Hypospadias
and Associated Genital Anomalies |
Definition:
A
developmental anomaly in the male where the urethra opens on the underside
of the penis or in severe cases in the scrotum or perineum (area between scrotum
and rectum).
Anatomy:
-
Hypospadias:
The urethra normally opens on the glans at the tip of the penis in males.
In patients with this anomaly, the opening can range from just below the
tip on the glans to the perineum, which is the area between the scrotum
and the anus. With severe hypospadias other associated genito=urinary anomalies
will be more likely and screening will be recommended. Almost all except
the most distal hypospadiac will have a dorsal hood, incomplete foreskin.
-
Chordee: A
deflection or curve of the body of the penis most accentuated during an
erection. Chordee can range from very minor to severe, making intercourse
very painful or impossible.
-
Scrotal anomalies:
If the urethral meatus opening is located on the scrotum or perineum, the
scrotum will not be fully formed and will appear as a shawl, or may be transposed
above the penis. Occasionally a web will be found between the penis and
scrotum.
Problems:
- Psychological - feelings of inadequacy
- Inability to directly control urination
- Spraying when urinating
- Painful erections
- Inability to have intercourse
Surgery:
At present, surgery offers the only treatment. However, all hypospadias do not necessarily need correction. The most distal, closest to the normal urethral opening, not associated with other problems may be left alone. If the urethra opens in the lower part of the glans or if other anomalies are present, surgical correction is recommended. Most repairs use the patient's extra skin or foreskin to create a urethra to bridge the gap and repair the other anomalies as well. For severe hypospadias, more than one procedure is occasionally required. Surgery is best performed between six and twelve months of age. Most children go home the day of surgery. Many different procedures have been devised, however they required expertise and special training. Generally only pediatric urologists are trained to perform them.
Surgical Complications:
Even in the best hands some complications may arise. In the most distal repairs (smallest areas to the bridge) about 5% of cases may need further correction. In the scrotal and perineal repairs, the complication rate may be 15-20%. The two most common complications are:
-
Fistulas
- a communication between the new urethra and skin, a small opening before the tip
-
Strictures
- a narrowing of the new urethra
These can usually be corrected by a subsequent procedure that is usually much smaller than the first. Usually, at least six months must be allowed before the second procedure is done. Follow Up: Most patients have a bulky dressing and a stent (catheter or tube). The dressing is removed in the office two to five days after the procedure. The stent is generally removed ten days after the procedure. It is important to keep the area as dry as possible, especially during the first few days. Patients are usually re-examined three to four weeks after surgery and the periodically until the repair has been judged to have been completely healed.
|
Prenatally Detected Genito-Urinary Abnormalities |
With the increasing use of ultrasonography to monitor the progress of a pregnancy, urinary abnormalities are now detected in many cases prior to birth. Many of these abnormalities would otherwise be undetected until the child presented later in life with some problem. Although prenatal (antenatal) sonography can detect multiple abnormalities, accurate diagnosis is only possible in a few types of disorders. In the majority of cases the abnormalities can be followed through the pregnancy and diagnostic evaluation commences shortly after birth.
Prenatal Evaluation:
they types of genito-urinary problems that can be seen on obstetric sonograms are:
-
ureteral reflux
-
urinary obstructions
-
cystic abnormalities of the kidney
-
genital abnormalities
Repeat sonograms at regular intervals are all that is usually needed to monitor the abnormalities for change. In addition, the volume of amniotic fluid and presence of other fetal anomalies are assessed. Specific rare problems are occasionally detected very early in the pregnancy and these may require fetal intervention, such as: severe urinary obstructions with decreased or no amniotic fluid detected before 33 weeks gestation. In these rare cases, fetal testing of the amniotic fluid or bladder urine may be helpful in determining if treatment before birth is necessary. About one third of all prenatally detected problems turn out to have no true pathology.
Postnatal
Evaluation: The postnatal evaluation begins in the hospital within 24 to 48 hours after birth. The pediatric urologist should be contacted prior to birth if possible to counsel the family and coordinate the workup, or, at the latest, by 24 hours after birth. If the infant is able to urinate within the first 24 hours, a blood test to evaluate kidney function and a kidney and bladder ultrasound is done at 48 hours. A sonogram performed earlier may miss swelling of the kidney due to dehydration of newborns. Some infants may require other diagnostic tests prior to going home, while most will be followed in four to six weeks as outpatients. The usual adjunctive tests are a voiding cystourethrogram (VCUG) and/or a nuclear renogram (DPTA, DMSA, MAG-III) If the infant has not urinated within 24 hours, the workup may be moved up a day and a catheter will frequently be placed.
The goals of
the evaluation are:
-
preservation
of kidney function
-
prevention
of urinary infection
-
diagnosis
and treatment of urinary obstruction or vesico-ureteral reflux (an abnormality
that causes urine from the bladder to go back up to the kidney).
|
Vesico
- Ureteral Reflux |
Definition:
The passage of urine from the bladder back up the ureter.
Anatomy:
The ureter, the hollow tube that carries urine to the bladder, traverses the
wall of the bladder diagonally which allows increased bladder pressure to
close it, thus preventing reflux. In children with reflux, this valve mechanism
is defective.
Treatment:
May be medical surveillance or surgical repair and is based on the severity
of the reflux, the kidney function, and the presence of other abnormalities.
Follow Up:
All children will need:
-
-Urinalysis
(UA) every eight weeks
-
-UA whenever
child has fever of 38.5 C or above
-
-Urine culture
for any abnormal UA
-
-Repeat studies:
US every six months and VCUG or nuclear cystogram yearly thereafter to follow
improvement, detect resolution or deterioration. All documented breakthrough
infections must be reported to your pediatric urologist so that appropriate
management adjustments can be made.
Indications
for surgery:
-
-Noncompliance
with medical regimen
-
-Repeated
breakthrough infections
-
-High grade
reflux
-
-Evidence
of significantly reduced renal function at time of presentation
-
-Evidence
of significant renal scarring at time of presentation
-
-Evidence
of other anatomic defects which would make resolution of reflux unlikely
-
-Deterioration
of function or increase in degree of reflux during follow-up
-
-No improvement
over several years of surveillance
Surgery:
There are many different operative procedures used to repair reflux. Most
common are:
-
Intravesicle
repair: the ureter is completely freed from the bladder and tunneled under
the bladder lining to its new location. The bladder is open for this repair.
-
Extravesicle
repair: The ureter is freed from the bladder muscle from the outside of
the bladder but left attached to the bladder lining. It is then laid down
in a groove of bladder muscle which is closed over the ureter, thus creating
a longer tunnel. A catheter is left in the bladder for 2-5 days. A small
drain may be left in the abdomen and removed once it stops draining after
the catheter has been removed. Most children are able to go home in 2-5
days. Occasionally, the bladder catheter may need to be reinserted and the
child may go home with the catheter for up to a few weeks; this occurs more
commonly if a surgical repair was done on both sides.
