VoR Cowsec Kiguerpys — (Bend from Mestente atwen!) Eaten aaa Congenital Q Ne Speers eg Avuied < "a" « lateogenic, te ydeate se Budde Pressure! Oe. Qovinest aie . Blader cotter ober Avo nen Sot unig til bates « Newevasiaa © SFeamet ten Gublste Carre (Nan -eemplamt Z Breet 2 Bowel M: pee rary = avoid) constipang? eurovasiaal De efrcina - Treat Encoperesit > Bierhcolum 3 Soppresavie. Omri pronce = Unelerccole- : ue okeervatin eitnerh antibrties 5 fants cholenees , Spasmoly tee Tome fe 5 : G g MWianc Lean am ep. MM ir 20K, 208: [Surveitias (Cuite pr Maneqenent) : z pelume Colture » Dianna Aawie 1 O eee syns oer hat * Bua2der tall tovckonf Daeg Gents thereepyer = Divennea Eee ane’ Cycle che- Usa Gren peat ord Vel € -12- ean : 3-\wv Pov eo meni! 4 Penal Som — 6-12" Cses S veug — Yeon 4 Renal Seon" 6 Recerd Eau yen Dee a * ee en $ estes Sa @ Bets —Neany if ae Bet tua Neprepry tects 2 4: canner tf Akolenic o. Sepsemne ne Clef le gyrate fay =F men aefee : Operative Management \ Caosetic (etina) ss eral « Sere, an Silent Saw Fronatin Wacical Detysorra c fs f- ‘Exha Vasical Det key Sure. Spotances Cesiner scope ejection A Iupmavaci en oe ecucenr etonepranig Astecitewont i dents = Coheine + lead tame eses. ae : hay ~ bok = Glen Anderser Je Alermativer te Be-vapiantahon Orearedin Wsiostnt PERE peer n Scanned with CamScanner& eR tent 7 Neplee use kreotne rams eerern ureter y L me <4. tt r- Recurrent UTI a Me fey € Nema Otney feroney. Cees Apvanices Endeseapic Cennplautaren CAperoseepic “ cbetic ps oe Loeqeey [apieations Qe Agsouore + i Breatetoret Rictoneyrhritis a Proquessvig? Renal Satin Paddnts Qeenigomens} ett 3. An Associaled ~OVT atone ; Relatives te Gmde wily WR Ae Peistant reper Deeps Med ters? CRcy ond Bus) Be Lack +f Renal Gree 4. Moinpe 3H Alleges Hat Vedude we te Prpny aus SF. Deswe be terminals Ab Proply tenis a Parent} Ruear er Physician e: Medical oven -eompAiaiee + S teaatener Politame ‘ de om? Datempeten™ Framer uw Pomeneuce oe UseterRe 4. Creating oy gobmoasal +2 : ancl a pormel 1 RewnplanhZ] acter diameter” Be Prue good detreset @a + Avo: Co eters, kup eur cae 72 5 OE moviliaah™ 4. Cyeating Pumoel fixe? en ef owl ~ y € Resenatn of B19 BoP E IMPLANTATION Comocations fF Comeucatin® en sonte) 4 Biecduig om Rete peritores! spe Dns mel (tense Ae sngectnan - Uroeeps* 9 Giese Hematet _ p_ Wetatienre, Edam | Unereral ouctruchon Reeranent ~ Weteral Edema, intra tucekral Blood ote Mucous , Bladder ¢ pas cease Bladder tHematama. 084 vee] Ive | Reval Sean Mest Pesobe | Taw’ Spentemesty Weksal Slentwy Alor Cecolwuyy) &Pontamenct creel Nephi mete ere meld Sknstis) Pe "Cy Pear Remmplants Qeot, ©. Antuna Bin, 1 6. Périctent|Teansrent Contrataterl “anvient —E2ana? Scanned with CamScannerQ Poy: Tenatal “Momagement Ff se | Dre naka) OSG avg : male fetes, Thickened nan emp, ladder 28 pyerenepmecis 2 Powe Oa LL Conside Percible PLY Otner Vf Ga Se omer Molt Oiceip lus. S Team | eqonadvomnis norma, Ameen: / \ eye oe Froud e 1 —— No Treatment Teremincrtin i. Consider wnatore, ( Tem v Mas Dame: a t . Fetal ae \ Electely Les 2 Aceuxale Z \ Flo Powe Fumctrin Geo