- Email: [email protected]
Urethral strictures secondary to pelvic injury in children
ABSTRACTS
over a 10-yr period were reviewed, the average follow-up period being 13.2 yr. The main indications for diversion were neuropathic bladder secondary to spina bifida 67% (32) and ectopia vesicae 17% (8). The mortality rate was 36%; onethird of these died in the perioperative period. The rest were late deaths and half of these were due to renal failure. Twenty-six patients were available for review. Stomal complications were reported in over 60%, ureterocolic stenosis had a total incidence of 22%, calculi developed in 6 patients, and electrolyte disturbances in 3. More than 50% had organisms cultured from the urine at review and it was estimated that 21% had frequent and 66% occasional urine infections. Ureteric reflux was reported to have occurred in 58% of renal units and this was associated with a high rate (80%) of renal abnormality. Deterioration occurred in 48% of the 31 renal units normal at the time of original operation and of the 15 initially abnormal upper urinary tracts, only 2 were shown to have been improved. For a procedure designed mainly to prevent reflux and protect the upper urinary tract, the results are disappointing and show no advantage over ileal conduits. Regular follow-up with yearly radiographic investigation is recommended.--R. G. Buick Duplications of the Lower Urinary Tract in Children. C. R.
J. Woodhouse and D. L Williams. Br J Urol 51:481-487, 1979. There are 7 cases of bladder duplication and 27 cases of urethral duplication presented. Duplication of the bladder was collateral but urethral duplication was usually in the sagittal plane (except when it occurred with bladder duplication). This fundamental difference points to different etiologies. The cases of bladder duplication are described in detail; there was a high incidence of associated non-urological abnormalities. The main aim of managing these cases was to eliminate stasis by uniting the bladder in 5 cases and excising the bladder in 2 cases. Urethral duplications are either collateral, epispadiac, hypospadiac, spindle or Y-duplications, the latter type often having associated major congenital abnormalities. Effective sphincter mechanism was usually present in the normally placed urethra and in 22 of the 26 survivors there was normal continence.--R. G. Buick The Changing Role of Cystoscopy in the Pediatric Patient.
D. K. Johnson, R. L. Kroovand, A. D. Perlmutter. J Urol 123:232-233, (February), 1980. Cystoscopy is used too often in the pediatric patient and frequently is without diagnostic or therapeutic benefit to the child. Cystoscopy is of little proved benefit in the evaluation and treatment of recurrent cystitis, primary enuresis and most cases of hematuria. In children initially diagnosed with vesicoureteral reflux therapeutic determinations generally can be made on the basis of response to appropriate antimicrobial therapy and from uroradiographic findings. Cystoscopy is helpful in determining prognosis in reflux, particularly with persistent reflux and this procedure is not routinely necessary in initial evaluation, at least of lesser grades. Cystoscopy remains a valuable tool to evaluate urinary obstruction and severe congenital defects, such as intersex and cloacal anomalies, and to help place percutaneous suprapubic tubes for bladder cycling before urinary undiversion and for urodynamic evaluation.--George Holcomb, Jr.
703
Experiences With Urinary Undiversion in Children With Neurogenic Bladder. A. D. Perlmutter. J Urol 123:402-406,
(March), 1980. Six children have undergone reconstruction of the urinary tract 14 mo-14 yr after supravesical diversion for neurogenic bladder dysfunction. Five are continent: 4 by intermittent catheterization and i by voiding to completion. One child is just beyond infancy and wets but is not yet on a systematic program. One boy was considered a technical failure despite incontinence because of progressive hydronephrosis from a noncompliant bladder but he subsequently had an augmentation cystoplasty. Urinary undiversion into a neurogenic bladder is an acceptable option as an alternative to ileal conduit revision or for reasons of patient preference, provided bladder storage capacity is adequate at acceptably low resting pressures, without incontinence.--George Holcomb, Jr. Urethral Strictures Secondary to Pelvic Injury in Children.
