Urology for the Pediatrician, An Issue of Pediatric Clinics


The articles in this issue update important topics in pediatric urology, but also address some of the more controversial clinical topics. Those topics included in this issue are Prenatal Ultrasound and Urological Anomalies, Spina Bifida and Neurogenic Bladder, Inguinal and Genital Anomalies, Voiding Dysfunction, Vesicoureteral Reflux, Hydronephrosis, Urolithiasis in Children, Urinary Tract Infection (UTI) work up, Advances in Surgical Pediatric Urological Armamentarium, Pediatric Urologic Oncology, Pediatric ...

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The articles in this issue update important topics in pediatric urology, but also address some of the more controversial clinical topics. Those topics included in this issue are Prenatal Ultrasound and Urological Anomalies, Spina Bifida and Neurogenic Bladder, Inguinal and Genital Anomalies, Voiding Dysfunction, Vesicoureteral Reflux, Hydronephrosis, Urolithiasis in Children, Urinary Tract Infection (UTI) work up, Advances in Surgical Pediatric Urological Armamentarium, Pediatric Urologic Oncology, Pediatric Urological Emergencies, and Circumcision Controversies.

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Product Details

  • ISBN-13: 9781455739103
  • Publisher: Elsevier Health Sciences
  • Publication date: 9/11/2012
  • Series: Clinics: Internal Medicine Series
  • Pages: 1
  • Product dimensions: 6.20 (w) x 9.10 (h) x 0.70 (d)

Table of Contents

Preface: What Pediatricians Need to Know about Urology Pasquale Casale Walid A. Farhat xv

Prenatal Ultrasound and Urological Anomalies Douglass B. Clayton John W. Brock III 739

Prenatal ultrasound is an integral part of caring for pregnant women in the United States. Although surprisingly few data exist to support the clinical benefit of screening ultrasound during pregnancy, its use continues to rise. Urologic anomalies are among the most commonly identified, with overall detection sensitivity approaching 90%. Prenatal hydronephrosis is the most frequently identified finding and predicting postnatal pathology based on its presence can be difficult. As the degree of fetal hydronephrosis increases so does the risk of true urinary tract pathology. Diagnoses that require more urgent care include causes of lower urinary tract obstruction and bladder and cloacal exstrophy.

The Current Management of the Neurogenic Bladder in Children with Spina Bifida Dominic Frimberger Earl Cheng Bradley P. Kropp 757

The urological care of the neurogenic bladder consists of 2 components: medical management with preservation of renal function and quality-of-life issues with achieving dryness and independence of bladder and bowel management. Both components are equally important for patients to live a healthy and fulfilled life. This report explores the diagnosis of the neurogenic bladder; quality-of-life issues that caregivers and patients should expect; the importance of primary care knowledge of the neurogenic bladder and treatment; surgical options; the transition of pediatric patients to adult care; and the importance of caregiver and patient understanding of their disease, treatment options, and responsibilities.

Inguinal and Genital Anomalies Laura Stansell Merriman Lindsey Herrel Andrew J. Kirsch 769

Problems of the groin and genitalia are a common presenting complaint in both pediatrician's offices and emergency departments. The authors endeavor to provide a comprehensive review of the most common inguinal and genital anomalies encountered by the pediatrician, with a special focus on examination and management.

Functional Bladder Problems in Children: Pathophysiology, Diagnosis, and Treatment Israel Franco 783

Functional lower urinary tract problems, bladder and bowel problems, or dysfunctional elimination syndrome are all terms that describe the common array of symptoms that include overactive bladder syndrome, voiding postponement, stress incontinence, giggle incontinence, and dysfunctional voiding in children. This article discusses the nomenclature and looks at the pathophysiology of functional bladder disorders from a different perspective than has been the norm in the past. Some standard medical treatments as well as some newer forms of treatment are outlined. Treatment algorithms for urinary frequency and urinary incontinence have been created to help the practitioner manage the patient.

Current Options in the Management of Primary Vesicoureteral Reflux in Children Fernando F. Fonseca Fabio Y. Tanno Hiep T. Nguyen 819

The management of vesicoureteral reflux (VUR) is varied and remains controversial, which is likely because children with VUR have different risks for urinary tract infection or renal injury. Consequently, the treatment of VUR needs to be individualized based on the patient's characteristics. In this article, the authors review the medical and surgical management options for VUR in the pediatric population. The authors hope to provide a systematic approach to determine which treatment is optimal for a specific patient.

