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32 Cards in this Set

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What is the incidence of teen varicoceles?
~20%
What are the consensus recommendations on the tx of varicoceles?
1. surgical correction for ipsilateral volume loss >10-20%
2. surgery for symptoms
3. surgery if bilateral
4. observe if no testicular hypotrophy
5. surgery for Grade III if parents prefer
What are the complications with varicocelectomy?
1. hydrocele (~15%)
2. recurrence (more common with artery-sparing)
T/F: Infant hydroceles usually do not require intervention and resolve w/in 1-2 yrs of life
True; it is routine to operate those detected after the first 2 yrs of life
T/F: Pediatric hydroceles, like adult hydroceles are approached through the scrotum.
False; inguinal approach
What is the time period to worry about the contralateral groin in a unilateral presentation of hernia/hydrocele?
bilateral groin surgery in infants w/in 1-2 yrs of life
Does an apparently open internal ring on laparoscopy necessarily correlate with the development of a clinical hernia or hydrocele?
No; controversial
What do you suspect with a palpable gonad in the groin or labia of a girl?
most often an ovary; 1% represent males with complete androgen resistance and the gonad is a testis!
When does testicular descent occur?
28 wks
What % of testicular nubbins have germ cells?
8%
Testicular and epididymal appendices are vestigial remnants of what structures?
mullerian and wolffian ducts, respectively
How does torsed appendixes present differently from torsed testicle?
typically have less severe pain and are comfortable at rest but bothered by movement of the inflamed hemiscrotum
What's the tx algorithm for the acute scrotum?
acute onset, no scrotal rxn --> exploration;
gradual onset, scrotal rxn --> US, if intratesticular blood flow, then NSAIDs; if no flow, then exploration
When does the ureteral bud form?
5th wk
When does the fetus begin to make urine?
5-8th wk
When can you see hydro on prenatal US?
12-18th wk
When do you see distinct renal architecture?
20th wk
What is normal amniotic fluid volume?
380cc @ 20wks
800cc 28-40 wks
When is amniotic volume dependent on urine production?
16 wks
Potter's syndrome:
Flat nose,recessed chin, low set ears, bowed legs, small chest, tales equinovares, hypoplastic hands
When can you see the fetal genitalia?
24th wk
What is the most sensitive and reproducible parameter on US for pathological hydro?
AP diameter
Worse if calyceal dilatation also
Favorable urinary parameters for fetal intervention:
Over 3 days,
Na<100 mg/dL
Cl<110 mg/dL
Osm<210 mOsm/L
B2-microglobulin <4 mg/dL
CA<8 mg/dL
total protein <20 mg/dL
VATER syndrome
Vertebral defects
Anus imperforate
TE fistula
Radial/renal dysplasia
Cutoff for differential renal function in MAG-3
>40%
Indications for UPJO repair
<40% fcn + poor washout parameters
progressive hydro on US
progressive loss renal fcn
Renal pelvis size >5cm
Infection/stone
Endopyelotomy success rate
80-85%
Does periureteral diverticula alter the resolution rate?
No, unless it is large
Resolution rates for VUR
Grades
I: >90%
II: 60-85%
III: 50%
IV: 25-40%
V: <20%
ESRD in VUR
10%
90% will have diminished GFR
How does VUR complicate pregnancy?
Associated with Inc rates of pyelo, toxemia, pre term delivery, fetal growth retardation, fetal loss and Dec maternal renal function
What is the reported incidence of VUR in children with prenatal diagnosed hydro?
5-20%