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Pediatric Urology Consultant Reference Guide

 

Table of Contents

 

General

Disease State Work Up and Initial Management When to Refer
Spina bifida, neurogenic bladder; of any cause RUS, VCUG Upon Diagnosis
Urinary Stones CT A/P w/o contrast, KUB, UA, Ucx Upon Diagnosis
Microscopic Hematuria UA, Urine Cx, random urine calcium:creatinine ratio (NL<0.20), RUS nephrology if proteinuria, urology if abnormal tests
Macroscopic Hematuria UA, Urine, Cx Upon Diagnosis

Bladder

Disease State Work Up and Initial Management When to Refer
Febrile UTI- boy/girl, any age UrineCx, UA, RUS and VCUG; on first episode, prophylactic antibiotics After imaging studies
UTI of any child <2 yrs, any male UrineCx, UA, RUS and VCUG; on first episode, prophylactic antibiotics After imaging studies
Multiple UTI’s (>3), girl >2 yrs UCx, RUS, KUBĀ± prophylactic antibiotics After imaging studies
Diurinal Urinary Incontinence >3 yrs old UA, UCx, RUS, KUB, Timed Voiding-every 2 hrs, Bowel Management (Increase fluids and fiber, stool softeners) If imaging studies are abnormal, no response to initial therapy
Primary Nocturnal Enuresis Enuresis Alarm, DDAVP, Reassurance No response to initial therapy, >6 yrs old
Frequency/Urgency w/o UTI UA, UCx, Timed Voiding, Bowel Management Sx. >2 mos, or severe symptoms

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Kidney

Disease State Work Up and Initial Management When to Refer
Prenatal Hydronephrosis RUS, VCUG w/in 2-3 wks of birth; treat w/Amoxicillin or PVK 25 mg/kg/qday until seen by urologist; (MAG-3) renal scan w/Lasix at 1 mo if indicated by urologist Prenatal counseling for parents. Baby post-birth after studies
Hydronephrosis RUS, VCUG, UCx, UA Any abnormality
Multicystic Renal Dysplasia RUS, VCUG, UCx, UA Prenatal counseling for parents. Baby post-birth after studies
Kidney Tumor CT A/P w/ AND w/o IV Contrast Immediately after confirmation

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Ureter

Disease State Work Up and Initial Management When to Refer
Vesicoureteral Reflux RUS, VCUG, UCx, UA Upon Diagnosis
Ureterocele RUS, VCUG, UCx, UA Upon Diagnosis
Ectopic Ureter RUS, VCUG, UCx, UA Upon Diagnosis
Megaureter RUS, VCUG, UCx, UA Upon Diagnosis
Renal/Ureteral Duplication RUS and VCUG Upon Diagnosis

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Urethra

Disease State Work Up and Initial Management When to Refer
Posterior Urethral Valves RUS, VCUG, UCx, UA Upon Diagnosis (Urgent)
Hypospadias RUS if opening is at or more proximal than penoscrotal junction. Endocrine workup if at least one testis is undescended Early Parental Counseling. At 6 mos to plan for surgery
Meatal Stenosis Observe urine stream, will deviate laterally or upward Upon Diagnosis
Urethrocutaneous Fistula Observe urine stream Upon Diagnosis

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Penis

Disease State Work Up and Initial Management When to Refer
Phimosis
Paraphimosis
Chordee
Post-Circumcision Adhesion
Ambiguous Genitalia
Micropenis

Female Genetalia

Disease State Work Up and Initial Management When to Refer
Labia Fusion

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Testis/Scrotum

Disease State Work Up and Initial Management When to Refer
Undescended Testis Imaging studies generally not necessary Early Parental Counseling. At 6 mos to plan for surgery
Testis Mass Scrotal US w/Doppler. Tumor Markers (HCG, AFP, LDH, Testosterone) At diagnosis or suspicion
Testes Torsion ER referral for immediate scrotal US w/Doppler. Pain control At presentation (Emergent)
Torsion of testicular appendages (confirmed on US, testicular blood flow normal or increased) Ibuprofen, 10mg/kg QIDx 2 wks. Scrotal elevation. +/- ice packs. Light activity Persisitent swelling or recurrent pain
Epididymorchitis (+UA or Ucx) Scrotal US, RUS, VCUG After Studies
Varicoceles Scrotal US. Observe if testes same size and pt asymptomatic Testis size asymmetry, pain, visible or large varicoceles
Hydrocele (communicated or loculated) Scrotal/inguinal US if mass or testis not palpable If flucuates or gets bigger
When not to do newborn circumcision Buried, concealed, inconspicuous penis. Penoscrotal fusion/webbed penis, penile torsion, micropenis, hypospadias, epispadias, chordee
Care of uncircumcised male The recommendation of the American Academy of Pediatrics is to leave the foreskin alone. Adhesions can persist up to the age of puberty. By age 3, 90% of the time you can visualize the meatus

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