Bormeitaen L Considev - Fetal Vacizo Cant dened Pannen I Tear net oe enki ea CARE CENTRES CO Neenatal Weatmenr Scanned with CamScannerTABLE 55-5 Breakthrough UTI Management According to the 2010 American Urological Association Guidelines Clinical Scenario Recommendation (R)/ Option (O) Symptomatic BT-UT] Patient on CAP with febrile BT-UTI Patient on CAP with single febrile BT-UTI without evidence of existing or new renal cortical abnormalities Patient not on CAP with febrile UTI Patient not on CAP with afebrile UTI All patients with BT-UTI R: Change of therapy guided by scenario R: Consider open or endoscopic surgical intervention O: Change to alternative antibiotics is an option before surgical intervention R: Initiation of CAP R: Initiation of CAP O: Open or endoscopic surgical intervention BT, breakthrough; CAP, continuous antibiotic prophylaxis. Adapted from Peters CA, Skoog SJ, Arant BS Jr, et al. Summary of the AUA guideline on management of primary vesicoureteral reflux in children. J Urol 2010;184:1134. Scanned with CamScannerTM SECTION VI. Usorocy SUBTRIGONAL, "NIECTION Urabe dose Urterl axonass Detusor Detusor @ sure ® cosze Featon ste € EXTRAVESICAL AOVANCENED DETRUSORRHAPHY ott cose Urea! dose Detusor Urstol dese 4 dlosue ue Ustoral srasonese PAQUIN FIGURE 55-11 = Conceptual comparison of techniques to correct reflux. A common theme is the achievement of a long length of intravesical ureter based on a strong detrusor floor and covered with compressible urothelium. TABLE 55:6 Specific Advantages and Disadvantages of Commonly Performed Antireflux Procedures Procedure ‘Advantages Disadvantagos ‘Subtrigonal injection Endoscopic procedure ‘Material injected: Teflon—migration, granuloma formation Collagen—uncertain durability Extravesical detrusorrhaphy Bladder never opened No hematuria No ureteral anastomosis ‘Minimal bladder spasms Endoscopically accessible ureteral orifices ‘Advancoment ‘Avoids complications of nochiatus formation in ‘Leadbettar-Politano reimplantation Cohen (transtrigonal) Transtrigonal: difficult to access ‘ureter endoscopically Glenn-Anderson GlennAnderson: limited length of tunnel achievable Huteh ‘No ureteral anastomosis Good alternative with large associated congenital diverticulum Leadbetter-Politano Excellent ureteral tunnel dimensions with endoscopically Risk of ureteral obstruction ccessible ureteral orifices Risk of sigmoid colon injury with left reimplantation Paquin Versatility, extremely useful during complex. ‘econsifuctive procedures: Scanned with CamScannerSSS Leer: lees ™ re = obsiveenen Ayes cern ESS tn ae a pee oe a Reve! Kumetion Cotawecss Pave Vaiatiny — nclenpgy Tome f oan ate ee SS a _ ‘ue ‘ seem) her fects es, Sate SO nha, Stee Ocu Resecminet ‘sane Ponin L227 tena APU ein Ses Dias lowe rae 8 mmossn Qf Netkicdum “Vor uct Cdepicienr Speniyiaun L umant Jevnplembanin oer a Chahine Vasrasr Diverten, ie ef pene ro UE Rabe SIA Cpe “Femporat > va Fanpat & 'Diverticols ) Yecenstruaionr Gane with prune-belly syndrome, and they ate often then assoc with other clinical problems. The philosophy of teste