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skin tube for urethral reconstruction: An update
INTERNATIONAL ABSTRACTS
324
infant was 6 weeks old, follow-up abdominal ultrasound studies showed no gallstones. This case, as well as one previously reported, demonstrates that findings typical of gallstones may be seen in the fetus, and that these structures may spontaneously resolve.--N. Scott Adzick indications and Results of Splenectomy for Beta-Thalassemia in T w o Hundred and T w e n t y - O n e Pediatric Patients. A.D, Pinna, F.
Argiolu, L. Marongiu, et al. Surg Gynecol Obstet 167:109-113, (August), 1988. The authors evaluated the advantages and complications of sptenectomy in the treatment of beta-thalassemia in 221 children. There were 125 boys and 96 girls with a mean age of 8.2 years at the time of surgery. The postoperative complications in patients with thalassemia were 43.4% v 3.2% in control patients. Late complications occurred with an incidence of 10.7% and were due principally to sepsis. Six patients died of sepsis. Blood consumption decreased from 270 to 155 mL/kg per year postoperatively, and hemoglobin levels increased from 9.7 to 11.2 g / m E These results suggest that although splenectomy for beta-thalassemia causes a significant incidence of complications and fatalities, surgical treatment permits an improvement in the quality of lives of patients with betathalassemia and substantially reduces blood consumption. Prophylactic antibiotic therapy can reduce the incidence of sepsis in these patients.--George Holcomb, Jr GENITOURINARY TRACT Scrotal Fat Necrosis After Skiing. J. Viljanto and S. Toikkanen. Pediatr Surg Int 3:365-367, (July), 1988.
Fat necrosis in the scrotum is a rare lesion seen only before the age of puberty. The authors add one case of their own to three earlier reports. Common to most cases reported is the strict age limit of between 9 and 12 years at the time of onset, exposure to cold, a tender mass in close connection with one or both testicles, and difficulties in differentiating this condition preoperatively from other forms of acute scrotum. Microscopic similarities with cold panniculitis are discussed.--Prem Puri
children and adolescents with varicocele. Testicular volume and seminal variables were tested and compared in three groups of patients. The first group (young varieocele group) consisted of patients 16 to 23 years of age, all of whom had unilateral left varicocele clinically diagnosed with unknown fertility status, no previous urogenital disease, and no surgery or trauma in the genital area. Group 2 (varicocele infertility group) consisted of 18 patients, 25 to 38 years of age, referred from the infertility clinic after evaluation of sterile marriage. A left varicecele was the only pathologic finding. The third group consisted of 18 males, 16 to 38 years of age, referred for minor disorders unrelated to the urogenital system. No genital abnormalities were found during the physical examination. Evaluations included real-time ultrasonography and B-mode gray scale ultrasound. Sagittal and transverse planes were used to measure the volume of each testis. Seminal specimens were collected from each patient for evaluation of spermatic function. Statistical evaluation showed testicular volumes in both variocele groups to be significantly lower than the controls. Seminal evaluation showed no difference in motility index or morphology between the control and the young varicocele groups. However, a statistically significant difference was found in total sperm counts. A statistically significant difference was also found when controls were compared with the varicocele and fertility groups in all seminal findings. Data suggest that the detrimental effect of varicocele on testicular function is progressive. This report supports an active therapeutic approach to the young male varicocele. The classical surgical approach consists of high ligation of the internal spermatic vein. These investigators have previously shown that incompetence of the internal spermatie vein may not be the only source of reflux in varicocele. In a considerable number of patients, a hemodynamie derangement in the external spermatic vein may also be demonstrated. High ligation alone in these patients may be inadequate. The authors are currently conducting a randomized trial of therapy with ligation of the internal and/or external spermatic venous systems. A recommendation is provided to undertake a more thorough active screening among sehoolage boys for varicocele. Identification and treatment of prominent varicoceles accompanied by hypotrophic testes could prevent irreversible testicular lesions.--Edward G. Ford
Torsion of Scrotal Contents in Children. A.W. McCombe and W.G.
Scobie. Br J Uro161:148-150, (February), 1988. This is a retrospective review of 95 cases of torsion of testieular appendage and 45 cases of testicular torsion. The authors believe that it is often possible to differentiate between the two conditions. Pathogenic features of examination were an elevated or ectopic testis in 50% of cases of testicular torsion and a palpable tender blue nodule in 21% of cases of torsion of testicular appendage. When the diagnosis of the latter condition is possible, a conservative approach is justified.--Amir Azmy Abdominal Scrotal Hydrocele in Infancy. R. Squire and D.C.S.
