CARE OF THE CHILD WITH

GENITOURINARY
ALTERATION
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 Outlines
 Pediatric Differences in Urinary System
UTI
Acute Post Streptococcal Glomerulonephritis
Nephrotic Syndrome
Hypospadias , Epispadias

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 Pediatric Differences
in Urinary System

• All the nephrons that will make up the mature kidney are present at
birth.
• The kidneys grow and the tubular system matures gradually during
childhood, reaching full size by adolescence
• Most renal growth occurs during the first 5 years of life.
• This increase in size is due primarily to enlargement of the
nephrons.
• The kidney’s efficiency also increases with age.

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 Pediatric Differences
Urinary System , urine output

• The expected output is as follows:

• Infants—2 mL/kg/hr
• Children—0.5 to 1 mL/kg/hr
• Adolescents—40 to 80 mL per hour
• Bladder capacity increases with age from 20 to 50 mL at birth to
700 mL in adulthood

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 UTI

Is presence of infective agents ( usually bacteria) that

exists anywhere between the renal cortex and
urethral meatus.

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 UTI
• The risk of renal damage increases in the following instances:

• UTI in infant less than 1 year of age

• Delay in diagnosis and effective antibacterial treatment for an upper
UTI
• Anatomic obstruction or nerve supply interruption
• Recurrent episodes of upper UTIs

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 UTI
• The most causative organism is E.coli , streptococous ,
staphylococus , pseudomonas

• Most common route of entry is urethra or may be hematogenous

spread.

• Most common in girls.

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 UTI
Contributing causes;
• Congenital anomalies ; vesicoureteral reflux.(VUR)

• Obstruction of urinary tract .

• Urinary catheterization

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 Clinical Manifestation
• Urinary symptoms may be found as frequency , urgency , urine
maybe foul smell ,dysuria
• Moderate to high fever with chills, rigors
• Anorexia ,refusal of feeding
• Malaise
• Irritability , vomiting, abdominal pain or suprapubic pain

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 Clinical Manifestation
• Any child under 2 years of age with a fever of unknown origin
should be tested for UTI.

• The more “classic” symptoms of lower UTI are not seen until
the preschool years.

• Many UTIs are asymptomatic and are discovered incidentally

on routine examination.
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 Clinical Manifestation

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 Diagnostic Evaluation

• History , physical examination

• Urine Microscopy &C/s (midstream urine collection)
• Blood C/s
• US , +Ve Nitrate test
• IVU , MCUG (micturating cystourethrogram)

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 Treatment
• Antibiotic therapy for 10-14 days course
• General measures , high fluid intake , antipyretics if needed .
• Correction of congenital malformations
• Follow –up
• Prophylaxis therapy

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 Nursing Care
1. Deficient fluid volume related to decrease intake and increase
loss from fever
2. Deficient knowledge related to incomplete understanding on
the disease process , diagnostic tests , treatment , preventive
measures of UTI
3. Risk for injury to the kidney related to complications from the
infectious process
4. …..

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 Discharge Planning and
Home Care Teaching

01/31/2025 Dr . Fatima Alzahra .A .M 15

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 Acute Post Streptococcal
Glomerulonephritis

The most common cause of haematuria in

children.

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 Etiology
• The disease is antigen-antibody reaction secondary to recent
infection by group –A beta hemolytic streptococci either in
1. Throat ; acute follicular tonsillitis or scarlet fever
2. Skin : impetigo or boils.
The disorder is most commonly in 5 -12years old

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 Clinical Picture
• History suggest sore throat or skin infection 1-3 weeks
• Haematuria ( coca-cola or tea colored)
• Edema ; observed as preiorbital specially in morning time and
mild edema of lower limbs
• Hypertension
• Decrease urine output
• General manifestations; anorexia , malaise , fever , pallor

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01/31/2025 Dr . Fatima Alzahra .A .M 20
 Diagnostic Evaluation
• History • Throat or skin swab for C/s
• Urinalysis , hematuria , +ve for B-hemolytic strept
glanular casts
• RFT • Kidney biopsy indicated
• ESR, when delayed resolution &
• Antistreptolysin - O titer atypical presentation.
(ASO – titer)

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 Treatment
• Children with substantial edema , BP ,oliguria ,gross hematuria
, shoud be hospitalized .
• Dietary restriction depending on the severity of the child’s
condition ,Na & fluids resection for children with high BP &
edema , low K+ diet in case of oliguria .
• Antibiotic therapy may be for 10 days
• Antihypertensive therapy may be necessary

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 Nursing Care
1. Imbalance /Risk for fluid volume related to retention of Na &
fluids .
• Correct I&O
• Daily wt
• Vial signs (BP, HR ,RR, temp)
2. Activity intolerance related

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 Nursing Care
3. Imbalanced nutrition less than body requirement related to
diet restrictions .
4. Anxiety related to insufficient knowledge about the disease or
hospitalization .
5. Risk or impaired skin integrity related to edema and
decreased activity .

