- Email: [email protected]
Fifteen years of experience with urinary diversion in myelomeningocele patients
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
494
FIFTEEN YEARS OF EXPERIENCE WITH URINARY DIVERSION IN MYELOMENINGOCELE PATIENTS. W. K. Mebust, J. D. Foret, and W. L. Valk. J. Urol. 101: 177-182, (February), 1969.
This is an analysis of 211 patients with myelomeningocele seen at the Kansas University Medical Center. There were 25 hospital deaths, from meningitis, pneumonia, sepsis, and progressive hydrocephalus. One hundred and thirteen patients who had been followed for an average of 4.5 years were studied in detail to determine the incidence of urinary tract disease. There was an increasing incidence of pyelonephritis and hydronephrosis as the children grew older being more frequent in girls than boys. Two thirds of those patients with micropyuria developed pyelonephritis underlining the importance of this examination. An indwelling urethral catheter was a good method of long-term diversion in girls, but not boys. Bladder neck revision failed to reduce the incidence of pyelonephritis or incontinence and vesicostomies were of limited value. The authors conclude that an ileal conduit offered the best method of long-term diversion. In the management of the child with meningomyelocele it is suggested that, from the newborn period on, the mother should crede the child every 3 hours and give long-term antimicrobials if micropyuria becomes apparent. Excretory urograms, BUN, and creatinine are obtained yearly and by the age of 4 to 6 years urinary diversion should be performed to prevent progression of upper tract damage.-B. M. Henderson.
SUBCLINICAL NEUROGENK BLADDER IN CHILDREN. L. E. Dorfman, J. Bailey and J. P. Smith. J.
Urol. 101:48-54
(January),
1969.
This is an analysis of 8 children who were found to have congenital neurogenic dysfunction of the bladder. Repeated urologic investigation had failed to demonstrate any cause for recurring urinary tract infections and incontinence. Neurologic evaluation, on the other hand, showed 5 of them to have hypotonic anal sphincters and decreased or absent bulbocavernosus reflexes. Anal sphincter electromyography was abnormal in all instances. The authors conclude that the triad of chronic vesical dysfunction, minor defects of the lumbosacral laminae, and abnormal anal EMG strongly suggests subclinical congenital neurogenic bladder. They suggest that an EMG of the anal sphincter is indicated in the evaluation of any obscure voiding problem, especially if neurogenic dysfunction is suspected.-B. M. Henderson.
CRITIQUE ON THE CONCEPT OF VESICAL NECK OBSTRUCTION IN CHILDREN. D. R. Smith.
J.A.M.A.
207: 1686-1692
(Mar. 3), 1969.
The author reviews the arguments for and against the concept of vesical neck contracture and vesicoureteral reflux. A careful analysis of the diagnostic features of vesical neck obstruction is presented. This includes a critical look at (1) residual urine, (2) diminished maximum flow rate, (3) visualization of stenosis of the bladder neck or trabeculation or both on endoscopy, (4) increased maximum intravesical voiding pressure, (5) cystourethrographic findings, and (6) palpation of the bladder neck at surgery. The author concludes that the unequivocal diagnosis of vesical neck stenosis or dysfunction is difficult to establish as the common cause of urinary infection, reflux, and enuresis. Routine revision of the bladder neck in association with uretero-vesicoplasty does not improve the cure rate of the antireflux operation. Most agree that it is difficult, if not impossible, to diagnose such obstruction with endoscopy or cystourethrography. Outlet obstruction, through trigonal hypertrophy, tends to further protect the ureterovesical “valve” from incompetency. Voiding pressure studies reveal no significant gradient on either side of the vesical neck. Recent investigations show that the area of increased resistance in young girls is not at the vesical neck but in the midurethra and is caused by involuntary spasm of the periurethral striated muscle. Treatment of the accompanying distal urethral stenosis usually relieves this spasm.-]. Eagerxe Lewis, Jr.
ABNORMALITIESOF THE UPPER URINARYTRACT IN CRYPTORCHIDISM.G. H. Farrington and I. H. Kerr. Brit. .I. Urol. 41:77-79 (February), 1969.
Intravenous urography was carried out in a consecutive series of 45 patients between the ages of 1 and 24 years undergoing orchidopexy for undescended testes. Six patients had unsuspected anomalies. Three had uncomplicated ureteral duplication; in one the condition was bilateral and in 2 unilateral. One boy had minor calyces opening directly into the renal pelvis, and 2 patients had a minor degree of unilateral hydronephrosis. The authors comment aptly that Campbell’s reported incidence of 33 per cent urinary tract abnormalities in 292 autopsies of cryptorchids gives a misleading impression since it is likely that Campbell’s series contained instances of patients with multiple congenital abnormalities responsible for early death.-‘. H. Johnston.
