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Surgical Approaches in Pediatric Neurogenic Low Urinary Tract Dysfunction
DOI: http://dx.doi.org/10.5772/intechopen.115463
61
Improved Continence: The injection of bulking agents can significantly
improve urinary continence, reducing the need for protective garments and
increasing participation in social and physical activities [–].
Minimally Invasive: Bulking agent injections are less invasive compared to
other surgical options, leading to shorter recovery times and less postoperative
discomfort.
• Negative Aspects:
Variable Efficacy: The effectiveness of bulking agents can vary, and multiple
injections may be necessary to achieve the desired level of continence. The
improvements may not be permanent.
Need for Repeat Procedures: As the effects diminish over time, repeat injec-
tions may be necessary, which can be inconvenient and stressful for the child
and caregivers.
. Sling surgery
Positive Aspects: Improved continence rates and enhanced quality of life,
especially in patients with stress urinary incontinence. The procedure can
significantly reduce leakage and the need for protective wear [–].
Negative Aspects: Potential surgical complications, including infection or
mesh-related issues. Further surgeries or interventions may be required if
initial results are not satisfactory.
. Artificial urinary sphincter (AUS)
• Positive Aspects:
High Continence Rates: AUS can achieve high continence rates, significantly
reducing episodes of incontinence. This leads to major improvements in
social, emotional, and psychological well-being, allowing pediatric patients to
participate more fully in daily activities without the constant worry of incontinence [–].
Improved Self-Esteem and Social Integration: With better continence control,
children often experience enhanced self-esteem and confidence, facilitating
better integration into social and school environments, and improving overall
quality of life.
• Negative Aspects:
Surgical and Device-Related Complications: The implantation of an AUS
involves risks such as infection, device erosion, and malfunction. These
complications can necessitate additional surgeries, which can be stressful for
both the child and family.
Pediatric Surgical Procedures – An Updated Guide – Volume I
62
Maintenance and Follow-Up: The AUS requires regular follow-up to ensure
proper functioning and to monitor for potential complications. This ongoing
medical attention can be burdensome due to the frequent visits and possible
adjustments or replacements of the device.
. Augmentation cystoplasty
• Positive Aspects: Significant improvements in bladder capacity and reduction in
urinary incontinence can enhance social interactions, school performance, and
self-esteem [, , , –].
• Negative Aspects: Long-term issues such as metabolic complications, frequent
urinary tract infections, and the need for regular follow-up can affect quality
of life. Additionally, there may be concerns related to dietary restrictions and
potential bowel issues.
. Conclusions
The management of neurogenic bladder in young patients, whether congenital or acquired early in childhood, presents significant challenges for urologists.
Conservative treatments such as pharmacotherapy, intermittent catheterization,
and infection prophylaxis are typically employed. Monitoring the efficacy of these
treatments is conducted through urine tests and regular urodynamic and sonographic
examinations. The primary treatment goals include stabilizing renal function, ensuring unobstructed urine drainage, and preventing infection (the use of an oral autoimmune vaccine could be helpful). However, as patients transition to adolescence, issues
such as compliance with medical treatment and follow-up examinations may become
more complex, influenced by factors like the severity of the neurological defect and
the patient’s evolving preferences [, , ].
When conservative treatments fail, bladder augmentation is a common procedure,
often combined with continence procedures. Despite these interventions, incontinence remains a persistent problem for a significant portion of patients[,].
A multidisciplinary team, including pediatricians, neurosurgeons, orthopedic
surgeons, neurologists, and urologists, collaborates to comprehensively assess and
treat patients. This approach takes into account factors such as renal function, bladder
capacity, and continence [, , , ].
Figure 6.
Minimal invasive procedures in pediatric neurogenic lower urinary tract dysfunction (LUTD).
Surgical Approaches in Pediatric Neurogenic Low Urinary Tract Dysfunction
DOI: http://dx.doi.org/10.5772/intechopen.115463
63
While challenges such as incontinence and bowel dysfunction persist, advances
in surgical techniques and patient management strategies have led to improved
outcomes and quality of life for young patients with neurogenic bladder undergoing
continent urinary diversion. Long-term follow-up and comprehensive multidisciplinary care remain essential for optimizing outcomes and addressing the evolving
needs of these patients (Figures –) [, , , –].
Figure 7.
Surgical procedures in pediatric neurogenic lower urinary tract dysfunction (LUTD). VUR=vesicoureteral
reflux. UD=urinary diversion.
Figure 8.
Surgical procedures in pediatric neurogenic lower urinary tract dysfunction to increase outlet resistance.
VUR=vesicoureteral reflux.
Pediatric Surgical Procedures – An Updated Guide – Volume I
Acknowledgements
64
To Katherine Julia. March-García for her illustrations. Laboratorios Qpharma
S.L.U. Alicante, Spain, contributes to the financing of chapter publication.
Surgical Approaches in Pediatric Neurogenic Low Urinary Tract Dysfunction
DOI: http://dx.doi.org/10.5772/intechopen.115463
65
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Inguinal Hernia in Children:
70
A Literature Review
Chapter 4
ErickFeliz
Abstract
A hernia is described as the bulging out of the abdominal viscera, often resulting
from a weakening of the walls of the abdomen. This condition is diverse and includes
femoral hernias, indirect inguinal hernias, and direct hernias. Of these, indirect
inguinal hernias, which lie lateral to the inferior epicastric vessels, are the commonest
in children as they are due to the patency of processus vaginalis. The incidence is estimated to be 1–3% in full-term neonates and up to 30% in premature infants. In males,
the lifetime incidence of inguinal hernia is thought to occur at a rate as high as almost
5%. The diagnosis relies on history and physical examination. The gold approach to
inguinal hernia repair is open inguinal hernia repair. Despite this, more and more
patients are opting for laparoscopic procedures since they allow for a more thorough
examination and treatment of both sides in a single appointment, instant closure of
any uncommon hernias or open contralateral patent process vaginalis found during
the surgery, and overall less invasiveness. Furthermore, robotic-assisted approach is
arising as a new option for inguinal hernia repair in children.
Keywords: inguinal hernia, children, hernia repair, robotic-assisted surgery, pediatrics
and Marlenis V.Mercedes Martínez
. Introduction
Nowadays, inguinal hernias arise as a concern in pediatric surgery. It is characterized
by the bulging out of the abdominal viscera, often resulting from a weakening of the
walls of the abdomen. Nevertheless, this condition has been described since ancient
times. In fact, the Ebers Papyrus, dating back to around 1550BC, was one of the earliest
medical texts to name it [1, 2].
This papyrus suggests that Pharaoh Amenophis died of a strangulated hernia.
Despite not having a wide comprehension of the pathology, they reported recommendations such as a diet and external compression of the hernia with bandages and palm
oil. However, the Egyptian surgeons thought all the hernias, except the inguinal scrotal variety that was treated with orchiectomy, were treated nonsurgically; even the
strangulated hernias were considered inoperable. The Pharaoh Merneptah mummy
had an incision over his inguinal region with one testicle removed, and the mummy of
Ramses the 5th (1157BC) had a huge hernia sac in the groin with a fecal fistula [1].
Ancient Greek medicine evolved with Hippocrates from the prescientific phase,
linked to magical religious practices to a rational and scientific methodology [1].
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