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Management of the congenital neurogenic bladder in children
852
ABSTRACTS
Spinal transections were made at different lumbar levels in 51 rabbits. Six to eight weeks later 25 of these had isolated segments of ileum (with mucosa excised) grafted to the deperitonealized posterior bladder wall. The progress of their neurogenic bladder disturbances were followed up for up to a year. The radiological disturbances were comparable to those in adults and children with spinal damage and showed no evidence of recovery. Histological examination of the bladder walls showed no evidence of reinervation of the detrusor muscle by nerve fibers from the grafted ileum. -R.
C. M. Cook
Management of the Congenital Neurogenic Bladder in Children. R. S. Wp/Zbautn and E. C. Muecke. J. Urol. 108:163-166 (July), 1972. Forty-five children with congenital neurogenie bladders were studied. Twenty-eight had normal intravenous pyelograms while six had severe hydronephrosis. Sixteen had vesicoureteral reflux and eight had elevated blood urea nitrogen valves. Twenty-eight of 30 cystometrograms were abnormal. Twelve of I9 patients managed nonsurgically with multiple voiding techniques, crede, and drug therapy have clear signs of renal deterioration and continuous infection. Sixteen patients underwent surgical procedures for continence, reflux, or to facilitate emptying, with no improvement. Ten of the 16 have had permanent diversion. Of the 20 children undergoing urinary diversion, 16 patients have had no major complications with an average postoperative follow-up of 9 yr.-S. Kim
Diverticula Bladder Meyer.
of the Bladder in Children Without Neck Obstruction. Y. Civille and P. Ann. Chir. Infant 13:201~208, 1972.
,%,Rarely juxtaureteral diverticula (often assrjdiated with vesicoureteral reflux) may be found ip children without bladder neck obstruction. Leading symptoms are nonspecific: hematuria, alkbdominal pain. enuresis, buminuria, and unexplained pyuria. Diagnostic investigations show urinary infection in nearly all cases, but without renal insufficiency. The authors insist on the necessity of perfect retrograde cystography with films taken during micturition for demonstrating both the diverticulum and ureterovesical reflux. The latter is due to an anomaly of the ureteral meatus.
This type of reflux, associated with a’ juxtauieteral diverticulum is considered by the authors to be an absolute indication for diverticutar excision and ureteral reimplantation. They recommend careful screening for diverticula in all cases of vesicoureteral reflux. The authors report five of seven cases with reflux. The parents of one patient refused treatment. The other four children were treated surgically by removal of the diverticulum and reimplantation according to Leadbetter-Politano. The results from 6 mo to 3 yr are excellent in three cases. The last child has developed a secondary ureteral stenosis, but had at the same site prior surgery for diverticulum without reimplantation.-C. Brerscher Correction of Urethral Valves. J. Valayer. Chir. Infant 13:277-282 (July/August),
Ann. 1972.
After a short review of the different methods of correction of urethral valves and discussion of their advantages and disadvantages, the author gives preference to longitudinal urethrotomy at the level of the valves through a perineal approach. Placing of a transvesical Btnique sound is followed by splitting of the urethra and retrograde introduction of an endperforated silastic catheter which is fixed through the abdominal wall. No suture of the urethra is done; spontaneous reconstruction of the normal urethral lumen is left to progressive cicatrization along the catheter for at least I mo. Abdominal and perineal operative wounds are closed classically. The author reports four of his own cases operated on by this method. The author emphasizes that the proposed treatment should be reserved to lowsituated posterior urethral valves.-C. Brerscher Posterior Urethral Valves: A Study of Urinary Control After Operation. R. H. Whitaker, J. E. Keeron. and B. I. Williams. J. Urol. 108: 167-171 (July), 1972. One hundred twelve patients were questioned concerning urinary incontinence. Of the 112, 33 were fully continent, 42 had stress incontinence only, and 37 were wet continuously. No correlation could be made between the method of valve destruction, i.e., a resectoscope loop, a diathermy electrode, or suprapubic approach, and subsequent urinary control. There was also no correlation in the decrease in dilatation in the pre and postoperative radiographs of the bladder neck and urethra and urinary control. The authors felt that the risk of incontinence
ABSTRACTS
Spinal transections were made at different lumbar levels in 51 rabbits. Six to eight weeks later 25 of these had isolated segments of ileum (with mucosa excised) grafted to the deperitonealized posterior bladder wall. The progress of their neurogenic bladder disturbances were followed up for up to a year. The radiological disturbances were comparable to those in adults and children with spinal damage and showed no evidence of recovery. Histological examination of the bladder walls showed no evidence of reinervation of the detrusor muscle by nerve fibers from the grafted ileum. -R.
