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A new concept in the treatment of stomal stenosis
850
ABSTRACTS
The authors report renal injuries in 1 IO children and evaluate the results. The immediate use of infusion pyelography in assessment of the extent of the renal injury was helpful. The frequent use of infusion pyelography has eliminated the need for retrograde pyelography in most of the authors’ patients. They conclude that there is an occasional place for retrograde pyelography especially if a renal pelvis or ureteral injury is suspected. In exploration of the retroperitoneal area for evaluation of the extent of injury, repair of laceration, and debridement of renal parenchyma or segmental nephrectomy, the authors recommend proximal control of the renal vessel by vascular clamp. Otherwise, the surgeon may be forced to perform an unnecessary nephrectomy. Renal angiography is valuable if the kidney is not visualized on the infusion pyelogram. Intraoperative renal arteriography may be useful if the condition of the patient is critical and precludes preoperative x-ray studies. Renal scan may be helpful in determining the extent of the renal parenchymal injury although it was misleading in nine of 32 patients. Seventy-eight children were managed nonoperatively: 32 required operations.-George Holcomb Five Cases of Anuria Due to Obstruction of the Urinary Tract in Children. J. P. Jublonski, M. Lupold, h4. Gruner, and J. BrueziPre. Ann. Chir. Infant 13:369-378 (September/October), 1972. Five cases of anuria are discussed illustrating of obstructive various clinical aspects uropathy due to the following: calculi (three cases, one of which was in a single kidney), bothryosarcoma of the uterus invading the bladder (one case) with single kidney, and acute hydronephrosis in a single kidney (one case). Anuria was often associated with seizures leadin the diagnosis. The ing to confusion prevalence of single kidney in these cases is discussed as well as complications due to gramnegative sepsis. Medical management of anuria and surgical correction are also considered. Anuria is often easily reversible when the obstruction is relieved. Preliminary catheterization may promote diuresis.--M. Bettex and J. Deevqv Horseshoe Kidney In Children. J. IV. Segura. P. P. Kelalis, and E. C. Burke. J. Ural. 108: 333-336 (August), 1972. Thirty-four
cases
of
horseshoe
kidney
in
patients I5 yr or younger seen over a 35yr span at the Mayo Clinic are reviewed. Three patients had severe congenital anomalies of both urinary and other organ systems and died by 2 mo of age. Sixteen of 31 presented with urinary tract infection, three with an abdominal mass, three with gross hematuria, and three with abdominal pain. Sixteen had additional urologic abnormalities. Other abnormalities were found in the skeletal system in eight, cardiovascular system in eight, gastrointestinal system in four, and tumors were found in three. Twenty-one of the 31 had abnormal intravenous pyelograms, eight of 12 undergoing cystoscopy had abnormalities, five of five having tine cystograms were abnormal, and three of five had abnormalities on retrograde pyelogram. The major urinary tract abnormalities included reflux. valves, torsion of testis, duplication, ureterocele, paraureteral diverticulum, cryptorchidism, hypospadias, and urethral rectal fistula. The three tumors included neuroblastoma in two cases and lymphoblastic lymphoma of the small-bowel mesentery in the third. Of 20 patients seen in follow-up, I5 are living and well. Six have other urologic sequelae, five have died, and two have sequelae other than urologic, Because of the data presented. the authors feel that the pediatric patient with a horseshoe kidney should have a thorough urologic evaluation and that the higher mortality rate associated with horseshoe kidney in children is based on abnormalities in other organ systems. -S. Kim Congenital Diverticulum Of the Renal Pelvis: Report Of a Case. R. P. Myers and J. H. Deweerd. J. Ural. 108:330-332 (August), 1972. A case report of a 7-wk-old boy hospitalized with an abdominal mass. Intravenous pyelogram demonstrated a ring-shaped accumulation of dye encircling a central collection of dye on the right side and a normal left COIL letting system. Renal exploration revealed a diverticulum of the renal pelvis.--S. Kim
A New Concept in the Treatment of Stoma1 Stenosis. J. R. Richardson, Jr., P. C. Linton, and G. F. Leadbetter. Jr. J. Ural. 108:159161 (July), 1972. The authors discuss the use of radiation to treat stoma1 stenosis and excessive mucus pro-