Follow Up
After Surgery: Assuming no complications, the child will return for an
office visit 2-3 weeks following surgery. A renal ultrasound will be done
around four weeks after surgery and a VCUG or nuclear cystogram at twelve
weeks following surgery. Yearly renal ultrasound may be done for a few years
thereafter.
|
Dysfunctional
Voiding |
Anatomy:
The bladder is a muscular bag that can accept urine when it is relaxed but
can contract and expel all the urine it contains. The urethra is connected
to the bladder and is a hollow tube through which the urine exits once the
bladder contracts. The bladder neck (a funnel-shaped junction between the
bladder and urethra) and the external sphincter act as cinches and squeeze
the urethra closed to help hold the urine in place. These must open (relax)
prior to a bladder contraction for complete and efficient bladder emptying.
Normally, the sphincter and bladder neck open first and then the bladder contracts.
Development:
Infants void by reflex contraction. When the bladder is full, it sends a message
to the spinal cord that then initiates a coordinated contraction: the sphincter
and bladder neck open and the bladder contracts. Since adults want to control
urination, the brain gains the ability to withhold a contraction, and keep
the sphincter and bladder neck closed until it wishes to allow urination.
It takes several years for the brain to gain this control; this develops gradually.
The first phase is that the young child around two or three years old begins
to feel a contraction taking place. Unfortunately for the child, by the time
the contraction is felt, urination has already begun or is about to begin.
"They squeeze the urethra shut." This is an intermediate transitional phase
but is the first attempt to gain control. Within a few months, the child learns
the feeling of fullness prior to a contraction and eventually his brain develops
the ability to suppress an unwanted contraction, thus normal voiding occurs.
Dysfunctional
Voiding: Some children remain in the intermediate or transitional phase.
They learn to control urination by actively contracting the external sphincter
during bladder contractions. Generally these children become unable to completely
relax the external sphincter even when they want to urinate. In other words,
this behavior becomes habitual. This causes very high bladder pressures and
inefficient urination. Often the bladder is not completely emptied with each
urination and becomes large over time as it holds more and more urine. These
children often lose the sensation to urinate as frequently and hold their
urine for long periods of time, enlarging their bladders even more, although
at other times they have sudden severe urges to urinate that may result in
incontinence. They become prone to bladder infections, leaking during the
day and/or night, as well as other problems.
Treatment:
These children are not easy to treat. Learned behaviors are difficult to overcome.
Usually, these children are placed on a schedule of timed voiding - asked
to urinate at specified times during the day. They are also asked to relax
during urination, thus learning not to contract their sphincter muscle. They
are also placed on a regimen of double voiding - asked to urinate and try
again once they think they are through. Most children improve and eventually
resolve their problem, but others may need biofeedback or other more complex
therapy.
|
Cryptorchidism (Undescended Testis) |
Treatment:
Truly undescended testes will require surgical correction. If performed at
the earliest time after about six months of age, maximum preservation of
testis
function can be expected.
Surgery:
An inguinal incision is made. If the testis is located, it is freed from the
tethering tissues and dissected away, preserving the normal blood vessels
and sperm duct. It is then brought down to the scrotum through a tunnel and
secured in the scrotum. Most children go home the day of surgery. Occasionally
the incision is modified to look for a deep intra-abdominal testis. All testes
with good potential for function are brought down. Atrophic or dead testes
are removed.
Follow-up:
All stitches are absorbable and do not need removal. The child will return
for an office visit four to six weeks following surgery. Further follow-up
will be determined at that visit. Most children tolerate this surgery well
with minimal problems. It is one of the most common procedures done by pediatric
urologists.
Long-Term
Issues:
-
Testis malignancy:
The risk of testicular cancer is increased in an undescended testis. Whether
this risk is reduced by bringing the testis down is unknown at this time.
A testis in the scrotum is easy to examine, and all children who undergo
surgical correction must be taught to perform testis self-exams by puberty
-
Reduced fertility:
Fertility may be significantly reduced if both testes are undescended. In
most cases of one undescended testis, where at least one testis is normal,
fertility will be normal.
|
Uretero
- Pelvic Junction (UPJ) Obstruction |
Definition: A
blockage of the flow of urine between the kidney and the ureter, the hollow
tube that drains the kidney, which results in urine backing up and causing
swelling of the kidney, eventually resulting in the loss of kidney function
if untreated for a long time.
Anatomy: The
kidney has a collecting system that ends in a funnel called the renal or kidney
pelvis. The pelvis connects to the ureter. Most often a narrowing between
the pelvis and ureter causes the UPJ obstruction.
Diagnostic Tests:
-
Renal Ultrasound:
This is the least invasive test and can show the resultant swelling of the
kidney, however renal swelling may not be due to obstruction.
-
Intravenous
pyelogram (IVP): This test was the classic test used in the past and occasionally
is used now. It shows the anatomy of the UPJ. It also shows the resultant
swelling as well as providing some functional information and usually defining
the anatomy of the distal ureter. This test however is more invasive and
exposes the child to some radiation.
-
Nuclear renogram:
This test provides the least anatomic detail, but the most precise information
of renal function. Also, the child is exposed to very little radiation.
-
Voiding cystourethrogram
(VCUG): This test is necessary to rule out any reflux and is performed on
all children that present with an episode of pyelonephritis (infection of
the kidney).
-
Retrograde
uretogram: This test is used in the operating room, prior to the actual
surgical repair. It delineates the distal ureteral wall ensuring no other
abnormalities and uses very little radiation.
Most often the
diagnosis is established with renal ultrasound and nuclear renogram. If the
findings on these two tests are unusual, an IVP may be used to supplement
the above tests. Sometimes the tests are not conclusive and repeat tests are
done several weeks later to show whether improvement or deterioration in swelling
and/or renal function occurs over time.
Surgery: A dismembered
pyeloplasty is usually done. This entails removing the narrowed segment and
reattaching the ureter to the renal pelvis, the funnel shaped drainage area
of the kidney. A small drain is usually placed next to the repair, which exits
the body below the incision and is removed once it stops draining. A stent
(an internal tube) is often placed for 4-6 weeks. The child will usually go
home in three to five days.
Follow Up: Assuming
no complications, the child will return for an office visit two to three weeks
after surgery. A renal ultrasound will be done around four weeks after surgery
and a nuclear renogram may be done twelve weeks following surgery. Thereafter
a yearly renal ultrasound will be done until the child is fully grown.
|
Circumcision |
Anatomy:
At birth the penis consists of a cylindrical shaft with a rounded area at
the top called the glans, although the glans may not be visible, being covered
with foreskin. The normal urethral opening is located slightly below the tip
of the glans. The foreskin is a double layer of skin; the outer layer is a
continuation of the penile skin while the inner layer is a type of mucous
membrane similar to the lips. The inner foreskin may be adhered to the glans.
This is almost always true at birth. Over time, the inner foreskin and glans
separate. This separation may not occur until puberty. The white pearly material
seen under the foreskin is a collection of dead skin cells and some oils.
This is not pus. If considering circumcision, it is important to make sure
that the anatomy of the penis is normal.
Benefits:
Currently the American Academy of Pediatrics recommends infant circumcision
if the parents understand the benefits and risks.
-
Circumcision
significantly reduces the risk of urinary tract infection in the first year
of life in male infants.
