Page 1355 - TNFlipTest

Toronto Notes 2019
Pediatric Urology
Urology U37
Semen Analysis
Absent/low volume ejaculate, positive for sperm
r/o short abstinence period, incomplete collection
Post-ejaculatory urinalysis
Azoospermia
Bliateral testicular atrophy
Serum FSH
Normal or unilateral testicular atrophy
Serum FSH Abnormal
Normal
Testicular biopsy Normal
Obstruction
WHO Guidelines
Male Infertility Factors
SPERM COUNT Systemic factor/Smoking Psychological illness Endocrinopathy Retrograde ejaculation Medications
Chronic disease Obstructive
Unexplained
Narcotics
Testicular
Low
Hypogonadotropic hypogonadism
High
Primary testicular failure
+ve for sperm Retrograde ejaculation
-ve for sperm
Abnormal
Transrectal U/S Abnormal anatomy Normal anatomy
Determine level of Failure of emission obstruction
Figure 21. Infertility workup
Pediatric Urology
Congenital Abnormalities
• notuncommon;1/200havecongenitalabnormalitiesoftheGUtract • sixcommonpresentationsofcongenitalurologicalabnormalities
1 . ANTENATAL HYDRONEPHROSIS
Epidemiology
• 1-5%fetalU/S,somedetectableasearlyasfirsttrimester
• mostcommonurologicalconsultationinperinatalperiodandoneofmostcommonU/Sabnormalities
of pregnancy
Differential Diagnosis
• UPJorUVJobstruction
• multi-cysticdysplastickidney • VUR
• PUVs(onlyinboys)
• duplicationanomalies
• ureterocele
• ectopicureter
Treatment
• antenatal in utero intervention rarely indicated unless evidence of lower urinary tract obstruction with oligohydramnios
2 . POSTERIOR URETHRAL VALVES Epidemiology
• themostcommoncongenitalobstructiveurethrallesioninmaleinfants
Pathophysiology
• abnormalmucosalfoldsatthedistalprostaticurethracausingvaryingdegreesofobstruction
Clinical Presentation
• dependentonage
■ antenatal: bilateral hydronephrosis, distended bladder, oligohydramnios
■ neonatal (recognized at birth): palpable abdominal mass (distended bladder, hydronephrosis),
urinary ascites (transudation of retroperitoneal urine), respiratory distress (pulmonary hypoplasia from oligohydramnios), weak urinary stream
Majority of antenatal hydronephroses resolve duringpregnancyorwithinthefirstyearoflife