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Unusual aspects of urinary calculi in children
626
form of acquired nephrogenic diabetes insipidus in a baby after relief of obstruction due to valves. In this patient and in several others previously reported, restriction of sodium and thiazides proved to be lifesaving during the critical period when the patients are adapting to the chronic polyuric state. Diagnostic studies currently available for this group of disorders with polyuria as the major sign are summarized.George Holcomb, Jr. Unusual Aspects of Urinary Calculi in Children. R. J, Reiner, R. L. Kroovand, and A. D. Perlmutter. J Urol 121:48~481, (April), 1979.
The authors report their experience with 35 children with urinary calculi. The predisposing factors to calculus formation have been established in 20 children. Metabolic screening, although mandatory, has proved unrewarding in the evaluation of children with urinary calculi. Obstructive uropathy, immobilization, urinary stasis and infection, previously undiagnosed urologic anomalies, steroid therapy, milk-alkali syndrome, iatrogenic disease, and endemic disease have contributed to stone formation. The management of children with urinary calculi generally parallels that of adults but reflects a need for caution when performing transurethral extraction of lower ureteral calculi. Reduction in dairy product intake, fluid diuresis and frequent changes in position may provide adequate prophylaxis against urinary calculi in children who must be immobilized.--George Holcomb, Jr. Urolithiasis From Stapler Anastomosis. J. Bisson, R. K.
Vinson, and G. IV. Leadbetter. Am J Surg 137:280-282, (February), 1979. The authors point out that because of the speed, simplicity, and versatility of all automatic stapling devices in the creation of ileal conduits that they are used increasingly. They point out however three instances in which staples from the GIA stapling device served as a nidus for stone formation in Bricker ileal conduits. Attempts to separate the urinary stream from the staple line by oversewing the staple line with chromic cat gut were unsuccessful. In all three of the reported patients, the stones that were formed in the ileal conduit passed spontaneously and without complication. Because the authors remain enthusiastic about the use of the stapling device in the formation of the enteroenterostomy required for reconstitution of bowel continuity during the construction of an ileal conduit, they have modified their procedure. They now do one of two things to remove the staple line from exposure to the urinary stream: (1) they excise and oversew the intra-abdominal end of the ileal conduit when performing a Bricker procedure; (2) they excise the staple line and perform an ileal conduit after the method of Wallace (Br J Urol 38:522, 1966). The authors state that either of these two modifications obviate the problem of urolithiasis with the staple as a nidus.--Carey P. Page Urolithiasis in Children. R. F. X. Noronha, J. G. Gregory, and J. J. Duke. J Urol 121:478-479, (April), 1979.
In this 10-yr review of 22 documented cases of urolithiasis,
ABSTRACTS
it was found that the stones were related to infection most often and urinary diversion secondary to congenital abnormalities of the urinary tract was the most frequent predisposing cause. Urine cultures were positive in 54% of patients with Proteus mirabilis cultured most frequently either in pure or mixed culture. Operative removal of the stones was required in 14 patients for one or more of the following indications: (1) staghorn calculi or stones too large to be passed spontaneously, (2) recurrent urinary tract infection associated with obstruction by the calculi, and (3) obstruction without infection such as ureteropelvic junction obstruction when an operation was indicated to relieve renal parenchymal damage. Twenty-seven percent of the stones were passed spontaneously. Of the 10 stones that were analyzed, 6 were infection stones and the rest were calcium oxalate. There were no cystine or uric acid stones.--George Holcomb, Jr. Doppler Flowmeter in the Differential Diagnosis of the Acute Scrotum in Children. M. luchtman, L. Zoireff, and J.
Assa. J Urol 121:221-222, (February), 1979. Differential diagnosis of an acute scrotum in infants and children often represents a dilemma that can continue in the operating room when one is faced with an apparently badly damaged testis. A Doppler flowmeter was used to evaluate an acute scrotum in 23 children. A diminished or absent flow was noted in cases of torsion of the testis. Orchitis, epididymitis and torsion of the testicular appendix were accompanied by an increased blood flow. In all operated cases the diagnosis proved to be correct. Initially this technique was accepted as a complementary measure and only the accuracy confirmed in all operated cases led the authors to trust the readings as a good indicator for operative or non-operative treatment. Nine patients had complete torsion of the testis with no flow and four had torsion of the testicular appendix with an inflammatory reaction that was responsible for the increased flow. In this experience the Doppler flowmeter has proved to be reliable.--George Holcomb, Jr. An Abdominal Extraperitoneal Approach for the Difficult Orchidopexy. P. F. Jones and F. H. Bagley. Br J Surg
66:14-18, (January), 1979. The precise technical details of an abdominal extraperitoneal approach for orchidopexy using a muscle-splitting incision are explicitly described. The description of the operative procedure is accompanied by simple well-illustrated figures. The technique is advocated as a primary approach for all impalpable testes and also for the "emergent" type of maldescent of the testis, i.e., the testis that can be massaged out of the inguinal canal. The approach allows a certainty of diagnosis in cases of anorchia by affording wide exposure of the retroperitoneal area. The authors also recommend the procedure when orchidopexy has to be combined with a herniotomy in infancy. In a series of 86 operations, the testis was able to be located in the scrotum in 85. On 123 occasions a palpable testis (superficial inguinal ectopic type) was mobilized by the conventional inguinal approach and placed in a good position in the scrotum in every c a s e . Lewis Spitz
form of acquired nephrogenic diabetes insipidus in a baby after relief of obstruction due to valves. In this patient and in several others previously reported, restriction of sodium and thiazides proved to be lifesaving during the critical period when the patients are adapting to the chronic polyuric state. Diagnostic studies currently available for this group of disorders with polyuria as the major sign are summarized.George Holcomb, Jr. Unusual Aspects of Urinary Calculi in Children. R. J, Reiner, R. L. Kroovand, and A. D. Perlmutter. J Urol 121:48~481, (April), 1979.