494
FIFTEEN YEARS OF EXPERIENCE WITH URINARY DIVERSION IN MYELOMENINGOCELE PATIENTS. W. K. Mebust, J. D. Foret, and W. L. Valk. J. Urol. 101: 177-182, (February), 1969.
This is an analysis of 211 patients with myelomeningocele seen at the Kansas University Medical Center. There were 25 hospital deaths, from meningitis, pneumonia, sepsis, and progressive hydrocephalus. One hundred and thirteen patients who had been followed for an average of 4.5 years were studied in detail to determine the incidence of urinary tract disease. There was an increasing incidence of pyelonephritis and hydronephrosis as the children grew older being more frequent in girls than boys. Two thirds of those patients with micropyuria developed pyelonephritis underlining the importance of this examination. An indwelling urethral catheter was a good method of long-term diversion in girls, but not boys. Bladder neck revision failed to reduce the incidence of pyelonephritis or incontinence and vesicostomies were of limited value. The authors conclude that an ileal conduit offered the best method of long-term diversion. In the management of the child with meningomyelocele it is suggested that, from the newborn period on, the mother should crede the child every 3 hours and give long-term antimicrobials if micropyuria becomes apparent. Excretory urograms, BUN, and creatinine are obtained yearly and by the age of 4 to 6 years urinary diversion should be performed to prevent progression of upper tract damage.-B. M. Henderson.
SUBCLINICAL NEUROGENK BLADDER IN CHILDREN. L. E. Dorfman, J. Bailey and J. P. Smith. J.
Urol. 101:48-54
(January),
1969.
This is an analysis of 8 children who were found to have congenital neurogenic dysfunction of the bladder. Repeated urologic investigation had failed to demonstrate any cause for recurring urinary tract infections and incontinence. Neurologic evaluation, on the other hand, showed 5 of them to have hypotonic anal sphincters and decreased or absent bulbocavernosus reflexes. Anal sphincter electromyography was abnormal in all instances. The authors conclude that the triad of chronic vesical dysfunction, minor defects of the lumbosacral laminae, and abnormal anal EMG strongly suggests subclinical congenital neurogenic bladder. They suggest that an EMG of the anal sphincter is indicated in the evaluation of any obscure voiding problem, especially if neurogenic dysfunction is suspected.-B. M. Henderson.
CRITIQUE ON THE CONCEPT OF VESICAL NECK OBSTRUCTION IN CHILDREN. D. R. Smith.
J.A.M.A.
207: 1686-1692
(Mar. 3), 1969.
The author reviews the arguments for and against the concept of vesical neck contracture and vesicoureteral reflux. A careful analysis of the diagnostic features of vesical neck obstruction is presented. This includes a critical look at (1) residual urine, (2) diminished maximum flow rate, (3) visualization of stenosis of the bladder neck or trabeculation or both on endoscopy, (4) increased maximum intravesical voiding pressure, (5) cystourethrographic findings, and (6) palpation of the bladder neck at surgery. The author concludes that the unequivocal diagnosis of vesical neck stenosis or dysfunction is difficult to establish as the common cause of urinary infection, reflux, and enuresis. Routine revision of the bladder neck in association with uretero-vesicoplasty does not improve the cure rate of the antireflux operation. Most agree that it is difficult, if not impossible, to diagnose such obstruction with endoscopy or cystourethrography. Outlet obstruction, through trigonal hypertrophy, tends to further protect the ureterovesical “valve” from incompetency. Voiding pressure studies reveal no significant gradient on either side of the vesical neck. Recent investigations show that the area of increased resistance in young girls is not at the vesical neck but in the midurethra and is caused by involuntary spasm of the periurethral striated muscle. Treatment of the accompanying distal urethral stenosis usually relieves this spasm.-]. Eagerxe Lewis, Jr.
ABNORMALITIESOF THE UPPER URINARYTRACT IN CRYPTORCHIDISM.G. H. Farrington and I. H. Kerr. Brit. .I. Urol. 41:77-79 (February), 1969.
Intravenous urography was carried out in a consecutive series of 45 patients between the ages of 1 and 24 years undergoing orchidopexy for undescended testes. Six patients had unsuspected anomalies. Three had uncomplicated ureteral duplication; in one the condition was bilateral and in 2 unilateral. One boy had minor calyces opening directly into the renal pelvis, and 2 patients had a minor degree of unilateral hydronephrosis. The authors comment aptly that Campbell’s reported incidence of 33 per cent urinary tract abnormalities in 292 autopsies of cryptorchids gives a misleading impression since it is likely that Campbell’s series contained instances of patients with multiple congenital abnormalities responsible for early death.-‘. H. Johnston.