Posterior urethral injuries in children

Posterior urethral injuries in children

136 INTERNATIONAL simple diffusion was tested. Mouse l4-day urogenital ridges were placed in organ culture and microinjected with testosterone-album...

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136

INTERNATIONAL

simple diffusion was tested. Mouse l4-day urogenital ridges were placed in organ culture and microinjected with testosterone-albuminfluorescem isothiocyanate. At 17 hours, fluorescence was found throughout the wolffian duct and by 48 hours it was maximal in the dilated caudal end. These results support the hypothesis that androgens may be transported along the wolflian duct. Secretion of testicular hormones into the wolfftan duct may maintain hormone levels in the biologically active range.-George w Holcomb, Jr Posterior Urethral Injuries Herek, er al. Br J Urol77:597-600,

in Children. (Aprtl),

A. Avonglu, 1996.

I. Ubnan,

G.

Twenty-nine children (25 boys, 2 girls) were admitted to a single department over 14 years, 23 immediately after posterior urethral injury and six after previous unsuccessful repair. Fourteen had suprapubic diversion with primary realignment over a catheter. Seven achieved continuity wtth continence. Primary realignment with anastomosis was performed in nine patients, with satisfactory results in six. Stricture developed in all four patients with suprapubic diversion alone, two of whom underwent staged transpubic repair. Partial urethral tears in two patients healed with urethral catheterization alone. The authors recommend primary realignment with anastomosts as the most successful strategy.-MN. de la Hunt Late Failure of the Reconstructed Exstrophy Woodhouse and N.G. Redgrave. Br J Ural 77590-592,

Bladder. (April),

C.J.R. 1996.

Fifty-seven patients (46 boys, 9 girls) with exstrophy born between 1965 and 1974 were reviewed. Twenty-five underwent cystectomy with diversion in early childhood. Of 32 babies who underwent reconstruction, 19 had failure m childhood, and only 13 retained their native bladder in their second decade. Of the 13 with successful closure and bladder neck reconstruction. eight required further reconstruction in their second decade (5 augmentation + incontinence procedure, 1 augmentation, 2 artificial urethral sphincter), two were on intermittent catheterization, and three voided with straining or expression.-MN. de la Hunt

Salvage Procedures for Failed Benchekroun Hydraulic Valves: Experience in Four Patients. l?D.E. Mouriquand and S. Boddy. Br J Urol77:740-744, (May), 1996. Seven patients with spina bifida (2 males, 5 females) underwent lower urinary tract reconstruction with a Benchekroun valve, detubularized ileocystoplasty, and Kropp-onlay procedure. Three presented immediately, and one later, with problems of devagination and overdistension of the hydraulic valve. Stoma1 problems also were present. As salvage procedures, two patients had later appendicovesicostomy and two had inner tube vesicostomy. After this experience, the authors recommend the appendix as the first choice for a catheterizable conduit, However, the Benchekroun valve should still be used when the appendix is not available. The search for the Ideal conduit continues.-MN. de la Hunt Minimizing Stoma1 Stenosis in Appendicovesicostomy Using the Modified Umbilical Stoma. A.E. Khoury, J.G. Van Savage, G.A. McLorie, et al. J Ural 155:2050-2051, (June), 1996. Creation of a modified umbilical stoma is part of continent urinary diversion using appendtcovesicostomy. Umbilical stomas were created using the eversion-inversion principle in 25 patients undergoing appendicovesicostomy. The cosmetic results of the umbilical stoma was good in all cases. Stoma1 stenosis required surgical revision in 8% of cases. The authors recommend a modified umbilical stoma1 technique for appendicovesicostomy because it is cosmetically pleasing without compromismg stomaI function.&eorge IV Holcomb, Jr

ABSTRACTS

A Simple Device in the Prevention of Recurrent AppendicoUmbilical Stenosis. U. Kiihl, E. W Gerharz, K. Weingiirtner, et al. Br J Urol77:603-604, (April), 1996. The authors has succeeded mean follow-up

describe a cone-shaped metal pin for dilatation, in preventing recurrent stenosis in five patients period of 24 months.-MN. de la Hunt

which with a

Lower Urinary Spina Bifida. Urol77:593-596,

Tract Function in Ambulatory Children Wiih R.A. Mevorach, G.A. Bogaet?, L.S. Baskin, et al. Br J (April), 1996.

Forty-five “ambulatory” children with myelomeningocele were reviewed. Nineteen walked independently and 26 with ankle-foot orthotits. Clinically and urodynamically normal voiding was observed in only three. The rest displayed neurogenic lower urinary dysfunction, with no significant difference between independent walkers and those with orthotics.-M.N. de la Hunt

Retrograde Balloon Dilatation for Primary Pelvi-Ureteric tion Stenosis in Children. Y Sugita, ZD. Clamette, Hutson. Br J Urol77:587-589, (April), 1996.

and

JuncJ.M.

Sixteen children underwent retrograde dilatation of the pelvi-ureteric junction. A double pigtail catheter was left in the ureter for 6 weeks postoperatively. The patients had follow-up for 9 to 38 months. Preoperative and postoperative assessments were made by diuretic excretion renography. Dilatation was successful in 9 of the 17 renal units. Failure was attributed to inability to pass the catheter through the ureterovesical junction or pelvi-ureteric junction in three and to recurrent or persistent stenosis in five. The authors believe that failure may be attributable to scarring or persistent kinking of a redundant renal pelvis, in which case only reduction pyeloplasty would be likely to succeed.-M.N. de la Hunt

Pediatric Kidney: Functional Outcome After Extracorporeal Shock Wave Lithotripsy. M.C. Gael, N.S. Baserge, R.VR. Babu, al. J Urol 155:2044-2046, (June), 1996.

et

The authors studied the efficacy, functional outcome, and morphological changes after extracorporeal shock wave lithotripsy (ESWL) of renal calculi in a pediatric population. Prospective evaluation was accomplished with 50 patients aged 2 to 12 years (mean, 7.64 years) who underwent ESWL with the Siemens Lithostar Plus. Functional outcome was assessed by comparing total and ipsilateral glomerular filtration rates before and after ESWL. The glomerular filtration rate was measured using Gates’ method on a 99mtechnetium-pentetic acid radionuclide renal scan corrected to body surface area X 1.73 m2. Ultrasonography was performed to assess morphological changes after ESWL. The immediate fragmentation rate was 86%. and the clearance rate was 82%. At the end of the study, 40 patients could be evaluated. Immediately after ESWL, ultrasonography showed perirenal hematoma in three patients, intrarenal hematoma in two, and subcapsular hematoma in one. These changes were found to have resolved spontaneously at follow-up. There was no change in the total or ipsilateral glomerular filtration rate at the mean follow-up period of 3 I .7 months. Before and after ESWL the total glomerular filtration rates were 86.58 + 12.43 and 86.27 2 12.82 mL/min/1.73 m2, respectively. The treated kidney glomerular filtration rate decreased insignificantly from 40.58 2 12.61 to 40.41 t 12.61 mUmin/per 1.73 m2 at 3 months. At the last follow-up examination, the change in glomerular filtration rate was found to be insignificant. It is concluded that ESWL is effective in the pediatric population. It can be performed safely without long-term bio-effects on the function or morphology of the growing kidney.-George W; Huicomb, Jr