Pediatric hypospadias surgery.

The pediatric health care practitioner is a valuable resource of information for the family of an infant with hypospadias prior to the child and family's first visit to the pediatric urologist. Pediatric nurses are involved in the preoperative and postoperative care of children with surgical correction of hypospadias and should be aware of the newest advances in surgical techniques and improvements in postoperative care, particularly dressings and urethral stents. These advances have improved the outcome for children, including diminished pain and discomfort, minimal hospital stay and decreased complications. Minimal postoperative intervention is required. The current management of these children will ensure the optimum resolution with minimum physical and psychological problems for the child and family.

Silicone foam dressing for penis after reconstructive pediatric surgery.

Although silicone foam has been used abroad as an effective means to dress the penis after hypospadias surgery, its use has not been widespread in the United States. We have modified the method to apply the foam in order to facilitate its use. We used this method to dress the penis with silicone foam in 50 boys after reconstructive surgery. The dressing appeared to be effective in restricting edema and hematoma formation. Also, the dressing stabilized the indwelling urethral catheter thereby preventing disruption of the glansplasty. The urethrocutaneous fistula rate (10%) was not reduced by use of the foam. The dressings uncommonly fell off prematurely. The boys appeared to experience little discomfort while the foam was in place and during its removal.

Urinary prophylaxis and postoperative care of children at home with an indwelling catheter after hypospadias repair.

This study represents our observations of 50 pediatric patients who underwent urethroplasty for hypospadias and chordee. An indwelling Silastic Foley catheter remained indwelling postoperatively for ten to fourteen days, connected to an antireflux leg drainage bag. Prophylactic antimicrobial therapy was given to all patients from the day of operation until one week after removal of the catheter. Cultures obtained from urine specimens taken directly from the drainage bag revealed that only 16 percent of the cases had a significant bacterial colony count (greater than 100,000/cc). We describe the efficacy of a closed drainage system combined with prophylactic antimicrobials in the management of children after hypospadias surgery.

Management of cloacal exstrophy.

This case study demonstrates our experience in the very complex management of cloacal exstrophy. It exemplifies the aggressive therapy by a dedicated multidisciplinary health team and the excellent postoperative results.

Detrusorrhaphy: extravesical ureteral advancement to correct vesicoureteral reflux in children.

We used a modified extravesical technique, coined detrusorrhaphy, to correct surgically vesicoureteral reflux. By detrusorrhaphy the submucosal ureteral tunnel is opened, the ureteral meatus is advanced and anchored onto the trigone, and the detrusor buttress of the ureter is closed (-rrhaphy). The operation is performed extravesically. The procedure was used in the last 5 years in 79 children, or 120 renal units. Reflux resolved in 93 per cent of the renal units. Postoperative morbidity related to bladder spasms and hematuria was minimal compared to conventional transvesical surgical procedures. Detrusorrhaphy is an effective method to correct vesicoureteral reflux and to minimize postoperative morbidity.

Urodynamic biofeedback: a new therapeutic approach for childhood incontinence/infection (vesical voluntary sphincter dyssynergia).

A major cause of urinary incontinence and/or recurrent urinary infections in neurologically intact children is vesical voluntary sphincter/urogenital diaphragm dyssynergia and/or "strain" dyssynergia. These acquired or learned mechanisms are characterized by increased striated muscle tone during micturition, residual urine, daytime wetting and/or urinary infections. Generally, pharmacotherapy is prescribed and manipulated to achieve modification of these dysfunctions. Recently, urodynamic biofeedback has surfaced as a suitable therapeutic alternative. We selected 10 children, between 6 1/2 and 16 years old, for biofeedback therapy because of age, intelligence, commitment and conviction to improve. Following inpatient biofeedback 8 of the 10 children demonstrated complete abatement of signs and symptoms in long-term surveillance (6 to 19 months after biofeedback), while 2 moderately improved. Our experience with biofeedback therapy demonstrated that all patients convert to synergistic voiding within 48 hours of therapy. Urodynamic biofeedback appears to be an extremely useful tool in the armamentarium of the urologist treating neurologically normal children with voiding disorders. The possibility that this modality may be useful for adults is intriguing.