Palmer Pediatric Urology

A General Urologist's Guide
1. Auflage 2010
ISBN: 978-1-60327-420-3
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 392 Seiten

Reihe: Current Clinical Urology

A vast number of children in the United States are evaluated and treated for urologic conditions by urologists practicing general urology due to the relatively few fellowship-trained pediatric urologists. Pediatric Urology: A General Urologist's Guide is written specifically for general urologists as a concise and comprehensive reference of the more common pediatric urologic conditions. Other health practitioners (i.e. pediatrician, family practitioner, residents, medical students, and mid-level providers) will also find this book a key reference. Written by well-respected pediatric urologists, this volume will assist the health care provider to rapidly review the essential aspects of the physical examination, evaluation, diagnostic testing, and management while the patient is still in the office. The chapters are arranged into four sections to allow for easier access to the information: office urology, genitalia, urinary tract, and miscellaneous topics. Furthermore, the first chapter of the book will be dedicated to facts and figures (ex. normal penile and renal lengths based on age, dosing of common medications, and grading system for vesicoureteral reflux) that serves as a single source for this information. Pediatric Urology: A General Urologist's Guide offers the reader the essential information to assist them in the care of children.

Autoren/Hrsg.

Palmer, Jeffrey S.

Inhaltsverzeichnis

1;Preface;7
2;Contents;8
3;Contributors;10
4;Part I: Office Urology;12
4.1;1 Pediatric Urology Facts and Figures;13
4.2;2 Radiographic Imaging;23
4.2.1;Introduction;23
4.2.2;Imaging Modalities;24
4.2.2.1;Nuclear Imaging;26
4.2.3;Anomalies of the Kidney;27
4.2.3.1;Unilateral Renal Agenesis;27
4.2.3.2;Renal Ectopia;27
4.2.3.3;Renal Cystic Diseases;28
4.2.3.4;Hydronephrosis;29
4.2.3.5;Ureteropelvic Junction (UPJ) Obstruction;30
4.2.3.6;Collecting System Duplication;31
4.2.3.7;Stones;32
4.2.3.8;Pyelonephritis;33
4.2.4;Anomalies of the Ureters;34
4.2.4.1;Megaureter;34
4.2.4.2;Ureterocele;35
4.2.5;Anomalies of the Bladder;36
4.2.5.1;Vesicoureteral Reflux;36
4.2.5.2;Neurogenic Bladder;37
4.2.5.3;Bladder Diverticulum;39
4.2.6;Anomalies of the Urethra;40
4.2.6.1;Posterior Urethral Valves (PUV);40
4.2.6.2;Other Urethral Anomalies;40
4.2.7;Anomalies of the Testis;41
4.2.7.1;Acute Testicular Pain;41
4.2.8;Conclusion;44
4.2.9;References;44
4.3;3 Urinary Tract Infections;46
4.3.1;Introduction;46
4.3.2;Epidemiology;47
4.3.3;Etiology;47
4.3.4;Bacterial Virulence Factors;49
4.3.5;Host Defense and Risk Factors;50
4.3.5.1;Perineal Factors;50
4.3.5.2;Lower Urinary Tract Factors;51
4.3.5.3;Upper Urinary Tract Factors;52
4.3.6;Reflux Nephropathy;54
4.3.6.1;Pathogenesis of Post-pyelonephritic Renal Scarring;55
