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Prostatic utricular enlargement as a cause of vesical outlet obstruction in children
INTERNATIONAL
ABSTRACTS
OF PEDIATRIC
279
SURGERY
This paper is a study of the results following cutaneous vesicostomies in 12 patients. The procedure was performed as part of the treatment of atonic bladder secondary to meningomyelocele. One patient was lost to followup after one year and in another an ileocystoplasty was performed. Cram-negative bacteremia occurred in 2 cases in the early postoperative period. The commonest delayed complication was stoma1 stricture, occurring in more than half the patients (66 per cent). Half had to be readmitted to the hospital for acute urinary tract infection and over half developed persistent proteus or pseudomonas infections. They also had difficulty with collection devices many experiencing skin irritation, ostium erosion, or stoma1 stenosis. Only 2 patients (16 per cent) are doing well. The authors conclude that tubeless cystostomy in the management of atonic bladder secondary to meningomyelocele is not a satisfactory procedure. They recommend ileal conduit urinary diversion instead.-B. M. Henderson. OF THE BLADDER AND BLADDEROUTLET. R. 2’. Woodhurne. J. Urol. loo:474487 (October) 1968.
Ammhu
This paper is a study of the musculature of the bladder and urethra with a review of the literature. The detrusor muscle is made up of an interlacing mesh of muscle fascicles. It ascends the distal portion of the ureter as it enters the bladder wall, but it is not firmly adherent to the ureter itself. The ureter runs submucosally in the bladder wall for a distance of about 1.5 cm. ending in the trigone. The ureteral musculature is attached to the mucosa of the trigone, apparently fixing the ureter. The detrusor does not form a sphincter; rather it appears to continue down into the urethra so that as the bladder enlarges these muscle bundles become radially arranged tending to pull the bladder neck open. It appears that the bladder neck is very rich in elastic tissue which probably tends to maintain the bladder neck closed. As the detrusor muscle contracts it also causes the descent of the bladder. The urethral wall is made up of an external circular layer and an internal longitudinal one containing elastic tissue which appears to be the most important layer. The circular external musculature may be absent in the female. It is possible that this anatomic fact is the cause for greater vulnerability to incontinence in the female. The striated sphincter urethrae encircles not only the urethra but the vagina also.-B. At. Henderson. PROSIXTIC UTRICULAR ENLARGEMENT AS A CAUSE OF VESICAL OUTLET OBSTRUCTIONIN CHILDREN.
S. Poise, 332
and H. Edelbrock.
(September)
J. Urol.
100:329-
1968.
On rare occasions vesical outlet obstruction in children may result from enlarged mullerian duct remnants. Two cases are presented, one presenting with anemia and pyuria and the other with difficulty voiding and epididymitis. The mass was excised in one patient who also had hydroureter and hydronephrosis with bilateral vesicoureteral reflux. In the other child, the enlarged utricle was saucerized to the urethra. The cause of utricular enlargement may be obstruction to its outlet by valves, fused fetal membranes, or desquamated epithelium at the point where it enters the urogenital sinus. It may be associated with hypospadias. It is probable that the failure to empty adequately led to infection in these cases.-B. M. Henderson. STRESS INCONTINENCE: REVISION OF UIVSUCCESSFUL MARSHALL-MARCHETTI OPERATIOK IN h FIVE YEAH OLD CHILD. T. L. Ball, and J. ). Woodruff. J. Urol. loo:492497 (October) 1968. The authors present the case of a child who at the age of 3 years was found to have a congenital constriction ring of the urethra which required transurethral resection and resulted in severe incontinence. Six months later she underwent a Marshall-Marchetti procedure which was unsuccessful. At the age of 5 years, having had an indwelling Foley catheter for the previous 2 years, the child was operated on using a combined procedure, releasing the urethra from below and then plicating the bladder neck, followed by suprapubic resection of scars and recreation of the urethral vesical angle. The child is now dry at night and can retain urine for up to 4 hours during the day.-B. :M. Henderson.
