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Modified Mathieu's technique: A variation of the classic procedure for hypospadias surgical repair
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person spread of GAS is well known. Furthermore, the patient had a skin break in the form of multiple poison ivy plaques, many with excoriation, allowing a possible portal of entry. It is theorized that the infection localized itself in the retropetitoneum, via either hematogenous or lymphatic spread. The infection clinically mimicked acute appendicits, supported by ultrasonographic findings. In retrospect, the ultrasonographic lesion, which looked like an inflamed appendix, was likely a collection of inflamed lymph nodes, early ultrasound findings did not show extensive inflammatory changes or a large accumulation of fluid. It was only at repeat laparotomy that fibrinous exudate was noted in the retroperitoneum and mesentery, but not in the bowel proper. The patient’s leukocyte count remained near normal for the first 10 days of the infection; in fact, it only showed a marked elevation once appropriate antibiotic therapy had been instituted. In spite of the minimal elevation, a steadily increasing left shift was noted with over 30% bands as well as metamyelocytes at one point. This relative neutropenia, as well as associated lymphopenia, has been noted in other studies of invasive GAS infection. This relative lack of leukocytosis may be related to the rapid progression of the infection, with overwhelming of the host immune defence. The determining factor in the cure of this patient was the institution of the proper antibiotic regimen; improvement was only noted after the addition of clindamycin. Despite aggressive treatment, this patient did not show improvement for an extended period of time.~~gmund H. Ein
GENITOURINARY The Penile Disassembly S.V Perovic, ‘ci Vukadinovic, 81:479-487, (March), 1998.
Technique M.L.J.
TRACT in Hypospadias Repair. Djordjevic, et al. Br J Urol
The authors describe their technique and results in 92 patients (9 months to 32 years of age) for repair of severe chordee with or without hypospadias and small penis with hypospadias. The penis was completely separated into its component parts (glans with neurovascular bundle, urethra, and corpora cavemosae) and then reconstructed. Good correction of curvature was achieved in all, and the penis was enlarged. Urethral stenosis developed in four patients, fistulae in two, and diverticula in three. Despite the extent of the procedure, sensitivity and erection seemed to be preserved in ah-MN. de la Hunt Modified Mathieu’s Technique: A Variation of the Classic Procedure for Hypospadias Surgical Repair. E. De Grazia, R.M. Cigna, and M. Cimado,: Eur J Pediatr Surg 8:98-99, (April), 1998. Distal penile curvature associated with anterior hypospadias can be corrected by urethral plate mobilization. The authors present 11 cases in which this procedure was employed, modifying the classic Mathieu’s technique for surgical treatment of coronal and distal shaft hypospadias associated with chordee. The technique provided excellent results, both functionally and cosmetically, without complications.-Thomas A. Angerpointner Surgical Management BonieghbalandJ. Fonseca
of Uterine Prolapse in an Infant. Eur .I Pediatr Surg 8:119-120, (April), 1998.
9.
Neonatal uterine prolapse has been rarely described in the literature. Most cases have an underlying diasease, usually spinal cord malformations. The authors present a newborn girl with myelomeningocele and complete uterine prolapse. The prolapse was treated by classical uterine ventrisuspension via the Pfamrenstiel approach. The postoperative course was uneventful.--Thomas A. Angerpointner Concepts and Considerations for Repair of a Severe Cloaca1 Anomaly. S. Cacciaguerra and A. Bianchi. Eur J Pediatr Surg 8: 114118, (April), 1998. A l.S-kg cbromosomally having a cloacal anomaly
normal child was suspected and oligohydramnios. Both
antenatally of parents had a
ABSTRACTS
chromosome 9 inversion. The postnatal study showed a high confluence of the urinary, genital, and intestinal tracts. Because of prematurity, a right colostomy was performed, but the genitourinary tract was left undrained. One-stage reconstruction was carried out at 5 months (weight, 3.2 kg). Follow-up at 15 months is encouragingly suggestive of urinary and fecal continence. The vagina is patent. This report considers concepts in cloacal management and submits for evaluation an altemative surgical plan to the presently almost exclusively accepted posterior saggital approach according to Peha and de Vries.--Thomas A. Angerpointner Cystometry in Infants ing Symptoms. J.G. (March), 1998.
and Children Wen and EC.
