Bladder Outlet Obstruction
Everything in the library about bladder outlet obstruction — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Diagnosis & Workup
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Fetal Diagnostic Imaging: Cincinnati Fetal Center
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Dr. William Polzin, Division of Maternal-Fetal Medicine, discusses fetal diagnosis imaging and predictors as well as amnioinfusions by amnioport. Dr. Ron Jaekle, University of Cincinnati Department of Obstetrics & Gynecology, proceeds Dr. P
video10:34 · Nov 2018
Surgical Management
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Renal transplantation: Cincinnati Fetal Center
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Dr. Maria Alonso, Intestinal Transplant Surgeon, presents on renal transplantations. She discusses general surgical needs, gastrostomy tube, peritoneal dialysis catheter, hemodialysis catheter, extra peritoneal approach, extra vesicle re im
video13:51 · Nov 2018
Long-Term Care
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Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center
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Dr. Foong-Yen Lim introduces the session topics of discussion, the challenges of neonatal dialysis, the pathway of renal transplantation, and pulmonary survivor qualifications. Dr. Paul Kingma, Neonatal Director, Cincinnati Fetal Center, di
video35:10 · Nov 2018
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Renal transplantation: Cincinnati Fetal Center
Infants with renal failure are often called for gastrostomy tube and peritoneal dialysis catheter placement within the first few days of life.
clinicalAlonso0:13 ↗
Babies that make urine are not likely to need peritoneal dialysis immediately but are likely to need it in the future.
clinicalAlonso0:31 ↗
Peritoneal dialysis catheters should ideally be left alone for a couple of weeks after placement if possible.
clinicalAlonso0:49 ↗
Gastrostomy tube placement is focused along the lesser curvature or close to it to preserve stomach tissue for potential future bladder augmentation by Doctor Reddy.
clinicalAlonso0:49 ↗
Gastrostomy tube placement is performed laparoscopic-assisted to visualize exact stomach location, then the camera is turned into the pelvis to position the PD catheter.
clinicalAlonso1:21 ↗
The nephrology team is generally good at predicting which babies will need a peritoneal dialysis catheter.
opinionAlonso1:42 ↗
Hemodialysis catheters need to be fairly large caliber and are preferentially placed in the right internal jugular site because it provides a straight shot into the atrium.
clinicalAlonso2:04 ↗
Inguinal and umbilical hernias can develop when babies are on peritoneal dialysis.
clinicalAlonso3:03 ↗
Hernias in dialysis patients are generally left alone if they are not affecting dialysis mechanics or causing symptoms.
clinicalAlonso3:03 ↗
The ideal weight for infant renal transplantation is around 10 kg if the patient is not on peritoneal dialysis.
clinicalAlonso3:46 ↗
Infants on peritoneal dialysis have a more accommodating abdominal cavity and laxity in the abdominal wall, allowing transplantation at weights closer to 8 kg.
clinicalAlonso4:08 ↗
All infant renal transplant recipients at this center have been transplanted with adult donor kidneys.
clinicalAlonso4:24 ↗
An extraperitoneal approach is used for infant renal transplantation with an incision extending to the upper edge close to the costal margin.
clinicalAlonso4:39 ↗
Wound complications are the biggest complication from a general surgical perspective in infant renal transplantation, surprisingly more common than vascular complications.
clinicalAlonso5:06 ↗
Some infant transplant patients can only be closed at the skin level initially and develop leaks or dehiscence requiring biologic mesh (such as derma matrix) for closure.
clinicalAlonso5:15 ↗
In a 13-year follow-up study of gastrostomy tubes in babies, all G-tubes migrated superiorly onto the chest wall.
clinical7:21 ↗
Placing gastrostomy tubes too close to peritoneal dialysis catheters creates infection risk early on because drainage can get underneath the PD catheter dressing when there is insufficient space between sites.
clinicalAlonso7:54 ↗
The standard gastrostomy tube insertion site is 2 finger breadths below the costal margin.
clinicalAlonso8:31 ↗
For patients with posterior urethral valves, gastrostomy tube location is placed high on the stomach toward the lesser curvature to preserve the ability to use a gastric segment for gastric augmentation later in life.
clinical8:48 ↗
Some infants with posterior urethral valves will need urinary diversion with a vesicostomy placed about 1-2 finger breadths below the umbilicus, requiring mitigation of infection risks by spacing catheter sites appropriately.
clinical9:13 ↗
Peritoneal dialysis catheters can be placed in a way that allows immediate use with lower volumes, though waiting for healing is preferable.
clinicalAlonso11:27 ↗
Many infants with bladder outlet obstruction have unusually small stomachs, potentially related to minimal amniotic fluid during development.
host_summary11:50 ↗
Amnioinfusions are performed when patients present for first imaging to assess the baby's capacity to swallow and see if the stomach fills.
clinical12:30 ↗
Early onset large bladders that extend upward and push the diaphragm and stomach back may cause anatomical distortion that results in stomachs ending up higher long-term.
opinion13:23 ↗
Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center
If amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases to approximately 80%.
clinicalPaul Kingma2:42 ↗
If amniotic fluid levels are not returned to normal, the pulmonary outcome is poor.
clinicalPaul Kingma3:08 ↗
Many infants who are pulmonary survivors have reduced reserve lung function, similar to reduced reserve renal function, and can rapidly transition from pulmonary survivor to non-survivor if injured.
clinicalPaul Kingma5:33 ↗
Babies with renal problems who had normal amniotic fluid after replacement have developed chronic lung disease after delivery, demonstrating they are not normal from a respiratory standpoint.
clinicalPaul Kingma6:00 ↗
Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites.
clinicalJan Scober10:32 ↗
Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine.
clinicalJan Scober11:03 ↗
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