Sunday, December 7, 2008

Urinary Bladder Exostophy And Epispadiasis In A Child

A young father with limited financial resources presented with complaints of his child bieng operated several times for repair of his bladder and genitilial malformations.The dilemma here is how to provide adequate information and satisfy the guardian as a third party support person.As I am a trained family physician with vast experience in support counselling and referral,I could handle the situation.It is difficult for surgeons working in poor countries with vast populations with limited time and resources to provide adequate information and support to such people.For people with complicated surgeries it is imperative that a whole lot of information on Procedure,Type of Surgery,Expected or desired Results,Financial liabilities,Other costs be provided.A good website is provided on Boston Children Hospital for this necessary information.For people without access to internet it is the local family physician who is the best support person.Children with urinary bladder exostophy or bladder bieng outside abdomen several operations maybe needed depending on the extent of malformation.As usually the genitilia is also not formed properly, its repair is also an issue.The long term use of medicines is also required.The operating surgeon should discuss all these aspects in detail before starting treatment.In this case a long duration treatment by the mother using NSAIDS for joint pain during early pregnancy was most likely cause.It is essential that people be aware of using any drugs without prescription and also the physician should not provide long usage prescriptions to females of childbearing age.As a precaution all family physicians should use vigilance criteria checklists for all their patients using a groups and drugs with interactions in mind.A religious use of these checklists will ensure prevention of such morbidity and health burden.

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