Pediatric Urology (eBook)

Preface 7
Contents 8
Contributors 10
Part I: Office Urology 12
1 Pediatric Urology Facts and Figures 13
2 Radiographic Imaging 23
Introduction 23
Imaging Modalities 24
Nuclear Imaging 26
Anomalies of the Kidney 27
Unilateral Renal Agenesis 27
Renal Ectopia 27
Renal Cystic Diseases 28
Hydronephrosis 29
Ureteropelvic Junction (UPJ) Obstruction 30
Collecting System Duplication 31
Stones 32
Pyelonephritis 33
Anomalies of the Ureters 34
Megaureter 34
Ureterocele 35
Anomalies of the Bladder 36
Vesicoureteral Reflux 36
Neurogenic Bladder 37
Bladder Diverticulum 39
Anomalies of the Urethra 40
Posterior Urethral Valves (PUV) 40
Other Urethral Anomalies 40
Anomalies of the Testis 41
Acute Testicular Pain 41
Conclusion 44
References 44
3 Urinary Tract Infections 46
Introduction 46
Epidemiology 47
Etiology 47
Bacterial Virulence Factors 49
Host Defense and Risk Factors 50
Perineal Factors 50
Lower Urinary Tract Factors 51
Upper Urinary Tract Factors 52
Reflux Nephropathy 54
Pathogenesis of Post-pyelonephritic Renal Scarring 55
Congenital Reflux Nephropathy 56
Sequelae of Renal Scarring/Dysplasia 56
Renal Insufficiency 57
Diagnosis of Uti 58
Evaluation of Uti 59
Lower Tract Imaging 59
Upper Tract Imaging 60
''Top-Down'' Approach to Evaluation of UTI 63
Treatment of Uti 64
Cystitis 65
Pyelonephritis 65
Asymptomatic Bacteriuria 67
Antibiotic Prophylaxis 68
Renal Abscess 69
Xanthogranulomatous Pyelonephritis 69
Treatment in Renal Failure 70
Conclusions 70
References 71
4 Voiding Dysfunction, Urinary Incontinence, and Urodynamics 79
Introduction 79
Background and Epidemiology 80
Pathophysiology 80
Etiology of Nocturnal Enuresis 81
Iccs Definitions of Voiding Symptoms 82
Iccs Classification of Incontinence 83
Incontinence 83
Evaluating Children with Voiding Dysfunction and Incontinence 85
History 85
Physical Examination 85
Investigation 86
Management 90
Clean Intermittent Catheterization 94
Surgical Management 94
Conclusions 94
References 94
5 Hematuria: Gross and Microscopic 98
Introduction 99
Definition 99
Classification 101
Epidemiology 101
Etiology 106
Hematuria From Glomerular Causes 106
Acute Post-streptococcal Glomerulonephritis 106
IgA Nephropathy 107
Alport's Syndrome 108
Thin Glomerular Basement Membrane Disease 108
Membranous Glomerulonephritis 109
Membranoproliferative Glomerulonephritis 109
Glomerulonephritis Associated with Systemic Lupus Erythematosus 110
Henoch-Schonlein Purpura Nephritis 110
Rapidly Progressive Crescentic Glomerulonephritis 111
Goodpasture's Disease 112
Hemolytic-Uremic Syndrome 112
Hematuria Due to Renal Interstitial Diseases 113
Cystic Disease 113
Nephrocalcinosis 113
Interstitial Nephritis 114
Acute Tubular Necrosis 115
Cortical Necrosis 116
Nephrotoxins 116
Tumors 116
Vascular Causes of Hematuria 117
Trauma 118
Sickle Cell Nephropathy 119
Renal Vein Thrombosis 119
Renal Artery Thrombosis 121
Coagulopathies and Thrombocytopenia 121
Arteriovenous Malformations 121
Nutcracker Syndrome 122
Hematuria Originating From the Urinary Tract 122
Idiopathic Hypercalciuria 122
Nephrolithiasis 123
Bacterial Infection 123
Hemorrhagic Cystitis 124