J.F.R. Robertson, A.F. Azmy, and W. Cochran. Br J Urol 61:146-147, (February), 1988.
Assent to Ascent of the Testis.
Thirteen boys in whom the testes ascended from the normal scrotal position to an undescended position are reported. Ten patients showed patent processus vaginalis, and in three patients who had retractile testes, the testicles were held in the high position with surrounding adhesions. This report supports Atwell's earlier report on ascent of testes and expands on the finding that retractile testes without the presence of processus vaginalis may ascend as well. Early documentation of the position of the testis is emphasized.-Amir Azmy
Gough. Br J Uro161:347-349, (April), 1988. The authors describe three infants with abdominoscrotal hydrocele and discuss the theories of its causation. They propose a further possibility of a pulsion diverticulum following alongside an established hydrocele as two elements of the patent processus undergo relative occlusion.--Amir Azmy Varicoeele in Youth. J. Syfan, Y. Softer, H. Manor, et al. Ann Surg 207:223-227, (February), 1988.
Varicocele may be the most frequent treatable cause of male infertility. The authors reviewed their experience in light of several recent reports describing a decrease in the size of the left testicle in
Combined Free Autologoua Bladder Mucosa/Skin Tube for Urethral Reconstruction: An Update. P.G. Duffy, P.G. Ransley, P.S.
Malone, et al. Br J Urol 61:505-506, (June), 1988. Twenty-three patients aged 3 to 19 years (mean, 7 years) received a combined bladder mucosa/skin graft after failed hypospadias repair (21) and as a primary procedure (2). Nine patients had no complications, six developed a fistula that was successfully closed with a second minor operation, six developed minor distal stenosis, three developed mucosal prolapse through the skin tube requiring meatal revision, and one developed a stricture that did not respond to urethrotomy and is awaiting further surgery. The high rate of
INTERNATIONAL ABSTRACTS
complications in other series and recommendations to minimize or to avoid these complications are discussed.--Amir Azmy Posterior Urethral Obstruction: Prenatal Sonographic Findings and Clinical Outcome in 14 Cases. S.A. Hayden, P.D. Russ, D.H.
Pretorious, et al. J Ultrasound Mad 7:371-375, (August), 1988. Fourteen cases of fetal urethral obstruction were reviewed retrospectively. Decreased amniotic fluid volume complicated 12 pregnancies. Evaluation of the fetal kidneys showed hydronephrosis in 81%, increased parenchymal echogenicity in 73%, and macroscopic renal cysts in 15%. Of the 14 fetuses, there were seven live births. Five succumbed to intrauterine fetal demise of unknown etiology. Therapeutic abortion was elected in two eases. Of the seven live births, only two neonates survived beyond 5 weeks. Pulmonary hypoplasia contributed to the five postnatal deaths. One survivor had oligohydramnios during pregnancy and had a vesicoamniotic shunt placed at 28 weeks' gestation with subsequent normalization of amniotic fluid volume. The only other neonatal survivor in the series was the product of a pregnancy with normal amniotic fluid volume at 34 weeks' gestation without in utero intervention. The prognosis for fetuses with posterior urethral obstruction is poor. Fetal survival is adversely affected by oligohydramnios, which is inextricably linked to pulmonary hypoplasia. N. Scott Adzick Fulguration-Ablation of Atypical Accessory Urethra. S. Hoist and
325
Delayed bladder perforation with peritonitis following augmentation enterocystoplasty in children with spina bifida is a serious and potentially life-threatening complication. Experience with four such cases is presented. All patients had spina bifida with a neuropathic bladder. They had undergone augmentation enterocystoplasty with a tubular colonic segment of large bowel as part of an undiversion procedure. All patients were being managed with intermittent self-catheterization. The interval from augmentation enterocystoplasty until presentation ranged from 6 months to 3 years. Diagnosis was delayed in all cases, including three in which eystogram studies were normal despite findings of extravasation of urine at exploration. In one patient, generalized sepsis developed with respiratory distress syndrome and subsequent death.--George Holcomb, Jr Congenital Uterovesical Fistula in a Patient With the VATER Syndrome. M.P. Williams, S. ausaidy, and A.M.K. Rickwood. Br J
Urol 61:361-362, (April), 1988. A girl with VATER syndrome had associated right pelviureteric obstruction and left vesicoureteric reflux. A cystogram showed what was believed to be an abortive ureteric duplication. The child required reimplantation for recurrent urinary infections. Exploration showed the left ureter proper and an adjacent structure presumed to be a ureteric duplication, which was excised. Histology showed it to be an infantile uterus including cervical squamous mucosa and two small endometrial eavities.--Amir Azmy
N.E. Peterson. J Urol 140:347-348, (August), 1988. A male adolescent presented with perineal dribbling during voiding. Evaluation showed an accessory urethra originating from the prostatic urethra. There was persistent anatomical and functional dominance of the dorsal orthotopic urethra, constituting a reversal of the arrangement most commonly described for urethral duplication. Successful ablation of the accessory urethra was accomplished by electrofulguration. The salient features of urethral duplication are reviewed.--George Holcomb, Jr S'~Tc DTPA Scintography Compared With Intravenous Urography in the Follow-up of Posterior Urethral Valves. I. Gordon. P.G.
