Reconstructive Surgery

There are several conditions that require reconstructive surgery in a pediatric patient. Many of these conditions can be diagnosed at birth or shortly after. Some are even diagnosed before the child is born while in utero. Some conditions occur later in life possibly due to other illnesses or trauma.

Here are a few of the most common reconstructive surgeries performed on pediatric patients.

• A ureteropelvic junction (UPJ) obstruction is a condition that is commonly found or suggested on a prenatal ultrasound. It is due to a narrowing of the ureter tube as it leaves the drainage area in the kidney. This occurs as the tube does not develop normally as the fetus is developing. In mild cases, a UPJ obstruction may not cause problems immediately or may not cause problems until your child is older.
• For severe cases, a surgery called pyeloplasty can be performed. This procedure removes the blockage and reconnects the ureter to make it drain better.
• Pyeloplasty can be done in an open surgical technique, robotically, or laparoscopically, and has a high success rate.
• The patient will need to have follow up renal ultrasounds to ensure that the extra fluid in the kidney improves after the surgical correction.

• A common urological condition in children is vesicoureteral reflux (VUR). This condition causes urine in the bladder to flow back up into the ureters and sometimes into the kidneys. This can lead to kidney infections, damage or scarring of the kidneys, and even kidney failure if not corrected.
• Antibiotics may be used at first to help treat and prevent infections, but sometimes surgery is required to permanently fix the problem. One type of surgery moves the ureter from its refluxing position to one in the bladder that corrects VUR. This creates a better connection of the ureter to the bladder to keep the reflux from recurring.
• Another procedure uses a needle injection in the bladder using a scope through the urethra without any incisions with a bulking agent to support the ureter and its tunnel so the urine cannot flow upward.
• Ureters that are too big (megaureter) may be associated with blockage at the bladder ( ureterovesical junction (UVJ) obstruction ) or abnormal attachment of the ureter to other pelvic organs or bladder ( ectopic ureter) may require surgical treatment to correct the blockage that may cause UTI, stones, or pain due to blockage of kidney drainage. Some ectopic ureters will cause incontinence of urine if not draining in the bladder. Surgical correction may require moving the ureter to a place in the bladder where it will drain normally while some ureter blockage can be treated with dilating the tight ureter attachment to the bladder by using a balloon to stretch the opening and then placing temporary plastic tubes to allow the stretched area to heal.

• The urethra is the tube that carries urine out of the body. If urine cannot exit the body, it can cause infections and block the bladder from emptying well. Rarely, a child have  a urethral stricture at birth but most occur after traumatic injury to the urethra that may need a urethroplasty to fix the problem and improve the flow of urine.
• If the stricture is very short or thin, the surgery can consist of making an incision in the area of the stricture using a scope in the urethra.
• Much longer, thicker or recurrent narrowing or stricture of the urethra may require a more extensive surgical correction of the stricture where the scarred of the urethra is removed and replaced or reconstructed with a graft or tissue flap.

• Hypospadias is relatively commonly found in baby boys where the opening of the urethra, where urine exits the body, is not on the tip of the penis. There are different locations for the opening on the penis with the most common area being still on the head of the penis, just not on the tip.
• The opening can also be located further down on the underside of shaft that can even go to the base of the scrotum.
• An abnormal curve in the penis or chordee can also occur during development of the penis and may be associated with hypospadias, but can also occur on its own. This curvature may also require surgery to correct.
• Some hypospadias does not require any surgical correction if very mild, but most hypospadias will need surgical correction to get the urethral opening to the tip of the penis and to be of a good size to allow your child to urinate without straining, bleeding or infection.
• Most hypospadias or chordee surgery can generally be performed as an outpatient when your child is around six month old if born at term, but some children may require more than once surgery to correct.