Role of surgeon in treatment UTI

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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

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