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Reoperation for the failed ureteral reimplantation
ABSTRACTS
and the difficulties in diagnosis discussed. The authors have found that the renal segment draining into the ectopic ureter can generally be demonstrated by high-dose intravenous urography with delayed films.--J. H. Johnston Vesicoureteral Reflux and Distal Ureteral Obstruction. R. M. Weiss and B. Lytton. J. Urol. 111: 245-249 (February) 1974. The authors report 17/120 patients with vesicoureteral reflux requiring surgical correction because of obstruction at the UV junction. Radiologically, reflux with delayed ureteral drainage as well as a rounded appearance of the distal ureter separate from the bladder helped to make the diagnosis. Eleven of seventeen had reflux during bladder filling while six only had it with voiding. Cystoscopic exam showed 10 of 17 had n o r m a l orifices. Surgical exploration showed the distal ureteral segments grossly narrowed and histologically showed an increase in fibrous tissue and disruption of the musculature. Thirteen of seventeen underwent ureteroneocystostomy with excision of the narrow segment. S. Kim Reoperation for the Failed Ureteral Reimplantation. W. H. Hendren. J. Urol. 111:403-411 (March) 1974. Twenty-five of 990 ureters in 516 children undergoing ordinary reimplantation were unsatisfactory, 16 showing obstruction and nine persisting reflux. Causes of obstruction included angulation entering the bladder, fibrosis of the terminal ureter, paraureteral diverticulum, and inadvertent entry into the seromuscular layer of the small intestine. Causes of reflux included lateral placement, fistula at the upper end of the tunnel, and too short a tunnel. All cases were subjected to reoperation and in eight cases, a second reoperation, with success. Of the 30 ureters operated upon elsewhere initially, eight were obstructed and 22 refluxing. The causes for the initial failure were the same. Twenty-nine of thirty corrected by a single procedure. Thirteen of 126 megaureters required reoperation. Seven were obstructed and six refluxing. Eleven of thirteen were reoperated upon, two of which required a second reoperation. Two patients have planned reoperations and two are recent operations too soon to evaluate. O f eight other megaureters operated upon elsewhere, three were obstructed and five refluxed. All were corrected by a single operation. The a u t h o r describes techniques of reim-
161
plantation for both the refluxing ureter and the megaureter. S. Kim Congenital Urethral Membranes Causing Urethral Obstruction. P. L. Field and F. D. Stevens. J. Urol. 111:250-255 (September) 1974. Six cases of urethral m e m b r a n e are presented varying from a thin sheet of tissue with a central hole to a greatly ballooned wind-sock deformity with a side opening. The author differentiates these from valves and discussed the mechanics of obstruction. Treatment is endoscopic resect i o n . - - S . Kim The Repair of Genital Defects Associated With Persistent Cloaca. S. S. Ambrose. J. Urol. 111:256259 (February) 1974. This report concerns three male infants born with extrophy of the cloaca in w h o m eventual reconstruction of male genitalia was carried out. Case histories and operative reconstruction are reported. The author feels strongly that male children with cloacal extrophy should be raised as females. This would require removal of some of the male genitalia at an early age. This was not done in these cases because of the advanced age of the children and the resistance by the p a r e n t s . - - S . Kim Epispadias With Incontinence. G. T. Klauber, and J. Urol. 111:110-113 (January)
