Riley Pediatric Urology

Ambulatory Registration

Please complete for the first visit.

Authorization to Release Medical Records

Complete this form when you’d like for medical records to be released to another entity.

Bladder Autoaugmentation (Patient Information)

This treatment enlarges the bladder without using tissue harvested from the colon or elsewhere in the body.

Continent Urinary Reservoir (Patient Information)

This treatment creates a new pathway for the storage and removal of urine from the body.

Cutaneous Ureterostomy (Patient Information)

This procedure moves the ureter to an opening created in the skin called a stoma.

Cutaneous Vesicostomy (Patient Information)

This treatment can prevent kidney damage and improve kidney function.

Enterocystoplasty (Patient Information)

This procedure uses tissue from the intestine to make the bladder larger, which lowers pressure in the bladder.

General Consent

You will be asked to review and sign this consent to receive care from our physicians and staff.

Illeal Chimney (Patient Information)

In this procedure a new pathway is made with a section of the small intestine that is sewn onto the bladder.

Illeal or Colon Conduit (Patient Information)

Ileal conduit surgery involves creating a new pathway for urine to exit the body.

MACE Procedure (Patient Information)

MACE is a surgical procedure to treat constipation and fetal incontinence.

Mitrofanoff Catheterizable Channel (Patient Information)

This procedure creates a new tube inside the body that helps move urine from the bladder to outside the body.

Preferred Communication List

Complete this form to allow family and friends to receive information regarding your health.

Urinary System (Patient Information)

The urinary system's primary function is to remove the waste that the circulatory system collects as it moves blood through the body.