UROLOGIA PEDIATRYCZNA - WYTYCZNE EUROPEJSKIEGO TOWARZYSTWA UROLOGICZNEGO (6/6)

<h2 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 17px; font-stretch: inherit; font-weight: 500; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span class="" style="margin: 0px; padding: 0px;">3.16.</span></span></span><span style="margin: 0px; padding: 0px;"><span class="" style="margin: 0px; padding: 0px;"> Zaburzenia rozwoju płci</span></span></span></h2> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_16_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.16.1.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Epidemiologia, etiologia i patofizjologia</span></span></span></h3> <div class="separator" style="background-color: white; border: 0px; clear: both; color: #585858; font-family: Helvetica, Arial, sans-serif; font-size: 16px; font-stretch: inherit; line-height: 28px; margin: 0px; padding: 0px; text-align: center; vertical-align: baseline;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2pHbPKquhkIV-cZECzV8qHf9JI4XFxTnR-bUYchFksMLVniUMGkadmAPgKKo_JG0XuKG83WcDWMBmRYMZAPq-lDkE9yhlRh2MGdNcv6vi7ZB8EbcSDFs_W8FJaOnr0Z2FkSzqZ7yz5aU/s1600/a.png" imageanchor="1" style="border: 0px; clear: left; color: #333333; float: left; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 1em 1em 0px; outline: none; padding: 0px; text-decoration: none; transition: all 0.25s; vertical-align: baseline;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2pHbPKquhkIV-cZECzV8qHf9JI4XFxTnR-bUYchFksMLVniUMGkadmAPgKKo_JG0XuKG83WcDWMBmRYMZAPq-lDkE9yhlRh2MGdNcv6vi7ZB8EbcSDFs_W8FJaOnr0Z2FkSzqZ7yz5aU/s200/a.png" style="border: 0px none; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; height: auto; line-height: inherit; margin: 0px; max-width: 100%; outline: none; padding: 0px; position: relative; vertical-align: baseline;" width="115" /></a></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> The formerly called ‘intersex disorders’ were recently the subject of a consensus document in which it was decided that the term ‘intersex’ should be changed to ‘disorders of sex development’ (DSD) [<a href="https://uroweb.org/guideline/paediatric-urology/#note_742" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;">742</a>,<a href="https://uroweb.org/guideline/paediatric-urology/#note_743" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;">743</a>].</div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Nowa klasyfikacja powstała ze względu na postęp w dziedzinie wiedzy o molekularnych przyczyn genetycznych nieprawidłowego rozwoju seksualnego kontrowersje nieodłącznym elementem postępowania klinicznego oraz kwestii etycznych. </span><span style="margin: 0px; padding: 0px;">Kontrowersyjne i pejoratywne terminologii, np 'pseudohermafrodytyzm "i" hermafrodytyzm ", została zmieniona zgodnie z nowymi spostrzeżeniami patofizjologicznych. </span><span style="margin: 0px; padding: 0px;">Ponadto niektóre warunki stwarzające z ciężkimi wadami rozwojowymi narządów płciowych męskich, takich jak prącia agenezji, kloaki exstrophy, która nie mogła być zakwalifikowana, zostały również uwzględnione. </span><span style="margin: 0px; padding: 0px;">"Zaburzenia rozwoju płci" pojęcie proponuje, aby wskazać wrodzone warunki o nietypowej rozwoju gonad chromosomów, czy płeć anatomicznej. </span><span style="margin: 0px; padding: 0px;">Będzie to również obejmować idiopatycznej mikropenisa którą dodaje się tutaj jako osobnej pozycji.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Odnosimy się do dokumentu konsensusu jako ogólne wytyczne, a ten rozdział skupi się na tym, co jest istotne dla praktykującego urologa dziecięcego. </span><span style="margin: 0px; padding: 0px;">Jako urolog może być zaangażowany zarówno chirurgicznego i niechirurgiczne noworodkowym pracy, rozdział ten omówi noworodkowy awaryjnych oraz diagnostycznej i terapeutycznej roli urologa dziecięcego.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Ogólnie rzecz biorąc, jest niska baza dowodów na opublikowanej literaturze DSD. </span><span style="margin: 0px; padding: 0px;">Nie ma badań z randomizacją i większość badań oparte są na retrospektywnych badaniach klinicznych opisowych (LE: 4) lub są ekspertyzy. </span><span style="margin: 0px; padding: 0px;">Wyjątkiem jest ryzyko zachorowania na raka jąder, dla którego LE jest wyższa.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">DSD może występować jako diagnozy prenatalnej, diagnostyki noworodków i późnym rozpoznaniem.</span><span style="margin: 0px; padding: 0px;">Diagnostyka prenatalna może być oparta na kariotypu lub US ustaleń noworodków rozpoznanie opiera się na narządów niejasności i koniec diagnozy dokonuje się na początku lub opóźnienie dojrzewania. </span><span style="margin: 0px; padding: 0px;">W niniejszych wytycznych koncentruje się na prezentacji noworodkowym gdzie urolog pediatryczna odgrywa ważną rolę. </span><span style="margin: 0px; padding: 0px;">Do późnej diagnozy mówimy endokrynologii i ginekologii wytycznych dotyczących przedwczesnego i opóźnionego dojrzewania, gdzie urolodzy pediatryczne odgrywają mniejszą rolę [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_744" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">744</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_745" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">745</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Rozpoznanie i leczenie DSD wymaga interdyscyplinarnego podejścia, które powinno obejmować genetyków, neonatolodzy, endokrynologów dzieci i dorosłych, ginekologów, psychologów, etycy i pracowników socjalnych. </span><span style="margin: 0px; padding: 0px;">Każdy członek zespołu powinien być wyspecjalizowane w DSD oraz zespół powinien mieć wystarczającą ilość nowych pacjentów, aby zapewnić przeżycie.</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_1_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.1.1.</span></span><span style="margin: 0px; padding: 0px;"> Mikropenisa</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Mikropenisa jest mały, ale zazwyczaj inaczej uformowane penis z rozciągniętej długości <2 ej="" font="" nbsp="" poni="" redniej="" sd=""><a href="https://uroweb.org/guideline/paediatric-urology/#note_742" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">742</span></a><span style="margin: 0px; padding: 0px;"> ,</span><a href="https://uroweb.org/guideline/paediatric-urology/#note_743" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">743</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_746" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">746</span></a><span style="margin: 0px; padding: 0px;"> ].</span></2></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Poza idiopatyczną mikropenisa dwóch głównych przyczyn nieprawidłowej stymulacji hormonalnej zidentyfikowano:</span></div> <ul style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; list-style-position: outside; margin: 0px 0px 20px; outline: 0px; padding: 0px 18px; vertical-align: baseline;"> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Hipogonadyzm hipogonadyzmu (w wyniku niedostatecznego wydzielania GnRH);</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Hipergonadotropowy hipogonadyzmu (ze względu na niewydolność jąder do produkcji testosteronu).</span></li> </ul> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Penis jest mierzona na grzbietową, podczas rozciągania penisa od spojenia łonowego do czubka żołędzi [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_742" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">742</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Ciał jamistych są wyczuwalne, moszna jest często niewielka, a jądra mogą być małe i opuszczone. </span><span style="margin: 0px; padding: 0px;">Mikropenisa należy odróżnić od zakopanych i łapki prącia, które jest zazwyczaj normalnej wielkości. </span><span style="margin: 0px; padding: 0px;">Wstępna ocena musi określić, czy etiologia tej mikropenisa jest centralnym (podwzgórze / przysadka) lub jąder. </span><span style="margin: 0px; padding: 0px;">Endokrynologii pediatrycznej obróbka musi być przeprowadzone natychmiast. </span><span style="margin: 0px; padding: 0px;">Kariotypu jest obowiązkowe we wszystkich pacjentów z mikropenisa. </span><span style="margin: 0px; padding: 0px;">Endocrine funkcja jąder jest oceniana (bazowe i stymulowane testosteron, LH i FSH stężenia w surowicy). </span><span style="margin: 0px; padding: 0px;">Pobudzone poziom hormonów może także dać wyobrażenie o potencjale wzrostu penisa. </span><span style="margin: 0px; padding: 0px;">U pacjentów z niewyczuwalne jąder i hipogonadyzmu hipogonadyzmu, laparoskopia powinna być przeprowadzona w celu potwierdzenia zbiegu jąder syndrom lub w jamie brzusznej undescended niedorozwój jąder. </span><span style="margin: 0px; padding: 0px;">Dochodzenie może być opóźnione aż do wieku 1 roku [</span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_743" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">743</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Przysadki lub niewydolność jąder są traktowane przez endokrynologa dziecięcego. </span><span style="margin: 0px; padding: 0px;">U chorych z niewydolnością jąder i sprawdzonej wrażliwości androgenów, zaleca się terapię androgenową w dzieciństwie i okresie dojrzewania w celu stymulowania wzrostu penisa [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_747-750" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">747-750</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ] (LE 2; GR: B). </span><span style="margin: 0px; padding: 0px;">W obecności androgenów niewrażliwości, dobry wynik funkcji seksualnych jest kwestionowana i konwersja płci można uznać [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_751-753" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">751-753</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_16_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.16.2.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Oceny diagnostyczne</span></span></span></h3> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_2_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.2.1.</span></span><span style="margin: 0px; padding: 0px;"> Noworodkowy awaryjnego</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Pierwszym krokiem jest rozpoznanie możliwości DSD (tabela 10) i od razu skierować noworodka do trzeciorzędowej pediatrycznego centrum, w pełni wyposażonej noworodkowym, genetyki, endokrynologii i pediatrycznych jednostek urologicznych. </span><span style="margin: 0px; padding: 0px;">W centrum pediatrii, sytuacja powinna zostać wyjaśniona rodziców pełni i uprzejmie. </span><span style="margin: 0px; padding: 0px;">Rejestrowanie i nazywania noworodka należy opóźnić tak długo, jak to konieczne.</span></span></div> <h5 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_2_1_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.2.1.1.</span></span><span style="margin: 0px; padding: 0px;"> Historia rodzinna oraz badanie kliniczne</span></h5> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Dokładny wywiad rodzina musi być podjęta następnie dokładnego badania klinicznego (tabela 11).</span></div> <div class="bodytekst_bold_2e_regel_inspringen" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="table_inspringen" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Tabela 10:</span></span><span style="margin: 0px; padding: 0px;">  Ustalenia w noworodka sugerujące możliwość DSD (zaadaptowany z American Academy of Pediatrics)</span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">pozorna male</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ciężkie spodziectwo związane z dwudzielny moszny</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Undescended jądrowe / jądra z spodziectwa</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Dwustronne niewyczuwalne jąder w donoszonych niemowląt płci męskiej najwidoczniej</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">pozorna żeński</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Przerost łechtaczki jakiegokolwiek stopnia, niewyczuwalne gonady</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Srom z pojedynczym otworem</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nieokreślony</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">niejednoznaczne genitalia</span></div> </td></tr> </tbody></table> <div class="bodytekst_bold" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Tabela 11: Postępowanie diagnostyczne noworodków z zaburzeniami rozwoju płciowego</span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Historia (rodzina, matek, noworodków)</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">pokrewieństwo rodzicielska</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Poprzedni DSD lub narządów anomalie</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Poprzednia zgonów noworodków</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Pierwotne brak miesiączki lub niepłodność u innych członków rodziny</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Maternal narażenie na androgeny</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Niezastosowanie się rozwijać, wymioty, biegunka noworodków</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Badanie lekarskie</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Pigmentacja narządów płciowych i okolicy areolar</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Spodziectwo lub zatoki moczowo-płciowej</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Rozmiar fallusa</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Namacalna i / lub symetryczne gonady</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ciśnienie krwi</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Badania</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Analiza krwi: 17-hydroksyprogesteron, elektrolity, LH, FSH, TST, kortyzol, ACTH</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Mocz: sterydy kory nadnerczy</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">kariotyp</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ultradźwięk</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Genitogram</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Test stymulacji hCG</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Badania wiązania androgenów</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Endoskopia</span></div> </td></tr> </tbody></table> <div class="bodytekst_italic_onder_tabel_1e_regel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: -15px 0px 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">ACTH = adrenokortykotropiną; </span><span style="margin: 0px; padding: 0px;">FSH = hormon folikulotropowy;</span></span></div> <div class="bodytekst_italic_onder_tabel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: -15px 0px 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">hCG = gonadotropiny kosmówkowej ludzka; </span><span style="margin: 0px; padding: 0px;">LH = hormonu luteinizującego; </span><span style="margin: 0px; padding: 0px;">TST = testosteronu.</span></span></div> <h5 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_2_1_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.2.1.2.</span></span><span style="margin: 0px; padding: 0px;"> Wybór badań laboratoryjnych</span></h5> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Następujące badania laboratoryjne są obowiązkowe:</span></div> <ul style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; list-style-position: outside; margin: 0px 0px 20px; outline: 0px; padding: 0px 18px; vertical-align: baseline;"> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">kariotyp;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Plasma 17-hydroksyprogesteron test;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">elektrolitów w osoczu;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">USG w celu oceny obecności Müllera konstrukcji kanałowych.</span></li> </ul> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Badania te dostarczają dowodów wrodzonego przerostu nadnerczy (CAH), który jest najczęściej występującym DSD.</span><span style="margin: 0px; padding: 0px;">Jeśli tego stwierdzenia dowodów, nie są potrzebne dalsze badania. </span><span style="margin: 0px; padding: 0px;">Jeśli nie, to laboratorium obróbka powinna przejść dalej.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Test stymulacji hCG jest szczególnie pomocne w różnicowaniu głównych syndromów 46XYDSD oceniając potencjał komórek Leydiga. </span><span style="margin: 0px; padding: 0px;">Gdy metabolizm testosteronu oceniano obecność lub brak metabolitów pomoże określić problem. </span><span style="margin: 0px; padding: 0px;">Przedłużona stymulacja może pomóc zdefiniować falliczny potencjał wzrostu i wywołania jąder zejście w niektórych przypadkach powiązany wnętrostwo.</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_2_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.2.2.</span></span><span style="margin: 0px; padding: 0px;"> Przypisanie Płeć</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Jest to bardzo skomplikowane zadanie. </span><span style="margin: 0px; padding: 0px;">Powinien on nastąpić po ostateczne rozpoznanie zostało dokonane. </span><span style="margin: 0px; padding: 0px;">Pomysł, że dana osoba jest płci neutralnej przy urodzeniu i że hodowla determinuje rozwój płci nie jest standardowym podejściem.</span><span style="margin: 0px; padding: 0px;">Zamiast decyzje przypisania płci powinny być oparte na:</span></span></div> <ul style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; list-style-position: outside; margin: 0px 0px 20px; outline: 0px; padding: 0px 18px; vertical-align: baseline;"> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">wiek w chwili rozpoznania;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">potencjał płodności;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Wielkość prącia;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Obecność funkcjonalnego pochwy;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Funkcja hormonalny;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Potencjał złośliwości;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">prenatalna ekspozycja testosteronu;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Ogólny wygląd;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">psychospołeczne samopoczucie i stabilną tożsamość płciową;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Aspekt społeczno-kulturowe;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">opinie rodzicielskie.</span></li> </ul> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Każdy pacjent z objawami DSD powinny być przypisane płci tak szybko jak dogłębna diagnostycznych pozwala na ocenę. </span><span style="margin: 0px; padding: 0px;">Minimalny czas potrzebny wynosi 48 godzin. </span><span style="margin: 0px; padding: 0px;">W tym okresie wszelkie skierowanie do płci należy unikać, lepiej zająć się pacjentem jako "dziecko", "dzieckiem".</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_2_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.2.3.</span></span><span style="margin: 0px; padding: 0px;"> Rola urologa dziecięcego</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Rola urologa pediatrycznej można podzielić na znaczenie diagnostyczne i terapeutyczne roli (tabela 12). </span><span style="margin: 0px; padding: 0px;">Każdy z tych zadań zostanie pokrótce omówione.