Further Outpatient Care
- Bladder diverticula: No follow-up care is required after surgical removal. Small diverticula that are treated by observation alone may be annually monitored with renal and bladder ultrasonography.
- Urachal sinus: No follow-up care is required after surgical removal.
- Urachal cyst: perform yearly ultrasonographic studies if small cysts are to be monitored. No follow-up is necessary after surgical removal.
- Patent urachus: No follow-up care is necessary after surgical removal.
- Vesicourachal diverticulum: No follow-up care is necessary.
- Bladder ears: No follow-up care is necessary.
- Bladder agenesis: Frequent outpatient follow-up visits are necessary after urinary diversion. Initially, outpatient follow-up care may occur as often as monthly. Once stable, follow-up visits usually are annual. Serial renal ultrasonographic evaluation is used to assess renal growth and the presence or absence of hydronephrosis. Conduit ultrasonography can detect the presence of stones. Serum electrolytes and creatinine help detect metabolic disturbances and renal insufficiency.
- Megacystitis: Yearly renal and bladder ultrasonographic evaluation may be appropriate until just after the toilet training period to monitor the upper tracts and ensure adequate bladder emptying.
- Bladder duplication: Yearly renal and bladder ultrasonographic evaluation may be appropriate, as described for megacystitis.
- Bladder septation: Yearly renal and bladder ultrasonographic evaluation may be appropriate, as described for megacystitis.
Deterrence/Prevention
- These conditions are congenital. The timing of altered embryogenesis leading to these conditions has been a matter of speculation, and the embryologic cause of these lesions is unknown.
Complications
- Complications are related to persistent obstruction or recurrent urinary tract infections, namely renal insufficiency or failure. If the obstruction is corrected and urinary drainage is unimpeded, long-term complications are minimal. In the case of bladder agenesis, the long-term complications are related to those specific to urinary diversion, continent reservoir, or both. These include ureteral stricture at the junction of the ureter and reservoir, reservoir stones, recurrent urinary tract infection, stomal stenosis of the catheterizable segment, and metabolic disturbances relative to the intestinal segment used.
Prognosis
- Bladder diverticula - Excellent
- Urachal sinus - Excellent
- Urachal cyst - Excellent
- Patent urachus - Excellent
- Vesicourachal diverticulum - Excellent
- Bladder ears - Excellent
- Bladder agenesis - Guarded
- Megacystitis - Good
- Bladder duplication - Good to excellent
- Bladder septation - Variable, guarded to good depending on anatomy and degree of renal dysfunction
Patient Education
- In all these conditions, an element of voiding dysfunction may exist. Educate parents regarding frequent and complete bladder emptying after the toilet training period to guard against infrequent and dysfunctional voiding patterns. In general, children should void approximately 5-6 times per day, which equates to voiding every 3 hours. Infrequent and dysfunctional voiding in the presence of an anatomic abnormality may place the child at increased risk for febrile urinary tract infections and renal damage.
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