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Loop cutaneous ureterostomy in infancy
INTERNATIONAL
parenchymal
ABSTRACTS OF PEDIATRIC SURGERY
invasion
resulting
in
dilatation
of
segments of the renal tubules allowing for further bacterial multiplication-B. M. Henderson. FURTHER EFFECTS OF COLIFORM BACTERIA ON UHETERAL PERISTALSIS. N. Teague, and S. Broyarsky. J. Urol. 99:720, 1968. The authors describe an experiment carried out in dogs in which coliform bacteria and their endotoxins were injected directly into the renal pelvis and intraaortically. When injected into the renal pelvis, the coliform bacteria appeared to cause a marked decrease in ureteral peristalsis. When injected intra-aortically there was an increase in ureteral peristalsis. These effects were reversible, disappearing within 2 hours. The authors conclude that they are due to an endotoxin rather than an established infection---B. M. Henderson. EFFECTS OF GRAM-NEGATIVE BACTERIA ON URETEKAL STRUCTURE AND FUNCTION. L. Grana, W. L. Donnellan, and 0. Swenson. J Urol. 99: 538. 1968. The effects of various gram negative bacteria on ureteral function was studied in dogs. Ureteral peristalsis was recorded by observing pressure changes within it and by tine radiography. Biopsies were also obtained at various stages of the experiment. Pseudomonas Aeruginosa and E. coli both produced ureteral paralysis. Proteus mirabilis, on the other hand, did not. The Pseudomonas organism also caused severe damage to smooth muscle. Both E. coli and Proteus mirabilis produced superficial ulceration of ureteral and bladder mucosa. These findings suggest that chronic bacteruria, even if asymptomatic, may produce permanent damage to the urinary tract. Longterm antibacterial therapy may prevent these changes by either sterilizing the urine or reducing the numbers of bacteria sufliciently to reduce their toxic products to tolerable levels--B. M. Henderson. LOOP CUTANEOUS URETEROSTOMY IN INFANCY. A. D. Perlmutter and E. S. Tank. J. Urol. 99: 559, 1968. This is a report on the use of loop cutaneous ureterostomy in 5 children with various forms of lower urinary tract obstruction. In one case stomal stenosis occurred. In all there was satisfactory decompression of hydroureteronephrosis and irnprovement of ureteral peristalsis. The author notes that the most important factor leading to success in this procedure is the presence of a tortuous
635
as well as dilated ureter, so that it can be brought up to the skin easily.-B. M. Henderson. REIMPLANTATION OF URETERS INTO THE BLADDERS OF CHILDREN. J. H. McGovern, and V. F. Marshall. J. Ural. 99:572, 1968. This report concerns the results of reimplanting 327 ureters into the bladders of 226 children over a 10 year period, using Paquin’s technic. Reflux was demonstrated preoperatively in 250 ureters and the others were operated on for ureteral obstruction. Postoperatively, there was no obstruction or reflux in 294 ureters, a success rate of 90 per cent. These patients have been followed for a year or more (averaging 4.5 years). Most of the failures occurred in boys, possibly because the patholo?ic changes were more advanced in those patients. Preliminary nephrostomy was used whenever there is severe hydronephrosis. Persistent or recurrent infection was present at the 1 year follow-up in 69 children (34 per cent) and 29 of these children had normal excretory urograrm with no reflux. One hundred sixty-nine patients were followed for 2 or more years. Two girls had died of renal failure after discharge from the hospital. Of the remaining 167 patients 29 continued to have infected urine (17 per cent) and. only one of these had a radiographically normal urinary tract. There were 3 hospital deaths, 2 related to sepsis in the unoperated, undrained upper urinary tract and the third, possibly, from aspiration of vomitus.-B. M. Henderson. OPERATIVE MANAGEMENT OF THE NEUROGEXIC: BLADDER IN CHILDREX DIVERSION THROUGH INTEsrrxAr. CONDUITS. R. C. ibf. Cook, J. Lister., awl R. B. Zachary. Surgery 63:825-831 (May) 1968. Urinary diversions through intestinal conduits were performed on 57 children with neurogenic bladders. Four patients died, but only 1 death was closely related to the operative procedure.. About one fifth of the patients suffered fairly serious complications related to the stoma, an-. astomotic leakage, infarction of the loop, wound dehiscence, etc. Grossly or moderately dilated ureters are technically easier to anastomose to the intestine. However, ureteral dilatation implies already established severe renal damage and therefore higher risk. When the ureters are of sufficient length and caliber, ureterocutaneous anastomosis is preferrable to intestinal conduit. The operative procedure offers the best way to manage a child with myelomeningocele and unmanageable incontinence or
