Paediatric Urology Flashcards
What are the systemic signs of a paediatric urological problem?
fever, vomiting failure to thrive anaemia hypertension renal failure
What are the local signs of a paediatric urological problem?
pain changes in urine abnormal voiding mass visible abnormalities incidental
What are the antenatal signs of a paediatric urological problem?
asymptomatic
permits immediate postnatal assessment
How might an inguinal hernia present?
Bump on groin
Young child
Asymptomatic
Permits immediate postnatal assessment
How common are incarcerated hernias?
< 1 year 33% incarcerate
How are inguinal hernias managed?
< 1 year
- URGENT referral
- repair - no place for observation
> 1 year
-elective referral and repair
Incarcerated
-reduce and repair on same admission
How does hydrocele present?
SCROTAL swelling Very common in newborns Painless Increases with crying, straining, evening Bluish colour
How is hydrocele managed?
Conservative until 5 y/o
How may undescended testes (cryptorchidism) present?
Any testis that cannot be manipulated into the bottom half of the scrotum
- true undescended testis
- retractile testis
-(ascending testis)
What is orchidopexy?
A surgery to move a testicle that has not descended or moved down to its proper place in the scrotum
What are the indications for orchidopexy?
Fertility
-1% loss germs cells / month undescent……
Malignancy
- RR 3 x (probably intra-abdominal only)
- lifetime risk - <1%
Trauma
Torsion
Cosmetic
How may a normal non-retractile foreskin present?
“4 year old boy with non retractile foreskin”
“recurrent balanitis”
o/e “pinhole meatus”
How might BXO (Balinitis Xerotica Obliterans) present?
“14 year old boy with non retractile foreskin”
“struggling to pass urine”
o/e “scarred foreskin, narrow meatus”
What are the indications for circumcision?
Absolute:
Balanitis Xerotica Obliterans (BXO)
Relative:
balanoprosthitis
religious
UTI
What are the potential consequences of circumcision?
?UTI -120 circs prevent 1 UTI ?malignancy -Penile cancer VERY rare ?sexual enhancement -↑nerve endings in prepuce ?AIDS / STD’s -Sub-Saharan Africa
Overall, minimal evidence of medical benefit
What are the disadvantages of circumcision?
Painful Complications -bleeding -meatal stenosis -fistula -cosmetic
How might testicular torsion present?
“14 year old boy with 4 hour history of right sided testicular pain” o/e scrotum: -red -asymmetry -acutely tender to touch
How may appendix torsion testes present?
“14 year old boy with 4 hour history of right sided testicular pain” o/e scrotum: -red -NO Asymmetry -blue spot seen -tender to touch
What are the causes of acute scrotum in children?
Age related ….. ish Differential diagnosis -torsion testis -torsion appendix testis -RARELY epididymitis
Also:
- trauma
- haematocele
- incarcerated inguinal hernia
If in doubt - explore
6- 8 hours to recover testis
Why investigate a UTI?
Prevent renal scarring
-reflux nephropathy and chronic renal failure
Prevent hypertension
NICE guideline on UTI……..
-all <6/12, atypical, recurrent
What is the definition of a UTI?
Pure growth bacteria > 105
Pyuria (white cells)
Systemic upset
-fever, vomiting
If a UTI has mixed growth bacteria, no pyuria and no systemic symptoms, what is it?
Less significant
What might you assess in history and examination of a UTI?
FH, bowel habit, voiding dysfunction
What can a US show in a UTI?
Number, size, position, shape, hydronephrosis
