Patient Information

    All major surgery of the urinary tract in children more than 6 Kg by keyhole technique (Laparoscopy & Robotic) available in our unit

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Case Of The Month

Preoperative Diagnosis

  • Road traffic accident in year 2000
  • Extensive pelvic trauma
  • Multiple reconstructive surgeries
  • Perineal urethroplasty (reconstruction of urinary tube)
  • Urinary incontinence (loss of urinary control)
Comments

 

 

 

JM a 14 year boy had road traffic accident in 2000. He suffered extensive pelvic injury and underwent multiple surgeries and reconstruction of urethra. The child had urinary incontinence not amneble to conservative management. He was given a trial of anticholinergics, Clean intermittent catheterization, pelvic floor exercises, timed voiding. He had persistent, significant urinary leak on standing walking and coughing .

 

He was evaluated and investigated in detail and planned for artificial urinary sphincter. Preoperatively, micturating cystourethrogram, urodyanmic study, cystoscopy were done. The upper tracts were normal. There was no vesicoureteric reflux, stricture. Bladder capacity was 250 ml, maximum detrussor pressure was 30 cm of water and insignificant residual urine.

 

The upper tracts were normal and the urinary bladder had normal capacity and pressures and there was no blockage to urine flow, so he was an ideal candidate for artificial sphincter.

Procedure Done

 

 

 

Artificial urinary sphincter (AUS) implant

 

AUS implantation was done under general anaesthesia through the perineal incision in lithotomy position. Proper sized cuff was placed around the urethra and the pump which controls the device was placed in the scrotum. The cuff was kept open for 4 weeks after surgery to allow proper healing.

 

Postoperative period was uneventful and child was discharged the next day. 4 weeks later the device was activated. The cuff is opened by pressing a small button on the pump placed in scrotum. The cuff remains open for 2 minutes to allow the micturation and automatically closes after voiding.

 

The child is now dry, does not need any diapers and the device is functioning well

X Ray Showing Deformed Pelvis Scars of Multiple Pelvic Reconstructions
   
Micturating Cystourethrogram Cystometry
   
Urethra Exposed Artificial Urinary Sphincter
   
Device Implanted Device in Place
   
Activation of Pump Normal Voiding