D. h Williams. 1974.
Eighty cases of epispadias are reviewed, 58 are in boys and 22 are in girls. There were 17 boys and 21 girls who were incontinent. All operations were the Y o u n g Dees or Millin sling, singly or in combination in girls and the Y o u n g - D e e s procedure in boys. O f the 17 bladder-neck reconstructions in girls, nine were successful although one child required a second procedure. Eleven of twenty-seven boys achieved continence after a bladder-neck reconstruction. It is interesting to note that 22 of the 35 patients with good initial bladder capacity gained continence whereas only three of 14 patients with a small-capacity bladder achieved continence. Three boys had pelvic floor stimulators implanted after n u m e r o u s failures and were immediately continent. Only one has long-term continence. The authors advocate the Y o u n g - D e e s type of bladder-neck reconstruction with or without the Millin sling for the most satisfactory results in patients with a well-developed bladder and a good capacity musculature. T h o s e patients with small bladders and poor
and the difficulties in diagnosis discussed. The authors have found that the renal segment draining into the ectopic ureter can generally be demonstrated by high-dose intravenous urography with delayed films.--J. H. Johnston Vesicoureteral Reflux and Distal Ureteral Obstruction. R. M. Weiss and B. Lytton. J. Urol. 111: 245-249 (February) 1974. The authors report 17/120 patients with vesicoureteral reflux requiring surgical correction because of obstruction at the UV junction. Radiologically, reflux with delayed ureteral drainage as well as a rounded appearance of the distal ureter separate from the bladder helped to make the diagnosis. Eleven of seventeen had reflux during bladder filling while six only had it with voiding. Cystoscopic exam showed 10 of 17 had n o r m a l orifices. Surgical exploration showed the distal ureteral segments grossly narrowed and histologically showed an increase in fibrous tissue and disruption of the musculature. Thirteen of seventeen underwent ureteroneocystostomy with excision of the narrow segment. S. Kim Reoperation for the Failed Ureteral Reimplantation. W. H. Hendren. J. Urol. 111:403-411 (March) 1974. Twenty-five of 990 ureters in 516 children undergoing ordinary reimplantation were unsatisfactory, 16 showing obstruction and nine persisting reflux. Causes of obstruction included angulation entering the bladder, fibrosis of the terminal ureter, paraureteral diverticulum, and inadvertent entry into the seromuscular layer of the small intestine. Causes of reflux included lateral placement, fistula at the upper end of the tunnel, and too short a tunnel. All cases were subjected to reoperation and in eight cases, a second reoperation, with success. Of the 30 ureters operated upon elsewhere initially, eight were obstructed and 22 refluxing. The causes for the initial failure were the same. Twenty-nine of thirty corrected by a single procedure. Thirteen of 126 megaureters required reoperation. Seven were obstructed and six refluxing. Eleven of thirteen were reoperated upon, two of which required a second reoperation. Two patients have planned reoperations and two are recent operations too soon to evaluate. O f eight other megaureters operated upon elsewhere, three were obstructed and five refluxed. All were corrected by a single operation. The a u t h o r describes techniques of reim-
161
plantation for both the refluxing ureter and the megaureter. S. Kim Congenital Urethral Membranes Causing Urethral Obstruction. P. L. Field and F. D. Stevens. J. Urol. 111:250-255 (September) 1974. Six cases of urethral m e m b r a n e are presented varying from a thin sheet of tissue with a central hole to a greatly ballooned wind-sock deformity with a side opening. The author differentiates these from valves and discussed the mechanics of obstruction. Treatment is endoscopic resect i o n . - - S . Kim The Repair of Genital Defects Associated With Persistent Cloaca. S. S. Ambrose. J. Urol. 111:256259 (February) 1974. This report concerns three male infants born with extrophy of the cloaca in w h o m eventual reconstruction of male genitalia was carried out. Case histories and operative reconstruction are reported. The author feels strongly that male children with cloacal extrophy should be raised as females. This would require removal of some of the male genitalia at an early age. This was not done in these cases because of the advanced age of the children and the resistance by the p a r e n t s . - - S . Kim Epispadias With Incontinence. G. T. Klauber, and J. Urol. 111:110-113 (January)
D. h Williams. 1974.
Eighty cases of epispadias are reviewed, 58 are in boys and 22 are in girls. There were 17 boys and 21 girls who were incontinent. All operations were the Y o u n g Dees or Millin sling, singly or in combination in girls and the Y o u n g - D e e s procedure in boys. O f the 17 bladder-neck reconstructions in girls, nine were successful although one child required a second procedure. Eleven of twenty-seven boys achieved continence after a bladder-neck reconstruction. It is interesting to note that 22 of the 35 patients with good initial bladder capacity gained continence whereas only three of 14 patients with a small-capacity bladder achieved continence. Three boys had pelvic floor stimulators implanted after n u m e r o u s failures and were immediately continent. Only one has long-term continence. The authors advocate the Y o u n g - D e e s type of bladder-neck reconstruction with or without the Millin sling for the most satisfactory results in patients with a well-developed bladder and a good capacity musculature. T h o s e patients with small bladders and poor