Obstruction 124
Urethrorrhagia 124
Heavy Exercise 125
Loin Pain-Hematuria Syndrome 125
Evaluation 125
History 127
Physical Examination 128
Laboratory Testing 129
Radiologic Testing 129
Biopsy 130
Cystoscopy 130
Referral 131
References 131
6 Office Procedures 133
Introduction 133
The Pediatric Urology Office 134
Pain/anxiety Management 134
Penile Procedures 136
Circumcision 136
Penile Adhesions 137
Meatotomy 138
Paraphimosis 138
Procedures on the Female Genitalia 139
Lysis of Labial Adhesions 139
Prolapsing Ureterocele/Imperforate Hymen 139
Miscellaneous Procedures 140
Urethral Catheterization 140
Teaching Clean Intermittent Catheterization 143
Suprapubic Access to the Bladder 144
Management of Indwelling Tubes and Catheters 145
References 146
7 Genetic Diseases and Associated Urologic Manifestations 147
Introduction 147
Aarskog Syndrome 148
Familial Hematuria Due to Type Iv Collagen Mutations 148
Alport Syndrome 148
Thin Basement Membrane Nephropathy 149
Congenital Hepatorenal Fibrocystic Syndromes 149
Autosomal Recessive (Infantile) Polycystic Kidney Disease (Arpkd) 149
Autosomal Dominant (Adult) Polycystic Kidney Disease (Adpkd) 150
Bardet-Biedl Syndrome 150
Jeune Syndrome (Asphyxiating Thoracic Dysplasia) 151
Meckel-Gruber Syndrome 151
Branchio-Oto-Renal Syndrome (Melnick-Fraser Syndrome) 151
Charge Syndrome 152
Ehlers-Danlos Syndrome 152
Fraser Syndrome (Cryptophthalmos Syndrome) 152
Goldenhar Syndrome (Oculo-Auricular Vertebral Complex) 153
Hypertelorism-Hypospadius Syndrome (Opitz G/Bbb Syndrome) 153
Intersex Disorders 153
Lesch-Nyhan Syndrome 153
Menkes Disease 154
Murcs Syndrome 154
Nail-Patella Syndrome (Hereditary Osteoonychodysplasia) 154
Noonan Syndrome 155
Oculocerebrorenal Syndrome Of Lowe 155
Prader-Willi Syndrome 155
Prune Belly Syndrome (Eagle-Barrett Syndrome) 156
Robinow Syndrome (Fetal Face Syndrome) 156
Sickle Cell Disease 156
Smith-Lemli-Opitz Syndrome 157
Turner Syndrome 157
Vacterl Association 157
Wilms Tumor (Nephroblastoma) 158
Zellweger Syndrome (Cerebrohepatorenal Syndrome) 158
Recently Defined Genetic Syndromes 158
Pelvis Syndrome 158
IMAGe 158
References 159
Part II: Genitalia 162
8 Penis and Scrotum: Congenital and Acquired Anomalies 163
Introduction 163
Penile Anomalies 163
Prepuce (Foreskin) 164
Phimosis and Paraphimosis 164
Circumcision 164
Circumcision Complications 165
Meatal Stenosis 165
Glanular Adhesions and Skin Bridges 166
Penile Skin Complications 166
Penile Trauma 166
Balanitis Xerotica Obliterans 167
Accessory Urethral Openings 167
Urethral Duplication 167
Congenital Urethral Fistula 168
Penile Masses 169
Inclusion Cysts 169
Parameatal Urethral Cyst 169
Cyst of the Median Raphe 170
Congenital Penile Nevi 170
Abnormal Penile Orientation 171
Penile Torsion 171
Penile Curvature 172
Micropenis 172
Inconspicuous Penis 173
Buried Penis 173
Webbed Penis 175
Priapism 175
Scrotal Anomalies 176
Penoscrotal Transposition 176
Scrotal Hypoplasia 176
Bifid Scrotum 177
References 177
9 Hypospadias 180
Introduction 180
Etiology 181
Incidence 181
Associated Conditions 182
Diagnosis 182
Preoperative Evaluation 182
Indications For Surgery 183