-
There is
some evidence that circumcised males have a lower incidence of venereal
disease and AIDS.
-
There is some
evidence that the female sexual partners of circumcised males have slightly
lower rater of cervical cancer
-
Circumcised
males have significantly lower risk of developing cancer of the penis.
Risks:
As with any surgical procedure, infant circumcision has a few risks.
-
Infection
-
Bleeding that
can in rare cases be severe
-
Injury to
the penis, especially to the glans and urethra.
-
Failure to
detect a hypospadias (cases where the urethra opens lower on the shaft or
even in the scrotum). Circumcising these children may make later surgical
repair more difficult.
Controversy:
Because of the low incidence of infections and penile cancer in the US, the
benefits are considered slight. The risks are also rare in most hospitals.
Procedure:
The purpose is to remove foreskin that covers the glans. Many procedures are
used:
-
Plastibell:
A small bell that is large enough to cover the glans is placed under the
foreskin over the glans. A suture is tied over the lower end of the bell
over a groove. This suture cuts off the blood supply to the foreskin. The
foreskin is cut and the bell falls off once the suture dissolves, in 5-7
days.
-
Mogen clamp:
A Mogen clamp is applied over the foreskin after the foreskin is pulled
up and the glands is pushed down. The foreskin is then cut above the clamp.
Little bleeding occurs since the clamp has crushed the skin edges.
-
Surgical:
The inner and outer surfaces of the foreskin are cut and the edges are sutured
together a few millimeters below the edge of the glans.
Post-operative
care: The newly circumcised penis will normally become red, swollen, and
appear bruised for at least a week. This results from the normal healing process.
Sponge bathing for the first two days after surgery is recommended. It is
also important to apply antibiotic ointment over the suture line until all
the sutures have dissolved, usually about three to four weeks. |
Computed Tomography (CT Scan) |
What is Pediatric CT? top
CT scanning—sometimes called
CAT scanning—is a noninvasive, painless medical test that helps physicians
diagnose and treat medical conditions.
CT imaging uses special x-ray
equipment to produce multiple images or pictures of the inside of the body
and a computer to join them together in cross-sectional views of the area
being studied. The images can then be examined on a computer monitor or
printed.
CT scans of internal organs,
bone, soft tissue and blood vessels provide greater clarity than
conventional x-ray exams.
Newborns, infants and older
children may undergo CT scanning.
What are some common uses of
the procedure? top
Physicians use the CT
examination to help detect a wide range of abnormalities and disease,
including cancer, in any part of a child's body.
Pediatric CT is typically
used to help diagnose and monitor treatment for infectious or inflammatory
disorders, abdominal pain, headaches and injury-related changes.
CT is also
performed to evaluate:
In the case of head injury,
the exam can display or rule out serious complications such as bleeding
within the brain or other forms of brain damage.
Except for
the chest x-ray, CT is the most commonly used imaging procedure for
evaluating the chest. CT of the chest is used to evaluate:
-
complications from
infections such as pneumonia
-
a tumor that arises in the
lung or has spread there from a distant site
-
airway disease such as
inflammation of the bronchi (breathing passages)
-
birth defects
-
injured blood vessels or
lung damage
Using multidetector CT, it is
possible to obtain very detailed pictures of the heart and large blood
vessels of the chest in children, even newborn infants.
CT is
well-suited for visualizing diseases or injury of important organs in the
abdomen including the liver, kidney and spleen. CT is sometimes used to:
-
diagnose appendicitis
-
evaluate adolescents who
have inflammatory disorders of the bowel, such as colitis
-
detect abdominal tumors or
birth defects
In the
pelvic region, CT scans can help detect:
-
cysts or tumors of the
ovary
-
abnormalities of the
bladder
-
stones in the urinary tract
-
disease of the pelvic bones
How should my child be
prepared for the CAT scan? top
Your child should wear
comfortable, loose-fitting clothing to the exam. He or she may be given a
gown to wear during the procedure.
Metal objects including
jewelry, eyeglasses, removable dental work, hearing aids and hairpins may
affect the CT images and should be left at home or removed prior to your
child's exam.
Your child may be asked not
to eat or drink anything for several hours beforehand, especially if a contrast material, sedative or anesthesia will be used in the exam. With sedation or anesthesia, your
child probably will not be allowed to eat for three to six hours prior to
the exam. In general, children who have recently been ill are not sedated or
anesthetized. If this is the case or if you suspect that your child may be
getting sick, you should talk with your physician about rescheduling the CT
exam.
You should also inform your
physician of any medications your child is taking and if he/she has any
allergies, especially to contrast materials, iodine, or seafood.
Also inform your doctor of
any recent illnesses or other medical conditions your child may have, and if
there is a history of heart disease, asthma, diabetes, kidney disease or
thyroid problems. Any of these conditions may increase the risk of an
allergic reaction.
What does the equipment look
like? top
The CT scanner is typically a
large machine with a hole, or tunnel, in the center. A moveable examination
table slides into and out of this tunnel. In the center of the machine, the
x-ray tube and electronic x-ray detectors are located opposite each other on
a ring, called a gantry, which rotates around the patient. The computer that
processes the imaging information and monitor are located in a separate
room.
How does the procedure work? top
In many ways CT scanning
works very much like other x-ray examinations. X-rays are a form of
radiation—like light or radio waves—that can be directed at the body.
Different body parts absorb the x-rays in varying degrees.
In a conventional x-ray exam,
a small burst of radiation is aimed at and passes through the body,
recording an image on photographic film or a special image recording plate.
Bones appear white on the x-ray; soft tissue shows up in shades of gray and
air appears black.
With CT scanning, numerous
x-ray beams and a set of electronic x-ray detectors rotate around the
patient, measuring the amount of radiation being absorbed throughout the
body. At the same time, the examination table is moving through the scanner,
so that the x-ray beam follows a spiral path. A special computer program
processes this series of pictures, or slices of the body, to create
two-dimensional cross-sectional images, which are then displayed on a
monitor.
CT imaging is sometimes
compared to looking into a loaf of bread by cutting the loaf into thin
slices. When the image slices are reassembled by computer software, the
result is a very detailed multidimensional view of the body's interior.
Refinements in detector
technology allow new CT scanners to obtain multiple slices in a single
rotation. These scanners, called "multislice CT" or "multidetector CT,"
allow thinner slices to be obtained in a shorter period of time, resulting
in more detail and additional view capability.
Modern CT scanners are so
fast that they can scan through large sections of the body in just a few
seconds. Such speed is beneficial for all patients but especially children,
the elderly and critically ill.
For some CT exams, a contrast
material is used to enhance visibility in the area of the body being
studied.
What will my child
experience during and after the procedure? top
Most CT exams are painless,
fast and easy. With spiral CT, the amount of time that the patient needs to
lie still is reduced.
Though the scanning itself
causes no pain, your child may experience some discomfort from having to
remain still for several minutes.
If an intravenous contrast material is used, your child will feel a slight pin prick when
the needle is inserted into a vein in the hand or arm. The child may have a
warm, flushed sensation during the injection of the contrast materials and a
metallic taste in his/her mouth that lasts for a few minutes. Occasionally,
a patient will develop itching and hives, which can be relieved with
medication. If your child becomes light-headed or experiences difficulty
breathing, you should notify the technologist or nurse, as it may indicate a
more severe allergic reaction.
