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Standardization and definitions in lower urinary tract dysfunction in children
INTERNATIONAL
231
ABSTRACTS
Eighty patients had associated injuries. 32 had muscoloskeletal injuries, 24 had cerebral injuries. I8 had renal injuries. IO had pulmonary injuries. 1 had pancreatic injuries, and 3 had intestinal injuries. The injuries were diagnosed by plain radiographs. ultrasonography, computed tomography, and diagnostic peritoneal lavage or laparotomy. In 106 cahes the initial treatment was conservative. which failed in two cdhes. ln the remaining 14 cases, emergency surgery was nrcesyary because of excessive bleeding. Splenorrhaply. splenectomy, and hepatorraphy were performed as required. Three of the conservatively treated patienth developed fever and/or bilious vomiting and were found to have intestinal injuries at laparotomy. Plain radiographs, ultraaonography. and computed tomography did not demonstrate these intestinal injuries. but peritoneal lavage was diagnostic. One of these three patients died. The authors suggest conservative management of intraabdominal bleeding caused by blunt trauma. However. the risk of missing intestinal injuries is stressed, and repeated clinical evaluation of the patient is mandatory.-P. Pltr-i
Gastrointestinal Tract Perforation Due to Blunt Abdominal Trauma. A.O. C$ci, EC. 7+e/, il.B. Suin~rrr?. ~‘f cl/. Pediatr Surg Int 13:759--764. (April), 199X. This is a retrospective study of 805 patients who had blunt abdominal trauma. Thirty-five patients were found to have gastrointestinal tract perforations. The patients were divided into three groups. The first group comprised those with obvious clinical signs of peritonitis. The second group had abdominal distension and minima1 tenderness or guarding. Normal abdominal findings characterized the third group. Sixty percent of the patients had been involved in motor vehicle accident>. Twenty-six percent of cases had sustained a fall, and 14% were rnvolved in bicycle accidents. On plain abdominal radiographs. free intraabdominal air was encountered in 16% of cases. Other ahnorma1 radiographic findings were seen in 28% of cases. Twenty-si\ percent of patients had normal radiograph tinding\. Group I patients had higher tmnsaminase levels and white blood cell counts than group II 01 III patients. Perforation occurred at the \tomach in 4 cases. the duodenum in 2 cases. the jejunum in I I. the ileum in 12. the jejunum and ileum in 3, the colon in 2. and the ileum and colon in I case. Clinical peritonitis developed earlier in patient> with multiple perforations than in other patients. Closure of the perforation was performed in ?I cases, rchection and primary anastomobis in I2 patient\. and closure of the perf~lralmn and proximal enterostomy in 2 case,. Two patients in the series dlrd of associated head injuries. It i< emphasized that. de\pitc laboratory and radiographic facilities, careful clinical evaluation rcmain\: !cry Important in detecting perforations in patients subject to blunt ahd~lminal trauma.--7: IV~\tc,j-
GENITOURINARY
TRACT
Does Circumcision Alter the Periurethral Bacterial Flora? S.S. Wijc~si~~h. B.L. Atkirfs. N.E. Dud/+ cf trl. Pediatr Surg Int 13: 146-138. I Y‘JX. The authors prospectively studied 15 boys who underwent circumci\ion m order to determine whether this procedure alters the bacterial Rora of the periurethral region. At the time of operation. the foreskin wa\ retracted and cultures taken using a twab. Cultures were obtained ft-om the periurethral area at follow-up 3 weeks postoperatively. Before circumcision. I3 of the boys had uropathogem under the prepuce, such ah proteus. coliforms. and enterococci. After circumcision, none of the patients had growth of uropathogena. hut IO had coagulase-negative staphylococci. Thih study support< the opinion that uropathogens are common under the prepuce in boys with nonretractile foreshin and that these bacteria disappear after circumcision.-R P!lri
A Complex, High Cloaca1 Malformation: Case Report. G. Wagnrc A.M. Holsrhrwid~r: clnd M. Gharih. Eur J Pediatr Surg 8: IX?- 1X5. (June). 1998. Cloaca1 malformations are rare, complex inhibitional anomalies of early embryogenesis. The authors report on a patient with a cloaca1 malformation in whom a septate vagina and a rectal tistula emptied through a common oritice onto an extrophic bladder plate. Additional anomalies included an omphalocele and malfarmations of the upper urinary tract. the lower extremities, skeleton. and vertebral column. After initially successful surgical corrections, the girl died at 8 months of age for unknown reasons in a peripheral hospita1,~T~l~~lorncr.s A. Aqw~~ointrwt Voiding Function in Patients After Monfort Abdominoplasty. rott, era/. J Urol 159:1675-1679.
With
the Prune-Belly Syndrome C.A. Swith. E.A. Smirh. TX Par(May). 1998.