C. M. Cook
Management of the Congenital Neurogenic Bladder in Children. R. S. Wp/Zbautn and E. C. Muecke. J. Urol. 108:163-166 (July), 1972. Forty-five children with congenital neurogenie bladders were studied. Twenty-eight had normal intravenous pyelograms while six had severe hydronephrosis. Sixteen had vesicoureteral reflux and eight had elevated blood urea nitrogen valves. Twenty-eight of 30 cystometrograms were abnormal. Twelve of I9 patients managed nonsurgically with multiple voiding techniques, crede, and drug therapy have clear signs of renal deterioration and continuous infection. Sixteen patients underwent surgical procedures for continence, reflux, or to facilitate emptying, with no improvement. Ten of the 16 have had permanent diversion. Of the 20 children undergoing urinary diversion, 16 patients have had no major complications with an average postoperative follow-up of 9 yr.-S. Kim
Diverticula Bladder Meyer.
of the Bladder in Children Without Neck Obstruction. Y. Civille and P. Ann. Chir. Infant 13:201~208, 1972.
,%,Rarely juxtaureteral diverticula (often assrjdiated with vesicoureteral reflux) may be found ip children without bladder neck obstruction. Leading symptoms are nonspecific: hematuria, alkbdominal pain. enuresis, buminuria, and unexplained pyuria. Diagnostic investigations show urinary infection in nearly all cases, but without renal insufficiency. The authors insist on the necessity of perfect retrograde cystography with films taken during micturition for demonstrating both the diverticulum and ureterovesical reflux. The latter is due to an anomaly of the ureteral meatus.
This type of reflux, associated with a’ juxtauieteral diverticulum is considered by the authors to be an absolute indication for diverticutar excision and ureteral reimplantation. They recommend careful screening for diverticula in all cases of vesicoureteral reflux. The authors report five of seven cases with reflux. The parents of one patient refused treatment. The other four children were treated surgically by removal of the diverticulum and reimplantation according to Leadbetter-Politano. The results from 6 mo to 3 yr are excellent in three cases. The last child has developed a secondary ureteral stenosis, but had at the same site prior surgery for diverticulum without reimplantation.-C. Brerscher Correction of Urethral Valves. J. Valayer. Chir. Infant 13:277-282 (July/August),
Ann. 1972.
After a short review of the different methods of correction of urethral valves and discussion of their advantages and disadvantages, the author gives preference to longitudinal urethrotomy at the level of the valves through a perineal approach. Placing of a transvesical Btnique sound is followed by splitting of the urethra and retrograde introduction of an endperforated silastic catheter which is fixed through the abdominal wall. No suture of the urethra is done; spontaneous reconstruction of the normal urethral lumen is left to progressive cicatrization along the catheter for at least I mo. Abdominal and perineal operative wounds are closed classically. The author reports four of his own cases operated on by this method. The author emphasizes that the proposed treatment should be reserved to lowsituated posterior urethral valves.-C. Brerscher Posterior Urethral Valves: A Study of Urinary Control After Operation. R. H. Whitaker, J. E. Keeron. and B. I. Williams. J. Urol. 108: 167-171 (July), 1972. One hundred twelve patients were questioned concerning urinary incontinence. Of the 112, 33 were fully continent, 42 had stress incontinence only, and 37 were wet continuously. No correlation could be made between the method of valve destruction, i.e., a resectoscope loop, a diathermy electrode, or suprapubic approach, and subsequent urinary control. There was also no correlation in the decrease in dilatation in the pre and postoperative radiographs of the bladder neck and urethra and urinary control. The authors felt that the risk of incontinence