If the contrast material is
swallowed, your child may find the taste mildly unpleasant; however, most
patients can easily tolerate it. Your child can expect to experience a sense
of abdominal fullness and an increasing need to expel the liquid if the
contrast material is given by enema. In this case, encourage your child to
be patient, as the mild discomfort will not last long.
When your child enters the
scanner, special lights may be used to ensure that he/she is properly
positioned. With modern CT scanners, your child will hear only slight
buzzing, clicking and whirring sounds as the CT scanner revolves around
him/her during the imaging process.
Your child will be alone in
the exam room during the CT scan, however, the technologist will be able to
see, hear and speak with him/her at all times. A parent may be allowed in
the room but will be required to wear a lead apron to prevent radiation
exposure. If you suspect you may be pregnant it would be better for someone
else to be with your child.
Some imaging facilities may
use general anesthesia in young children who are unable to hold still. In this case
you will be permitted to stay in the exam room until your child has fallen
asleep. There may be a somewhat longer wait after the exam to be sure that
your child is fully alert.
When the exam is completed
and your child—if sedated—is fully awake, you will be free to return home.
After a CT exam, your child can return to his/her normal activities. If a
contrast material was used during the exam, you will be given special
instructions.
Who interprets the results
and how do we get them? top
A radiologist, a physician
specifically trained to supervise and interpret radiology examinations, will
analyze the images and send a signed report to your primary care or
referring physician, who will share the results with you.
What are the benefits vs.
risks? top
Benefits
-
Using a spiral (helical) CT
unit to examine children is faster than the older CT scanners, reducing
the need for sedation and general anesthesia.
-
New technologies that will
make even faster scanning possible are becoming increasingly available.
For children this means shorter imaging times and less time required to
hold still in order to produce clear images. Also, shorter scan times will
make it easier for children to hold their breath during critical parts of
the exam.
-
CT scanning is painless,
noninvasive and accurate.
-
A major advantage of CT is
that it is able to image bone, soft tissue and blood vessels all at the
same time.
-
Unlike conventional x-rays,
CT scanning provides very detailed images of many types of tissue as well
as the lungs, bones, and blood vessels.
-
CT examinations are fast
and simple; in emergency cases, they can reveal internal injuries and
bleeding quickly enough to help save lives.
-
CT has been shown to be a
cost-effective imaging tool for a wide range of clinical problems.
-
CT may be less expensive
than MRI. In addition, it is less sensitive to patient movement.
-
CT can be performed if you
have an implanted medical device of any kind, unlike MRI.
-
CT imaging provides
real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and needle aspirations of many areas of the body, particularly the lungs,
abdomen, pelvis and bones.
-
A diagnosis determined by
CT scanning may eliminate the need for exploratory surgery and surgical
biopsy.
-
No radiation remains in a
patient's body after a CT examination.
-
X-rays used in CT scans
usually have no side effects.
Risks
-
There is always a slight
chance of cancer from radiation. However, the benefit of an accurate
diagnosis far outweighs the risk.
-
The risk of serious
allergic reaction to contrast materials that contain iodine is rare, and
radiology departments are well-equipped to deal with them.
-
Radiation is necessary to
obtain CT images. It is known that high levels of radiation may cause
cancer. However, CT scans result in a low-level exposure. Whether such
levels cause cancer is debatable but because it is possible, every effort
is made to limit the amount of radiation children may receive from a CT
scan. The thyroid gland, bone marrow and gonads of a child are especially
sensitive to radiation. In addition, children have a longer time to
accumulate radiation throughout their lives. Each exposure, including that
from a CT exam, adds to this total lifetime exposure.
One of the best ways of limiting radiation exposure is to avoid CT scans
that are not clearly needed. Other measures are to restrict the area
scanned as much as possible and to "fine tune" the CT settings based on
the reason for the exam, the body area being examined, and the child's
size. Radiologists generally attempt to use the lowest radiation dose that
will provide the needed diagnostic information. See the Safety page for more information about radiation dose.
-
There always is a risk of
complications from general anesthesia or sedation. Every measure will be
taken to protect the welfare of your child, including close monitoring.
-
Children should have a CT
study only if it is essential for making a diagnosis and should not have
repeated CT studies unless absolutely necessary.
What are the limitations of
Pediatric CT? top
A person who is very obese
may not fit into the opening of a conventional CT unit.
Other imaging methods such as ultrasound or magnetic resonance (MR) imaging can provide pictures of certain areas of
the body that sometimes are as good as or better than those obtained by CT
scanning. Working together, your primary care physician or pediatrician and
the radiologist will decide which type of examination is best for your
child.
Motion can affect the quality
of a CT scan even when every effort is made to see that your child holds
still.
|
Radiography - Intravenous Pyelogram |
What is an Intravenous
Pyelogram (IVP)? top
An intravenous pyelogram (IVP)
is an x-ray examination of the kidneys, ureters and urinary bladder that uses contrast material.
An x-ray (radiograph) is a
painless medical test that helps physicians diagnose and treat medical
conditions. Radiography involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays
are the oldest and most frequently used form of medical imaging.
When a contrast material is
injected into the patient's arm, it travels through the blood stream and
collects in the kidneys and urinary tract, turning these areas bright white. An IVP
allows the
radiologist to view and assess the anatomy and function of the kidneys
and lower urinary tract.
What
are some common uses of IVP studies? top
An intravenous pyelogram
examination helps the physician assess abnormalities in the urinary system,
as well as how quickly and efficiently the patient's system is able to
handle waste.
The exam is used to help
diagnose symptoms such as blood in the urine or pain in the side or lower
back.
The IVP
exam can enable the
radiologist to detect problems within the urinary tract resulting from:
How should I prepare for the
procedure? top
Your doctor will give you
detailed instructions on how to prepare for your IVP study.
You will likely be instructed
not to eat or drink after midnight on the night before your exam. You may
also be asked to take a mild laxative (in either pill or liquid form) the evening before the
procedure.
You should inform your
physician of any medications you are taking and if you have any allergies,
especially to contrast material. Also inform your doctor about recent illnesses or
other medical conditions.
You may be asked to remove
some or all of your clothes and to wear a gown during the exam. You may also
be asked to remove jewelry, eye glasses and any metal objects or clothing
that might interfere with the x-ray images.
Women should always inform
their physician or x-ray technologist if there is any possibility that they are pregnant. Many
imaging tests are not performed during pregnancy because radiation can be
harmful to the
fetus. If an x-ray is necessary, precautions will be taken to minimize
radiation exposure to the baby. See the Safety page for more information about pregnancy and x-rays.
What
does the x-ray equipment look like? top
The equipment typically used
for this examination consists of a box-like structure containing the x-ray
tube and fluoroscopic equipment that sends the x-ray images to a
television-like monitor for viewing that is located in the examining room or
in a nearby room. This structure is suspended over a table on which the
patient lies. A drawer under the table holds the x-ray film or image
recording plate that captures the images.
