2A-S5-1

PAEDIATRIC UROLOGY - RECENT TRENDS AND CONTROVERSIES

Philip A King

West Perth, Australia

Advances in the management of children with urological abnormalities are providing paediatric urologists with an interesting array of challenges. Obviously in a lecture of half an hour, it would be difficult to cover all paediatric urological conditions and so I think it is appropriate if we concentrate on the more common abnormalities and where we seem to be heading with their management.

There is no doubt that endo-urology is becoming more sophisticated. And with the development of technologically near perfect instruments, such as the 9 Wolfe resectoscope and the improvement in the single chip cameras that are now available, safer and more accurate endoscopic resections of walves strictures urethral polyps will become commonplace. Combine this with laparoscopic pyeloplasty and nephrectomy techniques, which are becoming more and more successful, and requiring of course, for the patient to be in hospital less and, then the cost of these treatments will become much more available to all developing countries.

The commonest urological abnormalty perhaps is that of hypospadias and there seems to be a real increase in its incidence. It is therefore fortunate that the split urethral plate urethroplasty, which is simple and a straight-forward technique does make the earlier repair of hypospadias not only possible, but in most instances, reasonably successful. The operation can be performed for both distal and proximal hypospadias and I will review some of my own cases to highlight the issues.

The other common problems facing the paediatric urologists are those of vesicoureteric reflux, hydronephrosis and urinary incontinence. With hydronephrosis the problem is that we now get patients presented to us, 2-3 weeks of age, as a result of antenatal ultrasound and those that can wait .With careful nuclear isotope imaging, selection of cases requiring early intervention is possible and with the use of internal stenting systems following surgery, patients can be quickly discharged from hospital.

In vesico-ureteric reflux, the aim is to prevent scarring and therefore we should be thinking about early inter intervention in this condition. With the use of magnifying loupes and modern small stents, early operation is not only possible, but has proven to be safe. Mitrofanoff principle in paediatric urology is providing patients with urinary incontinence, who do not respond to all other means, as a popular concept of management. Some of the pitfalls of management will be highlighted and possible solutions offered.