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Extensive mobilization of the urethral plate and urethra for repair of hypospadias: The modified barcat technique
INTERNATIONAL
1285
ABSTRACTS
Extensive Mobilization of the Urethral Plate and Urethra for Repair of Hypospadias: The Modified Barcat Technique. S.A. Kofi J. Brinkman. J. Ulrich, et al. J Ural 151:466-469, (February),
1994. The modified Barcat technique was used to treat 168 patients with hypospadias during the last 5 years. The technique, which is applicable for distal hypospadias, uses apposing fully mobilized meatal-based skin flaps. Cosmetic and functional results are excellent, with only 3.5% of the patients requiring reoperation. Because the surgical technique does not depend on the configuration of the glans, depth of the urethral groove, caliber of the urethral meatus, or even on whether the patient has been circumcised, it is particularly suitable for training residents, who can perform a single operation to correct a wide variety of cosmetic deformities.Geoqe W. Holcomb, Jr Repair of Hypospadias Complications Using the Meatal Based Flap Urethroplasty. J.F. Teague, D.R. Roth, and E. T. Gonzales. J
Urol 151:470-472, (February), 1994 Although long used for primary hypospadias repair, meatalbased flap urethroplasty has not been widely considered a viable alternative for a secondary procedure. The authors reviewed the records of 200 patients who underwent meatal-based flap urethroplasty and identified nine (4.5%) who underwent the procedure for correction of complications of previous hypospadias repair, including urethrocutaneous fistula. severe meatal retraction, persistent chordee, and hair in the urethra. The complication was corrected with a single operation in eight of the nine patients (89%). A single small fistula developed in three patients; it closed spontaneously in two, and required another procedure in one. Meatal-based flap urethroplasty should be considered for correction of distal complications of hypospadias repair.-George W Holcomb, Jr Anterior Abdominal Wall Closure in Bladder Exstrophy. I/: Bhatnagar and D.K. Mitra. Pediatr Surg Int 9:188-190, (January),
1994. The authors describe a technique for anterior abdominal wall closure without pelvic osteotomy for bladder exstrophy. The technique involves bilateral detachment of the rectus abdominis from the pubic ramus, midline vertical closure, and rehxation to the public rami after medial and caudal advancement with or without a relaxing fascial incision. This is performed after the bladder turnin. The authors have managed 15 patients with this technique. Secondary surgery for urinary continence by a modified YoungDees technique has been performed in 12 patients. Only two patients had superficial wound dehiscence, which was sutured secondarily. Of the 12 patients who had the modified Young-Dees operation, seven are continent and can hold urine for one half hour or more. During secondary surgery, bladder dissection was simple because there were few adhesions. The authors believe that closure with this technique is effective and cosmetically acceptable.-p. Pun’ Iliac Osteotomy: A Model to Compare the Options in Bladder and Cloaca1 Exstrophy Reconstruction. P.H. McKenna, A.E. Khowy, G.A. McLorie, et al. J Urol 151:182-187, (January), 1994.
Traditionally. bilateral posterior iliac osteotomy has been performed in the majority of patients undergoing primary closure for bladder and cloaca1 exstrophy. Recently, two anterior osteotomy approaches have been proposed: (1) incision of the ilium transversely above the acetabulum (transverse osteotomy) and (2) incision of the superior ramus of the pubis (superior ramus osteotomy). The authors devised a new anterior midiliac diagonal osteotomy
that provides a more functional pelvic closure. To provide a fair comparison of the procedures, a pelvic exstrophy model, based on data from a three-dimensional computerized tomogram of a 3-yearold patient with classical bladder exstrophy. was developed. The different osteotomies were then performed on the model, and the results were compared. The authors’ new anterior midiliac diagonal osteotomy correction allowed the best surgical approach, provided the best correction of the flattened ilial bone deformities, was performed in the thinnest area of marrow bone, and resulted in the best pelvic symmetry-George W Holcomb. Jr Positive Bladder Cooling Test in Neurologically Normal Young Children. G. Geirsson, S. Lindstrom, M. Fall. et al. J Urol 151:446-
448, (February), 1994. The bladder cooling test, which consists of rapid infusion of 0 to 8°C saline into the bladder with simultaneous pressure measurement, was performed in 50 neurologically intact infants and children, aged 6 months to I3 years. The patients were referred for urodynamic investigation because of various disorders of the lower urinary tract. A positive bladder cooling test was defined as a sustained reflex detrusor contraction of about the same magnitude as the micturition contraction. The test result was positive during the first 4 years of life, but typically negative in children over 5 years of age. These findings indicate that a positive bladder cooling test is an infant reflex response that. with the maturation of the central nervous system, becomes suppressed by descending signals from higher centers.-George W. Holcomb, Jr Continent Urinary Diversion Using Mitrofanoff Principle in Children With Neurogenic Bladder. (Proceedings of the Glasgow Meeting of the Society for Research Into Hydrocephalus and Spina Bifida, 1993.) B. Khair, A.F. Azmy, R. Carachi, et al. Eur J Pediatr Surg 3:8-9 (December), 1993 (suppl 1).