Chsenerst) - Canene Tene, Me to Pawn Bey Sepdremen erat v Blasdey a) Dafficet’) Naive theme Chest 2 Scanned with CamScannerTHe LeetEeaL DoPucations = AurotomaL Beminantt Compete — xPney & > Unetert that dras Seperately into Incomplete — Haney é > Uneter teat Unvented YC A= Siggle plewis am? Btmd ent = one Twile of bifid Uwe! or belas Qlaader We sh a Unik primal to Claddey proximal aweter that Bi (funcntes © drain ecpenateey fer net ramming « perhin @f Penal Pevacceyymn Incomplete. duplization ee nue comwnen trevemantn « Gaeag, Roy premasic . cae Fan we te pee ee home ee i 1 puerded of Pevittalen at siti oF ffosion of uuelend Fon Vee oO wigel, 7 . wis 15 Ocfficolt joused Pet ex. els t ageee fo ckets Tented chccerdip) en Punch vip0e4 4 Stan verona Noe ~ Pa Protect Qime Cemal Seioneperet Coe praareee x Conve ‘ 2 es . saNeeh™ oan ages Drawn a eee fy L Pani¥eA tower 3 Goln Pate Nieplwr - trees vege “f So seit oemtes + 4 - Duma, onitial Draw comes ik shas arable Oe PTET ile Cun) ein sh eles awaitanesss Sa Rewind L Sharp vievense (Gielme sfeores “came of apgect mecity Ol Soggest Yee Pheneman het Lew ureter nel tL jfh—vete er eee anit Scanned with CamScannerCompuste DuePucation of Lester \ v OPPER Moewry acs { Lowe moerty tH Uraterocee Ubs0 oes expe . epee o Qeeuntiior! oReteR Next ) Famensnef Renat Cammen (retertatin Page eocieeiCoe sq Zoe woe eo Depiex Systerm co doar + Bniated Cuxeter ertrctyencnenc INFRA, \ ot eeepc i function Non Pane «oe Cade Secs Guade eden that “O L “er it Sar wren, Oa \ Patio . ie e Laver (2 “se amecsiss & ea Poco feomera Neprrro-vrett- - onffecet fanewon 5 outenen Greinen ~ @enal or nea te seating ey = ella en Q, exch gap es eet fresentaén . eupras Prenatal —bilatahen =P Ge Ae eek OTL, ramtonats So eee oy reuco op Preval fo deer eeatig eee rere) «Satara Oischenge ptt + Suess ee Oirentinene. eey. °C USG koe: ope ny ° Armes mers = Dilated Boptes threter Ceseive bow Pelee + Champes un Ceuegeasciry ool we @d tal Ne Clase Et of eilowine © Wher ete ’ phe Boe on pele pas Gaetececterey opto Meo 2 VOR vito laver pote. «Bon 210234 [A lplitat ex Bilateral a oo eplex bs20e4 3h enctve ae cxene Ouphastiont Deterierahen excrecio4 + “) Breet Sorgical citorventin cet 3 Bs ected Se — SE SOE i ociny — 4 13 geen! mai formatere ; ureter net only one. tuvetey W) Gike of appedta tuvater Endoccopte ae poet \ jen pila? aa Cera cubieen fer + . seca esPest Cys Bilatathen - Bo} assceale = @ Bere System Or CRE TEROCELES Assocs once istat tne le vor oioctweh uneter Dilanen ap” ptilar UPPER Mls Woks Bladdey svtfiow ebstreehen Prolapse canta tateral voR Linuca PRESENTATIONS 41K. Same as Ectopic Uneter 1 2 3 & S- @ e TREATMENT Pemepues ! i Teecewe Ceca on Te femumnig Polenta comee of thfectsn » Treat Awe Bo prevent Glee collet otetrsctin FUmeortinane Prevent Sitveat BMA tall Oxtyeene, ceautipancnseny rol eetept Cae ieee =ne WoR ye aterm eld ‘ acter i 1 Cee A Same well fourtil be ty yeaeuery uc we wok emarkeaic vppet Upped hae Appreects ‘Decomprasin, (ace ofan Betepeiteniasnpne Veen Fre erge Nant” Panchen sg Qomave. * Uveter ciewm — 62/ boplex em | Btades