review the components of urinary system and how abnormalities cause urologic problems discuss the...
TRANSCRIPT
Pediatric UrologyNursing care of common pediatric
urologic problems
Tara M. Albert, RN, MSN, CPNP
Objectives
Review the components of urinary system and how abnormalities cause urologic problems
Discuss the surgical management of common urologic problems
Management of the inpatient urology patient
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Common Urologic Problems Requiring Inpatient Care
Ureteropelvic Junction Obstruction Vesicoureteral Reflux Kidney stones Hypospadias Testicular Torsion Circumcision complications
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Narrowing of the ureter that cause dilation of the kidney
Presentation of UPJ obstruction
Hydronephrosis * prenatal ultrasound *evaluation for recurrent UTI Evaluation of abdominal or flank pain
of unknown origin
How to determine if UPJ obstruction is present
Ultrasound reveals hydronephrosis VCUG is negative for vesicoureteral
reflux Renogram is the use of IV tracer to
determine how long it takes for kidney to clear tracer (Nuclear Med Test)
Pyeloplasty
Surgical correction of UPJ obstruction Flank incision Removal of obstructed portion and
reanastomosis of the ureter
Postoperative Care of a Pyeloplasty
What to expect? IV, penrose drain, flank incision, IV,
foley and abdominal binder 23-48 hour admission Postop day 1: suppository in am,
advance diet if bowel sounds present, walk the hall, discontinue foley
Vesicoureteral Reflux
Backflow of urine from the bladder back to the kidney
Concern with UTI that may cause a pyelonephritis
Reflux is caused by the way ureter enters the bladder wall
Management of Vesicoureteral reflux
Prophylactic antibiotics when patient has had recurrent UTI especially associated with fever
Improve voiding habits Surgical intervention after age of 3 or 4 Deflux injection in grades 2 and
sometimes 3 Extravesical reimplantation in grade 3
or higher
Extravesical ureteral reimplantation
Ureters are detached from the bladder and reimplanted into a stronger portion of the bladder
Pfannenstiel incision (c-section
Postoperative Management of the extravesical ureteral reimplantation
Foley catheter remains in place 1 week NPO Post op day 0 Post Op Day 1: suppository in am,
bowel sounds present advance diet as tolerated, up out of bed and walking the halls
Plan for discharge 23 to 48 hours after discharge
Kidney Stones
Patient will present with flank pain, blood in the urine, may have hydronephrosis due to blockage of the ureter
NON contrast CT scan to determine presence of stone
No need for surgical management unless stone is blocking ureter
Surgical management of stones
Extracorporeal shCockwave lithotripsy Endoscopic Lithotripsy Both require placement of ureteral
stent to allow drainage of urine Can be a two to three step process
Postoperative Management of Kidney stone
Normal to have blood in the urine 23 hour admission after stent
placement and stone removal due to high rate of return due to pain
Require medication for bladder spasms (ditropan) and antibiotic while stent in place
Hypospadias
Congenital birth defect where urethral opening is on the underside of penis rather than the tip
Surgical correction after 6 months of age
Postoperative management of hypospadias repair
Blue dressing in place. DO NOT REMOVE!
Urethral stent stays in place 5-7 days Keep penis pointed to the nose not the
toes! Patient will require ditropan for bladder
spasms and septra while stent in place Tylenol with codeine for pain Follow up in office for dressing removal
Testicular Torison
A true urologic emergency Testicle twists in the scrotal sac cutting
off blood supply Extreme scrotal pain Orchiopexy bilaterally
Circumcision complications
Bleeding Plastibell is displaced to shaft of the
penis
Pearls of Wisdom
Each of your patients is the absolute center of their parent’s universe
Listen to parents and be patient Compassion starts when you imagine
your own child in the same situation
Please remember that every patient is someone’s child!
