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Paediatric Urologists (paediatric + urologist)
Selected AbstractsHypospadias repair: an overviewINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 1 2010Michael Pfeil Hypospadias is a birth defect in boys where the meatus is not placed at the tip of the glans of the penis. This article reviews the rapidly developing international literature surrounding hypospadias and hypospadias repairs paying specific attention to important aspects of nursing care, including preparing for surgery, use of dressings, stents and catheters as well as medication. It concludes by considering the long-term impact of hypospadias and its surgical correction on the patient's life. Hypospadias is treated surgically, normally during the second 6 months of the boy's life. Hospitalization periods vary from day case surgery to several days. The success of the hypospadias repair can be measured according to functional results and cosmetic appearance of the penis. The post-operative use of dressings as well as urinary catheters or stents is common but not uniform. Complication rates for hypospadias surgery vary from below 10% in boys with distal hypospadias to above 50% in children with a proximal meatus. The most common complications are urethral fistulas, strictures and stenoses. The continuing efforts by paediatric urologists focus on further optimizing the cosmetic and functional results. [source] Hypospadias surgery: when, what and by whom?BJU INTERNATIONAL, Issue 8 2004Gianantonio Manzoni Summary Hypospadias is repaired by paediatric surgeons, paediatric urologists, adult reconstructive urologists and plastic surgeons. This review is unique in representing all four specialities, to provide a unified policy on the management of hypospadias. The surgeon of whichever speciality should have a dedicated interest in this challenging work, ideally having an annual volume of at least 40,50 cases. The ideal time for primary repair is at 6,12 months old, although when this is not practicable there is another opportunity at 3,4 years old. A surgical protocol is presented which emphasises both functional and cosmetic refinement. Using a logical progression of a very few related procedures allows the reliable correction of almost any hypospadias deformity. A one-stage repair is used when the urethral plate does not require transection and its axial integrity can be maintained. Occasionally, when the plate is of adequate width and depth, it can be tubularized directly using the second stage of the two-stage repair. When (usually) the urethral plate is not adequately developed and requires augmentation before it can be tubularized, then that second-stage procedure is modified by adding a dorsal releasing incision ± a graft (alias Snodgrass and ,Snodgraft' procedures). The two-stage repair offers the most reliable and refined solution for those patients who require transection of the urethral plate and a full circumferential substitution urethroplasty. From available evidence this protocol combines excellent function and cosmesis with optimum reliability. Nevertheless, it would be complacent to assume that these gratifying results will be maintained into adult life. We therefore recommend that there is still a need for active follow-up through to genital maturity. [source] Mentored retroperitoneal laparoscopic renal surgery in children: a safe approach to learningBJU INTERNATIONAL, Issue 6 2003W. Farhat Minimally invasive surgery is not exclusive to the treatment of adult conditions. It has also been used in paediatric urology, and the authors from Toronto and Paris describe a mentorship-training model for laparoscopic retroperitoneal surgery. They confirmed that a mentored approach is the way to develop this procedure. They also found that ablative procedures are learned relatively early, but that reconstructive procedures require a high degree of skill in laparoscopic techniques, requiring formal training focusing mainly on suturing techniques. OBJECTIVE To review the feasibility of introducing advanced retroperitoneal renal laparoscopic surgery (RRLS) to a paediatric urology division, using the mentorship-training model. Although the scope of practice in paediatric urology is currently adapting endoscopic surgery into daily practice, most paediatric urologists in North America have had no formal training in laparoscopic surgery. METHODS The study included four paediatric urologists with 3,25 years of practice; none had had any formal laparoscopic training or ever undertaken advanced RRLS. An experienced laparoscopic surgeon (the mentor) assisted the learning surgeons over a year. The initial phases of learning incorporated detailed lectures, visualization through videotapes and ,hands-on' demonstration by the expert in the technique of the standardized steps for each type of surgery. Over 10 months, ablative and reconstructive RRLS was undertaken jointly by the surgeons and the mentor. After this training the surgeons operated independently. To prevent lengthy operations, conversion to open surgery was planned if there was no significant progression after 2 h of laparoscopic surgery. RESULTS Over the 10 months of mentorship, 36 RRLS procedures were undertaken in 31 patients (28 ablative and eight reconstructive). In all cases the mentored surgeons accomplished both retroperitoneal access and the creation of a working space within the cavity. The group was able to initiate ablative RRLS but the mentor undertook all the reconstructive procedures. After the mentorship period, over 10 months, 12 ablative procedures were undertaken independently, and five other attempts at RRLS failed. CONCLUSION Although the mentored approach can successfully and safely initiate advanced RRLS in a paediatric urology division, assessing the laparoscopic practice pattern after mentorship in the same group of trainees is warranted. Ablative RRLS is easier to learn for the experienced surgeon, but reconstructive procedures, e.g. pyeloplasty, require a high degree of skill in laparoscopic technique, which may only be acquired through formal training focusing primarily on suturing techniques. [source] The management of paediatric urolithiasisBJU INTERNATIONAL, Issue 7 2000S. Choong Objective To evaluate the efficacy and safety of the management of paediatric urolithiasis by extracorporeal shock wave lithotripsy (ESWL), endoscopic ureterolithotomy, percutaneous nephrolithotomy (PCNL) and open nephrolithotomy. Patients and methods In a 3-year period (1997,1999), 59 children were treated for urolithiasis and underwent a total of 79 procedures. Thirty-two ESWL sessions were performed in 23 children (mean age 7.4 years, median 6.0). PCNL was undertaken in 30 renal units in 25 children (mean age 6.4 years, median 4.0). Eight patients (mean age 7.8 years, median 5) underwent 17 ureteroscopic procedures, six of which involved the use of a holmium laser. Three children with staghorn calculi underwent open nephrolithotomy under conditions of renal ischaemia and hypothermia. Results Of the 23 children treated using ESWL, 21 (91%) became stone-free; 17 underwent one ESWL session (74%), three had two sessions and three (13%) had three sessions. All eight patients who underwent ureteroscopy became stone-free. Four patients in whom the stone could not be reached by ureteroscopy initially had a JJ stent inserted, and the stone and stent subsequently removed. Stones were cleared using PCNL in 27 of 30 renal units (90%); three patients who had residual stone fragments were rendered stone-free by ESWL. Two of three children undergoing open nephrolithotomy were stone-free after surgery and the remaining one rendered stone-free with ESWL. Metabolic evaluation showed that 25 of 45 children (55%) had a urinary infection, eight (18%) had hyperoxaluria, three (7%) had hypercalciuria, two (4%) had cystinuria, and no identifiable cause was found in seven (16%). Treatment by a single modality rendered 52 of the 59 children (88%) stone-free; when the different modalities were combined, 57 of 59 patients (97%) were cleared of their stones. Conclusions Technological advances in ESWL, ureteroscopy and PCNL have had a significant effect on the management of urolithiasis in children, allowing a safe and successful outcome. The comprehensive care of children with urolithiasis should include a full metabolic evaluation. Anatomical anomalies contribute to the complexity of many cases, necessitating a close liaison between adult and paediatric urologists, nephrologists and radiologists to optimize stone management in children. [source] | ||||||||||