4.3.6.2;Congenital Reflux Nephropathy;56
4.3.6.3;Sequelae of Renal Scarring/Dysplasia;56
4.3.6.4;Renal Insufficiency;57
4.3.7;Diagnosis of Uti;58
4.3.8;Evaluation of Uti;59
4.3.8.1;Lower Tract Imaging;59
4.3.8.2;Upper Tract Imaging;60
4.3.8.3;''Top-Down'' Approach to Evaluation of UTI;63
4.3.9;Treatment of Uti;64
4.3.9.1;Cystitis;65
4.3.9.2;Pyelonephritis;65
4.3.9.3;Asymptomatic Bacteriuria;67
4.3.9.4;Antibiotic Prophylaxis;68
4.3.9.4.1;Renal Abscess;69
4.3.9.4.2;Xanthogranulomatous Pyelonephritis;69
4.3.9.4.3;Treatment in Renal Failure;70
4.3.10;Conclusions;70
4.3.11;References;71
4.4;4 Voiding Dysfunction, Urinary Incontinence, and Urodynamics;79
4.4.1;Introduction;79
4.4.2;Background and Epidemiology;80
4.4.3;Pathophysiology;80
4.4.4;Etiology of Nocturnal Enuresis;81
4.4.5;Iccs Definitions of Voiding Symptoms;82
4.4.6;Iccs Classification of Incontinence;83
4.4.7;Incontinence;83
4.4.8;Evaluating Children with Voiding Dysfunction and Incontinence;85
4.4.8.1;History;85
4.4.8.2;Physical Examination;85
4.4.8.3;Investigation;86
4.4.8.4;Management;90
4.4.8.5;Clean Intermittent Catheterization;94
4.4.8.6;Surgical Management;94
4.4.9;Conclusions;94
4.4.10;References;94
4.5;5 Hematuria: Gross and Microscopic;98
4.5.1;Introduction;99
4.5.2;Definition;99
4.5.3;Classification;101
4.5.4;Epidemiology;101
4.5.5;Etiology;106
4.5.6;Hematuria From Glomerular Causes;106
4.5.6.1;Acute Post-streptococcal Glomerulonephritis;106
4.5.6.2;IgA Nephropathy ;107
4.5.6.3;Alport's Syndrome;108
4.5.6.4;Thin Glomerular Basement Membrane Disease;108
4.5.6.5;Membranous Glomerulonephritis;109
4.5.6.6;Membranoproliferative Glomerulonephritis;109
4.5.6.7;Glomerulonephritis Associated with Systemic Lupus Erythematosus;110
4.5.6.8;Henoch-Schonlein Purpura Nephritis ;110
4.5.6.9;Rapidly Progressive Crescentic Glomerulonephritis;111
4.5.6.10;Goodpasture's Disease;112
4.5.6.11;Hemolytic-Uremic Syndrome;112
4.5.7;Hematuria Due to Renal Interstitial Diseases;113
4.5.7.1;Cystic Disease;113
4.5.7.2;Nephrocalcinosis;113
4.5.7.3;Interstitial Nephritis;114
4.5.7.4;Acute Tubular Necrosis;115
4.5.7.5;Cortical Necrosis;116
4.5.7.6;Nephrotoxins;116
4.5.7.7;Tumors;116
4.5.8;Vascular Causes of Hematuria;117
4.5.8.1;Trauma;118
4.5.8.2;Sickle Cell Nephropathy;119
4.5.8.3;Renal Vein Thrombosis;119
4.5.8.4;Renal Artery Thrombosis;121
4.5.8.5;Coagulopathies and Thrombocytopenia;121
4.5.8.6;Arteriovenous Malformations;121
4.5.8.7;Nutcracker Syndrome;122
4.5.9;Hematuria Originating From the Urinary Tract;122
4.5.9.1;Idiopathic Hypercalciuria;122
4.5.9.2;Nephrolithiasis;123
4.5.9.3;Bacterial Infection;123
4.5.9.4;Hemorrhagic Cystitis ;124
4.5.9.5;Obstruction;124
4.5.9.6;Urethrorrhagia;124
4.5.9.7;Heavy Exercise;125
4.5.9.8;Loin Pain-Hematuria Syndrome;125
4.5.10;Evaluation;125
4.5.10.1;History;127
4.5.10.2;Physical Examination;128
4.5.10.3;Laboratory Testing;129
4.5.10.4;Radiologic Testing;129
4.5.10.5;Biopsy;130
