Pediatric Urology Consultant Reference Guide
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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 |
|
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 |
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UTI of any child <2 yrs, any male |
UrineCx, UA, RUS and VCUG; on first episode, prophylactic antibiotics |
After imaging studies |
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Multiple UTI’s (>3), girl >2 yrs |
UCx, RUS, KUB± 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 |
|
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 |
|
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 |
|
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 |
|
Disease State |
Work Up and Initial Management |
When to Refer |
|
Phimosis |
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Paraphimosis |
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Chordee |
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Post-Circumcision Adhesion |
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Ambiguous Genitalia |
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Micropenis |
|
Disease State |
Work Up and Initial Management |
When to Refer |
|
Labia Fusion |
|
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 |
|
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 |