Advances in paediatric urology

Abstract

Paediatric urological surgery is often required for managing congenital and acquired disorders of the genitourinary system. In this Series paper, we highlight advances in the surgical management of six paediatric urological disorders. The management of vesicoureteral reflux is evolving, with advocacy ranging from a less interventional assessment and antimicrobial prophylaxis to surgery including endoscopic injection of a bulking agent and minimally invasive ureteric reimplantation. Evidence supports early orchidopexy to improve fertility and reduce malignancy in boys with undescended testes. A variety of surgical techniques have been developed for hypospadias, with excellent outcomes for distal but not proximal hypospadias. Pelvi-ureteric junction obstruction is mostly detected prenatally; indications for surgery have been refined with evidence, and minimally invasive pyeloplasty is now standard. The outlook for patients with neurogenic bladder has been transformed by a combination of clean intermittent catheterisation, algorithms of diagnostic investigations, and innovative medical and surgical therapies. Posterior urethral valves are associated with considerable mortality; fetal diagnosis allows stratification of candidates for intervention, but ongoing bladder dysfunction in patients after valve ablation remains a cause of long-term morbidity.

Surgery for Pediatric Ureteropelvic Junction Obstruction—Comparison of Outcomes in Relation to Surgical Technique and Operating Discipline in Germany

“…4,8 Despite the evolution of minimally invasive techniques in the last decades, only 25% of patients in the present cohort were operated laparoscopically. [9][10][11] In contrast to other minimal invasive techniques that have been established as standard of care such as laparoscopic appendectomy, the rather restrictive dissemination of LP might reflect the challenging character of this operation. 8,12 Moreover, a group from Rochester recently showed that the minority of LP takes place in non-teaching hospitals.…”

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

“…If siblings become symptomatic, such as having febrile UTI, VUR examination should be planned soon after treatment of the febrile UTI . Because most siblings are still asymptomatic according to the 2010 AUA VUR guidelines, an observational approach is recommended nowadays …”

“…21 Because most siblings are still asymptomatic according to the 2010 AUA VUR guidelines, an observational approach is recommended nowadays. 22 Approximately 15% (95% CI 10.9-20.7) of children with mild-to-moderate PNH are found to have VUR. 11 These cases diagnosed after PNH have a high incidence of spontaneous resolution.…”

Bladder augmentation in children: current problems and experimental strategies for reconstruction

“…Neural tube defects represent one of the most common birth defects (33–52/100,000 live births [6, 7]) as well as the most common cause of neurogenic bladder dysfunction [8]. In this regard, there is high accuracy and precision for obtaining the diagnosis by antenatal ultrasound [9].…”

“…If medical treatment and/or interventional methods have failed, and high intravesical pressure and urinary incontinence or recurring urinary tract infections persist combined with present vesicoureteral reflux and impaired renal function, surgical treatment in terms of bladder augmentation is indicated [8, 23]. Urinary bladder augmentation-reconstruction includes and simplifies:Augmentation of the bladder capacityvia enterocystoplastyor autoaugmentationtreatment of incontinencecatheterizable conduit (Mitrofanoff appendicovesicostomy)…”