ABSTRACTS
851
duction, the use of 5-fluorouracil as a cream for stoma1 keratosis, and surgical excision of the peristomal scar and replacement with normal skin swung in as flaps. The authors feel that normal skin surrounding a stoma draining urine is much less apt to become irritated and inflamed than surgical scar tissue.-g. Kim Urinary Reconstruction Following Temporary Cutaneous Ureterostomy Diversion in Children. L. G. Lome and D. I. Williams. .I. Ural. 108: 1622164 (July), 1972. The authors review the cases of 26 infants and children who have had ureterovesical continuity restored after temporary cutaneous ureterostomy. Sixteen patients had bilateral loop cutaneous ureterostomy and ten had bilateral cutaneous end ureterostomy. Twentyfour loop cutaneous ureterdstomies have been closed with no complications in 20 of them. Ureterovesical continuity has been restored in 17 end ureterostomies, with only six instances that were satisfactory. Of the I2 loop cutaneous ureterostomies demonstrating vesicoureteral reflux, six had persistent reflux requiring correction after closure of the loop cutaneous ureterostomy. The authors now use temporary cutaneous loop ureterostomy for the infected and uremic neonates, but in healthy and in older children, lower reconstruction is carried out.--S. Kim Ectopic Vas Deferens Communicating With Lower Ureter,: Embryological Considerations. H. J. Alfert and J. Y. Gillenwater. J. Ural. 108: 172-173 (July), 1972. A single case report of a 7-yr-old boy with a left pelvic kidney and an ectopic vas deferens communicating with the ureter. Because the vas deferens and ureter on the same side share a common precurser in the Wolffian duct, this case illustrates the persistence of this common precursor.-S. Kim Bilateral Ectopic Openings of Single Ureters in Girls: 9 Cases. J. Cendron and Y. Melin. Ann. Chir. Infant 13:355-368 (September/ October), 1972. The authors ectopic openings the bilateral and is quite rare. As served to have
report nine cases of bilateral in girls. They maintain that single nature of these ureters exceptions, one child was oba bifurcation of the superior
aspect of one ureter and one to have double left ureters joining just prior to entering the bladder. No clitoral bifurcation was noted eliminating epispadias as causal. In I3 ureters, both were implanted on the bladder neck, bladder wall, or urethral wall. In three examples, the two ureters had different insertions. In one case the bladder neck had a tunnellike aspect and insertion was difficult to ascertain. In no case did the ureter terminate below the external sphincter. Several anatomic aspects were worth noting. The upper urinary tract was nearly always dilated with secondary kidney malfunction. There was accompanying dysplasia (three cases), reflux (four cases), absence of the bladder neck (two cases), thickening of the bladder wall (eight cases) and decrease in bladder capacity (four cases). The common denominator of this malformation seemed to be the absence of the trigone. Embryologic derivation of this lesion is discussed as well as the anatomical result. There usually was an accompanying partial or complete agenesis of the urinary sphincter. Clinical manifestations included albuminuria, febrile pyuria, and incontinence. Reimplantation by the Leadbetter-Politano technique was recommended as indicated by hydroureteronephrosis and reflux.--1. Deevey Simplified Treatment of Ureterocoele in Children. J. Valayer and Y. Melin. Ann. Chir. Infant 13:347-354 (September/October), 1972. Ten cases of ureterocoele treated by a more simple method than usual are reported. The ureterocoele is left intact necessitating removal of only the supranumerary pathway. Good results were obtained in seven cases, Other cases showing persistent reflux were carefully followed and reimplantation was achieved at a later date. At this time the procedure was facilitated by the larger size of the child and less septic environment. The authors suggest that maturation of the trigone may lead to disappearance of the ureterocoele as the walls tend to adhere to each other. They recognize the value of the accepted procedure of intravesical operation, but feel it should be reserved for cases in which the simpler procedure is ineffective.-/. Deevr, The Neurogenic Bladder: An Experimental Study. H. J. Pompino. W. Lb#ler. D. OerthrlHaid, and M. Sreiner. Prog. Pediatr. Surg. 5: 135~161, 1973.
