Sarcouncil Journal of Internal Medicine and Public Health

Abstract: Children have urogenital problems that frequently have complex management, such as hypospadias, vesicoureteral reflux, and neurogenic bladder. Non-surgical treatment is essential to optimize functional recovery, minimize symptom burden, and maximize long-term quality of life, but it is not a substitute for surgical correction. The purpose of this study was to evaluate the clinical efficacy, safety, and patient-centered efficacy and effectiveness of an integrated clinical protocol for children with urogenital disorders using surgery alongside non-surgical options. The cross-sectional study was performed on 125 children (mean age 7.2±2.8 years; 62.4% males) admitted with a diagnosis of hypospadias (33.6%), vesicoureteral reflux (28.0%), neurogenic bladder (22.4%), or other urogenital disorders (16.0%) from different hospitals in Iraq. In a 12-month follow-up, all patients who underwent an indicated surgical procedure (urethroplasty, Deflux injection, bladder augmentation, or other reconstructive surgery) received non-surgical treatment, including pelvic floor physical therapy (68.0%), biofeedback (49.6%), and pharmacotherapy (76.0%). The clinical success, complication set (Clavien-Dindo classification), Pediatric Quality of Life (QoL) score, number of incontinence episodes, and implementation of non-surgical protocols were evaluated. As per hospitalization outcomes, the integrated approach was able to achieve a complete resolution in 78.4% of the patients, while 17.6% showed improvement, and only 4.0% failed treatment. The rates of complications were low: minor (Clavien-Dindo Grade I-II) 9.6% and major (Clavien-Dindo Grade III-IV) 2.4%. There was a significant improvement in quality of life (baseline 62.4±8.5 vs. post-treatment 88.2±5.3) as well as in the number of incontinence episodes per week (5.2±1.8 before integration vs. 0.4±0.3 after integration). 72.0% of patients had high adherence to non-surgical protocols (more than 80% session attendance). This study summarized that the multimodal integrated treatment strategy has a high clinical success rate, good safety profile, and meaningful functional outcomes and quality of life effects for children with urogenital conditions.