Discover Paediatric Surgery

DPS PUJ obstruction
[00:00:00] Welcome to Discover Paediatric Surgery.
Andrew: My name is Andrew Grieve and I look forward to being your host today on this exciting episode. We are lucky to have Professor Henning Olsen today with us is a pediatric urologist from Denmark. And I can never pronounce his Hospital properly Aarhus, aahurs, but Aarhus, I definitely haven't got it.
Henning: No one gets it right.
Andrew: So Professor Olsen has two interests in life. The one is Urology and the other is sailing. But sadly today, we're going to talk a little bit about Urology and maybe next time it's about sailing. Thank you for [00:01:00] joining us. We appreciate your time. Sayo Henning. I mean, we'll just jump in we're going to talk about pelvic ureteric Junction obstructions and obviously in children. I mean in the first world
there's obviously a lot of antenatal diagnosis of hydronephrosis does your unit get referred all the patients with this antenatal diagnosis for review or do you only see those that's end up having a problem later in life.
Henning: Well it depends on and if they came from the local area, that means something like 500,000 we will see them and then they come from from outside of the country, which or referral area is something like three and a half million.
They are seen in local hospitals and the prenatal diagnosis made there. And in case of a bilateral hydronephrosis, they come up [00:02:00] the questions and and often with bilateral hydronephrosis they are born in our Hospital. Unilateral hydronephrosis are born very normally and and get the follow-up after a schedule which we have in Danish Pediatric Society in the Danish Urological Society.
It's very clear schedule how to handle these kind of of patients. So it's just in case in case of off bilateral hydronephrosis, then then they have to be referred to us.
Andrew: So they're very early. Okay, do you ever get involved in antental counseling for these these parents?
Henning: Well, if we talk about infra-vesicle obstruction means urethal valves.
We are involved. Yes, because this is in some cases involve some some questions about continuing [00:03:00] the pregnancy and then the prognosis and what kind of surgery has to be done. And what's the prognosis after surgery? And what did what in general the parents have a very little understanding of course what the problem is and then they need some some discussion.
Andrew: Just to give us an idea.
I mean how many kids with hydronephrois that's noted antenatally, how many of those kids eventually come to surgery? Is it the majority of them or is it quite infrequent?
Henning: No, it's is very infrequent, well not very but it's in the around 25 to 30 percent. We are very conservative in especially unilateral hydronephrosis.
Andrew: And and I mean, you know, obviously there's a massive differential diagnosis for hydronephrosis. Do you know what portion in your unit eventually end up actually having a pelvouretheric junction obstruction out of all the antenatal hydronephrosis patients.
[00:04:00] Henning: The majority the vast majority is UPJO (ureteric pelvic junction obstruction) . Of course it is, okay.
You see reflex is is the next common cause of a kind of hydronephrosis but it's not so pronounced but in if you get trained in a way of looking at ultrasound their many, you know the AP diameter and they have calluses and then anything else but if you look at the ultrasound of a kidney in many cases...

DPS Chylothorax
[00:00:00] Andrew: Welcome to Discover Paediatric Surgery. My name is Andrew Grieve and I look forward to being your host today on this exciting episode. All right, so I'd just like to welcome Professor Kokila Lakhoo who's with us today from Oxford in the UK. Kokila is a clinical head of pediatric surgery in Oxford. Although Kokila works in the UK she's got very strong ties with Africa including South Africa, Tanzania and Malawi and she's got quite a passion for promoting care for children worldwide. So Kokila welcome and thank you for taking the time to join us. Kokila Lakhoo: You're most welcome. Andrew: Kokila today, we're going to chat about [00:01:00] Chylothorax or Chylothracies. Maybe you can just kick off by just defining for us what a chylothorax is? Kokila Lakhoo: Okay. So from a starting point it's a lymphatic fluid or a lymphatic effusion in the chest. And that's why chylo meaning lymphatic, thorax meaning the chest and when you really studying such a subject or when you have a patient of chylothorax the question you want to ask yourself is that is this congenital or is this aquired? Congenital chylothoracies have associated with a lot of syndromes and and if it's an acquired one, it's usually traumatic. Traumatic meaning iatrogenti injury during thoracic or cardiac surgery or during trauma and the recovery phase of the management of the two are very similar. But the [00:02:00] one has a very good and quick, better outcome, which is acquired one. Whereas the congenital ones can be quite trying due to the fact that they have other Associated abnormalities and sometimes you actually prognosticating whether this child's management should continue or not due to quality of life for these babies. Andrew: Yes. I suppose is one of the many problems. I suppose you have to tie it all together and decide what's the best way for the for the child and for the family? Kokila any sort of specific, you know, obviously the congenital ones as you say the symptoms are associated with but the aquired ones I mean, do we find any predisposing factors? I mean apart from sort of cardiac surgery in those things. Are there any patients that are more prone to that others? Kokila Lakhoo: No, I think it's mainly you know for during cardiac surgery more [00:03:00] so than when we doing our tracheoesophageal fistula repairs. And I haven't found inclination for a group of patients except that they need in cardiac surgery. Andrew: Okay. Now see some papers say that males are more predisposed and females, but you guys haven't really seen that in your experience. Kokila Lakhoo: Again, you are absolutely right, you know in the in the literature they said there's a gender preference towards male. But if you look at it generally in our figures, you know, we haven't found that difference. Andrew: Yeah, and then and in terms of the side that they develop the chylothorax, I mean it's a generally depend upon the side of the surgery or is it really depending on where the injury occurs. Kokila Lakhoo: So most of the time you have like a right-sided surgery, so we've been seeing them a lot on the right side and [00:04:00] it's surgery dependence so cardiac surgery could be you know, it's mainly median sternotomy is yeah, so it could be on the side. So, you know for cardiac surgery, there's no preferences when we look at pediatric surgical thoracic lesions many tend to be on the right side. And that's where we found. But if I have to give you an answer I would say chylothorax does not prefer a side. It has no site preferences. Andrew: