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Experience with surgery for continence in children with a neuropathic bladder
INTERNATIONAL
ABSTRACTS
1399
Continent catheterizable channels using the Mitrofanoff principle were created in 35 patients (mean age, 9.1 years; range, 2 to 21). The mean follow-up period was 22 months (range, 1 to 60). Follow-up data are available for 33 patients. The authors used the appendix, ureter, fallopian tube, and gastric tube to construct the channel. All 33 patients used the Mitrofanoff catheterizable channel, without difficulty, for at least 3 months postoperatively. Sixteen patients (48%) can empty the bladder only by Mitrofanoff catheterization and do so without difficulty. All 11 patients (33%) who have the potential to catheterize either the Mitrofanoff channel or urethra choose to catheterize the Mitrofanoff channel. The patient not using Mitrofanoff catheterization had stoma1 stenosis 12 months postoperatively and elected to use urethral catheterization rather than undergo surgical repair. Five patients (15%) can void, but all use the Mitrofanoff catheterizable channel to monitor postvoid residual volumes. This study shows a high acceptance rate for patients receiving a continent catheterizable stoma.-George W. Holcomb,
Jr
Experience Neuropathic
With Surgery for Bladder. S. Nour
Continence in Children and E. MucKinnon. Eur
With
a
J Pediatr
Surg 4:22-24, (December), 1994 (suppl I). The experience with surgery for continence in a series of 23 children with neuropathic bladder is reported. Various techniques were employed. Eighteen children (85.7%) had achieved continence on clean intermittent catherization, at 3 hourly intervals. The procedures failed in three children, and the other two had their surgery too recently for follow-up assessment. The complications and their management are discussed.-ThomasA, Angerpointner The incidence Neurovesical lies. M. De
of Occult Spinal Dysraphism and the Onset of Dysfunction in Children With Anorectal AnomaGenrzaro, M. Rivosecchi, M.C. Lucchetri, et al. Eur J
Pediatr Surg 4:12-14, (December), 1994 (suppl I). The urologic malformations associated with anorectal anomalies (ARA) not only are anatomic but also are functional, the latter being related to congenital neurovesical dysfunction (NVD). The true incidence of spinal dysraphism (SD) in these children is still unclear and probably underestimated. The concept of caudal regression could explain its association with the anorectal anomalies. Because of awareness of the late onset of neurovesical dysfunction and/or orthopedic symptoms in some of these patients, the authors began to use magnetic resonance imaging (MRI) in patients with ARA. Eighteen of 41 (44%) without neurological or orthopedic symptoms and seven (78%) of nine with neurological or orthopedic symptoms screened by MRI showed pathological findings. The overall incidence of spinal dysraphism among the patients with ARA was 50%. The pathological MRI findings were fibrolipoma, tethering of the cord, syringomelia, and sac anomalies. To detect the presence of NVD in these children, urodynamic studies with external sphincter electromyography were performed in 24 children. Grouped by age, 14 were between 5 and 18 months, and 10 were between 4 and 13 years. Ten patients (71%) in the first group and three (30%) in the second had normal urodynamic patterns. A total of 11 children had pathological findings (hyperreflexic bladder). Two had Down’s syndrome. The incidence of spinal dysraphism in children with anorectal anomalies is high, and screening with morphological studies of the spinal cord is mandatory. Neurovesical dysfunction should be suspected in all these children and is likely to be congenital in nature. Early and repeat urodynamic studies are recommended to detect neurogenic bladder dysfunction before the onset of symptoms.-Thomas A. Angerpointner
Investigative Techniques Children With Spina SteZlman- Ward et al. Eur
and Bifida.
Renal M.A.
Parenchymal Lewis, N.J.A.
Damage in Webb, G.R.
J Pediatr Surg suppl I, 29-31,1994 (suppl I).
The case records of 72 patients attending a multidisiplinary spina bifida clinic were reviewed to discover the prevalence of renal parenchymal damage. Nineteen percent had such damage. More detailed analysis of the group according to age showed that the prevalence of parenchymal damage in the patients over 10 years of age (27.3%) was twice that of patients under five years of age (13.3%). On the basis that most renal parenchymal damage occurs early, the authors conclude that the current approach to investigation and treatment is reducing the incidence of renal parenchymal damage in this population. Further reduction would require early identification of the high-risk bladder before the onset of hydronephrosis.-Z7zomasA. Angerpointner Postoperative Adhesion Formation copy in the Pediatric Population. D.A. Bloom, et al. J Urol153:792-795,
After Urological R.G. Moore, L.R.