The authors report their experience with 35 children with urinary calculi. The predisposing factors to calculus formation have been established in 20 children. Metabolic screening, although mandatory, has proved unrewarding in the evaluation of children with urinary calculi. Obstructive uropathy, immobilization, urinary stasis and infection, previously undiagnosed urologic anomalies, steroid therapy, milk-alkali syndrome, iatrogenic disease, and endemic disease have contributed to stone formation. The management of children with urinary calculi generally parallels that of adults but reflects a need for caution when performing transurethral extraction of lower ureteral calculi. Reduction in dairy product intake, fluid diuresis and frequent changes in position may provide adequate prophylaxis against urinary calculi in children who must be immobilized.--George Holcomb, Jr. Urolithiasis From Stapler Anastomosis. J. Bisson, R. K.
Vinson, and G. IV. Leadbetter. Am J Surg 137:280-282, (February), 1979. The authors point out that because of the speed, simplicity, and versatility of all automatic stapling devices in the creation of ileal conduits that they are used increasingly. They point out however three instances in which staples from the GIA stapling device served as a nidus for stone formation in Bricker ileal conduits. Attempts to separate the urinary stream from the staple line by oversewing the staple line with chromic cat gut were unsuccessful. In all three of the reported patients, the stones that were formed in the ileal conduit passed spontaneously and without complication. Because the authors remain enthusiastic about the use of the stapling device in the formation of the enteroenterostomy required for reconstitution of bowel continuity during the construction of an ileal conduit, they have modified their procedure. They now do one of two things to remove the staple line from exposure to the urinary stream: (1) they excise and oversew the intra-abdominal end of the ileal conduit when performing a Bricker procedure; (2) they excise the staple line and perform an ileal conduit after the method of Wallace (Br J Urol 38:522, 1966). The authors state that either of these two modifications obviate the problem of urolithiasis with the staple as a nidus.--Carey P. Page Urolithiasis in Children. R. F. X. Noronha, J. G. Gregory, and J. J. Duke. J Urol 121:478-479, (April), 1979.
In this 10-yr review of 22 documented cases of urolithiasis,
ABSTRACTS
it was found that the stones were related to infection most often and urinary diversion secondary to congenital abnormalities of the urinary tract was the most frequent predisposing cause. Urine cultures were positive in 54% of patients with Proteus mirabilis cultured most frequently either in pure or mixed culture. Operative removal of the stones was required in 14 patients for one or more of the following indications: (1) staghorn calculi or stones too large to be passed spontaneously, (2) recurrent urinary tract infection associated with obstruction by the calculi, and (3) obstruction without infection such as ureteropelvic junction obstruction when an operation was indicated to relieve renal parenchymal damage. Twenty-seven percent of the stones were passed spontaneously. Of the 10 stones that were analyzed, 6 were infection stones and the rest were calcium oxalate. There were no cystine or uric acid stones.--George Holcomb, Jr. Doppler Flowmeter in the Differential Diagnosis of the Acute Scrotum in Children. M. luchtman, L. Zoireff, and J.
Assa. J Urol 121:221-222, (February), 1979. Differential diagnosis of an acute scrotum in infants and children often represents a dilemma that can continue in the operating room when one is faced with an apparently badly damaged testis. A Doppler flowmeter was used to evaluate an acute scrotum in 23 children. A diminished or absent flow was noted in cases of torsion of the testis. Orchitis, epididymitis and torsion of the testicular appendix were accompanied by an increased blood flow. In all operated cases the diagnosis proved to be correct. Initially this technique was accepted as a complementary measure and only the accuracy confirmed in all operated cases led the authors to trust the readings as a good indicator for operative or non-operative treatment. Nine patients had complete torsion of the testis with no flow and four had torsion of the testicular appendix with an inflammatory reaction that was responsible for the increased flow. In this experience the Doppler flowmeter has proved to be reliable.--George Holcomb, Jr. An Abdominal Extraperitoneal Approach for the Difficult Orchidopexy. P. F. Jones and F. H. Bagley. Br J Surg
66:14-18, (January), 1979. The precise technical details of an abdominal extraperitoneal approach for orchidopexy using a muscle-splitting incision are explicitly described. The description of the operative procedure is accompanied by simple well-illustrated figures. The technique is advocated as a primary approach for all impalpable testes and also for the "emergent" type of maldescent of the testis, i.e., the testis that can be massaged out of the inguinal canal. The approach allows a certainty of diagnosis in cases of anorchia by affording wide exposure of the retroperitoneal area. The authors also recommend the procedure when orchidopexy has to be combined with a herniotomy in infancy. In a series of 86 operations, the testis was able to be located in the scrotum in 85. On 123 occasions a palpable testis (superficial inguinal ectopic type) was mobilized by the conventional inguinal approach and placed in a good position in the scrotum in every c a s e . Lewis Spitz