100+ Free ABU Pediatric Urology Practice Questions

Vesicoureteral Reflux (VUR)

International Reflux Study Grade I-V, AUA VUR Guideline, RIVUR trial (NEJM 2014 — TMP-SMX or nitrofurantoin prophylaxis reduces recurrent febrile UTI ~50% in Grade I-IV VUR), endoscopic injection of dextranomer/hyaluronic acid (Deflux), ureteral reimplantation (Cohen cross-trigonal, Politano-Leadbetter, Lich-Gregoir extravesical), robotic-assisted reimplantation, top-down DMSA vs bottom-up VCUG, BBD (bladder-bowel dysfunction) treatment required before surgical correction.

Pediatric GU Oncology

Wilms tumor (COG AREN protocols — stage-based vincristine/dactinomycin ± doxorubicin ± radiation, WT1/WAGR 11p13/Denys-Drash/Beckwith-Wiedemann, favorable vs anaplastic histology, nephron-sparing for bilateral/syndromic), rhabdomyosarcoma GU (bladder/prostate/paratesticular, IRS Group I-IV, embryonal better than alveolar PAX3/7-FOXO1), neuroblastoma (MYCN amplification, INRG stage L1/L2/M/MS), testicular tumors (yolk sac — AFP elevated, teratoma, gonadoblastoma in DSD), Xp11 translocation RCC.

Neurogenic Bladder

Spina bifida/myelomeningocele, tethered cord, sacral agenesis, urodynamics (detrusor leak point pressure ≥40 cm H2O predicts upper-tract deterioration), CIC (clean intermittent catheterization) cornerstone, oxybutynin/anticholinergics, intradetrusor onabotulinumtoxinA, augmentation cystoplasty (ileal, sigmoid; complications — mucus, stones, perforation, electrolyte imbalance, long-term malignancy), Mitrofanoff appendicovesicostomy/Monti, MACE Malone antegrade continence enema, transitional urology.

Disorders of Sex Development (DSD)

Chicago 2006 consensus nomenclature, 46,XX DSD (CAH — 21-hydroxylase deficiency most common; salt-wasting with hyponatremia/hyperkalemia; elevated 17-OHP), 46,XY DSD (complete/partial androgen insensitivity — AR gene; 5-alpha-reductase deficiency — DHT deficiency; gonadal dysgenesis — Swyer SRY), sex chromosome DSD (mixed gonadal dysgenesis 45,X/46,XY; Klinefelter 47,XXY), ovotesticular DSD, Y-chromosome material and gonadoblastoma risk — prophylactic gonadectomy indicated, multidisciplinary team, genitoplasty timing controversy.

Posterior Urethral Valves (PUV)

Young Type I (>95%), antenatal findings (keyhole sign, bilateral hydroureteronephrosis, oligohydramnios/anhydramnios → Potter sequence with pulmonary hypoplasia), VCUG diagnostic gold standard postnatal, primary valve ablation (cold knife, Bugbee electrode), temporary vesicostomy or high diversion in small/sick neonates, valve bladder syndrome (noncompliant small-capacity, then myogenic failure with large-capacity hypocontractile bladder), POP-OFF mechanisms (VURD — unilateral reflux with dysplastic kidney), progression to CKD/ESRD, transplantation.

Cryptorchidism

AUA Cryptorchidism Guideline — orchiopexy by 6-18 months of age to optimize fertility and reduce malignancy risk; palpable (inguinal canal, superficial pouch) vs nonpalpable (laparoscopic exploration gold standard); Fowler-Stephens two-stage for high intra-abdominal testis; malignancy relative risk ~2-4x (seminoma most common; germ cell neoplasia in situ precursor); no preoperative imaging needed; retractile testis has normal exam cremasteric reflex; hCG and GnRH analogs rarely used.

Hypospadias

Classification — glanular, coronal, distal shaft (most common), midshaft, proximal/penoscrotal/perineal; chordee correction (degloving, dorsal plication, ventral grafting); TIP/Snodgrass tubularized incised plate (workhorse for distal); MAGPI meatal advancement; Mathieu flip-flap; onlay island flap; two-stage Bracka for severe proximal with severe chordee; staged buccal mucosa graft for redo; complications (urethrocutaneous fistula most common, meatal stenosis, urethral diverticulum, glans dehiscence, urethral stricture); optimal age 6-18 months.

Pediatric UTI

AAP 2011 UTI Guideline (reaffirmed 2016) — febrile UTI in age 2-24 months requires catheterized or suprapubic urine culture and renal-bladder ultrasound; VCUG reserved for recurrent febrile UTI or abnormal ultrasound; RIVUR trial supports prophylaxis in VUR I-IV; pathogens (E. coli >80%; Proteus in uncircumcised boys); circumcision reduces infant UTI risk ~10-fold; BBD evaluation and bowel regimen; DMSA for renal scarring assessment.

Genitourinary Trauma

AAST renal injury scale (Grade I-V); children more susceptible (less rib protection, proportionately larger kidneys, less perinephric fat, softer ribs); nonoperative management preferred for hemodynamically stable blunt injury even high-grade; contrast CT with 10-minute delayed phase to assess collecting system; pediatric pelvic fracture with posterior urethral injury (retrograde urethrogram, suprapubic cystostomy + delayed repair); straddle injury to anterior urethra; testicular rupture requires ultrasound then surgical exploration within 72 hours for salvage.

