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The absence of vesicoureteral reflux in the neonate with myelodysplasia
ABSTRACTS
lateral ureterosigmoidostomy for bladder exstrophy. Literature search for t u m o r s after ureterosigmoidostomy reveals 19 m a l i g n a n t colonic neoplasms, as well as three transitional carcin o m a s and nine benign tumors of colonic origin. The most c o m m o n presentations were rectal bleeding and ureteral obstruction. If elderly patients diverted for carcinoma of the bladder are excluded from the search, colon cancers were diagnosed at a m e a n age of 35.2 yr. Because patients with ureterosigmoidostomy often have rectal bleeding a n d / o r ureteral obstruction, the authors stress close, long-term followu p . - - S . Kim Antireflux Ureterocystostomy at the Vertex of the Bladder. I. Bradic, M. Pasini and G. Vlatkovic. Br J Urol 47:525-530 (October), 1975.
The authors, from Zagreb, Yugoslavia, describe a technique of ureteroneocystostomy similar to that of Lich-Gregoir except that the ureter is implanted into the bladder vertex. The advantage is that a very long submucosal segm e n t o f ureter can be constructed. This is of particular value in the case of a very dilated ureter where, in spite of operative narrowing, the ureter is still wider than normal. The operation was performed on 90 children, 16 bilaterally. In 40 cases ureteric tailoring was carried out. The overall rate of recurrent reflux was 5.7~o.--J. H. Johnston Bilateral Vesicoureteral Reflux With Pyelonephritis in Identical Twins. N. Hampel, D. R. Levin, and I. Gersh. Br J Urol 47:535-537 (October), 1975.
T h e authors, from Haifa, Israel, report the cases of identical male twins aged 20 yr. O n e presented with pain due to a left ureteric stone. He was shown to have right pyelonephritic scarring and bilateral reflux. T h e asymptomatic twin was investigated; he had severe bilateral pyelonephritis with bilateral reflux. There are two hypotheses to explain the m o d e of inheritance of reflux. O n e suggests a d o m i n a n t gene with incomplete penetrance. T h e other postulates that the condition is transmitted by multiple genes of cumulative effect. It is concluded that, when one m e m b e r of a family is found to have reflux, the others should be investigated.-J. H. Johnston Nonobstructive Megacystis And Refluxing Megaureter In Preteen Enuretic Boys With Minimal Symptoms. K. J. Welch, W. Stewart and R. L. Lebowltz. J Urol 114:449 (September), 1975.
489
F o u r male patients between the ages of 7-10 yr are reported, presenting with enuresis and urinary tract infection. O n investigation each h a d nonobstructive, nonneurogenic refluxing m e g a c y s t i s - - m e g a u r e t e r as described by D. I. Williams. Three of the children have been totally reconstructed with a follow up in excess of 4 yr. The fourth child is in the process of reconstruction. T h e treatment in each case was individualized. T h e a u t h o r s m a k e a plea that any older child with nocturnal enuresis should be completely evaluated.--S. Kim The Absence of Vesicoureteral Reflux In The Neonate With Myelodysplasia. S. B. Levitt and H. J. Sandier. J Urol 114:118 (July), 1975. Twenty-one newborns with spina bifida were studied during the first 6 wk of life. Initial studies included suprapubic bladder aspiration which was sterile in 20 cases. IVP was abnormal in five and V C U G a b n o r m a l in six, alt h o u g h none h a d vesicoureteral reflux. The a u t h o r s feel the increasing incidence of reflux in the child with myelodysplasia is secondary to recurrent infections and bladder dysfunction. T h e ureterovesical junction in a newborn with myelodysplasia is probably n o r m a l . - - S . Kim The Silent Neurogenic Bladder. J. G. Bucy and M. R. Carlin. J Urol 114:296 (August), 1975. Three cases are presented where antireflux surgery was carried o u t for severe reflux in neurogenic bladders. All cases demonstrated deterioration in renal function following reimplantation. The a u t h o r s feel that patients with neurogenic bladders should be evaluated very extensively and carefully before antireflux surgery is contemplated. S. Kim Obstructive Posterior Urethral Valves. S. Vaage, G. Stake, and O. Knutrud. Prog Pediatr Surg 7: 125-140, 1974.