</span></span></div> <div class="bodytekst_bold" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Tabela 12: Rola urologa dziecięcego</span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">rola diagnostyczne</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Badanie kliniczne</span></div> <div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ultradźwięk</span></div> <div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Genitography</span></div> <div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Cystoskopia</span></div> <div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">laparoskopia diagnostyczna</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">rola terapeutyczna</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Chirurgia Masculinising</span></div> <div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">feminizacja chirurgii</span></div> <div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Gonadectomy</span></div> </td></tr> </tbody></table> <h5 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_2_3_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.2.3.1.</span></span><span style="margin: 0px; padding: 0px;"> Badanie kliniczne</span></h5> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Dokładne badanie kliniczne u noworodka, prezentując z niejednoznacznym genitaliów jest bardzo ważne. </span><span style="margin: 0px; padding: 0px;">Jak również dokładny opis niejednoznacznych genitaliów, niektóre szczegółowe informacje powinny być podane na namacalność i lokalizacji gonad. </span><span style="margin: 0px; padding: 0px;">Informacje gromadzone przez różne badania opisane poniżej powinny pomóc zespołowi, aby dojść do ostatecznej diagnozy.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Namacalna gonad</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Jeśli jest to możliwe, aby czuć się gonad, to prawie na pewno jąder; </span><span style="margin: 0px; padding: 0px;">Dlatego też stwierdzenie to kliniczne praktycznie wyklucza 46XXDSD.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Medycyna</span></span><span style="margin: 0px; padding: 0px;">  fotografia może być przydatne, ale wymaga wrażliwości i zgodę [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_754" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">754</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Fallus</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Fallus powinny być mierzone. </span><span style="margin: 0px; padding: 0px;">Wacikiem bawełnianym umieszczone na nadłonowego podstawy implantu rozciągniętym prąciu umożliwia dobry pomiar długości phallic.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Moczowo-płciowy Otwarcie zatok</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Otwarcie zatoki moczowo-płciowej musi być dobrze oceniany. </span><span style="margin: 0px; padding: 0px;">Czy istnieje tylko jeden otwór widoczny? </span><span style="margin: 0px; padding: 0px;">Czy hymenal pierścień widać? </span><span style="margin: 0px; padding: 0px;">Co oznacza fuzja labioscrotal fałdy wyglądać; </span><span style="margin: 0px; padding: 0px;">nie fałdy pokazać rugae lub jakieś przebarwienia?</span></span></div> <h5 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_2_3_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.2.3.2.</span></span><span style="margin: 0px; padding: 0px;"> Badania</span></h5> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">USG</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">  może pomóc opisać palpacyjnie gonady lub wykryć niewyczuwalne gonad. </span><span style="margin: 0px; padding: 0px;">Jednak czułość i specyficzność nie są wysokie. </span><span style="margin: 0px; padding: 0px;">Na nas, Mülllerian konstrukcje mogą być oceniane. </span><span style="margin: 0px; padding: 0px;">Czy istnieje pochwy? </span><span style="margin: 0px; padding: 0px;">Czy istnieją jakieś gonady brzucha?</span><span style="margin: 0px; padding: 0px;">Czy istnieje pochwy lub utriculur struktura widoczna [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_755" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">755</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_756" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">756</span></a><span style="margin: 0px; padding: 0px;"> ]?</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Genitography</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">  może dostarczyć trochę więcej informacji na temat zatoki moczowo-płciowej. </span><span style="margin: 0px; padding: 0px;">Jak nisko lub jak wysoka jest zbieg? </span><span style="margin: 0px; padding: 0px;">Czy jest jakaś duplikacja pochwy? </span><span style="margin: 0px; padding: 0px;">W jaki sposób odnoszą się do cewki moczowej pochwy?</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Znieczulenie ogólne</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">W niektórych przypadkach, dalsze badania w znieczuleniu ogólnym może być pomocny. </span><span style="margin: 0px; padding: 0px;">Na cystoskopii, zatoki moczowo-płciowej można ocenić, a poziom przecięcia pomiędzy szyi pęcherza moczowego i pęcherza. </span><span style="margin: 0px; padding: 0px;">Cystoskopię mogą być również wykorzystane do oceny pochwy lub utriculus np obecność szyjki w górnej części pochwy mogą być istotne informacje.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Laparoskopia</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">  jest konieczne w celu uzyskania ostatecznej diagnozy w obecności niedostrzegalnych gonad i obecność struktur Müllera. </span><span style="margin: 0px; padding: 0px;">Jeśli wspomniano, gonad Biopsja może być wykonywana [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_757" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">757</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_758" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">758</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_16_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.16.3.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Zarządzanie</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nawiązując do dokumentu konsensusu [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_742" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">742</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_743" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">743</span></a><span style="margin: 0px; padding: 0px;"> ], to jest oczywiste, że czas operacji jest znacznie bardziej kontrowersyjne niż do tej pory.</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Uzasadnieniem dla wczesnego zabiegu obejmuje:</span></div> <ul style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; list-style-position: outside; margin: 0px 0px 20px; outline: 0px; padding: 0px 18px; vertical-align: baseline;"> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">korzystne działanie estrogenu w tkance dla niemowląt;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">unikanie powikłań anomalii anatomicznych;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">minimalizuje niepokój rodziny;</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">łagodzenia ryzyka stygmatyzacji i pomieszania tożsamości płci [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_759" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">759</span></a><span style="margin: 0px; padding: 0px;"> ].</span></li> </ul> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Jednak niekorzystne efekty doprowadziły do zaleceń, aby opóźnić niepotrzebną operację do wieku, kiedy pacjent może udzielić świadomej zgody. </span><span style="margin: 0px; padding: 0px;">Operacja, która zmienia wygląd nie jest pilna. </span><span style="margin: 0px; padding: 0px;">Wczesna operacja powinna być zarezerwowana dla pacjentów z wysokim zlewających moczowo-płciowego, dziewcząt z ciężkim zmaskulinizowanych genitaliów i chłopców z undervirilised genitaliów. </span><span style="margin: 0px; padding: 0px;">Vaginoplasty powinno zostać opóźnione do czasu dojrzewania i łagodniejsze formy maskulinizacji nie powinni być leczeni operacyjnie. </span><span style="margin: 0px; padding: 0px;">Ostatnio ESPU i SPU miały miejsce w debacie na temat chirurgii DSD [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_760" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">760</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_3_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.3.1.</span></span><span style="margin: 0px; padding: 0px;"> Chirurgii feminizacji</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Clitororeduction</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Redukcja rozszerzonej łechtaczki powinno odbywać się z zachowaniem tej naczyniową wiązki.</span><span style="margin: 0px; padding: 0px;">Łechtaczki operacja została zgłoszona mieć negatywny wynik na funkcje seksualne i dlatego powinny być ograniczone do ciężkiej powiększone clitorises [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_761" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">761</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_762" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">762</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Świadoma zgoda rodziców powinny być uzyskane. </span><span style="margin: 0px; padding: 0px;">Mimo, że niektóre techniki, które oszczędzać tkanki erekcji zostały opisane, rezultat długoterminowy jest nieznany [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_763" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">763</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Oddzielenie pochwy i cewki</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">  jest zachowana dla dużych nieprawidłowości konfluencji. </span><span style="margin: 0px; padding: 0px;">Wiele technik naprawy zatoki moczowo-płciowej zostały opisane, ale ich wyniki nie były oceniane prospektywnie [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_764" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">764</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_765" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">765</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Vaginoplasty</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">  powinny być wykonywane w ciągu kilkunastu lat. </span><span style="margin: 0px; padding: 0px;">Każda technika (self-dylatacja, skóry lub zastąpienie jelita) ma swoje specyficzne zalety i wady [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_766" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">766</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Wszystko posiadać potencjał do powstawania blizn, które wymagają dalszych operacji, zanim funkcje seksualne było możliwe.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Estetyczne udoskonalenia</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Cele operacji narządów płciowych są maksymalizacja anatomii, aby umożliwić funkcji seksualnych i romantyczny Partnerstwo. </span><span style="margin: 0px; padding: 0px;">Estetyka jest ważna w tej perspektywie. </span><span style="margin: 0px; padding: 0px;">Rekonstrukcja moll labiae z rozszerzonej łechtaczki kaptur jest przykładem estetycznego wyrafinowania.</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_16_3_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.16.3.2.</span></span><span style="margin: 0px; padding: 0px;"> Chirurgii Masculinising</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Hormonalnej terapii</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">  we wczesnym okresie życia jest popierane przez wielu lekarzy. </span><span style="margin: 0px; padding: 0px;">Poziom dowodów jest niska dla przywrócenia normalnego rozmiaru penisa.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Operacja spodziectwa</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Patrz rozdział spodziectwa (rozdział 3.5).</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Wycięcie struktur Mullera</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">U pacjenta DSD przypisanej płci męskiej płci, struktury Mullera powinien zostać wycięty. </span><span style="margin: 0px; padding: 0px;">Nie ma dowodów na to, czy torbiele utricular muszą być wycinane.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Orchidopeksja</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Patrz rozdział orchidopeksja (rozdział 3.2).</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Prącia</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Rosnące doświadczenie prącia w leczeniu pacjentów płci męskiej, do kobiet transseksualnych doprowadziła do raportów o niezawodność i skuteczność tej techniki. </span><span style="margin: 0px; padding: 0px;">W związku z tym stają się dostępne w leczeniu ciężkiej nieadekwatność prącia u pacjentów DSD.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Estetyczne udoskonalenia</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Należą do nich korekty penoscrotal transpozycji, scrotoplasty i wstawiania protez jąder.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Gonadectomy</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Mutagenne na komórki nowotwór występuje tylko u pacjentów z DSD, którzy mają materiał Y-chromosomalnych. </span><span style="margin: 0px; padding: 0px;">Najwyższe ryzyko jest u pacjentów z gonad gonad oraz u pacjentów z częściowym androgenów niewrażliwości z gonad intra-abdominal (LE: 2). </span><span style="margin: 0px; padding: 0px;">Gonady w obrębie jamy brzusznej pacjentów wysokiego ryzyka, powinien zostać usunięty w czasie diagnozy [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_767" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">767</span></a><span style="margin: 0px; padding: 0px;"> ] (GR: A).</span></div> <div class="kop3_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_16_4" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.16.4.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Zestawienie dowodów i zaleceń w zakresie zarządzania zaburzenia rozwoju płci</span></span></span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Podsumowanie dowodów</span></div> </th><th class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">LE</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Czas operacji zależeć będzie od ciężkości stanu chorobowego i od przyporządkowanego płci.</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 4</div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">U chłopców korekta chirurgiczna będzie składać się głównie z spodziectwa naprawy i orchidopeksja, więc czas będzie przestrzegać zaleceń dotyczących naprawy i spodziectwa orchidopeksja (z sześciu miesięcy życia, a przed dwóch lat).</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 2</div> </td></tr> </tbody></table> <table class="tabel_blauw" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">zalecenia</span></div> </th><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">GR</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">zaburzenia rozwoju płci (DSD) traktować w multidyscyplinarnym zespole.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Patrz dzieci doświadczonych ośrodkach, gdzie neonatologii, endokrynologii dziecięcej, urologii dziecięcej, psychologii dziecięcej i przejście do dorosłego opieki są gwarantowane.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nie zwlekaj traktowanie każdego noworodka, prezentując z niejednoznacznych genitaliów od słonej utraty dziewczyny 46xx CAH może być śmiertelna.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Przypisanie płci jest nieunikniona i powinna opierać się na multidyscyplinarnym konsensusu z uwzględnieniem najnowszej wiedzy.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nie zwlekaj leczenia chirurgicznego u dziewcząt z objawami poważnych anomalii.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Oferować bardziej konserwatywne podejście w mniej poważnych przypadkach, w porozumieniu z rodzicami.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Postępuj zgodnie z zaleceniami dla chłopców, dla spodziectwa naprawy i orchidopeksja (z sześciu miesięcy życia, a przed dwóch lat).</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> </tbody></table> <h2 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 17px; font-stretch: inherit; font-weight: 500; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_17" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.17.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Zastawki cewki tylnej</span></span></span></h2> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_17_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.17.1.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Epidemiologia, etiologia i patofizjologia</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Zastawki cewki tylnej (PUV) są jednym z nielicznych zagrażających życiu wad wrodzonych układu moczowego stwierdzono w okresie noworodkowym. </span><span style="margin: 0px; padding: 0px;">Pomimo optymalnego leczenia PUV dzieci mogą spowodować niewydolność nerek u prawie jednej trzeciej przypadków [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_768-770" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">768-770</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">PUV występują u 1 na 1250 w populacji poddawanej płodu przesiewowe nas [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_484" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">484</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Częstością ZCT 1 w 5,000-12,500 żywo urodzeń została oszacowana [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_771" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">771</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_772" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">772</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">W jednym raporcie, do 46% płodów diagnozy puv zostało zakończone, co wskazywało na możliwe zmniejszenie częstości [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_773" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">773</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_17_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.17.2.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Systemy klasyfikacyjne</span></span></span></h3> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_17_2_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.17.2.1.</span></span><span style="margin: 0px; padding: 0px;"> Zawór cewki moczowej</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Pomimo niedawnych prób wprowadzenia nowych warunków klasyfikacyjnych, takich jak "wrodzonej błony obturacyjna cewki tylnej '(COPUM) [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_774" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">774</span></a><span style="margin: 0px; padding: 0px;"> ], pierwotną klasyfikację Hugh Hampton Younga pozostaje najczęściej używane [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_775" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">775</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Hugh Hampton Młoda opisano trzy kategorie: typ I, typ II i typ III. </span><span style="margin: 0px; padding: 0px;">Jednak dzisiaj, tylko typu I i typu III znajdują się obturacyjna. </span><span style="margin: 0px; padding: 0px;">Jako typ II wydaje się być bardziej krotnie i nie blokuje działania nie jest już dalej w zaworze. </span><span style="margin: 0px; padding: 0px;">Opisy Hampton Younga typu I i III są:</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Typ I </span></span> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">(90-95%).