4.5.10.6;Cystoscopy;130
4.5.10.7;Referral;131
4.5.11;References;131
4.6;6 Office Procedures;133
4.6.1;Introduction;133
4.6.2;The Pediatric Urology Office;134
4.6.3;Pain/anxiety Management;134
4.6.4;Penile Procedures;136
4.6.4.1;Circumcision;136
4.6.4.2;Penile Adhesions;137
4.6.4.3;Meatotomy;138
4.6.4.4;Paraphimosis;138
4.6.5;Procedures on the Female Genitalia;139
4.6.5.1;Lysis of Labial Adhesions;139
4.6.5.2;Prolapsing Ureterocele/Imperforate Hymen;139
4.6.6;Miscellaneous Procedures;140
4.6.6.1;Urethral Catheterization;140
4.6.6.2;Teaching Clean Intermittent Catheterization;143
4.6.6.3;Suprapubic Access to the Bladder;144
4.6.6.4;Management of Indwelling Tubes and Catheters;145
4.6.7;References;146
4.7;7 Genetic Diseases and Associated Urologic Manifestations;147
4.7.1;Introduction;147
4.7.2;Aarskog Syndrome;148
4.7.3;Familial Hematuria Due to Type Iv Collagen Mutations;148
4.7.4;Alport Syndrome;148
4.7.5;Thin Basement Membrane Nephropathy;149
4.7.6;Congenital Hepatorenal Fibrocystic Syndromes;149
4.7.7;Autosomal Recessive (Infantile) Polycystic Kidney Disease (Arpkd);149
4.7.8;Autosomal Dominant (Adult) Polycystic Kidney Disease (Adpkd);150
4.7.9;Bardet-Biedl Syndrome;150
4.7.10;Jeune Syndrome (Asphyxiating Thoracic Dysplasia);151
4.7.11;Meckel-Gruber Syndrome;151
4.7.12;Branchio-Oto-Renal Syndrome (Melnick-Fraser Syndrome);151
4.7.13;Charge Syndrome;152
4.7.14;Ehlers-Danlos Syndrome;152
4.7.15;Fraser Syndrome (Cryptophthalmos Syndrome);152
4.7.16;Goldenhar Syndrome (Oculo-Auricular Vertebral Complex);153
4.7.17;Hypertelorism-Hypospadius Syndrome (Opitz G/Bbb Syndrome);153
4.7.18;Intersex Disorders;153
4.7.19;Lesch-Nyhan Syndrome;153
4.7.20;Menkes Disease;154
4.7.21;Murcs Syndrome;154
4.7.22;Nail-Patella Syndrome (Hereditary Osteoonychodysplasia);154
4.7.23;Noonan Syndrome;155
4.7.24;Oculocerebrorenal Syndrome Of Lowe;155
4.7.25;Prader-Willi Syndrome;155
4.7.26;Prune Belly Syndrome (Eagle-Barrett Syndrome);156
4.7.27;Robinow Syndrome (Fetal Face Syndrome);156
4.7.28;Sickle Cell Disease;156
4.7.29;Smith-Lemli-Opitz Syndrome;157
4.7.30;Turner Syndrome;157
4.7.31;Vacterl Association;157
4.7.32;Wilms Tumor (Nephroblastoma);158
4.7.33;Zellweger Syndrome (Cerebrohepatorenal Syndrome);158
4.7.34;Recently Defined Genetic Syndromes;158
4.7.34.1;Pelvis Syndrome;158
4.7.34.2;IMAGe;158
4.7.35;References;159
5;Part II: Genitalia;162
5.1;8 Penis and Scrotum: Congenital and Acquired Anomalies;163
5.1.1;Introduction;163
5.1.2;Penile Anomalies;163
5.1.3;Prepuce (Foreskin);164
5.1.3.1;Phimosis and Paraphimosis;164
5.1.3.1.1;Circumcision;164
5.1.3.1.2;Circumcision Complications;165
5.1.3.1.3;Meatal Stenosis;165
5.1.3.1.4;Glanular Adhesions and Skin Bridges;166
5.1.3.1.5;Penile Skin Complications;166
5.1.3.1.6;Penile Trauma;166
5.1.4;Balanitis Xerotica Obliterans;167
5.1.5;Accessory Urethral Openings;167
5.1.5.1;Urethral Duplication;167
5.1.5.2;Congenital Urethral Fistula;168
