Control of Post-Operative Pain in Children Undergoing Hypospadias and Penile Curvature Surgery: Quasi-Experimental Study (original) (raw)
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Pakistan Armed Forces Medical Journal
Objective: To compare the post-operative analgesic efficacy of penile block vs caudal block following hypospadias repair. Study Design: Quasi-experimental study. Place and Duration of Study: Pediatric and Plastic Surgery Departments, Combined Military Hospital, Multan Pakistan, from Jul 2019 to Jul 2021. Methodology: The total of 34 patients undergoing hypospadias operation was booked for this study after approval of the ethical committee. All patients were operated on under General anaesthesia. The booked patients were randomly divided into Groups 1 and 2. For post-operative analgesia, the first group got penile block while the latter was given caudal epidural block. Results: The mean age of the patients was 3.99±2.68 years. These patients were split into two groups. Group-1 (n=17)underwent a Penile block, and Group-2 (n=17) underwent a Caudal block. There were no serious complications after a penile block or caudal block. A substantial decline in pain scores was noted, more in the...
Bimonthly Journal of Hormozgan University of Medical Sciences, 2014
Introduction: Hypospadias is a common congenital malformation in boys. One of the common surgical techniques for correction of hypospadias is (Tubularized Incised Plate urethraplasty=TIP). Meatal stenosis and fistula formation are known post-operative complications. The purpose of our study was to evaluate the effect of early urethral dilatation in prevention of post operative complications. Methods: A randomized clinical trial including 60 patients with distal hypospadias who underwent tabularized incised plate urethroplasty with or without dilatation was conducted in Bandar Abbas children hospital in 2011. Patients were divided in two groups. The number of the patients and mean age were not different in two groups. Urethral dilatation was started in first group at two weeks following surgery and continued for six months. The patients of second group were followed without urethral dilatation. All patients were followed for occurance of complications for one year. Chi-Square and t-t...
The Horizon of Medical Sciences, 2014
Aims: Hypospadias is one of the common external genitalia disorders in children. The aim of this study was to compare the effect of closed and open urine discharge care on acute complications of hypospadias after repair operation. Materials & Methods: This controlled clinical trial study was done on children admitted to the Mofid children's hospital. Sample selecting method was random. 108 selected children were divided into two experimental (open) and control (closed) groups. Acute post-operative complications (bleeding at the surgical site, fever, positive urine culture, urinary catheter removal by patient, the urinary tract fistula and urethral stricture) were compared in two groups. Findings: Among all studied subjects in 60 children (55.5%) one or more acute post-operative complications were observed. There were significant differences between the frequency of urinary catheter removal by children in two studied groups (p<0.001). There was significant difference between received Acetaminophen (p=0.005), the number of urinary catheter washing (p=0.001), those with less than normal 24hour urine discharge the (p=0.196) and fixing time of the stent catheter in the urinary tract (p=0.001) between two groups. Conclusion: There is no significant difference in acute complications in open and closed urine discharge care method. However, open urine discharge method reduces "the number of urinary catheter removal by child".
Innovative publication, 2016
Background: Post-operative pain poses special problems in children. The use of caudal epidural analgesia for post-operative pain relief, either completely eliminates or appreciably reduces the hazards of narcotic analgesics. So, this study was planned to clinically evaluate the efficacy, safety and duration of pain relief following caudal epidural analgesia in children. Materials & Methods: This prospective study was conducted in children from age group 0 to 12 years undergoing perianal and genital surgery after taking permission from institutional ethics committee. Patients with sacral anomalies, skin infection, poor bony land marks, movements and previous operation were not included in study. 1% lignocaine hydrochloride was used with adrenaline in concentration of 1:2000000 for caudal analgesia Children were observed for pain as well as for any untoward effects in post-operative period. Results: In this study caudal block was successful in 48 (96%) cases out of total 50 surgical patients who were recruited during the study period. The duration of pain relief ranged from 265 minutes to 500 minutes. The average duration was 394 minutes. Haematoma and Blood in epidural tap were observed in 4% and 8% cases respectively. Retention of urine was recorded in 4% cases. Pain at injection site was complained by 12% cases. Nausea and vomiting was recorded in 20% cases. Conclusion: It is concluded that caudal block is an efficient and safe method for achieving pain relief of reasonable duration during post-operative period in children.
BJU …, 2010
In 56 patients, there were a total of 105 complications (39 bladder stones, 16 stoma complications, 11 bowel obstructions, 5 reservoir perforations, 7 VUR recurrences, 1 ureteral obstruction, 4 vesico-urethral fistulae, 4 orchido-epididymitis, 4 haematuria-dysuria ...
