Chapter 29: Genitourinary Conditions in Children

Genitourinary Conditions in Children begins by defining the functional unit of the kidney, the nephron, and outlines key developmental differences in urinary function between children and adults, including bladder capacity estimates and age-specific urine output norms. The text explores congenital anomalies such as phimosis, paraphimosis, hypospadias, and epispadias, emphasizing surgical interventions like chordee repair and the contraindication of routine circumcision in cases where foreskin tissue is needed for reconstruction. Severe defects like exstrophy of the bladder and obstructive uropathy, which may lead to hydronephrosis or polycystic kidney disease, are discussed alongside urinary diversion procedures such as ureterostomies and ileal conduits. A significant portion of the chapter is dedicated to distinguishing between Nephrotic Syndrome and Acute Glomerulonephritis; the former is characterized by massive edema, proteinuria, and hypoalbuminemia treated with corticosteroids and infection precautions due to potential neutropenia, while the latter is typically an immune complex response to a group A beta-hemolytic streptococcal infection presenting with hypertension, oliguria, and hematuria. Nursing care priorities are highlighted throughout, including skin care for edematous tissue, strict intake and output monitoring, and dietary adjustments for electrolyte balance. The summary also covers Wilms tumor (nephroblastoma), a malignant renal tumor where abdominal palpation is strictly contraindicated to prevent capsule rupture and metastasis. Furthermore, the chapter addresses male reproductive issues like cryptorchidism (undescended testes) requiring orchiopexy to preserve fertility, hydrocele, and testicular torsion, as well as the management of urinary tract infections and vesicoureteral reflux. Finally, the content underscores the psychosocial impact of genitourinary surgery on a child's body image, toilet training, and psychosexual development.