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Urinary reconstruction following temporary cutaneous ureterostomy diversion in children
ABSTRACTS
851
duction, the use of 5-fluorouracil as a cream for stoma1 keratosis, and surgical excision of the peristomal scar and replacement with normal skin swung in as flaps. The authors feel that normal skin surrounding a stoma draining urine is much less apt to become irritated and inflamed than surgical scar tissue.-g. Kim Urinary Reconstruction Following Temporary Cutaneous Ureterostomy Diversion in Children. L. G. Lome and D. I. Williams. .I. Ural. 108: 1622164 (July), 1972. The authors review the cases of 26 infants and children who have had ureterovesical continuity restored after temporary cutaneous ureterostomy. Sixteen patients had bilateral loop cutaneous ureterostomy and ten had bilateral cutaneous end ureterostomy. Twentyfour loop cutaneous ureterdstomies have been closed with no complications in 20 of them. Ureterovesical continuity has been restored in 17 end ureterostomies, with only six instances that were satisfactory. Of the I2 loop cutaneous ureterostomies demonstrating vesicoureteral reflux, six had persistent reflux requiring correction after closure of the loop cutaneous ureterostomy. The authors now use temporary cutaneous loop ureterostomy for the infected and uremic neonates, but in healthy and in older children, lower reconstruction is carried out.--S. Kim Ectopic Vas Deferens Communicating With Lower Ureter,: Embryological Considerations. H. J. Alfert and J. Y. Gillenwater. J. Ural. 108: 172-173 (July), 1972. A single case report of a 7-yr-old boy with a left pelvic kidney and an ectopic vas deferens communicating with the ureter. Because the vas deferens and ureter on the same side share a common precurser in the Wolffian duct, this case illustrates the persistence of this common precursor.-S. Kim Bilateral Ectopic Openings of Single Ureters in Girls: 9 Cases. J. Cendron and Y. Melin. Ann. Chir. Infant 13:355-368 (September/ October), 1972. The authors ectopic openings the bilateral and is quite rare. As served to have
report nine cases of bilateral in girls. They maintain that single nature of these ureters exceptions, one child was oba bifurcation of the superior
aspect of one ureter and one to have double left ureters joining just prior to entering the bladder. No clitoral bifurcation was noted eliminating epispadias as causal. In I3 ureters, both were implanted on the bladder neck, bladder wall, or urethral wall. In three examples, the two ureters had different insertions. In one case the bladder neck had a tunnellike aspect and insertion was difficult to ascertain. In no case did the ureter terminate below the external sphincter. Several anatomic aspects were worth noting. The upper urinary tract was nearly always dilated with secondary kidney malfunction. There was accompanying dysplasia (three cases), reflux (four cases), absence of the bladder neck (two cases), thickening of the bladder wall (eight cases) and decrease in bladder capacity (four cases). The common denominator of this malformation seemed to be the absence of the trigone. Embryologic derivation of this lesion is discussed as well as the anatomical result. There usually was an accompanying partial or complete agenesis of the urinary sphincter. Clinical manifestations included albuminuria, febrile pyuria, and incontinence. Reimplantation by the Leadbetter-Politano technique was recommended as indicated by hydroureteronephrosis and reflux.--1. Deevey Simplified Treatment of Ureterocoele in Children. J. Valayer and Y. Melin. Ann. Chir. Infant 13:347-354 (September/October), 1972. Ten cases of ureterocoele treated by a more simple method than usual are reported. The ureterocoele is left intact necessitating removal of only the supranumerary pathway. Good results were obtained in seven cases, Other cases showing persistent reflux were carefully followed and reimplantation was achieved at a later date. At this time the procedure was facilitated by the larger size of the child and less septic environment. The authors suggest that maturation of the trigone may lead to disappearance of the ureterocoele as the walls tend to adhere to each other. They recognize the value of the accepted procedure of intravesical operation, but feel it should be reserved for cases in which the simpler procedure is ineffective.-/. Deevr, The Neurogenic Bladder: An Experimental Study. H. J. Pompino. W. Lb#ler. D. OerthrlHaid, and M. Sreiner. Prog. Pediatr. Surg. 5: 135~161, 1973.