From 1990 to 1993. 12 patients with prune-belly syndrome underwent Monfort abdominoplasty with or without concomitant genitourinary reconstruction. All patients completed questionnaires on voiding before and after abdominoplasty, including incontinence. bladder sensation. urinary flow. history of urinary tract infections, and the ability to defecate. Urodynamic testing was performed in 8 patients before and after abdominoplasty. Subjective changes that occurred after ahdominoplasty included resolution of or less double voiding in 9 patients, improved urinary continence in 7. improved bladder fullness sensation in I I. improved urinary Row in IO, and improved defecation in 5. The incidence of urinary tact infections decreased from a preoperative average of 5.7 per patient per year to I.2 per patient per year. Urodynamic studies demonstrated no significant changes in measured urinary flow, capacity. or maximal detrusor pressure. Compliance decreaxed on average, but it remained in the compliant range. However, postvoid residual volume\ decreased significantly. from a preoperative average of 40.3% of bladder capacity to 13% after abdominoplasty. When the five patients who underwent concomitant urinary reconstruction were excluded, the reduction in average postvoiding residuals was approximately the same (40% of bladder capacity preoperatively to 14.36’ after abdominoplasty). These data suggest that abdominoplasty alone was responsible for improved micturition. In addition to the cosmetic benefits and exposure provided for genitourinary reconstruction, Manfort abdominoplasty appears to improve voiding efficiency.--Gco,:qc W Ho/~~o/tlh. Jr Standardization and function in Children. nl. BrJ UrolXl:l-16.(May).
Definitions in Lower Urinary Tract Dys.1.6! Noryard. J.D. vats Cool. K. Hjalrms. or lY98(suppl3)
This introductory article was produced on behalf of the International Children’s Continence Society to provide definitions and a basic framework for reporting and research of lower urinary tract dysfunction in children. This is a useful comprehensive account providing guidelines that. if followed, will facilitate the interpretation and comparison of research work in this field--M.N. die la Hlr?lr Management of Nocturnal Enuresis in Children With Desmopressin and Bladder Physiotherapy. K. Y~znnnX-o~or~~~s, E. loanni&.s, A. Znhnriolr. et cl/. Pediatr Surg Int 1328 l-283. (April). 1998. In this study. 19 patient\ (22 boys. 7 girls: 7 to I7 years of age) were treated for nocturnal enuresis with intranasal desmopressin. Other treatment options such aa alarms and ortricyclic antidepressants had failed. Desmopressin (20 pg every night) was administered for 6 months. In addition, bladder physiotherapy was recommended. This treatment resulted in absence of enuretic episodes in I4 patients. No relapses occurred in these cases over the following 6 to 22 months. In
231
ABSTRACTS
Eighty patients had associated injuries. 32 had muscoloskeletal injuries, 24 had cerebral injuries. I8 had renal injuries. IO had pulmonary injuries. 1 had pancreatic injuries, and 3 had intestinal injuries. The injuries were diagnosed by plain radiographs. ultrasonography, computed tomography, and diagnostic peritoneal lavage or laparotomy. In 106 cahes the initial treatment was conservative. which failed in two cdhes. ln the remaining 14 cases, emergency surgery was nrcesyary because of excessive bleeding. Splenorrhaply. splenectomy, and hepatorraphy were performed as required. Three of the conservatively treated patienth developed fever and/or bilious vomiting and were found to have intestinal injuries at laparotomy. Plain radiographs, ultraaonography. and computed tomography did not demonstrate these intestinal injuries. but peritoneal lavage was diagnostic. One of these three patients died. The authors suggest conservative management of intraabdominal bleeding caused by blunt trauma. However. the risk of missing intestinal injuries is stressed, and repeated clinical evaluation of the patient is mandatory.-P. Pltr-i
Gastrointestinal Tract Perforation Due to Blunt Abdominal Trauma. A.O. C$ci, EC. 7+e/, il.B. Suin~rrr?. ~‘f cl/. Pediatr Surg Int 13:759--764. (April), 199X. This is a retrospective study of 805 patients who had blunt abdominal trauma. Thirty-five patients were found to have gastrointestinal tract perforations. The patients were divided into three groups. The first group comprised those with obvious clinical signs of peritonitis. The second group had abdominal distension and minima1 tenderness or guarding. Normal abdominal findings characterized the third group. Sixty percent of the patients had been involved in motor vehicle accident>. Twenty-six percent of cases had sustained a fall, and 14% were rnvolved in bicycle accidents. On plain abdominal radiographs. free intraabdominal air was encountered in 16% of cases. Other ahnorma1 radiographic findings were seen in 28% of cases. Twenty-si\ percent of patients had normal radiograph tinding\. Group I patients had higher tmnsaminase levels and white blood cell counts than group II 01 III patients. Perforation occurred at the \tomach in 4 cases. the duodenum in 2 cases. the jejunum in I I. the ileum in 12. the jejunum and ileum in 3, the colon in 2. and the ileum and colon in I case. Clinical peritonitis developed earlier in patient> with multiple perforations than in other patients. Closure of the perforation was performed in ?I cases, rchection and primary anastomobis in I2 patient\. and closure of the perf~lralmn and proximal enterostomy in 2 case,. Two patients in the series dlrd of associated head injuries. It i< emphasized that. de\pitc laboratory and radiographic facilities, careful clinical evaluation rcmain\: !cry Important in detecting perforations in patients subject to blunt ahd~lminal trauma.--7: IV~\tc,j-
