Urology

Question 1

How can paediatric urology problems present systemically?

Answer 1

• Fever, vomiting
• Failure to thrive
• Anaemia
• Hypertension
• Renal failure

Question 2

How can paediatric urology problems present locally?

Answer 2

• Pain
• Changes in urine
• Abnormal voiding
• Mass
• Visible abnormalities
• Incidental

Question 3

How can paediatric urology problems present antenatally?

Answer 3

• Seen on scan
• Foetus will be asymptomatic
• Permits immediate postnatal assessment

Question 4

What is the epidemiology of inguinal hernias?

Answer 4

• 2% boys
• M:F 9:1
• 99% direct
• Increase with prematurity
• <1 year 33% incarcerate

Question 5

How do inguinal hernias present?

Answer 5

GROIN swelling

Question 6

How are inguinal hernias managed in the <1 years?

Answer 6

• URGENT referral by phone

- Repair: no place for observation

Question 7

How are inguinal hernias managed in the >1 years?

Answer 7

Elective referral and repair

Question 8

How are inguinal hernias treated in they are incarcerated?

Answer 8

Reduce and repair on same admission

Question 9

How do hydroceles present?

Answer 9

• SCORAL swelling
• Painless
• Increases with crying, straining and in the evening
• Bluish colour

Question 10

Who are hydroceles very common in?

Answer 10

New-borns

Question 11

How are hydroceles managed?

Answer 11

Conservative until 5 years of age

Question 12

What is cryptorchidism?

Answer 12

Any testis that cannot be manipulated into the bottom half of the scrotum

Question 13

What are the types of cryptorchidism?

Answer 13

• True cryptorchidism
• Retractile
• Ectopic
• Ascending testes

Question 14

Why are the testis located in the scrotum?

Answer 14

To keep the sperm cool for viability

Question 15

What is the incidence of cryptorchidism?

Answer 15

• 0.8-1%

- Much more common in babies under 2kg

Question 16

What are the indications for ochidopexy?

Answer 16

• Fertility preservation
• Malignancy prevention
• trauma
• Torsion
• Cosmetic

Question 17

What is orchidopexy?

Answer 17

Fixation of testis into the scrotum

Question 18

What is circumcision?

Answer 18

Removal of the foreskin

Question 19

What are the absolute indications for circumcision?

Answer 19

Balanitis xerotica obliterans

Question 20

What are the relative indications for circumcision?

Answer 20

• Balanoprosthitis
• Religious reasons
• UTI

Question 21

What are the suggested advantages of circumcision?

Answer 21

• UTI prevention
• Malignancy prevention
• Sexual enhancement (increased nerve endings in prepuce)
• AIDS/STDs
• Overall no medical benefit

Question 22

What are the disadvantages of circumcision?

Answer 22

• Painful
• Complications
• Looks different

Question 23

What are the possible complications of circumcision?

Answer 23

• Bleeding
• Meatal stenosis
• Fistula
• Cosmetic

Question 24

What is the differential diagnosis for the acute scrotum?

Answer 24

• Torsion testis
• Torsion appendix testis
• Epididymitis
• Trauma, haematocele, incarcerated inguinal hernia

If in doubt, explore the scrotum

Question 25

How long are the testis viable in an acute scrotum?

Answer 25

6-8 hours

Question 26

Why are UTIs investigated?

Answer 26

Prevent renal scarring -Reflux nephropathy and CKD Prevent hypertension

Question 27

Who is investigated for UTI?

Answer 27

All 6/12, atypical and recurrent

Question 28

How is a UTI defined?

Answer 28

Pure growth of >10^5 with pyuria and systemic upset Mixed growth bacteria with no pyuria or systemic upset is less significant

Question 29

How are UTIs assessed?

Answer 29

History and examination -FH, bowel habit, voiding dysfunction Ultrasound scan -Number, size, position, shape, hydronephrosis Renography - MAG3 - drainage, function, reflux DMSA- function, scarring Micturating cystourethrogram (MCUG)

Question 30

How is VUR managed?

Answer 30

Conservative -Voiding advice, constipation, fluids Antibiotic prophylaxis - ? Until age 4 - Trimethoprim (2mg/kg nocte) STING -Mild/moderate with symptoms Ureteric reimplantation

Question 31

What is hypospadias?

Answer 31

Urethral meatus on the ventral aspect of the penis

Question 32

How is hypospadias classified?

Answer 32

- Anterior 50% - Middle 30% - Posterior 20%

Question 33

What are the associated anomalies of hypospadias?

Answer 33

- Upper tract abnormalities | - Intersex

Question 34

How is hypospadias investigated?

Answer 34

- Clinical examination | - US if severe

Question 35

How is hypospadias managed?

Answer 35

DO NOT CIRCUMCISE | -One stage or 2 stage surgical procedure