- Email: [email protected]
Surgical implications of genitourinary tract anomalies in patients with imperforate anus
136
Surgical Implications of Genitourinary Tract Anomalies in Patients With Imperforate Anus. C.A. Sheldon, A. Gilbert, A.G. Lewis, et aL J Urol 152:196-199, (July), 1994. Genitourinary anomalies in patients with imperforate anus are a frequent source of significant morbidity, which often exceeds that of the imperforate anus itself. The authors report a retrospective study of 64 genitourinary procedures performed on 23 patients. Renal, collecting system, bladder, and perineal anomalies were encountered in 65%, 83%, 87%, and 65% of these complex cases, resPectively. Seventy percent of the patients required intermittent catheterization because of bladder dysfunction. Surgical alternatives, complications of management, and functional outcomes are reviewed in detail. Genitourinary reconstruction is best undertaken as an integral part of imperforate anus reconstruction. Failure to do so results in the loss of surgical alternatives, unnecessary reoperative procedures, and compromised outcomes.--George W. Holcomb, Jr
Primary Dilated Megaureter: Long-Term Followup. L.S. Baskin, S.A. Zderic, H.M. Snyder, et al. J Urol 152:618-621, (August), 1994.
INTERNATIONAL ABSTRACTS
Hydronephrosis in Renal Ectopia: Incidence, Etiology and Significance. P.E. Gleason, P.P. Kelalis, D.A. Husmann, et aL J Urol 151:t660-1661, (June), 1994. The incidence, cause, and significance of hydronephrosis in patients with renal ectopia are unknown. Therefore, the authors conducted a retrospective review of 77 patients having a total of 82 ectopic kidneys. Of the 82 kidneys, 46 (56%) had hydronephrosis. Dilatation of the renal pelvis was the result of primary ureteropelvic or ureterovesical obstruction in 52%; grade 3, 4, or 5 vesicoureteral reflux in 26%; and extrarenal collecting systems, with malrotation that produced apparent ureteropelvic junction obstruction, in 22%. Surgery was performed in 41 patients, including primary nephrectomy (18), ureteral reimplantation in (14), and nreteropelvie junction repair (8). Hydronephrosis was present in 15 of 58 contralateral nonectopic kidneys, and 11 required surgery, mostly for vesicoureteral reflux. Solitary ectopic kidneys with no associated obstruction or reflux demonstrated normal renal function. These data indicate that the prognosis for renal ectopia relates directly to the associated urologic disease and timely surgical intervention--not to eetopia alone.--George W. Holcomb, Jr NEOPLASMS
Previously this group reported on the changing concepts in the management of 35 neonates with primary obstructive megaureters, 25 of whom were observed without surgery for a mean of 28 months, and 10 were treated surgically. The nonsurgical group consists of 19 male and 6 female neonates, with 19 unilateral and 6 bilateral dilated ureters. Seventeen of the patients presented with an antenatal diagnosis of hydronephrosis, 2 with infection and 6 with incidental findings. No patient had vesicoureteral reflux. Follow-up serial imaging (2 or more studies per case) consisted of excretory urography in 18 of the 25 cases, diethylenetriaminepentaacetic acid renal scan in 16, and/or sonogram in 10. The mean follow-up period was 7.3 years (range, 4.8 to 12.4) for 24 patients, and 1 was lost to follow-up after 1.5 years. Excretory urography showed improvement of urinary tract dilatation in 12 cases and stable dilatation in 6. Renal scans demonstrated expected interval increases in the glomerular filtration rate with age, without any decrease in the percentage of renal function in any of the 16 cases. No patient had stones, pain, or pyelonephritis. It is concluded that it is safe to observe a select group of patients who have primary dilated megaureters in the absence of vesicoureteral reflux. The authors recommend that antibiotic prophylaxis and serial urinary tract imaging be performed to confirm renal growth and preserve renal function.--George W. HoIcomb, Jr
