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

Ureteropelvic Junction Obstruction
 Vesicoureteral Reflux
 Kidney stones
 Hypospadias
 Testicular Torsion
 Circumcision complications

Narrowing of the ureter that cause dilation of the kidney
Hydronephrosis
* prenatal ultrasound
*evaluation for recurrent UTI
 Evaluation of abdominal or flank pain of
unknown origin

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)

Surgical correction of UPJ obstruction
 Flank incision
 Removal of obstructed portion and
reanastomosis of the ureter

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

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

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
Ureters are detached from the bladder
and reimplanted into a stronger portion
of the bladder
 Pfannenstiel incision (c-section

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

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

Extracorporeal shCockwave lithotripsy
 Endoscopic Lithotripsy
 Both require placement of ureteral stent
to allow drainage of urine
 Can be a two to three step process

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

Congenital birth defect where urethral
opening is on the underside of penis
rather than the tip
 Surgical correction after 6 months of age

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

A true urologic emergency
 Testicle twists in the scrotal sac cutting off
blood supply
 Extreme scrotal pain
 Orchiopexy bilaterally

Bleeding
 Plastibell is displaced to shaft of the penis

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!