PEDIATRIC UROLOGY TUBE MANAGEMENT: YOU PUT WHAT TUBE, WHERE?

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PEDIATRIC UROLOGY TUBE MANAGEMENT:

YOU PUT WHAT TUBE, WHERE?

Presented by Katie Willihnganz-Lawson, MD at the AORN of the Twin Cities Fall Workshop November 4, 2017
Attended and Reviewed by Caroline Ness

Dr. Willihnganz-Lawson provided a great presentation reviewing the urinary tract anatomy and discussing some common GU procedures along with a review of different types of tubes and drains used in these procedures.

[/vc_column_text][vc_row_inner][vc_column_inner][vc_column_text]The urinary system structures include the kidneys, ureters, bladder and urethra. Some Urologic Surgeries related to these structures that are part of the urinary
system are:

Urethra:

  • Hypospadias
  • Posterior urethral valves
  • Urethral Stricture
  • Transurethral resection of prostate (TURP)
  • Prostatectomy

Bladder:

  • Transurethral resection of bladder tumor (TURBT)
  • Incision of ureterocele
  • Suprapubic tube
  • Vesicostomy
  • Bladder Augmentation

Ureter:

  • Ureteral stones
  • Ureteral strictures
  • Ureteral Re-implant

Kidney:

  • Pyeloplasty
  • Nephrectomy, partial
  • Kidney stones
  • Kidney tumors

Other:

  • Mitrofanoff procedure (appendicovesicostomy)
  • ACE procedures (appedicoceostomy)

The purpose of Post-Surgical Urinary Drainage tubes is to:

  • Keep natural urinary tracts open during healing process
  • Diverts urine away from healing organ and suture lines
  • Helps avoid fistula, stricture, urinoma or abscess formation.

The types of urinary catheters are and their locations:

Type:

  • Foley: a catheter with balloon
  • Council tip Foley: hole through tip to pass wire
  • Coude Foley: bend at tip to navigate urethra
  • Malecot catheter: looped end, no balloon
  • Straight catheter: no balloon, intermittent use

Location:

  • Urethra
  • Suprapubic
  • Continent channels

Foley and Straight Catheters are used to keep the surgical site drained or new urinary channel open (ie-Vesicostomy, Suprapbic tube, Continent catheter channel). Catheters are typically kept in for a minimum of 24 hours up to four weeks.

Urethral Stents are used to keep the urethra open and the bladder draining and are used in hypospadias, posterior urethral valves, and urethral stricture surgeries. Stents are typically kept in place for 7-14 days.

In reviewing the pediatric anatomy, Dr. Willignganz-Lawson noted that placing a foley catheter in a young girl may be a 2 person job in order to visualize the urethral meatus.

Common pediatric procedures:
Ureteral Reimplant is indicated when vesicoureteral reflux (VUR) causes urine to travel from the bladder up to the kidney. Depending on the grade of reflux surgical intervention is indicated when there is a high grade VUR, recurrent febrile UTI’s or failed medical management. The goal is to create a longer tunnel for ureter to prevent reflux of urine to kidneys thereby preventing pyelonephritis. There are a variety of operations: extra-vesical, intra-vesical, open vs. robotic. The tubes typically placed in this type of procedure are a double-J stent or feeding tube into the ureter (overnight to 1-3 weeks), possible penrose drain next to the bladder for 1-2 days, and a foley in urethra, usually removed post op day 1-2.

Percutaneous Nephrolithotomy (PCNL is indicated when there are large renal stones. Drains typically placed in this procedure are a stent in the ureter, foley in the urethra and nephrostomy or foley in the PCNL tract.

Pyeloplasty is indicated when there is a UPJ(ureteropelvic junction) obstruction which is a narrowing of the junction between the ureter and renal pelvis. The procedure can be performed as an open procedure or robotically. Nephrostomy tubes are a percutaneous placed kidney tube inserted by the surgeon or interventional radiologist to divert urine from the healing area for 2-3 weeks after surgery.

Bladder Augmentation
is indicated when there is poor bladder compliance or capacity. Most commonly a portion of the ileum is used as a patch. Typical drains are bladder catheters kept in for 3-4 weeks to allow anastomosis to seal, prevent leakage, and allow kidneys to drain. Irrigation of bladder catheters (urethral or suprapubic) prevents mucous plugs in the catheter.

Bladder Neck Reconstruction
is indicated when there is incontinence due to incompetent bladder neck. The tubes used in this procedure are ureteral stents, suprapubic catheters, and urethral catheters.

Continent Catheterizable Stomas-Mitrofanoff or Monti
are indicated for intermittent catheterization, difficult to catheterize through the urethra. The procedure is an appendicovesicostomy. The tubes used in this procedure are a straight catheter in newly created channel, suprapubic tube, and JP drain.

Antegrade Continence Enemas (ACE) is indicated for neurogenic bowel, and parodoxical diarrhea. Tubes used are a straight catheter or Chait tube placed for 3 weeks. A continent channel can be intermittently catheterized after healing. Chait tubes are changed every 6-12 months. Adapter is attached to the opening of the tube and enema fluids are infused through the adapter into the colon.

Some other tubes and drains in urology occasionally used in ACE or Mitrofanoff openings are Mic-KEY, Chait, Penrose and Jackson-Pratts.

The goal in Urinary tube management is to keep it draining.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][vc_column width=”1/3″][vc_wp_custommenu nav_menu=”11″][/vc_column][/vc_row]