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 Complications
• Heart Failure

• Hypertensive encephalopathy

• Acute Renal Failure

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01/31/2025 Dr . Fatima Alzahra .A .M 26
 Nephrotic Syndrome

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 Nephrotic Syndrome
• This is a clinical condition characterized by

1. massive protienuria
2. hypoalbuminemia
3. massive edema
4. Hyperlipidemia

Occurs in children between the age of 2-7 years of age , more in

boys .
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 Classifications
It can be classified into :
• Primary Nephrotic Syndrome or minimal changes NS (MCNS)
or Idiopathic NS , the commonest type .
• Secondary NS : secondary to a systemic disease e.g SLE , Ca ,
drug toxicity .
• Congenital NS ( rare ).

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 Clinical Manifestations
• Wt gain , puffiness face , edema around the eyes ,ascites , pleural
effusion , labia & scrotal swelling
• Irritability , easily fatigue .
• BP normal or slightly decreased
• GIT disturbance diarrhea , loss of appetite
• Decrease urine volume
• Susceptibility to infection (RTI)

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 Diagnostic Evaluation
• Clinical presentation
• Urine examination shows ; proteinuria & increased specific gravity
(dark &frothy urine)
• 24hrs collection of urine for protein
• T. serum protein is reduced
• S. albumin is significantly (<2.5g/dl)
• S. cholesterol (>200mg/dl)
• RFT

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 Treatment
• Bed rest & high protein & no added-salt diet with fluid
restriction are important aspects of treatment

• Steroid therapy , oral predinsolone 2mg/kg/day in 2-3 divided

doses at least 4-6 weeks then gradually tapered off.

• Diuretics in severe edema

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 Treatment
• Albumin infusion may be given in case o massive edema & ascities

• Immunosuppressive drugs (cyclophosphamide)

In case of frequent relapses

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 Prognosis

• In early diagnosis and appropriate treatment with steroids &

supportive care 80% o children with NS will recover .

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 Nursing Care
1. Fluid volume excess related to fluid accumulation in tissues
2. Altered nutrition less than body requirement
3. anxiety related to hospitalization and disease process
4. Knowledge deficit related to home management .
5. Risk for infection
6. Risk for impaired growth & D

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 Genitourinary tract Disorders
• Hypospadias : is the congenital abnormal urethral opening on the
ventral aspect of the penis .

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• Epispadias : is the congenital abnormal urethral opening on the
dorsal aspect of the penis .

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 Classifications of Hypospadias
• Anterior hypospadias (65-70%) may be found as glandular or
colonal or distal penile shaft

• Middle hypospadias (10-15%)

• Posterior hypospadias ( 20%) @ the penoscrotal ,scrotal or

perineal area

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 Problems Related to Hypospadias
• Due to chordee (downward curvature) there is defected stream
of urine .
• Inability to void urine while standing
• Associated problems may include undescended testes
• Meatal stenosis
• if left untreated the child will experience psychlogical & sexual
problems later .

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 Management
• Surgical reconstruction to maintain strait penis @ erection & to
form urethral meatus at the normal site.

• The surgical repair should be completed before admission to

school

• Operation can be performed as multistage .

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 Management
• Infants with hyospadias should not be circumcised because the
foreskin may be used in the surgical reconstruction

• Urinary diversion is common after surgery with indwelling urinary

catheter to allow the healing of the meatus.

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 Surgical repair

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 Nursing Care
1. Deficit knowledge related to diagnosis , surgical procedure
and postoperative care.

• Provide parents with detailed preoperative teaching .

• Encourage them to participate in postoperative care .
• Psychological support

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 Nursing Care

• Impaired physical mobility related to surgical procedure

• Anxiety related to un known outcomes

• Risk for infection related to indwelling catheter

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 Families Want to Know
Caring for the Child After Hypospadias
and Epispadias Repair
• Use double-diapering to protect the operative site.

• Do not bathe the child in a tub until the stent (the small tube that
drains the urine) or catheter is removed.

• Restrict the infant or toddler from activities (e.g., playing on riding

toys) that put pressure on the surgical site
• Avoid holding the infant or child straddled on the hip
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 Families Want to Know
Caring for the Child After Hypospadias
and Epispadias Repair

• Limit the child’s activity for 2 weeks.

• Encourage the infant or toddler to drink fluids to ensure adequate
hydration
Administer the complete course of prescribed antibiotics to
avoid infection.
• Observe for signs of infection: fever, swelling, redness, pain,
strong-smelling urine, or change in flow of the urinary stream.
• The urine will be blood tinged for several days. Call the healthcare
provider if urine is seen leaking from any area other than the penis
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 Double-diapering

01/31/2025 Dr . Fatima Alzahra .A .M 52

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 Cryptorchidism
• Undescended or hidden testes : one or both testes fail to
descend through the inguainal canal into scrotal .

• Manifestations :Testes are not palpable

• Diagnostic evaluation : clinical , U/S

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 Treatment
• Observation ( during the 1st year of life)
• Surgery is the treatment of choice orchidopexy.
• Surgery is done to preserve testicular function & to avoid
torsion & avoid psychological disability
• Most common complication for surgery is bleeding & infection

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 Nursing Care
1. Deficit knowledge related to diagnosis , surgical procedure
and postoperative care.

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 Testicular Torsion

• In testicular torsion, a testicle is abnormally attached to the

scrotum and twisted.

• It requires immediate attention because ischemia can result if the

torsion is left untreated, leading to infertility

• Testicular torsion may occur at any age but most commonly

occurs in boys aged 12 to 18 years
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 Thanks

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