Practical Pediatric Urology: An Evidence-Based Approach

Foreword
Preface
Contents
1: The Evolution of Evidence Based Clinical Medicine
1.1 Introduction
1.2 The Evolution of Evidence Based Medicine
1.3 A Methodological Approach to Evidence Based Medicine
1.3.1 Reviewing the Evidence
1.3.2 Categorising the Quality of Evidence
1.3.3 Grading
1.4 Challenges to Evidence Based Medicine
1.5 Conclusion
References
2: Clinical Practice Guidelines: Choosing Wisely
2.1 Introduction
2.1.1 Clinical Guideline Development
2.2 Identifying an Area in Which to Develop Guidelines
2.3 Establish a Core Guideline Developmental Group
2.4 Agree on a Guideline Appraisal Process
2.5 Assessing Existing Guidelines
2.6 Decision to Adapt or Adopt a Guideline
2.7 External Peer Review
2.7.1 Endorsement and Ratification at Local Level
2.8 Local Adoption
2.9 Conformity to Guideline Adherence
2.10 Conclusion
Appendix: Domains of AGREE II Appraisal Instrument
3: Antibiotic Stewardship in Pediatric Urology: Editorial Comment
3.1 Introduction
3.2 Antenatal Hydronephrosis
3.3 Vesicoureteral Reflux
3.4 Compliance
3.5 Choice of Antibiotics
3.6 Conclusion
Suggested Further Reading
4: Pain Management in Paediatric Urology
4.1 Introduction
4.2 Assessment of Pain
4.3 Analgesia
4.3.1 Paracetamol (Acetaminophen)
4.3.2 Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
4.3.3 Opioids
4.3.4 Local Anaesthetics
4.4 Types of Blocks Performed
4.4.1 Penile Block
4.4.2 Caudal Block
4.4.3 Ilio Inguinal Block
4.4.4 Transversus Abdominus Plane (TAP) Block
4.4.5 Paravertebral Blocks
4.4.6 Epidural Block
4.5 Types of Surgery
4.5.1 Cystoscopy
4.5.2 Circumcision
4.5.3 Orchidopexy
4.5.4 Hypospadias Repair
4.5.5 Pyeloplasty
4.5.6 Nephrectomy
4.6 Ureteric Reimplantation
4.7 Repair of Bladder Extrophy
4.8 Summary
References
5: Antenatal Urology
5.1 Scenario 1
5.2 Answer 1
5.3 Question 2
5.4 Answer 2
5.5 Question 3
5.6 Answer 3
5.7 Scenario 2
5.8 Question 1
5.9 Answer 1
5.10 Question 2
5.11 Answer 2
5.12 Question 3
5.13 Answer 3
5.14 Scenario 3
5.15 Question 1
5.16 Answer 1
5.17 Question 2
5.18 Answer 2
5.19 Question 3
5.20 Answer 3
5.21 Question 4
5.22 Answer 4
5.23 Scenario 4
5.24 Question 1
5.25 Answer 1
5.26 Question 2
5.27 Answer 2
5.27.1 Prenatal MRI of Cloacal Exstrophy
5.28 Answer 3
5.29 Scenario 5
5.30 Question 1
5.31 Answer 1
5.32 Question 2
5.33 Answer 2
5.34 Question 3
5.35 Answer 3
References
6: Office Paediatric Urology
6.1 Introduction
6.2 Undescended Testicles
6.3 History and Physical Examination
6.4 Summary
6.5 Hernia/Hydrocele
6.6 History and Physical Examination
6.7 Summary
6.8 Phimosis
6.9 History and Physical Examination
6.9.1 Physiologic Phimosis
6.9.1.1 History
6.9.1.2 Physical Examination
6.9.1.3 Management
6.10 Pathologic Phimosis
6.10.1 History
6.10.2 Physical Examination
6.10.3 Management
6.11 Summary
6.12 Concealed Penis
6.13 History and Physical Examination
6.14 Summary
6.15 Routine Newborn Circumcision Contraindications
6.15.1 Hypospadias
6.15.2 Webbed or Buried Penis
6.15.3 Penile Curvature/Torque
6.16 Circumcision Complications
6.16.1 Preputial Adhesions
6.16.2 Buried/Trapped Penis
6.16.3 Meatal Stenosis
6.17 Bladder and Bowel Dysfunction
6.18 History and Physical Examination
6.19 Management
6.20 Summary