How does the procedure work? top
X-rays are a form of
radiation like light or radio waves. X-rays pass through most objects,
including the body. Once it is carefully aimed at the part of the body being
examined, an x-ray machine produces a small burst of radiation that passes
through the body, recording an image on photographic film or a special image
recording plate.
Fluoroscopy uses a continuous
x-ray beam to create a sequence of images that are projected onto a
fluorescent screen, or television-like monitor. When used with a contrast
material, which clearly defines the area being examined by making it appear
bright white, this special x-ray technique makes it possible for the
physician to view internal organs in motion. Still images are also captured
and stored either on film or electronically on a computer.
In the IVP exam, iodine
injected through a vein in the arm collects in the
kidneys, ureters and
bladder, giving these areas a bright white and sharply defined
appearance on the
x-ray images.
X-ray images are maintained
as hard film copy (much like a photographic negative) or, more likely, as a
digital image that is stored electronically. These stored images are easily
accessible and are sometimes compared to current x-ray images for diagnosis
and disease management.
What will I experience
during and after the procedure? top
The IVP is a painless
procedure.
You will feel a minor sting
as the iodine is injected into your arm. Some patients experience a flush of
warmth, a mild itching sensation and a metallic taste in their mouth as the
iodine begins to circulate throughout their body. These common side effects
usually disappear within a minute or two and are harmless. Itching that
persists or is accompanied by hives, can be easily treated with medication. In rare cases, a patient
may become short of breath or experience swelling in the throat or other
parts of the body. These can be indications of a more serious reaction to
the contrast material that should be treated promptly. Tell the
radiologist immediately if you experience these symptoms.
During the imaging process,
you may be asked to turn from side to side and to hold several different
positions to enable the radiologist to capture views from several angles.
Near the end of the exam, you may be asked to empty your bladder so that an
additional
x-ray can be taken of your urinary bladder after it empties.
The contrast material used
for IVP studies will not discolor your urine or cause any discomfort when
you urinate. If you experience such symptoms after your IVP exam, you should
let your doctor know immediately.
Who interprets the results
and how do I get them? top
A radiologist, a physician
specifically trained to supervise and interpret radiology examinations, will
analyze the images and send a signed report to your primary care or
referring physician, who will share the results with you.
What are the benefits vs.
risks? top
Benefits
-
Imaging of the urinary
tract with IVP is a minimally invasive procedure with rare complications.
-
IVP images provide
valuable, detailed information to assist physicians in diagnosing and
treating urinary tract conditions from kidney stones to cancer.
-
An IVP can often provide
enough information about kidney stones and obstructions to direct
treatment with medication and avoid more invasive surgical procedures.
-
The imaging process is
fast, painless and less expensive than alternatives such as computed tomography (CT) and magnetic resonance imaging (MRI).
-
No radiation remains in a
patient's body after an x-ray examination.
-
X-rays usually have no side
effects.
Risks
-
There is always a slight
chance of cancer from radiation. However, the benefit of an accurate
diagnosis far outweighs the risk.
-
The effective radiation
dose from this procedure is about 1.6 mSv, which is about the same as the average person receives from
background radiation in six months. See the Safety page for more information about radiation dose.
-
Contrast materials used in IVP studies can cause adverse reactions in
some people.
-
Women should always inform
their physician or x-ray technologist if there is any possibility that
they are pregnant. See the Safety page for more information about pregnancy and x-rays.
A Word About Minimizing
Radiation Exposure
Special care is taken during
x-ray examinations to use the lowest radiation dose possible while producing
the best images for evaluation. National and international radiology
protection councils continually review and update the technique standards
used by radiology professionals.
State-of-the-art x-ray
systems have tightly controlled x-ray beams with significant filtration and
dose control methods to minimize stray or scatter radiation. This ensures
those parts of a patient's body not being imaged receive minimal radiation
exposure.
What are the limitations of
IVP studies? top
An IVP shows details of the
inside of the urinary tract including the
kidneys,
ureters and
bladder. Computed tomography (CT) or magnetic resonance imaging (MRI) may add valuable information about the
functioning tissue of the kidneys and surrounding structures nearby the
kidneys, ureters and bladder.
IVP studies are not usually
indicated for pregnant women.
|
Children's (Pediatric) Voiding
Cystourethrogram |
| Click image to view larger |
 |
What is a Voiding Cystourethrogram?
A children's (pediatric) voiding cystourethrogram (VCUG) is an x-ray examination of a child's bladder and lower urinary tract that uses a special form of x-ray
called fluoroscopy and a contrast material.
An x-ray (radiograph) is a painless medical test that helps physicians
diagnose and treat medical conditions. Radiography involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body.
X-rays are the oldest and most frequently used form of medical imaging.
Fluoroscopy makes it possible to see internal organs in motion. When
the bladder is filled with and then emptied of a water-soluble contrast
material, the radiologist is able to view and assess the anatomy and
function of the bladder and lower urinary tract.
What are some common uses of the procedure?back
to top
A voiding cystourethrogram enables a radiologist, a physician
specifically trained to supervise and interpret radiology examinations, to
detect abnormalities in the flow of urine through the urinary tract.
This examination is often recommended after a urinary tract infection
to check for a condition known as vesicoureteral (VU) reflux.
About VU Reflux
Urine is produced in the kidneys and flows through the ureter, the tube that carries urine from each kidney to the bladder. A valve mechanism prevents urine from backing up into the
kidneys as the bladder gets full. Urine leaves the bladder through the urethra and is eliminated from the body during urination.
In some children, an abnormality in the valve or the
ureters allows urine to flow backwards, a condition called VU reflux. In
mild cases urine backs up into the lower ureter. In severe cases it can
back up into a swollen kidney. Usually, children with this condition are
born with it. Other causes include:
- blockage to the bladder
- abnormal urination with very high pressure within the bladder
- incomplete emptying of the bladder
- urinary tract infections.
Urinary tract infection may be the only symptom of the problem.
How should I prepare my child for the procedure?back
to top
You should inform your physician of any medications your child is
taking and if he or she has any allergies, especially to contrast materials. Also inform your doctor about recent illnesses or
other medical conditions.
Because a voiding cystourethrogram (VCUG) is an x-ray procedure, metal objects can affect the image, so avoid dressing
your child in clothing with snaps or zippers. Replace metal diaper pins
with adhesive tape. No other special preparation is required. An older
child may be asked to wear a gown during the exam and to remove jewelry
and eye glasses.
Sedation is rarely needed.
What does the x-ray equipment look like?back
to top
The equipment typically used for this examination consists of a
radiographic table, an x-ray tube and a television-like monitor that is
located in the examining room or in a nearby room. When used for viewing
images in real time (called fluoroscopy), the image intensifier (which
converts x-rays into a video image) is suspended over a table on which the
patient lies. When used for taking still pictures, a drawer under the
table holds the x-ray film or image recording plate that captures the
images.
A catheter, a flexible, hollow plastic tube, will be used to fill the bladder with a water-soluble contrast material.
How does the procedure work?back
to top
X-rays are a form of radiation like light or radio waves. X-rays pass
through most objects, including the body. Once it is carefully aimed at
the part of the body being examined, an x-ray machine produces a small
burst of radiation that passes through the body, recording an image on
photographic film or a special image recording plate.