</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">  'W najbardziej powszechnym typom jest grzbiet na podłodze cewki moczowej, ciągłe z verumontanum, który przyjmuje przebieg przedniej i dzieli się na dwa procesy widelca, w obszarze bulbo-błoniaste skrzyżowania. </span><span style="margin: 0px; padding: 0px;">Procesy te są kontynuowane jako cienkie arkusze błoniaste, bezpośrednio w górę i do przodu, który może być dołączony do cewki moczowej, w całym jego obwodzie. </span><span style="margin: 0px; padding: 0px;">Powszechnie Przypuszcza się, że zawory mają pełną fuzję ku przodowi, pozostawiając jedynie otwartego kanału w ścianie cewki tylnej. </span><span style="margin: 0px; padding: 0px;">Jednak fuzja zaworów do przodu może nie być kompletne we wszystkich przypadkach, a w tym momencie istnieje nieznaczne rozdzielenie fałdy "[ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_775" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">775</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Typ III.</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">  "Jest jeszcze trzeci typ, który został uznany na różnych poziomach cewki tylnej i które najwyraźniej nie ponosi taką relację do verumontanum. </span><span style="margin: 0px; padding: 0px;">Ta przeszkoda została dołączona do całego obwodu cewki, z małym otworem w środku "[ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_775" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">775</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Poprzeczny membrana opisano przypisuje niepełnego rozwiązaniu z układu moczowo-płciowego części steku membrany [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_776" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">776</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Embriologii zastawek cewki moczowej jest słabo poznany. </span><span style="margin: 0px; padding: 0px;">Membrana może być nieprawidłowe wsunięcie przewodów śródnercza język steku płodu [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_777" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">777</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_17_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.17.3.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Oceny diagnostyczne</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Przeszkoda powyżej poziomu cewki ma wpływ na cały układ moczowy w różnym stopniu.</span></div> <ul style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; list-style-position: outside; margin: 0px 0px 20px; outline: 0px; padding: 0px 18px; vertical-align: baseline;"> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Sterczowego odcinka cewki moczowej jest rozdęte i przewody wytrysku może być rozszerzona z powodu nietrzymania refluksu.</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Na szyi pęcherza moczowego jest przerośnięte i sztywne.</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Przerośnięte pęcherza czasami ma wiele uchyłki.</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Prawie wszyscy pacjenci zaworowe mają dylatacji obu górnych dróg moczowych. </span><span style="margin: 0px; padding: 0px;">Może to być wynikiem samego zaworu i wysokiego ciśnienia w pęcherzu, lub ze względu na przeszkody węzła ureterovesical przez przerostu pęcherza.</span></span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Jeśli nie ma drugorzędne zwrotną zakażone funkcje nerek słabo w większości przypadków.</span></li> </ul> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Podczas badań prenatalnych USA, dwustronnej wodonercza i rozdętym pęcherza są podejrzane objawy zastawki cewki moczowej. </span><span style="margin: 0px; padding: 0px;">Również grubościenne pęcherza moczowego i cewki moczowej tylnej rozszerzone ( "dziurka" sign) sprawiają, prawdopodobnie PUV. </span><span style="margin: 0px; padding: 0px;">W jednym z badań, jednakże, dziurka znak nie znaleziono być wiarygodnym wskaźnikiem (p = 0.27) [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_778" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">778</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">W obecności zwiększonej echogeniczności nerki, rozszerzenie dróg oddechowych i małowodzie, diagnozowania ZCT powinien zdecydowanie być brane pod uwagę.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Cystografia mikcyjna (VCUG) potwierdza diagnozę PUV. </span><span style="margin: 0px; padding: 0px;">Badanie to jest niezbędne, gdy nie ma mowy o infravesical niedrożności, jak anatomia cewki moczowej jest dobrze opisane w trakcie oddawania moczu. </span><span style="margin: 0px; padding: 0px;">Drugi refluksu występuje w co najmniej 50% pacjentów z ZCT [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_779" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">779</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Refluksu niezmiennie związane z dysplazją nerek u pacjentów z ZCT. </span><span style="margin: 0px; padding: 0px;">Jest ogólnie akceptowane, że orosienie w jednostkach nerkowych działa jak "zawór odskakującą ciśnienia", która chroni drugą nerki, co prowadzi do lepszej prognozy [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_780" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">780</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Inne typy mechanizmu pop-off to uchyłki pęcherza i dróg moczowych wynaczynienia, z lub bez wodobrzusza moczowych [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_781" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">781</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Jednak w dłuższej perspektywie, domniemany efekt ochronny nie wykazały istotnej różnicy w porównaniu do innych pacjentów z ZCT [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_782" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">782</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_783" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">783</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Renography jądrowa z podziału czynności nerek jest ważne, aby ocenić czynność nerek (DMSA lub MAG3).</span><span style="margin: 0px; padding: 0px;">Kreatyniny, azotu mocznikowego we krwi i elektrolity powinny być ściśle monitorowane w ciągu pierwszych kilku dni.</span><span style="margin: 0px; padding: 0px;">Nadir kreatyniny 80 umol / l koreluje z lepszym rokowaniem [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_770" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">770</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Zarządzanie początkowe zawiera multidyscyplinarny zespół z udziałem pediatrycznego nefrolog.</span></span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_17_4" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.17.4.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Zarządzanie</span></span></span></h3> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_17_4_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.17.4.1.</span></span><span style="margin: 0px; padding: 0px;"> Leczenie prenatalna</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">O 40-60% ZCT są odkryte przed urodzeniem [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_784" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">784</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Wewnątrzmacicznego niedrożność prowadzi do zmniejszenia ilości wydalanego moczu, co mogłoby doprowadzić do małowodzie. </span><span style="margin: 0px; padding: 0px;">Płyn owodniowy jest konieczna do prawidłowego rozwoju płuc i ich brak może prowadzić do niedorozwoju płuc, powodując problem zagrażający życiu.</span><span style="margin: 0px; padding: 0px;">Wewnątrzmaciczne podjęto wysiłki leczyć płody z ZCT.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Jak dysplazja nerek nie jest odwracalny, ważne jest zidentyfikowanie płodów prawidłowa czynność nerek.</span><span style="margin: 0px; padding: 0px;">Poziom sodu poniżej 100 mg / dl, wartość chlorek <90mmol 200="" dni="" ej="" font="" i="" l="" lepsz="" moczu="" mosm="" na="" nbsp="" odu="" osmolarno="" p="" poni="" prognoz="" s="" si="" trzech="" w="" z="" zane="" zdobyte="" znajduje="" zwi=""></90mmol></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_785" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">785</span></a><span style="margin: 0px; padding: 0px;"> ].</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Umieszczenie w vesicoamniotic bocznika ma częstość powikłań 21-59%, zwichnięcie przecieku występuje u do 44%, śmiertelność wynosi między 33% a 43%, a niewydolność nerek jest powyżej 50% [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_785-787" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">785-787</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Chociaż manewrowy jest skuteczna w odwracaniu małowodzie, nie ma znaczenia dla rozstrzygnięcia i długoterminowych wyników pacjentów z ZCT [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_786" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">786</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_787" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">787</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Pluton-trail (randomizowanym badaniu) nie mógł udowodnić korzyści umieszczenia zastawki [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_788" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">788</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Zawór leczenie płodu np ablacja laserowa ma wysoką częstość powikłań bez dowodów skuteczności tych interwencji. </span><span style="margin: 0px; padding: 0px;">Dlatego to powinno być nadal uważane za interwencję doświadczalnej [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_789" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">789</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_790" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">790</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_17_4_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.17.4.2.</span></span><span style="margin: 0px; padding: 0px;"> Leczenie poporodowa</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Drenaż pęcherza</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Jeśli chłopiec rodzi się z podejrzeniem ZCT, drenażu pęcherza i, jeśli to możliwe, natychmiastowe VCUG jest konieczne. </span><span style="margin: 0px; padding: 0px;">Noworodka można cewnikowanie z 3.5-5 F cewnika. </span><span style="margin: 0px; padding: 0px;">Cewniki balonowe nie są dostępne w tej wielkości. </span><span style="margin: 0px; padding: 0px;">VCUG jest wykonywany, aby sprawdzić, że diagnoza jest prawidłowa i czy cewnik znajduje się wewnątrz pęcherza a nie do cewki tylnej. </span><span style="margin: 0px; padding: 0px;">Alternatywną opcją jest umieszczenie nadłonowy cewnika przeprowadzić VCUG i opuszcza rurę aż noworodek jest wystarczająco stabilna, aby wykonać nacięcia endoskopowej lub resekcję zaworu.</span></span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Ablacja zaworu</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Kiedy sytuacja medyczna noworodków ustabilizowała się, a poziom kreatyniny zmniejszył się, następnym krokiem jest usunięcie śródpęcherzowego przeszkodę. </span><span style="margin: 0px; padding: 0px;">W przypadkach były cewka moczowa jest zbyt mała, aby bezpiecznie przejść małą faetal cystoskop, A nadłonowy przekierowania jest wykonywana dopóki armatura ablacji może być wykonana. </span><span style="margin: 0px; padding: 0px;">Małe cystoskopów pediatrii oraz resektoskopach obecnie dostępne są albo naciąć, ablacji lub wycięcia zawór w pozycji 4-5, 7-8 lub 12 godzinie, albo na wszystkich trzech pozycjach, w zależności od preferencji chirurga. </span><span style="margin: 0px; padding: 0px;">Ważne jest, aby uniknąć częstych elektrokoagulacji, a najczęściej powikłaniem tej metody jest powstawanie zwężenie. </span><span style="margin: 0px; padding: 0px;">Jeden ostatnio opublikowanych badań wykazano istotny niższy współczynnik zwężenia cewki moczowej za pomocą zimnego noża w porównaniu do diatermii [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_791" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">791</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">W ciągu trzech miesięcy po wstępnej obróbce, o VCUG sterowania lub cystoscopy ponowne spojrzenie powinien wykazać skuteczność leczenia, w zależności od przebiegu klinicznego [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_792" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">792</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Vesicostomy</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Jeśli dziecko jest zbyt małe i / lub zbyt chory, by poddać się operacji endoskopowej, A nadłonowy przekierowanie odbywa się opróżnić pęcherz czasowo. </span><span style="margin: 0px; padding: 0px;">Jeśli początkowo nadłonowy rura została umieszczona, może być pozostawiony w miejsce sześciu do dwunastu tygodni. </span><span style="margin: 0px; padding: 0px;">W przeciwnym razie, skóry vesicostomy dostarcza poprawy lub stabilizacji górnych dróg moczowych w ponad 90% przypadków, [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_793" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">793</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Chociaż nie było obawy, że vesicostomy może zmniejszyć zgodności pęcherza lub zdolności, do tej pory nie ma żadnych ważnych danych potwierdzających te oczekiwania [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_794" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">794</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_795" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">795</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Wysoka przekierowania</span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> . </span><span style="margin: 0px; padding: 0px;">Jeśli drenażu pęcherza jest niewystarczająca, aby spuścić górnych dróg moczowych, nietrzymanie wysokiej przekierowania należy rozważyć. </span><span style="margin: 0px; padding: 0px;">Przekierowanie mogą być odpowiednie, jeśli nie są nawracające infekcje górnych dróg, brak poprawy funkcji nerek i / lub podwyższenia górnej dylatacji moczowych, pomimo odpowiedniego drenażu pęcherza moczowego. </span><span style="margin: 0px; padding: 0px;">Wybór odprowadzenia moczu zależy od preferencji chirurga dla ureterostomy wysokiej pętli, pierścień ureterostomy, końcowego ureterostomy lub pyelostomy, z każdą techniką mającą zalety i wady [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_796-798" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">796-798</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Chirurgia rekonstrukcyjna powinny być opóźnione aż testowany egzemplarz poprawiła się znacznie, jak można się spodziewać.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Refluks jest bardzo powszechne u pacjentów PUV (do 72%) i jest opisane w dwustronnie do 32% [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_799" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">799</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">W ciągu pierwszych miesięcy życia, profilaktyka antybiotykowa może mieć, zwłaszcza w tych, o wysokiej jakości pod chłodnicą zwrotną [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_562" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">562</span></a><span style="margin: 0px; padding: 0px;"> ], a u osób z stulejki, obrzezka mogą być omawiane w celu zmniejszenia ryzyka ZUM [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_800" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">800</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ].</span><span style="margin: 0px; padding: 0px;">Jednakże, nie ma randomizowanych badań na poparcie tego dla pacjentów z ZCT. </span><span style="margin: 0px; padding: 0px;">Wysokim stopniu deflegmacji wiąże się ze złym funkcjonowaniem nerek i jest uznane za słabe czynnika prognostycznego [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_768" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">768</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_801" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">801</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Niemniej jednak, na początku usuwania jednostki nerek wydaje się być konieczna, tak długo jak nie powoduje żadnych problemów. </span><span style="margin: 0px; padding: 0px;">Może to być konieczne do zwiększenia pęcherza i w tym przypadku można stosować moczowodu [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_802" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">802</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_17_5" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.17.5.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Następcze</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Monitorowanie przez całe życie wśród tych pacjentów jest obowiązkowe, jak dysfunkcja pęcherza ( "pęcherz zawór ') nie jest niczym niezwykłym, a opóźnienie zarówno w dzień jak iw nocy w czasie wstrzemięźliwości jest poważnym problemem [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_770" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">770</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_779" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">779</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Słabe pęcherza sensacją i zgodność, niestabilność wypieracza i wielomocz (zwłaszcza w nocy) i ich kombinacje są odpowiedzialne za zaburzenia czynności pęcherza moczowego. </span><span style="margin: 0px; padding: 0px;">W tych z niestabilności pęcherza, leczenie antycholinergiczne mogą poprawić czynność pęcherza. </span><span style="margin: 0px; padding: 0px;">Jednak przy niskim ryzyku odwracalnej niewydolności mięśniowego (3/37 pacjentów w jednym badaniu) [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_803" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">803</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_804" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">804</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">U pacjentów ze słabym opróżniania pęcherza  </span></span><span class="symbol" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">alfa</span></span><span style="margin: 0px; padding: 0px;"> -blokery mogą być stosowane w celu zmniejszenia moczu PVR, jak wykazano w jednym z badań z 42 pacjentów z wykorzystaniem terazosyny (średnio po mikcji [PVR], została zmniejszona z 16 do 2 ml), [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_805" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">805</span></a><span style="margin: 0px; padding: 0px;"> ] i W innym badaniu tamsulosin była skuteczna [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_806" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">806</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Między 10% i 47% pacjentów może rozwinąć się w końcowym stadium niewydolności nerek [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_768-770" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">768-770</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Wysoka Nadir kreatyniny i ciężkie zaburzenia czynności pęcherza moczowego są czynnikami ryzyka leczenia nerkozastępczego [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_807" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">807</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Niewydolność transplantacji u tych pacjentów może być wykonywana bezpiecznie i efektywnie [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_808" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">808</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_809" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">809</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Pogorszenie czynności przeszczepu jest związane głównie z LUTD [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_809" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">809</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_810" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">810</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Algorytm oceny i leczenia został przedstawiony na Figurze 10.