Pediatric Urology
Core concepts
Pediatric urology emphasizes congenital anomalies, antenatal hydronephrosis, and age-appropriate management. Understand antenatal hydronephrosis grading and postnatal evaluation with ultrasound and, when indicated, VCUG or diuretic renography. Distinguish ureteropelvic junction obstruction from vesicoureteral reflux. Know the presentation and management of hypospadias (do not circumcise before repair), undescended testis (timing of orchidopexy, usually within the first year), and inguinal hernia/hydrocele. Recognize posterior urethral valves as a cause of bilateral hydronephrosis in a male infant with a thick-walled bladder. Understand vesicoureteral reflux grading and the trend toward antibiotic prophylaxis in selected high-grade cases. Know the difference between cryptorchidism and retractile testis, and the evaluation of ambiguous genitalia as a social and medical emergency.
Traps
Questions test timing of surgery and the pitfall of circumcising a child with hypospadias before reconstruction. Do not confuse retractile testis (normal) with true undescended testis. Posterior urethral valves require prompt bladder drainage and later valve ablation; a thick-walled bladder with bilateral hydronephrosis in a male infant is the classic clue.
Worked example / rule of thumb
A newborn male with bilateral hydronephrosis and a thick-walled bladder: suspect posterior urethral valves; drain the bladder and confirm with VCUG. Rule of thumb: boys with bilateral hydronephrosis and a thick bladder wall have valves until proven otherwise.