• Narrowing or stenosis of the opening of the foreskin that prevents retraction of the foreskin over the glans penis 
• Obstructs flow of urine
• S/S: dribble, foreskin balloons to one side.
• If unable to retract becomes necrotic=medical emergency
• If severe, will circumcise

• Fluid collection w/undescended testicle (usually)
• Can resolve spontaneously
• Treatment: hormone therapy or surgery

• One/both testes undescended. 
• S/S: pea sized bulge in inguinal area. If true, will not be able to pull down testes
• Compilcations: hernias, tortion, fertility issues later. 
• Treatment: Orchiopexy-anchor testes down into scrotum
• Nursing: avoid sports & straddle toys for 2 weeks, good peri care to avoid infection, pain control

• Urethral opening below glans 
• Treatment: no cicumcision (need skin for surgery), give steroids
• Surgery: 6-12 months of age, testosterone first. Goals: void in standing position, cosmetic, fertility
• Nursing: Monitor swelling, bleeding, infection. Cath care. Avoid baths, swimming, straddle toys, sand boxes.

• Urethra opening on top of penis.
• Treatment: no cicumcision (need skin for surgery), give steroids
• Surgery: 6-12 months of age, testosterone first. Goals: void in standing position, cosmetic, fertility
• Nursing: Monitor swelling, bleeding, infection. Cath care. Avoid baths, swimming, straddle toys, sand boxes.

• Bladder & portion of abdominal wall are outside the body
• Splaying of the urethra 
• Separation of the pelvic bone
• Medical Emergency: surgery ASAP (multiple)
• Nursing: Cover with moist, sterile dressing until surgery. Constant fluid loss: monitor fluid/lytes, pain control.

• High # of microorganisms in UT
• Most in lower UT-cystitis & urethritis
• Upper- pylelonephritis & glomerulonephritis
• Common in infancy & 2-6yrs, girls 
• Gram neg can be fatal, e.coli most common
• At risk: diabetic kids (high sugar, warm environment), immunosuppressed
• Pediatric: rule out UTI with any child <2yrs w/ fever of unknown origin
• Peds S/S:frequency, fever, odiferous urine, blood in urine, sepsis, dysuria, urgency, pain in lower stomach, cloudy urine
• Pyelonephritis: flank pain, chills & fever
• Diagnostics: clean catch preferred, U-bag, aspiration or cath if necessary
• Treatment: ST->LT antibiotics
• Broad spectrum: bactrim or septra
• Gentamycin- ototoxicity (peak & trough)
• Peridieum- coats badder, decreases spasms, stains urine red
• Nursing: empty bladder/bowel regularly & completely, wipe front to back, lots of fluids, wash hands, no bubble baths, cranberry juice

• Backflow of urine from bladder->ureters->system
• Primary: insufficient muscles in ureterovesical junction or abnormal muscle length in ureter
• Secondary: (aquired) frequent UTI, obstruction
• Treament: possible surgery

• Inflammation by bacteria, virus, etc via ascending urethral route
• Associated w/ VUR, lower UT dysfunction, kidney stones, stricture/stenosis
• S/S: nonspecific (fever, chills, frequency, urgency, low back pain, n/v), Costovertebral tenderness (CVA)
• Symptoms go away in a few days. Bacteriuria & Pyuria persist
• Treatments: Parenteral antiobiotics, relapse: 6-8 wk course of antibiotics. Surgery only if significant anatomic abnormality & recurrent UTIs, treat agressively to prevent sepsis
• Nursing: hydration, nutrition, fluid/lyte balance, acidotic

• Post infectious: under/untreated group A β-hemolytic strep
• S/S 1-2 wks after sore throat, skin infection, impetigo, rash
• S/S: generalized edema (periorbital->LE->ascites), HTN, Oligura, Hematuria (cola-colored), Proteinuria
• Diagnosis: hematuria, ESR elevated, strep positive, Blood- high Na, BUN/Creatinine off
• Nursing: manage edema (daily weights, I/O, measure abdomen), manage HTN, low sodium, low protein diet

Minimal Change Nephrotic Syndrome (MCNS)

• if developed w/in 1-2 yrs old- kidney transplant likely
• Proteinuria, hypoalbuminemia, hyperlipidemia, edema
• Edema Phase: distended belly, periorbitla edema->ankles, anorexia, malnutrition
• Remission Phase (w/steroid treatment): less proteinuria
• S/S: oliguria, dark, concentrated urine, ascites, edema, anorexia, fatigue, HTN (later)
• Complications: Respiratory Compromise, SE of steroids
• Treatment
• Low Na, low protein diet
• Steroids- 2mg/kg/day BID
• Immunosuppressant: Cytoxan
• Diuretics, prophylactic antibiotics, lytes (K), pain meds, ace inhibitor for HTN
• Nursing: bed rest, I/O, fluid/lytes, edema, SE of meds, wear gloves to protect child, adequate fluid to flush out bacteria

• Grapelike cysts in place of normal kidney tissue
• Hereditary, two types: childhood & adult
• S/S: achy lower back/flank, polycystic liver disease, cysts of spleen, ovaries, etc.
• Treatment
• Supportive: treat UTI, control HTN
• Infections: broad spectrum antibiotics
• End Stage renal disease: dialysis, nephrectomy, transplant

• Age 1 ¹/₂: passes urine at regular intervals
• Age 2: announces when voiding
• Age 2 ¹/₂: announces need to void; can hold it
• Age 3: goes to BR by self, holds urge if preoccupied by play
• Age2 ¹/₂- 3 ¹/₂: achieves nighttime control
• Age 4: interested in going to BR when away from home
• Age 5: voids about 7 times/day. Prefers privacy, able to empty bladder at any degree of fullness 

• inability fo control urination
• daytime: diurnal
• nighttime: nocturnal
• up to 5-10 yrs of age, boys more common
• Physiologic causes
• small bladder
• UTI
• lack of awareness of signal to empty
• Psychological
• Toilet training before child is ready
• resentment towards caregiver
• Regress to get more attention
• emotional stress/sexual abuse
• Treatment: rule out organic problem, TIME, condition to wake up with urine alarm, diapers, pull-ups, DDAVP, NEVER use punishment