851
duction, the use of 5-fluorouracil as a cream for stoma1 keratosis, and surgical excision of the peristomal scar and replacement with normal skin swung in as flaps. The authors feel that normal skin surrounding a stoma draining urine is much less apt to become irritated and inflamed than surgical scar tissue.-g. Kim Urinary Reconstruction Following Temporary Cutaneous Ureterostomy Diversion in Children. L. G. Lome and D. I. Williams. .I. Ural. 108: 1622164 (July), 1972. The authors review the cases of 26 infants and children who have had ureterovesical continuity restored after temporary cutaneous ureterostomy. Sixteen patients had bilateral loop cutaneous ureterostomy and ten had bilateral cutaneous end ureterostomy. Twentyfour loop cutaneous ureterdstomies have been closed with no complications in 20 of them. Ureterovesical continuity has been restored in 17 end ureterostomies, with only six instances that were satisfactory. Of the I2 loop cutaneous ureterostomies demonstrating vesicoureteral reflux, six had persistent reflux requiring correction after closure of the loop cutaneous ureterostomy. The authors now use temporary cutaneous loop ureterostomy for the infected and uremic neonates, but in healthy and in older children, lower reconstruction is carried out.--S. Kim Ectopic Vas Deferens Communicating With Lower Ureter,: Embryological Considerations. H. J. Alfert and J. Y. Gillenwater. J. Ural. 108: 172-173 (July), 1972. A single case report of a 7-yr-old boy with a left pelvic kidney and an ectopic vas deferens communicating with the ureter. Because the vas deferens and ureter on the same side share a common precurser in the Wolffian duct, this case illustrates the persistence of this common precursor.-S. Kim Bilateral Ectopic Openings of Single Ureters in Girls: 9 Cases. J. Cendron and Y. Melin. Ann. Chir. Infant 13:355-368 (September/ October), 1972. The authors ectopic openings the bilateral and is quite rare. As served to have
report nine cases of bilateral in girls. They maintain that single nature of these ureters exceptions, one child was oba bifurcation of the superior
aspect of one ureter and one to have double left ureters joining just prior to entering the bladder. No clitoral bifurcation was noted eliminating epispadias as causal. In I3 ureters, both were implanted on the bladder neck, bladder wall, or urethral wall. In three examples, the two ureters had different insertions. In one case the bladder neck had a tunnellike aspect and insertion was difficult to ascertain. In no case did the ureter terminate below the external sphincter. Several anatomic aspects were worth noting. The upper urinary tract was nearly always dilated with secondary kidney malfunction. There was accompanying dysplasia (three cases), reflux (four cases), absence of the bladder neck (two cases), thickening of the bladder wall (eight cases) and decrease in bladder capacity (four cases). The common denominator of this malformation seemed to be the absence of the trigone. Embryologic derivation of this lesion is discussed as well as the anatomical result. There usually was an accompanying partial or complete agenesis of the urinary sphincter. Clinical manifestations included albuminuria, febrile pyuria, and incontinence. Reimplantation by the Leadbetter-Politano technique was recommended as indicated by hydroureteronephrosis and reflux.--1. Deevey Simplified Treatment of Ureterocoele in Children. J. Valayer and Y. Melin. Ann. Chir. Infant 13:347-354 (September/October), 1972. Ten cases of ureterocoele treated by a more simple method than usual are reported. The ureterocoele is left intact necessitating removal of only the supranumerary pathway. Good results were obtained in seven cases, Other cases showing persistent reflux were carefully followed and reimplantation was achieved at a later date. At this time the procedure was facilitated by the larger size of the child and less septic environment. The authors suggest that maturation of the trigone may lead to disappearance of the ureterocoele as the walls tend to adhere to each other. They recognize the value of the accepted procedure of intravesical operation, but feel it should be reserved for cases in which the simpler procedure is ineffective.-/. Deevr, The Neurogenic Bladder: An Experimental Study. H. J. Pompino. W. Lb#ler. D. OerthrlHaid, and M. Sreiner. Prog. Pediatr. Surg. 5: 135~161, 1973.