Ransley, and C.S. Hubbard. Br J Urol 60:447-449, (November), 1987. Twenty-seven patients with posterior urethral valves underwent both intravenous urography (IVU) and DTPA scan during followup. The DTPA scan was successful in 43 kidneys in excluding obstruction, compared with 31 kidneys by use of IVU. Also, the DTPA scan provides quantitative renal function and less exposure to radiation without any morbidity. The investigators believe that the DTPA scan should be the examination of choice for long-term follow-up.--Amir Azmy Symphyseal Diastasis in the Absence of the Exstrophy-Epispadias Complex. C.P. Steidle, H.A. Kennedy, M.E. Mitchell, et al. JUro[
140:349-350, (August), 1988. Symphyseal diastasis in the absence of exstrophy or epispadias is rare. Eleven reported cases are reviewed and two additional ones are reported. Based on these findings, it is recommended that a thorough physical examination be done in all patients. A voiding cystourethrogram in those with the radiographic finding of symphyseal diastasis in the absence of exstrophy or epispadias may be helpful. A significant number of patients have associated congenital anomalies.--George Holcomb, Jr Delayed Bladder Rupture After Augmentation Entarocystopiasty.
H.G. Rushton, J.R. Woodard, T.S. Parrott, et al. J Urol 140:344346, (August), 1988.
Radionuclide Cystography in Vosicoureteric Reflux. S.J. Chapman,
C. Chantler, G.B. Haycock, et aL Arch Dis Child 63:650-671, (June), 1988. Conventional micturating cystography was compared with the less invasive indirect radionuclidc cystography in the assessment of clinically suspected vesicoureteric reflux. Forty-four children, aged 5 and 15 years, underwent both investigations with 85 potentially refluxing kidney-ureter units available for comparison. Conformity of results was achieved in the detection or exclusion of reflux in 61% of units overall and in 88% of units with severe reflux. Both techniques had an apparent false-negative rate of 20%. Indirect radionuclide cystography was significantly better in detecting severe reflux. The investigators recommend indirect radionuclide cystography in the diagnosis or monitoring of vesicoureteric reflux in cooperative girls >3 years of age and in boys >5 years who have previously had micturating cystography to exclude posterior urethral valves.--D.M. Burge Treatment of Vesicoureteric Reflux. Preliminary Report of a Prospective Study. R.J. Scholtmeifer and D.J. GriSiths. Br J Urol
61:205-209, (March), 1988. Ninety-two children with 137 refluxing ureters were followed up for at least 18 months. All children with grade III or less were treated conservatively. Children with grade IV were randomized for antibiotic treatment alone v surgery plus antibiotics. Ureters with grade V were reimplanted. Reflux disappeared in 49 of the 91 cases and was reduced in 20. Reflux was cured in 40 of the 46 ureters treated by reimplantation. The authors concluded that conservative treatment of reflux grades I to III is satisfactory, but in grades IV and V surgery is the treatment of ehoiee.--Amir Azmy The Endoscopic Correction of Vesicoureteric Reflux. P.A. King
andL Gollow. Aust N Z J Surg 58:569-571, (July), 1988. Endoscopic correction of vesicoureteric reflux is now possible using a submucosal injection of Teflon paste (the "sting" operation). Twenty patients (36 ureters) aged 9 months to 6 years (mean, 2.5 years) have been treated endoscopically. All children had proven
324
infant was 6 weeks old, follow-up abdominal ultrasound studies showed no gallstones. This case, as well as one previously reported, demonstrates that findings typical of gallstones may be seen in the fetus, and that these structures may spontaneously resolve.--N. Scott Adzick indications and Results of Splenectomy for Beta-Thalassemia in T w o Hundred and T w e n t y - O n e Pediatric Patients. A.D, Pinna, F.