Preoperative Hormone Stimulation 183
Timing Of Surgery 184
Surgical Repair 184
Distal Hypospadias 184
Proximal Hypospadias 185
Correcting Penile Curvature 186
Complications 187
Fistulas 188
Meatal Stenosis 189
Urethral Stricture 190
Urethral Diverticulum 190
Wound Dehiscence 190
Hypospadias Reoperations 190
Tip 191
Inlay Grafting 191
Staged Buccal Grafts 191
Long-Term Results Of Hypospadias Repair 192
References 193
10 Varicoceles, Hernias, and Hydroceles 194
Varicocele 194
Introduction 194
Detection of Varicoceles 195
Risk Factors 196
Adolescents and Varicoceles 198
Conclusion 198
Hernia 198
Introduction 198
Pathophysiology 199
Diagnosis 200
Treatment 201
Conclusion 202
Hydrocele 202
Background and Treatment 202
Special Consideration 204
Conclusion 204
References 204
11 Testicles: Undescended, Retractile, and Ascended 206
Introduction 206
Embryology 207
Testicular Descent 207
Anatomy 207
Definition 207
Epidemiology 208
Consequences of Undescended Testicles 208
Infertility 208
Neoplasia 209
Testicular Torsion 210
Hernia 210
Diagnosis 211
History and Physical Examination 211
Radiological Evaluation 212
Hormonal Evaluation 212
Management 213
Hormonal Treatment 213
Surgical Treatment 213
Palpable Testicle 214
Nonpalpable Testicle 215
Complications of Orchidopexies 216
Conclusion 216
References 217
12 Acute Scrotum 219
Embryology and Normal Descent 219
First Rule Out Torsion 219
Taking a Complete History 220
The Physical Exam 221
Torsion of the Spermatic Cord 223
Torsion in the Neonate 227
Torsion of the Testicular Or Epididymal Appendage 228
Epididymitis 230
Trauma 231
Idiopathic Scrotal Oedema 232
Acute Scrotal Hydrocele 232
Henoch-schnlein Purpura 232
Uncommon Etiologies 233
Conclusion 233
References 233
Part III: Urinary Tract 235
13 Hydronephrosis: Prenatal and postnatal 236
Introduction 236
Prenatal Hydronephrosis 237
Prenatal Intervention 239
Postnatal Hydronephrosis 241
Indications for Surgical Intervention 244
Hydronephrosis and Reflux 246
Conclusion 248
References 248
14 Vesicoureteral Reflux 250
Overview and Epidemiology of Vesicoureteral Reflux 250
Etiology of Reflux 251
Embryology 252
Presentation/symptomatology 252
Diagnosis 252
Grading 254
Other Urologic Considerations with Vur 254
Pregnacy and Vur 254
Treatment Options 255
Medical Management Prophylactic Antibiotics 255
Open Surgical Treatment 256
Types of Surgery 256
Intravesical Ureteral Reimplantation 257
Extravesical Ureteral Reimplantation 259
Laparoscopic Techniques 262
Laparoscopic Transvesical Reimplantation 262
Laparoscopic Extravesical Reimplantation 263
Cystoscopic Injection 263
Injection Material 265
Conclusion 265
References 266
15 Urinary Tract Obstruction 270
Introduction 271
Hydrocalycosis 272
Infundibulopelvic Dysgenesis 273
Ureteropelvic Junction Obstruction 273
Epidemiology and Etiology 273
Presentation and Diagnosis 274
Management and Complications 275
Preureteral Vena Cava 276
Vascular Obstruction of the Distal Ureter 276
Ureteral Stenosis and Stricture 277
Ureteral Valves 277
Persistent Fetal Folds 277
Ectopic Ureter 277
Epidemiology and Etiology 277
Presentation and Diagnosis 278
Management 279
Ureteral Filling Defects 279
