Peds GU

• control at 18-36months
• readiness:
• shows interest in potty
• understand and follow simple directions
• able to communicate needs
• BM at regular intervals everyday
• able to sit for short periods
• remains dry throughout 2hr nap
• knows when they defecate

• provide potty and place in bathroom
• sit on potty chair with clothes on at first
• give child's book/video on potty training
• place on potty when anticipating #1 or 2
• praise for results (stickers, etc) AVOID candy/food
• stop if not interested dont force issue (restart when become interested)

• 1. uncomplicated:
• cystitis and pyelo develop in absence of structural abnormality, obstruction, or other dz
• 2. complicated:
• cystitis and pyelo develop in presence of structural abnormality, obstruction, or other dz

• 1. newborn= male >female 5x
• 2. 6mo=female > male 10x
•   increase incidence girls potty training
•   3-5yr girls with detrusor instability
•   sexual activity
•   pregnancy

• bacteria
• viral
• fungal
• STI
• congenital obstructive lesion
• nonobstructive cz
• acquired nonobstructive cz

• uncomplicated:
•  E. coli 85%
•  S. saprophyticus
• complicated:
•  E. coli 20%
•  S. aureus

• short female urethra
• uncircumsized male in 1st 6 months (10x higher incidence)
• incomplete bladder emptying

• infants= no other source identified, <2months associated w/sepsis
• <3yrs= due to UTI in 13% girls and 7% boys

fever, poor feeding, vomiting, irritability, weight loss, FTT, foul smelling urine

• uncircumsized male <6mo
• lack of breast feeding
• female
• constipation
• VU reflux
• obstruction
• recent ATB use
• family HX
• pregnancy

• poor hygiene
• bubble bath use
• type of undergarment
• pinworms

• gold= urine C&S
• not trained= straight cath
• trained= mid stream clean void in AM

• uncomplicated=
• Bactrim DS, Amoxi, Augmentin, Gantrisin, Macrobid DS
• TX for 10-14 days

• F/U 1-2wks after completion of meds
• 1-3 months until free of infection for 1yr
• then F/U yearly

• prophylactic ATB's= recurrent UTI >3 in 6month period (refer)
• sexually active adolescent postcoital

prognosis reinfection: 40% female, 32% male

• increase fluid intake
• frequent complete voiding of bladder
• perineal hygiene- front to back wipe
• white cotton undies
• avoid bubble bath
• F/U if sx not improved

• wetting
• frequency, urgency
• dysuria relieved by voiding
• may/may not have fever

• fever
• flank, back pain
• CVAT
• WBC casts in urine
• elevated ESR and CRP

etiology: >80% E. coli 0157:H7, undercooked meat and unpastuerized milk

• patho- toxin produced and absorbed form intestine
• endothelial cell injury leads to intravascular coagulopathy
• microangiography results hemorrhagic colitis

• oliguria/anuria
• HTN
• pallor
• lethargic
• watery D+= after 3 days becomes bloody and painful
• petechiae, purpura, bruising
• mild hematuria
• microangiopathic hemolytic anemia
• thrombocytopenia (90%)

• hospitalized
• supportive care
• dialysis
• contraindicated ATB's (avoid bc makes bacteria worse)

• long term F/U
• PX= mortality <10% (w/appropriate mgmt)
• 9% develop ESRD
• late findings appear after 20yrs
•    HTN
•    CRI
•    proteinuria

• immune response of the kidney to group A beta-hemolytic streptococcus (GABHS)
• most common form of nephritis in kids 5-12yrs peaks at 7yrs
• male >female (2:1)

• enlargement and inflammatory response of the glomeruli
• latent 7-14 days after pharyngitis (winter)
• latent 21-42 days after impetigo (winter)

• HX
• sudden onset gross hematuria/proteinuria
• oliguria
• lethargy
• anorexia/vomiting
• abdominal pain
• fever
• periorbital edema

• HTN (60%)
• CVAT
• periorbital edema

• UA: RBC casts, leukocytes, > protein 2+++
• CBC:
• lytes: K, BUN, Crea elevated
•           TP, Na decreased
• ASO elevated
• ESR elevated
• Cult: neg

• treat effects of HTN and renal insufficiency
• 10 day course ATB's to limit spread of nephritogenic organism
•     low Na diet
•     daily weights
•     UOP measured
•     follow closely
•     refer to nephrologist
•     hospitalized
•     diuretics, vasodilators, fluid and sodium restriction,
•     rest

• 95% complete receovery in 6-8wks
• hematuria may persist for 1-2yrs
• recurrences are rare
• BP monitor monthly for 6 months
• monitor lytes Q3months for 1 year

• prevalence:
• <1yr old w/UTI, >50% DX w/VUR
• reflux found in 35-50% siblings
• 1% kids have VUR
• mean age 2-3yrs
• 80% DX after UTI
• girls>boys

• flow of urine from the bladder into the ureter and renal pelvis
• different degree of involvement and graded

• I-III: low grade= reflux to renal pelvis w/little to no distention
•     self limiting
•     70-80 % by follow up
•     20-30% resolve in 2 yrs
• IV-V: high grade= distention of ureters and renal pelvis

