Peds - GU and GYN Flashcards
(28 cards)
Define primary enuresis
bladder control has never been established (in a child old enough that it is expected)
Define secondary enuresis
had bladder control for 6-12 months or more and then lost it
Define nocturnal enuresis
incontinence during sleep
Define diurnal enuresis
incontinence during waking hours
What percentage of 10 year olds have enuresis?
up to 3%
What percentage of enuresis is functional in orgin (in other words there is no underlying cause)?
95%
What diagnostic tests are important to perform in children with enuresis?
urinalysis and urine culture to rule out UTI
What is the most effective treatment for enuresis?
Hypnosis and self-hypnosis
What medications can be used for enuresis?
o imipramine (Tofranil) -- anti-dep also used in migraine o Desmopressin (DDAVP) o oxybutinin (Ditropan)
What are important considerations to keep in mind if using medications for enuresis?
o must give drug holiday
o when not on the medication, recurrence is expected
What organism is most likely implicated in “uncomplicated” UTI?
E. coli in 80-90% of cases
What organism is most likely implicated in “complicated” UTI?
Staph aureus
often seen with catheterization in hospital
Predisposing factors for UTI (6)
o urinary STASIS o OBSTRUCTIVE lesions o NEUROGENIC bladder o poor HYGIENE o CONSTIPATION o INTERCOURSE
Signs of UTI in infants (3)
o may be asypmtomatic
o irritability
o failure to thrive
What might urinalysis show in UTI? (3)
o leukocytes
o erythrocytes
o nitrites
What might CBC show in UTI? (1)
leukocytosis
Duration of antibiotic therapy for younger children with UTI?
7-10 days
Antibiotics used for UTI in children (4)
o trimethoprim/sulfamethoxazole - TMP/SMX (Bactrim)
o cephalosporins
o amoxicillin
o nitrofurantoin (Macrobid)
Follow up after initiation of therapy in UTI
o follow-up in 2 days and change antibiotic if no improvement
o follow-up in 1-2 weeks
o then every 1-3 months x 1 year
What is the treatment of UTI in children < 2 months of age?
Hospitalization
parenteral antibiotics
When is a renal ultrasound indicated?
After first UTI in febrile children 2 - 24 months of age
When is a VCUG indicated?
If ultrasound is reflective of renal abnormalities
What is prime age for hypospadias repair?
6 - 12 months
Management of cryptorchidism
o if undescended at 1 year, refer to urology
o teach testicular self examination due to increased testicular cancer probability
