Role of surgeon in treatment of UTI : Role of surgeon in treatment of UTI Prof. M.K. Ajayakumar
Prof. & HOD
Dpt. of Paediatic Surgery
Bacteriological factors : Bacteriological factors Organism & serology
Virulence factrs
Host factors : Host factors Perineum
colonization with uropathologic bacteria
Perpuce
Urethra
Dysfunctional elemination
Anatomic abnormalites of urinary tract
Immunologic factors
Diagonosis : Diagonosis Urine analysis
Routine
Leukocyte esterase test
Nitrite test
Urine C&S
Evaluvation : Evaluvation History
Dysfunctional voiding
Constipation
Physical examination
Flank mass
Bladder distention
Examination of genitalia
Imaging : Imaging USS
MCU
4- 6 weeks after UTI
DMSA
Slide 8: Dilated ureter Hydronephrosis
Slide 9: VUR PUV
Urodynamic studies : Urodynamic studies Dysfunctional voiding
Uroprophylaxis : Uroprophylaxis For VUR
Children < 1yr with documented pyelonephritis / renal scaring
Surgical treatment : Surgical treatment Circumcision
UTI more in uncircumcised infants
Prepuce as site of colonization
Controversial
low incidence of UTI even in uncircumcised infants
may be justified in boys with urinary tract anomalies
Obstructing lesions : Obstructing lesions Improves drainage
Decrease UTI
Pyeloplasty : Pyeloplasty
Ureteric reimplantation : Ureteric reimplantation
Ureteric reimplantation : Ureteric reimplantation
Cystoscopic fulgration of PUV : Cystoscopic fulgration of PUV
Cystoscopic incision of ureteroceles : Cystoscopic incision of ureteroceles
VUR : VUR Recurrent break through infection
Scarring
Higher grade
Older children
Ureteric reimplantation
Subureteric injection
Dysfunctional voiding : Dysfunctional voiding Treat constipation
Regular voiding
Biofeedback therapy
Anticholinergics
CIC
Neurogenic Bladder : Neurogenic Bladder Surgical therapy
Not relived with conservative measures
Difficulty to do CIC
Small capacity bladder
Bladder augmentation & appendicovesicostomy
Slide 24: thank you