Paediatric Urology

Question 1

What are common urology conditions?

Answer 1

• Hernias and hydroceles
• Undescended testes
• Childhood UTI
• Peno-scrotal conditions

Question 2

How does the presentation of urological conditions differ from adults?

Answer 2

• Systemic
  
  • Fever, vomiting
  • Failure to thrive
  • Anaemia
  • Hypertension
  • Renal failure
• Local
  
  • Pain
  • Changes in urine
  • Abnormal voiding
  • Mass
  • Visible abnormalities
  • Incidental
• Antenatal
  
  • Asymptomatic
  • Permits immediate postnatal assessment

Question 3

Inguinal hernia - epidemiology

(sex)

Question 4

Inguinal hernia - presentation

Answer 4

• Lump in left/right groin that appears and reappears
  
  • Key feature is groin and not scrotum

Question 5

Inguinal hernia - management

Answer 5

• <1 year
  
  • Urgent referral
  • Repair – no place for observation
• >1 year
  
  • Elective referral and repair
• Incarcerated
  
  • Reduce and repair on same admission

Question 6

Hydrocele - presentation

Answer 6

• Lump in scrotum that appears and disappears
• Bluish colour
• Painless

Question 7

Hydrocele - management

Answer 7

• Conservative until 5 years old

Question 8

What is cryptorchidism?

Answer 8

Undescended testes

Question 9

Cryptochidism - presentation

Answer 9

• Scrotum empty at bath time

Question 10

Cryptochidism - management

Answer 10

• Maybe orchidectomy
  
  • Indications – fertility, malignancy, trauma, torsion, cosmetic

Question 11

Normal non-retractile foreskin - presentation

Answer 11

Young presentation (physiological):

• Non-retractile foreskin
• Recurrent balanitis
• Pinhole meatus

Question 12

Balinitix xerotica obliterans - presentation

Answer 12

• Older children
• Non-retractile foreskin
• Struggling to pass urine
• Scarred foreskin, narrow meatus

Question 13

Balinitix xerotica obliterans - management

Answer 13

• Steroid cream
• Circumcision
  
  • Removal of foreskin
  • Indications – balanitis xerotica obliterans, balanoprosthitis, religious, UTI

Question 14

What are indications for circumcision?

Answer 14

• Indications – balanitis xerotica obliterans, balanoprosthitis, religious, UTI

Question 15

Testicular torsion - presentation

Answer 15

• Unilateral testicular pain
• Scrotum red, asymmetry, acutely tender to touch

Question 16

Testicular torsion - management

Answer 16

• Emergency, operation asap

Question 17

Torsion appendix testis - presentation

Answer 17

• Unilateral testicular pain
• Red scrotum
• NO ASYMMETRY
• Blue spot seen
• Tender to touch

Question 18

UTI - definition

Answer 18

• Pure growth bacteria > 10⁵
• Pyuria

Question 19

UTI - clinical features

Answer 19

• Pyuria
• Systemic upset
  
  • Fever, vomiting

Question 20

UTI - investigations

Answer 20

• USS
• Renography
  
  • MAG3 – drainage, function, reflux
  • DMSA – function, scarring
• Micturating cystourethrogram (MCUG)

Question 21

Vesiculoureteral reflux (VUR) - pathology

Answer 21

• Urine flows backwards from bladder to one or both ureters and sometimes kidneys

Question 22

Vesiculoureteral reflux (VUR) - management

Answer 22

• Conservatrive
  
  • Voiding advice, constipation, fluids
• Antibiotic prophylaxis
  
  • Trimethoprim
• STING
• Ureteric reimplantation

Question 23

Hypospadias - pathology

Answer 23

• Urethral meatus on ventral aspect of penis

Question 24

Hypospadias - classification

Answer 24

• Anterior (most common)
• Middle
• Posterior

Question 25

Hypospadias - associated abnormalities

Answer 25

* Upper tract * Ambiguous genitalia

Question 26

Hypospadias - investigations

Answer 26

* US * Karyotype * Only if severe

Question 27

Hypospadias - management

Answer 27

Surgery