Fluoroscopy uses a continuous x-ray beam to create a sequence of images
that are projected onto a fluorescent screen, or television-like monitor.
When used with a contrast material, which clearly defines the area being
examined by making it appear bright white, this special x-ray technique
makes it possible for the physician to view internal organs in motion.
Still images are also captured and stored either on film or electronically
on a computer.
X-ray images are maintained as hard film copy (much like a photographic
negative) or, more likely, as a digital image that is stored
electronically. These stored images are easily accessible and are
sometimes compared to current x-ray images for diagnosis and disease
management.
What will my child experience during and after the
procedure?back
to top
A voiding cystourethrogram is painless, though young children can be
frightened when they are tightly wrapped and unable to move. The
antiseptic used to clean and prepare for the insertion of the catheter may feel cold. Some children may experience mild discomfort
when the catheter is inserted and the bladder is filled with the liquid contrast material.
A parent is sometimes allowed to stay in the room to comfort the child
but will be required to wear a lead apron to prevent radiation exposure.
Who interprets the results and how do we get them?back
to top
A radiologist, a physician specifically trained to supervise and
interpret radiology examinations, will analyze the images and send a
signed report to your primary care or referring physician, who will share
the results with you.
What are the benefits vs. risks?back
to top
Benefits
- Voiding cystourethrogram (VCUG) images provide valuable, detailed
information to assist physicians in diagnosing and treating urinary
tract conditions to prevent kidney damage.
- Imaging of the urinary tract with VCUG is a minimally invasive
procedure with rare complications.
- A VCUG can often provide enough information to direct treatment with
medication, avoiding more invasive surgical procedures.
- The imaging process is fast, painless and less expensive than
alternatives such as computed tomography (CT) and magnetic resonance imaging (MRI).
- No radiation remains in a patient's body after an x-ray examination.
- X-rays usually have no side effects.
Risks
- There is always a slight chance of cancer from radiation. However,
the benefit of an accurate diagnosis far outweighs the risk.
- For a child that is 5-10 years old, the effective radiation dose
from this procedure is about 1.6 mSv, which is about the same as the average person receives from
natural background radiation in 6 months. For an infant, the effective
radiation dose from this procedure is about 0.8 mSv, which is about the
same as the average person receives from background radiation in 3
months. See the Safety page for more information about radiation dose.
A Word About Minimizing Radiation Exposure
Special care is taken during x-ray examinations to use the lowest
radiation dose possible while producing the best images for evaluation.
National and international radiology protection councils continually
review and update the technique standards used by radiology professionals.
State-of-the-art x-ray systems have tightly controlled x-ray beams with
significant filtration and dose control methods to minimize stray or
scatter radiation. This ensures those parts of a patient's body not being
imaged receive minimal radiation exposure.
What are the limitations of a Voiding
Cystourethrogram? back to top
A voiding cystourethrogram cannot evaluate obstruction of flow of urine
from the kidneys. Additional examinations are needed if obstruction is
suspected.
A voiding cystourethrogram should not be performed while an active,
untreated urinary tract infection is present.
|
Post-Operative Care - Chordee Repair
|
1. Vaseline gauze
is applied during surgery. Begin applying Vaseline to any exposed areas of
the penis - every 2-3 hours.
2. Remove the
clear dressing on post-op day #2.
3. If the dressing
can not be removed easily, then allow the patient to soak for 5-10 minutes in a
warm bath. This should loosen up the bandage. It may take more than one
soaking. You may also give a dose of pain medication.
4. If the dressing
falls off before day #2 - DON'T WORRY.
5. Once the
dressing is removed, apply the Neosporin or Vaseline at least every few hours
(or with diaper changes) for the first seven days.
6. The patient may
shower or bathe after 48 hours, and every day thereafter.
7. It is normal to
see some redness, swelling, bruising, and some bloody drainage during the
first week after surgery. Also, it is normal to see yellow/white scabs or
discharge on the penis. This is usually results from drainage at the surgery
site or from the residue of Vaseline or Neosporin ointments.
CALL THE DOCTOR IF:
- Fever
of 101 or greater
- Worsening redness and swelling
- Worsening pain
- Persistent bleeding (soaks diaper or underwear)
- Pus
around incision
Some
young boys may have difficulty urinating after circumcision (either due to
fear, pain, or anesthesia). If this happens, try letting them sit in a warm
bath for a short while to ease their pain and make them more comfortable.
On rare occasions, patients experience continual oozing
of blood from the surgical site on the first post-op day. If this happens,
place a generous amount of Vaseline on a gauze. Then with the Vaseline gauze,
hold firm pressure over the oozing area of the penis for at least 2-3
minutes. You may need to repeat this. Holding firm pressure over the penis
is usually all that is needed to stop the bleeding.
Sutures may be visible until approximately 6-8 weeks
after surgery. They will eventually fall off or be reabsorbed by the body. |
Post-Operative Care - Circumcision
|
1. Vaseline gauze
is applied during surgery. Begin applying Vaseline to any exposed areas of
the penis - every 2-3 hours.
2. Remove the
clear dressing on post-op day #2.
3. If the dressing
can not be removed easily, then allow the parent to soak for 5-10 minutes in a
warm bath. This should loosen up the bandage. It may take more than one
soaking. You may also give a dose of pain medication.
4. If the dressing
falls off before day #2 - DON'T WORRY.
5. Once the
dressing is removed, apply the Neosporin or Vaseline at least every few hours
(or with diaper changes) for the first seven days.
6. The patient may
shower or bathe after 48 hours, and every day thereafter.
7. It is normal to
see some redness, swelling, bruising, and some bloody drainage during the
first week after surgery. Also, it is normal to see yellow/white scabs or
discharge on the penis. This is usually results from drainage at the surgery
site or from the residue of Vaseline or Neosporin ointments.
CALL THE DOCTOR IF:
- Fever
of 101 or greater
- Worsening redness and swelling
- Worsening pain
- Persistent bleeding (soaks diaper or underwear)
- Pus
around incision
Some
young boys may have difficulty urinating after circumcision (either due to
fear, pain, or anesthesia). If this happens, try letting them sit in a warm
bath for a short while to ease their pain and make them more comfortable.
On rare occasions, patients experience continual oozing
of blood from the surgical site on the first post-op day. If this happens,
place a generous amount of Vaseline on a gauze. Then with the Vaseline gauze,
hold firm pressure over the oozing area of the penis for at least 2-3
minutes. You may need to repeat this. Holding firm pressure over the penis
is usually all that is needed to stop the bleeding.
Sutures may be visible until approximately 6-8 weeks
after surgery. They will eventually fall off or be reabsorbed by the body. |
Post-Operative Care - Concealed Penis Repair
|
1. Vaseline gauze
is applied during surgery. Begin applying Vaseline to any exposed areas of
the penis - every 2-3 hours.
2. Remove the
clear dressing on post-op day #2.
3. If the dressing
can not be removed easily, then allow the parent to soak for 5-10 minutes in a
warm bath. This should loosen up the bandage. It may take more than one
soaking. You may also give a dose of pain medication.