CINERADIOCRAPHIC ANALYSIS OF NEUROGENJC BLADDER IN CHILDREN. R. H. Edwards, H. Burke, R. K. Rhamy, and J. D. Trapp. J. Urol. 100:290-292 (September) 1968. This is a study of 71 cases of neurogenic bladder in children in whom the radiographic findings were analyzed. Several cineradiographic features are described among which changes in bladder contour are the most frequent. These included alongation, irregularity in outline (trabeculations and/or diverticula), and triangular shape. Either low or high pressure reflux was present in 43 patients. Vesical outlet relaxation was normal in 55 cases. Internal sphincter action was said to be normal in
ABSTRACTS
OF PEDIATRIC
279
SURGERY
This paper is a study of the results following cutaneous vesicostomies in 12 patients. The procedure was performed as part of the treatment of atonic bladder secondary to meningomyelocele. One patient was lost to followup after one year and in another an ileocystoplasty was performed. Cram-negative bacteremia occurred in 2 cases in the early postoperative period. The commonest delayed complication was stoma1 stricture, occurring in more than half the patients (66 per cent). Half had to be readmitted to the hospital for acute urinary tract infection and over half developed persistent proteus or pseudomonas infections. They also had difficulty with collection devices many experiencing skin irritation, ostium erosion, or stoma1 stenosis. Only 2 patients (16 per cent) are doing well. The authors conclude that tubeless cystostomy in the management of atonic bladder secondary to meningomyelocele is not a satisfactory procedure. They recommend ileal conduit urinary diversion instead.-B. M. Henderson. OF THE BLADDER AND BLADDEROUTLET. R. 2’. Woodhurne. J. Urol. loo:474487 (October) 1968.
Ammhu
This paper is a study of the musculature of the bladder and urethra with a review of the literature. The detrusor muscle is made up of an interlacing mesh of muscle fascicles. It ascends the distal portion of the ureter as it enters the bladder wall, but it is not firmly adherent to the ureter itself. The ureter runs submucosally in the bladder wall for a distance of about 1.5 cm. ending in the trigone. The ureteral musculature is attached to the mucosa of the trigone, apparently fixing the ureter. The detrusor does not form a sphincter; rather it appears to continue down into the urethra so that as the bladder enlarges these muscle bundles become radially arranged tending to pull the bladder neck open. It appears that the bladder neck is very rich in elastic tissue which probably tends to maintain the bladder neck closed. As the detrusor muscle contracts it also causes the descent of the bladder. The urethral wall is made up of an external circular layer and an internal longitudinal one containing elastic tissue which appears to be the most important layer. The circular external musculature may be absent in the female. It is possible that this anatomic fact is the cause for greater vulnerability to incontinence in the female. The striated sphincter urethrae encircles not only the urethra but the vagina also.-B. At. Henderson. PROSIXTIC UTRICULAR ENLARGEMENT AS A CAUSE OF VESICAL OUTLET OBSTRUCTIONIN CHILDREN.
S. Poise, 332
and H. Edelbrock.
(September)
J. Urol.
100:329-
1968.
On rare occasions vesical outlet obstruction in children may result from enlarged mullerian duct remnants. Two cases are presented, one presenting with anemia and pyuria and the other with difficulty voiding and epididymitis. The mass was excised in one patient who also had hydroureter and hydronephrosis with bilateral vesicoureteral reflux. In the other child, the enlarged utricle was saucerized to the urethra. The cause of utricular enlargement may be obstruction to its outlet by valves, fused fetal membranes, or desquamated epithelium at the point where it enters the urogenital sinus. It may be associated with hypospadias. It is probable that the failure to empty adequately led to infection in these cases.-B. M. Henderson. STRESS INCONTINENCE: REVISION OF UIVSUCCESSFUL MARSHALL-MARCHETTI OPERATIOK IN h FIVE YEAH OLD CHILD. T. L. Ball, and J. ). Woodruff. J. Urol. loo:492497 (October) 1968. The authors present the case of a child who at the age of 3 years was found to have a congenital constriction ring of the urethra which required transurethral resection and resulted in severe incontinence. Six months later she underwent a Marshall-Marchetti procedure which was unsuccessful. At the age of 5 years, having had an indwelling Foley catheter for the previous 2 years, the child was operated on using a combined procedure, releasing the urethra from below and then plicating the bladder neck, followed by suprapubic resection of scars and recreation of the urethral vesical angle. The child is now dry at night and can retain urine for up to 4 hours during the day.-B. :M. Henderson.
CINERADIOCRAPHIC ANALYSIS OF NEUROGENJC BLADDER IN CHILDREN. R. H. Edwards, H. Burke, R. K. Rhamy, and J. D. Trapp. J. Urol. 100:290-292 (September) 1968. This is a study of 71 cases of neurogenic bladder in children in whom the radiographic findings were analyzed. Several cineradiographic features are described among which changes in bladder contour are the most frequent. These included alongation, irregularity in outline (trabeculations and/or diverticula), and triangular shape. Either low or high pressure reflux was present in 43 patients. Vesical outlet relaxation was normal in 55 cases. Internal sphincter action was said to be normal in