Procedures

Radiology

Several different imaging studies are used routinely in the work-up of pediatric patients with urologic abnormalities. Some of these tests will be scheduled at the Shands Medical Plaza, while others will be scheduled at Shands Hospital. Please pay careful attention to the location and time that your tests are scheduled. In order to prepare your child for these tests, a description of each procedure is provided below.

Renal Ultrasound

This is a test that uses sound waves to image the kidneys, ureters, and bladder. The test is painless and not associated with any radiation exposure. A gel will be placed on the abdomen and a hand held transducer will be pushed against the skin to image the internal organs. An ultrasound is very effective in demonstrated swelling of the kidneys (hydronephrosis), kidney stones, bladder abnormalities, and masses of the kidney. It takes approximately 30-45 minutes to complete.

Voiding Cystourethrogram (VCUG)

A voiding cystourethrogram is a fluoroscopic study (real time X-ray) that is used to evaluate the urinary bladder during bladder filling and emptying (urination). Many children with urinary tract infections are found to have an abnormality of the bladder detected on a VCUG, most commonly vesicoureteral reflux. The test is performed by inserting a catheter into the patient and then slowly filling the bladder with contrast. Images of the bladder are taken during filling until the bladder is filled to capacity. The catheter is then removed and the child is asked to urinate and images of the bladder are again taken while the child voids. The test takes approximately 30-45 minutes to complete.

Renal Scan (Nuclear Renography)

A renal scan is a nuclear medicine exam in which a small amount of radioisotope is administered intravenously in order to measure the function of the kidneys and drainage of urine out of the kidneys. This test is usually performed if significant hydronephrosis or swelling of the kidneys is detected on a renal ultrasound, or if there is any question about the function of the kidneys. A catheter will also be inserted into young children who are not able to urinate on command. After the isotope is administered (most commonly Mag3), multiple images of the kidneys are taken. The uptake of the isotope by the kidneys is then measured in order to determine relative kidney function. Following uptake by the kidneys, the isotope is then filtered/excreted into the collecting system and drains down into the urinary bladder. Lasix (a diuretic) is administered through the IV about 10-20 minutes into the test in order to increase urine production from the kidneys. The speed at which the isotope drains out of the kidneys is then measured to determine if any significant kidney obstruction is present. This test takes approximately 1 hour to complete.

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Laparoscopic Surgery

Laparoscopic surgery is minimally invasive surgery in which a surgical technique is performed through multiple small incisions using a laparoscope and specialized instruments inserted through small trochars. The surgery is performed by insufflating the abdomen with carbon dioxide gas in order to create an adequate work space and to allow visualization of intra-abdominal organs. The goal of laparoscopy is to minimize patient morbidity and improve cosmesis while maintaining outcomes comparable to open surgery. The most common laparoscopic procedures in pediatric urology are laparoscopic orchiopexy (bringing down an intra-abdominal testicle into the scrotum) and nephrectomy (removal of the kidney).

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Robotic Surgery

Robotic surgery (da Vinci Surgical System) is similar to laparoscopic surgery in that the surgical technique is performed through multiple small incisions using a laparoscope and abdominal insufflation. Using a combination of computer and robotic technologies, however, robotic surgery provides the surgeon with enhanced visualization, precision, and dexterity over traditional laparoscopic surgery. This technology is particularly useful for urologic procedures that require suturing, such as a pyeloplasty (surgical correction of ureteropelvic junction obstruction) or ureteral reimplantation (surgical correction of vesicoureteral reflux).

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