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Glanuloplasty and in situ tubularization of the urethral plate: A simple reliable technique for the majority of boys with hypospadias
INTERNATIONAL
455
ABSTRACTS
Glanuloplasty and In Situ Tubularization of the Urethral Plate: A Simple Reliable Technique for the Majority of Boys With Hypospadias. A.C. Van Horn and E.J: Km. J Urol 154:1505-1507,
(October), 1995. Results of hypospadias repair using glanuloplasty and in situ tubularization of the urethral plate were evaluated in 166 boys aged 5 months to 13.5 years (mean, 20 months). Overall cosmetic results were excellent. There was no evidence of meatal stenosis, urethral stricture, residual chordee, or ballooning of the neourethra noted during follow-up. A small urethrocutaneous fistula that formed in 10% of the patients was closed successfully in a brief outpatient procedure. The authors conclude that glanuloplasty and in situ tubularization of the urethral plate is an excellent technique for the majority of boys with distal shaft and subcoronal hypospadias, producing a cosmetic result that is superior to that associated with the Mathieu procedure or meatal advancement and glanuloplasty.-George IK Holcomb, Jr Vesical Tissues.
Exstrophy: J.H. Kelly.
Repair
Using
Radical
Mobilisation
of Soft
Pediatr Surg Int 10:298-304, (July), 1995.
Vesical exstrophy remains one of the most difficult problems treat in pediatric surgery. Many surgical procedures have been described to attain a satisfactory result. The author reports the results for 27 patients operated on during a 7-year period (in Melbourne). The surgical technique is described in detail, and the various important aspects in the surgery of these children are highlighted. The report is an important contribution to the literature; it is based on a large experience of one surgeon and describes a different approach to this problem.-v Kalidasan Maximum and Average The Miskolc Nomograms. 76:16-20, (July), 1995.
Urine Flow Rates L. Szabo and
in Normal
Children-
S. Fegyvemeki. Br J Urol
Voiding studies were performed in 200 healthy children (96 girls, 104 boys), aged 8 to 13 years, who had no urological, neurological, or psychological problems. From 433 voiding studies, percentile charts were produced for voided volume and maximum and average flow rates in three size bands: surface area < 0.92 m2, 0.92 to 1.42 m2, and > 1.42 m2.-M.N. de la Hunt Pelvic Floor Exercises Dysfunctional Voiding. 76:9-S, (July), 1995.
for Children: H. Wennergren
A Method of Treating and B. Oberg. Br J Urol
Sixteen girls with nonneurogenic dysfunctional voiding were taught pelvic floor exercises to improve pelvic floor awareness and to learn to relax and contract the pelvic floor at will. At 1 year, nine were cured and seven had improved. Three of them were cured by 3 to 4 years of follow-up.-MN. de la Hunt Augmentation Valves. A.M.
Cystoplasty Kajbafradeh,
in Boys With Posterior Urethral F.M.1 Quinn, l?G. Dufi, et al. J Urol
154:574-877, (August), 1995. The authors report experience with augmentation cystoplasty in 20 boys with previously treated posterior urethral valves. Urodynamic studies confirmed poorly compliant, unstable bladders with low functional capacities, which had failed to respond to anticholinergic treatment. The bladder was augmented with ileum in nine cases, stomach in seven, colon in two, and ureter in two. A Mitrofanoff channel was fashioned in six cases. Upper tract dilatation improved in 17 patients and remained stable in three. Seventeen patients are dry day and night. Eleven patients void spontaneously without significant residual urine, seven are on clean
intermittent catheterization for residual urine of greater than 50 mL, and two are completely dependent on catheterization. Augmentation cystoplasty is a safe and effective method to achieve continence with a low-capacity poorly compliant bladder in children whose posterior urethral valves do not respond to medical management. In contrast to the neuropathic and exstrophy bladder, the augmented valve bladder allows spontaneous voiding, without significant residual urine, in the majority of cases. Early intervention in these patients may prevent deterioration in renal functionGeorge
W. Holcomb,
Posterior Function.
Jr
Urethral Valves, M. Kaefer. M.A.
