💧 Pediatric Genitourinary
Undescended testes, hypospadias, enuresis and pinworms — the small things that come up constantly.
🩸 Cryptorchidism & hypospadias
| CRYPTORCHIDISM | HYPOSPADIAS | |
|---|---|---|
| What | Testis has not descended | Urethral opening on the underside of the penis |
| Found | Newborn exam; empty scrotum | Newborn exam; abnormal stream |
| Repaired | Orchiopexy, usually by 6–18 months | Usually 6–18 months |
| Key rule | Repair protects fertility and allows cancer surveillance | DO NOT CIRCUMCISE — the foreskin is needed for the repair |
A newborn with hypospadias must not be circumcised. The surgeon uses that foreskin tissue to reconstruct the urethra.
✅ After repair
- Double diaper technique to protect the stent or catheter
- Watch for urine output and any bleeding
- Avoid straddle toys, sandpits and rough play for a few weeks
- Encourage fluids
- After orchiopexy the testis is stitched in place — no bike riding or straddling while healing
🛀 Enuresis
Bedwetting is normal until about age 5, and even then it is common. It is not laziness and it is not deliberate.
New bedwetting in a previously dry child is the red flag, not longstanding bedwetting.
Think: urinary tract infection, type 1 diabetes, constipation, emotional stress or abuse.
Sudden onset of wetting in a dry child is investigated, not managed with a star chart.
✅ What actually helps
- Never punish or shame — it worsens outcomes and damages self-esteem
- Fluids earlier in the day; limit in the two hours before bed
- Empty the bladder immediately before sleep; treat constipation, which is a common cause
- Bedwetting alarm is the most effective long-term treatment
- Desmopressin for short-term needs like sleepovers or camp
- Reward effort — taking a drink earlier, going to the toilet — not dry nights, which they cannot control
🧠 Toilet training readiness
Usually 18–24 months and beyond. Look for readiness rather than pushing a date:
- Stays dry for 2 hours; wakes dry from a nap
- Can walk to the toilet, sit and pull down clothing
- Shows awareness of needing to go; can say so
- Shows interest and wants to please
Regression during stress is normal — a new baby, hospital admission, starting nursery. Handle it without comment and it usually resolves.
🦠 Pinworms & UTI
🦠 Pinworms (enterobiasis)
The classic sign is intense anal itching at night, when the female worm emerges to lay eggs. The child sleeps badly and is irritable.
- Tape test — clear tape pressed to the perianal skin first thing in the morning, before washing or opening the bowels
- Treat the whole household; a second dose in 2 weeks catches the next cycle
- Wash bedding and nightclothes in hot water; keep fingernails short; hand hygiene, especially after the toilet and before eating
- Reassure parents — it is extremely common and says nothing about cleanliness
💧 Pediatric UTI
Infants present non-specifically: fever, poor feeding, vomiting, irritability, jaundice in a newborn — not dysuria.
A febrile infant with no obvious source needs a urine sample. Missing pyelonephritis scars the kidney permanently.
Teaching: wipe front to back, cotton underwear, avoid bubble baths, empty the bladder fully and often, treat constipation, and plenty of fluids.
Recurrent infections prompt investigation for vesicoureteral reflux.
🎯 NCLEX traps
- Hypospadias → no circumcision
- Orchiopexy protects fertility
- New bedwetting is investigated; longstanding is managed
- Never punish for wetting
- Tape test in the morning before washing
- Febrile infant, no source → check the urine