• VCUG (voiding cystourethrogram) is gold standard
• U/S
• IVP

• urine C&S every 6months or if symptomatic
• ATB's 1/3 or 1/2 dose QHS: prophylactic to prevent scarring
•      Bactrim
•      Augmentin
•      Cephalosporin
• VCUG Q18months
• how long to TX asymptomatic: 6-8yrs age, 1-2neg VCUG's

surgical

• I-II= 80% resolve in kids <5yr
• III= unilateral 46% resolve, bilateral 10% resolve
• IV-V= surgical 95% corrected
• LTC= HTN
•      renal scarring
•      pyelonephritis
•      ESRD

• VUR
• pyelo in kids <1yr
• recurrent cystitis (>3x in one year)
• renal scarring in girl <10yrs

def- involuntary urination at night w/o dry period of any sustained length by kid >5yr

• HX-
• UTI
• allergies
• DM
• delayed neuro development
• family HX
• changes at home or school

primary: kid has never been dry, no UTI, PE normal

secondary: kid has been dry >6-12 months, no UTI

DDX- UTI, VUC, primary or secondary nocturnal enuresis

• watchful waiting <7yr
• behavior modification
• hypnotherapy (no evidence yet)
• enuresis alarm pads (75% success)
• bladder training- during day hold urine longer to increase bladder capacity
• short term- camp or sleepovers (DDAVP)

• explain child is not doing it on purpose
• dont punish
• talk with siblings
• support and reinforce success
• PX:
• cure rates 60-80% long term
• alarm and behavior therapy works best

• benign or symptom of dz
• origin: golmerulus or tubules
• clinical findings:
•    asymptomatic
•    polydipsia, polyuria, edema (periorbital),HTN,malaise,
•    fatigue

• UA= 75% asymptomatic pts repeat UA then normal findings
• **significant if**
•    protein +1 and SG <1.015
•    protein +2 and SG >1.015

body excretes abnormal amts of protein when upright but normal amounts when lying down

labs: morning void trace > protein +1

• nephrotic syndrome
• define- changes in the renal tubule without inflammation
• sx- orbital edema, low UOP, anoreix, FTT
• mgmt- refer to nephrologist

• sx pyelonephritis regardless of age and gender
• UTI kids <8yrs
• male w/first infection
• female w/second infection
• child w/suspicious factors:
•    HTN
•    FTT
•    abnormal urine stream

• evaluates structural and developmental abnormalities
• weak in identifying scarring or VUR

only way to eval for reflux

• nuclear study
• ID scarring and examines renal fxn

• 10-20/1000 births
• male > female (6:1)
• 55-70% R side
• increased incidence w/preemies (30%)
• 12-17% incarcerated

process vaginalis fails to obliterate

indirect= congenital= bowel or omentum is forced into scrotum via the inguinal canal

• direct= acquired r/t obesity, weight lifting, family HX
• increased incidence after 3 yrs

mgmt= surgery

• common in infant to adult
• sudden onset
• risks-
•      anatomical= poor fixation at birth
•      strenuous activity
•      HX of intermittent torsion

• color doppler U/S if not clinically clear
• irreversible ischemia after 12 hrs
• immediate surgical intervention
• detorsion and fixation of testicles

• rare
• risk factors=
• UTI/sepsis
• instrumentation
• unprotected intercourse w/infected partner

• exquisite tenderness
• swelling at epididymis
• fever
• increased WBC w/sepsis
• negative UA and urine C&S

• STD:
• Chlamydia
• Gonorrhea

• Typical:
• E. coli
• pseudomonas

• hospitalize if sepsis
• Chlamydia or Gonorrhea- Rocephin 250mg IM, Doxy100mg x10days
• other gram negs- Cipro/Levaquin x2wks
• F/U- 2-3wks

• dilatation of the pampiniform plexus of spermatic veins
• 15-20% post pubertal males
• 70% left
• 30% bilateral

• dull, aching L scrotal pain, typically worse w/standing and relieved by recumbency
• testicular atrophy
• 25% males infertile w/varicocele

• indicated in younger males for infertility/testicular atrophy
• referral to urologist
• surgical TX ligating the gonadal vein to stop retrograde blood flow
• scrotal support/NSAIDS

• cystic masses, vary in size
• arise from the caput of the epididymis
• always located superior to the testis
• epididymal cyst are one size 0.5mm-1cm

• 2cm-5cm in size (epididymal cyst smaller)
• palpated distinct from the testis
• U/S
• assurance
• pain= scrotal support and NSAIDS
• rarely require surgery

• peritoneal fluid between parietal and visceral layers of tunica vaginalis
• small to massive
• idiopathic
• inflammatory

• slow accumulation
• trauma or infection
• infants w/communicating patent processus vaginalis
• pain and disability increase with size
• illuminates w/penlight in dark room

physiologic adherence of uncircumsized foreskin to gland

• 1:250 live births
• genetic
• 5x higher incidence in infants conceived through IVF
• mgmt- surgical repair 6-12 months
• PX- erection normal, fertility unaffected