Minimally Invasive Pediatric Urologic Surgery

Samir S. Taneja, MD, Consulting Editor

Pediatric Urology is truly a discipline of Urology unto itself. While most of us trained in the basics of the “bread-and-butter” procedures, the practice of Pediatric Urology has evolved to a highly specialized science with techniques and approaches to disease that are often entirely distinct from their Adult Urology counterpart. Nonetheless, an understanding of the contemporary approach to urinary tract disease within the pediatric patient is critically important for every practicing urologist—not just for the ability to counsel patients at time of triage but also to determine if such practices might influence our approach to the adult patient. Much of the innovation in urologic surgical approach, reconstruction, disease management, and perioperative management comes from our pediatric colleagues. Some of the advances are, indeed, specific to the pediatric patient, but many span across the discipline.

Minimally invasive approaches to urologic surgery have revolutionized the surgical management of most common urinary tract disorders. The impact is, perhaps, greatest in the management of pediatric patients. My recollection of pediatric urologic surgery is that of complex procedures performed through small incisions stretched wide open. While such incisions left small scars, the pain children encountered in recovery was certainly considerable. Aside from the commonly thought of impact of minimally invasive procedures on the speed of recovery, the implications on the psychological recovery of the child are broad reaching, ranging from pain and pain medication use to return of appetite to cosmetic outcome. Furthermore, the ability to perform procedures in a minimally invasive pattern, if proven to have less impact on the recovery of the child, may impact on the indications for the surgery itself.

In this issue of Urologic Clinics , Dr Aseem Shukla, the Director of Minimally Invasive Surgery at the Children’s Hospital of Philadelphia, has created a comprehensive overview of common and emerging minimally invasive procedures in Pediatric Urology. The contributing authors have provided not only a description of the technique but also a discussion of the potential impact of each procedure on the field, and controversies surrounding its use. I am deeply indebted to Dr Shukla and all the contributing authors for this outstanding issue.

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