LaparosKavoussi,
(March), 1995.
The risk of intraperitoneal adhesion formation is a concern with transperitoneal laparoscopic surgery. To evaluate the incidence of adhesions after interventional urologic laparoscopy, the authors reviewed 41 pediatric cases that had second-look procedures. The number of adhesions and quantitation of the degree of each adhesion were assessed. Major laparoscopic procedures had been performed previously in eight patients: 29 had moderate procedures and four had minor ones. Adhesions were noted in four patients (9.8%)-two at the operative site and two at trocar sites. The risk of adhesions increased with the extent of dissection. Two adhesions developed after major procedures, but the grade and extent of these were minimal. In the majority of patients, reperitonealization occurred with minimal or no scarring. Although the adhesions may occur with pediatric urologic laparoscopic procedures, the incidence appears lower than what one would expect with open exploration.-George W. Holcomb, Jr NEOPLASMS The Role of Surgery in Advanced koyama, H. Ikawa, M. Endow, et al.
Neuroblastoma.
J. Yo-
Eur J Pediatr Surg 5:23-26,
(February), 1995. The authors performed multimodal therapy, including chemotherapy with bone marrow transplantation (BMT), surgery. and local irradiation, in the treatment of advanced neuroblastoma. All patients with stage III survived and four of the eight with stage IV who underwent the original systemic gross complete resection survived long-term. Long-term survival patients were treated by local irradiation, brain surgery, and intense induction chemotherapy before primary site operation. When resolution of distant metastases was obtained, the primary site was resected completely, followed by postoperative supralethal chemotherapy with BMT. The positive long-term results support the necessity of such an agressive regimen for cases of advanced neuroblastoma.-Thomas A. AngeFointner Congenital W. Morgan,
Hemangiopericytoma and T.L. Anderson.
of the C1itoris.J.
K Brock,
ZZZ
J Urol 153:468-469, (February),
1995. Hemangiopericytoma is a rare vascular tumor that is believed to arise from the pericyte of Zimmerman. Approximately 10% of cases occur in children and one third are congenital. To the authors’ knowledge, this is the first report of congenital hemangiopericytoma arising from the clitoris. Total clitoridectomy was required to provide a negative margin. The anterior perineum was
ABSTRACTS
1399
Continent catheterizable channels using the Mitrofanoff principle were created in 35 patients (mean age, 9.1 years; range, 2 to 21). The mean follow-up period was 22 months (range, 1 to 60). Follow-up data are available for 33 patients. The authors used the appendix, ureter, fallopian tube, and gastric tube to construct the channel. All 33 patients used the Mitrofanoff catheterizable channel, without difficulty, for at least 3 months postoperatively. Sixteen patients (48%) can empty the bladder only by Mitrofanoff catheterization and do so without difficulty. All 11 patients (33%) who have the potential to catheterize either the Mitrofanoff channel or urethra choose to catheterize the Mitrofanoff channel. The patient not using Mitrofanoff catheterization had stoma1 stenosis 12 months postoperatively and elected to use urethral catheterization rather than undergo surgical repair. Five patients (15%) can void, but all use the Mitrofanoff catheterizable channel to monitor postvoid residual volumes. This study shows a high acceptance rate for patients receiving a continent catheterizable stoma.-George W. Holcomb,
Jr
Experience Neuropathic
With Surgery for Bladder. S. Nour
Continence in Children and E. MucKinnon. Eur
With
a
J Pediatr
Surg 4:22-24, (December), 1994 (suppl I). The experience with surgery for continence in a series of 23 children with neuropathic bladder is reported. Various techniques were employed. Eighteen children (85.7%) had achieved continence on clean intermittent catherization, at 3 hourly intervals. The procedures failed in three children, and the other two had their surgery too recently for follow-up assessment. The complications and their management are discussed.-ThomasA, Angerpointner The incidence Neurovesical lies. M. De
of Occult Spinal Dysraphism and the Onset of Dysfunction in Children With Anorectal AnomaGenrzaro, M. Rivosecchi, M.C. Lucchetri, et al. Eur J
Pediatr Surg 4:12-14, (December), 1994 (suppl I). The urologic malformations associated with anorectal anomalies (ARA) not only are anatomic but also are functional, the latter being related to congenital neurovesical dysfunction (NVD). The true incidence of spinal dysraphism (SD) in these children is still unclear and probably underestimated. The concept of caudal regression could explain its association with the anorectal anomalies. Because of awareness of the late onset of neurovesical dysfunction and/or orthopedic symptoms in some of these patients, the authors began to use magnetic resonance imaging (MRI) in patients with ARA. Eighteen of 41 (44%) without neurological or orthopedic symptoms and seven (78%) of nine with neurological or orthopedic symptoms screened by MRI showed pathological findings. The overall incidence of spinal dysraphism among the patients with ARA was 50%. The pathological MRI findings were fibrolipoma, tethering of the cord, syringomelia, and sac anomalies. To detect the presence of NVD in these children, urodynamic studies with external sphincter electromyography were performed in 24 children. Grouped by age, 14 were between 5 and 18 months, and 10 were between 4 and 13 years. Ten patients (71%) in the first group and three (30%) in the second had normal urodynamic patterns. A total of 11 children had pathological findings (hyperreflexic bladder). Two had Down’s syndrome. The incidence of spinal dysraphism in children with anorectal anomalies is high, and screening with morphological studies of the spinal cord is mandatory. Neurovesical dysfunction should be suspected in all these children and is likely to be congenital in nature. Early and repeat urodynamic studies are recommended to detect neurogenic bladder dysfunction before the onset of symptoms.-Thomas A. Angerpointner
Investigative Techniques Children With Spina SteZlman- Ward et al. Eur
and Bifida.
