The Child with a Genitourinary Disorder Chapter 39: The Child with a Genitourinary Disorder

Growth and Development of the Genitourinary System The kidneys in children are located lower in relationship to the ribs than in adults. This placement and the fact that the child has less of a fat cushion around the kidneys cause the child to be at greater risk for trauma to the kidneys.

Growth and Development of the Genitourinary System In infants and children, emptying the bladder is a reflex action. In the newborn, the bladder empties when only about 15 mL of urine is present, so the newborn voids as many as 20 times a day. Between ages 2 and 3 years, the child develops control of urination. The kidneys reach their full size and function by the time the child is an adolescent. The reproductive portion of the genitourinary system in males and females matures at the time of puberty.

Urinary Tract Infections UTIs are fairly common in the “diaper age,” in infancy, and again between the ages of 2 and 6. The condition is more common in girls than in boys the symptoms may be fever, nausea, vomiting, foul- smelling urine, weight loss, and increased urination. Occasionally there is little or no fever. UTIs are usually treated with anti-infectives such as trimethoprim-sulfamethoxazole, ampicillin or amoxicillin, nitrofurantoin or cephalosporins. The entire course of the medication should be taken, even if the symptoms subside after a few days. Goals for the child with a UTI include reducing temperature, maintaining normal urinary elimination, and increasing fluid intake.

Enuresis Enuresis, or bed-wetting, is involuntary urination beyond the age when control of urination is commonly acquired. Many children do not acquire complete nighttime control before 5 to 7 years of age, and occasional bed-wetting may be seen in children as late as 9 or 10 years of age. Physiologic causes of enuresis may include a small bladder capacity, UTI, and lack of awareness of the signal to empty the bladder because of sleeping too soundly. If a physiologic cause has been ruled out, psychological causes, including emotional stress, may be the cause of the enuresis.

Acute Glomerulonephritis Acute glomerulonephritis is a condition that appears to be an allergic reaction to a specific infection—most often group A beta-hemolytic streptococcal infections, as in rheumatic fever. Peak incidence in children 5 to 7 years of age and occurs twice as often in boys. Presenting symptoms of acute glomerulonephritis appear 1 to 3 weeks after the onset of a streptococcal infection, with the most common symptom being grossly bloody urine, which may be described as smoky or bloody. Periorbital edema may accompany or precede hematuria. Nursing care includes encouraging bed rest and preventing fatigue, protecting from infection, monitoring vital signs, intake and output, and urine for protein and hematuria.

Nephrotic Syndrome Edema is usually the presenting symptom in nephrotic syndrome, appearing first around the eyes and ankles. The edema becomes generalized with an abdomen full of fluid. Respiratory problems and edema of the scrotum on the male is characteristic. Anorexia, irritability, and loss of appetite develop. The goals for the child with nephrotic syndrome are relieving edema, improving nutritional status, maintaining skin integrity, conserving energy, and preventing infection.

Nephrotic Syndrome (cont.) Acute glomerulonephritis has an abrupt onset and usually lasts for 2 to 3 weeks. Nephrotic syndrome has an insidious onset and a course of remissions and exacerbations that usually last for months.

Question In a child with a diagnosis of acute glomerulonephritis symptoms usually appear 1 to 3 weeks after the onset of what? a. A staph infection b. A strep infection c. Ingestion of a toxin d. Grossly bloody urine

Answer b. A strep infection Rationale: Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo.

Wilms Tumor (Nephroblastoma) Wilms tumor is one of the most common abdominal neoplasms of early childhood. The tumor arises from bits of embryonic tissue that cause cancerous growth in the area of the kidney. Abdominal palpation should be avoided because cells may break loose and spread the tumor. Treatment consists of surgical removal as soon as possible after the growth is discovered, combined with radiation and chemotherapy.

Hydrocele Hydrocele is a collection of peritoneal fluid that accumulates in the scrotum through a small finger-like projection in the inguinal canal through which the testes descend. Usually the processus closes soon after birth; if the processus does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.

Cryptorchidism One or both of the testes do not descend Testes are usually normal in size If both testes remain undescended: Sterility occurs Treatment recommended if testes have not descended by age 1 Orchiopexy: Surgical correction

Menstrual Disorders PMS symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. The major cause of PMS is thought to be water retention. Dysmenorrhea (painful menstruation) has symptoms of pain associated with menstruation, including cramping abdominal pain, leg pain, and backache. The absence of menstruation is called amenorrhea.

Question What is one symptom of premenstrual syndrome? a. Intense itching b. Severe abdominal pain c. Weight loss d. Increased anxiety

Answer d. Increased anxiety Rationale: Symptoms of premenstrual syndrome include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings.