Urinary Tract Infection
Everything in the library about urinary tract infection — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Evidence & Research
2 items
Challenging Dogma: Does Colostomy Type Matter?
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Dr. Todd Ponsky reviews the article "loop versus divided colostomy for the management of anorectal malformations: a systematic review and meta-analysis," by Dr. Fouad Youssef, Dr. Baird and colleagues at The Montreal Children's Hospital of
video1:29 · Sep 2018
Challenging Dogma: Does Colostomy Type Matter?
Watch →
Dr. Todd Ponsky reviews the article "loop versus divided colostomy for the management of anorectal malformations: a systematic review and meta-analysis," by Dr. Fouad Youssef, Dr. Baird and colleagues at The Montreal Children's Hospital of
video1:29 · Sep 2018
In-Depth Reviews
1 item
Urology Part I
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This podcast is a discussion between Dr. Todd Ponsky and Dr. Patricio C. Gargollo, the Senior Associate Consultant Pediatric Urologist at the Mayo Clinic Rochester and Associate Professor of Urology at the Mayo Medical School. The goal of
podcast69:50 · Dec 2020
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Urology Part I
UTI risk in the first year of life is 3-4% overall, with uncircumcised boys having 1/100 risk versus circumcised boys 1/1000 risk
epidemiologicalPatricio Gargollo2:40 ↗
Circumcision provides 53% protection against HIV transmission in randomized trials from Kenya and Uganda, with both trials stopped early due to significant benefit
clinicalPatricio Gargollo4:16 ↗
Circumcision decreases risk of HIV, syphilis, gonococcus, HPV, and HSV-2, but does not change chlamydia risk
clinicalPatricio Gargollo3:16 ↗
The AAP states that data are not sufficient to recommend routine neonatal circumcision, and parents should be given accurate, unbiased information
host_summaryPatricio Gargollo5:19 ↗
Office circumcision should be limited to infants 3 months or younger or weighing less than 13 pounds to minimize restraint difficulty and bleeding risk
opinionPatricio Gargollo6:56 ↗
Exposing young children to elective general anesthesia such as for circumcision is not recommended from an anesthetic safety standpoint
clinicalPatricio Gargollo7:53 ↗
The best analgesia for circumcision is a dorsal penile nerve block combined with a ring block using 0.25% bupivacaine without epinephrine
clinicalPatricio Gargollo9:28 ↗
The Gomco clamp is preferred over Plastibell (subjectively more complications) and Mogen clamp (risk of glans amputation)
opinionPatricio Gargollo10:22 ↗
Glans amputation during circumcision has been seen 2-3 times with Mogen clamp when small glans is pulled through the slit
clinicalPatricio Gargollo11:07 ↗
Complete preputial adhesion takedown is essential—you must see the ridge under the corona all the way around to avoid asymmetric skin removal
clinicalPatricio Gargollo15:55 ↗
When using Gomco, leave the bell on for at least 5 minutes for older infants (closer to 3 months/13 pounds) and 1-2 minutes for newborns
clinicalPatricio Gargollo16:56 ↗
When removing the Gomco bell, force the skin off the bell rather than pulling the bell off the skin to avoid separating crushed edges
clinicalPatricio Gargollo17:01 ↗
A safety pin through both edges of the dorsal slit helps pull foreskin through the Gomco base hole more easily
clinicalPatricio Gargollo17:51 ↗
Before clamping, check underneath the bell to ensure shaft skin (not scrotal skin) is visible and the median raphe is centered to avoid twisting
clinicalPatricio Gargollo19:35 ↗
Vaseline dissolves Dermabond, so parents must be instructed not to apply Vaseline after Dermabond circumcision
clinicalPatricio Gargollo20:47 ↗
Office circumcision tray should include 6-0 chromic or fast-absorbing plain suture for bleeding and 1:1000 epinephrine for topical hemostasis
clinicalPatricio Gargollo21:27 ↗
For OR circumcision, 6-0 or 5-0 fast-absorbing plain gut (used by plastic surgeons on face) heals nicely; Vicryl causes pie-crusting unless subcuticular
clinicalPatricio Gargollo22:17 ↗
Physiologic post-circumcision adhesions (distinct line visible, common in chubby babies) do not need treatment and will lyse spontaneously as the child grows
clinicalPatricio Gargollo25:38 ↗
Lysing physiologic adhesions in the office can turn a non-problem into a problem by creating a raw surface that forms a true skin bridge
clinicalPatricio Gargollo26:21 ↗
True skin bridges (no line, two holes on each side) require treatment because they tether the penis and do not resolve spontaneously
clinicalPatricio Gargollo27:15 ↗
Most skin bridges can be lysed in office with EMLA cream for 30-40 minutes, hemostat placement, and fine scissor division
clinicalPatricio Gargollo27:47 ↗
Redundant foreskin appearance after circumcision is usually due to suprapubic fat pad displacing skin distally; if penis looks circumcised when fat pad is pushed down, no revision is needed
clinicalPatricio Gargollo29:25 ↗
Dr. Gargollo has never seen an adolescent complain of too much foreskin after circumcision, suggesting most cases resolve with puberty
clinicalPatricio Gargollo29:57 ↗
Dr. Gargollo performs only 1-2 redo circumcisions per year despite high volume, indicating most redundant skin resolves spontaneously
clinicalPatricio Gargollo30:53 ↗
Meatal stenosis is a condition exclusively seen in circumcised boys, caused by meatal inflammation from rubbing against diaper/underwear creating a 6 o'clock web
clinicalPatricio Gargollo32:11 ↗
Meatal stenosis requires intervention only when urine stream deviates straight upward or child must sit to void, not for subjectively narrow meatus alone
clinicalPatricio Gargollo32:45 ↗
Office meatotomy can be performed with EMLA cream, straight hemostat crush of 6 o'clock web, and fine scissors; sutures at 3 and 6 o'clock have no proven benefit for reducing recurrence
clinicalPatricio Gargollo33:44 ↗
Dr. Gargollo has never seen an adolescent with meatal stenosis, suggesting many subjectively narrow meatuses normalize with growth
clinicalPatricio Gargollo33:29 ↗
Hypospadias, buried penis, penile-scrotal webbing, penile torsion, and congenital megaprepuce are contraindications to routine circumcision and should be referred to pediatric urology
clinicalPatricio Gargollo36:58 ↗
For distal hypospadias discovered during circumcision, the circumcision can be completed because foreskin is not used in modern distal hypospadias repairs
clinicalPatricio Gargollo51:14 ↗
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