Pediatric clinics of North America
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In the current era of pediatric uroradiology, use of nuclear medicine, ultrasonography, CT, and MRI has been valuable in the identification and management of genitourinary diseases. Excellent information about the renal parenchyma and renal function is currently attainable with current cross-sectional imaging techniques that can identify tissue differentiation of lesions, distinguish dilatation of the pelvocalyceal system, and determine margins of the kidney and perirenal space. Invasive angiography is limited in application specifically to vascular diseases, although they are uncommon in childhood. Because of these newer techniques, intravenous urography has lost its position as the "cornerstone" of urinary tract imaging and is used mainly to identify pathologic conditions of the ureters.
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The more common urologic problems seen in infancy and childhood that require urgent or emergent pediatric urologic referral are discussed, including a brief description of the usual presenting signs or symptoms, differential diagnoses, proper diagnostic work-up recommended before or at the time of referral, and the usual therapeutic course of management after evaluation by the urologist. These conditions include the acutely swollen scrotum, scrotal masses, penile swelling and erythema, exstrophy, hematuria, urinary retention, abdominal masses, and various genital abnormalities including interlabial masses, hypospadias with any degree of cryptorchidism, and ambiguous genitalia. This article is designed to provide the primary care practitioner with a focused review and a useful resource for managing children who have genitourinary abnormalities in the hospital or clinic setting.