Renal M.A.
Parenchymal Lewis, N.J.A.
Damage in Webb, G.R.
J Pediatr Surg suppl I, 29-31,1994 (suppl I).
The case records of 72 patients attending a multidisiplinary spina bifida clinic were reviewed to discover the prevalence of renal parenchymal damage. Nineteen percent had such damage. More detailed analysis of the group according to age showed that the prevalence of parenchymal damage in the patients over 10 years of age (27.3%) was twice that of patients under five years of age (13.3%). On the basis that most renal parenchymal damage occurs early, the authors conclude that the current approach to investigation and treatment is reducing the incidence of renal parenchymal damage in this population. Further reduction would require early identification of the high-risk bladder before the onset of hydronephrosis.-Z7zomasA. Angerpointner Postoperative Adhesion Formation copy in the Pediatric Population. D.A. Bloom, et al. J Urol153:792-795,
After Urological R.G. Moore, L.R.
LaparosKavoussi,
(March), 1995.
The risk of intraperitoneal adhesion formation is a concern with transperitoneal laparoscopic surgery. To evaluate the incidence of adhesions after interventional urologic laparoscopy, the authors reviewed 41 pediatric cases that had second-look procedures. The number of adhesions and quantitation of the degree of each adhesion were assessed. Major laparoscopic procedures had been performed previously in eight patients: 29 had moderate procedures and four had minor ones. Adhesions were noted in four patients (9.8%)-two at the operative site and two at trocar sites. The risk of adhesions increased with the extent of dissection. Two adhesions developed after major procedures, but the grade and extent of these were minimal. In the majority of patients, reperitonealization occurred with minimal or no scarring. Although the adhesions may occur with pediatric urologic laparoscopic procedures, the incidence appears lower than what one would expect with open exploration.-George W. Holcomb, Jr NEOPLASMS The Role of Surgery in Advanced koyama, H. Ikawa, M. Endow, et al.
Neuroblastoma.
J. Yo-
Eur J Pediatr Surg 5:23-26,
(February), 1995. The authors performed multimodal therapy, including chemotherapy with bone marrow transplantation (BMT), surgery. and local irradiation, in the treatment of advanced neuroblastoma. All patients with stage III survived and four of the eight with stage IV who underwent the original systemic gross complete resection survived long-term. Long-term survival patients were treated by local irradiation, brain surgery, and intense induction chemotherapy before primary site operation. When resolution of distant metastases was obtained, the primary site was resected completely, followed by postoperative supralethal chemotherapy with BMT. The positive long-term results support the necessity of such an agressive regimen for cases of advanced neuroblastoma.-Thomas A. AngeFointner Congenital W. Morgan,
Hemangiopericytoma and T.L. Anderson.
of the C1itoris.J.
K Brock,
ZZZ
J Urol 153:468-469, (February),
1995. Hemangiopericytoma is a rare vascular tumor that is believed to arise from the pericyte of Zimmerman. Approximately 10% of cases occur in children and one third are congenital. To the authors’ knowledge, this is the first report of congenital hemangiopericytoma arising from the clitoris. Total clitoridectomy was required to provide a negative margin. The anterior perineum was