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