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Ureterocalicostomy for renal salvage
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was done in two children. External sphincterotomy failed to cure reflux in five children. Five infants with mild grades of reflux were managed expectantly and one had spontaneous resolution of the reflux. Overall this systematic approach resulted in cure in 23 patients (64%), stable but persistent reflux without recurrent infection or renal deterioration in 11 (30%) and failure in two (6%). No child required urinary diversion. The indications for each treatment modality are discussed.--George Holcomb, Jr. Whitaker Test After Pyeloplasty: Establishment of Normal Ureteral Perfusion Pressures. J. H. Newhouse, R. C. Pfister,
W. H. Hendren, et al. Am J Roentgenol 137:223-226, (August), 1981. Antegrade percutaneous ureteral perfusion after successful repair of a unilateral ureteropelvic junction obstruction in 29 patients yielded results for normal ureters. During perfusion absolute pressures in the renal pelvis and bladder increased, but differential pressures (renal pelvic minus bladder) fell as the bladder filled. The maximum pressure reached in the renal pelvis was 13 cm in two patients and 24 never went higher than 9 cm (figures at perfusion rate of 10 ml/min). The authors feel these figures represent normal ureteral function and should be utilized to evaluate abnormal ureters when using the Whitaker test.--Randall W. Powell
INTERNATIONAL ABSTRACTS
children died. If a graft can be preserved for more than 2 yr, a long duration of graft function can be expected. Due to immunosuppressive therapy, growth and sexual development is retarded. The authors recommend renal transplantation as optimal therapy in chronic renal insufficiency in childhood.-- Thomas A. Angerpointner Supportive Testosterone Treatment in Surgical Repair of
Hypospadias. U. C. Heinrich and M. Bolkenius. Z Kinderchir 37:20-22, 1982. A hypoplastic penis may render the surgical repair of a hypospadias difficult. An increase of penis size might sometimes be desired to provide satisfactory surgical results. According to Guthrie et al (1973) growth of a micropenis can be achieved by low-dose testosterone administration. The authors applied this therapy (testosterone-enantate 3 x 25 to 3 • 250 mg i.m.) in nine boys with hypospadias and micropenis. Therapy was started 6 wk before operation. While there was a significant increase of penis size in all patients, a slight transitory acceleration of skeletal development appeared in three boys and transitory acceleration of growth rate in seven boys. No signs of masculinization were noted.-- Thomas A. Angerpointner Endocrinological Study of Testicular Descent in the Rabbit.
J. Rafter. J Surg Res 33:158-163, (August), 1982. Ureterocalicostomy for Renal Salvage. J. W. Duckett and
R. R. Pfister. J Urol 128:98-101, (July), 1982. The surgical technique and indications of ureterocalicostomy in children are presented along with six illustrated cases. If the renal pelvis and ureter can be mobilized adequately, the strictured area excised and reanastomosis achieved without tension, a repeat pyeloplasty is the procedure of choice. However, when the renal pelvis is either markedly involved in dense scarring secondary to infection or previous surgery, or is intrarenal, a ureteropelvic anastomosis may not be satisfactory. In such circumstances ureterocalicostomy can provide the necessary drainage.--George Holcomb, Jr. Results of Renal Transplantation in Childhood. R. Rauhs, O.
