Cecoureterocele and concepts on the embryology and etiology of ureterocele

ABSTRACTS as favorable candidates renal transplantation--C.

for therapy L. Rubin

with

CADAVERIC RENAL TRANSPLANTATION IN CHILDREN. R. N. Fine, H. H. Edelbrock, L. P. Brennan, C. M. Grushkin, B. M. Korsch, H. Riddell, Q. Stiles, and E. Lieberman. Lancet I: 1087-1091 (May 29) 1971. Although cadaveric renal transplantation is an accepted method of treatment for end-stage renal disease in adults, its use in the treatment of uremic children is still controversial. Twenty-nine children aged 18 mo to 18 yr received 32 cadaveric renal transplants between February 1968 and August 1970. Twenty-five children ( 86%) and 22 allografts (69%) are surviving &32 mo after transplantation. The results are discussed and medical and surgical complications and causes of death are considered. Growth has occurred in four or five children whose bone age was less than 12 yr at the time of transplantation and who survived more than a year with good allograft function. Knowledge of the source of the kidney did not interfere with emotional adjustment or rehabilitation.-W. M. Dennifon THE MANAGEMENT OF RENAL CA=I. I. Blandy. Ann. Roy. Coll. Surg. Eng. 48:159 (March)

1971.

The etiology of stone formation in the kidney is discussed. The formation of a stone due to Randall’s plague does not account for all stones seen in the calyx. The management of ureteric calculi is discussed. Operative removal is only undertaken if the stone gets stuck month after month and the (or remains) hydronekidney becomes phrotic above it. Large calyceal stones may be removed by Gil-Vemet’s extended pyelolithotomy through the renal sinus. Accessory methods that involve cooling of the kidney have not been found necessary. Ruthless follow-up of stoneforming patients is the most important part of the management.-N. V. Freeman TEMPORARY URINARY DIVERSION IN SEVERE URINARY TRAIX OBSTRUCTION. H. Wiltschke. Z.KIin.-Chir. 9:387395, 1971.

Temporary urinary diversion is performed to relieve the back pressure and allow for further surgery when the renal function has been seriously impaired, when retention of urine is associated with severe infection, or when there are considerable disturbances in ureteric peristalsis. The operative techniques of terminal ureterostomy and nephrostomy are described in detail and examples are given-S. Hofmann and H B. Eckstein PROBLEMS OF ANTIREFLUX SURGERY AND URETERIC REIMPLANTATION USING THE METHOD OF GREGOIR. Th. Senge and P. Strohmenger. Z. Klin.-Chir. 9:39!%403, 1971. The authors report 59 antireflux procedures using the method of Gregoir in 51 children. The indications for operation included symptomatic megaureter and double kidneys with double ureters. In all but one patient there was improvement within 6 mo.-S. Hofmann and H. B. Eckytein CECOUFBTEROCELEAND CONCEPTS ON THE EMBRYOLOGY AND ETIOLOGY OF UFIETEROCELE. D. Stephens. Aust. New Zeal. 1. Surg.

40:239-248

(February)

1971.

Cecoureterocele, an uncommon variety of ureterocele, has two characteristics: the lumen extends beyond its orifice as a urethral submucosal tongue; and the vesical orifice is large and incompetent. Three cases are reported out of a total of 60 ureteroceles, the remainder being classified as stenotic, sphincteric, sphmcterostenotic, blind, or nonobstructive. The embryology of the ureter and ureterocele is discussed in detail. The Miillerian duct migration is responsible not only for the transposition of the orifices of some ectopic ureters from the trigone to the distal half of the female urethra, the urethrovaginal bridge, and the hymen of the vagina, but aIso for the urethral extension of the cecoureterocele. The cecoureterocele and other ureteroceles, which exhibited large orifices, were considered developmental in origin though an obstructive component may be superadded by virtue of the location of the orifice within the grasp of the internal sphincter of the urethra. Though many ureteroceles arise as dilatations secondary to stenosis of the

796

ABSTRACTS

ureteric orifice, obstruction is not an essential component and in the nonobstructive group the basic etiological factor is primary malformation--J. R. Solomon BLADDER EXSTROPHY. H. C. Sommerschild and 0. Knutrud. Z. Klin.-Chir. 9:404412,

1971.