ABSTRACTS
The authors report renal injuries in 1 IO children and evaluate the results. The immediate use of infusion pyelography in assessment of the extent of the renal injury was helpful. The frequent use of infusion pyelography has eliminated the need for retrograde pyelography in most of the authors’ patients. They conclude that there is an occasional place for retrograde pyelography especially if a renal pelvis or ureteral injury is suspected. In exploration of the retroperitoneal area for evaluation of the extent of injury, repair of laceration, and debridement of renal parenchyma or segmental nephrectomy, the authors recommend proximal control of the renal vessel by vascular clamp. Otherwise, the surgeon may be forced to perform an unnecessary nephrectomy. Renal angiography is valuable if the kidney is not visualized on the infusion pyelogram. Intraoperative renal arteriography may be useful if the condition of the patient is critical and precludes preoperative x-ray studies. Renal scan may be helpful in determining the extent of the renal parenchymal injury although it was misleading in nine of 32 patients. Seventy-eight children were managed nonoperatively: 32 required operations.-George Holcomb Five Cases of Anuria Due to Obstruction of the Urinary Tract in Children. J. P. Jublonski, M. Lupold, h4. Gruner, and J. BrueziPre. Ann. Chir. Infant 13:369-378 (September/October), 1972. Five cases of anuria are discussed illustrating of obstructive various clinical aspects uropathy due to the following: calculi (three cases, one of which was in a single kidney), bothryosarcoma of the uterus invading the bladder (one case) with single kidney, and acute hydronephrosis in a single kidney (one case). Anuria was often associated with seizures leadin the diagnosis. The ing to confusion prevalence of single kidney in these cases is discussed as well as complications due to gramnegative sepsis. Medical management of anuria and surgical correction are also considered. Anuria is often easily reversible when the obstruction is relieved. Preliminary catheterization may promote diuresis.--M. Bettex and J. Deevqv Horseshoe Kidney In Children. J. IV. Segura. P. P. Kelalis, and E. C. Burke. J. Ural. 108: 333-336 (August), 1972. Thirty-four
cases
of
horseshoe
kidney
in
patients I5 yr or younger seen over a 35yr span at the Mayo Clinic are reviewed. Three patients had severe congenital anomalies of both urinary and other organ systems and died by 2 mo of age. Sixteen of 31 presented with urinary tract infection, three with an abdominal mass, three with gross hematuria, and three with abdominal pain. Sixteen had additional urologic abnormalities. Other abnormalities were found in the skeletal system in eight, cardiovascular system in eight, gastrointestinal system in four, and tumors were found in three. Twenty-one of the 31 had abnormal intravenous pyelograms, eight of 12 undergoing cystoscopy had abnormalities, five of five having tine cystograms were abnormal, and three of five had abnormalities on retrograde pyelogram. The major urinary tract abnormalities included reflux. valves, torsion of testis, duplication, ureterocele, paraureteral diverticulum, cryptorchidism, hypospadias, and urethral rectal fistula. The three tumors included neuroblastoma in two cases and lymphoblastic lymphoma of the small-bowel mesentery in the third. Of 20 patients seen in follow-up, I5 are living and well. Six have other urologic sequelae, five have died, and two have sequelae other than urologic, Because of the data presented. the authors feel that the pediatric patient with a horseshoe kidney should have a thorough urologic evaluation and that the higher mortality rate associated with horseshoe kidney in children is based on abnormalities in other organ systems. -S. Kim Congenital Diverticulum Of the Renal Pelvis: Report Of a Case. R. P. Myers and J. H. Deweerd. J. Ural. 108:330-332 (August), 1972. A case report of a 7-wk-old boy hospitalized with an abdominal mass. Intravenous pyelogram demonstrated a ring-shaped accumulation of dye encircling a central collection of dye on the right side and a normal left COIL letting system. Renal exploration revealed a diverticulum of the renal pelvis.--S. Kim
A New Concept in the Treatment of Stoma1 Stenosis. J. R. Richardson, Jr., P. C. Linton, and G. F. Leadbetter. Jr. J. Ural. 108:159161 (July), 1972. The authors discuss the use of radiation to treat stoma1 stenosis and excessive mucus pro-
