

Partial

Question 15

What other conditions are a duplex collecting system associated with?

Answer 15

Ectopic urether

Ureterocele

Question 16

What are the most common sites for an ectopic urether?

Answer 16

Males: posterior urethra

Females: bladder neck, urethra, vagina

more common in girls

Question 17

What is a ureterocele?

Answer 17

Malformation characteried by pseudo-cystic dilatation of the distal, intravesical portion of urethra

are often a source of obstruction

Question 18

How common are ureteroceles?

Answer 18

1:4000

Question 19

How common are ureteroceles in duplex systems?

Answer 19

80% are found in upper pole urether

20% in single systems

Question 20

How common are bilateral ureteroceles?

Answer 20

10%

Question 21

What is the ratio boys:girls in the prevalence of ureteroceles?

Answer 21

1:4-7

Question 22

What is a Posterior Urethral Valve?

Answer 22

Obstructing membranous fold within the lumen of the posterior urethra

Question 23

What is the most common urinary obstruction that affects newborn boys?

Answer 23

Posterior Urethral Valve (PUV)
1: 5000-8000 live births

is lifethreatening
35% renal insufficiency despite optimal treatment

Question 24

How do you treat PUV and what is the result?

Answer 24

Shunting
Fetal valve ablation

bladder decompression
restoration of amniotic fluid
lungs can expand
restoration of surfactant
no benefit for renal function

Question 25

At what age is the foreskin most often retractable?

Answer 25

90% at 3 years old

Question 26

How many boys still have physiological fimosis at 17?

Answer 26

1%

Question 27

How do you treat secondary fimosis?

Answer 27

Stereoid creme (class III-stereoids, twice daily 39 days) Dorsal slit Circumcision

Question 28

What are the medical indications for circumcision?

Answer 28

Congenital urinary tract malformation to reduce risk for UTI Secondary phimosis with recurrent UTI BXO (balanitis xerotica obliterans)

Question 29

What is the NNT to prevent UTI for circumcisions?

Answer 29

111 | therefore not justified as a routine

Question 30

What are the contraindications for circumcision?

Answer 30

acute infection congenital anomalies bleeding disorders

Question 31

What is the complication rate for circumcision?

Answer 31

0,2-5%

Question 32

What is the incidence of hypospadias?

Answer 32

1:300 newborn boys

Question 33

In hypospadias, how many are distal and how many are proximal?

Answer 33

Distal 80% | proximal 20%

Question 34

What factors are associated with hypospadias?

Answer 34

Mainly unknown ``` low birth weight young and older mothers vegeterian diet during pregnancy IVF some genetic disorders disorders of sexual differentation ```

Question 35

What are the indication for surgical correction of hypospadias?

Answer 35

Straighten the penis Enable standing voiding Enable normal sexual function Meatal stenosis correction cosmetic- foreskin reconstruction

Question 36

What is the most prevalent procedure for correcting hypospadias?

Answer 36

Tubularised incised plate if proximal, two stage procedure with buccal or skin behind the ear (important, skin without hair)

Question 37

What are longtime complications after hypospadia surgery?

Answer 37

urethrocutaneous fistula 7-25% | Stricture/stenosis 5-15%

Question 38

What is Epispadias?

Answer 38

Defect in the dorsal wall of the urethra together with incontinence and small penis size

Question 39

What is the incidence of epispadias?

Answer 39

1: 120 000 male births

Question 40

How do you define a micropenis?

Answer 40

stretched penis length < 2,5 SD of age specific length

Question 41

What other conditions are micropenises associated with?

Answer 41

``` Hypogonadism PAIS Chromosomal abberations -Klinefelter's syndrome -Prader- Willis syndrome Idiopathic ```

Question 42

What other investigations should be conducted on a patient with a micropenis?

Answer 42

Karyotype Hormonal analysis hCG stimulations test Paediatric endocrinologist

Question 43

When is surgical intervention varranted for a hydrocele?

Answer 43

If persistent >12 months

Question 44

Differential diagnoses for acute onset scrotal masses:

Answer 44

``` Torsion Trauma Abscess Orchitis Epididymnitis ```

Question 45

Differential diagnoses for non-acute onset scrotal masses:

Answer 45

``` Hydrocele Hernia Spermatocele Varicocele Neoplasia ```

Question 46

What is the most common age for testicular torsion?

Answer 46

12-20 years

Question 47

What is the difference between regular testicular torsion and Neonatal testicular torsion?

Answer 47

Neonatal testicular torsion can be extravaginal

Question 48

What are the most common viral causes for epididymo-orchitis in children?

Answer 48

Adenovirus | Mumps

Question 49

What is Acute Idiopathic scrotal edema?

Answer 49

Inflammation, tenderness and swelling of scrotal skin can extend to the perineum & abdomen age 2-10 non-tender testis spntanous resolution <72 hours UL -thickening of scrotal skin Colud be an allergic reaction

Question 50

How common is cryptorchidism?

Answer 50

3% at birth | 1% at 1 year

Question 51

How often is cryptochidism bilateral?

Answer 51

30%

Question 52

How often is the testicle palpable in cryptochidism?

Answer 52

80%

Question 53

How often is the testicle absent in cryptochidism?

Answer 53

of those that are not palpable 20% are without testicle

Question 54

When should cryptiochidism be corrected?

Answer 54

Before 1 year of age