Urology Flashcards
(46 cards)
What is the first investigation to do for congenital urinary obstruction?
US
What are the x2 functional assessments that can be done in the setting of urinary obstruction?
- DMSA
- MAG3 (gold standard)
What is the most common cause of congenital urinary obstruction?
UPJ
What x2 investigations do you do for PUV?
- US
- Voiding cystourethrography
What x2 complications from intra-uterine environment for neonates with PUV?
- pulmonary hypoplasia
- renal insufficiency
What is the concern for paraphimosis?
emergency because can lead to gangrene
Best timing for hypospadias correction
6-18 months
How to treat phimosis?
- Betamethasone cream 0.1% BID x2 weeks on then off x4 cycles, need to retract foreskin
- Circumcision
What APD measurement of the kidney would be consider “high grade” for congenital hydronephrosis?
> 15 mm
Most common cause of urinary obstruction in children
UPJ
What x2 things can VCUG detect?
- PUV (in males only)
- VUR
What is the important indication for renal scans that other imaging modalities cannot provide?
Differential renal function
Difference between DMSA vs MAG3
- Both provide functional information
- DMSA = renal scarring
- MAG3 = filtration + drainage
All grades of congenital hydronephrosis carry a 10-15% risk of what?
VUR
4 most common causes of high grade congenital hydronephrosis
- UPJ obstruction
- UVJ obstruction
- VUR
- PUV
What is the APD measurement in low grade congenital hydronephrosis?
<10mm
When should you do the first post-natal RBUS for (a) low grade vs (b) high grade congenital hydronephrosis?
(a) first 1-3 months
(b) first 2 weeks
Most common cause of acquired hydronephrosis
UPJ obstruction
Investigations for acquired hydronephrosis
- RBUS
- Diuretic renal scan (MAG3)
Typical presentation of acquired hydronephrosis
- Recurrent abdo pain + flank pain
- Recurrent pyelo
- Emesis/pain following increased fluid intake
Clues on prenatal US to suggest PUV
- Male
- Oligohydramnios
- Bilateral hydronephrosis
- Distended, thick-walled bladder
- Keyhole sign
Post-natal management if PUV
- Stabilize respiratory
- Decompress bladder
- Check Cr
- Urgent RBUS + confirmatory VCUG
- Consult nephro + urology
What is the most common non-infectious cause of daytime urinary incontinence?
Overactive bladder
What are x2 scary things you want to make sure are not present in setting of overactive bladder?
- Signs of spinal dysraphism / sacral agenesis (aka caudal regression syndrome)
- Bladder outlet from scarred phimosis or meatal stenosis
