Journal of pediatric urology
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Postoperative pain control is a fundamental aspect of contemporary pediatric surgery. While many options for analgesia are available to the general patient population, choices are limited for individuals with spinal dysraphism who undergo major urologic procedures. Continuous infusion of local anesthetics has been shown to improve postoperative pain scores and decreases the need for systemic analgesia. We present our technique for continuous local anesthetic infusion utilizing readily available equipment with limited additional cost.
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To determine utility of short pelvic floor electromyography (EMG) lag time in monitoring therapeutic response in children with idiopathic detrusor overactivity (DO) and quiet EMG during voiding (idiopathic detrusor overactivity disorder, IDOD). ⋯ A short EMG lag time on noninvasive uroflow/EMG in a patient with urgency can be a surrogate for urodynamics study (UDS) in diagnosing DO and objectively monitoring response to therapy. When effectively treated, children with DO have amelioration of their lower urinary tract symptoms (LUTS) and normalization of both EMG lag time and bladder capacity.
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We review the English literature between 1980 and 2013 and summarize the clinical classification, aetiology, physiology, and pathophysiology of paediatric priapism. We propose a clinical guideline for the management of priapism in children. ⋯ Priapism in children must be assessed urgently. Rapid resolution of ischaemic priapism prevents permanent cavernosal structural damage and is associated with improved prognosis for potency later in life. Stuttering priapism requires careful counselling for episodic management. Chronic prophylaxis may be obtained using α-adrenergic sympathomimetics, phosphodiesterase type 5 inhibitors and, in sickle cell disease, hydroxyurea. Non-ischaemic and neonatal priapism may generally be treated less urgently.
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To evaluate the management and outcomes of pediatric patients presenting with torsion of an undescended testis in the inguinal canal. ⋯ Torsion of an undescended testis is a relatively rare phenomenon that should be suspected, diagnosed and treated without delay. This study highlights the importance of examination of external genital organs. With improved recognition of this entity and earlier referrals of patients with undescended testes by primary care physicians, its occurrence might eventually be prevented.
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Pediatric urolithiasis can cause significant morbidity and damage to the kidney, or even renal failure. We review our experience of the management of urolithiasis in pediatric patients at a tertiary referral center. ⋯ Availability of smaller instruments has led to safer use of percutaneous endoscopy and ureteroscopy in children, with results comparable to those in adults and an acceptable complication rate. The presence of a metabolic abnormality is quite common and is a cause of recurrence.