With no Apparent VoidTong. Br J Urol 81:468-473,
Nine of 83 infants and children without neurological impairment or lower urinary tract abnormalities were found to have detrusor instability on slow filling cystometry with simultaneous electromyography. The authors present their range of normal values. The detmsor instability was found in the late filling phase.-MN de la Hunt Urodynamic Patterns in Infants With Normal Lower Urinary Tracts or Primary Vesico-Ureteric Reflux. C.K. Yeung, M.L. Godley, H.K. Dhillon, et al. Br J Urol81:461-467, (March), 1998. Thirty-two boys and six girls (3 to 8 months of age) with grade III-IV vesico-ureteric reflux (VUR) had 24-hour natural filling cystometry. Results were compared with 21 age-matched controls who had suprapubit catheters inserted at the time of pyeloplasty or nepbrectomy. Twenty-four of the infants (57%) with VUR had abnormal urodynamic patterns: instability with small voided volume (7), inadequate voiding dynamics (5), dyssenergic patterns (lo), and obstructive patterns (2). For all without VUR, patterns were described as normal or normalimmature. This study confirms the close association between bladder dysfunction and primary VUR.-M.N. de la Hunt lpsilateral Ureteroureterostomy Obstruction in a Duplicate Smith et al. J Urol 159:1016-1018,
for Single Ureteral Reflux or System. M. Bieri, C.K. Smith, A.Z (March), 1998.
The traditional treatment for obstruction or reflux involving a single ureter in a duplicated system has been common sheath reimplantation. More recently, ipsilateral ureteroureterostomy has been suggested as an alternative. Twenty-two patients (24 duplicate systems) underwent ipsilateral ureteroureterostomy between March 1986 and December 1996. Patient charts were reviewed and analyzed for patient age, sex, ureteral and renal anatomy, initial presentation, the clinical situation necessitating operation, and the occurrence of early and late complications. The patients had follow-up for a mean period of 41.4 months. Clinical presentations included urinary tract infection (13), hydronephrosis on maternal ultrasonography (5), dirbbling (2), ureteral calculus (l), and hydronephrosis on neonatal abdominal ultrasonography (1). The mean hospital stay was 3 days. There was one early and one late complication. It is concluded that ipsilateral ureteroureterostomy is an acceptable alternative to common sheath reimplantation in select patients with single ureteral disease in a duplicate system.-George u! Holcomb. Jr
NEOPLASMS Rarity of Surgical Complications After Postchemotherapy Nephrectomy for Nephroblastoma. Experience of the International Society of Paediatric Oncology-Trial and Study “SIOP-9.” J. Godzinski, M.-E Toumade, J. deKraker; et al. Eur J Pediatr Surg 8:83-86, (April), 1998. The aim of the study was to assess rates and types of nepbrectomyrelated complications in children nepbrectomized for nephroblastoma after preoperative chemotherapy. Records of 598 Wilms’ tumor patients,
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person spread of GAS is well known. Furthermore, the patient had a skin break in the form of multiple poison ivy plaques, many with excoriation, allowing a possible portal of entry. It is theorized that the infection localized itself in the retropetitoneum, via either hematogenous or lymphatic spread. The infection clinically mimicked acute appendicits, supported by ultrasonographic findings. In retrospect, the ultrasonographic lesion, which looked like an inflamed appendix, was likely a collection of inflamed lymph nodes, early ultrasound findings did not show extensive inflammatory changes or a large accumulation of fluid. It was only at repeat laparotomy that fibrinous exudate was noted in the retroperitoneum and mesentery, but not in the bowel proper. The patient’s leukocyte count remained near normal for the first 10 days of the infection; in fact, it only showed a marked elevation once appropriate antibiotic therapy had been instituted. In spite of the minimal elevation, a steadily increasing left shift was noted with over 30% bands as well as metamyelocytes at one point. This relative neutropenia, as well as associated lymphopenia, has been noted in other studies of invasive GAS infection. This relative lack of leukocytosis may be related to the rapid progression of the infection, with overwhelming of the host immune defence. The determining factor in the cure of this patient was the institution of the proper antibiotic regimen; improvement was only noted after the addition of clindamycin. Despite aggressive treatment, this patient did not show improvement for an extended period of time.~~gmund H. Ein
GENITOURINARY The Penile Disassembly S.V Perovic, ‘ci Vukadinovic, 81:479-487, (March), 1998.
Technique M.L.J.
TRACT in Hypospadias Repair. Djordjevic, et al. Br J Urol
The authors describe their technique and results in 92 patients (9 months to 32 years of age) for repair of severe chordee with or without hypospadias and small penis with hypospadias. The penis was completely separated into its component parts (glans with neurovascular bundle, urethra, and corpora cavemosae) and then reconstructed. Good correction of curvature was achieved in all, and the penis was enlarged. Urethral stenosis developed in four patients, fistulae in two, and diverticula in three. Despite the extent of the procedure, sensitivity and erection seemed to be preserved in ah-MN. de la Hunt Modified Mathieu’s Technique: A Variation of the Classic Procedure for Hypospadias Surgical Repair. E. De Grazia, R.M. Cigna, and M. Cimado,: Eur J Pediatr Surg 8:98-99, (April), 1998. Distal penile curvature associated with anterior hypospadias can be corrected by urethral plate mobilization. The authors present 11 cases in which this procedure was employed, modifying the classic Mathieu’s technique for surgical treatment of coronal and distal shaft hypospadias associated with chordee. The technique provided excellent results, both functionally and cosmetically, without complications.-Thomas A. Angerpointner Surgical Management BonieghbalandJ. Fonseca
of Uterine Prolapse in an Infant. Eur .I Pediatr Surg 8:119-120, (April), 1998.