Urethral valves m a y form from unduly large or mobile urethral folds or as irregularities at the site of termination of the Wolfian ducts in the lateral wall of the posterior urethra. In 13 yr, 26 boys presented with urethral valves. Sixteen were under 1 yr o f age, eight between 4 and 8 yr and one aged 11 yr. Only one had no anatomical changes proximal to the urethra; 14 had severely dilated upper tracts with disturbed renal function. Improved results have been obtained in recent years by early reconstruction and reimplantation of grossly dilated ureters. U p p e r tract pathology m a y be a specific congen-
lateral ureterosigmoidostomy for bladder exstrophy. Literature search for t u m o r s after ureterosigmoidostomy reveals 19 m a l i g n a n t colonic neoplasms, as well as three transitional carcin o m a s and nine benign tumors of colonic origin. The most c o m m o n presentations were rectal bleeding and ureteral obstruction. If elderly patients diverted for carcinoma of the bladder are excluded from the search, colon cancers were diagnosed at a m e a n age of 35.2 yr. Because patients with ureterosigmoidostomy often have rectal bleeding a n d / o r ureteral obstruction, the authors stress close, long-term followu p . - - S . Kim Antireflux Ureterocystostomy at the Vertex of the Bladder. I. Bradic, M. Pasini and G. Vlatkovic. Br J Urol 47:525-530 (October), 1975.
The authors, from Zagreb, Yugoslavia, describe a technique of ureteroneocystostomy similar to that of Lich-Gregoir except that the ureter is implanted into the bladder vertex. The advantage is that a very long submucosal segm e n t o f ureter can be constructed. This is of particular value in the case of a very dilated ureter where, in spite of operative narrowing, the ureter is still wider than normal. The operation was performed on 90 children, 16 bilaterally. In 40 cases ureteric tailoring was carried out. The overall rate of recurrent reflux was 5.7~o.--J. H. Johnston Bilateral Vesicoureteral Reflux With Pyelonephritis in Identical Twins. N. Hampel, D. R. Levin, and I. Gersh. Br J Urol 47:535-537 (October), 1975.
T h e authors, from Haifa, Israel, report the cases of identical male twins aged 20 yr. O n e presented with pain due to a left ureteric stone. He was shown to have right pyelonephritic scarring and bilateral reflux. T h e asymptomatic twin was investigated; he had severe bilateral pyelonephritis with bilateral reflux. There are two hypotheses to explain the m o d e of inheritance of reflux. O n e suggests a d o m i n a n t gene with incomplete penetrance. T h e other postulates that the condition is transmitted by multiple genes of cumulative effect. It is concluded that, when one m e m b e r of a family is found to have reflux, the others should be investigated.-J. H. Johnston Nonobstructive Megacystis And Refluxing Megaureter In Preteen Enuretic Boys With Minimal Symptoms. K. J. Welch, W. Stewart and R. L. Lebowltz. J Urol 114:449 (September), 1975.
489
F o u r male patients between the ages of 7-10 yr are reported, presenting with enuresis and urinary tract infection. O n investigation each h a d nonobstructive, nonneurogenic refluxing m e g a c y s t i s - - m e g a u r e t e r as described by D. I. Williams. Three of the children have been totally reconstructed with a follow up in excess of 4 yr. The fourth child is in the process of reconstruction. T h e treatment in each case was individualized. T h e a u t h o r s m a k e a plea that any older child with nocturnal enuresis should be completely evaluated.--S. Kim The Absence of Vesicoureteral Reflux In The Neonate With Myelodysplasia. S. B. Levitt and H. J. Sandier. J Urol 114:118 (July), 1975. Twenty-one newborns with spina bifida were studied during the first 6 wk of life. Initial studies included suprapubic bladder aspiration which was sterile in 20 cases. IVP was abnormal in five and V C U G a b n o r m a l in six, alt h o u g h none h a d vesicoureteral reflux. The a u t h o r s feel the increasing incidence of reflux in the child with myelodysplasia is secondary to recurrent infections and bladder dysfunction. T h e ureterovesical junction in a newborn with myelodysplasia is probably n o r m a l . - - S . Kim The Silent Neurogenic Bladder. J. G. Bucy and M. R. Carlin. J Urol 114:296 (August), 1975. Three cases are presented where antireflux surgery was carried o u t for severe reflux in neurogenic bladders. All cases demonstrated deterioration in renal function following reimplantation. The a u t h o r s feel that patients with neurogenic bladders should be evaluated very extensively and carefully before antireflux surgery is contemplated. S. Kim Obstructive Posterior Urethral Valves. S. Vaage, G. Stake, and O. Knutrud. Prog Pediatr Surg 7: 125-140, 1974.
Urethral valves m a y form from unduly large or mobile urethral folds or as irregularities at the site of termination of the Wolfian ducts in the lateral wall of the posterior urethra. In 13 yr, 26 boys presented with urethral valves. Sixteen were under 1 yr o f age, eight between 4 and 8 yr and one aged 11 yr. Only one had no anatomical changes proximal to the urethra; 14 had severely dilated upper tracts with disturbed renal function. Improved results have been obtained in recent years by early reconstruction and reimplantation of grossly dilated ureters. U p p e r tract pathology m a y be a specific congen-