Paediatric urology

Paediatric urology is a subject that covers the urological aspects of care in children, some of which are seen also in adults, but may have specific diagnostic methods and treatments that are quite different. Additionally, it covers a range of congenital anomalies either on their own or in combination with a spectrum of disorders that need more complex management available at only specialized centres. For the purposes of a broad and basic understanding of the subject, this article will cover relevant topics and up-to-date guidelines.     

Percutaneous cystostomy drainage for early removing urethral catheter in robotic-assisted laparoscopic radical prostatectomy: Improving on patients' discomfort

ObjectiveUrethral catheterization is often a major source of discomfort and pain to a patient after a surgical procedure. To better understand the safety and feasibility of the early removal of urethral Foley catheter after robotic-assisted laparoscopic radical prostatectomy by using percutaneous cystostomy drainage, we collected the related data and present our experience.Patients and methodsThis study involved 20 patients. In the study group (10 patients), we used the percutaneous cystostomy device (PCD) and an 18 French urethral catheter together. The urethral catheter was removed at postoperative day (POD) 3 and the PCD was removed at POD 7. In the control group (10 patients), they had standard urethral catheterization with an 18 French catheter and the catheter was removed at POD 7. Demographic and outcome data were measured and analyzed. Urethral pain was recorded using the visual analog scale.ResultsThe two groups were comparable in terms of age, serum prostate specific antigen level, body mass index, clinical tumor stage, surgical duration, estimated blood loss, and surgical times. The study group had significantly less penile pain in POD 3 and POD 7 (mean visual analog scale: 0.9 vs. 2.2, p < 0.001 at POD 3; 0.1 vs. 1.4, p = 0.002 at POD 7). All patients had good urinary continence within 30 days and no urethra stricture was found during the follow up period.ConclusionThe use of a percutaneous cystostomy device is feasible and safe for the early removal of urethral Foley catheter in robotic-assisted laparoscopic radical prostatectomy to decrease penile pain and patient discomfort.     

Staged urethroplasty in the management of complex anterior urethral stricture disease

Staged buccal mucosa graft urethroplasty has emerged as a reliable procedure for difficult anterior urethral strictures not amenable to one-stage graft or flap reconstruction. It has primarily been used for strictures and/or fistulae occurring after previous surgery for hypospadias or those related to lichen sclerosus (LS). Success rates in these patient populations have improved when compared to earlier techniques. However, prior studies have demonstrated a number of patients requiring more than two procedures to complete the reconstruction, as well as some who have been content with their voiding pattern after the first operation and therefore elected to forego second stage tubularization. In this setting, we have reviewed the surgical technique and summarized previously published work. There may be an opportunity to complete more of these repairs in two operations using additional oral mucosa at the time of tubularization.