Argiolu, L. Marongiu, et al. Surg Gynecol Obstet 167:109-113, (August), 1988. The authors evaluated the advantages and complications of sptenectomy in the treatment of beta-thalassemia in 221 children. There were 125 boys and 96 girls with a mean age of 8.2 years at the time of surgery. The postoperative complications in patients with thalassemia were 43.4% v 3.2% in control patients. Late complications occurred with an incidence of 10.7% and were due principally to sepsis. Six patients died of sepsis. Blood consumption decreased from 270 to 155 mL/kg per year postoperatively, and hemoglobin levels increased from 9.7 to 11.2 g / m E These results suggest that although splenectomy for beta-thalassemia causes a significant incidence of complications and fatalities, surgical treatment permits an improvement in the quality of lives of patients with betathalassemia and substantially reduces blood consumption. Prophylactic antibiotic therapy can reduce the incidence of sepsis in these patients.--George Holcomb, Jr GENITOURINARY TRACT Scrotal Fat Necrosis After Skiing. J. Viljanto and S. Toikkanen. Pediatr Surg Int 3:365-367, (July), 1988.
Fat necrosis in the scrotum is a rare lesion seen only before the age of puberty. The authors add one case of their own to three earlier reports. Common to most cases reported is the strict age limit of between 9 and 12 years at the time of onset, exposure to cold, a tender mass in close connection with one or both testicles, and difficulties in differentiating this condition preoperatively from other forms of acute scrotum. Microscopic similarities with cold panniculitis are discussed.--Prem Puri
children and adolescents with varicocele. Testicular volume and seminal variables were tested and compared in three groups of patients. The first group (young varieocele group) consisted of patients 16 to 23 years of age, all of whom had unilateral left varicocele clinically diagnosed with unknown fertility status, no previous urogenital disease, and no surgery or trauma in the genital area. Group 2 (varicocele infertility group) consisted of 18 patients, 25 to 38 years of age, referred from the infertility clinic after evaluation of sterile marriage. A left varicecele was the only pathologic finding. The third group consisted of 18 males, 16 to 38 years of age, referred for minor disorders unrelated to the urogenital system. No genital abnormalities were found during the physical examination. Evaluations included real-time ultrasonography and B-mode gray scale ultrasound. Sagittal and transverse planes were used to measure the volume of each testis. Seminal specimens were collected from each patient for evaluation of spermatic function. Statistical evaluation showed testicular volumes in both variocele groups to be significantly lower than the controls. Seminal evaluation showed no difference in motility index or morphology between the control and the young varicocele groups. However, a statistically significant difference was found in total sperm counts. A statistically significant difference was also found when controls were compared with the varicocele and fertility groups in all seminal findings. Data suggest that the detrimental effect of varicocele on testicular function is progressive. This report supports an active therapeutic approach to the young male varicocele. The classical surgical approach consists of high ligation of the internal spermatic vein. These investigators have previously shown that incompetence of the internal spermatie vein may not be the only source of reflux in varicocele. In a considerable number of patients, a hemodynamie derangement in the external spermatic vein may also be demonstrated. High ligation alone in these patients may be inadequate. The authors are currently conducting a randomized trial of therapy with ligation of the internal and/or external spermatic venous systems. A recommendation is provided to undertake a more thorough active screening among sehoolage boys for varicocele. Identification and treatment of prominent varicoceles accompanied by hypotrophic testes could prevent irreversible testicular lesions.--Edward G. Ford
Torsion of Scrotal Contents in Children. A.W. McCombe and W.G.
Scobie. Br J Uro161:148-150, (February), 1988. This is a retrospective review of 95 cases of torsion of testieular appendage and 45 cases of testicular torsion. The authors believe that it is often possible to differentiate between the two conditions. Pathogenic features of examination were an elevated or ectopic testis in 50% of cases of testicular torsion and a palpable tender blue nodule in 21% of cases of torsion of testicular appendage. When the diagnosis of the latter condition is possible, a conservative approach is justified.--Amir Azmy Abdominal Scrotal Hydrocele in Infancy. R. Squire and D.C.S.