Pressure Pop-Offs Keating, M.C. Adams
and Bladder et al. J Urol
154:708-711, (August), 1995. The pop-off mechanisms that sometimes occur with posterior urethral valves have well-recognized implications for renal function, such that one or both kidneys can be protected from the deleterious effects of elevated bladder pressures. What has not been defined is the significance, if any, of pressure pop-offs to the developing bladder and ultimate bladder function. The authors reviewed the records of 63 boys with posterior urethral valves. Eight boys who were not yet toilet trained had unevaluable bladder outcomes. Of the 55 remaining boys, there were one or more pressure pop-offs in 39 (71%), including massive (grade 5) reflux, massive reflux associated with ipsilateral renal dysplasia, a patent urachus, large diverticula, and urinomas. Bladder outcomes were judged as favorable or unfavorable on the basis of urodynamic parameters and/or patient clinical status. A statistically significant positive correlation was found between the presence of pop-off and a favorable outcome. Favorable characteristics were found in 34 of 39 bladders (87%) with pressure pop-offs. In contrast, only nine of 16 bladders (55%) without pressure vents had a favorable outcome. In addition, five of the remaining seven boys without pressure vents required augmentation cystoplasty. A direct correlation between absolute number of pop-offs and favorable bladder outcome also was noted, further emphasizing this relationship.-George W. Holcomb,
Jr
Perinatal Renal Changes Associated Reflux. L.J. Cussen and R.A. MacMahon. 355, (July), 1995.
With
Vesico-Ureteral
Pediatr Surg Int 10:354-
The authors present the results of an interesting study designed to determine if in utero reflux causes renal damage. They tested infants who died within 96 hours after birth for the presence of vesico-ureteric reflux by filling the bladder and ligating the urethra. They found 46 refluxing systems (6.7% of infants tested); 26 of them were unilateral and 10 were bilateral. The kidneys were examined. Although 11 kidneys were hypoplastic and four were dysplastic, no kidney showed evidence of scarring. The authors suggest that postnatal UT1 is a possible cause of scarring. They offer three other possible reasons. (1) the duration of in utero reflux may not have been for long, (2) the pressure induced by voiding in utero may not be high enough to cause a hydrodynamic effect, and (3) there may not be many infants with high-grade reflux. They then explain why these factors are unlikely to be the explanation for their results. The report adds more information to an unresolved but controversial subject.--V. Kulidasan The Long-Term Urologic Response of Neonates With Myelodysplasia Treated Proactively With Intermittent Catheterization and Anticholinergic Therapy. R.A. Edelstein, S.B. Bauer, MD. Kelly, et al. .I Urol 154:1500-1504, (October), 1995.
455
ABSTRACTS
Glanuloplasty and In Situ Tubularization of the Urethral Plate: A Simple Reliable Technique for the Majority of Boys With Hypospadias. A.C. Van Horn and E.J: Km. J Urol 154:1505-1507,
(October), 1995. Results of hypospadias repair using glanuloplasty and in situ tubularization of the urethral plate were evaluated in 166 boys aged 5 months to 13.5 years (mean, 20 months). Overall cosmetic results were excellent. There was no evidence of meatal stenosis, urethral stricture, residual chordee, or ballooning of the neourethra noted during follow-up. A small urethrocutaneous fistula that formed in 10% of the patients was closed successfully in a brief outpatient procedure. The authors conclude that glanuloplasty and in situ tubularization of the urethral plate is an excellent technique for the majority of boys with distal shaft and subcoronal hypospadias, producing a cosmetic result that is superior to that associated with the Mathieu procedure or meatal advancement and glanuloplasty.-George IK Holcomb, Jr Vesical Tissues.
Exstrophy: J.H. Kelly.
Repair
Using
Radical
Mobilisation
of Soft
Pediatr Surg Int 10:298-304, (July), 1995.
Vesical exstrophy remains one of the most difficult problems treat in pediatric surgery. Many surgical procedures have been described to attain a satisfactory result. The author reports the results for 27 patients operated on during a 7-year period (in Melbourne). The surgical technique is described in detail, and the various important aspects in the surgery of these children are highlighted. The report is an important contribution to the literature; it is based on a large experience of one surgeon and describes a different approach to this problem.-v Kalidasan Maximum and Average The Miskolc Nomograms. 76:16-20, (July), 1995.