Eetopic — frat. has pation tak Permamentey Be ye ecteprd ai ein Ge Seva ie System Uvelevocele: peyend Bladder Neck Snae Suse UPETE ROCELE more comenon es wr Boyt ‘Almnest ALWAYS Ustawasizal Prenatal Diaanecie ott atarahin (6 absent ot track Dilatahin (5 alse write mosera Ca, 5 Renal fimcner 6 neva pres \ Asymptomatic ~ Symptomabe: Preserwed ~ Bopper tract ‘Demat Ramet cnet L cone Conservative os tendecceQic Decempresciey eKretele at Blartey level t Reunpoudadion bn Bide Cate Leconetrection Scanned with CamScanner(Dsp__. 2 taggers a a ve Females P nysetar ee? — Abundant ae 4 Qenene a a B Genene mates — Deficient ae" cmt areca cule « ASum Motahen — Aesenr, moon 4 s. a a salt wactvio, wena, _ = CAH- alow - “ he ea — Sat Peteation AY ot mM @ucs esomy = Stara = AeTeet 2 Oe bet nia Ome emene mates Uox% 9s p—AReepror Defy Motapier - SotR- TA DHT. 4661 Qocent Differentiate — Pure Gernnaar ota 5 — Mixed Qonadat poegone LO vamp — — Ovotesticslay DED . DSp_aT Buetny —onry y CAvses = 4686 050 Gimmdat Syme Pete Ww 4e eu DED - BH mares Gerncat Srarer'| fremont megonmel| W eveteshesiay OSD. me Cow nthe Scanned with CamScannerbsp. Ameiquors Generar Bl. Gonads \ | i 1 Nes a ait No 1 Gonadl Perinea | WeSnebe, L + Kanotayerey Kenlgpe Yee ow Rea —_ WEG Stimelahen Test Kemal Uoxx Yexy SrTectestene, Son, \ L MIS yg 4 CO (Fou Pr tates xy [yo Urrinom Qeroid Mie wit enn een YOxX Ng wren 2M wv Dens Contes} Mesteikiont \ L i \ MKEd OvoTESncoLAe_| ind Gonnon ce Uexndsr —__Yoxyase DYEKENEEIS L a Ry (Beko PeBwerase. { Oysqenesu a) an! Qa Brepatat : Odeonyertintieoe, re Newets a Mrestesteeneoae® @yrectos terre. 1@ \ Female] ale Phenetype Female. prevelipe “yp and vor - Ne Mollanian ste L a NBryemyie 2 ym, empuete ie ae Anweoqen | re a 2 a INSENS FuNety, beveanin) ce) Pee] Dain SEqoenens ef AR GENE Ls Pont Mute Scanned with CamScannerwe balan? { Newborn & more Geverals (ner sege)) Fame wef ee anit eopeond) er umexpeck? comet paca: 2 tins camity = Previews geo cam Hever of oy ae * nett aga = maiero “a pan Durer, PIAened Letina § ginnaserene = pues yori » bw net dam Athearn aoe prodvey male | | a mse of ~matern® vat lant how Ceasrenre EanrnsnTion SEF, s,, Ral fice, MOM! - Qengtalia : Bye7e oma denver f arffeennaren f Phallus fosiner of Lwretnr mean : Lapiogeret) Folds Ors Site ater bert > ee eel Qanaral | Doturrent” Peatpotole a ; at or ne Symone Pal parole nt Oe d pesende? + uncesconde> y ” am SIE Coca xan yarant CArite URES con frm movlian: viens in telatndy ele? ae lowers pecaue bs fe “f materned ashy - cat) pecarfied ig Duommenph featwes Seid Chest , ie wiigples} ete Needle were vencun je Kory “emg « ace ph S4y 2 - Chromesanal Ane . bo one. Endoenne Secon - Bi nyorrey pregeerne a ee Te. Bonen Baocncenl Na, | . 1 . & Bleemep eouclase ped welt ten viteana Jenin oe! 3g Rue se ae usa, mod | IMIS Iigafieanin “fmt Tana, Cetergente Py eet wingd, cant ars Due Genf ni tegen? J” gum O- vet gee el ce tobe ponat ansic sa An exntle feoP| ex |mer fF Rev — Zovirn No sane ete Bn Ceunst oe “Sepemmuned bY wacened © Sse, Tingaugeble Gy vata alezernesral VeEhs 4 Soupectes 05D shuts rssie, vleetis, S. Farnilal Yen . 