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Endoscopic submucosal teflon injection (STING): An alternative treatment of vesicoureteric reflux in children
INTERNATIONAL
1398
eters proved to be significant risk factors with regard to prognosis: birth weight, age at time of diagnosis, renal function, bilateral grade IV or V vesicoureteral reflux, and late incontinence. The study showed that numerous neoimplantations associated with high complication rates were carried out in both groups. However, no significant effect on long-term prognosis could be established, ie, broad indications for supravesical urinary diversion did not prove demonstrable parenchymal protection. No significant relationship between procedure and long-term clinical course could be shown. The results of the study indicate that resection of urethral valves as early as possible is of particular importance to long-term prognosis.-Thomas A. Angerpointner The Changing Urodynamic Pattern in Valve Bladders During Infancy. G. Holmdahl, U. Sillen, M. Bachelard, et al. J Urol153:463-
467, (February), 1995. Bladder dysfunction in boys with posterior urethral valves is well documented in long-term follow-up studies. These reports suggest that dysfunctional bladders can be divided into three main types for older boys: unstable, low compliant, and overdistended. To the authors’ knowledge, urodynamic findings at presentation during infancy have not been described previously. This is a report of 16 boys born between 1989 and 1993 who presented with symptoms of posterior urethral valves between birth and age 5 months, and who had follow-up with repeated urodynamic evaluations for a mean of 19 months. At presentation, the bladder was hypercontractile with low capacity. During the first 3 years of life, the urodynamic pattern changed, with vanishing hypercontractility and increasing bladder capacity. However, instability remained unchanged, with emptying difficulties. Thus, the three patterns of bladder dysfunction reported in older boys after resection of the posterior urethral valves could not be found in infants and small children.-George W: Holcomb,
Jr
Measurement of Pudendal Evoked Potentials During Feminizing Genitoplasty: Technique and Applications. J.P. Gearhart, A. Burnett, andJ.H. Owen. J Urol153:486-487, (February), 1995.
The authors report on six patients (average age, 13 months) with ambiguous genitalia who underwent stimulation of the dorsal neurovascular bundle of the phallus during feminizing genitoplasty. Three patients had the adrenogenital syndrome, one underwent removal of a masculinizing adrenal tumor before genital reconstruction, one had mixed gonadal dysgenesis, and one had male pseudohermaphroditism. Stimulation of the dorsal neurovascular bundle with measurement of electromyographic nerve conduction latencies was performed before and after ligation of the corporeal bodies and excision of the erectile tissue. In all six cases, electromyographic responses were preserved after phallic reduction. This study clearly shows that modern techniques of genital reconstruction allow for preservation of nerve conduction in the dorsal neurovascular bundle and may permit normal sexual function in adulthood. However, precise follow-up through adulthood is necessary to assess the success of this operation.-George W. Holcomb, Technical Deformities.
Jr Considerations in the Repair of Cloaca1 F. AZexanderandR. Kay. J Urol153:788-791,
Vaginal
(March),
1995. Various techniques of vaginal repair used in the reconstruction of cloaca1 deformities are discussed. In 4 years the authors performed primary reconstruction of cloaca1 anomalies in four children-three had hydrocolpos and one had vaginal agenesis. Vaginal reconstruction was accomplished using a variety of techniques tailored to the primary anomaly. Distal vaginal occlusion related to
ABSTRACTS
ischemia occurred in two patients; in both, the vagina was reconstructed successfully during a second-stage procedure. Overall, cosmetic and functional results were good. All patients are dry but require clean intermittent catheterization, and three currently require a bowel regimen. The follow-up period ranges from 18 months to 4 years.-George W Holcomb, Jr Transrectal (Mullerian
Posterior Sagittal Approach to Prostatic Utricle Duct Cyst).J.F. Siegel, WA. Brock, andA. Pena. J Urol
153:785-787, (March), 1995. The posterior sagittal approach is an accepted technique for repair of anorectal malformations. Increased experience and familiarity with this approach and better understanding of functional pelvic anatomy have led pediatric surgeons to use this technique in other situations, such as reconstruction of major perineal lacerations and delayed repair of traumatic urethral avulsion. The authors used the transrectal posterior sagittal approach to excise a large prostatic utricular cyst in a 3-year-old boy. The outstanding advantage offered by this technique is the wide exposure, which permits meticulous removal of a large mullerian remnant without inadvertent injury to adjacent pelvic organs.-George W. Holcomb, Jr Endoscopic Submucosal Teflon Injection tive Treatment of Vesicoureteric Reflux VO de Boe, J. Braeckmann, et al. Eur
(STING): An Alternain Children. L. Merckx,
J Pediatr Surg 5:34-36,
(February), 1995. The authors present their results of treating vesicoureteric reflux with an endoscopic submucosal teflon injection (STING) of the refluxing ureter. One hundred refluxing units in 68 children were treated, with a maximum follow-up period of 5 years. Indications were high-grade reflux (III-V), persistence or progression of reflux despite conservative therapy, urinary infections despite antibiotic prophylaxis, and bad antibiotic compliance. Treatment was performed on an outpatient basis and appeared to be free of complications. Reflux was cured in 75% after a single injection and in 96% after two injections. The best results were obtained in low-grade reflux cases, and a 60% to 70% success rate was achieved in high-grade reflux (III-V). The main advantages of STING are its noninvasiveness, simplicity, and the possibility of repeating it in cases of failure.-Thomas A. Angerpointner Oxybutynin Administration cular Tone Associated Shelton, D. Reeves, andA.G.