5.1.6;Penile Masses;169
5.1.6.1;Inclusion Cysts;169
5.1.6.2;Parameatal Urethral Cyst;169
5.1.6.3;Cyst of the Median Raphe;170
5.1.6.4;Congenital Penile Nevi;170
5.1.7;Abnormal Penile Orientation;171
5.1.7.1;Penile Torsion;171
5.1.7.2;Penile Curvature;172
5.1.8;Micropenis;172
5.1.9;Inconspicuous Penis;173
5.1.9.1;Buried Penis;173
5.1.9.2;Webbed Penis;175
5.1.10;Priapism;175
5.1.11;Scrotal Anomalies;176
5.1.11.1;Penoscrotal Transposition;176
5.1.11.2;Scrotal Hypoplasia;176
5.1.11.3;Bifid Scrotum;177
5.1.12;References;177
5.2;9 Hypospadias;180
5.2.1;Introduction;180
5.2.2;Etiology;181
5.2.3;Incidence;181
5.2.4;Associated Conditions;182
5.2.5;Diagnosis;182
5.2.6;Preoperative Evaluation;182
5.2.7;Indications For Surgery;183
5.2.8;Preoperative Hormone Stimulation;183
5.2.9;Timing Of Surgery;184
5.2.10;Surgical Repair;184
5.2.10.1;Distal Hypospadias;184
5.2.10.2;Proximal Hypospadias;185
5.2.10.3;Correcting Penile Curvature;186
5.2.11;Complications;187
5.2.11.1;Fistulas;188
5.2.11.2;Meatal Stenosis;189
5.2.11.3;Urethral Stricture;190
5.2.11.4;Urethral Diverticulum;190
5.2.11.5;Wound Dehiscence;190
5.2.12;Hypospadias Reoperations;190
5.2.12.1;Tip;191
5.2.12.2;Inlay Grafting;191
5.2.12.3;Staged Buccal Grafts;191
5.2.13;Long-Term Results Of Hypospadias Repair;192
5.2.14;References;193
5.3;10 Varicoceles, Hernias, and Hydroceles;194
5.3.1;Varicocele;194
5.3.1.1;Introduction;194
5.3.1.2;Detection of Varicoceles;195
5.3.1.3;Risk Factors;196
5.3.1.4;Adolescents and Varicoceles;198
5.3.1.5;Conclusion;198
5.3.2;Hernia;198
5.3.2.1;Introduction;198
5.3.2.2;Pathophysiology;199
5.3.2.3;Diagnosis;200
5.3.2.4;Treatment;201
5.3.2.5;Conclusion;202
5.3.3;Hydrocele;202
5.3.3.1;Background and Treatment;202
5.3.3.2;Special Consideration;204
5.3.3.3;Conclusion;204
5.3.4;References;204
5.4;11 Testicles: Undescended, Retractile, and Ascended;206
5.4.1;Introduction;206
5.4.2;Embryology;207
5.4.2.1;Testicular Descent;207
5.4.3;Anatomy;207
5.4.4;Definition;207
5.4.5;Epidemiology;208
5.4.6;Consequences of Undescended Testicles;208
5.4.6.1;Infertility;208
5.4.6.2;Neoplasia;209
5.4.6.3;Testicular Torsion;210
5.4.6.4;Hernia;210
5.4.7;Diagnosis;211
5.4.7.1;History and Physical Examination;211
5.4.7.2;Radiological Evaluation;212
5.4.7.3;Hormonal Evaluation;212
5.4.8;Management;213
5.4.8.1;Hormonal Treatment;213
5.4.8.2;Surgical Treatment;213
5.4.8.3;Palpable Testicle;214
5.4.8.4;Nonpalpable Testicle;215
5.4.9;Complications of Orchidopexies;216
5.4.10;Conclusion;216
5.4.11;References;217
5.5;12 Acute Scrotum;219
5.5.1;Embryology and Normal Descent;219
5.5.2;First Rule Out Torsion;219
5.5.3;Taking a Complete History;220
5.5.4;The Physical Exam;221
5.5.5;Torsion of the Spermatic Cord;223
5.5.6;Torsion in the Neonate;227
5.5.7;Torsion of the Testicular Or Epididymal Appendage;228
5.5.8;Epididymitis;230
5.5.9;Trauma;231
5.5.10;Idiopathic Scrotal Oedema;232
5.5.11;Acute Scrotal Hydrocele;232
5.5.12;Henoch-schnlein Purpura;232