7 a1 Cirtumstamees Yelatea “4 Benet Agena Ni * Fenny era SA es Fitaardae | Seratent € Phone20b @ al 95% M1 12:21 virilization are classified into five Prader stages (see Figure 2). \St Si Be Wa a Yale Je LV Nar VA vy vy wv wo we Ob eH SL EA2e Figure 2. Different degrees of virilization according to the scale developed by Prader Stage I: clitoromegaly without labial fusion Stage II: clitoromegaly and posterior labial fusion Stage III: greater degree of Scanned with CamScannerZO © dl 90% ff 13:05 Stage I: clitoromegaly without labial fusion Stage II: clitoromegaly and posterior labial fusion Stage III: greater degree of clitoromegaly, single perineal urogenital orifice, and almost complete labial fusion Stage IV: increasingly phallic clitoris, urethra-like urogenital sinus at base of clitoris, and complete labial fusion Stage V: penile clitoris, urethral meatus at tip of phallus, and scrotum-like labia (appear like males without palpable gonads) Scanned with CamScannerundermasculinization in a ( A =) Male genitals, infertility andlor otherwise normal males ay 2 Male genitals tnd under- masculinized, PAIS isolated hypospadias i se Sa Severely under-masculinized ( g ) PAIS (undescended testes, and/or bifid scrotum) Ste A Ambiguous genitals, severely a under-masculinized, PAIS | cliteromegaly pe 5 Female genitals (including separate urethral and vaginal PAI ne vaginal ices, mild clitoromegaly S | orifices, mild clit ly) hse Female genitals with small (A) 6 labial folds, normal PAIS pubiclunderarm hair E W Female genitals with little or 7 no pubiclunderarm hair Scanned with CamScanner[=] rm (4) Hi Hl lt Penile shatt Fossa navicularis Push back and ‘meatotomy enemy vesicolithotomy Figure 2: Algorithm for management of impacted urethral stones. Scanned with CamScanner| 6: Algorithm for the management of children with myelodysplasia with a neurogenic bladder | Time at diagnosis * ee rs Newborn Late presentation * Eatly CIC | Understanding the |” relationship status: history, USG, > yuoNGU, ¥ | ‘rusiear medicine | ¥ Y Yr 7 Detrussor overactive, Detnussor Detrussor underactive, | | Detrussor underactive, ‘Sphincter Sphincter underactive under/normonctive ——-Sphinctar ovuractive exer normoaetin [a oF ¥ ¥ 7 | Antimusearinic Artiemuscarinc (OIC # resid! urine CIC H residual wine CIC If residual urine ac (CAP VUR present CAP VUR present | CAPILVUR present CAP IKVUR present ’ a * - | Ineases of clinical 4 casas of ctnical Decision Bladder neck talure of upper failure or upper regarding the clinical ‘urinary tract ‘urinary tract situation +++ auginentation deterioration: deterioration: Botutnun toxin ‘Botulinum toxin as Injection to bladder: injection to blacker ‘added to treatment or sphincter: added, to treatment ¥ * Augmentation ‘Augmentation procedures Procedures , Yr In tailed cases bladder neck closure Or *) Urinary diversion continuous antibiotic prophylaxis; CIC = clean intermittent cathaterisation; US = ultrasound; = voiding cystourethrography; VUD = videourodynamic; VUR = vesicoureteric reflux. Scanned with CamScanner