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Pediatric Urology

Pediatric Urology. Nursing care of common pediatric urologic problems Tara M. Albert, RN, MSN, CPNP. Objectives. Review the components of urinary system and how abnormalities cause urologic problems Discuss the surgical management of common urologic problems

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Pediatric Urology

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  1. Pediatric Urology Nursing care of common pediatric urologic problems Tara M. Albert, RN, MSN, CPNP

  2. Objectives • Review the components of urinary system and how abnormalities cause urologic problems • Discuss the surgical management of common urologic problems • Management of the inpatient urology patient

  3. Anatomy

  4. Common Urologic Problems Requiring Inpatient Care • Ureteropelvic Junction Obstruction • Vesicoureteral Reflux • Kidney stones • Hypospadias • Testicular Torsion • Circumcision complications

  5. Ureteropelvic obstruction Narrowing of the ureter that cause dilation of the kidney

  6. Presentation of UPJ obstruction • Hydronephrosis * prenatal ultrasound *evaluation for recurrent UTI • Evaluation of abdominal or flank pain of unknown origin

  7. How to determine if UPJ obstruction is present • Ultrasound reveals hydronephrosis • VCUG is negative for vesicoureteral reflux • Renogram is the use of IV tracer to determine how long it takes for kidney to clear tracer (Nuclear Med Test)

  8. Pyeloplasty • Surgical correction of UPJ obstruction • Flank incision • Removal of obstructed portion and reanastomosis of the ureter

  9. Postoperative Care of a Pyeloplasty • What to expect? • IV, penrose drain, flank incision, IV, foley and abdominal binder • 23-48 hour admission • Postop day 1: suppository in am, advance diet if bowel sounds present, walk the hall, discontinue foley

  10. Vesicoureteral Reflux • Backflow of urine from the bladder back to the kidney • Concern with UTI that may cause a pyelonephritis • Reflux is caused by the way ureter enters the bladder wall

  11. Management of Vesicoureteral reflux • Prophylactic antibiotics when patient has had recurrent UTI especially associated with fever • Improve voiding habits • Surgical intervention after age of 3 or 4 • Deflux injection in grades 2 and sometimes 3 • Extravesicalreimplantation in grade 3 or higher

  12. Extravesicalureteralreimplantation • Ureters are detached from the bladder and reimplanted into a stronger portion of the bladder • Pfannenstiel incision (c-section

  13. Postoperative Management of the extravesicalureteralreimplantation • Foley catheter remains in place 1 week • NPO Post op day 0 • Post Op Day 1: suppository in am, bowel sounds present advance diet as tolerated, up out of bed and walking the halls • Plan for discharge 23 to 48 hours after discharge

  14. Kidney Stones • Patient will present with flank pain, blood in the urine, may have hydronephrosis due to blockage of the ureter • NON contrast CT scan to determine presence of stone • No need for surgical management unless stone is blocking ureter

  15. Surgical management of stones • Extracorporeal shCockwave lithotripsy • Endoscopic Lithotripsy • Both require placement of ureteral stent to allow drainage of urine • Can be a two to three step process

  16. Postoperative Management of Kidney stone • Normal to have blood in the urine • 23 hour admission after stent placement and stone removal due to high rate of return due to pain • Require medication for bladder spasms (ditropan) and antibiotic while stent in place

  17. Hypospadias • Congenital birth defect where urethral opening is on the underside of penis rather than the tip • Surgical correction after 6 months of age

  18. Postoperative management of hypospadias repair • Blue dressing in place. DO NOT REMOVE! • Urethral stent stays in place 5-7 days • Keep penis pointed to the nose not the toes! • Patient will require ditropan for bladder spasms and septra while stent in place • Tylenol with codeine for pain • Follow up in office for dressing removal

  19. Testicular Torison • A true urologic emergency • Testicle twists in the scrotal sac cutting off blood supply • Extreme scrotal pain • Orchiopexy bilaterally

  20. Circumcision complications • Bleeding • Plastibell is displaced to shaft of the penis

  21. Pearls of Wisdom • Each of your patients is the absolute center of their parent’s universe • Listen to parents and be patient • Compassion starts when you imagine your own child in the same situation

  22. Please remember that every patient is someone’s child!

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