4. If the dressing
falls off before day #2 - DON'T WORRY.
5. Once the
dressing is removed, apply the Neosporin or Vaseline at least every few hours
(or with diaper changes) for the first seven days.
6. The patient may
shower or bathe after 48 hours, and every day thereafter.
7. It is normal to
see some redness, swelling, bruising, and some bloody drainage during the
first week after surgery. Also, it is normal to see yellow/white scabs or
discharge on the penis. This is usually results from drainage at the surgery
site or from the residue of Vaseline or Neosporin ointments.
CALL THE DOCTOR IF:
- Fever
of 101 or greater
- Worsening redness and swelling
- Worsening pain
- Persistent bleeding (soaks diaper or underwear)
- Pus
around incision
Some
young boys may have difficulty urinating after circumcision (either due to
fear, pain, or anesthesia). If this happens, try letting them sit in a warm
bath for a short while to ease their pain and make them more comfortable.
On rare occasions, patients experience continual oozing
of blood from the surgical site on the first post-op day. If this happens,
place a generous amount of Vaseline on a gauze. Then with the Vaseline gauze,
hold firm pressure over the oozing area of the penis for at least 2-3
minutes. You may need to repeat this. Holding firm pressure over the penis
is usually all that is needed to stop the bleeding.
Sutures may be visible until approximately 6-8 weeks
after surgery. They will eventually fall off or be reabsorbed by the body. |
Post-Operative Care
Hernia, Hydroceles, Orchiopexy, and
Varicoceles
|
1. You may sponge
bathe for two days then begin showering or bathing after that. Keep the
incision and dressing as dry as possible for the first week following surgery.
2. Do not soak,
rub, or scrub the dressing area for the first 7 days after surgery. This
includes NO SWIMMING.
3. Remove the
groin dressing around day seven, if it has not come off on its own. You may
let the child sit in the bathtub – to soak it off.
4. Redness,
swelling, and bruising is normal for approximately one week post
–operatively.
CALL THE DOCTOR IF:
- Fever
of 101 or greater
- Worsening redness and swelling
- Worsening pain
- Persistent bleeding (soaks diaper or underwear)
- Pus
around incision
FOR
ORCHIOPEXY/VARICOCELECTOMY PATIENTS ONLY:
Do not
remove the scrotal dressing. It will dissolve or come off on its own.
Physical Restrictions
- Infants – Use caution when carrying them
- Walking toddlers, preschoolers – No straddle toys. No climbing.
- School age children – No P.E. No strenuous activity. No sports. No
bicycles.
All
restrictions are for two weeks after surgery.
The
average amount of school missed is ONE week after surgery. |
Post-Operative Care - Hypospadias
|
1. The doctor will
let you know when to return to the office for the first follow-up visit
(usually in about 2-4 days after surgery.
2. You should
sponge bathe the patient (after surgery) until the catheter is removed. Wash
the body with soapy water, rinse and blot dry.
3. If the dressing
is in place, try not to wet the dressing.
4. Once the
dressing has been removed, gently soap and rinse the genital area, and blot
and dry with a wash cloth.
5. Apply
Neosporin/Vaseline along the incision every diaper change after the dressing
is removed. Continue until all stitches have dissolved (about 6-8 weeks).
6. The Doctor or
Nurse Practitioner will remove the catheter about one week after the foam
dressing is removed (about 1 ½ weeks after surgery).
7. It is normal to
see some blood, spotting, redness, swelling, and bruising for about one to two
weeks.
CALL THE DOCTOR IF:
- Fever
of 101 or greater
- Worsening redness and swelling
- Persistent bleeding
- Pus
around incision
- Vomiting
- The
foam dressing gets very soiled with stool
Physical Restrictions
- Infants – Use caution when carrying them
- Walking toddlers, preschoolers – No straddle toys. No climbing.
- School age children – No P.E. No strenuous activity. No sports. No
bicycles.
All
restrictions are for two weeks after surgery. |
Post-Operative Care - P-S Web Repair
|
1. Vaseline gauze
is applied during surgery. Begin applying Vaseline to any exposed areas of
the penis - every 2-3 hours.
2. Remove the
clear dressing on post-op day #2.
3. If the dressing
can not be removed easily, then allow the parent to soak for 5-10 minutes in a
warm bath. This should loosen up the bandage. It may take more than one
soaking. You may also give a dose of pain medication.
4. If the dressing
falls off before day #2 - DON'T WORRY.
5. Once the
dressing is removed, apply the Neosporin or Vaseline at least every few hours
(or with diaper changes) for the first seven days.
6. The patient may
shower or bathe after 48 hours, and every day thereafter.
7. It is normal to
see some redness, swelling, bruising, and some bloody drainage during the
first week after surgery. Also, it is normal to see yellow/white scabs or
discharge on the penis. This is usually results from drainage at the surgery
site or from the residue of Vaseline or Neosporin ointments.
CALL THE DOCTOR IF:
- Fever
of 101 or greater
- Worsening redness and swelling
- Worsening pain
- Persistent bleeding (soaks diaper or underwear)
- Pus
around incision
Some
young boys may have difficulty urinating after circumcision (either due to
fear, pain, or anesthesia). If this happens, try letting them sit in a warm
bath for a short while to ease their pain and make them more comfortable.
On rare occasions, patients experience continual oozing
of blood from the surgical site on the first post-op day. If this happens,
place a generous amount of Vaseline on a gauze. Then with the Vaseline gauze,
hold firm pressure over the oozing area of the penis for at least 2-3
minutes. You may need to repeat this. Holding firm pressure over the penis
is usually all that is needed to stop the bleeding.
Sutures may be visible until approximately 6-8 weeks
after surgery. They will eventually fall off or be reabsorbed by the body. |
Post-Operative Care - Penile Torsion Repair
|
1. Vaseline gauze
is applied during surgery. Begin applying Vaseline to any exposed areas of
the penis - every 2-3 hours.
2. Remove the
clear dressing on post-op day #2.
3. If the dressing
can not be removed easily, then allow the parent to soak for 5-10 minutes in a
warm bath. This should loosen up the bandage. It may take more than one
soaking. You may also give a dose of pain medication.
4. If the dressing
falls off before day #2 - DON'T WORRY.
5. Once the
dressing is removed, apply the Neosporin or Vaseline at least every few hours
(or with diaper changes) for the first seven days.
6. The patient may
shower or bathe after 48 hours, and every day thereafter.
7. It is normal to
see some redness, swelling, bruising, and some bloody drainage during the
first week after surgery. Also, it is normal to see yellow/white scabs or
discharge on the penis. This is usually results from drainage at the surgery
site or from the residue of Vaseline or Neosporin ointments.
CALL THE DOCTOR IF:
- Fever
of 101 or greater
- Worsening redness and swelling
- Worsening pain
- Persistent bleeding (soaks diaper or underwear)
- Pus
around incision
Some
young boys may have difficulty urinating after circumcision (either due to
fear, pain, or anesthesia). If this happens, try letting them sit in a warm
bath for a short while to ease their pain and make them more comfortable.