With
Diminishes Bladder
the High Gastric Reconstruction.
Lewti. J Urol153:461-462,
MusC.A.
(February),
1995. Oxybutynin has a proven role in correcting uninhibited detrusor contractions in the intact and the bowel-augmented bladder. Beneficial responses to oxybutynin also have been noted after gastrocystoplasty. Normalization of bladder pressure is of paramount importance in cases of gastrocystoplasty, because every effort must be made to protect the native upper urinary tract or transplanted kidney from the effects of elevated bladder pressure. It has been questioned whether this response reflects a selective effect on the bladder segment or whether there is an additional effect on the gastric patch musculature. The authors report a case of improved function of a previously poorly compliant gastric neobladder caused by oxybutynin, thereby demonstrating a direct action on gastric smooth muscle.--George W. Holcomb, Jr The Mitrofanoff Catheterizable Channel: M. Horowitz, C.S. Kuhr, and M.E. Mitchell.
Patient
Acceptance
J Urol 1531771-772,
(March), 1995. Experience with the Mitrofanoff catheterizable channel, with emphasis on patient acceptance and preference, is presented.
1398
eters proved to be significant risk factors with regard to prognosis: birth weight, age at time of diagnosis, renal function, bilateral grade IV or V vesicoureteral reflux, and late incontinence. The study showed that numerous neoimplantations associated with high complication rates were carried out in both groups. However, no significant effect on long-term prognosis could be established, ie, broad indications for supravesical urinary diversion did not prove demonstrable parenchymal protection. No significant relationship between procedure and long-term clinical course could be shown. The results of the study indicate that resection of urethral valves as early as possible is of particular importance to long-term prognosis.-Thomas A. Angerpointner The Changing Urodynamic Pattern in Valve Bladders During Infancy. G. Holmdahl, U. Sillen, M. Bachelard, et al. J Urol153:463-
467, (February), 1995. Bladder dysfunction in boys with posterior urethral valves is well documented in long-term follow-up studies. These reports suggest that dysfunctional bladders can be divided into three main types for older boys: unstable, low compliant, and overdistended. To the authors’ knowledge, urodynamic findings at presentation during infancy have not been described previously. This is a report of 16 boys born between 1989 and 1993 who presented with symptoms of posterior urethral valves between birth and age 5 months, and who had follow-up with repeated urodynamic evaluations for a mean of 19 months. At presentation, the bladder was hypercontractile with low capacity. During the first 3 years of life, the urodynamic pattern changed, with vanishing hypercontractility and increasing bladder capacity. However, instability remained unchanged, with emptying difficulties. Thus, the three patterns of bladder dysfunction reported in older boys after resection of the posterior urethral valves could not be found in infants and small children.-George W: Holcomb,
Jr
Measurement of Pudendal Evoked Potentials During Feminizing Genitoplasty: Technique and Applications. J.P. Gearhart, A. Burnett, andJ.H. Owen. J Urol153:486-487, (February), 1995.