9.
Neonatal uterine prolapse has been rarely described in the literature. Most cases have an underlying diasease, usually spinal cord malformations. The authors present a newborn girl with myelomeningocele and complete uterine prolapse. The prolapse was treated by classical uterine ventrisuspension via the Pfamrenstiel approach. The postoperative course was uneventful.--Thomas A. Angerpointner Concepts and Considerations for Repair of a Severe Cloaca1 Anomaly. S. Cacciaguerra and A. Bianchi. Eur J Pediatr Surg 8: 114118, (April), 1998. A l.S-kg cbromosomally having a cloacal anomaly
normal child was suspected and oligohydramnios. Both
antenatally of parents had a
ABSTRACTS
chromosome 9 inversion. The postnatal study showed a high confluence of the urinary, genital, and intestinal tracts. Because of prematurity, a right colostomy was performed, but the genitourinary tract was left undrained. One-stage reconstruction was carried out at 5 months (weight, 3.2 kg). Follow-up at 15 months is encouragingly suggestive of urinary and fecal continence. The vagina is patent. This report considers concepts in cloacal management and submits for evaluation an altemative surgical plan to the presently almost exclusively accepted posterior saggital approach according to Peha and de Vries.--Thomas A. Angerpointner Cystometry in Infants ing Symptoms. J.G. (March), 1998.
and Children Wen and EC.
With no Apparent VoidTong. Br J Urol 81:468-473,
Nine of 83 infants and children without neurological impairment or lower urinary tract abnormalities were found to have detrusor instability on slow filling cystometry with simultaneous electromyography. The authors present their range of normal values. The detmsor instability was found in the late filling phase.-MN de la Hunt Urodynamic Patterns in Infants With Normal Lower Urinary Tracts or Primary Vesico-Ureteric Reflux. C.K. Yeung, M.L. Godley, H.K. Dhillon, et al. Br J Urol81:461-467, (March), 1998. Thirty-two boys and six girls (3 to 8 months of age) with grade III-IV vesico-ureteric reflux (VUR) had 24-hour natural filling cystometry. Results were compared with 21 age-matched controls who had suprapubit catheters inserted at the time of pyeloplasty or nepbrectomy. Twenty-four of the infants (57%) with VUR had abnormal urodynamic patterns: instability with small voided volume (7), inadequate voiding dynamics (5), dyssenergic patterns (lo), and obstructive patterns (2). For all without VUR, patterns were described as normal or normalimmature. This study confirms the close association between bladder dysfunction and primary VUR.-M.N. de la Hunt lpsilateral Ureteroureterostomy Obstruction in a Duplicate Smith et al. J Urol 159:1016-1018,
for Single Ureteral Reflux or System. M. Bieri, C.K. Smith, A.Z (March), 1998.
The traditional treatment for obstruction or reflux involving a single ureter in a duplicated system has been common sheath reimplantation. More recently, ipsilateral ureteroureterostomy has been suggested as an alternative. Twenty-two patients (24 duplicate systems) underwent ipsilateral ureteroureterostomy between March 1986 and December 1996. Patient charts were reviewed and analyzed for patient age, sex, ureteral and renal anatomy, initial presentation, the clinical situation necessitating operation, and the occurrence of early and late complications. The patients had follow-up for a mean period of 41.4 months. Clinical presentations included urinary tract infection (13), hydronephrosis on maternal ultrasonography (5), dirbbling (2), ureteral calculus (l), and hydronephrosis on neonatal abdominal ultrasonography (1). The mean hospital stay was 3 days. There was one early and one late complication. It is concluded that ipsilateral ureteroureterostomy is an acceptable alternative to common sheath reimplantation in select patients with single ureteral disease in a duplicate system.-George u! Holcomb. Jr
NEOPLASMS Rarity of Surgical Complications After Postchemotherapy Nephrectomy for Nephroblastoma. Experience of the International Society of Paediatric Oncology-Trial and Study “SIOP-9.” J. Godzinski, M.-E Toumade, J. deKraker; et al. Eur J Pediatr Surg 8:83-86, (April), 1998. The aim of the study was to assess rates and types of nepbrectomyrelated complications in children nepbrectomized for nephroblastoma after preoperative chemotherapy. Records of 598 Wilms’ tumor patients,