Ureterocele 280
Epidemiology and Etiology 280
Presentation and Diagnosis 280
Management 281
Single System Ureteroceles 281
Prolapsing Ureteroceles 282
Ureterovesical Junction Obstruction 282
Epidemiology and Etiology 282
Diagnosis and Management 282
Posterior Urethral Valves 283
Epidemiology and Etiology 283
Presentation and Diagnosis 283
Management 284
Anterior Urethral Valves 284
Congenital Urethral Stricture 285
Urethral Atresia 286
References 286
16 Tissue Engineering and Regenerative Medicine Current Concepts 287
An Introduction to Regenerative Medicine and Tissue Engineering Strategies 287
Biomaterials 288
Cells 289
Using Tissue Engineering Techniques to Build Specific Urologic and Genital Structures 292
Urethra 292
Bladder 293
Tissue Expansion for Bladder Augmentation 294
Seromuscular Grafts and De-epithelialized Bowel Segments 294
Matrices for Bladder Regeneration 294
Bladder Replacement Using Tissue Engineering 295
Kidney 296
Ex Vivo Functioning Renal Units 297
Creation of Functional Renal Structures In Vivo 297
Genital Tissues 298
Reconstruction of Corporal Smooth Muscle 298
Engineered Penile Prostheses 299
Female Genital Tissues 299
Injectable Therapies 300
Conclusion 302
References 302
Part IV: Miscellaneous Topics 306
17 Adolescent Urology 307
Introduction 307
Transitional Care 308
The Kidneys 310
Renal Function 310
Hypertension 311
The Bladder Or Urinary Reservoir 312
Posterior Urethral Valves 313
Exstrophy 314
Intestinal Urinary Reservoirs 315
Sexuality and Fertility 317
Disclosure 317
Hypospadias 318
Exstrophy Males 318
Exstrophy Females 318
Posterior Urethral Valves 320
Fertility 320
References 321
18 Laparoscopy in the Pediatric Population 323
Introduction 323
Anesthetic Concerns 324
Laparoscopic Pyeloplasty 324
Laparoscopic Orchiopexy 326
Laparoscopic Renal Ablative Surgery 328
Laparoscopic Lower Urinary Tract Reconstruction 329
Laparoscopic Ureteral Reimplantation 330
Laparoscopic Varicocelectomy 331
Conclusion 333
References 333
19 Genitourinary Tumors 339
Renal Tumors 340
Wilms Tumor 340
Other Renal Tumors 343
Adrenal Tumors 344
Neuroblastoma 344
Other Adrenal Tumors of Childhood 345
Testicular Tumors 346
Presentation and Evaluation 346
Surgical Approach 347
Adjuvant Therapy 347
Germ Cell Tumors 347
Stromal Tumors 348
Gonadoblastoma 349
Rhabodomyosarcoma 349
Vaginal/Uterine Rhabdomyosarcoma 350
Bladder/Prostate Rhabdomyosarcoma 350
Paratesticular Rhabdomyosarcoma 351
References 352
20 Genitourinary Trauma 355
Introduction 355
Epidemiology 355
Renal Injuries 356
Hemodynamic Stability 356
Congenital Anomalies 356
Hematuria 357
Evaluation and Imaging 357
Radiographic Imaging 358
CT Scan 358
Ultrasound 358
Ivp 359
Retrograde Pyelogram 359
Management of Renal Trauma 359
Surgical Management of Renal Trauma 360
Laparotomy 360
Endoscopic and Radiologic Intervention 360
Upj Disruption 361
Long-term Complications of Renal Trauma 361
Ureteral Injury 362
Bladder Injuries 363
Rupture of a Bladder Augmentation 363
Imaging 363
Treatment 364
Urethral Injury 364
Diagnosis 365
Management 365
Genital Injuries 366
Scrotal Injury 367
References 367
Subject Index 372