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Significance of ureteral submucosal tunnel length, orifice configuration and position in vesicoureteral reflux
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Management of the Large Tortuous Adynamic Ureter With Reflux. F. C. Derrick, Jr. J Urol 108:153-155 (July), 1972. Ten patients with megaloureter underwent lower urinary reconstruction. All cases later underwent a pyeloileocutaneous conduit. The author believes that the best results are obtained by early permanent urinary diversion--S. Kim Significance of Ureteral Submucosal Tunnel Length, Orifice Configuration and Position in Vesicoureteral Reflux. A. S. Cass and G. W. Ireland. J Urol 107:963-965 (June), 1972. A total of 552 ureters were studied for submucosal tunnel length, orifice configuration, and position in relation to the presence or absence of reflux. The authors findings indicate that the length of tunnel is probably more responsible for ureterovesicle competence rather than the orifice configuration and trigonal support. In 250 cases, they showed that the tunnel length was shorter and the orifice position laterally displaced with filling of the bladder. Evidence to substantiate their conclusions is found in the surgical procedures forming a new submucosal ureter and the high rateof success in preventing reflux.-S. Kim Treatment of Reflux in Bifid Ureters by Conversion to Complete Duplication. A. D. Amar. J Urol 108:77-78 (July), 1972. The author describes three types of reflux that can occur in bifid systems. He discusses a technique where the junction of the Y is within 3 or 4 cm of the bladder wall and the short length of common ureter below that point can be sacrificed. After sacrifice, the two ureters are then reimplanted side by side, converting them to a complete double system. He has five cases, one of which had only ureteroureteral reflux. There is cessation of vesicoureteral reflux in the other four cases.-S. Kim Vesicoureteral Reflux Associated With Congenital Bladder Diverticulum in Boys and Young Men. A. B. Amar. J Urol 107:966-968 (June), 1972. Of 304 consecutive patients seen over a lO:yr span, there were 81 male patients with reflux. This group included seven boys and three young men with primary nonobstructive congenital bladder diverticula. This group compares in-
ABSTRACTS
terestingly with 1041 girls, 14 yr or less, none of whom had a bladder diverticulum. The author discusses the difference between congenital and acquired diverticula, citing that the latter are due to relative obstruction distal to the bladder. His treatment includes excision of the diverticulum and an antireflux procedure, unless the kidney has been destroyed.-S. Kim Ectopic Ureter Emptying Into the Rectum: Report of a Case. A. C. Uson and C. C. Schulman. J Urol 108:156-158 (July), 1972. An interesting female infant had bilateral complete duplication and hydrouretero nephrosis in both upper segments. At cystotomy an ectopic ureterocele involving the left upper segment as well as the two lower-pole ureters were present. Persistent hydronephrosis of the right upper pole led to further studies, including a negative retrograde urethrogram and negative vaginogram. Intravenous indigocarmine was noted in the baby’s stool. A heminephroureterectomy was carried out revealing the opening into the rectum. There is a discussion of the embryologic development of this anomaly. The authors report this as the fifth case of congenital ectopic ureteral connection to the rectum.--S. Kim Urinary Tract Infection In Children: Fact and Fancy. A. R. Kendall and L. Karafn. J Urol 197:1068-1072(June), 1972. This is a review of a 6-yr experience of over 400 children with recurrent urinary tract infections. The authors conclude that children should be studied at the time of a first urinary infection since 25% of children have inflammatory changes on the IVP. Urethral dilatation or meatotomy appears to produce the same cure rates. Ureteral reflux is present in 40% of cases with recurrent infection, but only 16% have needed operative treatment. Operation produces a 90% success rate.--S. Kim The Occurrence of Empyema Cystis: Management of the Bladder To Be Efunctionalized. S. P. Dretler. J Urol 108:82-84 (July), 1972. A total of 236 patients underping urinary diversion were studied. This included 49 children, four of them with empyema cystis. Treatment in the four has included cystectomy in two, creation of a vesicovaginal tistula in one, and intermittent vesicle irrigations in the other. The author concludes that the infrequent occurrence of em-