5.5.13;Uncommon Etiologies;233
5.5.14;Conclusion;233
5.5.15;References;233
6;Part III: Urinary Tract;235
6.1;13 Hydronephrosis: Prenatal and postnatal;236
6.1.1;Introduction;236
6.1.2;Prenatal Hydronephrosis;237
6.1.2.1;Prenatal Intervention;239
6.1.3;Postnatal Hydronephrosis;241
6.1.3.1;Indications for Surgical Intervention;244
6.1.3.2;Hydronephrosis and Reflux;246
6.1.4;Conclusion;248
6.1.5;References;248
6.2;14 Vesicoureteral Reflux;250
6.2.1;Overview and Epidemiology of Vesicoureteral Reflux;250
6.2.2;Etiology of Reflux;251
6.2.3;Embryology;252
6.2.4;Presentation/symptomatology;252
6.2.5;Diagnosis;252
6.2.6;Grading;254
6.2.7;Other Urologic Considerations with Vur;254
6.2.8;Pregnacy and Vur;254
6.2.9; Treatment Options;255
6.2.10;Medical Management Prophylactic Antibiotics;255
6.2.11;Open Surgical Treatment;256
6.2.11.1;Types of Surgery;256
6.2.11.2;Intravesical Ureteral Reimplantation;257
6.2.11.3;Extravesical Ureteral Reimplantation;259
6.2.12;Laparoscopic Techniques;262
6.2.12.1;Laparoscopic Transvesical Reimplantation;262
6.2.12.2;Laparoscopic Extravesical Reimplantation;263
6.2.13;Cystoscopic Injection;263
6.2.13.1;Injection Material;265
6.2.14;Conclusion;265
6.2.15;References;266
6.3;15 Urinary Tract Obstruction;270
6.3.1;Introduction;271
6.3.2;Hydrocalycosis;272
6.3.3;Infundibulopelvic Dysgenesis;273
6.3.4;Ureteropelvic Junction Obstruction;273
6.3.4.1;Epidemiology and Etiology;273
6.3.4.2;Presentation and Diagnosis;274
6.3.4.3;Management and Complications;275
6.3.5;Preureteral Vena Cava;276
6.3.6;Vascular Obstruction of the Distal Ureter;276
6.3.7;Ureteral Stenosis and Stricture;277
6.3.8;Ureteral Valves;277
6.3.9;Persistent Fetal Folds;277
6.3.10;Ectopic Ureter;277
6.3.10.1;Epidemiology and Etiology;277
6.3.10.2;Presentation and Diagnosis;278
6.3.10.3;Management;279
6.3.11;Ureteral Filling Defects;279
6.3.12;Ureterocele;280
6.3.12.1;Epidemiology and Etiology;280
6.3.12.2;Presentation and Diagnosis;280
6.3.12.3;Management;281
6.3.12.4;Single System Ureteroceles;281
6.3.12.5;Prolapsing Ureteroceles;282
6.3.13;Ureterovesical Junction Obstruction;282
6.3.13.1;Epidemiology and Etiology;282
6.3.13.2;Diagnosis and Management;282
6.3.14;Posterior Urethral Valves;283
6.3.14.1;Epidemiology and Etiology;283
6.3.14.2;Presentation and Diagnosis;283
6.3.14.3;Management;284
6.3.15;Anterior Urethral Valves;284
6.3.16;Congenital Urethral Stricture;285
6.3.17;Urethral Atresia;286
6.3.18;References;286
6.4; 16 Tissue Engineering and Regenerative Medicine Current Concepts;287
6.4.1;An Introduction to Regenerative Medicine and Tissue Engineering Strategies;287
6.4.2;Biomaterials;288
6.4.3;Cells;289
6.4.4;Using Tissue Engineering Techniques to Build Specific Urologic and Genital Structures;292
6.4.5;Urethra;292
6.4.5.1;Bladder;293
6.4.5.1.1;Tissue Expansion for Bladder Augmentation;294
6.4.5.1.2;Seromuscular Grafts and De-epithelialized Bowel Segments;294
