By Prasad P. Godbole, John P. Gearhart, Duncan T. Wilcox
Potent problem-solving strategy utilizing instances truly encountered in scientific perform!
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Extra info for Clinical Problems in Pediatric Urology
J Urol. 1997;157(6):2295–7. 24 Case 2 CASE 2 An 11-year-old boy presents with new onset of day and nighttime wetting and two symptomatic urinary tract infections over the past 3 months. He was antenatally diagnosed to have bilateral hydronephrosis, and a postnatal diagnosis of posterior urethral valves with left vesicoureteric reﬂux and chronic renal failure was conﬁrmed. He underwent resection of the posterior urethral valves, circumcision, and a left orchidopexy. Post resection of the valves, his renal function was stable and was monitored regularly by the nephrology team.
Hinman’s syndrome. Children with Hinman’s syndrome clinically mimic a neuropathic bladder, with no neurological abnormality that can be found on investigations. Some believe that this may be a result of persistence of the transitional phase of gaining bladder control during toilet training. Like detrusor hyperreﬂexia, this condition is characterized by urgency, urge incontinence, and daytime and/or nocturnal enuresis. Moreover, these children also suffer from recurrent urinary tract infections and have irregular bowel movements with fecal soiling.
Diverticula are very unusual after urethral plate tubularization, but do occur with both onlay and tubularized prepucial ﬂaps. Care should be taken to avoid oversizing these ﬂaps, but diverticulum formation can still occur – presumably from the distensability of prepucial skin and the irregular lumen ﬂaps created within the neourethra. Meatal stenosis can result from overzealous closure of the distal aspect of the neourethra or postoperative scarring. Strictures are considered a problem with the circular anastomosis of tubularized ﬂaps to the native meatus, which accordingly should be widely spatulated.
Clinical Problems in Pediatric Urology by Prasad P. Godbole, John P. Gearhart, Duncan T. Wilcox