6.21 Antenatal Hydronephrosis
6.22 Epidemiology
6.23 History and Physical Examination
6.24 Diagnosis
6.24.1 Antenatal Diagnosis
6.24.2 Postnatal Diagnosis
6.25 Investigations and Management
6.25.1 Based on Current Literature and Expert Opinion [22–25, 28–32] We Recommend the Above
6.26 Surgical Indications
6.27 Summary
6.28 Vesicoureteral Reflux and Urinary Tract Infection
6.29 Initial Diagnosis and Evaluation of a Child with VUR
6.29.1 History and Physical Examination
6.30 Investigations
6.31 Circumcision
6.32 Continuous Antibiotic Prophylaxis
6.32.1 Hematuria
6.33 History and Physical Examination
6.34 Investigations
6.35 Summary
References
7: Neonatal Urological Emergencies
7.1 Scenario 1
7.2 Question 1
7.3 Answer 1
7.4 Question 2
7.5 Answer 2
7.6 Question 3
7.7 Answer 3
7.8 Scenario 2
7.9 Thickened Bladder on Ultrasound
7.9.1 Question 1
7.9.2 Answer 1
7.9.3 Question 2
7.9.4 Answer 2
7.9.5 Question 3
7.9.6 Answer 3
7.10 Scenario 3
7.11 Question 1
7.12 Answer 1
7.13 Question 2
7.14 Answer 2
7.15 Question 3
7.16 Answer 3
7.17 Question 3
7.18 Answer 3
7.19 Scenario 4
7.20 Question 1
7.21 Answer 1
7.22 Question 2
7.23 Answer 2
7.24 Question 3
7.25 Answer 3
7.26 Question 4
7.27 Answer 4
7.28 Scenario 5
7.29 Question 1
7.30 Answer 1
7.31 Question 2
7.32 Answer 2
7.33 Question 3
7.34 Answer 3
7.35 Answer 4
References
8: Urinary Tract Infection in Infants and Children
8.1 Scenario 1
8.2 Question 1
8.3 Answer 1
8.4 Question 2
8.5 Answer 2
8.6 Question 3
8.7 Answer 3
8.8 Scenario 2
8.9 Question 1
8.10 Answer 1
8.11 Question 2
8.12 Answer 2
8.13 Question 3
8.14 Answer 3
8.15 Scenario 3
8.16 Question 1
8.17 Answer 1
8.18 Question 2
8.19 Answer 1
8.20 Question 3
8.21 Answer 3
8.22 Scenario 4
8.23 Question 1
8.24 Answer 1a
8.25 Answer 1b
8.26 Answer 1c
8.27 Question 2
8.28 Answer 2
Suggested Further Reading
9: Upper Urinary Tract Obstruction
9.1 Case 1
9.1.1 Discussion
9.2 Case 2
9.2.1 Discussion
9.3 Case 3
9.3.1 Discussion
9.4 Case 4
9.4.1 Discussion
9.5 Case 5
9.5.1 Discussion
9.6 A. VUJO
9.6.1 Case 6
9.7 Case 7
9.7.1 Discussion for Cases 6 and 7
9.8 Case 8
9.8.1 Discussion
9.9 Case 9
9.9.1 Discussion
9.10 Case 10
9.10.1 Discussion
9.11 B. Duplex Kidney
9.11.1 Case 11
9.11.2 Discussion
9.12 Case 12
9.12.1 Discussion
9.13 Case 13
9.13.1 Discussion
9.14 Case 14
9.15 Case 15
9.15.1 Discussion for Cases 14 and 15
9.16 Case 16
9.16.1 Discussion
9.17 Case 17
9.17.1 Discussion
9.18 Case 18
9.18.1 Discussion
9.19 Case 19
9.19.1 Discussion
9.20 E. VUR
9.20.1 Case 20
9.20.2 Discussion
9.21 Case 21
9.22 Case 22
9.22.1 Discussion for Cases 21 and 22
9.23 Case 23
9.23.1 Discussion
9.24 Case 24
9.24.1 Discussion
9.25 Case 25
9.25.1 Discussion
9.26 Case 26
9.26.1 Discussion
9.27 F. Multicystic Dysplastic Kidney
9.27.1 Case 27
9.27.2 Discussion
References
10: Congenital Upper Tract Anomalies: Duplication, Cystic Renal Dysplasia, Multicystic Dysplastic Kidney
10.1 Introduction
10.2 Renal Duplication
10.2.1 Scenario 1
10.2.1.1 Question 1
10.2.1.2 Answer 1
Embrylogy and Anatomy
Vesicoureteric Reflux in Duplex Kidneys
10.2.1.3 Question 2
10.2.1.4 Answer 2
10.2.1.5 Question 3
10.2.1.6 Answer 3
10.2.1.7 Question 4
10.2.1.8 Answer 4
Ectopic Ureter in Duplex Kidneys
10.2.1.9 Question 5
10.2.1.10 Answer 5