Management of the Large Tortuous Adynamic Ureter With Reflux. F. C. Derrick, Jr. J Urol 108:153-155 (July), 1972. Ten patients with megaloureter underwent lower urinary reconstruction. All cases later underwent a pyeloileocutaneous conduit. The author believes that the best results are obtained by early permanent urinary diversion--S. Kim Significance of Ureteral Submucosal Tunnel Length, Orifice Configuration and Position in Vesicoureteral Reflux. A. S. Cass and G. W. Ireland. J Urol 107:963-965 (June), 1972. A total of 552 ureters were studied for submucosal tunnel length, orifice configuration, and position in relation to the presence or absence of reflux. The authors findings indicate that the length of tunnel is probably more responsible for ureterovesicle competence rather than the orifice configuration and trigonal support. In 250 cases, they showed that the tunnel length was shorter and the orifice position laterally displaced with filling of the bladder. Evidence to substantiate their conclusions is found in the surgical procedures forming a new submucosal ureter and the high rateof success in preventing reflux.-S. Kim Treatment of Reflux in Bifid Ureters by Conversion to Complete Duplication. A. D. Amar. J Urol 108:77-78 (July), 1972. The author describes three types of reflux that can occur in bifid systems. He discusses a technique where the junction of the Y is within 3 or 4 cm of the bladder wall and the short length of common ureter below that point can be sacrificed. After sacrifice, the two ureters are then reimplanted side by side, converting them to a complete double system. He has five cases, one of which had only ureteroureteral reflux. There is cessation of vesicoureteral reflux in the other four cases.-S. Kim Vesicoureteral Reflux Associated With Congenital Bladder Diverticulum in Boys and Young Men. A. B. Amar. J Urol 107:966-968 (June), 1972. Of 304 consecutive patients seen over a lO:yr span, there were 81 male patients with reflux. This group included seven boys and three young men with primary nonobstructive congenital bladder diverticula. This group compares in-
ABSTRACTS
terestingly with 1041 girls, 14 yr or less, none of whom had a bladder diverticulum. The author discusses the difference between congenital and acquired diverticula, citing that the latter are due to relative obstruction distal to the bladder. His treatment includes excision of the diverticulum and an antireflux procedure, unless the kidney has been destroyed.-S. Kim Ectopic Ureter Emptying Into the Rectum: Report of a Case. A. C. Uson and C. C. Schulman. J Urol 108:156-158 (July), 1972. An interesting female infant had bilateral complete duplication and hydrouretero nephrosis in both upper segments. At cystotomy an ectopic ureterocele involving the left upper segment as well as the two lower-pole ureters were present. Persistent hydronephrosis of the right upper pole led to further studies, including a negative retrograde urethrogram and negative vaginogram. Intravenous indigocarmine was noted in the baby’s stool. A heminephroureterectomy was carried out revealing the opening into the rectum. There is a discussion of the embryologic development of this anomaly. The authors report this as the fifth case of congenital ectopic ureteral connection to the rectum.--S. Kim Urinary Tract Infection In Children: Fact and Fancy. A. R. Kendall and L. Karafn. J Urol 197:1068-1072(June), 1972. This is a review of a 6-yr experience of over 400 children with recurrent urinary tract infections. The authors conclude that children should be studied at the time of a first urinary infection since 25% of children have inflammatory changes on the IVP. Urethral dilatation or meatotomy appears to produce the same cure rates. Ureteral reflux is present in 40% of cases with recurrent infection, but only 16% have needed operative treatment. Operation produces a 90% success rate.--S. Kim The Occurrence of Empyema Cystis: Management of the Bladder To Be Efunctionalized. S. P. Dretler. J Urol 108:82-84 (July), 1972. A total of 236 patients underping urinary diversion were studied. This included 49 children, four of them with empyema cystis. Treatment in the four has included cystectomy in two, creation of a vesicovaginal tistula in one, and intermittent vesicle irrigations in the other. The author concludes that the infrequent occurrence of em-