Fifteen children with urinary incontinence underwent continent urinary diversion using the Mitrofanoff principle at a mean age of 14 years. Neurogenic bladder was the main underlying cause of incontinence, and spina bifida accounted for the majority of cases (12 children). Reversed vascularized appendix was used as a cutaneous stoma for intermittent self-catheterisation. Fourteen of the 15 children treated achieved urinary continence with 3- to 4-hourly catheterization.-Thomas A. Angerpointner Urologic Emergencies in Neonates: The Place of Percutaneous Nephrotomy With the Guidance of Ultrasound. F. Arena, F. Proietto, P.M. Vifa, et al. RASS IT Chir Pediatr 35:70-72, (April),
1993 (supp12). The authors describe 18 cases of ultrasound-guided percutaneous nephrotomy in babies with severe dilatations of the urinary tract. This procedure was performed with an l&gauge needle from the posterolateral approach. The authors conclude that the technique allows rapid decompression of congenitally obstructed and functionally altered kidneys. It is also possible to verify residual renal function and to establish a definitive diagnosis. Drainage of the urinary tract in neonates, inoperable for other reasons, is sometimes the only remedy for their urologic problem. It also affords temporary relief before corrective surgery as well as access for irrigation of drugs--G. Perrino Urinary Levels of the Renal Tubular Enzyme N-Acetyl-B-DGlucosaminidase in Unilateral Obstructive Uropathy. M.C. Cam, CA. Peters, A.B. Retik, et al. J Urol 151:442-445, (February).
1994. Elevated urinary levels of the renal tubular enzyme N-acetyl-BD-glucosaminidase (NAG) have been shown to be associated with
1285
ABSTRACTS
Extensive Mobilization of the Urethral Plate and Urethra for Repair of Hypospadias: The Modified Barcat Technique. S.A. Kofi J. Brinkman. J. Ulrich, et al. J Ural 151:466-469, (February),
1994. The modified Barcat technique was used to treat 168 patients with hypospadias during the last 5 years. The technique, which is applicable for distal hypospadias, uses apposing fully mobilized meatal-based skin flaps. Cosmetic and functional results are excellent, with only 3.5% of the patients requiring reoperation. Because the surgical technique does not depend on the configuration of the glans, depth of the urethral groove, caliber of the urethral meatus, or even on whether the patient has been circumcised, it is particularly suitable for training residents, who can perform a single operation to correct a wide variety of cosmetic deformities.Geoqe W. Holcomb, Jr Repair of Hypospadias Complications Using the Meatal Based Flap Urethroplasty. J.F. Teague, D.R. Roth, and E. T. Gonzales. J
Urol 151:470-472, (February), 1994 Although long used for primary hypospadias repair, meatalbased flap urethroplasty has not been widely considered a viable alternative for a secondary procedure. The authors reviewed the records of 200 patients who underwent meatal-based flap urethroplasty and identified nine (4.5%) who underwent the procedure for correction of complications of previous hypospadias repair, including urethrocutaneous fistula. severe meatal retraction, persistent chordee, and hair in the urethra. The complication was corrected with a single operation in eight of the nine patients (89%). A single small fistula developed in three patients; it closed spontaneously in two, and required another procedure in one. Meatal-based flap urethroplasty should be considered for correction of distal complications of hypospadias repair.-George W Holcomb, Jr Anterior Abdominal Wall Closure in Bladder Exstrophy. I/: Bhatnagar and D.K. Mitra. Pediatr Surg Int 9:188-190, (January),
1994. The authors describe a technique for anterior abdominal wall closure without pelvic osteotomy for bladder exstrophy. The technique involves bilateral detachment of the rectus abdominis from the pubic ramus, midline vertical closure, and rehxation to the public rami after medial and caudal advancement with or without a relaxing fascial incision. This is performed after the bladder turnin. The authors have managed 15 patients with this technique. Secondary surgery for urinary continence by a modified YoungDees technique has been performed in 12 patients. Only two patients had superficial wound dehiscence, which was sutured secondarily. Of the 12 patients who had the modified Young-Dees operation, seven are continent and can hold urine for one half hour or more. During secondary surgery, bladder dissection was simple because there were few adhesions. The authors believe that closure with this technique is effective and cosmetically acceptable.-p. Pun’ Iliac Osteotomy: A Model to Compare the Options in Bladder and Cloaca1 Exstrophy Reconstruction. P.H. McKenna, A.E. Khowy, G.A. McLorie, et al. J Urol 151:182-187, (January), 1994.
