Chapter 29: Genitourinary Conditions in Children

Genitourinary Conditions in Children begins by identifying the nephron as the functional unit of the kidney and establishing critical baselines for urine output, defining oliguria as output lesser than 1 mL/kg/hr and polyuria as output greater than 3 mL/kg/hr. The text explores a variety of structural and congenital anomalies, including phimosis (narrowing of the foreskin), paraphimosis, and urethral placement defects such as hypospadias and epispadias, noting that circumcision is often contraindicated in these cases to preserve tissue for surgical repair. Severe malformations like exstrophy of the bladder and obstructive uropathy are discussed, with a focus on how conditions like hydronephrosis can lead to renal damage and metabolic acidosis. A significant portion of the chapter is dedicated to the diagnosis, treatment, and prevention of Acute Urinary Tract Infections (UTIs), identifying Escherichia coli as the primary pathogen and explaining the role of vesicoureteral reflux (VUR) in recurring infections and potential kidney scarring. The summary differentiates between two major renal disorders: Nephrotic Syndrome, an autoimmune-related condition characterized by massive proteinuria, hypoalbuminemia, hypercholesterolemia, and edema managed with steroid therapy; and Acute Glomerulonephritis (AGN), which often follows a group A beta-hemolytic streptococcal infection and presents with hematuria, hypertension, and periorbital edema. The chapter also outlines the critical safety precautions for Wilms tumour (nephroblastoma), specifically the prohibition of abdominal palpation to prevent tumour rupture. Finally, it addresses male reproductive issues such as hydrocele and cryptorchidism (undescended testes), details surgical interventions like orchiopexy and urinary diversions, and highlights the psychosocial impact of genitourinary surgery on a child's developing body image and sexuality.