Wagner, G. Kretschmer, et al. Z Kinderchir 36:107-109, 1982. Chronic glomerulonephritis is the most common cause of renal insufficiency in childhood. Besides dialysis, increased experience with renal transplantation has led to successful application of this method in the treatment of terminal renal insufficiency. Twenty-seven children underwent 37 renal transplantations at the University Surgical Clinic of Vienna from 1968 to 1980. This was 6.9% of a total of 536 renal transplantations performed during this time. The mean age was 12.5 yr, ranging from 2 to 16 yr. Preceding dialysis lasted 7 mo on the average. Children over 10 yr underwent heterotropic transplantation, children under 10 yr orthotopic transplantation. In 67% transplant function was maintained for more than 2 yr. Thirteen children had functioning grafts by the beginning of 1981 with a mean serum Creatinin level of 1.8 _+ 1.2 mg%. These children are fully rehabilitatedl Four children had a functioning graft for more than 7 yr. Nine
Testicular descent in the rabbit can be completely inhibited by administration of estrogen. This inhibition of testicular descent by estrogen can be reversed by simultaneous treatment with dihydrotestosterone, human chorionic gonadotrophin, or three alpha-androstanediol. It cannot be reversed by testosterone. The author concludes from these data that in the rabbit (a) testicular descent appears to be an androgenmediated event, (b) the active androgen involved in this event is most likely dihydrotestosterone, and (c) testicular descent appears to be under the regulation of the hypothalamicpituitary-testicular axis.--Richard R. Ricketts Treatment and Schedule of Cryptorchidism. B. H~cht and F. Hadziselimovic. Z Kinderchir 37:15-19, 1982.
Endocrine dysfunctions are among the most important causes of cryptorchidism. Whereas all undescended testicles showed spermatogonia when biopsies were done during the first 6 mo of life, a dramatic loss of spermatogonia in both the undescended and the descended testicle was seen already in the second year of life. Because of reduced follicle-stimulating hormone levels, a disturbance of the hypothalamuspituitary gland-testicle-axis is assumed as cause of cryptorchidism. Therefore gonadotrophin treatment of cryptorchidism is a logical consequence. In this study 119 boys (2-8 yr old) were treated for uni- and bilateral cryptorchidism with a LH-RH nasal spray. Descensus rate thereafter was 47%-55%. LH-RH-treatment should be initiated as the first conservative treatment in the first year of life. If it is not successful, descensus can be achieved by additional administration of human chorionic gonadotrophin in a high percentage of cases. Combined conservative treatment provided descensus in up to 83% of maldescended testicles in this study.-- Thomas A. Angerpointner
was done in two children. External sphincterotomy failed to cure reflux in five children. Five infants with mild grades of reflux were managed expectantly and one had spontaneous resolution of the reflux. Overall this systematic approach resulted in cure in 23 patients (64%), stable but persistent reflux without recurrent infection or renal deterioration in 11 (30%) and failure in two (6%). No child required urinary diversion. The indications for each treatment modality are discussed.--George Holcomb, Jr. Whitaker Test After Pyeloplasty: Establishment of Normal Ureteral Perfusion Pressures. J. H. Newhouse, R. C. Pfister,
W. H. Hendren, et al. Am J Roentgenol 137:223-226, (August), 1981. Antegrade percutaneous ureteral perfusion after successful repair of a unilateral ureteropelvic junction obstruction in 29 patients yielded results for normal ureters. During perfusion absolute pressures in the renal pelvis and bladder increased, but differential pressures (renal pelvic minus bladder) fell as the bladder filled. The maximum pressure reached in the renal pelvis was 13 cm in two patients and 24 never went higher than 9 cm (figures at perfusion rate of 10 ml/min). The authors feel these figures represent normal ureteral function and should be utilized to evaluate abnormal ureters when using the Whitaker test.--Randall W. Powell
INTERNATIONAL ABSTRACTS
children died. If a graft can be preserved for more than 2 yr, a long duration of graft function can be expected. Due to immunosuppressive therapy, growth and sexual development is retarded. The authors recommend renal transplantation as optimal therapy in chronic renal insufficiency in childhood.-- Thomas A. Angerpointner Supportive Testosterone Treatment in Surgical Repair of
Hypospadias. U. C. Heinrich and M. Bolkenius. Z Kinderchir 37:20-22, 1982. A hypoplastic penis may render the surgical repair of a hypospadias difficult. An increase of penis size might sometimes be desired to provide satisfactory surgical results. According to Guthrie et al (1973) growth of a micropenis can be achieved by low-dose testosterone administration. The authors applied this therapy (testosterone-enantate 3 x 25 to 3 • 250 mg i.m.) in nine boys with hypospadias and micropenis. Therapy was started 6 wk before operation. While there was a significant increase of penis size in all patients, a slight transitory acceleration of skeletal development appeared in three boys and transitory acceleration of growth rate in seven boys. No signs of masculinization were noted.-- Thomas A. Angerpointner Endocrinological Study of Testicular Descent in the Rabbit.
