Genitourinary Alterations in Pediatric Patients

• Genitourinary alterations is the topic.

Genitourinary System

• The genitourinary system includes the kidneys, ureters, bladder, and urethra.
• In pediatric patients, the kidney is large in relation to the rest of the body.
• In pediatric patients, the kidneys are not as well protected.
• In girls, the urethra is close to the rectum.
• The renal system matures at around 2 years old.
• The glomerular filtration rate (GFR) is slower in pediatric patients.
• Pediatric patients are less able to concentrate urine and reabsorb amino acids, increasing the risk for dehydration.

General Nursing Care for GU Disorders

• Nursing care includes strict intake and output monitoring.
• Daily weights, obtaining specimens for UA and cultures are required.
• Assess fluid status and for acid/base imbalances.
• Frequent vital signs with peripheral pulses and BP should be taken.
• Other requirements are specialized interventions for specific disorders, obtaining samples for lab testing.
• Monitor required nutritional intake.

Bladder Exstrophy

• The urinary bladder extrudes to the outside of the body through the lower abdominal wall.
• Preoperatively, the exposed bladder must be covered with a nonadhering plastic wrap or Silastic wrap.
• Nursing care involves surgical reconstruction.
• Wound and pelvis immobilization is needed to facilitate healing with meticulous wound care.
• Strict intake and output monitoring and emotional support are also important.

Hemolytic Uremic Syndrome

• Hemolytic Uremic Syndrome is a rare, acute renal disease.
• It includes a triad of symptoms including hemolytic anemia, thrombocytopenia, and acute renal failure.
• It usually follows gastroenteritis.
• Hemolytic Uremic Syndrome is associated with E. coli.
• Manifestations include abdominal pain with nausea, vomiting, diarrhea, pallor, fever, irritability, lethargy with decreased urinary output, hypertension, & anorexia.
• Lab results show decreased hemoglobin, hematocrit, and platelets.

Vesicoureteral Reflux

• Vesicoureteral reflux involves retrograde urine flow back into the ureters.
• It is caused by defective valves at birth, unusual bladder pressure, or improperly implanted ureters.
• This condition can cause pressure in the kidneys, resulting in destroyed nephrons.
• Diagnosis is by voiding cystourethrogram (VCUG).
• There is a risk for kidney infection.
• Treatment includes antibiotics and/or surgical reimplantation of ureters.

Urinary Tract Infections

• A urinary tract infection is caused by bacteria ascending into the bladder, and can continue into the upper urinary tract.
• Fecal material is the cause 80% of the time.
• Risk factors include a short urethra in females and being uncircumcised in males under 1 year old.
• Other risk factors are urinary stasis, kidney reflux, sexual activity, urinary tract obstructions, and constipation.

UTI Manifestations

• In infants, manifestations include fever or hypothermia, irritability, dysuria, change in urine odor/color, poor weight gain, and feeding difficulties.
• In children, manifestations include abdominal or suprapubic pain, frequency, urgency, dysuria, new or increased enuresis, and fever.

UTI Teaching

• Instructions include wiping front to back, forcing fluids, voiding every 2 hours while awake.
• Recommendations are to double void, wear loose cotton underwear, and avoid bubble baths.
• Teen females should void before and after intercourse.

Prune Belly Syndrome

• Prune Belly Syndrome is a rare disorder characterized by partial or no abdominal muscles.
• It involves failure of the testicles to descend and urinary tract malformations.
• Patients can have club foot and cardiovascular issues.
• Nursing care involves expecting ultrasound, X-ray, and intravenous pyelogram (IVP).
• Preparation includes surgery such as vesicostomy and orchiopexy.
• Preserve kidney function and prophylactic antibiotics to decrease UTI risk.

Wilm's Tumor

• Wilm's Tumor, also known as nephroblastoma, has a good prognosis, with early detection, surgery, chemo, and radiation.
• It is a malignant renal tumor that is encapsulated and occurs in young, preschool children.
• The mass is in the flank area, confined to midline
• Parents often discover it while bathing
• DO NOT palpate the abdomen because of the potential of spreading the cancerous cells.

Epispadias and Hypospadias

• In epispadias, the urinary meatus is located on the upper side (dorsal) of the penile shaft and is less common than hypospadias.
• In hypospadias, the urinary meatus is on the lower (ventral) or underside.

Epispadias and Hypospadias Repair

• Surgical interventions include release of chordee/lengthening of the urethra, repositioning of the meatus at the penile tip, and reconstruction of penis.
• The surgery is usually done at 6-12 months of age.
• No circumcision of infant with hypospadias.
• Surgical intervention is usually done in one stage.
• Urinary diversion is used after surgery via stents or catheters.
• The goal of surgery is to make urinary and sexual function as normal as possible and to improve the cosmetic appearance of the penis.

Phimosis

• Phimosis involves a penile foreskin that is too tight in an uncircumcised male.
• It is normal until between age 2 and 6.
• The risks increase with other skin conditions like eczema and with repeated infections, trauma, and repeated rough handling of the penis.

Testicular Torsion

• Testicular torsion is a MEDICAL EMERGENCY!
• The twisting of the spermatic cord cuts off blood supply to the testicles.
• It is more common in newborns and adolescents.
• It is an increased risk after scrotal trauma.

Testicular Torsion Assessment

• In infants, assessment includes scrotal mass with a discolored and firm scrotum.
• In adolescents, assessment includes sudden severe pain, scrotal edema, abdominal pain, and nausea/vomiting.
• Ultrasound is expected, as well as surgery within 4 hours.

Inguinal Hernia/Hydrocele

• Inguinal hernia usually involves a weakness in the abdominal wall from birth.
• A bulge in the groin increases with any type of strain.
• Most cases are in males.

Hydrocele

• Hydrocele is common in newborns and disappears by 1 year of age.
• It involves scrotal edema and pain increasing with inflammation.
• Risk factors are scrotal trauma and infection (including STI).

Cryptorchidism

• Cryptorchidism involves undescended testes, usually in premature babies.
• It occurs when one or both testes fail to descend through the inguinal canal into the scrotum.
• It is detected in newborn exams.
• Refer if not resolved by 6 months of age.