Pediatric Genitourinary Disorders

What are retractile testes?

out of the scrotum but can be brought back and remain

What are ascending testes?

used to be the scrotum, then become undescended

What are absent testes?

agenesis or atrophy of the testis

What are ectopic testes?

lies out of the normal path of descent

What is the transabdominal phase of testicular descent?

8-15 weeks gestation

What is the inguinoscotal phase of testicular descent?

25-35 weeks gestation

What factors discrupt descent?

Hormonal, genetic, and environmental

What is the most common congenital abnormality of the GU tract in male infants?

Cryptorchidism

What is Cryptorchidism?

Failure of one or both testes to descend into the scrotal sac → Testis is absent from its normal scrotal position

What are the risk factors for Cryptorchidism?

Prematurity, low birth weight, Maternal smoking, and Chromosomal abnormalities

What are the clinical features of Cryptorchidism?

empty scrotum, decreased scrotal rugation, inguinal fullness, hydrocele/hernia

When in cryptorchidism palpable?

Along the normal path of descent, inguinal canal

When in cryptorchidism nonpalpable?

Intra-abdominal, atrophic, absent

How is unilateral cryptorchidism evaluated?

Surveillance with testicular exam at each well-child visit

How is bilateral cryptorchidism evaluated?

Ultrasound, Serum labs (electrolytes, hormones), and Karyotype analysis

What are the potential complications of cryptorchidism?

infertility, testicular malignancy, testicular torsion, inguinal hernia

When is Orchiopexy/Orchidopexy indicated for cryptorchidism?

6 months of age if descent has not occurred; Surgery between 6 and 18 months of age

What is Enuresis?

Intermittent urinary incontinence after age 5 when toilet training should be complete

What is nocturnal enuresis?

nighttime "bedwetting"

What is diurnal enuresis?

urinary incontinence during waking hours

What is primary enuresis?

never achieved sustained nighttime dryness

What is secondary enuresis?

recurrence after at least six months of dryness

What are the risk factors for enuresis?

Family hx. delayed or absence of toilet changing, prolonged diaper use, low SES, psychosocial stressors

What are the comorbid complications of enuresis?

constipation, UTIs, ADHD, OCD

What is the difference between monosymptomatic and non-monosymptomatic enuresis?

monosymptomatic has no daytime symptoms whereas non-monosymptomatic had daytime bladder and bowel dysfunction (MC)

What is the diagnostic criteria for enuresis?

- 2+ times/week for at least 3 consecutive months

- distress/impairments

- at least 5 years old

- not attributed to physiologic effects

What is the prioritized management of enuresis?

Treat daytime symptoms and constipation BEFORE nocturnal enuresis

What is the first line treatment of enuresis?

Urotherapy through maintaining a voiding schedule and regulating fluid intake +/- enuresis alarms

When can medication be initated for enuresis and what type is used?

Desmopressin can be started in patients > 7 y/o with previous unsuccessful attempts; can be used up to 6 months

When should enuresis prompt pediatric urologist referral?

- Daytime urinary tract symptoms or daytime incontinence

- abnormal H/P suggesting underlying cause

- failure to respond to alarms and desmopressin