parenchymal
ABSTRACTS OF PEDIATRIC SURGERY
invasion
resulting
in
dilatation
of
segments of the renal tubules allowing for further bacterial multiplication-B. M. Henderson. FURTHER EFFECTS OF COLIFORM BACTERIA ON UHETERAL PERISTALSIS. N. Teague, and S. Broyarsky. J. Urol. 99:720, 1968. The authors describe an experiment carried out in dogs in which coliform bacteria and their endotoxins were injected directly into the renal pelvis and intraaortically. When injected into the renal pelvis, the coliform bacteria appeared to cause a marked decrease in ureteral peristalsis. When injected intra-aortically there was an increase in ureteral peristalsis. These effects were reversible, disappearing within 2 hours. The authors conclude that they are due to an endotoxin rather than an established infection---B. M. Henderson. EFFECTS OF GRAM-NEGATIVE BACTERIA ON URETEKAL STRUCTURE AND FUNCTION. L. Grana, W. L. Donnellan, and 0. Swenson. J Urol. 99: 538. 1968. The effects of various gram negative bacteria on ureteral function was studied in dogs. Ureteral peristalsis was recorded by observing pressure changes within it and by tine radiography. Biopsies were also obtained at various stages of the experiment. Pseudomonas Aeruginosa and E. coli both produced ureteral paralysis. Proteus mirabilis, on the other hand, did not. The Pseudomonas organism also caused severe damage to smooth muscle. Both E. coli and Proteus mirabilis produced superficial ulceration of ureteral and bladder mucosa. These findings suggest that chronic bacteruria, even if asymptomatic, may produce permanent damage to the urinary tract. Longterm antibacterial therapy may prevent these changes by either sterilizing the urine or reducing the numbers of bacteria sufliciently to reduce their toxic products to tolerable levels--B. M. Henderson. LOOP CUTANEOUS URETEROSTOMY IN INFANCY. A. D. Perlmutter and E. S. Tank. J. Urol. 99: 559, 1968. This is a report on the use of loop cutaneous ureterostomy in 5 children with various forms of lower urinary tract obstruction. In one case stomal stenosis occurred. In all there was satisfactory decompression of hydroureteronephrosis and irnprovement of ureteral peristalsis. The author notes that the most important factor leading to success in this procedure is the presence of a tortuous
635
as well as dilated ureter, so that it can be brought up to the skin easily.-B. M. Henderson. REIMPLANTATION OF URETERS INTO THE BLADDERS OF CHILDREN. J. H. McGovern, and V. F. Marshall. J. Ural. 99:572, 1968. This report concerns the results of reimplanting 327 ureters into the bladders of 226 children over a 10 year period, using Paquin’s technic. Reflux was demonstrated preoperatively in 250 ureters and the others were operated on for ureteral obstruction. Postoperatively, there was no obstruction or reflux in 294 ureters, a success rate of 90 per cent. These patients have been followed for a year or more (averaging 4.5 years). Most of the failures occurred in boys, possibly because the patholo?ic changes were more advanced in those patients. Preliminary nephrostomy was used whenever there is severe hydronephrosis. Persistent or recurrent infection was present at the 1 year follow-up in 69 children (34 per cent) and 29 of these children had normal excretory urograrm with no reflux. One hundred sixty-nine patients were followed for 2 or more years. Two girls had died of renal failure after discharge from the hospital. Of the remaining 167 patients 29 continued to have infected urine (17 per cent) and. only one of these had a radiographically normal urinary tract. There were 3 hospital deaths, 2 related to sepsis in the unoperated, undrained upper urinary tract and the third, possibly, from aspiration of vomitus.-B. M. Henderson. OPERATIVE MANAGEMENT OF THE NEUROGEXIC: BLADDER IN CHILDREX DIVERSION THROUGH INTEsrrxAr. CONDUITS. R. C. ibf. Cook, J. Lister., awl R. B. Zachary. Surgery 63:825-831 (May) 1968. Urinary diversions through intestinal conduits were performed on 57 children with neurogenic bladders. Four patients died, but only 1 death was closely related to the operative procedure.. About one fifth of the patients suffered fairly serious complications related to the stoma, an-. astomotic leakage, infarction of the loop, wound dehiscence, etc. Grossly or moderately dilated ureters are technically easier to anastomose to the intestine. However, ureteral dilatation implies already established severe renal damage and therefore higher risk. When the ureters are of sufficient length and caliber, ureterocutaneous anastomosis is preferrable to intestinal conduit. The operative procedure offers the best way to manage a child with myelomeningocele and unmanageable incontinence or