UROLOGICAL EMERGENCIES IN NEWBORN INFANTS

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Abstract
Children who do not void after birth should be recognized as being in great danger. Where obstructing urinary lesions are found, drainage by nephrostomy is always safer than by a suprapubic cystostomy or a urethral catheter, which is necessarily small, and might lead to lethal sepsis in this situation. The treatment of obstructions of the bladder neck is surgical. Patent urachus may result from obstructions of the bladder outlet. The treatment is surgical and the obstruction should be relieved before the urachus is closed. Children born with deficient abdominal musculature, even when partial, usually have an accompanying severe obstruction of the bladder neck, dilation and infection of the urinary tract. They are also prone to have undescended testes and other extraurinary anomalies, such as club foot. Obstructions must be relieved and a corset prescribed. Neurogenic bladders in children are troublesome and must be assumed to be present when meningoceles, sacral defects and neurologic deficits of the perineum and legs are found. Urological studies may be deferred, but for a few weeks only. Masses in the abdomen must be considered to be Wilms tumors or sympathocoblastomas until proven otherwise by pyelograms or even exploration. The kidney is by far the most common organ to cause a surgical mass in the abdomen, whether it be enlarged from tumor, cystic disease or hydronephrosis. The treatment of undescended testes can usually be put off until the age of 5 or 6 years, unless a large hernia is present, whereupon operation can be done at once. A trial of hormone therapy is advised before age 6; if it is unsuccessful, orchidopexy should be done before age 7. Exstrophy of the urinary bladder may now be treated by functional closure in most cases, and every child should be offered at least one good chance at this anatomic restoration, either at birth or at the age of 3 months. Traumatic torsion of the genitalia, if severe, usually requires surgery. The contralateral testis should be fixed in place, to forestall its possible torsion at some future date. Thromboses of the renal vein with dehydration and omphalitis can be treated hopefully with anticoagulants and chemotherapy and other supporting measure. Surgery may be considered, but is precarious. Salt-losing tendencies in newborn children with congenital adrenogenital syndrome and dehydration can be treated medically and successfully if recognized in time. Fistulas between rectum and urethra, accompanying imperforate anus, can be treated surgically after the child is several months old and better able to tolerate anesthesia. Masses presenting at the vulva, with or without urinary obstruction, may be prolapsing ureteroceles or imperforate hymens with mucocolpos. Large teratomas are sometimes seen attached to the perineum causing urethral obstruction, and they must be removed.

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