GU - STUDENT - Fall 2024

Pediatric Genitourinary Disorders Overview

Objectives

  • Compare anatomy and physiology of genitourinary system in children vs. adults.

  • Examine common medical treatments and assessments for urinary tract disorders in children.

  • Identify common childhood genitourinary disorders, alongside their diagnosis and nursing interventions.

  • Discuss medications and treatments for managing pediatric genitourinary disorders.

Variations in Anatomy and Physiology

  • Structural differences

    • Glomerular filtration rate (GFR) is slower until age 2, leading to reduced capability to concentrate urine and reabsorb amino acids, increasing the risk of dehydration.

    • Normal urine output ranges from 0.5-2 ml/kg/hr in infants and children (1 ml/kg/hr is essential to remember).

    • Blood urea nitrogen (BUN) and creatinine levels are lower in newborns and young children.

Assessment of the Genitourinary System

  • Health History:

    • Prenatal history, medical conditions, previous surgeries, age of potty training, hygiene routines, and patterns of urinary accidents.

  • Symptoms to Note:

    • Changes in voiding patterns, burning urination, scratching, unusual discharge, trauma, fever, poor growth, blood in urine, or abdominal/groin masses.

Nursing Assessment - Physical Examination

  • Inspection and Observation:

    • General appearance, skin condition, external genitalia (males and females), abdomen examination.

  • Auscultation:

    • Listen for heart, lung, and bowel sounds; check blood pressure.

  • Percussion:

    • Abdomen and costovertebral angle.

  • Palpation:

    • Abdomen and genitalia examination.

Nursing Assessment – Laboratory/Diagnostic Testing

  • Tests to include:

    • CBC, BUN/creatinine, potassium levels.

    • Urinalysis and urine culture.

    • Cystoscopy and voiding cystourethrogram (VCUG).

    • Renal ultrasound.

Nursing Assessment for Urinary Tract Infection (UTI) Risk Factors

  • Risk factors include:

    • Gender, history of previous UTIs, urinary stasis, constipation, decreased fluid intake, vesicoureteral reflux, poor hygiene practices.

  • UTI often correlates with risk of bladder infection.

Signs & Symptoms of UTI

  • Older Children:

    • Fever, dysuria, frequent urination, urgency, enuresis, hematuria.

  • Infants:

    • Similar symptoms plus irritability, poor feeding, foul-smelling urine, vomiting, jaundice.

UTI Lab/Diagnostic Testing

  • Types of diagnostics:

    • Urinalysis, urine cultures, bagged specimens, clean catch, or straight cath methods.

    • Renal ultrasound and VCUG for further assessment.

  • Treatment typically includes antibiotics and antipyretics.

Prevention of UTIs

  • Key strategies involve:

    • Maintaining effective voiding habits and managing constipation (e.g., double voiding).

    • Establishing a voiding schedule; avoiding infrequent voiding and incomplete emptying to mitigate risks.

    • Encourage liberal fluid intake; implement hygiene measures like wearing cotton underwear and avoiding tight clothing.

  • Important Note: No bubble baths; cranberry juice's efficacy is debated.

Vesicoureteral Reflux (VUR)

  • Definition:

    • Abnormal retrograde flow of urine from the bladder back into the ureters.

    • Presence of infection can lead bacteria to the kidneys, heightening the risk of pyelonephritis.

  • Grades of VUR:

    • I to V, with I-III often resolving spontaneously; IV and V generally require surgical intervention.

  • Diagnostic VUR Testing:

    • Voiding cystourethrogram (VCUG) assesses for VUR by observing urine flow via fluoroscopy.

Nursing Management for VUR

  • Primary goal: Prevent infection to reduce risks of pyelonephritis and renal scarring.

  • Strategies include:

    • Eradicating infection through antibiotics, increasing fluid intake, ensuring complete bladder emptying, considering surgery for severe cases.

    • Employing IV fluids for increased output post-surgery and monitoring urine output.

    • Providing analgesics and antispasmodics as needed.

Definitions Related to Enuresis

  • Primary Enuresis: Never achieving voluntary bladder control.

  • Secondary Enuresis: Urinary incontinence after achieving control for 3-6 months.

  • Diurnal Enuresis: Daytime loss of control; Nocturnal Enuresis: Nighttime bedwetting with interventions like alarms to train the child.

Pediatric Female Organ Disorders

  • Vulvovaginitis:

    • Common symptoms: redness, itching, discharge; preventive measures include wearing cotton underwear and practicing good hygiene.

    • Treatment may require antifungal creams or antibiotics.

Pediatric Male Organ Disorders

  • Common disorders:

    • Hypospadias: Urethral opening on the penis' ventral aspect.

    • Epispadias: Urethral opening on the dorsal aspect.

  • Management:

    • Postoperative care includes catheter or stent care, medications, and discharge education.

    • Cryptorchidism: Undescended testis that requires surgical intervention (orchidopexy).

Nephrotic Syndrome (MCNS)

  • Pathophysiology:

    • Characterized by increased glomerular permeability with consequent proteinuria, hypoalbuminemia, and generalized edema.

    • Weight gains, irritability, and fatigue are common symptoms.

APSGN - Acute Poststreptococcal Glomerulonephritis

  • Characterized by inflammation of glomerular capillaries, often occurring 1-2 weeks post-streptococcal infection.

  • Nursing assessments must include monitoring vital signs, urine output, and symptoms such as headache and abdominal pain.

  • Management includes medications (antihypertensives, loop diuretics) and dietary modifications.