Pediatric Urology
Core concepts
Focus on antenatal hydronephrosis, vesicoureteral reflux (VUR), hypospadias, cryptorchidism, phimosis, hydrocele/hernia, and posterior urethral valves (PUV). Understand grading (hydronephrosis SFU, VUR grades I–V), when to image (VCUG for high-grade hydronephrosis or febrile UTI), and timing of surgery (orchidopexy by 6–18 months; hypospadias repair at 6–18 months). Know that PUV presents with bilateral hydronephrosis, thick-walled bladder, and a keyhole urethra; initial management is catheter drainage.
Traps
Do not circumcise a child with hypospadias before repair (foreskin may be needed). Do not perform VCUG routinely for low-grade unilateral hydronephrosis. Undescended testis needs timely orchidopexy to reduce malignancy and infertility risk. Distinguish communicating hydrocele (resolves) from hernia (needs repair).
Worked rule of thumb
Antenatal hydronephrosis: repeat ultrasound after birth; if persistent high-grade or febrile UTI, obtain VCUG. For a newborn with bilateral hydronephrosis and poor stream, suspect PUV and place a catheter.
Exam strategy
Age and presentation (antenatal vs febrile UTI vs incidental) drive imaging and timing.