J.F.R. Robertson, A.F. Azmy, and W. Cochran. Br J Urol 61:146-147, (February), 1988.
Assent to Ascent of the Testis.
Thirteen boys in whom the testes ascended from the normal scrotal position to an undescended position are reported. Ten patients showed patent processus vaginalis, and in three patients who had retractile testes, the testicles were held in the high position with surrounding adhesions. This report supports Atwell's earlier report on ascent of testes and expands on the finding that retractile testes without the presence of processus vaginalis may ascend as well. Early documentation of the position of the testis is emphasized.-Amir Azmy
Gough. Br J Uro161:347-349, (April), 1988. The authors describe three infants with abdominoscrotal hydrocele and discuss the theories of its causation. They propose a further possibility of a pulsion diverticulum following alongside an established hydrocele as two elements of the patent processus undergo relative occlusion.--Amir Azmy Varicoeele in Youth. J. Syfan, Y. Softer, H. Manor, et al. Ann Surg 207:223-227, (February), 1988.
Varicocele may be the most frequent treatable cause of male infertility. The authors reviewed their experience in light of several recent reports describing a decrease in the size of the left testicle in
Combined Free Autologoua Bladder Mucosa/Skin Tube for Urethral Reconstruction: An Update. P.G. Duffy, P.G. Ransley, P.S.
Malone, et al. Br J Urol 61:505-506, (June), 1988. Twenty-three patients aged 3 to 19 years (mean, 7 years) received a combined bladder mucosa/skin graft after failed hypospadias repair (21) and as a primary procedure (2). Nine patients had no complications, six developed a fistula that was successfully closed with a second minor operation, six developed minor distal stenosis, three developed mucosal prolapse through the skin tube requiring meatal revision, and one developed a stricture that did not respond to urethrotomy and is awaiting further surgery. The high rate of
INTERNATIONAL ABSTRACTS
complications in other series and recommendations to minimize or to avoid these complications are discussed.--Amir Azmy Posterior Urethral Obstruction: Prenatal Sonographic Findings and Clinical Outcome in 14 Cases. S.A. Hayden, P.D. Russ, D.H.
Pretorious, et al. J Ultrasound Mad 7:371-375, (August), 1988. Fourteen cases of fetal urethral obstruction were reviewed retrospectively. Decreased amniotic fluid volume complicated 12 pregnancies. Evaluation of the fetal kidneys showed hydronephrosis in 81%, increased parenchymal echogenicity in 73%, and macroscopic renal cysts in 15%. Of the 14 fetuses, there were seven live births. Five succumbed to intrauterine fetal demise of unknown etiology. Therapeutic abortion was elected in two eases. Of the seven live births, only two neonates survived beyond 5 weeks. Pulmonary hypoplasia contributed to the five postnatal deaths. One survivor had oligohydramnios during pregnancy and had a vesicoamniotic shunt placed at 28 weeks' gestation with subsequent normalization of amniotic fluid volume. The only other neonatal survivor in the series was the product of a pregnancy with normal amniotic fluid volume at 34 weeks' gestation without in utero intervention. The prognosis for fetuses with posterior urethral obstruction is poor. Fetal survival is adversely affected by oligohydramnios, which is inextricably linked to pulmonary hypoplasia. N. Scott Adzick Fulguration-Ablation of Atypical Accessory Urethra. S. Hoist and
325
Delayed bladder perforation with peritonitis following augmentation enterocystoplasty in children with spina bifida is a serious and potentially life-threatening complication. Experience with four such cases is presented. All patients had spina bifida with a neuropathic bladder. They had undergone augmentation enterocystoplasty with a tubular colonic segment of large bowel as part of an undiversion procedure. All patients were being managed with intermittent self-catheterization. The interval from augmentation enterocystoplasty until presentation ranged from 6 months to 3 years. Diagnosis was delayed in all cases, including three in which eystogram studies were normal despite findings of extravasation of urine at exploration. In one patient, generalized sepsis developed with respiratory distress syndrome and subsequent death.--George Holcomb, Jr Congenital Uterovesical Fistula in a Patient With the VATER Syndrome. M.P. Williams, S. ausaidy, and A.M.K. Rickwood. Br J
Urol 61:361-362, (April), 1988. A girl with VATER syndrome had associated right pelviureteric obstruction and left vesicoureteric reflux. A cystogram showed what was believed to be an abortive ureteric duplication. The child required reimplantation for recurrent urinary infections. Exploration showed the left ureter proper and an adjacent structure presumed to be a ureteric duplication, which was excised. Histology showed it to be an infantile uterus including cervical squamous mucosa and two small endometrial eavities.--Amir Azmy
N.E. Peterson. J Urol 140:347-348, (August), 1988. A male adolescent presented with perineal dribbling during voiding. Evaluation showed an accessory urethra originating from the prostatic urethra. There was persistent anatomical and functional dominance of the dorsal orthotopic urethra, constituting a reversal of the arrangement most commonly described for urethral duplication. Successful ablation of the accessory urethra was accomplished by electrofulguration. The salient features of urethral duplication are reviewed.--George Holcomb, Jr S'~Tc DTPA Scintography Compared With Intravenous Urography in the Follow-up of Posterior Urethral Valves. I. Gordon. P.G.