</span></span></div> <div class="bodytekst_bold" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Rysunek 10: Algorytm w sprawie oceny, zarządzania i obserwacji noworodków z możliwych ZCT</span></div> <img src="https://uroweb.org/wp-content/guidelines/Paediatric_Urology_2016/images/Fig_10_An_algorithm_on_assessment_treatment_and_follow_up_of_newborns_with_possible_PUV.png" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; display: inline-block; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; height: auto; line-height: 18px; margin: 18px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; vertical-align: middle;" /><br style="background-color: white; color: #585858; font-family: Helvetica, Arial, sans-serif; font-size: 16px; line-height: 28px; margin: 0px; padding: 0px;" /><div class="bodytekst_italic_onder_tabel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: -15px 0px 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">CIC = czystego przerywanego cewnikowania; </span><span style="margin: 0px; padding: 0px;">OAB = pęcherz nadreaktywny; </span><span style="margin: 0px; padding: 0px;">PUV zaworu = cewki tylnej; </span><span style="margin: 0px; padding: 0px;">RF = czynność nerek; </span><span style="margin: 0px; padding: 0px;">UT = dróg moczowych; </span><span style="margin: 0px; padding: 0px;">UUT = górna dróg moczowych; </span><span style="margin: 0px; padding: 0px;">VCUG = cystografia mikcyjna.</span></span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_17_6" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.17.6.</span></span><span style="margin: 0px; padding: 0px;"> Podsumowanie</span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Zastawki cewki tylnej (PUV) są jednym z nielicznych zagrażających życiu wad wrodzonych układu moczowego stwierdzono w okresie noworodkowym i pomimo optymalnego leczenia w wyniku niewydolności nerek u prawie jednej trzeciej przypadków. </span><span style="margin: 0px; padding: 0px;">Dwustronna wodonercza i rozdęte pęcherza są podejrzane objawy ZCT u noworodków. </span><span style="margin: 0px; padding: 0px;">VCUG potwierdza diagnozę PUV. </span><span style="margin: 0px; padding: 0px;">renography jądrowa z podziału czynności nerek jest ważne, aby ocenić czynność nerek i kreatyniny w surowicy powyżej nadir 80 umol / l jest skorelowana ze złym rokowaniem.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Poporodowa leczenie obejmuje drenaż pęcherza albo przezcewkowej lub nadłonowy a jeśli dziecko jest na tyle stabilny, endoskopowe nacięcie zaworu jest wykonana. </span><span style="margin: 0px; padding: 0px;">Jeśli dziecko jest zbyt małe i / lub zbyt chory, by poddać się operacji endoskopowej, A vesicostomy jest opcją dla drenażu pęcherza moczowego. </span><span style="margin: 0px; padding: 0px;">Jeśli drenażu pęcherza jest niewystarczająca, aby spuścić górnych dróg moczowych, nietrzymanie wysokiej przekierowania należy rozważyć.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">U wszystkich pacjentów monitorowanie przez całe życie jest obowiązkowe, gdyż dysfunkcja pęcherza jest dość powszechne i mogą powodować postępujące pogorszenie moczowych górną, jeśli nie jest właściwie zarządzane.</span><span style="margin: 0px; padding: 0px;">W długim okresie pomiędzy 10% a 47% pacjentów może rozwinąć schyłkową niewydolność nerek. </span><span style="margin: 0px; padding: 0px;">Niewydolność transplantacji u tych pacjentów może być wykonywana bezpiecznie i skutecznie.</span></span></div> <div class="kop3_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_17_7" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.17.7.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Zestawienie dowodów i zaleceń w zakresie zarządzania zaworami cewki tylnej</span></span></span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Podsumowanie dowodów</span></div> </th><th class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">LE</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">PUV są jednym z nielicznych zagrażających życiu wad wrodzonych układu moczowego stwierdzono w okresie noworodkowym.</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">1b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Pomimo optymalnego leczenia prawie jedna trzecia pacjentów kończy się u pacjentów z niewydolnością nerek.</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">2b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Dwustronna wodonercza i rozdęte pęcherza są podejrzane objawy na nas; </span><span style="margin: 0px; padding: 0px;">VCUG potwierdza diagnozę.</span></span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">2b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nadir kreatyniny w surowicy powyżej 80 mmol / l jest skorelowana ze złym rokowaniem.</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">2a</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">W długim okresie pomiędzy 10% a 47% pacjentów rozwija schyłkową niewydolność nerek z powodu pierwotnego dysplazji i / lub dalszej deteroration powodu dysfunkcji pęcherza.</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">2a</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Niewydolność transplantacji u tych pacjentów jest bezpieczne i skuteczne, jeśli funkcja pęcherza normalizuje.</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"></td></tr> </tbody></table> <table class="tabel_blauw" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="87%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">zalecenia</span></div> </th><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">LE</span></div> </th><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">GR</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="87%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Diagnozowanie PUV początkowo przez USA, ale VCUG jest wymagane w celu potwierdzenia diagnozy.</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Ocenić podziału czynności nerek przez DMSA skanowania lub MAG3 odprawy. </span><span style="margin: 0px; padding: 0px;">Stężenie kreatyniny w surowicy jest markerem prognostycznym.</span></span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 3</div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="87%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Pęcherzowo-owodniowy zastawki przed urodzeniem nie jest zalecany w celu poprawy wyników nerek.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">1b</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="87%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Oferta zaworu endoskopowej ablacji po drenażu pęcherza i stabilizacji dziecka.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">3</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="87%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Oferta suprapupic przekierowanie do drenażu pęcherza w przypadku, gdy dziecko jest zbyt małe dla chirurgii cewki moczowej.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"></td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"></td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="87%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Oferujemy wysoki przekierowania moczu, jeśli pęcherz jest niewystarczające odwodnienia do kanalizacji testowanej jednostki i dziecko pozostaje niestabilna.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"></td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"></td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="87%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Monitorowanie długo pęcherza moczowego i nerek życia funkcji, u wszystkich pacjentów.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">3</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> </tbody></table> <div class="bodytekst_italic_onder_tabel_1e_regel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: -15px 0px 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">DMSA = Kwas Dimerkaptobursztynowy skanowania; </span><span style="margin: 0px; padding: 0px;">MAG3 = mercaptoacetyltriglycine; </span><span style="margin: 0px; padding: 0px;">US = USG; </span><span style="margin: 0px; padding: 0px;">VCUG = cystografia mikcyjna.</span></span></div> <h2 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 17px; font-stretch: inherit; font-weight: 500; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_18" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.18.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Pediatryczny urologiczne trauma</span></span></span></h2> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Uraz jest najczęstszą przyczyną zachorowalności i śmiertelności u dzieci i jest odpowiedzialny za więcej zgonów dzieci niż suma wszystkich innych przyczyn [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_811" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">811</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">U około 3% dzieci obserwowanych w ośrodkach pediatrycznych szpitala z urazami, istnieje znaczące zaangażowanie układu moczowo-płciowego [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_812" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">812</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Jest to spowodowane zarówno tępymi urazami od upadków, wypadków samochodowych, urazów sportowych, fizycznej napaści i przemocy seksualnej lub przenikających obrażeń, zazwyczaj z powodu upadków na ostrych przedmiotów lub z postrzałowych lub nożem rany.</span></span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_18_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.18.1.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Pediatryczny uraz nerek</span></span></span></h3> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_1_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.1.1.</span></span><span style="margin: 0px; padding: 0px;"> Epidemiologia, etiologia i patofizjologia</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">W tępego urazu brzucha, nerka jest organem najczęściej dotknięte, co stanowi około 10% wszystkich tępych urazów jamy brzusznej [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_811" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">811</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Dzieci są bardziej narażone niż dorośli do utrzymania urazów nerek po tępym urazie powodu ich anatomii.</span><span style="margin: 0px; padding: 0px;">W porównaniu z nerki dorosłych, nerki dziecka jest większa w stosunku do pozostałej części korpusu i często zachowuje lobulations płodu, tak że tępy uraz jest bardziej prawdopodobne, że doprowadzi do miejscowego zaburzenia miąższu. </span><span style="margin: 0px; padding: 0px;">Nerka jest również pediatryczny słabiej chronione niż nerki dorosłych. </span><span style="margin: 0px; padding: 0px;">Dzieci mają mniej tłuszczu, okołonerkowej znacznie słabsze mięśnie brzucha i mniej skostniałe, a zatem o wiele bardziej elastyczny i ściśliwy klatki piersiowej [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_813" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">813</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Blunt uraz nerek jest zazwyczaj wynikiem nagłego hamowania ciała dziecka, w szczególności z powodu wypadków sportowych, spada, a kontakt z tępymi przedmiotami. </span><span style="margin: 0px; padding: 0px;">Zwalniania ani kruszyć urazy powodują stłuczenia, zranienia lub avulsion z słabiej chronione pediatrii miąższu nerek.</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_1_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.1.2.</span></span><span style="margin: 0px; padding: 0px;"> Systemy klasyfikacyjne</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Urazy nerek są klasyfikowane według skali uszkodzenia nerek z Amerykańskiego Towarzystwa Chirurgii Urazowej (tabela 13) [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_814" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">814</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_bold_2e_regel_inspringen" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="table_inspringen" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Tabela 13:</span></span><span style="margin: 0px; padding: 0px;">  nerkowy uraz klasyfikowane według skali uszkodzenia nerek z Amerykańskiego Towarzystwa Chirurgii Urazowej [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_814" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">814</span></a><span style="margin: 0px; padding: 0px;"> ]</span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="13%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Stopień</span></div> </th><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Rodzaj obrażeń</span></div> </th><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Opis</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" rowspan="2" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="13%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> I</div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Stłuczenie</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Niewidoczny lub widoczny krwiomocz</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Krwiak</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zwykłe badania urologiczne</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" rowspan="2" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="13%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">II</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Krwiak</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nierozwijane podtorebkowa krwiak</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Skaleczenie</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Uszkadzania kory <1 cm="" font=""></1></span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="13%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">III</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Skaleczenie</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Skaleczenie> 1,0 cm bez zerwania systemu zbierania</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" rowspan="2" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="13%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">IV</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Skaleczenie</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Poprzez kory, rdzenia i system zbierania</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Naczyniowy</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Vascular szkody</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" rowspan="2" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="13%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">V</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Skaleczenie</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Całkowicie zniszczone nerki</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Naczyniowy</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="53%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Avulsion z wnęką płuca nerek</span></div> </td></tr> </tbody></table> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_1_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.1.3.</span></span><span style="margin: 0px; padding: 0px;"> Oceny diagnostyczne</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">W dzieciństwie która uległa tępego urazu brzucha, zajęciem nerek często można przewidzieć na podstawie historii, badania fizykalnego i oceny laboratoryjnej. </span><span style="margin: 0px; padding: 0px;">zajęciem nerek może być związany z brzucha lub okolicy lędźwiowej czułością, niższe złamań żeber, złamania kręgów lub nasady pnia, stłuczeń i otarć i krwiomocz.</span></span></div> <h5 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_1_3_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.1.3.1.</span></span><span style="margin: 0px; padding: 0px;"> Krwiomocz</span></h5> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Krwiomocz może być wiarygodnym stwierdzenie. </span><span style="margin: 0px; padding: 0px;">W ciężkich urazów nerek, 65% cierpi widoczny krwiomocz i 33% niewidoczne, a tylko 2% nie ma krwiomocz, wcale [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_815" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">815</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Radiologicznej oceny dzieci z podejrzeniem urazu nerek pozostaje kontrowersyjne. </span><span style="margin: 0px; padding: 0px;">Niektóre ośrodki polegać na obecności krwiomocz zdiagnozować uraz nerek, z progiem zajęciem nerek 50 RBC / HPF. </span><span style="margin: 0px; padding: 0px;">Chociaż może to być wiarygodnym próg znaczące niewidoczny w urazach, pojawiło się wiele doniesień o znaczących urazów nerek, które przejawiają się z małym lub nawet żadnym krwi w moczu [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_816" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">816</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Jest zatem obowiązek wziąć pod uwagę wszystkie aspekty związane klinicznych, w tym historii, badania fizykalnego, świadomości dziecka, ogólnego stanu klinicznego i wyników badań laboratoryjnych, aby podjąć decyzję w sprawie algorytmu diagnostycznego i czy dziecko wymaga dalszych badań obrazowych.</span></span></div> <h5 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_1_3_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.1.3.2.</span></span><span style="margin: 0px; padding: 0px;"> Ciśnienie krwi</span></h5> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ważne jest, aby wziąć pod uwagę, że dzieci, w przeciwieństwie do osób dorosłych, są w stanie utrzymać swoje ciśnienie krwi, nawet w obecności hipowolemii, ze względu na zgodność z drzewa naczyniowego i mechanizmy kompensacji serca [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_817" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">817</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ponieważ ciśnienie krwi jest niewiarygodne predyktorem zajęciem nerek u dzieci, niektóre ośrodki zalecane obrazowanie dróg moczowych u dzieci z jakimkolwiek stopniem krwiomocz następujących istotnych uraz jamy brzusznej.</span></div> <h5 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_1_3_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.1.3.3.</span></span><span style="margin: 0px; padding: 0px;"> Wybór metody obrazowania</span></h5> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">W dzisiejszych czasach, CT jest najlepszą metodą obrazowania zajęciem nerek u dzieci. </span><span style="margin: 0px; padding: 0px;">Tomografia komputerowa skanowania jest fundamentem nowoczesnej inscenizacji tępych urazów nerek, zwłaszcza jeśli chodzi o klasyfikacji ciężkości urazu nerek</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">CT jest bardzo szybkie i zwykle wykonywane wstrzykiwanie środków kontrastowych. </span><span style="margin: 0px; padding: 0px;">Aby wykryć wynaczynienia, druga seria obrazów jest konieczne, ponieważ początkowa seria zwykle kończy się w 60 sekund po wstrzyknięciu środka kontrastującego, a zatem może nie wykryć w moczu wynaczynienia [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_818" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">818</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">W ostrym urazem USA mogą być stosowane jako narzędzie do badań przesiewowych i niezawodnie następujący przebieg uszkodzenia nerek. </span><span style="margin: 0px; padding: 0px;">Jednak USA ma ograniczoną wartość w początkowej oraz ostrej oceny urazu.