 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  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: sJPG

 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!