The authors report 26 patients with exstrophy of the bladder seen in the years 1960-1969. At the follow-up examination, 12 of these patients were aged 5 yr or more. Reconstruction of the bladder was attempted in 19 patients but failed in every one as far as incontinence was concerned. In eight patients a rectal conduit was performed using the method of Duhamel with three successful results and 15 patients have had conduit diversion to the skin, The authors come to the following conclusions: ( 1) The patient should be operated on between the ages of 1 and 2 yr. ( 2) Reconstruction of the bladder should be attempted in females who have a particularly well-developed bladder. (3) Ureterosigmoid anastomosis with an intact colon should be performed in all other patients and in those in whom reconstruction of the bladder has failed. (4) An ileal loop urinary diversion is the method of choice when previous procedures have failed. (5) Renal function should not be sacrificed in an attempt to achieve normal anatomy.-S. Hofmann and H. B. E&stein STRESSINCONTINENCE AND THE USE OF IMPLANTED ELECTRONIC STIMULATORS IN CHILDREN. N. W. Harrison. Proc. Roy. Sot.

Med.

64:128-130

(February)

1971.

Twenty-six children ( 12 boys and 14 girls) with urinary incontinence were investigated by cystometrography and measurement of urethral pressure profiles. It was found that children ,with incontinence had lower intraurethral pressures than normal children, and those with stress incontinence had pressures that were even lower. Treatment by the implantation of an electronic stimulator was carried out in six cases; five of these were successful and one failed. Criteria for the use of implanted electronic stimulators in children are enumerated and it is suggested that the method should be used only in boys, a fascial sling procedure

being preferable in girls. Other types of incontinence discussed are congenital wide urethra in males, the relaxed bladder neck in females, the congenital short urethra, and posttraumatic incontinence.-_1. E. S. Scott MANAGE~~ENT OF AGENESISOF THE PHALLUS. H. Young, II, A. Cockett, R. Staller, F. Ashley, and W. Goodwin. Pediatrics 47: 81-87 (January) 1971. Four patients with agenesis of the phallus are presented with discussion as to possible management from a surgical, psychological, and social viewpoint. The authors stress the importance of early sex assignment, minimal early surgical procedures, and the relative ease of female appearance with the later use of supplementary estrogens at puberty. If sexual assignment is delayed, the legal problems concerning a sex change and the social problems of sexual ambiguity among relatives and friends are outweighed only by the psychological problems confronting the patient himself, who is confused by his sexual ambiguity.-C. L. Rubin TREATMENTOF HYPOSPADIAS. Jean Cendron. Proc. Roy. Sot. ary) 1971.

Med. 64: 125-127

(Febru-

This paper reviews the results of the treatment of 309 cases of hypospadias. Associated congenital malformations such as cryptorchidism were found in 10% of the cases. There were 17 pseudohermaphrodites among 45 with peiirenal hypospadias, and these included one patient with mosaic chromosomes. The operation favored in the treatment of anterior hypospadias is the Leveuf technique performed between the ages of 10 and 12 yr. For the scrotal and perineal deformity the Duplay operation is used to repair the posterior part of the urethra at the age of 5 yr, to be followed by the Leveuf operation at 10 yr.-J. E. S. scoff HYPOSPADIAS AND CRYPTOSPADIAS. J. C. uan der M&en. Brit. J. Plast. Surg. 24:101105 (January) 1971. The relationship between hypospadias and cryptospadias (chordee with hypospadias, congenital short urethra, congenital urethral fistula) is discussed. Seven cases of crypto-