ESPU Meeting on Friday 10, June 2022, 17:05 - 17:40
Raimondo Maximilian CERVELLIONE
Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM
The advantage of external corpora rotation compared to the previous proposed internal rotation described with the Cantwel-Ransley have previously been discussed at the ESPU. Enrique Jaureguizar and Margaret Baka-Ostrowska demonstrated clearly that the correction of the chordee in epispadias should be done with the physiological external rotation that normally develops during the maturation of the embryo. The problem has been so far that to perform an external corpora rotation, total penile disassembly has been necessary. We know that total penile disassembly is frequently associated with glandular and corporal loss and for this reason it is not anymore recommended. For this reason, many paediatric urologists perform still internal corpora rotation to move the urethra ventrally to the corpora during epispadias repair, but unfortunately internal corpora rotation does not permanently resolve the dorsal chordee.
Antonio MACEDO JR
Federal University of São Paulo, Pediatrics / Pediatric Urology, São-Paulo, BRAZIL
Distal hypospadias represent the most frequent presentation of hypospadias . The TIP repair is regarded as the prefered procedure by most pediatric urologists but the efficacy of this technique has been increasingly questioned. We propose the GUD technique (glandular urethral disassembly), an aggressive partial glandar disassembly in association with minor urethral mobilization to treat distal hypospadia forms. The combination of these two steps avoid the need for urethroplasty and suture lines, minimizing the risk for fistulas. The aggressive glans mobilization and disconnection from the corpora offer great mobility and capability of refurbishing it. We also noticed that reconfiguration of glans enabled at the end a much more conical aspect. The merit of the procedure is the combination of minor mobilization of the urethra with down adjustment and rotation of the glans medially.
Sadaf ABA UMER KODWAVWALA
Sindh Institute of Urology & Transplantation, Philip G. Ransley Department of Paediatric Urology, Karachi, PAKISTAN
JUGAAD is a creative approach to problem-solving. It is the use of skill to solve a problem with limited resources. Here presenting JUGAADs/ Tips to deal with a few working problems in paediatric urology.
MATERIAL AND METHODS
Few working problems like Fractured /broken Pigtail catheter (external) end, unavailability of Drainage bag connector and neonates minipaed suprapubic catheter sets are being faced especially in developing countries and rural settings. Tips to solve these problems are presented.
1. Non-availability of “Drainage bag connector”
Pigtail catheter (PCN) and feeding tube as ureteric splints need “drainage bag connectors” to connect with urine bag. Sometimes connectors are not freely available. One can use a 3/5 cc syringe as an alternative. Take out the plunger and needle from the syringe. Attach the needle end of the syringe with the Pigtail catheter or tube and insert the urine bag on the other side of the syringe. The syringe will work as a drainage bag connector.
2. Fractured/broken Pigtail catheter, nelaton catheter/feeding tube.
Take the feeding tube/nelaton tube size two Fr. larger than the broken catheter size. Cut the tip end of the new tube and slip it over the fractured tube. For eg. for a fractured 6 Fr. Pigtail catheter, take an 8 Fr. Feeding tube. It will work perfectly as a normal tube.
3. Unavailability of neonates minipaed suprapubic drainage set.
Use 14 Fr. IV cannula to puncture urinary bladder suprapubically. Take out the stylet, and leave the cannula in place. Pass 4 Fr. Feeding tube through a cannula into the urinary bladder and remove the cannula. Secure tube in place as suprapubic drainage catheter.
Constraints of resources should not be a handicap to better management. JUGAAD is an important way out in such situations and holds an important tool for developing countries.
Sindh Institute of Urology & Transplantation, Paediatric Urology, Karachi, PAKISTAN
We report a case of an 8 year old boy with history of trauma leading to transection of ureter at the pelviureteric junction (PUJ). Patient had developed urine leak, peritonitis and had undergone laparotomy and peritoneal drain placement elsewhere.
After optimizing, the patient was explored with a flank incision for possible restoration of PUJ anatomy / anastomosis. On exploration the kidney capsule was found to be severely adherent to the surrounding tissue and thus when the kidney was mobilized it became denuded of its capsule. The ureteric length proved to be too short for a direct pyeloureteric anastomosis and therefore an ureterocalicostomy was planned to compensate for the ureteric length. However, the capsule denuded renal tissue would not hold the fixation / everting sutures of the opened calyceal margins. The use of appendix or bowel would have required a more extensive surgery with a possible failure considering the history of peritonitis and associated bowel adhesions.
Though difficult, a portion of omentum with intact blood supply was used to support the renal tissue around the calyceal opening and to fix the margins in order to prevent retraction. Finally, the splayed open ureter was anastomosed to the calicostomy over a JJ stent. The stent was removed about 12 weeks later. A good drainage of urine from the kidney was observed through the uretero-calicolostomy with good renal function on the follow up scan 3months after stent removal.
University of Chicago Medicine, Paed Urology, Chicago, USA
Appendicovesicostomy introduced by, Dr. Paul Mitrofanoff has changed the paradigm in the neurogenic bladder management in pediatric and adult population. The maturation of the stoma at skin level to either at umbilicus or right iliac fossa has issue of stomal stenosis to the extent of almost more than 15% of this population. Often the length is not adequate in children with abdominal obesity – to combat these problems we have been using the part of cecum flap to harvest along with appendix in continuity. Over last five years more than 25 cases have been done and we have seen the stomal stenosis, revision rates are much less when compared with traditional technique. The additional length has also been helpful to allow the stoma to be matured to umbilicus without tension.