J. L Harty and M. Amin. J Urol 123:234-236, (February), 1980. The surgical repair of a membranous urethral stricture is difficult because of the location and potential risks of incontinence, impotence, and infertility. The treatment of 2 such strictures in a 6-yr-old and 13-yr-old boy by the Badenoch pullthrough urethroplasty is presented. The technique is described and its apparent advantages over other methods of repair are discussed. George Holcomb, Jr. Utricular Configuration in Hypospadias and Intarsex. C. J,
Devine, Jr., L. Gonzalez-Serva, J. F. Stecker, Jr., el al. J Urol 123:407~,11, (March), 1980. To evaluate the incidence and significance of an enlarged prostatic utricle in hypospadiac patients without underlying intersex 44 patients with the meatus located in the perineum, penoscrotal junction, or proximal two-thirds of the penis were evaluated with cystourethroscopy immediately before the operation. There was an abnormally enlarged utricle in 57% of the perineal, 10% of the penoscrotal, and none of the penile hypospadiacs, for an over-all incidence of 14%. Concurrent analysis of a series of phenotypic male patients with hypospadias and intersex revealed a high incidence of enlarged utricle or the presence of a vagina masculinus. Utricular enlargement in itself does not indicate intersexuality but careful cystoscopic examination if its vault needs to be undertaken, searching for a cervix. An enlarged utricle can be a manifestation of delayed mullerian duct regression or decreased androgenic stimulation of the urogenital s i n u s . George Holcomb, Jr. Urinary Diversion by Ileo-Cystostomy in Traumatic Avulsion of the Male Genitals. D. C. Keramidas, G. Fotis, Th.
Dolatzas, et al. Z Kinderchir 27:73-75, (May), 1979. A case of urinary diversion by ileo-cystostomy in a child who was submitted previously to cystostomy following traumatic avulsion of the genitals is described. The isolated ileal loop was anastomosed isoperistaltically with the bladder and its distal part was fashioned as a permanent ileostomy so that a plastic adhesive bag could be used. The complications of cystostomy were overcome with this operation and the
over a 10-yr period were reviewed, the average follow-up period being 13.2 yr. The main indications for diversion were neuropathic bladder secondary to spina bifida 67% (32) and ectopia vesicae 17% (8). The mortality rate was 36%; onethird of these died in the perioperative period. The rest were late deaths and half of these were due to renal failure. Twenty-six patients were available for review. Stomal complications were reported in over 60%, ureterocolic stenosis had a total incidence of 22%, calculi developed in 6 patients, and electrolyte disturbances in 3. More than 50% had organisms cultured from the urine at review and it was estimated that 21% had frequent and 66% occasional urine infections. Ureteric reflux was reported to have occurred in 58% of renal units and this was associated with a high rate (80%) of renal abnormality. Deterioration occurred in 48% of the 31 renal units normal at the time of original operation and of the 15 initially abnormal upper urinary tracts, only 2 were shown to have been improved. For a procedure designed mainly to prevent reflux and protect the upper urinary tract, the results are disappointing and show no advantage over ileal conduits. Regular follow-up with yearly radiographic investigation is recommended.--R. G. Buick Duplications of the Lower Urinary Tract in Children. C. R.
J. Woodhouse and D. L Williams. Br J Urol 51:481-487, 1979. There are 7 cases of bladder duplication and 27 cases of urethral duplication presented. Duplication of the bladder was collateral but urethral duplication was usually in the sagittal plane (except when it occurred with bladder duplication). This fundamental difference points to different etiologies. The cases of bladder duplication are described in detail; there was a high incidence of associated non-urological abnormalities. The main aim of managing these cases was to eliminate stasis by uniting the bladder in 5 cases and excising the bladder in 2 cases. Urethral duplications are either collateral, epispadiac, hypospadiac, spindle or Y-duplications, the latter type often having associated major congenital abnormalities. Effective sphincter mechanism was usually present in the normally placed urethra and in 22 of the 26 survivors there was normal continence.--R. G. Buick The Changing Role of Cystoscopy in the Pediatric Patient.