ABSTRACTS
851
duction, the use of 5-fluorouracil as a cream for stoma1 keratosis, and surgical excision of the peristomal scar and replacement with normal skin swung in as flaps. The authors feel that normal skin surrounding a stoma draining urine is much less apt to become irritated and inflamed than surgical scar tissue.-g. Kim Urinary Reconstruction Following Temporary Cutaneous Ureterostomy Diversion in Children. L. G. Lome and D. I. Williams. .I. Ural. 108: 1622164 (July), 1972. The authors review the cases of 26 infants and children who have had ureterovesical continuity restored after temporary cutaneous ureterostomy. Sixteen patients had bilateral loop cutaneous ureterostomy and ten had bilateral cutaneous end ureterostomy. Twentyfour loop cutaneous ureterdstomies have been closed with no complications in 20 of them. Ureterovesical continuity has been restored in 17 end ureterostomies, with only six instances that were satisfactory. Of the I2 loop cutaneous ureterostomies demonstrating vesicoureteral reflux, six had persistent reflux requiring correction after closure of the loop cutaneous ureterostomy. The authors now use temporary cutaneous loop ureterostomy for the infected and uremic neonates, but in healthy and in older children, lower reconstruction is carried out.--S. Kim Ectopic Vas Deferens Communicating With Lower Ureter,: Embryological Considerations. H. J. Alfert and J. Y. Gillenwater. J. Ural. 108: 172-173 (July), 1972. A single case report of a 7-yr-old boy with a left pelvic kidney and an ectopic vas deferens communicating with the ureter. Because the vas deferens and ureter on the same side share a common precurser in the Wolffian duct, this case illustrates the persistence of this common precursor.-S. Kim Bilateral Ectopic Openings of Single Ureters in Girls: 9 Cases. J. Cendron and Y. Melin. Ann. Chir. Infant 13:355-368 (September/ October), 1972. The authors ectopic openings the bilateral and is quite rare. As served to have
report nine cases of bilateral in girls. They maintain that single nature of these ureters exceptions, one child was oba bifurcation of the superior
aspect of one ureter and one to have double left ureters joining just prior to entering the bladder. No clitoral bifurcation was noted eliminating epispadias as causal. In I3 ureters, both were implanted on the bladder neck, bladder wall, or urethral wall. In three examples, the two ureters had different insertions. In one case the bladder neck had a tunnellike aspect and insertion was difficult to ascertain. In no case did the ureter terminate below the external sphincter. Several anatomic aspects were worth noting. The upper urinary tract was nearly always dilated with secondary kidney malfunction. There was accompanying dysplasia (three cases), reflux (four cases), absence of the bladder neck (two cases), thickening of the bladder wall (eight cases) and decrease in bladder capacity (four cases). The common denominator of this malformation seemed to be the absence of the trigone. Embryologic derivation of this lesion is discussed as well as the anatomical result. There usually was an accompanying partial or complete agenesis of the urinary sphincter. Clinical manifestations included albuminuria, febrile pyuria, and incontinence. Reimplantation by the Leadbetter-Politano technique was recommended as indicated by hydroureteronephrosis and reflux.--1. Deevey Simplified Treatment of Ureterocoele in Children. J. Valayer and Y. Melin. Ann. Chir. Infant 13:347-354 (September/October), 1972. Ten cases of ureterocoele treated by a more simple method than usual are reported. The ureterocoele is left intact necessitating removal of only the supranumerary pathway. Good results were obtained in seven cases, Other cases showing persistent reflux were carefully followed and reimplantation was achieved at a later date. At this time the procedure was facilitated by the larger size of the child and less septic environment. The authors suggest that maturation of the trigone may lead to disappearance of the ureterocoele as the walls tend to adhere to each other. They recognize the value of the accepted procedure of intravesical operation, but feel it should be reserved for cases in which the simpler procedure is ineffective.-/. Deevr, The Neurogenic Bladder: An Experimental Study. H. J. Pompino. W. Lb#ler. D. OerthrlHaid, and M. Sreiner. Prog. Pediatr. Surg. 5: 135~161, 1973.