Management of Primary Vesicoureteral Reflux in Children: Editorial Commentary Ron Keren 835

Decisions are needed about the clinical management of children with vesicoureteral reflux (VUR) and a standardized risk-specific treatment approach is needed. Clinicians and researchers must begin to think creatively about VUR. Clinicians are beginning to understand that there are a variety of abnormalities in specific host defenses that might predispose some children to recurrent urinary tract infection, and that knowledge of these deficiencies may lead to therapies designed to compensate for them. There is also much to be learned about host inflammatory response to kidney infection.

Hydronephrosis: A View from the Inside Hrair-George O. Mesrobian Shama P. Mirza 839

Unilateral ureteropelvic junction obstruction (UPJO) is the most common prenatally detected disease leading to hydronephrosis. The obstructive anatomic lesion leads to varying degrees of hydronephrosis, ranging from no apparent effect on renal function to atrophy. Furthermore, the natural course of hydronephrosis varies from spontaneous resolution to progressive deterioration and may take upwards of 3 years for a kidney to declare itself. The objectives of this article are to update our knowledge regarding the evaluation and management of UPJO in depth and to discuss the emerging value of urinary proteome analysis to the clinical arena.

Update on the Management of Disorders of Sex Development Rodrigo LP. Romao Joao L. Pippi Salle Diane K. Wherrett 853

A number of factors have contributed to a sharp increase in the number of publications related to disorders of sex development (DSD) in the past 5 years, namely: the establishment of a consensus in 2006 about nomenclature, investigations and the need to treat these patients in a multidisciplinary setting; increase of the knowledge base about genetic mechanisms of normal and abnormal sex development; critical appraisal about the timing and nature of genital surgery in patients with DSD. Herein, the authors present a comprehensive review with up-to-date data about the approach to the newborn with ambiguous genitalia as well as the diagnosis and management of the most common DSD.

Management of Disorders of Sex Development: Editorial Commentary David E. Sandberg 871

In 2005, the Lawson Wilkins Pediatric Endocrine Society and the European Society for Pediatric Endocrinology convened a conference on intersex to review clinical management practices and data from long-term health-related and gender-related outcomes research and to identify key areas for future research. Romao and colleagues provide an overview of the evolving changes after publication of this guidance, informed by experiences in their multidisciplinary clinic. This commentary highlights and expands on several of the topics explored, with a special emphasis on the psychosocial aspects of care for persons affected by disorders of sex development and their families.

Urolithiasis in Children: Medical Approach Lawrence Copelovitch 881

Childhood urolithiasis is an evolving condition with an increasing incidence and prevalence over the last 2 decades. Over that time the underlying cause has shifted from predominantly infectious to metabolic in nature. This review describes the pathophysiology, underlying metabolic abnormalities, clinical presentation, evaluation, and management of childhood urolithiasis. A comprehensive metabolic evaluation is essential for all children with renal calculi, given the high rate of recurrence and the importance of excluding inherited progressive conditions.

Urolithiasis in Children: Surgical Approach Candace F. Granberg Linda A. Baker 897

Over the past 3 decades, minimally invasive stone surgery has completely overtaken open surgical approaches to upper tract pediatric urolithiasis. Progressing from least to most minimally invasive, extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy are the surgical methods of today for kidney and ureteral stones. The choice of treatment modality is individualized in children, considering patient age, stone size, number, location, and anatomic and clinical contributing factors. The purpose of this article is to review these techniques for pediatric upper urinary tract stones and summarize outcomes and complications.

Issues in Febrile Urinary Tract Infection Management Martin A. Koyle Donald Shifrin 909

Urinary tract infections are common occurrences in the pediatric age group and are a cause of significant morbidity and expense. The understanding of the consequences and sequelae of febrile urinary tract infections led to revision of standard protocols initiated by the American Academy of Pediatrics (AAP) in 1999. A less invasive protocol of radiologic evaluation has been the major outcome of the revised AAP guidelines. Emphasis on prevention of recurrent febrile urinary tract infections has also led to therapeutic programs that are centered less around the use of prophylactic antibiotics than has previously been the practice.