</span><span style="margin: 0px; padding: 0px;">Standardowe IVP jest dobrą metodą obrazowania alternatywą, jeśli TK nie jest dostępna. </span><span style="margin: 0px; padding: 0px;">Jest to lepsze USA, ale nie jest tak dobra jak skanowanie CT w celach diagnostycznych.</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_1_4" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.1.4.</span></span><span style="margin: 0px; padding: 0px;"> Zarządzania Disease</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nowoczesne zarządzanie uraz jest interdyscyplinarne, wymagające pediatrzy, lekarze medycyny ratunkowej, chirurdzy, urolodzy i inne specjały w miarę potrzeb.</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Non-chirurgiczne leczenie zachowawcze z leżenia w łóżku, płyny i monitorowania stał się standardowym podejściem do leczenia tępego urazu nerek. </span><span style="margin: 0px; padding: 0px;">Nawet w wysokiej jakości urazów nerek, konserwatywne podejście jest skuteczne i zalecane do stabilnych dzieci. </span><span style="margin: 0px; padding: 0px;">Jednak takie podejście wymaga ścisłej obserwacji klinicznej, Serial TK i częstego ponownej oceny ogólnego stanu pacjenta.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Bezwzględne wskazania do zabiegu zawierają uporczywe krwawienia do rozszerzającej lub nieograniczonej krwiaka. </span><span style="margin: 0px; padding: 0px;">Wskazania względne do operacji są ogromne i rozległe wynaczynienia moczu martwicze tkanki nerek [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_819" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">819</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="kop4_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_1_5" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.1.5.</span></span><span style="margin: 0px; padding: 0px;"> Zalecenia dotyczące diagnostyki i leczenia pediatrycznego urazu nerek</span></div> <table class="tabel_blauw" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">zalecenia</span></div> </th><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">GR</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Za pomocą obrazowania u wszystkich dzieci, którzy ponieśli tępy uraz penetrujący lub z dowolnym poziomie krwiomocz, zwłaszcza gdy historia ujawnia zwalniania uraz bezpośredni uraz przyłożenia lub upadku z wysokości.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Użyj szybkiego skanowania spiralna CT dla celów diagnostycznych i postoju.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Mnanage najbardziej rannych nerki zachowawczo.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Oferta interwencji chirurgicznej w przypadku niestabilności hemodynamicznej i klasy V uszkodzenia nerek.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> </tbody></table> <div class="bodytekst_italic_onder_tabel_1e_regel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: -15px 0px 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">CT = tomografia komputerowa.</span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_18_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.18.2.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Pediatryczny moczowodów trauma</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Urazy moczowodów są rzadkie. </span><span style="margin: 0px; padding: 0px;">Moczowód jest dobrze zabezpieczony; </span><span style="margin: 0px; padding: 0px;">górna część jest zabezpieczona przez jego przybliżeniem do kręgosłupa i mięśni przykręgosłupowych oraz dolnej części przez jego trasy przez kostnych miednicy.</span><span style="margin: 0px; padding: 0px;">Ponadto, moczowód ma mały cel, a elastyczność i komórkowego. </span><span style="margin: 0px; padding: 0px;">Oznacza to również, że uszkodzenia moczowodów spowodowane są coraz częściej przez głęboki uraz niż urazu tępego [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_820" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">820</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Od moczowód jest jedynym przewodem do transportu moczu między nerki i pęcherza moczowego, wszelkie uszkodzenie moczowodu może zagrozić funkcję ipsilateralnej nerki.</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_2_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.2.1.</span></span><span style="margin: 0px; padding: 0px;"> Oceny diagnostyczne</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Ponieważ nie istnieją żadne klasyczne objawy kliniczne sugerujące moczowodu traumy, ważne jest przeprowadzenie starannej Postępowanie diagnostyczne przy użyciu różnych technik obrazowania. </span><span style="margin: 0px; padding: 0px;">Niestety, wstępne badania obrazowe, takie jak IVP i rutynowa CT skanów, są niewiarygodne; </span><span style="margin: 0px; padding: 0px;">studium jedenastu zakłóceń skrzyżowaniu ureteropelvic okazało się, że 72% miało normalny lub niediagnostycznym IVP na badaniach wstępnych [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_820" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">820</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Dokładność diagnostyczna skanowania CT można poprawić przez wprowadzenie opóźnione TK do dziesięciu minut po wstrzyknięciu środka kontrastującego [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_821" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">821</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Najbardziej czułym testem diagnostycznym jest wsteczna pyelogram.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Sporo pacjentów prezentują kilka dni po urazie, gdy urinoma produkuje flankę i ból brzucha, nudności i gorączka.</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Gdyż objawy często może być całkiem niejasne, to ważne jest, aby pozostać podejrzane o potencjalnym nierozpoznaną moczowego uszkodzenia spowodowane znacznym tępy uraz jamy brzusznej u dziecka.</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_2_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.2.2.</span></span><span style="margin: 0px; padding: 0px;"> Zarządzania</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Natychmiastowe naprawy podczas eksploracji brzusznej jest rzadkością. </span><span style="margin: 0px; padding: 0px;">Minimalnie inwazyjne procedury są metodą z wyboru, zwłaszcza, że wiele urazów moczowodów są diagnozowane późno po traumatycznym wydarzeniu.</span><span style="margin: 0px; padding: 0px;">Przezskórna lub rurka nephrostromy drenaż urinomas może odnieść sukces, jak również wewnętrzne stentowania urazów moczowodów [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_822" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">822</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Jeśli zarządzanie endoskopowe nie jest to możliwe, pierwotne naprawa częściowych skaleczenia powinny być przestrzegane przez wewnętrzne stentowania. </span><span style="margin: 0px; padding: 0px;">Zarządzanie kompletnych skaleczenia lub zranienia, avulsions zgniotu zależy od ilości utraconej moczowodu i jego lokalizacji. </span><span style="margin: 0px; padding: 0px;">Jeśli istnieje odpowiednia zdrowa długość moczowodu, podstawowym ureteroureterostomy może być wykonana. </span><span style="margin: 0px; padding: 0px;">Jeżeli podstawowym ponowne zespolenie nie jest osiągalne, dalsze urazy moczowodów mogą być zarządzane za pomocą zaczepu psoas pęcherz, Boari klapę lub nawet nephropexy. </span><span style="margin: 0px; padding: 0px;">Proksymalnych urazy mogą być zarządzane za pomocą transureteroureterostomy, Autotransplantacja lub wymianę moczowodu z jelit lub dodatku [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_823" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">823</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="kop4_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_2_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.2.3.</span></span><span style="margin: 0px; padding: 0px;"> Zalecenia dotyczące diagnostyki i leczenia pediatrycznego moczowodu traumy</span></div> <table class="tabel_blauw" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">zalecenia</span></div> </th><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">GR</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Diagnozowanie podejrzanych urazów moczowodów przez wsteczną pyelogram.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"></td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Jednak w początkowej fazie uszkodzenia ciała, to jest bardzo prawdopodobne, że uszkodzenia moczowodów nie zostanie wykryty za pomocą rutynowych metod obrazowania, włącznie z kontrastem spiralnej CT.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zarządzaj urazów moczowodów endoskopowo, używając wewnętrznego stentowania lub odprowadzanie do urinoma, albo przezskórnie lub poprzez rurkę nefrostomii.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zarządzaj dalszego i bliższego urazów moczowodów z otwartą operacją.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zarządzaj dystalnych obrażeń z bezpośredniego ponownego zespolenia i ureteroneocystostomy.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zarządzaj bliższe obrażeń z transureteroureterostomy, wymiana moczowodu z jelit lub dodatku, a nawet autotransplantacją.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> </tbody></table> <div class="bodytekst_italic_onder_tabel_1e_regel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: -15px 0px 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">CT = tomografia komputerowa.</span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_18_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.18.3.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Pediatryczne urazów pęcherza</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Pęcherz pediatryczna jest mniej chronione niż pęcherza dorosłych, a zatem jest bardziej podatne na urazy niż pęcherza dorosłych, zwłaszcza gdy jest on pełny, z tytułu:</span></div> <ul style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; list-style-position: outside; margin: 0px 0px 20px; outline: 0px; padding: 0px 18px; vertical-align: baseline;"> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Jej wyższa pozycja na brzuchu a jej ekspozycja ponad kostnych miednicy.</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Fakt, że ściana brzucha dostarcza mniej mięśni ochrony.</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Fakt, że jest mniej miednicy i brzucha tłuszczu wokół pęcherza zamortyzować go urazu.</span></li> </ul> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Blunt uraz jest najczęstszą przyczyną znacznego uszkodzenia pęcherza. </span><span style="margin: 0px; padding: 0px;">U dorosłych, uszkodzenie pęcherz jest często związane ze złamaniami miednicy. </span><span style="margin: 0px; padding: 0px;">To jest mniej powszechne u dzieci, ponieważ pęcherz pediatryczna siedzi powyżej pierścienia miednicy. </span><span style="margin: 0px; padding: 0px;">W dużym badaniu prospektywnym, tylko 57% dzieci ze złamaniami miednicy również miał uraz pęcherza moczowego w porównaniu do 89% dorosłych [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_824" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">824</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_3_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.3.1.</span></span><span style="margin: 0px; padding: 0px;"> Oceny diagnostyczne</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Charakterystyczne objawy uszkodzenia pęcherza są nadłonowy ból i tkliwość, niemożność oddawania moczu oraz widoczny krwiomocz (95% urazów). </span><span style="margin: 0px; padding: 0px;">Pacjenci ze złamaniami miednicy i widoczny krwiomocz Obecnie z pęknięciem pęcherza w wysokości do 45% przypadków [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_825" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">825</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Rozpoznanie rozerwania pęcherza może być trudne w niektórych przypadkach. </span><span style="margin: 0px; padding: 0px;">Pęcherz powinien być odwzorowana zarówno przy pełnym rozdęte i po drenażu przy użyciu standardowej radiografii lub tomografię komputerową. </span><span style="margin: 0px; padding: 0px;">Najlepsze wyniki można osiągnąć przez wsteczny napełniania pęcherza za pomocą cewnika. </span><span style="margin: 0px; padding: 0px;">Pomimo postępu w obrazowaniu CT, pęcherz nadal muszą być wypełnione po brzegi, aby dokładnie zdiagnozować ewentualne uszkodzenia pęcherza [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_826" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">826</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Tępe urazy do pęcherza są klasyfikowane jako:</span></div> <ul style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; list-style-position: outside; margin: 0px 0px 20px; outline: 0px; padding: 0px 18px; vertical-align: baseline;"> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Stłuczenia z uszkodzeniem błony śluzowej pęcherza moczowego lub mięśni, bez utraty ciągłości ściany pęcherza lub wynaczynienia ;,</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Pęknięcia, które są albo dootrzewnowe lub pozaotrzewnowego.</span></li> </ul> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Dootrzewnowe pęknięcia pęcherza są częstsze u dzieci ze względu na odsłoniętej pozycji pęcherza i ostrego wzrostu ciśnienia podczas urazu. </span><span style="margin: 0px; padding: 0px;">To spowoduje, że pęcherz pękł w jego najsłabszym punkcie, tj kopułę. </span><span style="margin: 0px; padding: 0px;">Pozaotrzewnowego zmiany występują w dolnej części pęcherza moczowego i są prawie zawsze wiąże się ze złamaniami miednicy.</span><span style="margin: 0px; padding: 0px;">Cystogram pokaże wynaczynienia do tkanek miękkich okołopęcherzowej w typowym płomienia wzór i materiał kontrast jest ograniczony do miednicy.</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_3_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.3.2.</span></span><span style="margin: 0px; padding: 0px;"> Zarządzania</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Kontuzje zwykle występujące w różnym stopniu krwiomoczu i potraktowano cewnika samym drenażu.</span></div> <h5 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_3_2_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.3.2.1.</span></span><span style="margin: 0px; padding: 0px;"> Dootrzewnowym urazy</span></h5> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Przyjęty zarządzanie otrzewnowych pęknięcia pęcherza jest otwarte badanie chirurgiczne i naprawa podstawowej.</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Drenaż pooperacyjny ze spojeniem łonowym rury jest obowiązkowe. </span><span style="margin: 0px; padding: 0px;">Najnowsze dane wskazują, że drenaż przezcewkowe może być równie skuteczne, z mniejszą liczbą powikłań, co skutkuje krótszymi okresami dywersji [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_827" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">827</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">]. </span><span style="margin: 0px; padding: 0px;">Zazwyczaj, po około siedmiu do dziesięciu dni, powtórzyć cystogram jest wykonywana w celu zapewnienia uzdrawianie odbywa się prawidłowo.</span></span></div> <h5 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_3_2_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.3.2.2.</span></span><span style="margin: 0px; padding: 0px;"> Zaotrzewnowej urazy</span></h5> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Zarządzanie nieoperacyjnego z odwodnieniem cewnika przez siedem do dziesięciu dni sam jest metodą z wyboru do pęknięcia pęcherza zaotrzewnowej. </span><span style="margin: 0px; padding: 0px;">Jednakże, jeżeli fragmenty kości w obrębie pęcherza moczowego, muszą być usunięte, a pęcherz musi zostać naprawiony i odsączeniu, zgodnie z zasadami obróbki dootrzewnowe pęknięcia [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_828" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">828</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="kop4_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_3_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.3.3.</span></span><span style="margin: 0px; padding: 0px;"> Zalecenia dotyczące diagnostyki i leczenia urazów pęcherza moczowego u dzieci</span></div> <table class="tabel_blauw" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">zalecenia</span></div> </th><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">GR</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Użyj wstecz cystografia do diagnozowania podejrzanych urazów pęcherza.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"></td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Upewnić się, że pęcherz został napełniony do pełna jego pojemności oraz dodatkowa folia zostanie podjęta po drenażu.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zarządzaj zaotrzewnowej pęknięcia pęcherza zachowawczo z przezcewkowej cewnika pozostawione w miejscu przez siedem do dziesięciu dni.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nie zwlekaj leczenie pęknięcia pęcherza otrzewnowych przez eksploracji chirurgicznej i naprawy, a także drenaż pooperacyjny przez siedem do dziesięciu dni.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> </tbody></table> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_18_4" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.18.4.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Pediatryczne urazów cewki moczowej</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Z wyjątkiem części prącia cewki moczowej, cewka moczowa pediatryczna jest dość dobrze chronione. </span><span style="margin: 0px; padding: 0px;">Ponadto, jego kształt i sprężystość znaczy cewka moczowa jest rzadko rannych w wyniku urazu. </span><span style="margin: 0px; padding: 0px;">Jednak uraz cewki moczowej należy podejrzewać u każdego chorego ze złamaniem miednicy lub znacznym urazem krocza aż potwierdzone inaczej diagnostycznego obróbki.</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_4_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.4.1.</span></span><span style="margin: 0px; padding: 0px;"> Oceny diagnostyczne</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Pacjenci z podejrzeniem urazu cewki moczowej i złamań miednicy zazwyczaj obecne w historii ciężkiego urazu, często z udziałem innych narządów.</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Objawy uszkodzenia cewki moczowej są krwi u ujścia cewki, widoczne krwiomocz i ból podczas oddawania moczu lub niemożność nieważne. </span><span style="margin: 0px; padding: 0px;">Nie mogą być również obrzęk i krwiak krocza udziałem moszny. </span><span style="margin: 0px; padding: 0px;">Odbyt, aby określić pozycję i utrwalenie prostaty jest ważne w każdym mężczyzna z podejrzeniem urazu cewki moczowej.</span><span style="margin: 0px; padding: 0px;">Prostaty, jak pęcherz może być przemieszczana do góry z miednicy, zwłaszcza w błoniastej cewki urazu.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Radiologiczna ocena cewki moczowej wymaga wsteczny urethrogram. </span><span style="margin: 0px; padding: 0px;">Ważne jest, aby wystawiać na całej długości cewki moczowej, w tym szyjki pęcherza moczowego. </span><span style="margin: 0px; padding: 0px;">Jeżeli cewnik ma już wprowadzone przez kogoś innego i nie podejrzewa cewki uraz, cewnik powinien pozostać na miejscu i nie powinny być usunięte. </span><span style="margin: 0px; padding: 0px;">Zamiast tego, mała niemowląt otwór wlotowy może być umieszczony w dalszej cewki wzdłuż cewnika, aby umożliwić wstrzykiwanie środka kontrastowego do skanowania diagnostyczne [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_829" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">829</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_4_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.4.2.