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The functional approach to the management of the pediatric neuropathic bladder: A clinical study
106
ABSTRACTS
greater curvature was displaced, or where the rib-stomach displacement was equivocal, peritoneal lavage is recommended. This investigation has been found to be of value in children with suspected splenic trauma. The significant distance between the greater curvature of the stomach and the inner rib margin in childhood is 3 cm (L.S.~-Lewis
Spitz Feminizing Adrenal Adenoma in a Boy. Case Report and Literature Review. C. P. Howard, H. Takakashi, and A. B. Hay/es. Mayo Clin Proc 52:354-357 (June), 1977.
Feminizing adrenal tumors in young boys initially show bilateral gynecomastia and may have signs of virilization. Presented is a patient with bilateral gynecomastia, left adrenal adenoma, and elevated estrogen levels, but normal levels of 17-ketosteroids.--S. L. Gans
GENITOURINARY
TRACT
Staghom Calculi in Children. F. F. Bartone and J. H. Johnston.
The indications for urinary diversion have become less common since electrostimulation of the bladder, neurosurgical procedures, and drugs like phenoxybenzamine have been introduced. The indication and the advantages of the colon conduit are summarized: a colonic segment lying extraperitoneal avoids adhesions; emptying is prompt and complete because of the strong colonic muscular layer; stenosis of the stoma is seldom seen; acidosis with chloride resorption and loss of potassium does not occur since there is little resorption from the colonic mucosa; replanting the ureters without reflux is technically easier. Very short segments of cecum or sigmoid are used. These short segments are described as caps. Eight children 4-12 yr old underwent urinary diversion without any complications. Only in one boy did a stenosis at the ureterointestinal anastomosis occur a half-yr postoperatively. There was no low pressure reflux, no recurrent urinary infection, and normal serum electrolytes and alkali reserve. Radiographic and isotope studies showed a marked reduction of urinary back pressure c o m b i n e d with b e t t e r function o f the renal pa-
renchyma.--Karl-Ludwig Wang
J Urol 118:76-79 (July), 1977.
Nineteen children who underwent extensive nephrotomies for staghorn calculi (bilateral in 4 cases) are presented. There were 14 boys and 5 girls ranging in age from 1 to 13 yr. Fourteen of these children were less than 6 yr old. Proteus infection was the cause of the calculus in most cases. In the absence of recurrent stones, postoperative renal growth and function were excellent. Stone recurrence was minimal if all calculi were removed and infection was controlled. Follow-up ranged from a few me to 13 yr.--George
Holcomb Predictive Value of Renal Vein Renin Measurements in Children With Various Forms of Renal Hypertension. An International Study. C. Godard. Helv Paediatr Acta 3 2 : 4 9 - 5 7
(June), 1977.
This retrospective international study was undertaken in order to study the value of renal vein renin determinations in predicting the result of surgery in children with hypertension due to renovascular or other renal lesions. From a total of 55 patients (18 children with renal artery stenosis or aneurysm and 37 children with renal parenchymal disease), 33 have been t r e a t e d surgically (29 unilateral nephrectomies, 4 revascularization procedures). The overall cure rate after operation was 87.9% (96.5% in the unilateral lesions). Of 23 patients having a renal vein renin ratio greater than 1.5, 20 were operated successfully. In the group with a ratio less than 1.5, 9 of 10 patients also benefited from surgery. Therefore, the frequency of false-positive or false-negative renal vein renin ratios was 36.4%. Considering the technical problems of sampling and the potential risks of catheterization, the author is of the opinion that at the present time, renal vein renin measurements are not useful as a routine procedure for investigation of a child with renovascular hypertension. Selection of patients with renal hypertension for surgery is better done by adequate conventional methods.--B. Kehrer The Value of the Cecum and Sigmoid Cap in Urinary Diversion. Indication for Operation and Results. C. Janneck. Z
Kinderchir 2 1 : 7 4 - 8 6 (May), 1977.
Congenital Diverticula of the Bladder. C. Janneck. Z Kinderchit 2 0 : 3 4 9 - 3 5 7 (April). 1977.
True congenital diverticula comprise only 10% Of all diverticula of the bladder. They are usually found in boys. Microscopically, congenital diverticula comprise all layers of the bladder. The diverticula are classified according to their site. They are mainly found in the area of the trigone or in the pare-urethral area. Urinary infection and typical twostage micturation are the dominant clinical signs. Micturating cystourethrogram and extretory pyelography are essential for diagnosis. Diverticulectomy is the treatment of choice. Operative details depend upon the localization and upon the size of the diverticulum. Combined intra- and extravesical dissection is necessary in cases of large diverticula near the urethral orifice. Small diverticula can be resected from inside the bladder. Simple diverticulotomy should not be performed in children and may only be indicated in high risk patients.--Karl-Ludwig Wang The Functional Approach to the M a n a g e m e n t of the Pediatric Neuropathic Bladder: A Clinical Study. D. M. Raezer, G, S, Benson, A. J. Wein, and J. W. Duckett, Jr, J Urol
117:649-654 (May). 1977.
A functional approach has been used in the management of the pediatric neuropathic bladder. The experience with 28 incontinent children is reported using pharmacologic manipulation with anticholinergic and sympathomimetic agents. Neuropharmacology and neuroanatomy as they apply to this approach are reviewed. It is concluded that urinary diversion should be used only as a last resort in treatment of urinary incontinence secondary to a neuropathic bladder. The authors believe the patient should be given a trial of these pharmacologic methods during an extended period of time. The trial should be undertaken only when the child has reached an age when he or she can participate in the care. When a combination of pharmacologic manipulation and intermittent catheterization fail, then the Scott genitourinary sphincter is recommended. A failure is reversible and urinary diversion can always be undertaken, if necessary, at a later date.--George Holcomb
ABSTRACTS
greater curvature was displaced, or where the rib-stomach displacement was equivocal, peritoneal lavage is recommended. This investigation has been found to be of value in children with suspected splenic trauma. The significant distance between the greater curvature of the stomach and the inner rib margin in childhood is 3 cm (L.S.~-Lewis
Spitz Feminizing Adrenal Adenoma in a Boy. Case Report and Literature Review. C. P. Howard, H. Takakashi, and A. B. Hay/es. Mayo Clin Proc 52:354-357 (June), 1977.