Ransley, and C.S. Hubbard. Br J Urol 60:447-449, (November), 1987. Twenty-seven patients with posterior urethral valves underwent both intravenous urography (IVU) and DTPA scan during followup. The DTPA scan was successful in 43 kidneys in excluding obstruction, compared with 31 kidneys by use of IVU. Also, the DTPA scan provides quantitative renal function and less exposure to radiation without any morbidity. The investigators believe that the DTPA scan should be the examination of choice for long-term follow-up.--Amir Azmy Symphyseal Diastasis in the Absence of the Exstrophy-Epispadias Complex. C.P. Steidle, H.A. Kennedy, M.E. Mitchell, et al. JUro[
140:349-350, (August), 1988. Symphyseal diastasis in the absence of exstrophy or epispadias is rare. Eleven reported cases are reviewed and two additional ones are reported. Based on these findings, it is recommended that a thorough physical examination be done in all patients. A voiding cystourethrogram in those with the radiographic finding of symphyseal diastasis in the absence of exstrophy or epispadias may be helpful. A significant number of patients have associated congenital anomalies.--George Holcomb, Jr Delayed Bladder Rupture After Augmentation Entarocystopiasty.
H.G. Rushton, J.R. Woodard, T.S. Parrott, et al. J Urol 140:344346, (August), 1988.
Radionuclide Cystography in Vosicoureteric Reflux. S.J. Chapman,
C. Chantler, G.B. Haycock, et aL Arch Dis Child 63:650-671, (June), 1988. Conventional micturating cystography was compared with the less invasive indirect radionuclidc cystography in the assessment of clinically suspected vesicoureteric reflux. Forty-four children, aged 5 and 15 years, underwent both investigations with 85 potentially refluxing kidney-ureter units available for comparison. Conformity of results was achieved in the detection or exclusion of reflux in 61% of units overall and in 88% of units with severe reflux. Both techniques had an apparent false-negative rate of 20%. Indirect radionuclide cystography was significantly better in detecting severe reflux. The investigators recommend indirect radionuclide cystography in the diagnosis or monitoring of vesicoureteric reflux in cooperative girls >3 years of age and in boys >5 years who have previously had micturating cystography to exclude posterior urethral valves.--D.M. Burge Treatment of Vesicoureteric Reflux. Preliminary Report of a Prospective Study. R.J. Scholtmeifer and D.J. GriSiths. Br J Urol
61:205-209, (March), 1988. Ninety-two children with 137 refluxing ureters were followed up for at least 18 months. All children with grade III or less were treated conservatively. Children with grade IV were randomized for antibiotic treatment alone v surgery plus antibiotics. Ureters with grade V were reimplanted. Reflux disappeared in 49 of the 91 cases and was reduced in 20. Reflux was cured in 40 of the 46 ureters treated by reimplantation. The authors concluded that conservative treatment of reflux grades I to III is satisfactory, but in grades IV and V surgery is the treatment of ehoiee.--Amir Azmy The Endoscopic Correction of Vesicoureteric Reflux. P.A. King
andL Gollow. Aust N Z J Surg 58:569-571, (July), 1988. Endoscopic correction of vesicoureteric reflux is now possible using a submucosal injection of Teflon paste (the "sting" operation). Twenty patients (36 ureters) aged 9 months to 6 years (mean, 2.5 years) have been treated endoscopically. All children had proven