Laparoscopic Renal Surgery in Children. R.M. Ehrlich, A. Gershman, and G. Fuchs. J Urol 151:735-739, (March), 1994. A total of 17 laparoscopic renal procedures were performed in children, including nephrectomy (10), nephroureterectomy (4), partial nephrectomy (2), and giant renal cyst excision (1). The patients' age range was 4 months to 11 years (average, 34 months). The average operating time was 2 hours 15 minutes (range, 1 hour 50 minutes to 2 hours 45 minutes). The usual period of hospitalization was 23 hours; the longest was 36 hours (2 patients). No complications ensued. Despite the decreased working space in children, laparoscopic renal surgery offers compelling advantages, including short hospitalization, less perioperative and postoperative pain, improved cosmetic result, earlier return to normal unrestricted activities, and early return to work for the parents. Methods to accomplish renal laparoscopic surgery safely in children are detailed.--George W. Holcomb, Jr
Fat Containing Renal Mass in Childhood: A Case Report of Teratoid Wilms' Tumor. M.A. Williams, K.P. Schropp, and H.N. Noe. J Urol 151:1662-1663, (June), 1994. Renal masses in childhood rarely contain adipose tissue as a major component. A case is reported of teratoid Wilms' tumor, an atypical variant of nephroblastoma, in which bilateral renal masses were found on computerized tomography to have a high fat content. Previously reported cases have had clinical characteristics in common with this case. However, this patient died of metastatic disease, which, to the authors' knowledge, had not been described previously.--George W. Holcomb, Jr
Tumor Infiltration of the Vena Cava in Nephroblastoma. R. Daum, H. Roth, and Z. Zachariou. Eur J Pediatr Surg 4:16-20, (February), 1994. Although operative treatment of Wilms' tumors has become more straightforward as a result of advances in preoperative treatment and precise diagnosis, vascular involvement of the tumor can pose serious problems during surgery. Therefore, vascular involvement must be identified preoperatively, and the level of the intravascular tumor thrombus must be defined. The authors propose a classification of intravascular involvement in Wilms' tumors, suggesting clinical consequences and operative strategy. In a series of 84 patients, seven (8.3%) were diagnosed preoperatively a having vascular involvement by means of ultrasound. Surgical technique depends on the stage. Patients with stage III or IV should be operated on in deep hypothermic circulatory arrest in cooperation with the cardiovascular surgeon. --ThomasA. Angerpointner
Bilateral Adrenal Neuroblastoma. Y.. Ishiguro, I£. Iio, M. Nagaya, et al. Eur J Pediatr Surg 4:37-39, (February), 1994. Two cases of bilateral adrenal neuroblastoma in infants are reported. The first patient presented with abdominal distension caused by metastatic hepatomegaly, and the second had elevated urinary vanillylmandelic acid. Both had stage IV-S neuroblastoma. In each case, unilateral adrenalectomy was performed, and the contra]ateral tumor was observed. The size of the remaining tumors decreased slowly, and the clinical progress was good. The
Surgical Implications of Genitourinary Tract Anomalies in Patients With Imperforate Anus. C.A. Sheldon, A. Gilbert, A.G. Lewis, et aL J Urol 152:196-199, (July), 1994. Genitourinary anomalies in patients with imperforate anus are a frequent source of significant morbidity, which often exceeds that of the imperforate anus itself. The authors report a retrospective study of 64 genitourinary procedures performed on 23 patients. Renal, collecting system, bladder, and perineal anomalies were encountered in 65%, 83%, 87%, and 65% of these complex cases, resPectively. Seventy percent of the patients required intermittent catheterization because of bladder dysfunction. Surgical alternatives, complications of management, and functional outcomes are reviewed in detail. Genitourinary reconstruction is best undertaken as an integral part of imperforate anus reconstruction. Failure to do so results in the loss of surgical alternatives, unnecessary reoperative procedures, and compromised outcomes.--George W. Holcomb, Jr
Primary Dilated Megaureter: Long-Term Followup. L.S. Baskin, S.A. Zderic, H.M. Snyder, et al. J Urol 152:618-621, (August), 1994.