D. K. Johnson, R. L. Kroovand, A. D. Perlmutter. J Urol 123:232-233, (February), 1980. Cystoscopy is used too often in the pediatric patient and frequently is without diagnostic or therapeutic benefit to the child. Cystoscopy is of little proved benefit in the evaluation and treatment of recurrent cystitis, primary enuresis and most cases of hematuria. In children initially diagnosed with vesicoureteral reflux therapeutic determinations generally can be made on the basis of response to appropriate antimicrobial therapy and from uroradiographic findings. Cystoscopy is helpful in determining prognosis in reflux, particularly with persistent reflux and this procedure is not routinely necessary in initial evaluation, at least of lesser grades. Cystoscopy remains a valuable tool to evaluate urinary obstruction and severe congenital defects, such as intersex and cloacal anomalies, and to help place percutaneous suprapubic tubes for bladder cycling before urinary undiversion and for urodynamic evaluation.--George Holcomb, Jr.
703
Experiences With Urinary Undiversion in Children With Neurogenic Bladder. A. D. Perlmutter. J Urol 123:402-406,
(March), 1980. Six children have undergone reconstruction of the urinary tract 14 mo-14 yr after supravesical diversion for neurogenic bladder dysfunction. Five are continent: 4 by intermittent catheterization and i by voiding to completion. One child is just beyond infancy and wets but is not yet on a systematic program. One boy was considered a technical failure despite incontinence because of progressive hydronephrosis from a noncompliant bladder but he subsequently had an augmentation cystoplasty. Urinary undiversion into a neurogenic bladder is an acceptable option as an alternative to ileal conduit revision or for reasons of patient preference, provided bladder storage capacity is adequate at acceptably low resting pressures, without incontinence.--George Holcomb, Jr. Urethral Strictures Secondary to Pelvic Injury in Children.
J. L Harty and M. Amin. J Urol 123:234-236, (February), 1980. The surgical repair of a membranous urethral stricture is difficult because of the location and potential risks of incontinence, impotence, and infertility. The treatment of 2 such strictures in a 6-yr-old and 13-yr-old boy by the Badenoch pullthrough urethroplasty is presented. The technique is described and its apparent advantages over other methods of repair are discussed. George Holcomb, Jr. Utricular Configuration in Hypospadias and Intarsex. C. J,
Devine, Jr., L. Gonzalez-Serva, J. F. Stecker, Jr., el al. J Urol 123:407~,11, (March), 1980. To evaluate the incidence and significance of an enlarged prostatic utricle in hypospadiac patients without underlying intersex 44 patients with the meatus located in the perineum, penoscrotal junction, or proximal two-thirds of the penis were evaluated with cystourethroscopy immediately before the operation. There was an abnormally enlarged utricle in 57% of the perineal, 10% of the penoscrotal, and none of the penile hypospadiacs, for an over-all incidence of 14%. Concurrent analysis of a series of phenotypic male patients with hypospadias and intersex revealed a high incidence of enlarged utricle or the presence of a vagina masculinus. Utricular enlargement in itself does not indicate intersexuality but careful cystoscopic examination if its vault needs to be undertaken, searching for a cervix. An enlarged utricle can be a manifestation of delayed mullerian duct regression or decreased androgenic stimulation of the urogenital s i n u s . George Holcomb, Jr. Urinary Diversion by Ileo-Cystostomy in Traumatic Avulsion of the Male Genitals. D. C. Keramidas, G. Fotis, Th.
Dolatzas, et al. Z Kinderchir 27:73-75, (May), 1979. A case of urinary diversion by ileo-cystostomy in a child who was submitted previously to cystostomy following traumatic avulsion of the genitals is described. The isolated ileal loop was anastomosed isoperistaltically with the bladder and its distal part was fashioned as a permanent ileostomy so that a plastic adhesive bag could be used. The complications of cystostomy were overcome with this operation and the