Pediatric urological conditions: Clinical

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Pediatric urological conditions: Clinical

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A 13-year-old boy is brought to the emergency department for evaluation of testicular pain and swelling. The patient was running when he felt sudden onset groin pain. Since then, he experienced severe scrotal pain with associated nausea and vomiting. He has had similar episodes of pain over the past two months that have all self-resolved without intervention. He has no significant past medical history and has received all age-appropriate vaccinations. Temperature is 37.0°C (98.6°F), pulse is 94/min, respirations are 21/min, and blood pressure is 141/80 mmHg. Physical examination demonstrates an uncomfortable adolescent male in significant pain. Examination demonstrates an edematous and erythematous right scrotum. Stroking of the right inner thigh does not result in elevation of the right testis. The pain is worsened with elevation of the scrotum, and the scrotum does not transilluminate. Which of the following is the best next step in management?  


Content Reviewers


Some of the most common urologic issues in children include congenital defects of the urethra - so hypospadias and epispadias; hematuria; pathologies associated with hydronephrosis - so congenital ureteropelvic junction obstruction, ectopic ureter, vesicoureteral reflux, and posterior urethral valves; and lastly, urinary tract infections.

Let’s begin with congenital defects of the urethra. First, hypospadias is a congenital disorder that’s common in males but extremely rare in females.

In hypospadias, the urethral opening or meatus is not at the tip of the penis but on the bottom of the urethra, which is located on the ventral side of the penis. This occurs because the urethral folds along the penile urethra don’t meet up and close properly, leaving an opening along the bottom of the penile shaft. Diagnosis is mostly clinical.

On examination, there are three possible types of hypospadias in males: glanular, which is near the head of the penis, midshaft, which is the middle of the penis, and penoscrotal—where the penis and scrotum come together. Additional findings include foreskin that fails to become circumferential and appears as a dorsal hood; chordee, which is when the penis has a hook shape and curves inwardly; inguinal hernia, which is a protrusion of bowel through the inguinal canal, and cryptorchidism, which is the absence of testes from the scrotum. The clinical picture might also present with painful urination, recurrent urinary tract infections, sexual dysfunction, infertility, and psychosocial problems, especially as the individual grows and matures sexually.


Pediatric urological conditions refer to disorders that affect the urinary tract and/or the reproductive organs in children. Examples include urinary tract infections, vesicoureteral reflux, hypospadias, ectopic ureter, posterior urethral valves, and phimosis.

Symptoms differ depending on each specific condition. They include frequent urination, painful urination or dysuria, bedwetting, hematuria, and fever. Management varies depending on the specific condition and may include antibiotics, medication, and in some cases, surgery. Early detection and intervention can help to prevent complications and improve outcomes.


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