How do you prepare families for a major reconstructive surgery?
Patients with epispadias, bladder exstrophy, and cloacal exstrophy all require major reconstructive surgery in the newborn period in order to close the bladder and close the urethra that’s typically exposed on the lower abdominal wall. I can never put myself in the parents’ shoes, but we assume and try to appreciate as best we can that this is a major event: it’s a traumatic event, it’s a highly-charged and anxiety-provoking event for the families. As best we can, we try to prepare them for the surgery by educating them as to why we think it’s necessary and exactly what we do during the surgery. In a way, we try to simplify it so that they can understand the general principles of what we’re doing and in that way feel a little more comfortable about a major reconstruction. In the case of the patient who needs surgery as a newborn, it’s really helpful if the diagnosis made is prenatally. Then we can work with the family quite a bit on those issues and educate and prepare them before the child is born.
Joseph Borer, MD, Department of Urology
How do families decide to pursue reconstructive surgery?
Some of the later reconstructions, maybe even all of them, are elective. Very few of them are emergencies. The emergency for a patient who can’t empty their bladder is what we call urinary retention, and then we might pass a catheter to relieve the obstructed urine flow, either in the Emergency Department or even in the operating room with a patient under anesthetic. The other procedures are generally options. We might feel as physicians, with our education and knowledge and experience, that the reconstruction would be a big benefit to this patient, and that way we make our recommendations. These are strategies towards optimizing the health of the child. For example, to correct incontinence or protect the kidneys that might be at risk for damage if bladder pressures are too high, we might recommend bladder augmentation.
Joseph Borer, MD, Department of Urology