</span></span><span style="margin: 0px; padding: 0px;"> Zarządzania Disease</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ponieważ wiele z tych pacjentów są niestabilne, początkowe odpowiedzialność urologa jest opracowanie sposobu opróżniania i monitorowania diurezy.</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Przezcewkowe cewnika należy wprowadzić tylko wtedy, gdy istnieje historia mikcji po traumatycznym wydarzeniu, a jeśli badanie odbytu i miednicy, jak opisano powyżej, nie zaproponował pęknięcie cewki moczowej. </span><span style="margin: 0px; padding: 0px;">Jeśli cewnik nie przechodzi łatwo natychmiastowe wsteczna urethrogram powinny być wykonywane.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nadłonowy rura może być umieszczona w izbie przyjęć przezskórnie, lub nawet na sali operacyjnej, gdy pacjent musi być poddany natychmiastowej poszukiwania z powodu innych życiowych threateninginjuries.</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Są to często związane z nimi żadnych obrażeń bulwiastego z cewki moczowej lub bramowego kontuzji i zarządzania jest więc zazwyczaj proste. </span><span style="margin: 0px; padding: 0px;">W tych przypadkach, przezcewkowe Cewnik jest najlepszym rozwiązaniem dla zapobiegania krwawienie z cewki moczowej i / lub bolesne oddawanie [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_830" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">830</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Początkowe zarządzanie urazów cewki tylnej pozostaje kontrowersyjna, głównie w odniesieniu do wyników długoterminowych z pierwotnym wyrównanie porównaniu do prostego nadłonowego odwodnienia z późniejszej rekonstrukcji.</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Główne cele w naprawie chirurgicznym urazów cewki tylnej to:</span></div> <ul style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; list-style-position: outside; margin: 0px 0px 20px; outline: 0px; padding: 0px 18px; vertical-align: baseline;"> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Zapewnienie zwężenia cewki moczowej wolne.</span></li> <li style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px 0px 0px 60px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Unikanie powikłań nietrzymania moczu i impotencji.</span></li> </ul> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nadłonowy odwodnienia i późno cewki moczowej rekonstrukcja została pierwsza próba, ponieważ niezwłocznej naprawy chirurgicznej miał słabe wyniki, przy znacznym krwawienia i wysokich stóp nietrzymania moczu (21%) i impotencji u do 56% przypadków [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_831" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">831</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">U osób dorosłych, badanie stóp sukcesu opóźnionego remontu Podawane ceny ponownie struktury o 11-30% ceny wstrzemięźliwości 90-95%, a ceny o 62-68% impotencja [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_832" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">832</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Jednak u dzieci, jest o wiele mniej doświadczenia z naprawą opóźnione. </span><span style="margin: 0px; padding: 0px;">Największy pediatryczna seria opóźnionego remontu w 68 chłopców odnotowano wskaźnik sukcesu 90% [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_833" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">833</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">W innym badaniu odnotowano zwężeń i impotencji u 67% chłopców, chociaż wszyscy chłopcy byli kontynentu [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_832" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">832</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Alternatywą dla zapewnienia wstępnej nadłonowy drenaż i opóźnione naprawy jest podstawowym przebudowa cewki moczowej za pomocą cewnika. </span><span style="margin: 0px; padding: 0px;">Cewnik ma zwykle miejsce w czasie wolnym cystostomia przepuszczając ją z obu szyi pęcherza lub ujściem cewki i przez segment uszkodzonej. </span><span style="margin: 0px; padding: 0px;">W serii 14 dzieci poddanych tej procedury spowodowało tempie zwężenie 29% i moczu u 7% chorych [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_834" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">834</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="kop4_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_18_4_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.18.4.3.</span></span><span style="margin: 0px; padding: 0px;"> Zalecenia dotyczące diagnostyki i leczenia urazów u dzieci i młodzieży</span></div> <table class="tabel_blauw" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">zalecenia</span></div> </th><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">GR</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ocenić cewki moczowej przez wsteczną urethrogram w przypadku podejrzenia urazu cewki moczowej.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Przeprowadzić odbyt w celu określenia położenia prostaty.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zarządzaj bulwiaste urazów cewki moczowej zachowawczo z przezcewkowej cewnika.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zarządzaj tylną zakłóceń cewki moczowej za pomocą:</span></div> <div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">rekonstrukcja pierwotnej;</span></div> <div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Podstawowym monoterapia drenaż nadłonowego cewnika i naprawy opóźnieniem;</span></div> <div class="tabel_bodytekst_9pt_bullet" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px 30px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Podstawowym ponowne wyrównanie z przezcewkowej cewnika.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">do</span></div> </td></tr> </tbody></table> <h2 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 17px; font-stretch: inherit; font-weight: 500; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_19" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.19.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Pooperacyjne Fluid Management</span></span></span></h2> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_19_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.19.1.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Epidemiologia, etiologia i patofizjologia</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">W porównaniu do dorosłych, dzieci mają inny całkowity rozkład płynów ustrojowych, nerek wymagań fizjologii i elektrolitów, a także słabsze mechanizmy kompensacyjne sercowo-naczyniowych [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_835" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">835</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Ponieważ dzieci rozwijają one mieć wysoki stopień przemiany i niskiej zawartości tłuszczu i przechowuje składników odżywczych, co oznacza, że są one bardziej podatne na zakłócenia metabolicznych spowodowanych stresem chirurgicznego [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_836" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">836</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Reakcja metabolicznej znieczulenia i zabiegu u niemowląt i dzieci jest związany z nasileniem działania [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_837" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">837</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_19_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.19.2.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Zarządzanie Disease</span></span></span></h3> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_19_2_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.19.2.1.</span></span><span style="margin: 0px; padding: 0px;"> Czczo przedoperacyjna</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Czczo przedoperacyjne zostało zalecone planowanym zabiegiem chirurgicznym w celu uniknięcia komplikacji związanych z aspiracji do płuc podczas indukcji znieczulenia. </span><span style="margin: 0px; padding: 0px;">Tabela 14 podaje aktualne wytyczne dotyczące głodówki przedoperacyjnej planowanym zabiegiem chirurgicznym [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_838" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">838</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_839" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">839</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_bold" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Tabela 14: przedoperacyjna razy na czczo do planowej operacji</span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">materiał spożywana</span></div> </th><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Minimalny okres, na czczo (h)</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Klarowne ciecze</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">2</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Mleko matki</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">4</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Preparat dla niemowląt</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">4 (<3 6="" cy="" do="" miesi=""> 3 miesięcy)</3></span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">mleka nie ludzkiego</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 6</div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Lekki posiłek</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">6</span></div> </td></tr> </tbody></table> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Chociaż hipoglikemia jest istotnym problemem u dzieci, badania wykazały, że hipoglikemia jest rzadkością w przypadku dzieci są nadal karmione do czterech godzin przed indukcją znieczulenia [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_840" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">840</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Noworodki często mają niskie zapasy glikogenu i zaburzenia glukoneogenezy, z których oba mogą być wspomagane poprzez ograniczenie okresu głodzenia przedoperacyjnego i podawania roztworów zawierających glukozę. </span><span style="margin: 0px; padding: 0px;">Ważne jest, aby kontrolować poziom cukru we krwi oraz w celu regulacji dopływu glukozy ciągle u noworodków i małych dzieci, które dla ich wieku, ponieważ pomaga to uniknąć nadmiernych wahań poziomu glukozy we krwi [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_841" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">841</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_19_2_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.19.2.2.</span></span><span style="margin: 0px; padding: 0px;"> Leczenie podtrzymujące i śródoperacyjnej płynoterapia</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Generalnie, anestezjolog jest odpowiedzialny za zarządzanie śródoperacyjne i chirurg jest odpowiedzialny za instrukcjami pooperacyjnych. </span><span style="margin: 0px; padding: 0px;">Celem śródoperacyjnej gospodarki płynami jest utrzymanie homeostazy przez dostarczenie odpowiedniej ilości płynu pozajelitowego; </span><span style="margin: 0px; padding: 0px;">Ten utrzymuje odpowiednie objętości wewnątrznaczyniowej, pojemność minutową serca i dostarczanie tlenu do tkanek w czasie, gdy normalne funkcje fizjologiczne nie zostały zmienione przez stres pooperacyjny i środków znieczulających [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_841" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">841</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Płyny do terapii podtrzymującej wymienić straty z dwóch źródeł: nieczuły (parowanie) oraz utrata moczu.</span><span style="margin: 0px; padding: 0px;">Nie zastępują one utratę krwi lub innych przestrzeni utratę płynu do przestrzeni śródmiąższowej lub jelit. </span><span style="margin: 0px; padding: 0px;">Głównymi wzory na obliczenie dziennego zapotrzebowania na wodę konserwacyjnych nie zmieniły się w ciągu ostatnich 50 lat (tabela 15) [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_842" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">842</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Obliczenia wykazały, że usypia się i nie narkozie dzieci mają podobne wymagania płynów [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_843" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">843</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Połączenie cieczy z wymaganiami konserwacji i elektrolitów wyniki hipotonicznym roztworze elektrolitu.</span><span style="margin: 0px; padding: 0px;">Zazwyczaj dożylne płynu konserwacji podawać dzieciom przez pediatrów jest o jedną czwartą do jednej trzeciej siły fizjologiczna [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_844" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">844</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_bold" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Tabela 15: godzinowe i dzienne zapotrzebowanie płynu według masy ciała</span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Masy ciała</span></div> </th><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Cogodzinny</span></div> </th><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Codziennie</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><10 font="" kg=""></10></span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 4 mL/kg</div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 100 mL/kg</div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 10-20 kg</div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 40 mL + 2 mL/kg; > 10 kg</div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 1,000 mL + 50 mL/kg; > 10 kg</div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> > 20 kg</div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 60 mL + 1 mL/kg; > 20 kg</div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="33%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 1,500 mL+ 20 mL/kg; > 20 kg</div> </td></tr> </tbody></table> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Deficyt na czczo jest obliczana przez pomnożenie godzinowej wymóg utrzymania płynu przez liczbę godzin ograniczeniem płynów. </span><span style="margin: 0px; padding: 0px;">Zaleca się, że 50% z deficytem czczo otrzymuje w pierwszej godzinie i 25% w drugim i trzecim godzin [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_845" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">845</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Jagodowe (1986) zaproponowano uproszczone wytyczne do podawania płynu, w zależności od wieku dziecka i ciężkości urazu operacyjnego [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_846" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">846</span></a><span style="margin: 0px; padding: 0px;"> ] (Tabela 16).</span></div> <div class="bodytekst_bold_2e_regel_inspringen" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="table_inspringen" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">Tabela 16:</span></span><span style="margin: 0px; padding: 0px;">  Intra-operative zarządzanie płynu przystosowany dla dzieci pościł przez sześć do ośmiu godzin, po klasyczną zalecenie 'nil na ustny po północy "</span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_zwart" colspan="4" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Furman,  </span><span class="bodytekstitalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: italic; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">i wsp.</span></span><span style="margin: 0px; padding: 0px;">  [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_845" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">845</span></a><span style="margin: 0px; padding: 0px;"> ]</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Godzina wymiany płynu</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">płyn Konserwacja</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Wymiana Deficyt na czczo</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">straty Trwałe</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">pierwsza godzina</span></div> </td><td class="Celstijl_1" rowspan="3" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">W tabeli 14</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 50%</div> </td><td class="Celstijl_1" rowspan="3" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Trzecie miejsce + wymiana utrata krwi</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">druga godzina</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> 25%</div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">trzecia godzina</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">25%</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_zwart" colspan="4" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="100%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Berry [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_846" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">846</span></a><span style="margin: 0px; padding: 0px;"> ]</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">pierwsza godzina</span></div> </td><td class="Celstijl_1" colspan="2" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><3 25="" font="" kg="" lat:="" ml=""></3></span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">> 4 lat: 15 ml / kg</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Wymiana krwi 1: 1</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">krwią lub koloidu</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span class="bodytekstbold" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">lub</span></span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">3: 1 krystaloidami</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Wszystkie pozostałe godziny</span></div> </td><td class="Celstijl_1" colspan="2" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="50%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">dawkę podtrzymującą = 4 ml / kg / h,</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Konserwacja + łagodna uraz = 6 ml / kg / h,</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Konserwacja + umiarkowany uraz = 8 ml / kg / h</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Konserwacja + ciężki uraz = 10 ml / kg / h,</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="25%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Wymiana krwi 1: 1</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">krwią lub koloidu</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span class="bodytekstbold" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">lub</span></span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">3: 1 krystaloidami</span></div> </td></tr> </tbody></table> <div class="bodytekst_italic_onder_tabel_1e_regel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: -15px 0px 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">* Zmniejszenie ilości płynem podawanym podczas pierwszej godziny, gdy dzieci są poszczeniu przez krótszy okres czasu, lub gdy dziecko już podano płynu dożylnego przed zabiegiem.