Urine Flow Rates L. Szabo and
in Normal
Children-
S. Fegyvemeki. Br J Urol
Voiding studies were performed in 200 healthy children (96 girls, 104 boys), aged 8 to 13 years, who had no urological, neurological, or psychological problems. From 433 voiding studies, percentile charts were produced for voided volume and maximum and average flow rates in three size bands: surface area < 0.92 m2, 0.92 to 1.42 m2, and > 1.42 m2.-M.N. de la Hunt Pelvic Floor Exercises Dysfunctional Voiding. 76:9-S, (July), 1995.
for Children: H. Wennergren
A Method of Treating and B. Oberg. Br J Urol
Sixteen girls with nonneurogenic dysfunctional voiding were taught pelvic floor exercises to improve pelvic floor awareness and to learn to relax and contract the pelvic floor at will. At 1 year, nine were cured and seven had improved. Three of them were cured by 3 to 4 years of follow-up.-MN. de la Hunt Augmentation Valves. A.M.
Cystoplasty Kajbafradeh,
in Boys With Posterior Urethral F.M.1 Quinn, l?G. Dufi, et al. J Urol
154:574-877, (August), 1995. The authors report experience with augmentation cystoplasty in 20 boys with previously treated posterior urethral valves. Urodynamic studies confirmed poorly compliant, unstable bladders with low functional capacities, which had failed to respond to anticholinergic treatment. The bladder was augmented with ileum in nine cases, stomach in seven, colon in two, and ureter in two. A Mitrofanoff channel was fashioned in six cases. Upper tract dilatation improved in 17 patients and remained stable in three. Seventeen patients are dry day and night. Eleven patients void spontaneously without significant residual urine, seven are on clean
intermittent catheterization for residual urine of greater than 50 mL, and two are completely dependent on catheterization. Augmentation cystoplasty is a safe and effective method to achieve continence with a low-capacity poorly compliant bladder in children whose posterior urethral valves do not respond to medical management. In contrast to the neuropathic and exstrophy bladder, the augmented valve bladder allows spontaneous voiding, without significant residual urine, in the majority of cases. Early intervention in these patients may prevent deterioration in renal functionGeorge
W. Holcomb,
Posterior Function.
Jr
Urethral Valves, M. Kaefer. M.A.
Pressure Pop-Offs Keating, M.C. Adams
and Bladder et al. J Urol
154:708-711, (August), 1995. The pop-off mechanisms that sometimes occur with posterior urethral valves have well-recognized implications for renal function, such that one or both kidneys can be protected from the deleterious effects of elevated bladder pressures. What has not been defined is the significance, if any, of pressure pop-offs to the developing bladder and ultimate bladder function. The authors reviewed the records of 63 boys with posterior urethral valves. Eight boys who were not yet toilet trained had unevaluable bladder outcomes. Of the 55 remaining boys, there were one or more pressure pop-offs in 39 (71%), including massive (grade 5) reflux, massive reflux associated with ipsilateral renal dysplasia, a patent urachus, large diverticula, and urinomas. Bladder outcomes were judged as favorable or unfavorable on the basis of urodynamic parameters and/or patient clinical status. A statistically significant positive correlation was found between the presence of pop-off and a favorable outcome. Favorable characteristics were found in 34 of 39 bladders (87%) with pressure pop-offs. In contrast, only nine of 16 bladders (55%) without pressure vents had a favorable outcome. In addition, five of the remaining seven boys without pressure vents required augmentation cystoplasty. A direct correlation between absolute number of pop-offs and favorable bladder outcome also was noted, further emphasizing this relationship.-George W. Holcomb,
Jr
Perinatal Renal Changes Associated Reflux. L.J. Cussen and R.A. MacMahon. 355, (July), 1995.
With
Vesico-Ureteral
Pediatr Surg Int 10:354-
The authors present the results of an interesting study designed to determine if in utero reflux causes renal damage. They tested infants who died within 96 hours after birth for the presence of vesico-ureteric reflux by filling the bladder and ligating the urethra. They found 46 refluxing systems (6.7% of infants tested); 26 of them were unilateral and 10 were bilateral. The kidneys were examined. Although 11 kidneys were hypoplastic and four were dysplastic, no kidney showed evidence of scarring. The authors suggest that postnatal UT1 is a possible cause of scarring. They offer three other possible reasons. (1) the duration of in utero reflux may not have been for long, (2) the pressure induced by voiding in utero may not be high enough to cause a hydrodynamic effect, and (3) there may not be many infants with high-grade reflux. They then explain why these factors are unlikely to be the explanation for their results. The report adds more information to an unresolved but controversial subject.--V. Kulidasan The Long-Term Urologic Response of Neonates With Myelodysplasia Treated Proactively With Intermittent Catheterization and Anticholinergic Therapy. R.A. Edelstein, S.B. Bauer, MD. Kelly, et al. .I Urol 154:1500-1504, (October), 1995.