Pediatric Urology Consultant Reference Guide

Table of Contents

Disease State Work-up and Initial Management
When to Refer
General    
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

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Bladder
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, 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

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Kidney
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
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
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
Phimosis
Paraphimosis
Chordee
Post-Circumcision Adhesion
Ambiguous Genitalia
Micropenis
Female Genitalia
    
Labia Fusion

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Testis/Scrotum
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

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When not to do newborn circumcision Buried, concealed, inconspicuous penis. Penoscrotal fusion/webbed penis, penile torsion, micropenis, hypospadias, epispadias, chordee

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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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