Structural

Defects

Cryptorchidism
Undescended testes, occurs when one or both testes fail to descend
through the inguinal canal into the scrotum.
Testes usually descend during the 7th to 9th month gestation.
Palpated at well child exams- newborn assessment.
Procedure:
Orchiopexy pulling testes down into scrotum and narrowing canal
o Wait 6-12 months because in that time they may descend on
their own (sometimes at 3months of age)
o Kids at great risk for testicular cancer follow-up care!
Post-operative care:
Cool compresses to decrease swelling
Pain control Tylenol or Tylenol with codene
Monitor for severe edema, infection
Parent teaching (follow ups)
Discharge:
Sponge bath for 2 days after surgery then continue
baths, for 2 weeks no child on hip or straddle toys
No meds or ointment on incision

Exstrophy of Bladder
Extrusion of bladder through the abdominal wall
Surgical closure prior to discharge
High risk for infection (goes straight into isolation after c-section)
o Pre-operative care:
Covered w/ sterile plastic wrap non adherent dressing
o Post-operative care:
Avoid abduction of infants legs (dont interrupt incision)
Monitor renal function
Promote bonding
Wound and drainage tube care
Prevent and assess for infection (monitor temp freq)

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 Hypospadius vs Epispadius

Hypo Epi
Meatus is on the ventral Meatua is on the dorsal surface of the
surface of the penis penis
DX in neonatal period or Surgical correction is more complicated,
by ultrasound, unless its may involve lengthening urethra and
severe bladder reconstruction
Delay circumcision to Often more then one surg procedure
allow for skin growth for Waiting until infant is more then 10kg
repair, so its important its puts at less risk for anesthesia problems
recognized early!
Correction allows for POST OP CARE:
normal urine stream and - Urethral stent -Hourly I&O
ejaculation - Increase fluids -Preventive
antibiotics
- Pain management of bladder spasms-
anticholinergic meds- oxybutin

- Often go home with catheter, at least for a
week, teach parents how to irrigate sterile

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 Hydrocele
Fluid travels into scrotum with testicle
Transilluminate
o make sure its fluid by using flashlight under the scrotum
and if its red/orange glow is present then its fluid
Usually spontaneous resolution

Testicular Torsion
Spermatic cord is twisted, compromising blood flow to the testicle
Emergent surgery within 6 hours
Most prevalent in adolescence
Sudden onset
o Sever scrotal pain
o Erythema and edema
Diagnosed by ultrasound
Procedure = orchiopexy
At least two days of BR before gradually returning to activity
o No strenuous activity for 2 weeks after surgery
o No heavy lifting for 4 weeks
Note: b/c greater risk for testicular cancer, make sure he knows how to
do a monthly self-examination.

Hydronephrosis
Accumulation of urine in the renal pelvis
Due to obstructive uropathy; the pressure caused by the urine
backup compromise kidney function
This causes:
o Decreased GFR
o Hypertension
o Impairment of the kidney function
Polyuria and polydipsia- kids cant concentrate urine
o Urinary stasis
o Progressive renal damage
Because of great enlargement and pressure

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 DIAGNOSIS: (urinary reflux)
o Early DX and treatment prevent kidney damage and
deterioration of renal function.
o Prenatal US may detect it; voiding cystourethrogram
o If severe- surgical correction
o If mild- may resolve on own, preventive antibiotics
SURGICAL:
o Goals:
Lower the pressure within the collecting system
Reduces renal damage
Prevent stasis
Decreases risk of infection
o Pyeloplasty
Removal of an obstructed segment of the ureter and
reimplantation into the renal pelvis
o Urinary incontinence resulting from
sphincter weakness common postop
Pre-operative nursing care
o Prep client and parents on post-surg outcome
o Provide parents the opportunity to discuss concern about how
this disorder will affect childs long-term renal functioning
Post-operative nursing care
o Monitor vital signs, I&O,
o Observe for urine retention- decrease output, distention
o Teach parents how to:
Change dressings
Double-diaper
Care for catheter or stent
Assess pain and when to give analgesics
Recognize signs of possible obstruction or infection
Encourage child to do normal age activities but no
contact sports b/c risk for injury to bladder
May have to go home with suprabubic cath

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 Prune Belly Syndrome
Or Eagle-Barrett syndrome
Congenital defect where the abdominal muscle fails to develop, skin is
thin and wrinkly
Most coming in males
Also associated with GI and Orthopedic defects
Requires correction of defects and abdominal wall reconstruction
Baby/infant will have binder until old enough for surgical repair


Phimosis
Non-retractable fore skin