Pediatric Genitourinary Disorders

8/2/2019 Pediatric Genitourinary Disorders

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PEDIATRIC GENITOURINARY

DISORDERS

Galvan, Maricar

Hernandez,Harley


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Urinary Tract Infection

-bacterial(e.coli) of

kidney or bladder whichis usually common in

children and girls.


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- Assessment:

1. low grade fever

2. abdominal pain3. enuresis, pain/ burning sensation, frequency,

hematuria


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INTERVENTIONS

1. administer antibiotics

2. Provide warm baths.3. Force fluids

4. encourage acid ash diet.

5. encourage perineal hygeine.


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Vesicouriteral Reflux

-Regergitation of urine

from bladder to urethersdue to faulty valve

mechanism at thevesicouretheral junction.


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-ASSESSMENT FINDINGS ARESIMILAR WITH

THAT OF UTI.

-


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INTERVENTION:

surgical repair


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Extrophy of the Bladder

ASSESSMENT FINDINGS:

Prolapsed rectum

Inguinal hernia

Widely separated symphysis

Rotated Hips

Epispadias

Cleft scrotum or clittoris

Cryptorchidism

Chordee


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Extrophy of the Bladder

MANAGEMENT

Two stage recostructivesurgery with urinary

diversion delayed until3-6 mons.


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Cryptorchidism

-ASSESSMENT

-Unable to palpate testes in

scotal sac and be careful not to

ilicit cremasteric reflex.


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Cryptorchidism

MEDICAL MANAGEMENT

If not descended by 8 or 9, chronic

gonadotropin can be given.

Orchipexy, surgical procedure to retrieve and

secure testes placement between ages 1 to 3

years.


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Hypospadias

Opening loacted anywhere along ventral

surface of penis.

Chordee is often associated, causing

constriction.

In extreme cases, child sex may be uncertain.


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Hypospadias

MANAGEMENT:

Minimal defects need no intervention.

Neonatal circumcision delayed, tissue may beneeded for corrective repair.

Surgery at 3-9 months, for complex repairs,

may be delayed until 2 years.


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Enuresis

Involuntary passage of

urine after the age ofcontrol is expected,

usually 4 years.


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Enuresis

TYPES:

1. Primary- children who have never achievedcontrol

2. secondary- those who developed control and

then lose it


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Enuresis

- MANAGEMENT:

1. Bladder retention exercises.

2. behavior modificatio such as bed alarmdevices.

3. drug theraphy:

a. tricyclic antidepressants: imipraminehydrochloride (tofranil)

b. anticholinergics


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Nephrotic Syndrome

Nephronic syndrome is a nonspecific autoimmunedisorder in which the kidneys are damaged, there isstructural alteration in the glomerular membrane,causing tem to leak large amounts of protein (

proteinuria at least 3.5 grams per day per 1.73 m2

bodysurface area) from the blood into the urine.

Kidneys affected by the nephrotic syndrome havesmall pores in the podocytes, large enough to permitproteinuria ( and subsequently hypoalbumenemia,

because some of the protein albumin has gone fromthe blood to the urine) but not large enough to allowcell pass through ( hence no hematuria).


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Nephrotic Syndrome

Characterized by:

Proteinuria (less than 3.5g/day)

Hypoalbuminemia Hyperlipidemia

Generalized edema


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Nephrotic Syndrome

Management

Monitor urine output.

Fluid restriction to 1 L.

Diuretics (IV furosemide).

Treat hyperlipidemiato prevent further aterolosclerosis.

Albumin infusions are generally not used because their effects last onlytransiently. Prophylactic anticoagulation may be appropriate to somecircumstances.

Immunosuppression for the glumerulonephritides ( corticosteroids,cyclosporin)

Standard reime for the firstepisode id prednisolone, frequent relapses

treated by cyclophosphamide. Achieve better blood glucose level control if the patient is diabetic.

Blood pressure control. ACE Inhibitors rea the drug of choice. Independentof their blood pressure lowering effect , they have been shown todecrease protein loss.


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Nephrotic Syndrome

Dietary Recommendations

1. Reduce sodium intake to 1000 to 2000 mg daily. Foods high in sodium includesalt used in cooking and at the table seasoning blends( garlic salt, adobo, seasonsalt) canned soups, canned vegetable containing salt, luncheon meats includingturkey, ham bologna and salami, prepared foods , fast food, soy sauce, ketchup,and salad dressing. On food labels, compare milligrams of sodium to calories perserving . sodium should be less than or equal to calories per serving.

2. Eat moderate amount of high protein animal food: 3 to 5 oz per meal (preferablylean cuts of meat, fish, and poultry)

3. Avoid saturated fats such as butter, cheese, fried foods, fatty cuts of red meat,egg yolks and poultry skin. Increase unsaturated fat intake, including olive oil,canola oil, peanut butter, avocadoes, fish and nuts. Eat low fat desserts.

4. Increase intake of fruits and vegetables. No potassium or phosphorus restriction

necessary.5. Monitor fluid intake, which includes all fluids and foods that are liquid at room

temperature. Fluid management in nephrotic syndrome is tenuous, especiallyduring an acute flare.


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Acute Glumerulonephritis

A self-limiting immunecomplex disease resulting

from an antigen-antibodyreaction secondary to a beta-

hemolytic streptococcalinfection.


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Acute Glumerulonephritis

Interventions

1. Administer drugs

a) Antibiotics

b) Antihypertensives

c) Digitalis

2. Fluid restriction of with urinal insufficiency

3. Peritoneal dialysis if severe renal orcardiopulmonary problems develop.


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Hydronephrosis

Collection of urine in renal

pelvis due to obstruction to

outflow common at

uretheral and pelvicjunction


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Hydronephrosis

Obstruction causes of the ffg:1. Increase intrarenal pressure

2. Decrease circulation3. Atrophy of the kidney


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Hydronephrosis

ASSESSMENT findings

1. Repeated UTI

2. Failure to thrive3. Abdominal pain, fever

4. Fluctuating mass in region of kidney


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Hydronephrosis

MANAGEMENT

Surgery to correct or remove obstruction.

Pediatric Genitourinary Disorders

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