GU peds exam 2

over 1st 5 years of life

• efficiency increases with age
• -less able to concentrate urine
• GFR 30% fo adult level at age 1

• increases with age
• ureters are short

auricle

• after retraction occurs, retract and clean with soap and water
• NEVER FORCE
• ALWAYS REPLACE AFTER CLEANING

• STD prevention
• decreased # of UTIs (1% to 0.1%)
• penile cancer (rare) : prevention is hygiene 

• consent 
• not precise with NB

• buried penis 
• large hernia
• small, ambiguous genital,
• hypospadias

• tylenol
• local penile block
• sucrose 
• white noise

• bleeding
• swelling

• trapped penis
• suboptimal cosemsis 
• adhesions, skin bridges
• meateal stenosis

• consent signed
• schedule prior to next feeding
• prepare equip
• restrain on board, keep warm
• adminster meds, sweeties

if Gomco used: apply vaseline gauze to penis

after it falls off: apply vaseline to diaper area at circum site for 24 hours

• resolves 3-5 years
• LEAVE PENIS ALONE
• can occur due to infection, forceful retraction
• signs: unable to retract foreskin
• -ballooning of foreskin while peeing
• Treatment: steriod application 4-6 weeks, cir, dorsal slit

• undescended testes
• normally descended by: 7-9 mon of gestation
• causes: testosterone deficient, absent/defective testes, structural problem, short spermatic cord or adhesions

higher temp in abd may damage: infertility and malignancy

• commonly found on NB assessment
• associated with inguinal hernia
• US, CT, MRI, used to locate testes
• IF NOT descended by 12 months: surgical procedure(orchiopexy)

• inability to replace foreskin 
• -hospital cath
• -child

• treatment: ice with penile block for pain
• compression, squeeze out edema
• then gently reduce
• may need surgery

• after circumcision
• signs occur after potty training:
• thin, deflected urinary stream
• straining 
• dysuria
• terminal hematuria

surgical repair if bothersome

• bedrest
• monitor voiding
• ice to surgical site
• sponge bath for 2 days after
• identify s/s infection
• analgesic for pain
• DO NOT STRATTLE ACROSS HIP 
• no strenous activity or riding straddle toy for 2 weeks after

• painless, scrotal swelling when bowel falls into inguinal canal
• common in males

signs: swelling of scroctum , round, smooth, nontender mass; more apparent when crying/.straining ; reducible (not recommended for routine exam(

treatment surgical usually after 3 months to avoid incarceration 

incarceration=surgical emergency

• "lights up"
• collection of fluid in the scrotum 
• very common
• resolves spontaneously with time
• dx with transillumination

• testes suddenly rotate on speramtic cord and cuts off blood supply to testis
• leads to vascular engorgement and ischemia 
• can occur in adulthood 
• 2/3 cases: 12-18 yrs

signs: severe pain, scrotal swelling, discoloration, N/V, abd pain, tenderness

• usually have NORMAL UA
• surgery within 6 hour to save testes

• rare 1 in 35,000-40,000 NB
• bladder extrudes through abd wall, bladder tissues abnml, wide pubic symphsis 
• most common in males
• failure to abd wall to close
• urine leaks onto skin
• severity varies
• repair: cover with plastic wrap 
•   -primary closure 48-72 hours after birth

• meatal opening on DORSAL side of penile shaft
• broad, spacelike penis
• opening may extend down the entire shaft
• dx made on NB exam

• abnormal location of the urethreal meatus, occuring anywhere on the ventral surface of the shaft
• fairly common defect 1 in 200-300 boys
• dx: made on 1st exam
• repair by 1 year of age
• DO NOT CIRCUMSIZE!!

• testosterone therapy prior to surgery
• stent for urinary drainage
• do not dislodge stent, double diaper
• immoblize of UEs
• encourage fluid intake
• strict I/O
• no tub bath until stent or catheter is removed