</span></div> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Pięć procent dekstrozy z jednej ćwierć do połowy soli fizjologicznej jest często używany jako płyn do utrzymywania, podczas zrównoważony roztwór soli lub soli fizjologicznej jest stosowany jako płyn wymiany. </span><span style="margin: 0px; padding: 0px;">Straty krwi zastępowane w stosunku 1: 1 z krwi lub koloidu lub 3: 1 stosunek krystalicznych. </span><span style="margin: 0px; padding: 0px;">Jednakże, stosowanie do dużej ilości soli fizjologicznej może spowodować rozcieńczeniem kwasicę lub hiperchloremiczna kwasicę, podczas gdy duża ilość zrównoważonym roztworze soli, takiej jak roztwór Ringera z dodatkiem mleczanu, można zmniejszyć osmolalność osocza, które nie jest korzystna u pacjentów ze zmniejszoną zgodność wewnątrzczaszkowego. </span><span style="margin: 0px; padding: 0px;">W razie potrzeby, albuminy osocza, syntetyczne koloidów i we krwi powinien być podawany [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_841" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">841</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Straty trzeciego miejsca może wahać się od 1 ml / kg / h na drobne zabiegu chirurgicznym do 15-20 ml / kg / h dla głównych procedur brzucha, a nawet do 50 ml / kg / h do zabiegu martwiczego zapalenia jelit u wcześniaków ,</span><span style="margin: 0px; padding: 0px;">Straty trzeciego miejsca należy zastąpić krystaloidy (soli fizjologicznej lub mleczanu Ringera) [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_839" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">839</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Większość płynów wymaganych podczas operacji potrzebne są do zastąpienia strat deficytu na czczo lub trzeciego miejsca, które są głównie w płynach. </span><span style="margin: 0px; padding: 0px;">Nawilżające roztwory powinny zawierać wysokie stężenie jonów sodowych i chlorkowych, a niskie stężenia wodorowęglanu, wapnia i potasu.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Hipoglikemia śródoperacyjne rzadko występuje u dzieci. </span><span style="margin: 0px; padding: 0px;">W przeciwieństwie do tego, hiperglikemia jest powszechnie spotykane w czasie znieczulenia ogólnego i chirurgii. </span><span style="margin: 0px; padding: 0px;">Płyn zastępcza powinna być wolna od dekstroza czy nie powinien mieć> 1% dekstrozy. </span><span style="margin: 0px; padding: 0px;">Aktualne zalecenia obejmują stosowanie niskich zawierających glukozę-rozwiązań dla terapii płynu konserwacji, z wyjątkiem pacjentów, którzy są w grupie wysokiego ryzyka wystąpienia hipoglikemii [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_835" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">835</span></a><span style="margin: 0px; padding: 0px;">, </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_844" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">844</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Podawanie śródoperacyjnej izotonicznych roztworów nawilżających wolnej glukozy powinna być rutynowym przypadku większości procedur dzieci od 4-5 lat. </span><span style="margin: 0px; padding: 0px;">U niemowląt i małych dzieci, 5% roztwory dekstrozy, należy unikać, jednak należy użyć 1% lub 2% dekstrozę w roztworze Ringera, [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_839" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">839</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_19_2_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.19.2.3.</span></span><span style="margin: 0px; padding: 0px;"> Pooperacyjne Fluid Management</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">W okresie pooperacyjnym, podstawową zasadą jest monitorowanie funkcji układu pokarmowego i kontynuować żywienie doustne lub dojelitowe jak najwięcej [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_836" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">836</span></a><span style="margin: 0px; padding: 0px;"> ], pamiętając, że wstrzymanie płynów doustnie w okresie pooperacyjnym od dzieci poddawanych operacjom dziennie pomaga zapobiegać wymiotów [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_847" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">847</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ] , </span><span style="margin: 0px; padding: 0px;">W niewielkich zabiegach chirurgicznych, podawanie śródoperacyjnej dużych objętościach krystaloidów jest związane ze zmniejszeniem występowania pooperacyjnych nudności i wymiotów po znieczuleniu, zarówno u dzieci jak i dorosłych [</span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_848" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">848</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Wskazówki dotyczące wymiany płynu berry może nastąpić pod warunkiem, że dziecko otrzymuje mleczanowy roztwór lub polyionique B66 Ringera, który ma podobną do osmolarności osocza [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_849" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">849</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Nie jest to obowiązkowe, aby sprawdzić chemię surowicy po niepowikłanym zabiegu u dzieci z prawidłową przedoperacyjnej czynności nerek i wątroby. </span><span style="margin: 0px; padding: 0px;">Jednakże, jeśli przyjęcie doustne został przesunięty do> 24 godzin (na przykład jak w chirurgii jelita), istnieje zwiększone ryzyko wystąpienia zaburzeń elektrolitowych, wymagające dalszej oceny i późniejszego zarządzania, szczególnie w potas. </span><span style="margin: 0px; padding: 0px;">Wyniki pooperacyjne, takie jak zmniejszone ruchy jelit i niedrożność, mogą to być objawy hipokaliemii, które mogą zostać usunięte z roztworem 20 mmol / l potas i infuzji z szybkością nie większą niż 3 mmol / kg / dzień. </span><span style="margin: 0px; padding: 0px;">Potasu należy poprzez obwodowego dostępu żylnego, jeśli nie przewiduje się, czas trwania infuzji niż 5 dni, lub poprzez centralny punkt dostępu żylnego, gdy odżywianie pozajelitowe długoterminowa jest konieczne.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Cele terapii płynu jest zapewnienie podstawowych potrzeb metabolicznych oraz w celu zrekompensowania strat z przewodu pokarmowego i dodatkowych. </span><span style="margin: 0px; padding: 0px;">Jeśli hipowolemia jest obecny, powinien być szybko leczony.</span><span style="margin: 0px; padding: 0px;">Hyponatremia jest najczęstszym zaburzeniem elektrolitu w okresie pooperacyjnym [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_849" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">849</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_850" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">850</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Oznacza to, że płyn hipotoniczny nie powinny być rutynowo podawać hospitalizowanych dzieci, ponieważ mają one wiele bodźców wytwarzania wazopresyny argininowej i dlatego istnieje duże ryzyko rozwinięcia hiponatremii [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_839" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">839</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_849" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">849</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_851-854" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">851-854</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ].</span><span style="margin: 0px; padding: 0px;">Korzystne płyny do leczenia podtrzymującego to 0,45% solanka z dekstrozą lub płynów izotonicznych, w przypadku braku konkretnego wskazania do 0,25% soli fizjologicznej. </span><span style="margin: 0px; padding: 0px;">Wskazane jest również podawanie płynów izotonicznych śródoperacyjnie, a także bezpośrednio po zabiegu, choć dwie trzecie obliczonej stopy podtrzymującej w sali pooperacyjnej. </span><span style="margin: 0px; padding: 0px;">Skład płynu powinien zrównoważyć wysokie wymagania sodowe, zapotrzebowanie na energię i rozwiązanie osmolarności. </span><span style="margin: 0px; padding: 0px;">Dodatkowe straty z rur żołądka lub skrzyni należy zastąpić Mleczan Ringera. </span><span style="margin: 0px; padding: 0px;">Płyn, który został podany do rozcieńczania lekarstwa muszą być również brane pod uwagę, [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_839" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">839</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Dzieci, które przechodzą interwencje w leczeniu wszelkiego rodzaju chorób obturacyjnych zasługują na szczególną uwagę, zwłaszcza ryzyko wielomocz ze względu na post-obturacyjną diurezy. </span><span style="margin: 0px; padding: 0px;">U dzieci, które rozwijają wielomocz, ważne jest, aby monitorować spożycie płynów i wydalania moczu, a także czynność nerek i elektrolitów w surowicy. </span><span style="margin: 0px; padding: 0px;">Jeśli to konieczne, lekarze nie powinni się wahać w konsultacji z pediatrii nefrologa.</span></span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_19_2_4" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.19.2.4.</span></span><span style="margin: 0px; padding: 0px;"> Czczo Pooperacyjne</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Donoszono, że post zmniejsza ryzyko wymioty o 50% [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_847" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">847</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_855" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">855</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_856" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">856</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Jednak badania wykazały, że jeśli dzieci były swobodnie wolno pić i jeść, gdy czują się gotowe lub o to, częstość występowania wymiotów nie zwiększają, a dzieci czuł szczęśliwsi i były znacznie mniej przeszkadza bólu niż dzieci, które były na czczo [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_857" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">857</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ] , </span><span style="margin: 0px; padding: 0px;">Średni czas do momentu pierwszego drinka i pierwszym jedzenia w dzieci, które były wolne jeść ani pić były 108 i 270 minut, odpowiednio, które były cztery godziny i trzy godziny wcześniej niż w grupie na czczo. </span><span style="margin: 0px; padding: 0px;">Poprzednie badania wykazały, że ruchliwość żołądka powraca do normalnego godzinę po wyjściu z znieczulenia u dzieci, które nie zostały poddane operacji brzusznej [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_858" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">858</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Pierwszy wlot ustnej u dzieci w ciągu jednej godziny, po wyjściu z znieczulenia do niewielkich operacji nie powoduje wzrost częstości występowania wymiotów, pod warunkiem, że płyn spożytego w temperaturze ciała, [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_859" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">859</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">W związku z tym członkowie EAU panelowe zalecane zachęcały do szybkiego spożycia płynu u dzieci, które przeszły niewielki lub nie brzucha operację prostaty.</span></span></div> <div class="kop3_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_19_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.19.3.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Zestawienie dowodów i zaleceń w zakresie zarządzania pooperacyjnego gospodarki płynem</span></span></span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Podsumowanie dowodów</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">LE</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Dzieci nie są po prostu mniejszymi wersjami fizjologiczne dorosłych. </span><span style="margin: 0px; padding: 0px;">Mają swoje własne unikalne cechy metaboliczne, które należy uwzględnić podczas operacji.</span></span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">2</span></div> </td></tr> </tbody></table> <table class="tabel_blauw" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">zalecenia</span></div> </th><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">GR</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Upewnić się, że krótsze okresy przedoperacyjnej czczo zastosowanie do planowych zabiegów (do czterech godzin)</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Za pomocą płynów o niższych stężeniach dekstrozy gdyż hiperglikemia jest powszechne u dzieci, w porównaniu do hipoglikemii śródoperacyjne (co jest bardzo rzadkie).</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Nie używać płynu hipotoniczne rutynowo u hospitalizowanych dzieci, ponieważ są na wysokie ryzyko wystąpienia hiponatremii.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Oceny poziomów bazowych i dziennych elektrolitów w surowicy, glukozy, mocznika i / lub kreatyniny w każdym dziecku, które otrzymuje płynów dożylnych, szczególnie w chirurgii jelita (np jelita krętego Augmentacja), niezależnie od rodzaju wybranego rozwiązania, ponieważ istnieje zwiększone ryzyko elektrolitu Nieprawidłowości u dzieci poddawanych takiej operacji.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zacznij wcześnie spożycie płynów jamy ustnej u pacjentów zakwalifikowanych do małych zabiegów chirurgicznych.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">ZA</span></div> </td></tr> </tbody></table> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> </div> <h2 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 17px; font-stretch: inherit; font-weight: 500; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span style="border: 0px; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_20" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">. 3.20</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Pooperacyjne leczenie bólu: Informacje ogólne</span></span></span></h2> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_20_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.20.1.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Epidemiologia, etiologia i patofizjologia</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zapewnienie odpowiedniej kontroli bólu wymaga właściwej oceny bólu, dokładny wybór leku i sposobu podawania, i uwagę od wieku, kondycji fizycznej i rodzaju zabiegu i znieczulenia [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_860" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">860</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Jednakże, nadal nie ma znormalizowany algorytm do leczenia bólu pooperacyjnego u dzieci [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_861" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">861</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Istnieje pilna potrzeba pooperacyjnego protokołu leczeniem bólu u dzieci, szczególnie do wytycznych dotyczących częstotliwości oceny bólu, stosowanie opioidów pozajelitowego wprowadzenia znieczulenia regionalnego, a stosowanie leków przeciwbólowych ratowniczych [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_862" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">862</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Tradycyjne wierzenia medyczne, które noworodków niezdolnych do odczuwania bólu zostały porzucone po niedawnym oraz lepszego zrozumienia w jaki sposób system ból dojrzewania u ludzi, lepszych metod oceny bólu i znajomości klinicznych następstw bólu u noworodków [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_863-867" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">863-867</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Liczne badania wykazały, że niedobór lub niewystarczające działanie przeciwbólowe mogą być przyczyną przyszłych następstw somatycznych i behawioralnych [</span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_868-871" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">868-871</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Nasze obecne rozumienie leczenia bólu u dzieci zależy całkowicie na przekonaniu, że wszystkie dzieci, niezależnie od wieku, zasługują na odpowiednie traktowanie.</span></span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_20_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.20.2.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Oceny diagnostyczne</span></span></span></h3> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Ocena bólu jest pierwszym krokiem w leczeniu bólu. </span><span style="margin: 0px; padding: 0px;">Potrzebne są potwierdzone narzędzia oceny bólu w tym celu ważne jest, aby wybrać odpowiednią technikę oceny bólu. </span><span style="margin: 0px; padding: 0px;">Kilka narzędzi oceny bólu zostały opracowane w zależności od wieku dziecka, tło kulturowe, stanu psychicznego, umiejętności komunikacyjne i reakcje fizjologiczne [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_872" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">872</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_873" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">873</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Jednym z najważniejszych tematów w pediatrii leczenia bólu jest informowanie i angażowanie dziecka i rodziców w trakcie tego procesu. </span><span style="margin: 0px; padding: 0px;">Rodzice i pacjenci mogą zarządzać bólu pooperacyjnego w domu lub w szpitalu, jeśli dostarczone z prawidłowym informacji. </span><span style="margin: 0px; padding: 0px;">Rodzice i pacjenci, jeżeli są one na tyle dorosły, może aktywnie uczestniczyć w leczeniu bólu w aplikacjach rodziny pacjenta analgezji kontrolowanej [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_874-879" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">874-879</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h3 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 30px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_20_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.20.3.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Zarządzanie Disease</span></span></span></h3> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_20_3_1" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.20.3.1.</span></span><span style="margin: 0px; padding: 0px;"> Narkotyki i droga podawania</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Wyprzedzające przeciwbólowe jest ważnym pojęciem, które ma na celu skłonić tłumienie bólu, zanim nastąpi neuronowa uczuleniową [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_880" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">880</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Miejscowe środki znieczulające lub niesteroidowe leki przeciwbólowe są podane śródoperacyjnie opóźnić bólu pooperacyjnego oraz zmniejszenie zużycia pooperacyjny przeciwbólowy. </span><span style="margin: 0px; padding: 0px;">Leki przeciwbólowe należy stopniowo zwiększać aż do uzyskania właściwej reakcji został osiągnięty. </span><span style="margin: 0px; padding: 0px;">Opioidy można podawać dzieciom, drogą doustną, przez błony śluzowe, przezskórne, podskórne, domięśniowe lub dożylne [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_876" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">876</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ].</span><span style="margin: 0px; padding: 0px;">Połączenie opioidów z niesteroidowymi lekami przeciwzapalnymi (NLPZ) lub miejscowych środków znieczulających (zrównoważonym lub multimodalne analgezji) mogą być stosowane w celu poprawy jakości działania przeciwbólowego i zmniejszać niepożądane efekty związane z opioidami [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_881" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">881</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">To samo połączenie lokalne środki znieczulające opioidy i nieopioidowe leki stosowane u dorosłych mogą być stosowane u dzieci, biorąc pod uwagę wiek, ciężar ciała i indywidualnego stanu medycznego.