Pediatric Potpourri

Abstract

Primary care physicians who treat children will frequently encounter urological disorders. Painless scrotal masses include hydroceles, hernias, and tumors. Hydroceles that fail to resolve by 1 year of age, and all hernias, require surgical correction. Tumors are managed by excision or orchiectomy. Prenatally detected hydronephrosis is evaluated postnatally with ultrasonography, VCUG, and renal scan. Some hydronephrotic conditions will improve spontaneously while others require surgical intervention. Undescended testicles are common and should be repaired at 6–12 months of age if they fail to descend spontaneously. Children and adolescents presenting with an acute scrotum require emergent evaluation for testicular torsion which can be diagnosed on physical exam and Doppler ultrasound. Emergent surgical intervention is required. Other causes of acute scrotum include torsion of the appendix testis which resolves without therapy and epididymoorchitis which is treated with antibiotics. Minor complications of circumcision and foreskin issues in uncircumcised boys can be managed by observation, steroid cream, or minor surgical procedures. An understanding of the normal care of the foreskin is important to avoid unnecessary interventions. Diurnal and nocturnal enuresis is common and may be treated with behavioral and/or medical approaches. Ultrasound and noninvasive urodynamics are helpful in selected patients. Varicoceles occur in 15 % of adolescent boys. Treatment should be considered if the left testis is consistently and significantly smaller than the right.