10.2.1.11 Question 6
10.2.1.12 Answer 6
Ureterocele in Duplex Kidneys
10.3 Cystic Renal Dysplasia
10.3.1 Overview
10.3.2 Scenario 2
10.3.2.1 Question 1
10.3.2.2 Answer 1
Simple Renal Cysts
10.3.2.3 Question 2
10.3.2.4 Answer 2
Multilocular Cyst (Cystic Nephroma)
Acquired Cystic Disease
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Autosomal Recessive Polycystic Kidney Disease (ARPKD)
Syndromes with Renal Cysts
10.3.3 Scenario 3
10.3.3.1 Question 1
10.3.3.2 Answer 1
10.3.3.3 Question 2
10.3.3.4 Answer 2
10.3.3.5 Question 3
10.3.3.6 Answer 3
10.3.3.7 Question 4
10.3.3.8 Answer 4
Overview
MCKD Management
References
11: Practical Pediatric Urology: An Evidence Based Approach—Vesicoureteral Reflux and Bladder Diverticulum
11.1 Introduction
11.1.1 Continuous Antibiotic Prophylaxis
11.1.2 Circumcision
References
12: Lower Urinary Tract Obstruction
12.1 Discussion
12.2 Discussion: Valve Bladder Syndrome
12.3 Discussion
References
13: The Lower Urinary Tract
13.1 The Lower Urinary Tract
13.1.1 Case 1
13.1.2 Case 2
13.1.3 Case 3
13.2 Urethral Duplication
13.2.1 Case 4
13.2.2 Case 5
13.3 Enlarged Prostatic Utricle
13.3.1 Case 6
13.4 Cowper’s Gland Cysts and Syringoceles
13.4.1 Case 7
13.4.2 Case 8
13.5 Verumontanum Polyp
References
14: Hypospadias
14.1 Glanular Hypospadias
14.2 Proximal Hypospadias
14.3 DSD (5α Reductase Deficiency)
14.4 Midshaft Hypospadias
14.5 Mega-Meatus Intact Prepuce (MIP)
14.6 Failed Hypospadias Repair
References
15: Bladder Exstrophy
15.1 Case 1
15.1.1 Classic Strategy
15.1.2 Complete Primary Repair of Exstrophy
15.1.3 The Kelly Procedure
15.1.4 The Delayed Bladder Closure Approach
15.1.5 The Nantes Approach
15.2 Case 2
15.3 Case 3
References
16: Genitalia: Undescended Testis, Acute Scrotum, Buried Penis
16.1 Genitalia: Undescended Testis, Non-Palpable (2 Figures Required)
16.2 Genitalia: Undescended Testis, Palpable
16.3 Genitalia: Undescended Testis, with Hernia
16.4 Acute Scrotum—Appendix Testes
16.5 Acute Scrotum-Nonvascular—Epididymo-Orchitis
16.6 Acute Scrotum-Vascular—Testicular Torsion
16.7 Buried Penis-Acquired
16.8 Buried Penis—Congenital Megaprepuce
16.8.1 Scenario 1
16.8.2 Scenario 2
16.8.3 Scenario 3
16.8.4 Scenario 5
16.8.5 Scenario 6
16.8.6 Scenario 7-Acquired
16.8.7 Scenario 8-Congenital
References
17: Inguinal Hernia, Hydrocele, Varicocele, Spermatocele and Abdomino-Scrotal Hydrocele
17.1 Inguinal Hernia
17.2 Hydrocele
17.3 Varicocele
17.4 Abdomino-Scrotal Hydrocele
17.5 Spermatocele
References
18: Urolithiasis
18.1 Preamble
18.2 Imaging
18.2.1 Ultrasonography (USG)
18.2.2 X-Ray
18.2.3 Intravenous Urogram (IVU)
18.2.4 Non-Contrast Computed Tomography (NCCT)
18.2.5 Contrast Computed Tomography (Urogram)
18.2.6 Dimercaptosuccinic acid (DMSA) Scintigraphy
18.3 Treatment Modalities
18.3.1 Open Surgery
18.3.2 Minimally Invasive Surgery (MIS)
18.4 Renal Stones
18.4.1 Extra Corporeal Shockwave Lithotripsy (ESWL)
18.4.2 Retrograde Intra Renal Surgery (RIRS)
18.4.3 Percutaneous Nephrolithotomy (PCNL)
18.4.4 Endoscopic Combined Intra Renal Surgery (ECIRS)
18.4.5 Laparoscopic/Robotic Surgery
18.5 Ureteric Stones
18.6 Vesical Stones
18.7 Endoscopic Intra Corporeal Lithotripsy (EIL) Disintegration Technologies
18.7.1 Electro Hydraulic Lithotripsy (EHL)