Evidence Basis for Individualized Evaluation and Less Imaging in Febrile Urinary Tract Infection: An Editorial Commentary Thomas B. Newman 923

The past decade has seen a remarkable retreat from previous dogma regarding urinary tract infections (UTIs). Less aggressive imaging is now recommended because although vesicoureteral reflux (VUR) is frequently found in children with a history of febrile UTIs, most VUR resolves spontaneously and we do not have evidence that treatment of the rest improves outcome. Available evidence suggests urine testing for UTI can be less aggressive as well, focusing on those with the most riskfactors for UTI, those with the most severe illness, and those at highest risk of complications.

Advances in the Surgical Pediatric Urologic Armamentarium Robert M. Turner II Janelle A. Fox Michael C. Ost 927

The surgical armamentarium of the pediatric urologist has changed greatly in the past 2 decades on account of new technology and careful adaptation of minimally invasive techniques in children. Conventional laparoscopy, robotic-assisted laparoscopy, laparoendoscopic single-site surgery, and endourologic surgery have, to varying degrees, provided new approaches to urologic surgery in the pediatric population. This article reviews the technology and adaptations behind these recent advances as well as their current applications in management of urologic disease in children.

Is Bladder Dysfunction in Children Science Fiction of Science Fact: Editorial Comment Darius J. B├Ągli 943

Functional bladder problems in children are often insidious and are frequently ignored by the child, by parents, and by many caregivers. Consideration of both the urinary and bowel outlets, and more recently, of the corticospinal tracts and brain reveal great complexity in this condition. In this article, the author addresses many of these issues in depth with a familiar personal experience derived from many years of dedicated consideration of these problems. Bladder dysfunction in the child is in many ways the pediatric urologist's hypertension diagnosis. Like antihypertensive therapy, bladder retraining strategies must be adhered to for life.

Pediatric Urologic Oncology Gwen M. Grimsby Michael L. Ritchey 947

This article reviews common pediatric urologic cancers involving the genitourinary system. Rhabdomyosarcoma may occur in the bladder, prostate, paratesticular regions, vagina, or uterus. Some of these locations, such as the paratesticular region, have a more favorable outcome. Benign neoplasms account for the majority of pediatric testicular tumors and most are managed with testis-sparing surgery. Most genitourinary malignancies are expected to have a good outcome. One focus of treatment is organ preservation but not at the expense of a good oncologic outcome. Late sequelae of anticancer therapy are a concern and every attempt is made to decrease the intensity of tumor treatment.

Geintourinary Malignancies in Children: Editorial Comment Armando J. Lorenzo 961

The modern management of pediatric genitourinary malignancies has resulted in survival rates that are dramatically better than figures from just a few decades ago. This is largely due to advances in multimodal treatment, collaborative efforts, and multidisciplinary management. Nevertheless, issues related to long-term side effects, treatment-related morbidity, and progression or recurrences remain important and pressing in terms of research directions and areas for improvement. In this Editorial Comment the author attempts to employ the current state of the art, masterfully summarized in the accompanying review by Drs Grimsby and Ritchey, to provide a view of trends that are likely to become increasingly important in the future, highlighting common patterns in treatment philosophy seen in other areas of oncology: more selective or patient-tailored treatment strategies, refined protocols and -whenever possible- tissue sparing and minimally invasive surgical interventions.

Pediatric Urological Emergencies Sarah M. Lambert 965

Although few children are severely ill when evaluated in the pediatric office, developing the skills to recognize an infant or child who requires hospitalization is critical. Some children will require treatment in an emergency department or direct admission to an inpatient facility, whereas other children can be managed as outpatients. Determining when an infant requires an inpatient admission is particularly important because the metabolic reserve is less abundant in the newborn. Patients with hemodynamic instability must be emergently addressed. This article outlines the most common urgent and emergent pediatric urological conditions with the goal to direct initial evaluation and treatment.

Circumcision Controversies Kirk Pinto 977

Despite its long history and common practice, circumcision remains a controversial procedure. This article reviews the history of this operation, examines the controversy that surrounds it, and emphasizes the performing practitioner's responsibility to the patient and his family in guiding them through the complicated decision making surrounding newborn circumcision.

Index 987

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