Feminizing adrenal tumors in young boys initially show bilateral gynecomastia and may have signs of virilization. Presented is a patient with bilateral gynecomastia, left adrenal adenoma, and elevated estrogen levels, but normal levels of 17-ketosteroids.--S. L. Gans
GENITOURINARY
TRACT
Staghom Calculi in Children. F. F. Bartone and J. H. Johnston.
The indications for urinary diversion have become less common since electrostimulation of the bladder, neurosurgical procedures, and drugs like phenoxybenzamine have been introduced. The indication and the advantages of the colon conduit are summarized: a colonic segment lying extraperitoneal avoids adhesions; emptying is prompt and complete because of the strong colonic muscular layer; stenosis of the stoma is seldom seen; acidosis with chloride resorption and loss of potassium does not occur since there is little resorption from the colonic mucosa; replanting the ureters without reflux is technically easier. Very short segments of cecum or sigmoid are used. These short segments are described as caps. Eight children 4-12 yr old underwent urinary diversion without any complications. Only in one boy did a stenosis at the ureterointestinal anastomosis occur a half-yr postoperatively. There was no low pressure reflux, no recurrent urinary infection, and normal serum electrolytes and alkali reserve. Radiographic and isotope studies showed a marked reduction of urinary back pressure c o m b i n e d with b e t t e r function o f the renal pa-
renchyma.--Karl-Ludwig Wang
J Urol 118:76-79 (July), 1977.
Nineteen children who underwent extensive nephrotomies for staghorn calculi (bilateral in 4 cases) are presented. There were 14 boys and 5 girls ranging in age from 1 to 13 yr. Fourteen of these children were less than 6 yr old. Proteus infection was the cause of the calculus in most cases. In the absence of recurrent stones, postoperative renal growth and function were excellent. Stone recurrence was minimal if all calculi were removed and infection was controlled. Follow-up ranged from a few me to 13 yr.--George
Holcomb Predictive Value of Renal Vein Renin Measurements in Children With Various Forms of Renal Hypertension. An International Study. C. Godard. Helv Paediatr Acta 3 2 : 4 9 - 5 7
(June), 1977.
This retrospective international study was undertaken in order to study the value of renal vein renin determinations in predicting the result of surgery in children with hypertension due to renovascular or other renal lesions. From a total of 55 patients (18 children with renal artery stenosis or aneurysm and 37 children with renal parenchymal disease), 33 have been t r e a t e d surgically (29 unilateral nephrectomies, 4 revascularization procedures). The overall cure rate after operation was 87.9% (96.5% in the unilateral lesions). Of 23 patients having a renal vein renin ratio greater than 1.5, 20 were operated successfully. In the group with a ratio less than 1.5, 9 of 10 patients also benefited from surgery. Therefore, the frequency of false-positive or false-negative renal vein renin ratios was 36.4%. Considering the technical problems of sampling and the potential risks of catheterization, the author is of the opinion that at the present time, renal vein renin measurements are not useful as a routine procedure for investigation of a child with renovascular hypertension. Selection of patients with renal hypertension for surgery is better done by adequate conventional methods.--B. Kehrer The Value of the Cecum and Sigmoid Cap in Urinary Diversion. Indication for Operation and Results. C. Janneck. Z
Kinderchir 2 1 : 7 4 - 8 6 (May), 1977.
Congenital Diverticula of the Bladder. C. Janneck. Z Kinderchit 2 0 : 3 4 9 - 3 5 7 (April). 1977.
True congenital diverticula comprise only 10% Of all diverticula of the bladder. They are usually found in boys. Microscopically, congenital diverticula comprise all layers of the bladder. The diverticula are classified according to their site. They are mainly found in the area of the trigone or in the pare-urethral area. Urinary infection and typical twostage micturation are the dominant clinical signs. Micturating cystourethrogram and extretory pyelography are essential for diagnosis. Diverticulectomy is the treatment of choice. Operative details depend upon the localization and upon the size of the diverticulum. Combined intra- and extravesical dissection is necessary in cases of large diverticula near the urethral orifice. Small diverticula can be resected from inside the bladder. Simple diverticulotomy should not be performed in children and may only be indicated in high risk patients.--Karl-Ludwig Wang The Functional Approach to the M a n a g e m e n t of the Pediatric Neuropathic Bladder: A Clinical Study. D. M. Raezer, G, S, Benson, A. J. Wein, and J. W. Duckett, Jr, J Urol
117:649-654 (May). 1977.
A functional approach has been used in the management of the pediatric neuropathic bladder. The experience with 28 incontinent children is reported using pharmacologic manipulation with anticholinergic and sympathomimetic agents. Neuropharmacology and neuroanatomy as they apply to this approach are reviewed. It is concluded that urinary diversion should be used only as a last resort in treatment of urinary incontinence secondary to a neuropathic bladder. The authors believe the patient should be given a trial of these pharmacologic methods during an extended period of time. The trial should be undertaken only when the child has reached an age when he or she can participate in the care. When a combination of pharmacologic manipulation and intermittent catheterization fail, then the Scott genitourinary sphincter is recommended. A failure is reversible and urinary diversion can always be undertaken, if necessary, at a later date.--George Holcomb