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UROLOGY
LAUREN TRAVIS, NP
Urology 101
• What is pediatric urology?– Urinary tract– Reproductive
Urologic testing: The what and why• Common tests
– Renal bladder ultrasound (RBUS)– Voiding cystourethrogram (VCUG)– Urodynamic evaluation– Urinalysis/urine culture
•Why is this important?
“At birth, the majority of patients with neurogenic bladder have normal upper urinary tracts. “Without proper management, urinary tract infections and elevated bladder pressures with secondary bladder‐wall changes may cause upper urinary tract deterioration within 3 years in up to 58%.”
Renal Bladder Ultrasound (RBUS)
• Provides noninvasive structural information regarding the kidneys and bladder.
When? •Shortly after birth •Birth to 1 year: every 3 months•Toddler/school age: every 6 months•Puberty: annually
RBUS
• Normal • Abnormal
*Important note. A normal ultrasound does not ensure safe bladder pressures and/or absence of VUR
Voiding Cystourethrogram(VCUG)
• Voiding, cysto, urethrogram– Bladder: shape/appearance
– Assess for vesicoureteralreflux (VUR)
– Outlet: images of urethra during voiding
– Prelim info regarding capacity, PVR
VCUG• Bladder shape & appearance
• Vesicoureteral reflux (VUR)
Urodynamics (UDS)
What is it? Where is it performed?When is it performed? Why it’s important?
First, a quick review of bladder dyanmics
• The bladder has two main functions:– (1) to STORE urine– (2) to EMPTY urine when it is full
• In order for this process to be successful, the nerves and the muscles of the urinary tract work together. Nerves carry messages from the bladder to the brain and from the brain to the muscles of the bladder sphincter. These messages tell the bladder to relax or contract.
UDS components
• Storage– Sensation– Bladder capacity– Bladder compliance
• Emptying
• +/‐ Fluoroscopy (X‐ray)
Clean intermittent Catheterization (CIC)
• What is CIC? • Why is it important?
– Prevent kidney damage– Prevent urinary tract infection– Help achieve urine continence
• Usually combined with medication to relax bladder
Prevention of kidney damage
• Hydronephrosis• Vesicoureteral reflux (VUR)
Prevention of UTI
• UTI=urinary tract infection• Contributing factors: gender, stagnant urine, bowels
• Complications:
Urine continence
The digestion process is managed by messages sent between the brain and digestive system. These messages are sent through nerves located in the spine which are responsible for sensation of bowel fullness and emptying.
Neurogenic Bowel
•Lack of awareness that the rectum is filled with stool•Slow motility•Inability to effectively empty bowel completely
Neurogenic bowel
• Why urologist care about “poo”
Bowel management
• Stool softeners (MiraLax, doculax)• Laxatives (Ex‐lax/senna)• Suppositories• Digital stimulation• Enemas
– Traditional – (versus) MACE
Traditional enemas
• An enema is a liquid that is placed into the rectum. It flushes out stool that has built up in the bowel.
Types of Traditional Enemas
• Over the counter fleets• Cone• Foley• Peristeen
Malone Antegrade Continence Enema (MACE)
Fiber, water and exercise
References
• McLone & Bowman (2015). Overview of the management of myelomeningocele (spinabifida). Uptodate.
• Verpoorten & Buyse (2008). The neurogenicbladder: medical treatment. Pediatric Nephrology (23) 717‐725.
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