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

ANATOMY

Common Urologic Problems Requiring Inpatient Care

Ureteropelvic Junction Obstruction Vesicoureteral Reflux Kidney stones Hypospadias Testicular Torsion Circumcision complications

URETEROPELVIC OBSTRUCTION

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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

Type: s JPG

Extravesical ureteral reimplantation

Ureters are detached from the bladder and reimplanted into a stronger portion of the bladder

Pfannenstiel incision (c-section

http://emedicine.medscape.com/article/1893904-overview

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!