INTERNATIONAL ABSTRACTS
Hydronephrosis in Renal Ectopia: Incidence, Etiology and Significance. P.E. Gleason, P.P. Kelalis, D.A. Husmann, et aL J Urol 151:t660-1661, (June), 1994. The incidence, cause, and significance of hydronephrosis in patients with renal ectopia are unknown. Therefore, the authors conducted a retrospective review of 77 patients having a total of 82 ectopic kidneys. Of the 82 kidneys, 46 (56%) had hydronephrosis. Dilatation of the renal pelvis was the result of primary ureteropelvic or ureterovesical obstruction in 52%; grade 3, 4, or 5 vesicoureteral reflux in 26%; and extrarenal collecting systems, with malrotation that produced apparent ureteropelvic junction obstruction, in 22%. Surgery was performed in 41 patients, including primary nephrectomy (18), ureteral reimplantation in (14), and nreteropelvie junction repair (8). Hydronephrosis was present in 15 of 58 contralateral nonectopic kidneys, and 11 required surgery, mostly for vesicoureteral reflux. Solitary ectopic kidneys with no associated obstruction or reflux demonstrated normal renal function. These data indicate that the prognosis for renal ectopia relates directly to the associated urologic disease and timely surgical intervention--not to eetopia alone.--George W. Holcomb, Jr NEOPLASMS
Previously this group reported on the changing concepts in the management of 35 neonates with primary obstructive megaureters, 25 of whom were observed without surgery for a mean of 28 months, and 10 were treated surgically. The nonsurgical group consists of 19 male and 6 female neonates, with 19 unilateral and 6 bilateral dilated ureters. Seventeen of the patients presented with an antenatal diagnosis of hydronephrosis, 2 with infection and 6 with incidental findings. No patient had vesicoureteral reflux. Follow-up serial imaging (2 or more studies per case) consisted of excretory urography in 18 of the 25 cases, diethylenetriaminepentaacetic acid renal scan in 16, and/or sonogram in 10. The mean follow-up period was 7.3 years (range, 4.8 to 12.4) for 24 patients, and 1 was lost to follow-up after 1.5 years. Excretory urography showed improvement of urinary tract dilatation in 12 cases and stable dilatation in 6. Renal scans demonstrated expected interval increases in the glomerular filtration rate with age, without any decrease in the percentage of renal function in any of the 16 cases. No patient had stones, pain, or pyelonephritis. It is concluded that it is safe to observe a select group of patients who have primary dilated megaureters in the absence of vesicoureteral reflux. The authors recommend that antibiotic prophylaxis and serial urinary tract imaging be performed to confirm renal growth and preserve renal function.--George W. HoIcomb, Jr
Laparoscopic Renal Surgery in Children. R.M. Ehrlich, A. Gershman, and G. Fuchs. J Urol 151:735-739, (March), 1994. A total of 17 laparoscopic renal procedures were performed in children, including nephrectomy (10), nephroureterectomy (4), partial nephrectomy (2), and giant renal cyst excision (1). The patients' age range was 4 months to 11 years (average, 34 months). The average operating time was 2 hours 15 minutes (range, 1 hour 50 minutes to 2 hours 45 minutes). The usual period of hospitalization was 23 hours; the longest was 36 hours (2 patients). No complications ensued. Despite the decreased working space in children, laparoscopic renal surgery offers compelling advantages, including short hospitalization, less perioperative and postoperative pain, improved cosmetic result, earlier return to normal unrestricted activities, and early return to work for the parents. Methods to accomplish renal laparoscopic surgery safely in children are detailed.--George W. Holcomb, Jr
Fat Containing Renal Mass in Childhood: A Case Report of Teratoid Wilms' Tumor. M.A. Williams, K.P. Schropp, and H.N. Noe. J Urol 151:1662-1663, (June), 1994. Renal masses in childhood rarely contain adipose tissue as a major component. A case is reported of teratoid Wilms' tumor, an atypical variant of nephroblastoma, in which bilateral renal masses were found on computerized tomography to have a high fat content. Previously reported cases have had clinical characteristics in common with this case. However, this patient died of metastatic disease, which, to the authors' knowledge, had not been described previously.--George W. Holcomb, Jr
Tumor Infiltration of the Vena Cava in Nephroblastoma. R. Daum, H. Roth, and Z. Zachariou. Eur J Pediatr Surg 4:16-20, (February), 1994. Although operative treatment of Wilms' tumors has become more straightforward as a result of advances in preoperative treatment and precise diagnosis, vascular involvement of the tumor can pose serious problems during surgery. Therefore, vascular involvement must be identified preoperatively, and the level of the intravascular tumor thrombus must be defined. The authors propose a classification of intravascular involvement in Wilms' tumors, suggesting clinical consequences and operative strategy. In a series of 84 patients, seven (8.3%) were diagnosed preoperatively a having vascular involvement by means of ultrasound. Surgical technique depends on the stage. Patients with stage III or IV should be operated on in deep hypothermic circulatory arrest in cooperation with the cardiovascular surgeon. --ThomasA. Angerpointner
Bilateral Adrenal Neuroblastoma. Y.. Ishiguro, I£. Iio, M. Nagaya, et al. Eur J Pediatr Surg 4:37-39, (February), 1994. Two cases of bilateral adrenal neuroblastoma in infants are reported. The first patient presented with abdominal distension caused by metastatic hepatomegaly, and the second had elevated urinary vanillylmandelic acid. Both had stage IV-S neuroblastoma. In each case, unilateral adrenalectomy was performed, and the contra]ateral tumor was observed. The size of the remaining tumors decreased slowly, and the clinical progress was good. The