6.4.5.1.3;Matrices for Bladder Regeneration;294
6.4.5.1.4;Bladder Replacement Using Tissue Engineering;295
6.4.5.2;Kidney;296
6.4.5.2.1;Ex Vivo Functioning Renal Units;297
6.4.5.3;Creation of Functional Renal Structures In Vivo;297
6.4.6;Genital Tissues;298
6.4.6.1;Reconstruction of Corporal Smooth Muscle;298
6.4.6.2;Engineered Penile Prostheses;299
6.4.6.3;Female Genital Tissues;299
6.4.6.4;Injectable Therapies;300
6.4.7;Conclusion;302
6.4.8;References;302
7;Part IV: Miscellaneous Topics;306
7.1;17 Adolescent Urology;307
7.1.1;Introduction;307
7.1.2;Transitional Care;308
7.1.3;The Kidneys;310
7.1.3.1;Renal Function;310
7.1.3.2;Hypertension;311
7.1.4;The Bladder Or Urinary Reservoir;312
7.1.4.1;Posterior Urethral Valves;313
7.1.4.2;Exstrophy;314
7.1.4.3;Intestinal Urinary Reservoirs;315
7.1.5;Sexuality and Fertility;317
7.1.5.1;Disclosure;317
7.1.5.2;Hypospadias;318
7.1.5.3;Exstrophy Males;318
7.1.5.4;Exstrophy Females;318
7.1.5.5;Posterior Urethral Valves;320
7.1.5.6;Fertility;320
7.1.6;References;321
7.2;18 Laparoscopy in the Pediatric Population;323
7.2.1;Introduction;323
7.2.2;Anesthetic Concerns;324
7.2.3;Laparoscopic Pyeloplasty;324
7.2.4;Laparoscopic Orchiopexy;326
7.2.5;Laparoscopic Renal Ablative Surgery;328
7.2.6;Laparoscopic Lower Urinary Tract Reconstruction;329
7.2.7;Laparoscopic Ureteral Reimplantation;330
7.2.8;Laparoscopic Varicocelectomy;331
7.2.9;Conclusion;333
7.2.10;References;333
7.3;19 Genitourinary Tumors;339
7.3.1;Renal Tumors;340
7.3.1.1;Wilms Tumor;340
7.3.1.2;Other Renal Tumors;343
7.3.2;Adrenal Tumors;344
7.3.2.1;Neuroblastoma;344
7.3.2.2;Other Adrenal Tumors of Childhood;345
7.3.3;Testicular Tumors;346
7.3.3.1;Presentation and Evaluation;346
7.3.3.2;Surgical Approach;347
7.3.3.3;Adjuvant Therapy;347
7.3.3.3.1;Germ Cell Tumors;347
7.3.3.3.2;Stromal Tumors;348
7.3.3.3.3;Gonadoblastoma;349
7.3.4;Rhabodomyosarcoma;349
7.3.4.1;Vaginal/Uterine Rhabdomyosarcoma;350
7.3.4.2;Bladder/Prostate Rhabdomyosarcoma;350
7.3.4.3;Paratesticular Rhabdomyosarcoma;351
7.3.5;References;352
7.4;20 Genitourinary Trauma;355
7.4.1;Introduction;355
7.4.2;Epidemiology;355
7.4.3;Renal Injuries;356
7.4.3.1;Hemodynamic Stability;356
7.4.3.2;Congenital Anomalies;356
7.4.3.3;Hematuria;357
7.4.4;Evaluation and Imaging;357
7.4.5;Radiographic Imaging;358
7.4.5.1;CT Scan;358
7.4.5.2;Ultrasound;358
7.4.5.3;Ivp;359
7.4.5.4;Retrograde Pyelogram;359
7.4.6;Management of Renal Trauma;359
7.4.7;Surgical Management of Renal Trauma;360
7.4.7.1;Laparotomy;360
7.4.7.2;Endoscopic and Radiologic Intervention;360
7.4.8;Upj Disruption;361
7.4.9;Long-term Complications of Renal Trauma;361
7.4.10;Ureteral Injury;362
7.4.11;Bladder Injuries;363
7.4.11.1;Rupture of a Bladder Augmentation;363
7.4.12;Imaging;363
7.4.13;Treatment;364
7.4.14;Urethral Injury;364
7.4.15;Diagnosis;365
7.4.16;Management;365
7.4.17;Genital Injuries;366
7.4.17.1;Scrotal Injury;367
7.4.18;References;367
8;Subject Index;372