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Ileal conduits in children
583
ABSTRACTS tained from children with myelomeningocele. The intrinsic nerve plexus of the ureter is a diffuse structure with ganglion cells present throughout. No definite qualitative or quantitative differences were found between the two groups and there was no evidence of a defect in the intramural nerves in the dilated ureters of children with myelomeningocele. It is felt that further studies are needed to quantitate the amount of muscle and the extrinsic nerve supply in various parts of the myelomeningocele ureter.---/. H. Johnston PRIMARY
Zmrs
OBSTRUCTIVE
Williarm
MEGA-URETER.
and I. Hnlme-Moir.
.I. Urol. 42:140-149
(April),
D.
Brit.
1970.
Primary obstructive mega-ureter implies a dilatation of the ureter in all but its terminal segment, without obvious cause and without vesicoureteric reflux. Seventy cases, including 18 bilateral cases are reviewed. The length of the terminal undilated segment of ureter varied from 0.5 to 4 cm. The nature of the obstruction is obscure but is much more often functional than organic. The condition is commoner in males and involves the left ureter more often than the right. Three patients had coincident pelviureteral obstruction. The presenting symptoms were most commonly due to urinary infection. With bilateral cases there may be renal failure. Some cases had hematuria of uncertain origin. The clinical and pathological features varied with age. During the first year the disease tended to present with infection, to occur in males and to be often bilateral and severe. Over 3 years of age, pain and hematuria became more prominent. Several lines of treatment were carried out. A nonoperative regime was followed when the obstruction was mild and infection could be controlled. 18 cases were so treated with satisfactory results on follow-up. Ureteric reimplantation to the bladder, usually with narrowing of the reimplanted portion, is indicated when chemotherapy fails to control infection or when the pyeloshows gram advanced pressure effects. Nephroureterectomy was performed in unilateral cases where the condition was very advanced or where reconstructive surgery had failed. In acutely ill infants temporary nephrostomy may be needed. Permanent external urinary diversion may be indicated
occasionally in severe bilateral renal failure.
disease with
Of the 45 ureters treated by reimplantation, all but four were relieved of further damage and 31 were improved, sometimes considerably.--l. H. Johnston ILEAL CONDUITS IN CHILDREN. R. M. McCoy
and R. K. Rhamy.
(April),
J. Urol.
103:491-495
1970.
This study compares the results of ileal conduits used in children who underwent the operation for social reasons with those who required it because of radiographic evidence of renal deterioration. The cause for bladder dysfunction included myelodysplasia, epispadias, traumatic paraplegia, transverse myelitis, bladder exstrophy, and congenital stricture. There were seven complications among the 23 conduits done for social reasons and seven among the 14 done in patients who had evidence of renal damage. They included intestinal obstruction, acute pyonephritis, prolonged ileus, incisional pyovesicle. hernia, uretero-ileal stenosis, stoma1 stenosis, urethral diverticulum and calculi. Abacteruria was obtained in 86 per cent of the patients without continuous antimicrobial therapy, The complication rate among those patients with normal upper urinary tracts was low and they remained abacteruric in 96 per cent of the cases. It is concluded that ileal conduit urinary diversion should be performed prior to renal deterioration.-Bruce M. Henderson SOME
OBSERVATIONS
SION. R. A. Mogg.
Eng. 46~251-266
ON
URINARY
DIVER-
Ann. Roy. Coll. Surg. (May), 1970.
The various urinary diversions, both temporary and permanent have been described. The importance of selecting the right type of diversion depending on the age of the patient and the indications for the operation has been mentioned. Superior results are obtained by separating the urinary and fecal stream; particularly in children where preservation and improvement of renal function is important, diversions which make use of conduit, whether ileal, colonic or ureterostomy are safer and give the best results--J. Ltrri
ABSTRACTS tained from children with myelomeningocele. The intrinsic nerve plexus of the ureter is a diffuse structure with ganglion cells present throughout. No definite qualitative or quantitative differences were found between the two groups and there was no evidence of a defect in the intramural nerves in the dilated ureters of children with myelomeningocele. It is felt that further studies are needed to quantitate the amount of muscle and the extrinsic nerve supply in various parts of the myelomeningocele ureter.---/. H. Johnston PRIMARY
Zmrs
OBSTRUCTIVE
Williarm
MEGA-URETER.
and I. Hnlme-Moir.
.I. Urol. 42:140-149
(April),
D.
Brit.
1970.
Primary obstructive mega-ureter implies a dilatation of the ureter in all but its terminal segment, without obvious cause and without vesicoureteric reflux. Seventy cases, including 18 bilateral cases are reviewed. The length of the terminal undilated segment of ureter varied from 0.5 to 4 cm. The nature of the obstruction is obscure but is much more often functional than organic. The condition is commoner in males and involves the left ureter more often than the right. Three patients had coincident pelviureteral obstruction. The presenting symptoms were most commonly due to urinary infection. With bilateral cases there may be renal failure. Some cases had hematuria of uncertain origin. The clinical and pathological features varied with age. During the first year the disease tended to present with infection, to occur in males and to be often bilateral and severe. Over 3 years of age, pain and hematuria became more prominent. Several lines of treatment were carried out. A nonoperative regime was followed when the obstruction was mild and infection could be controlled. 18 cases were so treated with satisfactory results on follow-up. Ureteric reimplantation to the bladder, usually with narrowing of the reimplanted portion, is indicated when chemotherapy fails to control infection or when the pyeloshows gram advanced pressure effects. Nephroureterectomy was performed in unilateral cases where the condition was very advanced or where reconstructive surgery had failed. In acutely ill infants temporary nephrostomy may be needed. Permanent external urinary diversion may be indicated
occasionally in severe bilateral renal failure.
disease with
Of the 45 ureters treated by reimplantation, all but four were relieved of further damage and 31 were improved, sometimes considerably.--l. H. Johnston ILEAL CONDUITS IN CHILDREN. R. M. McCoy
and R. K. Rhamy.
(April),
J. Urol.
103:491-495
1970.
This study compares the results of ileal conduits used in children who underwent the operation for social reasons with those who required it because of radiographic evidence of renal deterioration. The cause for bladder dysfunction included myelodysplasia, epispadias, traumatic paraplegia, transverse myelitis, bladder exstrophy, and congenital stricture. There were seven complications among the 23 conduits done for social reasons and seven among the 14 done in patients who had evidence of renal damage. They included intestinal obstruction, acute pyonephritis, prolonged ileus, incisional pyovesicle. hernia, uretero-ileal stenosis, stoma1 stenosis, urethral diverticulum and calculi. Abacteruria was obtained in 86 per cent of the patients without continuous antimicrobial therapy, The complication rate among those patients with normal upper urinary tracts was low and they remained abacteruric in 96 per cent of the cases. It is concluded that ileal conduit urinary diversion should be performed prior to renal deterioration.-Bruce M. Henderson SOME
OBSERVATIONS
SION. R. A. Mogg.
Eng. 46~251-266
ON
URINARY
DIVER-
Ann. Roy. Coll. Surg. (May), 1970.
The various urinary diversions, both temporary and permanent have been described. The importance of selecting the right type of diversion depending on the age of the patient and the indications for the operation has been mentioned. Superior results are obtained by separating the urinary and fecal stream; particularly in children where preservation and improvement of renal function is important, diversions which make use of conduit, whether ileal, colonic or ureterostomy are safer and give the best results--J. Ltrri