18.7.2 Ballistic Lithotripsy (Pneumatic Lithoclast)
18.7.3 Ultrasonic Lithotripsy
18.7.4 Combination Devices
18.7.5 Holmium YAG Laser (Ho:YAG)
18.8 Case 1
18.9 Case 2
18.10 Case 3
18.11 Case 4
18.12 Case 5
18.13 Case 6
18.14 Case 7
References
19: Urologic Tumors
19.1 Part 1: Kidney Tumors
19.1.1 Wilms Tumor
19.1.2 Renal Cell Carcinoma
19.1.3 Other Pediatric Renal Tumors
19.1.3.1 Clear Cell Sarcoma of the Kidney
19.1.3.2 Rhabdoid Tumor of the Kidney
19.1.3.3 Congenital Mesoblastic Nephroma
19.1.3.4 Renal Medullary Carcinoma
19.1.3.5 Angiomyolipoma
19.1.3.6 MCN/CPDN/WT Spectrum
19.2 Part 2: Testis Tumors
19.2.1 Introduction
19.2.2 Evaluation
19.2.3 Diagnosis and Treatment
19.2.4 Prognosis and Surveillance
19.3 Part 3: Rhabdomyosarcoma
19.3.1 Introduction
19.3.2 Diagnosis and Evaluation
19.3.3 Treatment
19.3.4 Prognosis
19.4 Part 4: Bladder Tumors
19.4.1 Urothelial Cell Carcinoma
19.4.1.1 Introduction
19.4.1.2 Diagnosis and Evaluation
19.4.1.3 Treatment and Surveillance
19.4.2 Non-Urothelial Bladder Tumors
References
Kidney Tumors
Testes Tumors
Rhabdomyosarcoma
Bladder Tumors
20: Pediatric Urologic Trauma
20.1 Introduction
20.2 Scenario 1
20.3 Discussion of Scenario 1
20.4 Scenario 2
20.5 Discussion
20.6 Scenario 3
20.7 Urethral Injury
20.8 Discussion
20.9 Discussion
20.9.1 Genital Trauma
20.10 Discussion
References
21: Functional Voiding Disorders
21.1 Case 1
21.2 Case 2
21.3 Case 3
21.4 Case 4
21.5 Algorithm for Diagnostic Evaluation and Diagnosis of Children with Lower Urinary Tract Symptoms
Suggested Further Reading
22: Neurogenic Bladder
22.1 Introduction and Definition
22.2 Etiology
22.3 Pathophysiology
22.4 Prenatal Intervention
22.5 Newborn Evaluation and Management
22.6 Video Urodynamics
22.7 Tethered Spinal Cord
22.8 Appendicovesicostomy
22.9 Nocturnal Catheterization
22.10 Vesicoureteral Reflux
22.11 Continence
22.12 Bladder Augmentation
22.13 Transition to Puberty in Adulthood
22.14 Sexuality and Reproductive Health
22.15 Conclusions
References
23: Disorders of Sex Development
23.1 Scenario 1
23.1.1 Picture of CAH
23.1.1.1 Question 1
23.1.1.2 Answer 1
23.1.1.3 Question 2
23.1.1.4 Answer 2
23.1.1.5 Question 3
23.1.1.6 Answer 3
23.1.1.7 Question 4
23.1.1.8 Answer 4
Immediate
Subsequent
23.1.2 Further Surgical Management
23.1.2.1 Surgical Controversies in CAH Surgery and DSD Surgery in General
23.1.2.2 Surgical Management for the Vagina
23.1.3 Scenario 2
23.1.3.1 Question 1
23.1.3.2 Answer 1
23.1.3.3 Question 2
23.1.3.4 Answer 2
23.1.3.5 Question 3
23.1.3.6 Answer 3
23.1.3.7 Question 4
23.1.3.8 Answer 4
23.1.4 Scenario 3
23.1.4.1 Question 1
23.1.4.2 Answer 1
23.1.4.3 Question 2
23.1.4.4 Question 3
23.1.4.5 Answer 3
23.1.5 Scenario 4
23.1.5.1 Question 1
23.1.5.2 Answer 1
23.1.5.3 Question 2
23.1.5.4 Question 3
23.1.5.5 Answer 3
23.1.5.6 Question 4
23.1.5.7 Answer 4
Suggested Further Reading
24: Pediatric and Adolescent Gynecology
24.1 Pediatric Gynecology
24.2 Vulvovaginitis
24.3 Labial Adhesions
24.4 Lichen Sclerosus
24.5 Adolescent Gynecology
24.6 Labial Hypertrophy
24.7 Non Sexual Genital Ulcers
24.8 Hymenal Anomalies
24.9 Longitudinal Vaginal Septum
24.10 Obstructed Hemi-Vagina and Ipsilateral Renal Anomalies (OHVIRA)
24.11 Vaginal Agenesis
References
Index