Bladder augmentation in children and young adults: a review of published literature
International Journal of Urological Nursing, 2015
The objective of this study is to review published literature on bladder augmentation in children and young adults (C&YA) with a neuropathic bladder following a neural tube defect or spinal cord injury to inform nursing practice and patient education. Medline, Embase, CINAHL, PsycINFO and the British Nursing Index were systematically searched to identify studies. The papers reviewed were case studies and medical note review in single centres regarding outcome and post-operative complications. This limits the generalisability of the findings surrounding outcome and risk of bladder augmentation surgery in C&YA. Evidence suggests irrigation has a role in ongoing bladder management to reduce complications such as bladder calculi. However, data are sparse regarding both appropriate irrigation solutions and the frequency of irrigation necessary to minimise calculi formation. A statistically significant increase is noted in the risk of perforation following bladder augmentation when associated with bladder neck surgery at the time of primary surgery. Limited evidence exists regarding longer term systemic implications of bladder augmentation, such as malignancy or impact on bone mineral density. None of the studies demonstrated an overall improvement in health-related quality of life (HRQoL) following bladder augmentation. Discrepancies exist between parental and children's HRQoL scores. Bladder augmentation is clinically the standard surgical treatment used to manage refractory neuropathic bladder. However, current evidence demonstrates no improvements to HRQoL following surgery and also describes various complications. Future research in this area is necessary to explore standards of care and most importantly long-term outcome measures from the patient and professional perspective.
Complications after bladder augmentation in children
Acta Cirurgica Brasileira, 2016
Bladder augmentation is an effective surgical procedure for increasing bladder capacity and reducing pressure on the urinary system. It is indicated for patients with anomalies such as spina bifida, myelomeningocele, urethral valve and bladder exstrophy, who progress with low tolerance of medication.
Quality of life: urinary bladder augmentation or substitution in children
Pediatric Surgery International, 2009
Purpose Bladder augmentation and substitution has been assumed to improve health-related quality of life in patients with urinary incontinence. This study was performed to elicit an evidence base for or against the above hypothesis. Methods Between 1988 and 2006, 67 bladder augmentations and 7 bladder substitutions were performed at our institute. Inclusion criteria for the cross-sectional study were a postoperative period of more than 1 year and an age of at least 10 years at the time of operation. A multimodality treatment-specific questionnaire (comprising 38 questions) was designed and sent to 61 patients. Quality of life was investigated in all patients and between the groups of patients with meningomyelocele (Group A) versus bladder exstrophy (Group B), patients, who are catheterizing themselves via urethra (Group C) versus stoma (Group D) and patients who are using (Group E) versus not using wheelchair (Group F) following the surgery. For the statistical analysis Students t test, Wilcoxon signed rank test and correlation analysis were used. Results A significant overall improvement was found in patients quality of life following this surgery (P \ 0.05). Ninety percent of patients would prefer again bladder augmentation or substitution to their previous state. Patients with meningomyelocele are changing pads or diapers more frequently than exstrophy patients because of their bowel problems postoperatively. Quality of life improved better in patients performing CIC via stoma than in patients who perform it via their native urethra (P \ 0.05). Outcomes were independent of patients age and of the post-augmentation time to assessment (P \ 0.05). Conclusions Bladder augmentation or substitution significantly improved the health-related quality of life in children and young adolescents taking part in the study. The authors are planning a prospective long-term follow-up of the patients (longitudinal study) to validate the results.
The Treatment of Post-Urethrotomy Incontinence in Pediatric and Adolescent Females
The Journal of Urology, 2001
Purpose: Until 1986 many urologists performed currently outdated, redundant internal urethrotomy as standard therapy for recurrent urinary tract infection in girls. We describe the results of therapy in patients who became incontinent due to previous internal urethrotomy. Materials and Methods: Between 1986 and 1995, 21 female patients with post-Otis urethrotomy incontinence have presented at our department with combined dysfunctional voiding, recurrent urinary tract infection and various types of urinary incontinence partially based on bladder instability and often provoked by abdominal straining. All cases were diagnosed by repeat video urodynamics and ultrasound of the open bladder neck. Endoscopy provided proof of scarring in the bladder neck and urethra. All patients except 1 underwent conservative treatment for at least 2 years, consisting of pharmacological therapy, physical therapy and biofeedback training. Surgical therapy to cure incontinence was performed in 14 cases, including a conventional Burch-type colposuspension in 5, modified needle colposuspension in 4 and complete endoscopic excision of the urethral scars followed by open reconstruction of the bladder neck and urethra in an abdominoperineal procedure in 5.