On rare occasions, patients experience continual oozing
of blood from the surgical site on the first post-op day. If this happens,
place a generous amount of Vaseline on a gauze. Then with the Vaseline gauze,
hold firm pressure over the oozing area of the penis for at least 2-3
minutes. You may need to repeat this. Holding firm pressure over the penis
is usually all that is needed to stop the bleeding.
Sutures may be visible until approximately 6-8 weeks
after surgery. They will eventually fall off or be reabsorbed by the body. |
Post-Operative Care - Urethromeatoplasty
|
1. No dressing
or bandage is necessary after this surgery.
2. Apply
generous amounts of triple anti-biotic or petroleum jelly – enough to cover
the opening of the penis and all sutures. Start this the day of the
surgery! (“Generic” ointments are acceptable).
3. For children
who are in diapers, apply ointment with every diaper change. For toilet
trained children, apply ointment approximately three times a day until all
rawness or redness goes away and all the stitched have dissolved.
4. Frequent
application of the ointment will be necessary for at least 3-5 days after
surgery, consider applying ointment prior to urination.
5. Bathing by
shower or in the bathtub can begin the day after surgery.
6. Some
children have difficulty urinating or will hold their urine for long periods
after surgery due to pain and/or fear. If so:
a. Apply
ointment to the tip of the penis immediately before the child urinates in
order to lubricate the area.
b. Medicate
with a prescribed pain medication or ibuprofen (Motrin or Advil) about 45
minutes before the child urinates.
c. Allow the
patient to sit in a warm bath and have the child urinate in the water.
d. Increase
oral fluid intake to promote more urine production and stimulate the urge to
urinate.
SPECIAL NOTES
1. A diverted
urine stream or “spraying” may occur for several weeks after surgery. THIS IS
NORMAL!
2. If the
sutures are irritating or are rubbing against underwear – directly apply
petroleum jelly ON the underwear where they touch the penis. |
Care of the
Uncircumcised Penis |
Anatomy:
At birth the penis consists of a cylindrical shaft with a rounded area at
the top called the glans, although the glans may not be visible, being covered
with foreskin. The normal urethral opening is located slightly below the tip
of the glans. The foreskin is a double layer of skin; the outer layer is a
continuation of the penile skin while the inner layer is a type of mucous
membrane similar to the lips. The inner foreskin may be adhered to the glans.
This is almost always true at birth. Over time, the inner foreskin and glans
separate. This separation may not occur until puberty. The white pearly material
seen under the foreskin is a collection of dead skin cells and some oils.
This is not pus.
Hygiene:
All children should bathe regularly. During bathing, the genitals need to
be washed gently with mild soap. Do not retract the foreskin beyond any area
that does not easily separate. It is not necessary to cleanse the inner surface
as long as it is adherent to the glans. Moreover, forceful retraction of the
foreskin may cause bleeding and scar formation resulting in infections and
persistent discomfort that may necessitate a circumcision. Once the foreskin
retracts easily, the foreskin should be retracted and the inner surface should
be cleansed whenever the child bathes. |
High Fiber
Diet |
| GRAINS/CEREALS |
| Whole wheat bread, Rye bread/crackers, All-Bran, Raisin Bran, Oat Bran, corn
bread, Grape Nuts, oatmeal/rolled oats, grits, wheat germ, whole wheat
pasta, brown or wild rice. |
| FRUITS |
| Raisins, apples, bananas, blueberries, strawberries, blackberries, prunes,
pears, peaches, nectarines, oranges, grapefruit, figs, apricots. |
| VEGETABLES |
| Broccoli, carrots, asparagus, cabbage, green beans, green peppers, peas,
potatoes with skin, spinach, squash, sweet potatoes, tomatoes, corn. |
| MILK PRODUCTS |
| All milk products, especially those with higher fat content. (For some
children, milk tends to be constipating). |
| MEATS/NUTS/BEANS |
| All beans and peas (garbanzo, kidney, lima, and pinto beans, split peas).
All nuts and seeds - almonds, peanuts, Brazil nuts, cashews, walnuts, sesame
and sunflower seeds. All meat, poultry, fish, and eggs. |
| SNACKS |
| Popcorn, oatmeal cookies, dried fruit, crunchy peanut butter, whole-wheat
pretzels, baked tortilla chips, trail mix with dried fruit/nuts/seeds,
raisins, coconut. |
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Common Terminology - Bifid
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Split or cleft into two parts |
Common Terminology - Calyces
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The minor calyx, in the kidney, surrounds the apex of the malpighian pyramids. Urine formed in the kidney passes through a papilla at the apex into the minor calyx then into the major calyx. Peristalsis of the smooth muscle originating in pace-maker cells originating in the walls of the calyces propels urine through the pelvis and ureters to the bladder. |
Common Terminology - Distension
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Distension generally refers to an enlargement or ballooning effect. |
Common Terminology - Edima |
Formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body. |
Common Terminology - Hematoma
|
Hematoma: A haematoma, or hematoma, is a collection of blood outside the blood vessels, generally the result of hemorrhage, or more specifically, internal bleeding. Can resemble bruising. |
Common Terminology - Hydronephrosis
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The distension and dilation of the renal pelvis and calyces, usually caused by obstruction of the free flow of urine from the kidney, leading to progressive atrophy of the kidney. |
Common Terminology - Meatal Stenosis
|
A narrowing of the urethra generally caused by scar tissue related to circumcisions (most common in boys, however, can appear in females as a birth defect). It is treated as a short outpatient surgery using specialized tools to remove the scar tissue and widen the urethra. It is usually performed under a general and caudal anesthesia. |
Common Terminology - Nephrology
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Nephrology: (from Greek nephros, "kidney", combined with the suffix -logy, "the study of") is a branch of internal medicine and pediatrics dealing with the study of the function and diseases of the kidney. |
Common Terminology - Prophylaxis
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Prophylaxis: (Greek - to guard or prevent beforehand) is any medical procedure whose purpose is to prevent, rather than treat or cure a disease. In general terms, prophylactic measures are divided between primary prophylaxis (to prevent the development of a disease) and secondary prophylaxis (whereby the disease has already developed and the patient is protected against worsening of this process). This applies to primary and secondary prophylaxis. |
Common Terminology - Renal
|
Renal: The kidneys are paired organs, which have the production of urine as their primary function. Kidneys are seen in many types of animals, including vertebrates and some invertebrates. They are an essential part of the urinary system, but have several secondary functions concerned with homeostatic functions. These include the regulation of electrolytes, acid-base balance, and blood pressure. In producing urine, the kidneys excrete wastes such as urea and ammonium; the kidneys also are responsible for the re-absorption of glucose and amino acids. Finally, the kidneys are important in the production of hormones including vitamin D, renin and erythropoietin.
Located behind the abdominal cavity in the retroperitoneum, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder. Renal physiology is the study of kidney function, while nephrology is the medical specialty concerned with diseases of the nephron, which is the functional unit of the kidney. Diseases of the kidney are diverse, but individuals with kidney disease frequently display characteristic clinical features.
Common clinical presentations include the nephritic and nephrotic syndromes, acute kidney failure, chronic kidney disease, urinary tract infection, nephrolithiasis, and urinary tract obstruction. |
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