Annual Report 2016 PEDIATRIC UROLOGY. Seppo Taskinen

Transcription

1 Annual Report 2016 PEDIATRIC UROLOGY Seppo Taskinen

2 Contents Introduction 2 Personnel and resources 3 Pediatric surgery appointments 3 Children s urological surgeries 4 Quality 7 Networking of urology with other Children s Hospital specialities 8 Research activity 8 Introduction Figure 1. Percentage distribution of patients treatment days treated by HUH Children and adolescents in HUH Medical treatment for children and adolescents, Pediatric urology is responsible for the diagnostics and treatment of the structural abnormalities, diseases and dysfunctions of children s urinary organs and genitals. In addition, Pediatric urology is responsible for the relevant diagnostics and surgical treatment of tumours. Pediatric urology is not nationally centralised, but in practice, HUH is responsible for the bladder and cloacal extrophies, epispadias, difficult or rare genital structural abnormalities or the urinary tract reconstructions of patients with severe kidney disorders or kidney transplants, some surgical treatments of neurogenic bladder, and some of the more rare urogenital cancer surgeries in Finland. About a third of the pediatric urology patients treatment days consist of patients outside the HUS district (Figure 1). The largest outpatient group consists of children who are examined and whose need for care is assessed antenatally (prior to birth) due to suspected structural abnormalities of the urinary tract. Personnel and resources Two specialists (Head of Department and Senior Ward Physician) and a specialising pediatric surgeon are responsible for children s urological operations at the Children s Hospital. In addi- tion, administratively the unit includes one Senior Ward Physician working in Jorvi. The clinic has two nurses who are qualified urotherapists. Pediatric urology appointments There were 2400 urological outpatient visits in the Pediatric surgery clinic. 2 UROLOGIA TOIMINTAKERTOMUS

3 Urological outpatient clinic patients Based on age and other patient-specific factors, the patients of Pediatric urology are treated are treated in different departments of Children s Hospital (Figure 3). After urological surgeries, there is usually no need for treatment in the intensive care unit. Every year, patients from the Children s Hospital Pediatric kidney and transplant department inpatient ward undergo surgery for renal insufficiency. Children s urological surgeries igure 2. Pediatric urology outpatient clinic visits, consultations and calls. About children s urological surgeries are performed yearly (Figure 4). Most commonly, the operations are performed on preschool and school-age children (Figure 5). Surgical treatment has also been offered for so called transition-stage patients if it is a question of a birth defect, if the patient is severely handicapped, or in another specific, rare case. The major part of children s urological surgeries occur less than five times a year, so the yearly variation of single surgeries may be percentually significant. Table 1 displays the number of typical operations by disease group. Children s urological surgeries Figure 3. Number of urological patients and treatment days in inpatient ward. Figure 4. Number of children s urological procedures in total. 4 UROLOGIA TOIMINTAKERTOMUS

4 Quality Figure 5. Age distribution of urological procedures in Many children s urological surgeries are prone to complications. A typical example is the most common children s urological surgery, i.e. a hypospadias repair. The most common reported complication is an fistula, which is allowed to appear after less than 5% of distal and 15% of proximal hypospadias surgery. In practice, these make up less than 10% of all hypospadias surgeries. Table 2 presents the numbers of children s resurgeries after hypospadias surgery. The patient may have received treatment elsewhere before the repeated procedures. Most often, fistula surgeries and other repeated surgeries usually occur in a different year than the original surgery. In the latest years, the goal level has been reached. A third of patients treated for posterior urethral valves have undergone kidney transplant. A third of these patients were already adults at the time of the new surgery. In the last decades, more patients in poor condition have survived, so the need for kidney transplants has increased. During the last 25 years, two of about a hundred posterior urethral valve patients have died due to complications related to the disease. When assessing the results, it must be taken into account that pregnancy terminations are rare due to posterior urethral valves in Finland. The results of reconstructing urinary tracts are good. In this century, no initially well or acceptably working kidney with structural abnormality has been lost during follow-up or as a result of a reconstructive surgery. Typical children s urological surgeries Kidney surgeries kidney laparoscopy UPJ obstruction repairs Ureteral surgery deflux injections Bladder augmentations Boys outer genital repairs (incl. hypospadias) Gynaecological surgeries Malignant tumours Hypospadias new surgeries fistula surgeries all resurgeries Table 2. Repeated surgeries related to hypospadias repair. Benign tumours LK 3 surgery (renal insufficiency) Table 1. Typical children s urological surgeries in UROLOGIA TOIMINTAKERTOMUS

5 Networking of urology with other Children s Hospital specialities Children s urology is in close cooperation with other specialities. The most active cooperation is with children s nephrology. Several outpatient clinic patients demand urological and nephrological follow-up due to renal insufficiency. The control visits of these patients are attempted to be arranged so that, if necessary, it will be possible to see the urologist and the nephrologist on the same day. Urologists also participate in the planning of kidney transplants and transplant support services as necessary. A major part of urological patients arrive from the maternal hospital referred by a neonatologist. Some of the urological patients have structural abnormalities in several organs, and if necessary, the treatment is planned with other surgical specialities such as gastro surgery, neurosurgery and orthopedics. There has been especially active cooperation with gastro surgeons on anorectal anomaly patients, some of which have been followed-up on weekly outpatient clinic visits. In the last years, cooperation has also increased with adolescents gynaecologists, especially on planning the so called transition stage in patient care. There is a long history of cooperation with oncologists on cancer treatments. Urological patients need ICU care more rarely, but the unit does offer consultation services for the intensive care unit. Different consultation services are also offered for other children s surgical units in Finland. The children s urological unit also works together with adult urology, so that the transition to adult care of patients with severe problems would go smoothly. Research activity Children s urology also does research. In , children s urologists have published or participated in 24 international scientific papers. Research activities have traditionally focused on the long-term results of different urological disorders. Research subjects have included cryptorchidism, girls genital reconstructions, urethral flap and bladder exstrophy, and epispadias. Research is also performed on the problems of antenatal hydronephrosis, urological tumours (kidney, testicle, and ovary tumours) and neurogenic bladder. The problems of anorectal anomaly patients have been researched with gastro surgeons. In the last years, children s urology has actively participated in the Nordfertil effort whose goal is to develop treatment methods for preserving the fertility of children with cancer. 8 UROLOGIA TOIMINTAKERTOMUS

6 The Children s Hospital (Helsinki) Street address: Stenbäckinkatu 11, Helsinki Postal address: P.O. Box 281, FI HUS Telephone: +358 (0)