Pediatric Urology
What this domain tests
This domain tests congenital anomalies, vesicoureteral reflux, hypospadias, cryptorchidism, and pediatric urologic oncology. Questions emphasize age-specific management and avoiding harm from premature intervention.
Core rules and concepts
- Antenatal hydronephrosis is evaluated after birth with ultrasound; suspected ureteropelvic junction obstruction may require diuretic renography. Posterior urethral valves present with bilateral hydronephrosis, thick-walled bladder, and poor stream in a male infant and require urgent catheter drainage.
- Vesicoureteral reflux is graded I–V by contrast cystography. Low-grade reflux often resolves; management includes treating bowel and bladder dysfunction and preventing recurrent febrile urinary tract infections. Surgery is reserved for selected high-grade or breakthrough cases.
- Hypospadias involves a ventral meatus, curved penis, and deficient foreskin. Do not circumcise before reconstruction; repair is usually done between 6 and 18 months.
- Cryptorchidism requires orchiopexy, generally by 6–18 months, to preserve fertility potential and allow surveillance.
- Wilms tumor presents as an abdominal mass; nephrectomy and chemotherapy are standard. Avoid biopsy when typical. Rhabdomyosarcoma and neuroblastoma also occur.
Worked example
A 6-month-old boy has a febrile urinary tract infection and grade IV reflux. Reasoning: febrile UTI plus high-grade reflux warrants antibiotic prophylaxis and evaluation of bladder-bowel dysfunction. Surgery is considered if infections break through or reflux persists; do not simply observe without counseling.
Traps
Do not circumcise an infant with hypospadias. Do not delay orchiopexy indefinitely. Do not treat every low-grade reflux surgically.