GENITOURINARY
TRACT
Does Circumcision Alter the Periurethral Bacterial Flora? S.S. Wijc~si~~h. B.L. Atkirfs. N.E. Dud/+ cf trl. Pediatr Surg Int 13: 146-138. I Y‘JX. The authors prospectively studied 15 boys who underwent circumci\ion m order to determine whether this procedure alters the bacterial Rora of the periurethral region. At the time of operation. the foreskin wa\ retracted and cultures taken using a twab. Cultures were obtained ft-om the periurethral area at follow-up 3 weeks postoperatively. Before circumcision. I3 of the boys had uropathogem under the prepuce, such ah proteus. coliforms. and enterococci. After circumcision, none of the patients had growth of uropathogena. hut IO had coagulase-negative staphylococci. Thih study support< the opinion that uropathogens are common under the prepuce in boys with nonretractile foreshin and that these bacteria disappear after circumcision.-R P!lri
A Complex, High Cloaca1 Malformation: Case Report. G. Wagnrc A.M. Holsrhrwid~r: clnd M. Gharih. Eur J Pediatr Surg 8: IX?- 1X5. (June). 1998. Cloaca1 malformations are rare, complex inhibitional anomalies of early embryogenesis. The authors report on a patient with a cloaca1 malformation in whom a septate vagina and a rectal tistula emptied through a common oritice onto an extrophic bladder plate. Additional anomalies included an omphalocele and malfarmations of the upper urinary tract. the lower extremities, skeleton. and vertebral column. After initially successful surgical corrections, the girl died at 8 months of age for unknown reasons in a peripheral hospita1,~T~l~~lorncr.s A. Aqw~~ointrwt Voiding Function in Patients After Monfort Abdominoplasty. rott, era/. J Urol 159:1675-1679.
With
the Prune-Belly Syndrome C.A. Swith. E.A. Smirh. TX Par(May). 1998.
From 1990 to 1993. 12 patients with prune-belly syndrome underwent Monfort abdominoplasty with or without concomitant genitourinary reconstruction. All patients completed questionnaires on voiding before and after abdominoplasty, including incontinence. bladder sensation. urinary flow. history of urinary tract infections, and the ability to defecate. Urodynamic testing was performed in 8 patients before and after abdominoplasty. Subjective changes that occurred after ahdominoplasty included resolution of or less double voiding in 9 patients, improved urinary continence in 7. improved bladder fullness sensation in I I. improved urinary Row in IO, and improved defecation in 5. The incidence of urinary tact infections decreased from a preoperative average of 5.7 per patient per year to I.2 per patient per year. Urodynamic studies demonstrated no significant changes in measured urinary flow, capacity. or maximal detrusor pressure. Compliance decreaxed on average, but it remained in the compliant range. However, postvoid residual volume\ decreased significantly. from a preoperative average of 40.3% of bladder capacity to 13% after abdominoplasty. When the five patients who underwent concomitant urinary reconstruction were excluded, the reduction in average postvoiding residuals was approximately the same (40% of bladder capacity preoperatively to 14.36’ after abdominoplasty). These data suggest that abdominoplasty alone was responsible for improved micturition. In addition to the cosmetic benefits and exposure provided for genitourinary reconstruction, Manfort abdominoplasty appears to improve voiding efficiency.--Gco,:qc W Ho/~~o/tlh. Jr Standardization and function in Children. nl. BrJ UrolXl:l-16.(May).
Definitions in Lower Urinary Tract Dys.1.6! Noryard. J.D. vats Cool. K. Hjalrms. or lY98(suppl3)
This introductory article was produced on behalf of the International Children’s Continence Society to provide definitions and a basic framework for reporting and research of lower urinary tract dysfunction in children. This is a useful comprehensive account providing guidelines that. if followed, will facilitate the interpretation and comparison of research work in this field--M.N. die la Hlr?lr Management of Nocturnal Enuresis in Children With Desmopressin and Bladder Physiotherapy. K. Y~znnnX-o~or~~~s, E. loanni&.s, A. Znhnriolr. et cl/. Pediatr Surg Int 1328 l-283. (April). 1998. In this study. 19 patient\ (22 boys. 7 girls: 7 to I7 years of age) were treated for nocturnal enuresis with intranasal desmopressin. Other treatment options such aa alarms and ortricyclic antidepressants had failed. Desmopressin (20 pg every night) was administered for 6 months. In addition, bladder physiotherapy was recommended. This treatment resulted in absence of enuretic episodes in I4 patients. No relapses occurred in these cases over the following 6 to 22 months. In