Voiding Dysfunction & Enuresis

ICCS terminology, primary monosymptomatic nocturnal enuresis (desmopressin short-term, enuresis alarm for durable response — first-line behavioral), dysfunctional voiding (staccato/interrupted flow, pelvic floor discoordination), Hinman syndrome (non-neurogenic neurogenic bladder), overactive bladder/urge incontinence (oxybutynin), underactive bladder, BBD (constipation management — PEG 3350 critical), biofeedback, pelvic floor physical therapy.

Bladder Exstrophy–Epispadias Complex

Spectrum from epispadias → classic bladder exstrophy → cloacal exstrophy (OEIS — omphalocele/exstrophy/imperforate anus/spinal); modern staged repair of exstrophy (MSRE — closure → epispadias repair → bladder neck reconstruction) vs complete primary repair of exstrophy (CPRE — Mitchell single-stage); pelvic osteotomy (anterior innominate or posterior iliac) for tension-free closure; Young-Dees-Leadbetter bladder neck for continence; augmentation if inadequate capacity; fertility and sexual function considerations; increased malignancy risk (adenocarcinoma).

Ureteral Duplication & Ectopia

Weigert-Meyer rule — upper pole moiety inserts inferomedial/ectopic (often obstructed or drains ectopically), lower pole inserts superolateral (typically refluxing); ectopic ureter (female — insertion below sphincter → continuous incontinence; male — always above sphincter, may cause epididymitis/seminal vesicle cyst); ureterocele (intravesical simple vs ectopic/extravesical complex); duplex management (endoscopic ureterocele incision, upper-pole heminephrectomy, ipsilateral ureteroureterostomy, common-sheath reimplantation).

UPJ Obstruction & Hydronephrosis

Antenatal hydronephrosis (SFU grading 0-4; Urinary Tract Dilation UTD classification — A1/A2-3 postnatal), MAG3 diuretic renography (T1/2 >20 min obstructive, 10-20 equivocal, <10 nonobstructive), Anderson-Hynes dismembered pyeloplasty (open, laparoscopic, robotic-assisted — now standard in many centers), indications for intervention (symptomatic, split function <40%, progressive hydronephrosis, UTI, stones), crossing lower-pole vessel, horseshoe kidney association.

Pediatric Stone Disease

Metabolic evaluation critical (24-hour urine Ca/Ox/Cit/Cys/Na; plasma bicarbonate for distal RTA; cystinuria SLC3A1/SLC7A9; primary hyperoxaluria type I AGXT; hypocitraturia); imaging (ultrasound first-line for children; low-dose CT if needed; MRU research); SWL, ureteroscopy with miniaturized scopes (4.5-6 Fr semirigid, flexible), mini-PCNL/micro-PCNL, increasing incidence in adolescents, dietary therapy (fluid, normal calcium, low sodium).

Acute Scrotum

Testicular torsion (6-hour window for viability; bell-clapper deformity bilateral risk; emergent scrotal exploration with contralateral orchidopexy; manual detorsion outward/lateral — open book), torsion of appendix testis (blue dot sign, self-limited NSAIDs), epididymitis (uncommon prepubertal — always evaluate for structural anomaly like ectopic ureter), idiopathic scrotal edema, incarcerated hernia, HSP (Henoch-Schönlein purpura), post-pubertal epididymo-orchitis (sexually transmitted — N. gonorrhoeae, C. trachomatis).

Circumcision & Foreskin Disorders

AAP 2012 Circumcision Policy — benefits outweigh risks (UTI, HIV/STI, penile cancer reduction); not routine recommendation, family decision; phimosis (physiologic — resolves by age 5; pathologic BXO/lichen sclerosus requires circumcision); paraphimosis (urologic emergency — manual reduction, dorsal slit if needed); complications (bleeding most common, infection, meatal stenosis, glans/urethral injury, skin bridges, buried penis); techniques — Gomco clamp, Mogen clamp, Plastibell, sleeve resection.

Varicocele & Renal Transplant

Adolescent varicocele ~15%, predominantly left-sided (left gonadal vein drains into left renal vein at 90 degrees; right varicocele — evaluate for retroperitoneal pathology); indications for repair (testicular size discrepancy >20% or 2 mL, pain, bilateral, abnormal semen analysis in older adolescents); microsurgical subinguinal preferred (lowest recurrence/hydrocele). Pediatric transplant indications (CAKUT — PUV/reflux nephropathy/dysplasia; FSGS; Alport); preemptive transplant preferred; small-child intraperitoneal approach; bladder optimization pre-transplant (CIC, augmentation) in valve/neurogenic patients.

Renal Anomalies, Megaureter & Female Pediatric GU

Multicystic dysplastic kidney (nonfunctioning, typically involutes; contralateral anomaly ~30% — VUR, UPJ); bilateral renal agenesis (Potter sequence fatal); horseshoe kidney (isthmus at L3, increased UPJ/Wilms/stones); ARPKD (PKHD1) and ADPKD (PKD1/PKD2); primary obstructive megaureter (distal adynamic segment — observation first, many resolve; tapering/plication with reimplant if persistent); labial adhesions (topical estrogen); MRKH vaginal agenesis; cloacal malformation (PSARP, total urogenital mobilization); OHVIRA/Herlyn-Werner-Wunderlich.