Phimosis

narrowing/stenosis of preputial opening

normal finding in infants and young boys

normally resolves by around 3

treatment: circumcision

Hydrocele

collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum

2 types:

communicating - it will slide up or down, changes in size, will get bigger if child is crying, smaller when child has been lying down, inc. risk of hernia

noncommunicating - can be present at birth or develop years later, not change in size or will have very slow growth in size

Cryptorchidism

failure of testicles to descend into scrotal sac by birth

4 of 100 newborns, higher in preemies

75% correct itself by first birthday

often associated with hernias - will need surgery if doesn't correct self

higher risk for testicular cancer if not corrected

Urethral Stenosis

urethral opening is smaller than usual

difficulty in starting urination

urinating in strange angles

surgery to correct

Hypospadias

urethral opening beneath glans or ventral surface of penis

often associated with cordee (ventral curvature of penis)

familial 10-20% have 1st degree male relative with same condition

1 in 300 live births

5 fold increase with IVF

may have undecended testicle as well

do not let child with this condition to get circumcised (will use that skin in surgery)

Epispadias/Bladder Extrophy

urethral opens along top portion of penis

girls can have - at clitoris and labia

males > females

may be dx prenatal US

increased risk with parent hx of disorder

associated wtih diastasis of pubic bone

may have bifid clitoris or penis

females and males can have normal sexual function

Bladder extrophy treatment

immediate care post delivery: plastic wrap, antibiotics, no latex use

surgery - staged procedures

automatic LATEX precautions

Obstructive Uropathy

structural or functional abnormalities of the urinary tract that obstruct the normal flow of urine

eventually will cause dilation of the kidneys

associated with other congenital defects

can lead to acute/chronic renal failure and/or infection

may need nephrostomy tubes depending on severity

Vesicoureteral (renal) Reflux

abnormal backwash of urine into the ureter

primary: anatomic abnormality

seconday: acquired secondary to UTI or obstruction

autosomal dominant

muscles are weak and don't completely close, therefore urine can backwash

most resolve by 8 y/o, depends on stage

dx: voiding cystourethrogram (VCUG) - insert urinary cath into bladder with dye and take pictures to locate dye transportation, KUB

Renal Reflux: Treatment

control infection

continuous low dose ATB to prevent UTIs

frequent urine cultures (dip stick)

surgery grade III, IV, & V

deflux surgery - inject a silicone type base in opening of ureters to prevent backwash

UTI

presence of bacteria in the urinary tract

neonatal: boys > girls

non-structural UTI: peak age 2-6 y/o

typically asumptomatic - may complain of abd pain or wetting accidents

increase in adolescence with sexual activity

inc in males who are uncircumcised

Anatomic Factors of UTIs

short urethra of females

urinary stasis

renal reflux

anatomic abnormalities

extrinsic ureteral/bladder compression (constipation)

dysfunctional voiding - holding in, accidents, not potty-trained

External Factors of UTIs

Tight clothing

poor hygiene

local inflammation secondary to

vaginitis

pinworms

masturbation

bubble baths

sexual intercourse

caffeine, chocolate, citrus, carbonation can irritate UTI

Clinical Manifestations < 2 y/o

FTT

feeding problems

emesis

diarrhea

jaundice

NEONATES

fever

hypothermia

sepsis

irritability

abnormal stream

Clinical Manifestations > 2 y/o of UTI

enuresis

fever

strong smell to urine

increased frequency

dysuria

urgency

flank pain

high fever/chills (pyelo)

Clinical Manifestations of Adolescents in UTIs

LOWER TRACT

classic s/s

frequency

hesitancy

dysuria

hematuria

UPPER TRACT

fever

chills

flank pain

lower tract s/s 2 days after upper onset

UTI Dx

H&P - bubble baths, change of lotion, soap, etc.

Exam

Urinalysis (specimen collection issues)

dipstick

may need further tests if recurrent

VCUG, IVP, US

UTI Rx

Antibiotics (oral or IV) inpatient or out

Repeat urine cultures q 3 months

further evaluation

daily low dose abx

fluids inc. - water, avoid sodas/teas/flavored water

prevention

Glomerulonephritis

acute immune-complex disease

often follows strep infection

winter or spring

male > female

5-15 peak ages

Acute Glomerulonephritis

acute edema phase: 4-10 days but can last 2-3 weeks

S/S continue: edema, high BP, low urine output, blood/protein in urine, hx of strept throat, on U/A lots of blood and protein, retain sodium and water (which causes edema); strict I/O, fluid restriction, monitor K if low urine output

Glomerulonephritis

antigen-antibody complexes trapped in glomerulus

inflammatory response

damage to capillaries

decreased GFR

renal insufficiency

sodium & fluid retention & passage of large molecules (RBCs)

Initial S/S of Glomerulonephritis

facial edema esp. periorbital

anorexia

dark-colored urine

decreased urinary output

Glomerulonephritis: Labs

U/A: dark urine, RBCs, proteinuria, high SG

Lytes: BUN & creatinine abnormal

Nephrotic Syndrome

most common glomerular injury in children

types

primary

secondary

minimal change

congenital

damage to glomerular basement membrane

increased permeability

increased loss of plasma proteins (albumin)

heavy proteinuria

unexplained weight gain, dec output, pale, fatigued

intravascular fluid into interstitial spaces (ascites)

hypovolemia, increased renin, increased aldosterone

tubular reabsorption of Na and Fluid to restore intravascular volume

Glomerulonephritis: Rx

rest

diet: low salt

fluids: restrictions

steroids

diuretics

Varicocele

dilation of venous plexus and spermatic vein

occur 20% of men, 40% of infertile men

more common in left testicle

may impair sperm production

Rx: surgery

forms when bowels inside of veins in spermatic cord, blood backup, swelling of veins, make more wide

most common during 15-25 years old

Testicular Torsion

twisting of spermatic cord structures

may be in inguinal canal or below

peak age 13 years old

often in left testicle rather than right

severe testicular pain, sudden onset

swelling, erythema

surgery needed immediately, may be able to save testicle

Testicular Torsion: Rx

early dx

pain med

manual detorsion (work 30-70%)

surgery to detorsion & orchiopexy

may lose testicle - surgery within 6 hours to save testicle

Menstrual Disorders

primary amenorrhea - none by age 17 d/t malnutrition, athletic, obese, systemic disorders (DM)

secondary amenorrhea

Primary Amenorrhea

no menses by 17

causes

malnutrition, athletic, obses, systemic disorders (DM)

Secondary Amenorrhea

no menses for 6 months after regular periods

causes

pregnancy

stress

thyroid disease

polycystic ovarian syndrome

chronic illness

weight loss/gain

intensive exercise

eating disorders

Dx

history - family hx of repro problems

physical exam - vitals, height, weight, sexual maturity rate (sexual organs, tanner staging), pelvic

labs

estrogen/progesterone levels

hgbA1C

thyroid panels

Labs

depends on if signs of puberty present

delayed puberty

thyroid, bone age, LH, FSH & prolactin

normal puberty

HCG, LH, FSH, & prolactin

genital tract abnormalities

US (make sure have right organs), karotype

Rx depends upon cause