Pediatric Urology

Question 1

What are the three types of cryptochism?

Answer 1

undescended testicles, retractile testicles, and ascending testicles.

Question 2

When are undescended testicles most common?

Answer 2

at birth, they are more common in premature or low weight births.

Question 3

What is the recommended time to do surgery if they do not descend?

Answer 3

after 6 months but before 12-24 months.

Question 4

boys and bilateral normal testis and boys with unilateral UDT have the (same or different) risks of fertility

Answer 4

the same (both have 90%). bilateral udt has 50%.

Question 5

do retractile or ascending testis have associated cancer or fertility risks?

Answer 5

not shown

Question 6

When is the best time in life to do a scrotal exam?

Answer 6

birth.

Question 7

What is the most reliable way of diagnosing a UDT?

Answer 7

physical exam (current says you can use MRI or U/S also)

Question 8

When should a PCP order a scrotal US for UDT?

Answer 8

never (according to lecture)

Question 9

What might you expect to see for a non palpable testicle?

Answer 9

compensatory hypertropy > 1.8cm usually indicates the other testicle is dead. There may be a risk of cancer in the testiulcar nubbin, and a higher risk of torsion in a solitary testicle.

Question 10

What is the mandatory procedure in a child with a non palpable testicle?

Answer 10

laparoscopy

Question 11

What are the risks associated with hernias?

Answer 11

incarceration, strangulation and bowel necrosis

Question 12

what is a hydrocele?

Answer 12

it is a fluid filled sac surrounding a testicle that results in swelling of the scrotum. it is common in newborns and most disappear without treatment. it is not painful most of the time.

Question 13

what are the two types of hyrdoceles?

Answer 13

communication (sac open and fluid passes to and from abdominal cavity, higher risk of hernias. most resolve by 18 months) and non communicating (sac closes)

Question 14

compare a febrile UTI vs a non febrile UTI

Answer 14

febrile: younger, temp >38.5, sick, back pain, anatomic problem, workup = renal us and VCUG
non febrile: older, no fever, dysfunctional elimination, normal anatomy, workup: KUB, voiding diary

Question 15

what is the workup for a febrile UTI?

Answer 15

renal us and vcug

Question 16

what is the workup for a non febrile UTI

Answer 16

KUB and voiding diary

Question 17

What is hydronephrosis?

Answer 17

dilation of the kidney, specifically the renal pelvis (where urine is produced)

Question 18

What can cause hydronephrosis?

Answer 18

anatomic abnormality, variant of normal, or an obstruction are most common

Question 19

how is hydronephrosis classified?

Answer 19

grade 0-4

Question 20

Which children require immediate evals of hydronephrosis after birth?

Answer 20

boy, history of oligodraminos, bilateral grade 2 hydro
girl, bilateral ureteroceles
boy, bilateral grade 2 or more hydro

Question 21

Who should get a VCUG for hydronephrosis?

Answer 21

grade 2 or more

Question 22

Who should get a Mag 3 for hydronephrosis?

Answer 22

grade 3 or 4

Question 23

Between incontinence and encopresis, which should be treated first?

Answer 23

encopresis because constipation could be the underlying cause to both

Question 24

What is psuedofecal incontinence?

Answer 24

due to constipation

Question 25

Treatment of encopresis involves?

Answer 25

desimpaction, maintenince (stool softener with schedule potty time), and this can last for 6 months

Question 26

Daytime urinary incontinence in older kids, you need to order what?

Answer 26

renal us to r/o neurogenic bladder, valves, or anatomic problems.

Question 27

How do you treat daytime incontinence?

Answer 27

constipation relief, and time voiding, or double voiding.

Question 28

what is mono symptomatic nocturnal enuresis?

Answer 28

the brain and the bladder are not communicating about when each needs to go.

Question 29

What is the treatment for monsymptomatic nocturnal enuresis?

Answer 29

general measures: pee before bed, limit fluids medications: not very helpful bedwetting alarm: only help about 1/2 the time.

Question 30

What is the recommend care of the uncircumcised penis from age 0 to age 8.

Answer 30

once the foreskin becomes retractable, teach children to retract their own foreskin during voiding and bathing.

Question 31

For labial adhesions, what are the treatment options?

Answer 31

observatiogn, estrogen cream or surgical lysis

Question 32

What is phimosis?

Answer 32

you cannot retract the foreskin all the way back. there is physiological and pathological

Question 33

What is the difference between physio and patho phimosis?

Answer 33

physio= ring is supple, patho= ring is thick and inflammed

Question 34

Distinguish between soft penile adhesions and the penile bridge?

Answer 34

soft= do not involve the circumcision, disappear on their own without treatment. penile = involve circumsicion, require lysis.

Question 35

This is indicated in a child with significant hypospadius, which results in outflow abnormalities and likely sexual dysfunction

Answer 35

referral to a surgeon