BACKGROUND: Children with hypospadias, being born with congenital abnormalities, having repeated genital examination, hospitalization, and undewent genital surgery, experienced psychological stress that may negatively affect their psychosocial life. Choosing the proper time of surgery as recommended is important, since it may have a positive impact on the psychosocial adaptation. AIM: This study aims to find the risk factors causing psychosocial disorders in post-repair surgery on hypospadias children. METHODS: This is a case control study, from 203 hypospadias patients underwent urethroplasty from 2009 to 2018. Subjets were screened for psychosocial disorders by Pediatric Symptoms Questionnaire 17 (PSC-17) questionnaire to find those with psychosocial disorders, score 15 or more (case group) and those without psychosocial disorders (control group), score 0-14. We traced back the data retrospectively from both group (history of utrethrocutaneous fistula and meatal stenosis, age upon urethroplasty) and collecting new ones (cosmetic outcome, emotional stress after genital examination, and the existence of PTSD). Fisher’s exact test was performed to see the Odds ratio (OR) for each variable. RESULTS: Some children with hypospadias show impaired on psychocosial. Functional and cosmetic outcome not significantly different as potensial risk factor psychosocial disorders, genital examination doesn’t trigger psychological stress and also none children show PTSD symtomp after surgery. Comparison time of age urethroplasty did not differ significantly between two group CONCLUSIONS: Twenty-nine children post urthroplasty show psychosocial disorders. Functional and cosmetic urethroplasty outcomes, emotional stress after genital examination, post-traumatic stress disorder were not risk factors of pshycosocial disorder of hypospadias patients. Ages at time of surgery did not differ significantly between two group and this is contradict to the previous recommendations.

Cerebral salt wasting syndrome (CSW) defined as a renal loss of sodium during intracranial disorders leading to hyponatremia and a decrease in extracellular fluid volume. It is essential to differentiate it from the syndrome of inappropriate antidiuretic hormone secretion (SIADH) to avoid complications of hypovolaemia and reduced cerebral perfusion. Brain natriuretic peptide may be responsible for this syndrome. A 12th years old male patient had admitted to the hospital because of traumatic brain injury due to traffic accident, he had epidural hematoma at temporoparietal dextra. Patient was treated conservatively, on fourth day he has higher volume urine and on fifth day he had tonic clonic convulsion then he undergo head CT control and checked BGA also electrolyte status. Laboratory result; pH 7,45; pO2 225mmHg; pCO2 31 mmHg; BE -2,5mmol/L; HCO3-21,5 mmol/L; SO2 100%; BS: 105 g/dL, Na 117 mmol/L K 4,28 mmol/L; Cl 98,6 mmol/L. Patient was diagnosed with Cerebral Salt wasting Syndrome because of traumatic brain injury then transferred to intensive care unit and treatment focus on replacement of the sodium and water that is lost as a result of pathologic natriuresis and diuresis. In this case sodium replacement using either isotonic or hypertonic saline. Patient well recovered after 13 days hospitalized, then discharge from the hospital. Distinguishing CSW and SIADH is crucial importance because therapy are very opposite. Volume and sodium repletion are the goals of treatment of patients with CSW, and this can be performed using some combination of isotonic saline, hypertonic saline, and mineralocorticoids and patient requires closed monitoring and appropriate management and treatment to reduce morbidity and mortality.