Postnatal Surgical Repair for LUTO (8 of 9)

>> ONCE THESE BABIES ARE BORN, THERE'S REALLY A TRANSITION OF CARE TO OTHER MULTIDISCIPLINARY EXPERTS >> NEONATOLOGISTS ARE BABY DOCTORS WHO SPECIALIZE IN NEWBORNS WHO ARE SICK AND IN PREMATURE BABIES

AND IT'S IMPORTANT THAT THE FAMILY GET INPUT FROM THE NEONATOLOGISTS TO FIGURE OUT WHAT THEY'RE UP AGAINST WHEN THE BABY IS BORN >> DO THEY NEED EXTRA HELP WITH OXYGENATION, THE ISSUES OF PREMATURITY? >> A BABY WITH SMALL LUNGS WHO CAN SURVIVE, FOR INSTANCE, MIGHT BE IN THE INTENSIVE CARE NURSERY FOR QUITE SOME TIME FOR RESPIRATORY SUPPORT, VENTILATOR SUPPORT, THINGS OF THAT SORT THE PRINCIPAL FOLLOW-UP THOUGH, WILL BE UROLOGIC AND RENAL FUNCTION BASED, AND THE UROLOGIST HAS A GREAT BREADTH OF EXPERTISE ON ALL PROBLEMS UROLOGIC WITH CHILDREN >> WE PROVIDE SOME PERSPECTIVE ABOUT WHAT THE FAMILY SHOULD EXPECT IN THE SHORT RUN AND ALSO LONG TERM >> THEY NEED TO DO STUDIES OF KIDNEY FUNCTION

THEY NEED TO DO STUDIES TO LOOK AT THE ANATOMICAL RELATIONSHIPS OF HOW DO THE URETERS CONNECT INTO THE BLADDER IS THERE GOING TO BE A PROBLEM OF REFLUX THAT NEEDS TO BE ADDRESSED? >> ONCE THE BABY IS BORN, ONE FACTOR THAT REALLY BECOMES IMPORTANT IS TO UNDERSTAND HOW THE KIDNEYS ARE WORKING AND IN ORDER TO DO THAT, YOU'RE MONITORING THE URINE OUTPUT, AND ALSO THAT YOU'RE ASSESSING WHAT'S CALLED SERUM CREATININE, WHICH IS A REFLECTION OF HOW THE KIDNEYS ARE WORKING AND IN ADDITION, OF COURSE, WE DO IMAGING OF THE KIDNEYS WITH ULTRASOUND AGAIN, TO SEE IF THINGS LOOK DIFFERENT THAN THEY DID EVEN BEFORE THE BABY WAS BORN >> TRYING TO FIGURE OUT WHAT'S GOING ON, WILL THEN ALLOW THEM TO COUNSEL THE FAMILY ABOUT TREATMENT OPTIONS

>> THE WHOLE FOCUS IS ON TRYING TO ESTABLISH DRAINAGE OF THE BLADDER AND IT REALLY DEPENDS UPON WHAT IT IS THAT'S CAUSING THE OBSTRUCTION IN CERTAIN SITUATIONS LIKE VALVES, WE HAVE TO SOMEHOW INCISE THE VALVES, SO RID THAT OUTLET OBSTRUCTION THAT'S PRESENT >> IT CAN BE AS SIMPLE AS THE BABY UNDERGOING CYSTOSCOPY THROUGH A SCOPE, SCOPE TUBE THAT GOES THROUGH THE URETHRA TO WHERE THE VALVES ARE IN FULGURATION OR REMOVAL OF THAT VALVE TISSUE SO THE BABY CAN VOID NORMALLY, TO A MORE COMPLEX ARRANGEMENT WHERE IT'S IMPORTANT TO DECOMPRESS THE OBSTRUCTIVE BLADDER THROUGH A VESICOSTOMY, THROUGH A HOLE IN THE BELLY WALL TO WHICH THE BLADDER IS SEWN TO ALLOW URINE TO DRAIN, AND SOMETIMES THERE CAN BE QUITE COMPLICATED UROLOGIC RECONSTRUCTION >> IN TERMS OF WHAT ONE HAS TO DO WITH THE URINARY TRACT, A LOT OF THAT DEPENDS UPON LONGER TERM FOLLOW-UP TO MAKE SURE THAT OVER TIME THE DILATION REMAINS STABLE OR GRADUALLY DOES SHOW SOME IMPROVEMENT, AND MOST IMPORTANTLY THAT THE KIDNEY FUNCTION, THAT THE RENAL FUNCTION, MAINTAINS ITSELF AS WELL

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