General

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Augmentation cystoplasty is now commonly performed at most pediatric urological centres. Bladder augmentation has three major goals: to provide a compliant bladder reservoir, to limit bladder contractility, and to increase bladder capacity. Augmentation cystoplasty should allow the urinary tract to remain intact while preserving renal function and providing urinary continence. Various substrates are utilized to augment the bladder; the most commonly used is a segment of ileum, but stomach and large bowel also have been used. Ileum has been demonstrated to be the least contractile…

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The site of the stoma on the skin is selected entirely for the patient’s convenience. The umbilicus provides a good passage and the best cosmetic result, but it is not an option in exstrophy patients. With patients in wheelchairs, the spine tends to become twisted with time, causing progressive abdominal compression, and the abdomen becomes hidden from the patient’s field of vision. For these patients, a stoma site close to the xiphisternum is the best option."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The technique includes early closure of the bladder, posterior urethra, and abdominal wall, usually with pelvic osteotomy in the newborn period, subsequently followed by an early epispadias repair at 6 months to 1 year of age after testosterone stimulation by intramuscular injection. Around age 4–5 years, when adequate bladder capacity is reached and the child is ready to participate in a very structured preoperative and postoperative voiding program, a competent bladder neck is reconstructed, with bilateral ureteral reimplantation."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Ureteral reflux in various degrees is seen in 100% of cases after closure. A preoperative ultrasound evaluation of the otherwise usually unaffected upper tracts is mandatory to determine the presence of two normal kidneys"

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "The success rates of the P-L and the Cohen (transtrigonal) techniques are similar. The advantage of the P-L is that the ureter is much easier to catheterize for retrograde pyelography and ureteral endoscopy because the ureteral opening of the Cohen is on the opposite side of the bladder. The disadvantage is that in creating the new ureteral hiatus, there is a blind spot behind the bladder, and a peritoneotomy or even bowel injury may occur, particularly in reoperative cases."

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Medical management is based on the principles that VUR often diminishes or resolves over time, and maintaining sterile urine minimizes the risk of reflux nephropathy. Medical management includes bladder training (encouraging regular micturition and treating symptoms of bladder/bowel dysfunction) and possibly antibiotic prophylaxis with a daily dose of an antimicrobial such as nitrofurantoin, trimethoprim, or sulfatrim. Many children undergo regular follow-up assessment with a voiding cystourethrogram (VCUG) and renal ultrasonogram (US) every 12–18 months. Medical management is co…

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "In those patients who had prenatal diagnosis of hydronephrosis, ultrasonography is performed in the first week of life. If hydronephrosis is confirmed, radionuclide studies are undertaken when the child is 6–8 weeks old in order to assess renal function and rule out obstruction. In those patients who present with clinical symptoms, a renal ultrasound is performed, and if it shows hydronephrosis without dilated ureters, the diagnosis is confirmed with radionuclide studies. The most commonly used radionuclides are diethylenetriamine pentaacetate (DTPA) and mercaptoacetyltriglycine …

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Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "To improve the efficacy of the antireflux mechanism, we suggest the following parameters: (a) suture the anastomotic line not only to the mucosa but also to the detrusor muscle to avoid excessive traction on the bladder mucosa; (b) suture the bladder to the abdominal wall, if the surgeon observes excessive traction; and (c) if it is possible according to the mesentery axes, the choice of the apex of the appendix for the bladder anastomosis would be easier to incorporate on the tunnel than the base of the appendix."

Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "It was found that neonatal valve ablation would protect the bladder functions and allow normal bladder cycling and healing. This underscores the importance of routine prenatal screening and early intervention for the valves. These findings suggest that the long-term prognosis of PUV might be improved by prenatal diagnosis [6, 14]." Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "The management of children with PUV is a continuous process that starts …

Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "Irrigation fluid—water if monopolar diathermy is used, saline if bipolar electrocautery" Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "Introduction of bipolar electroresection is reported to allow TUR in saline and to minimize the risk of the obturator reflex, which can predispose to bladder perforation [1]."

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Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "The main disadvantage of retroperitoneoscopy is that it is not possible to isolate the ureter arriving near the bladder as in laparoscopy. This is a problem because if the indication is VUR, you can leave a long ureteral stump with the risk to have a postoperative reflux with UTI and the risk to have a second procedure to remove the stump."

Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "According to recommendations from the European Association of Urology and the American Urological Association, we decided to operate on children with VUR grade III or more, with renal dysfunction (DMSA < 40%) or renal scarring demonstrated on isotope renography, and children developing recurrent pyelonephritis despite optimal medical treatment."