The authors report on six patients (average age, 13 months) with ambiguous genitalia who underwent stimulation of the dorsal neurovascular bundle of the phallus during feminizing genitoplasty. Three patients had the adrenogenital syndrome, one underwent removal of a masculinizing adrenal tumor before genital reconstruction, one had mixed gonadal dysgenesis, and one had male pseudohermaphroditism. Stimulation of the dorsal neurovascular bundle with measurement of electromyographic nerve conduction latencies was performed before and after ligation of the corporeal bodies and excision of the erectile tissue. In all six cases, electromyographic responses were preserved after phallic reduction. This study clearly shows that modern techniques of genital reconstruction allow for preservation of nerve conduction in the dorsal neurovascular bundle and may permit normal sexual function in adulthood. However, precise follow-up through adulthood is necessary to assess the success of this operation.-George W. Holcomb, Technical Deformities.
Jr Considerations in the Repair of Cloaca1 F. AZexanderandR. Kay. J Urol153:788-791,
Vaginal
(March),
1995. Various techniques of vaginal repair used in the reconstruction of cloaca1 deformities are discussed. In 4 years the authors performed primary reconstruction of cloaca1 anomalies in four children-three had hydrocolpos and one had vaginal agenesis. Vaginal reconstruction was accomplished using a variety of techniques tailored to the primary anomaly. Distal vaginal occlusion related to
ABSTRACTS
ischemia occurred in two patients; in both, the vagina was reconstructed successfully during a second-stage procedure. Overall, cosmetic and functional results were good. All patients are dry but require clean intermittent catheterization, and three currently require a bowel regimen. The follow-up period ranges from 18 months to 4 years.-George W Holcomb, Jr Transrectal (Mullerian
Posterior Sagittal Approach to Prostatic Utricle Duct Cyst).J.F. Siegel, WA. Brock, andA. Pena. J Urol
153:785-787, (March), 1995. The posterior sagittal approach is an accepted technique for repair of anorectal malformations. Increased experience and familiarity with this approach and better understanding of functional pelvic anatomy have led pediatric surgeons to use this technique in other situations, such as reconstruction of major perineal lacerations and delayed repair of traumatic urethral avulsion. The authors used the transrectal posterior sagittal approach to excise a large prostatic utricular cyst in a 3-year-old boy. The outstanding advantage offered by this technique is the wide exposure, which permits meticulous removal of a large mullerian remnant without inadvertent injury to adjacent pelvic organs.-George W. Holcomb, Jr Endoscopic Submucosal Teflon Injection tive Treatment of Vesicoureteric Reflux VO de Boe, J. Braeckmann, et al. Eur
(STING): An Alternain Children. L. Merckx,
J Pediatr Surg 5:34-36,
(February), 1995. The authors present their results of treating vesicoureteric reflux with an endoscopic submucosal teflon injection (STING) of the refluxing ureter. One hundred refluxing units in 68 children were treated, with a maximum follow-up period of 5 years. Indications were high-grade reflux (III-V), persistence or progression of reflux despite conservative therapy, urinary infections despite antibiotic prophylaxis, and bad antibiotic compliance. Treatment was performed on an outpatient basis and appeared to be free of complications. Reflux was cured in 75% after a single injection and in 96% after two injections. The best results were obtained in low-grade reflux cases, and a 60% to 70% success rate was achieved in high-grade reflux (III-V). The main advantages of STING are its noninvasiveness, simplicity, and the possibility of repeating it in cases of failure.-Thomas A. Angerpointner Oxybutynin Administration cular Tone Associated Shelton, D. Reeves, andA.G.
With
Diminishes Bladder
the High Gastric Reconstruction.
Lewti. J Urol153:461-462,
MusC.A.
(February),
1995. Oxybutynin has a proven role in correcting uninhibited detrusor contractions in the intact and the bowel-augmented bladder. Beneficial responses to oxybutynin also have been noted after gastrocystoplasty. Normalization of bladder pressure is of paramount importance in cases of gastrocystoplasty, because every effort must be made to protect the native upper urinary tract or transplanted kidney from the effects of elevated bladder pressure. It has been questioned whether this response reflects a selective effect on the bladder segment or whether there is an additional effect on the gastric patch musculature. The authors report a case of improved function of a previously poorly compliant gastric neobladder caused by oxybutynin, thereby demonstrating a direct action on gastric smooth muscle.--George W. Holcomb, Jr The Mitrofanoff Catheterizable Channel: M. Horowitz, C.S. Kuhr, and M.E. Mitchell.
Patient
Acceptance
J Urol 1531771-772,
(March), 1995. Experience with the Mitrofanoff catheterizable channel, with emphasis on patient acceptance and preference, is presented.