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Światowa Organizacja Zdrowia "ból Drabina" jest użytecznym narzędziem dla strategii zarządzania bólu [</span><a href="https://uroweb.org/guideline/paediatric-urology/#note_882" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">882</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Strategia trzypoziomowy wydaje praktyczne zastosowania klinicznego. </span><span style="margin: 0px; padding: 0px;">Zarządzanie pooperacyjna powinna być oparta na wystarczającym śródoperacyjnej poboru analgezji z blokadą regionalną lub ogonowej następnie zrównoważonej analgezji.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Paracetamol i niesteroidowe leki przeciwzapalne są lekami z wyboru w pierwszym poziomie. </span><span style="margin: 0px; padding: 0px;">Jak stają się niewystarczające, aby zapobiec bólowi, słabe i silne opioidy są dodawane do leków doustnych, aby osiągnąć zrównoważony znieczulenia. </span><span style="margin: 0px; padding: 0px;">Każda instytucja musi zbudować własną strategię analgezji pooperacyjnej. </span><span style="margin: 0px; padding: 0px;">Proponowana strategia dla analgezji pooperacyjnej mogą być następujące:</span></span></div> <div class="bodytekst_geen_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -20px 0px 20px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">1. Intra-operative blok regionalny lub ogonowej</span></div> <div class="bodytekst_geen_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -20px 0px 20px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">2. Paracetamol + NLPZ</span></div> <div class="bodytekst_geen_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -20px 0px 20px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">3. Paracetamol + NLPZ + słabych opioidów (np tramadol lub kodeina)</span></div> <div class="bodytekst_geen_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -20px 0px 20px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">4. Paracetamol + NLPZ + silny opioid (np morfina, fentanyl, oksykodon lub petydyna)</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_20_3_2" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.20.3.2.</span></span><span style="margin: 0px; padding: 0px;"> Obrzezanie</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Obrzezanie bez znieczulenia, bez względu na wiek, nie jest zalecane. </span><span style="margin: 0px; padding: 0px;">Obrzezanie wymaga właściwego zarządzania bólu [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_886" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">886</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Pomimo tego, odpowiednie zarządzanie ból jest nadal poniżej oczekiwań [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_887" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">887</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Potencjalne działanie przeciwbólowe interwencji podczas obrzezanymi obejmują stosowanie bloku grzbietowej prącia nerwów (DPNB) lub blok pierścień, miejscowe środki znieczulające (np krem lidokaina, prilokaina, lub 4% liposomalna lidokainy śmietanka), mniej bolesne zacisk (np Mogen zacisk), smoczek , sacharoza i pieluszki, korzystnie w połączeniu [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_888-892" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">888-892</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Choć miejscowe środki znieczulające DPNB i zdają się mieć podobną pooperacyjny efekt przeciwbólowy, DPNB wciąż jest najbardziej preferowaną metodą [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_893" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">893</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ] (LE: 1a). </span><span style="margin: 0px; padding: 0px;">Ultrasonograficzną może poprawić wyniki, wraz ze wzrostem czasu procesowego [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_894" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">894</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_895" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">895</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Ogonowej blokada metody mają podobną skuteczność w porównaniu do DPNB. </span><span style="margin: 0px; padding: 0px;">Jednak rodzice powinni być informowani o częstszym występowaniem pooperacyjna niedowładów i mikcji problemów [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_896-901" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">896-901</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_20_3_3" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.20.3.3.</span></span><span style="margin: 0px; padding: 0px;"> Prącia, moszny i pachwinowe chirurgii</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Caudal blok jest najbardziej badane metodą analgezji po zabiegu dla spodziectwa. </span><span style="margin: 0px; padding: 0px;">Kilku agentów w różnych dawkach, stężenia i technik administracji zostały wykorzystane z podobnymi wynikami [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_902-916" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">902-916</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Zarówno pojedyncze i łączne stosowanie tych leków jest skuteczne [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_903" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">903</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_904" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">904</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_906" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">906</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_907" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">907</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_912" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">912</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_914" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">914</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Bloki prącia może być stosowany do analgezji pooperacyjnej i mają podobne pooperacyjnych właściwości przeciwbólowe jak ogonowych bloków [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_917" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">917</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Prącia dwa bloki na początku i na końcu operacji wydaje się zapewniać większą ulgę w bólu, [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_918" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">918</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Silne skurcze pęcherza powodowane przez obecność cewnika może czasem powodować więcej problemów niż w bólu i kieruje z leków przeciwmuskarynowych.</span></span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Dla inguinoscrotal operacji, wszystkie metody znieczulające, takie jak bloki ogonowych [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_356" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">356</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_919-921" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">919-921</span></a><span style="margin: 0px; padding: 0px;"> ] blokada nerwu [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_922" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">922</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_923" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">923</span></a><span style="margin: 0px; padding: 0px;"> ], gojenie infiltracji lub zakropleniu i nawadniania z miejscowo znieczulające [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_924-926" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">924-926</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ] Wykazano, że mają odpowiednią post- operative właściwości przeciwbólowe. </span><span style="margin: 0px; padding: 0px;">Kombinacje mogą poprawić wyniki [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_927" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">927</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <h4 style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; font-weight: 400; line-height: 20px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px; position: relative; text-rendering: optimizeLegibility; vertical-align: baseline;"> <a href="https://www.blogger.com/null" name="3_20_3_4" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;">3.20.3.4.</span></span><span style="margin: 0px; padding: 0px;"> Pęcherza moczowego i nerek chirurgii</span></h4> <div class="bodytekst" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ciągłego wlewu zewnątrzoponowego miejscowych środków znieczulających [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_928-930" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">928-930</span></a><span style="margin: 0px; padding: 0px;"> ], a także ogólnoustrojowe (dożylne) stosowanie analgetyków [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_931" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">931</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ] Wykazano, że skuteczna. </span><span style="margin: 0px; padding: 0px;">Ketorolak jest skutecznym środkiem, który jest w pełni wykorzystywana. </span><span style="margin: 0px; padding: 0px;">To zmniejsza częstość i nasilenie skurczów pęcherza i długość pooperacyjnego pobytu w szpitalu i kosztów [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_920" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">920</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_932-935" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">932-935</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">Otwarta operacja nerki jest szczególnie bolesna, ponieważ wszystkie trzy warstwy mięśni są wycinane podczas konwencjonalnego nacięcie lędźwi. </span><span style="margin: 0px; padding: 0px;">Grzbietową lumbotomy nacięcie może być dobrą alternatywą ze względu na krótszy pooperacyjnego pobytu w szpitalu, a wcześniej wrócić do przyjmowania doustnego i nieograniczonego codziennej aktywności [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_936" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">936</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_inspringen_eerste" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: -18px 0px 0px; outline: 0px; padding: 0px 0px 20px; text-indent: 80px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ogonowej bloki plus przeciwbólowe ogólnoustrojowe [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_937" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">937</span></a><span style="margin: 0px; padding: 0px;"> ] i ciągłe znieczulenie zewnątrzoponowe, są skuteczne pod względem zmniejszyła pooperacyjną wymóg morfiny po operacji nerek [ </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_938" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">938</span></a><span style="margin: 0px; padding: 0px;"> , </span><a href="https://uroweb.org/guideline/paediatric-urology/#note_939" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">939</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Jednak, gdy jest względne przeciwwskazanie do wstawienia linii, mniej doświadczony anestezjolog jest dostępne, lub rodzice wolą go [</span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_940" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">940</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ], nieinwazyjne schematy złożone z lekami przeciwbólowymi śródoperacyjne i pooperacyjne może być wybór.</span><span style="margin: 0px; padding: 0px;">Szczególnie w tej grupie pacjentów, krokowe protokoły znieczulenie może być realizowana [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_941" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">941</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> ]. </span><span style="margin: 0px; padding: 0px;">Dla laparoskopowych podejść, dootrzewnowo rozpylanie znieczuleniu miejscowym przed nacięcie powięzi okołonerkowej może być korzystny [ </span></span><a href="https://uroweb.org/guideline/paediatric-urology/#note_942" style="-webkit-font-smoothing: antialiased; -webkit-tap-highlight-color: rgb(0, 160, 227); background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"><span style="margin: 0px; padding: 0px;">942</span></a><span style="margin: 0px; padding: 0px;"> ].</span></div> <div class="bodytekst_bold" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Tabela 18: Prosta strategia zarządzania ból dziecięcej chirurgii urologicznej</span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="27%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Intensywność zabiegu</span></div> </th><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="21%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Pierwszy krok</span></div> </th><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="16%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Drugi krok</span></div> </th><th class="Celstijl_1_tint_zwart" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="36%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Trzeci etap</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="27%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Łagodny</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">(Pachwinowej, moszny, prącia)</span></div> </td><td class="Celstijl_1" rowspan="3" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="21%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Paracetamol i rany infiltracji ze znieczulenia miejscowego</span></div> </td><td class="Celstijl_1" rowspan="3" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="16%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">NLPZ</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="36%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">blok regionalny / słabych opioidów lub IV silny opioid o małych przyrostach jak ratunkowej znieczulenia (np nalbufinę, fentanyl, meperydyną, morfina)</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="27%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Umiarkowany</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">(Podbrzusza)</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="36%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Obwodowa blokada nerwu (pojedyncze zdjęcie lub ciągły wlew) / wtrysk opioidów (IV PCA)</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="27%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ciężka (górne brzucha</span></div> <div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">lub lombotomy)</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="36%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zewnątrzoponowe głównych nerwów obwodowych / splotu blok wtrysku local / / opioidów (IV PCA)</span></div> </td></tr> </tbody></table> <div class="bodytekst_italic_onder_tabel_1e_regel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: -15px 0px 0px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">IV PCA = dożylnie w systemie analgezji kontrolowanej; </span><span style="margin: 0px; padding: 0px;">NLPZ = niesteroidowe leki przeciwzapalne.</span></span></div> <div class="kop3_witregel" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; font-style: italic; line-height: 18px; margin: 0px 0px 0px 80px; outline: 0px; padding: 0px 0px 20px; vertical-align: baseline;"> <span class="kop3_bolditalic" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><a href="https://www.blogger.com/null" name="3_20_4" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; color: #2cace1; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: none; padding: 0px; text-decoration: none; transition: opacity 0.3s, color 0.3s; vertical-align: baseline;"></a><span class="list" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; display: inline-block; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 400; line-height: inherit; margin: 0px 0px 0px -80px; outline: 0px; padding: 0px; vertical-align: baseline; width: 80px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;">3.20.4.</span></span></span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"> Zestawienie dowodów i zaleceń w zakresie zarządzania bólu pooperacyjnego</span></span></span></div> <table class="tabel_zwart-wit" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 1px solid rgb(102, 102, 102); box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Podsumowanie dowodów</span></div> </th><th class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(240, 240, 240); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">LE</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Noworodki odczuwać ból.</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">3</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Ból może być przyczyną zachowań i somatyczne następstw.</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">3</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Każda instytucja musi opracować własną dobrze zorganizowanej strategii dla analgezji pooperacyjnej.</span></div> </td><td class="Celstijl_1" style="-webkit-font-smoothing: antialiased; background: rgb(255, 255, 255); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">4</span></div> </td></tr> </tbody></table> <table class="tabel_blauw" style="-webkit-font-smoothing: antialiased; background: 0px 0px rgb(245, 245, 245); border-collapse: collapse; border-spacing: 0px; border: 0px; box-sizing: border-box; color: #2c2b2b; font-family: Roboto, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px; font-stretch: inherit; line-height: 18px; margin: 0px 0px 20px; max-width: 100%; outline: 0px; padding: 0px; table-layout: auto; vertical-align: baseline; width: 693px;"><thead style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">zalecenia</span></div> </th><th class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 1.2rem; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 500; line-height: 1.4667rem; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekstbold_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: 16px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: 700; line-height: 18px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">GR</span></div> </th></tr> </thead><tbody style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Zapobieganie ból / uczta u dzieci w każdym wieku.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Oceny bólu za pomocą wiekiem kompatybilny narzędzia oceny.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Informowania pacjentów i rodziców dokładnie.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> </td></tr> <tr style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="93%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">Użyj poboru oraz zrównoważone znieczulenie w celu zmniejszenia skutków ubocznych opioidów.</span></div> </td><td class="Celstijl_1_tint_PMS" style="-webkit-font-smoothing: antialiased; background: rgb(197, 218, 241); border: 1px solid rgb(102, 102, 102); box-sizing: border-box; font-family: inherit; font-size: 13px; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 3px 5px; vertical-align: top;" width="7%"><div class="tabel_bodytekst_9pt" style="-webkit-font-smoothing: antialiased; background: 0px 0px; border: 0px; box-sizing: border-box; font-family: inherit; font-size: inherit; font-stretch: inherit; font-style: inherit; font-variant: inherit; font-weight: inherit; line-height: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> <span style="margin: 0px; padding: 0px;">b</span></div> <div> <span style="margin: 0px; padding: 0px;"><br /></span></div> </td></tr> </tbody></table>

UROLOGIA PEDIATRYCZNA - WYTYCZNE EUROPEJSKIEGO TOWARZYSTWA UROLOGICZNEGO (6/6)

3.16.  Zaburzenia rozwoju płci 3.16.1.  Epidemiologia, etiologia i patofizjologia The formerly called ‘intersex disorders’ were recen...

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