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Fulguration-ablation of atypical accessory urethra
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
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