Pediatric Urology Treatments
Although prenatal intervention is rarely needed, The Mount Sinai Medical Center’s Department of Obstetrics is highly experienced with this rare procedure. Fortunately, hydronephrosis in the prenatal stage can frequently be resolved with observation. Moderate to severe hydronephrosis may represent a significant urinary tract disorder. There are many diagnostic tools and methods at our disposal to determine the best therapeutic remedy.
A detailed evaluation is conducted in consultation with our colleagues in the Division of Nephrology (kidney care). Most often, using shock wave lithotripsy or endoscopy the stone can be disintegrated without the need for surgery.
Vesicoureteral Reflux (VUR)
The goals of treatment in VUR are to prevent infected urine from reaching the kidney which can cause pyelonephritis (kidney infection), scarring, hypertension, proteinuria and even end-stage renal disease. For that reason, many children are placed on daily low-dose antibiotics. In the case of high-grade VUR or if there is a concomitant condition that makes resolution unlikely through medication, surgical repair is an appropriate option.
Prune Belly Syndrome
The testes are usually able to be brought into the scrotum and the abdominal wall defect surgically corrected so it has a less wrinkled appearance. Reflux is corrected if it does not resolve.
Traditional treatment is to reconfigure the bladder as a sphere in the first 48 hours of life and to bring the widened pubic bones together. At a later date construction of the bladder neck and reflux correction will be performed. In the third stage, the penile abnormality is repaired. This is technically demanding surgery that requires committed follow-up by treating physician and family. Sometimes, several of these procedures can be combined under the same anesthesia; in many instances the exstrophy and epispadias are repaired together in the first 48 hours. The ultimate goals are the creation of a normally functioning bladder (adequate volume, lack of reflux and dryness) and a normal looking and functioning penis. Some patients will require augumentation of the bladder with a portion of the intestines.
Posterior Urethral Valves
In rare cases, a combined obstetric/urologic team needs to intervene prior to delivery to protect the development of the kidneys and lungs. Posterior urethral valves can be treated in the first few days after birth in almost all infants using a cytoscope placed into the urethra to ablate the valves.
Neural Tube Defects
The goals of treatment for a child with myelodysplasia are a normal capacity bladder with continence. In addition, we hope to preserve kidney function and decrease the incidence of infections. A great advance has been the common use of clean, intermittent catheterization as well as pharmacologic agents and urodynamic studies which help clarify bladder function. In cases where conservative measures are unsuccessful, surgical procedures can restore the bladder toward normal function.
The majority of procedures to correct hypospadias are done on an outpatient basis under general anesthesia and are highly successful. The foreskin of the penis, which is present only on the back side should not be removed prior to the reconstructive surgery as often this skin will be used in the repair. However, due to medical advances and new techniques, certain type hypospadias can be repaired in the absence of foreskin. It is important that these surgeries be done by experienced specialists who perform them on a regular basis, as we do at Mount Sinai.
Epispadias can corrected by creating a new urethra and rotation of the corporeal bodies to give the penis its more normal orientation.
Correction can usually be done on an outpatient basis by surgical resection and placing placating sutures in the penis.
Many of these conditions can be treated by surgical means and establishment of sexual and fertility potential. These disorders require early and close consultation between the pediatric urologist, pediatric endocrinologist, geneticist, and neonatal intensive care physician to determine what possible abnormalities are present in the genes, hormones, and anatomy.
If the testis has not descended by the first 6-12 months of life, it is unlikely to do so. In addition, the testis, which functions and grows better in its scrotal position, begins to undergo damage as early as one year of life if left outside the scrotum. We therefore recommend surgical correction at 6-12 months of age.
A non-palpable testis represents one of three scenarios:
- the testis is in the inguinal canal and for some reason cannot be palpated
- the testis is inside the abdomen
- the testis does not exist on that side
Our preference to differentiate between these three possibilities is to perform laparoscopy followed by the appropriate procedure (i.e., orchidopexy rather than the removal of testicular remnant) in the same sitting. Many of the intra-abdominal testes can be moved into the scrotum by laparoscopy alone. If cryptorchidism is corrected, fertility potential should approach that of the general population. Frequent testicular exams are required to check for possible testis tumors.
Inguinal hernias are treated by closing the patency with a surgical procedure. The recurrence rate is minimal. The surgery is done on an outpatient basis.
Like a hernia, hydroceles are very easily treated by simply closing the patency via surgery and the recurrence rate is minimal. The surgery can be done on an outpatient basis.
We Can Help
U.S. News & World Report ranks Mount Sinai among the nation’s best for Urology. At Mount Sinai’s Division of Pediatric Urology, our team’s priority is to provide you and your child with expert and compassionate care.
For additional information or to make an appointment, please call us at 212-241-4812.
Tel: 800-MD-Sinai (800-637-4624)
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