J. Rafter. J Surg Res 33:158-163, (August), 1982. Ureterocalicostomy for Renal Salvage. J. W. Duckett and
R. R. Pfister. J Urol 128:98-101, (July), 1982. The surgical technique and indications of ureterocalicostomy in children are presented along with six illustrated cases. If the renal pelvis and ureter can be mobilized adequately, the strictured area excised and reanastomosis achieved without tension, a repeat pyeloplasty is the procedure of choice. However, when the renal pelvis is either markedly involved in dense scarring secondary to infection or previous surgery, or is intrarenal, a ureteropelvic anastomosis may not be satisfactory. In such circumstances ureterocalicostomy can provide the necessary drainage.--George Holcomb, Jr. Results of Renal Transplantation in Childhood. R. Rauhs, O.
Wagner, G. Kretschmer, et al. Z Kinderchir 36:107-109, 1982. Chronic glomerulonephritis is the most common cause of renal insufficiency in childhood. Besides dialysis, increased experience with renal transplantation has led to successful application of this method in the treatment of terminal renal insufficiency. Twenty-seven children underwent 37 renal transplantations at the University Surgical Clinic of Vienna from 1968 to 1980. This was 6.9% of a total of 536 renal transplantations performed during this time. The mean age was 12.5 yr, ranging from 2 to 16 yr. Preceding dialysis lasted 7 mo on the average. Children over 10 yr underwent heterotropic transplantation, children under 10 yr orthotopic transplantation. In 67% transplant function was maintained for more than 2 yr. Thirteen children had functioning grafts by the beginning of 1981 with a mean serum Creatinin level of 1.8 _+ 1.2 mg%. These children are fully rehabilitatedl Four children had a functioning graft for more than 7 yr. Nine
Testicular descent in the rabbit can be completely inhibited by administration of estrogen. This inhibition of testicular descent by estrogen can be reversed by simultaneous treatment with dihydrotestosterone, human chorionic gonadotrophin, or three alpha-androstanediol. It cannot be reversed by testosterone. The author concludes from these data that in the rabbit (a) testicular descent appears to be an androgenmediated event, (b) the active androgen involved in this event is most likely dihydrotestosterone, and (c) testicular descent appears to be under the regulation of the hypothalamicpituitary-testicular axis.--Richard R. Ricketts Treatment and Schedule of Cryptorchidism. B. H~cht and F. Hadziselimovic. Z Kinderchir 37:15-19, 1982.
Endocrine dysfunctions are among the most important causes of cryptorchidism. Whereas all undescended testicles showed spermatogonia when biopsies were done during the first 6 mo of life, a dramatic loss of spermatogonia in both the undescended and the descended testicle was seen already in the second year of life. Because of reduced follicle-stimulating hormone levels, a disturbance of the hypothalamuspituitary gland-testicle-axis is assumed as cause of cryptorchidism. Therefore gonadotrophin treatment of cryptorchidism is a logical consequence. In this study 119 boys (2-8 yr old) were treated for uni- and bilateral cryptorchidism with a LH-RH nasal spray. Descensus rate thereafter was 47%-55%. LH-RH-treatment should be initiated as the first conservative treatment in the first year of life. If it is not successful, descensus can be achieved by additional administration of human chorionic gonadotrophin in a high percentage of cases. Combined conservative treatment provided descensus in up to 83% of maldescended testicles in this study.-- Thomas A. Angerpointner