Surgical Scrapbook

Some of the following pictures may be too graphic for some people. To us, they are just our kids, but they do show ostomies and catheters. These are posted so that other parents can see what they look like in case their children are in need of one of these surgeries.

PUV symptoms, especially in severe cases, are often seen on prenatal ultrasounds. In these few ultrasounds, you can see the black areas where urine is collecting. It cannot get out of the body, so the urine fills the bladder and then backs up into the kidneys where the pressure destroys the kidney tissue.

Sometimes there is so much fluid in the bladder and kidneys, that the abdomen of the baby is larger than his head. With all of that fluid inside, there is usually very little outside of the baby and that creates one of the biggest causes of death in these babies. Without fluid around the baby, they cannot practice breathing and their lungs do not develop.

Here are some children with pyelostomies and ureterostomies. These are holes made right into the ureter or kidney to let urine flow right out of the body. Some babies and children need these because their ureters and bladder are damaged.

A little boy is having a urine sample taken from his ureterostomy A bag is put over the ostomy so urine can flow into it.

Often when PUV babies have their ureters reimplanted into the bladder they need a stint to drain urine and help the area heal. Sometimes the stint can come out the lower abdomen area as well. When it is removed it only leaves a small hole that closes up on its own.

You can just see this little one's vesicostomy. It looks like another belly button a little lower down. A vesicostomy is a hole that goes right into the bladder to allow urine to flow right out. Some PUV kids have this and never need a ureterostomy or pyelostomy, but if the ureters are very stretched out, it might be better to divert the urine higher up, so there is less of a chance for urine to get stuck inside the kidneys or ureters.

Here is another little guy who has a vesicostomy. Sometimes the bladder "pooches" out of the hole. Sometimes this is ok, other times it causes the vesicostomy to fail and it needs to be fixed.

Of course having holes so high up on the body presents an interesting diapering situation.

Here's a guy who's PUVs caused him complete renal failure. This pictures shows his hemo dialysis catheter (in his upper chest with the square bandage). He was on hemo dialysis for a short time while his g-tube healed. You can see the g-tube (looks like the valve on a beach ball sort of) on the side of his tummy. Then there is also his peritoneal dialysis catheter. That is the long tube hanging out of his tummy. The exit site is covered with another square bandage. Unfortunately most children with renal failure do not want to eat, so they need a feeding tube either up their nose or surgically placed right into their stomach.

Another little boy who needed dialysis. You can see his Tenckhoff Catheter coming out of his tummy. This type of catheter is used for peritoneal dialysis. The tube coming out of his nose is a NG (naso-gastric) tube. It is used for feeding, just like a g-tube.

Here he is with a Bard Button to replace his NG tube
Some doctors feel that dialysis can't be done on newborns. This isn't the case. Here is a new baby with his peritoneal dialysis catheter.

This little boy was born with Prune Belly Syndrome. With PBS the stomach muscles are very weak or they don't form at all. This one has had surgery to help with the stomach muscles.

Here is a picture of the bladder wall taken during a cystoscopy (where they look up into the urethra and bladder). This picture shows trebeculation. This is what can happen to the walls of the bladder in a child with PUVs or other obstructive uropathy. If too much of the bladder wall looks like this, there can be serious bladder problems.
Here is a drawing of what is known as Type I PUV. We believe this to be the most common type of PUV, although most parents never know which type their child has or had.

Here you can see what the inside of the urethra can look like in a boy with type I PUVs.

Often kids with various urologic disorders have to have a lot of tests. A Mag 3 is one test that can determine kidney function. Another name is a Lasix Renal Scan. Babies and smaller children sometimes need to be sedated and/or strapped down so they can't move around a lot. This little boy has been sedated as well as strapped down.
There are many tests that can be done to determine what damage has been done to the bladder, ureters and kidneys. Many children will need to have a VCUG (voiding cystourethrogram) or similar test. Here are a few pictures of what a doctor might see from these tests. You can see how the fluid backs up into the kidneys and the ureters can be very enlarged and stretched out due to the pressure before birth.

This boy was born with VATERS. He needed to have various ostomies as well as a vesicostomy that he can cath through to empty his bladder.

This little one just had a surgery called pyeloplasty. It's used to correct a UPJ obstruction.

This picture below shows various scars. One is from the belly button down, that is from ureter reimplant surgery. The indented type scar is from his peritoneal dialysis catheter (was in that spot for 4 years). You can also see his Bard button, a gtube used for feeding and/or fluids.

Below you can see his scar from his nephrectomy as well as his kidney transplant scar.

Sometimes doctors will want to protect the remaining kidney when one has been removed. The picture below shows a kidney belt used for that purpose.

There are many structural changes that come from PUVs. Here is the urinary track from a baby with PUVs. You can see that everything from the bladder to the kidneys are damaged.