Traditionally. bilateral posterior iliac osteotomy has been performed in the majority of patients undergoing primary closure for bladder and cloaca1 exstrophy. Recently, two anterior osteotomy approaches have been proposed: (1) incision of the ilium transversely above the acetabulum (transverse osteotomy) and (2) incision of the superior ramus of the pubis (superior ramus osteotomy). The authors devised a new anterior midiliac diagonal osteotomy
that provides a more functional pelvic closure. To provide a fair comparison of the procedures, a pelvic exstrophy model, based on data from a three-dimensional computerized tomogram of a 3-yearold patient with classical bladder exstrophy. was developed. The different osteotomies were then performed on the model, and the results were compared. The authors’ new anterior midiliac diagonal osteotomy correction allowed the best surgical approach, provided the best correction of the flattened ilial bone deformities, was performed in the thinnest area of marrow bone, and resulted in the best pelvic symmetry-George W Holcomb. Jr Positive Bladder Cooling Test in Neurologically Normal Young Children. G. Geirsson, S. Lindstrom, M. Fall. et al. J Urol 151:446-
448, (February), 1994. The bladder cooling test, which consists of rapid infusion of 0 to 8°C saline into the bladder with simultaneous pressure measurement, was performed in 50 neurologically intact infants and children, aged 6 months to I3 years. The patients were referred for urodynamic investigation because of various disorders of the lower urinary tract. A positive bladder cooling test was defined as a sustained reflex detrusor contraction of about the same magnitude as the micturition contraction. The test result was positive during the first 4 years of life, but typically negative in children over 5 years of age. These findings indicate that a positive bladder cooling test is an infant reflex response that. with the maturation of the central nervous system, becomes suppressed by descending signals from higher centers.-George W. Holcomb, Jr Continent Urinary Diversion Using Mitrofanoff Principle in Children With Neurogenic Bladder. (Proceedings of the Glasgow Meeting of the Society for Research Into Hydrocephalus and Spina Bifida, 1993.) B. Khair, A.F. Azmy, R. Carachi, et al. Eur J Pediatr Surg 3:8-9 (December), 1993 (suppl 1).
Fifteen children with urinary incontinence underwent continent urinary diversion using the Mitrofanoff principle at a mean age of 14 years. Neurogenic bladder was the main underlying cause of incontinence, and spina bifida accounted for the majority of cases (12 children). Reversed vascularized appendix was used as a cutaneous stoma for intermittent self-catheterisation. Fourteen of the 15 children treated achieved urinary continence with 3- to 4-hourly catheterization.-Thomas A. Angerpointner Urologic Emergencies in Neonates: The Place of Percutaneous Nephrotomy With the Guidance of Ultrasound. F. Arena, F. Proietto, P.M. Vifa, et al. RASS IT Chir Pediatr 35:70-72, (April),
1993 (supp12). The authors describe 18 cases of ultrasound-guided percutaneous nephrotomy in babies with severe dilatations of the urinary tract. This procedure was performed with an l&gauge needle from the posterolateral approach. The authors conclude that the technique allows rapid decompression of congenitally obstructed and functionally altered kidneys. It is also possible to verify residual renal function and to establish a definitive diagnosis. Drainage of the urinary tract in neonates, inoperable for other reasons, is sometimes the only remedy for their urologic problem. It also affords temporary relief before corrective surgery as well as access for irrigation of drugs--G. Perrino Urinary Levels of the Renal Tubular Enzyme N-Acetyl-B-DGlucosaminidase in Unilateral Obstructive Uropathy. M.C. Cam, CA. Peters, A.B. Retik, et al. J Urol 151:442-445, (February).
1994. Elevated urinary levels of the renal tubular enzyme N-acetyl-BD-glucosaminidase (NAG) have been shown to be associated with