| What are neonatal uro emergencies? | These are difficult to diagnose because of the age of the patient |
| What is ambigious genitalia? | One of the most challenging clinical presentations in the newborn is that of ambiguous genitalia
-History: drug intake ….
-P.E : presence of absence of the gonads ….
-Lab studies : Karyotype ,17 ketosteroid and 17 hydroxyprogesterone
The principal aim of these studies is to rule in or rule out virilizing adrenal hyperplasia. This is the one condition that cannot be neglected, because it may produce life-threatening adrenal crisis at 7 to 10 days of life. |
| What are other neonatal uro emergencies? | II/ Undescended Testes : 4% in full term baby and higher in premature
III/ Large scrotum : hydrocele with or without hernia , tumor or torsion
IV/ Circumcision related injuries : gland removal , urethral injuries ….
VI/ Myelomeningocele
VII/Oligohydramnios/Potter's Syndrome/Renal Agenesis The anatomic features of Potter's syndrome should be familiar to all urologists. They include oligohydramnios, limb contractures (particularly club feet), and compressed facies with low-set ears.
VIII/ Bladder exstrophy
IX/Specific Diagnoses |
| What are specific diagnoses in neonatal uro emergencies? | Renal Vein Thrombosis factors include prolonged labor, birth trauma, and large birth weight.
Renal Artery Thrombosis : present with hypertension and hematuria .Most common cause of umbilical artery catheterization |
| What is renal colic? | -Present as an acute flank pain , radiating to the groin associated to nausea and vomiting with absence of relieving position ,during night or early morning
When irritative voiding sxs are present, the stone should be located near the bladder
- There are five locations where stones can be impacted in the urinary tract : calyx , a UPJ ,pelvic brim
posterior pelvis and vesicoureteral junction ( +++) |
| How is dx studies done in renal colic? | 1/ History : acute , location , radiation ,irritative sxs , family history , prior episode
2/Physical examination: no relieving position , tenderness over the flank and the area of the stone
3/Urinalysis : hematuria , pyuria , crystals
4/Radiology imaging: -KUB, IVP, U/S,Spiral CTscan(++) and MRI |
| How is management of renal colic? | Relief of pain : nonsteroidal anti-inflammatory first , morphinic drugs last
Only 10% of the patients will require hospitalization.
More than 90 % of the stone less than 4mm will pass spontaneously
Water intake : should be restricted during acute episode
1-ESWL
2- ESWL + insertion of ureteral catheter
3- Ureteroscopy + fragmentation
4- Percutaneous nephrolithotomy
5- Oral chemolysis
6- Open Surgery |
| How long can one wait before treating stone? | Detectable renal damage does not occur in previously normal kidneys until complete obstruction has been present for 4 weeks, so one can give the patient up to 4 weeks to pass the stone spontaneously |
| What is indication for stone removal? | Stone removal is strongly recommended in patients with the following:
persistent pain despite adequate medication
2. persistent obstruction with impaired renal function
3. urinary tract infection
4. risk of pyonephrosis or urosepsis
5. bilateral obstruction
6. obstructing calculus in a solitary kidney |
| What is pyelonephritis emergency? | Pyelonephritis :Acute pyelonephritis is a clinical syndrome of chills, fever, and flank pain that is accompanied by bacteriuria and pyuria
Routes of Infection: - Ascending Route(++)
-Hematogenous route: It is a rare route of infection –Urinary Pathogens :E.coli (+++),Klebsiella , proteus , staph.saprophyticus , pseudomonas , serratia …. |
| How is dx of pyelonephritis? | Diagnosis
Urinalysis and Urine culture
Clinical presentation: fever +flank pain
Imaging techniques
Types of imaging studies:
IVP
U/S
MRI and CTscan: best but not cost effective |
| How is tx of pyelonephritis? | Choice of antibiotics: according to antibiogram –
BUT before having the result , we can start empirical broad spectrum treatment
-Uncomplicated pyelo. :Oral Fluoroquinolones if stable and IV fluoroquinolone, Ceftriaxone or gentamycin for ill patient until the patient is stable then we convert to oral antibiotics for 14 days –
-Complicated Pyelo.: IV antibiotics Ampicillin-Gentamycin , Ceftriaxone or fluoroquinolone
-If obstructed kidney --- percutaneous drainage or insertion of ureteral catheter |
| How is sepsis, bacteremia and septic shock by pyelonephritis? | - Although bacteremia can be transient, self-limited, and, therefore, of little clinical significance , sepsis constitutes a medical emergency .
- Can be due mainly to Gram negative organisms but also to Gram positive , fungi as well as viruses
- Can be lethal in 13% in case of septic syndrome without shock and up to 43% in case of shock developing after a septic syndrome |
| How is clinical presentation of sepsis following pyelonephritis? | The classic clinical presentation of fever and chills followed by hypotension is manifest only in about 30% of patients with gram-negative bacteremia . Even before temperature elevation and the onset of chills, bacteremic patients often begin to hyperventilate. Thus, the earliest metabolic change in septicemia is a resultant respiratory alkalosis. |
| How is management of sepsis? | Correction of underlying cause
Take blood culture , urine culture
Supportive measures (insertion of Foley catheter , secure an IV line )
Transfer patient to ICU
IV antibiotics |
| How is prostitis? | LUT infection, Acute bacterial prostatitis is a generalized infection of the prostate gland
The most common organisms : Escherichia coli in 65% to 80% of infections . Pseudomonas aeruginosa, Serratia species, Klebsiella species, and Enterobacter aerogenes
Gram positive organisms account for 10 % |
| What are classifications of prostitis syndromes? | . |
| How is clinical presentation of acute prostatitis? | characterized by an acute onset of pain combined with irritative and obstructive voiding symptoms in a patient with manifestations of a systemic febrile illness.
Physical Examination :suprapubic pain or/and fullness , toxic , febrile , perineal pain, tachycardia,tachypnea all can be present
Laboratory tests: Blood culture and urine culture |
