Genitourinary Disorders

1. Hypospadias
1. Introduction: Hypospadias is a congenital anatomical defect of the male genitourinary tract, readily detected at birth through simple visual examination. In hypospadias, the urethral opening is located on the ventral surface of the penile shaft; this makes voiding in the standing position virtually impossible, and serious psychological problems could therefore occur. Ideally, staged surgical repair should be completed by 6-18 months of age, before body image is developed or castration fears are evident
2. Assessment:
1. Urethral opening is located on ventral surface of penis.
2. May be accompanied by “chordee”-ventral curvature of the penis due to a fibrous band of tissue.
3. Rare: ambiguous genitalia, resulting in need for chromosomal studies to determine sex of neonate.
3. Analysis/nursing diagnosis:
1. Altered urinary elimination related to congenital anatomical defect of penis.
2. Pain related to surgery and treatments.
3. Self-esteem disturbance related to anatomical defect in penis and resulting disturbance in ability to void standing up.
4. Knowledge deficit related to condition, surgeries, outcome.
4. Nursing care plan/implementation:
1. Goal: promote normal urinary function.
1. Teach family that surgery is done in several stages, beginning in the early months of life and finishing by age 18 months.
2. Provide age-appropriate information to child regarding condition, surgery.
3. Preoperative teaching with child: simulate anticipated postoperative urinary drainage apparatus and dressings on dolls; allow child to handle and play with them now, but stress need not to touch postoperatively.
4. Postoperatively: Monitor urinary drainage apparatus; note hourly urine output, color, appearance (should be clear yellow, no blood).
2. Goal: promote self-esteem.
1. Do not scold child if he exposes penis, dressings, catheters, etc.
2. Reassure parents that preoccupation with penis is normal and will pass.
3. Encourage calm, matter-of-fact acceptance of, and avoid strict discipline for, this behavior, which could negatively affect the child.
5. Evaluation/outcome criteria:
1. Child is able to void in normal male pattern.
2. Child does not experience disturbances in self-concept and has normal self-esteem.


2. Wilms’ tumor (nephroblastoma)
1. Introduction: Wilms’ tumor, a malignant tumor of the kidney, is the most common form of renal cancer in children. Peak incidence occurs at 3 years of age, with a slightly higher incidence in boys than girls. Ninety percent of the cases occur unilaterally; the treatment of choice is nephrectomy (and adrenalectomy) followed by chemotherapy and radiation.
2. Assessment:
1. Most common sign: abdominal mass (firm, nontender).
2. Most often first found by parent changing diaper; felt as a mass over the kidney area.
3. Intravenous pyelogram (IVP) confirms the diagnosis.
4. Metastasis occurs most frequently to the lungs: pain in chest, cough, dyspnea.
3. Analysis/nursing diagnosis:altered urinary elimination (other diagnoses depend on stage of tumor and presence of metastasis-similar to adult with cancer).
4. Nursing care plan/implementation:
1. Goal: promote normal urinary function.
1. Inform family that surgery is scheduled as soon as possible after confirmed diagnosis (within 24-48 hours).
2. Explain to family that the preferred surgical approach is nephrectomy (and adrenalectomy).
3. Preoperative: do not palpate abdomen because the tumor is highly friable, and palpation increases the risk of metastasis.
4. Postoperative nursing care: similar to care of adult with nephrectomy.
5. Postoperative care also includes long-term radiation therapy and chemotherapy (actinomycin D, vincristine, adriamycin;).
2. Goal: discharge teaching to prepare parents to care for child at home.
1. Teach parents need for long-term follow up care with specialists: oncologist, urologist.
2. Answer questions regarding prognosis, offering realistic hope.
1. Children with localized tumor: 90% survival rate.
2. Children with metastasis: 50% survival rate.
5. Evaluation/outcome criteria:
1. Child is able to maintain normal urinary elimination.
2. Parents verbalize their understanding of home care for the child.


3. Nephrosis (idiopathic nephrotic syndrome) is a chronic renal disease having no known cause, variable pathology, and no known cure. It is thought that several different pathophysiological processes adversely affect the glomerular membranes of the kidneys, resulting in increased permeability to protein. This “leakage” of protein into the urine results in massive proteinuria, severe hypoproteinemia, and total body edema. A chronic disease, nephrosis often has its onset during the preschool years but is characterized by periods of exacerbation and remission throughout the childhood years.
   
   The nursing care plan for the child with nephrosis is very similar to that for the adult with compromised renal functioning.