Genitourinary Disorders

Posted by e-Medical PPT
>Urinary Tract Infection
Most common serious bacterial infection in infants and children
Highest frequency in infancy
Uncircumcised males have a ten-fold incidence

Anatomic abnormalities
Neurogenic bladder – incomplete emptying of bladder
In the older child: infrequent voiding and incomplete emptying of bladder or constipation
Teenager: sexual intercourse due to friction trauma
Most common in females

Involuntary discharge of urine after the age by which bladder control should have been established, usually considered to be age of 5 years.
Familial history
Males outnumber females 3:2
5 to 10% will remain enuretic throughout their lives
Rule out UTI, ADH insufficiency, or food allergies

Pharmacological intervention:
Desmopressin synthetic vasopressin acts by reducing urine production and increasing water retention and concentration
Tofranil: anticholinrgic effect – FDA approval for treatment of enuresis
Side effect may be dry mouth and constipation
Some CNS: anxiety or confusion
Need to be weaned off

Ambiguous Genitalia
Genital appearance that does not permit gender declaration.

Extrophy of Bladder
Interrupted abdominal development in early fetal life produces an exposed bladder and urethra, pubic bone separation, and associated anal and genital abnormalities.
Occurs is 1 of 30,000 births
Congenital malformation in which the lower portion of abdominal wall and anterior bladder wall fail to fuse during fetal development.
Visible defect that reveals bladder mucosa and ureteral orifices through an open abdominal wall with constant drainage of urine.

Surgery within first hours of life to close the skin over the bladder and reconstruct the male urethra and penis.
Urethral stents and suprapubic catheter to divert urine
Further reconstructive surgery can be done between 18 months to 3 years of age

Most common anomaly of the male phallus
Incomplete formation of the anterior urethral segment
Urethral formation terminates at some point along the ventral fusion line.
Cordee – downward curve of penis.
In Newborn,
Circumcision not recommended.
Foreskin may be needed for reconstructive surgery...

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