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Urogenital tuberculosis in children
142
INTERNATIONAL ABSTRACTS
detorsion. Another patient with epididymitis was seen on ultrasound to have an abscess that required drainage. The authors feel that the 14% of patients that had alteration of operative therapy based upon the addition of ultrasound was a sufficient amount to recommend the routine use of this additional imaging modality.--Thomas V. Whalen Urethral Prolapse
in Children--Alternative Management. M.
Wright. S Afr Med J 72:551-552, (October 17), 1987. Six children with typical urethral prolapse (aged 4 to 11 years) were seen at the Red Cross War Memorial Children's Hospital, Cape Town over a 1-year period. A 9-year-old patient with a florid prolapse had the lesion excised over a Foley catheter under general anesthesia. The other five were treated with local application of conjugated estrogen cream applied twice daily. Three had completely resolved after 3 weeks and the other two by 6 weeks. The occurrence of urethral prolapse at extremes of the reproduction cycle suggests a hormonal influence. It is known that the distal female urethra has a rich supply of estrogen receptors. Thus, estrogen deficiency may be significant. From this report, it would seem that surgical intervention has little place in the management of this condition, as local application of estrogen cream appears to be a simple and effective treatment.--A.J.W. Millar Urethral Replacement With Ureter. M.E. Mitchell, M.C. Adams,
andR.C. Rink. J Urol 139:1282-1285, (June), 1988. Proximal or total urethral replacement was performed in eight patients using the distal ureter. This was accomplished by basing the ureteral segment solely on a vascular pedicle arising from the internal iliac artery. Diagnoses included classical bladder exstrophy in four patients, cloacal exstrophy in three, and an imperforate anus with hypoplasia of the bladder neck and urethra in one. Continence was achieved by a tunneled submucosal reimplantation into either the bladder (4), gastric reservoir (2), or colonic reservoir (2). Although an isolated distal segment of ureter was used in each case, all segments have remained viable. With limited follow-up (5 to 44 months), continence with either normal voiding or intermittent catheterization has been achieved in seven of the eight patients. A distal ureteral segment should be considered potentially useful in the construction or reconstruction of the proximal (male) or total (female) urethra in patients with congenital urethral malformations.--George Holcomb Jr Vesical Neck Reconstruction in Patients With Episadias-Exstrophy. M.L. Ritchey, S.A. Kramer, and P.P. Kelalis. J Urol 139:1278-
1280, (June), 1988. Vesical neck reconstruction was performed in 50 male and 12 female patients with the epispadias-exstrophy complex. Of these patients, 45 had epispadias and 17 had classical exstrophy. Ages ranged from 3 to 27 years (mean, 12.6 years). Follow-up after vesical neck reconstruction averaged 11.6 years. Of the 45 patients with epispadias, 35 (78%) are continent. Of the 17 with bladder extrophy, 13 (76%) are continent. The overall continence rate is 77%. An adequate bladder capacity was one of the most important determinants of continence. In 11 patients with a small capacity or poorly compliant bladder augmentation, cystoplasty was combined with vesical neck reconstruction to increase vesical capacity and to produce complete urinary continence.--George Holcomb, Jr Augmentation Cystoplasty in the Failed Exstrophy Reconstruction.
J.P. Gearhart and R.D. Jeffs. J Urol 139:790-793, (April), 1988. Of the 148 patients with bladder exstrophy seen during the last 10 years, 12 have ultimately required bladder augmentation. In four cases, augmentation was performed for an inadequate bladder capacity, upper tract decompensation, and dry interval of < one hour
after bladder neck reconstruction and epispadias repair. Likewise, three patients underwent augmentation for an inadequate bladder capacity and dry interval of < two hours after bladder neck reconstruction and epispadias repair. Of these seven patients, three had undergone two previous bladder neck reconstructions, while four had undergone one prior repair. Five augmentations were performed for an inadequate bladder capacity before any type of continence procedure had been done. Nine patients underwent adjunctive procedures in addition to bladder augmentation, including a YoungDees-Leadbetter procedure in four, an artificial urinary sphincter in three, transureteroureterostomy and psoas hitch in one, andf a Mitrofanoff procedure and bladder neck closure in one. Of the 12 patients, 11 are continent, although nine require intermittent catheterization. There were no major complications. However, one artificial urinary sphincter was removed for erosion 2 years after placement. Augmentation cystoplasty has provided prolonged stability of the upper tracts and continence in these patients, and it has proven to be a successful alternative to urinary diversion in this select group of exstrophy failures.--George Holcomb, Jr Pelvic Lymphocele After Pediatric Renal Transplantation: A Successful Technique for Prevention. M.R. Zaontz and C.F. Firlit. J
Urol 139:557-559, (March), 1988. Pelvic lymph accumulation (lymphocele) is a recognized complication of renal transplantation. During a 12-year period, 166 renal transplants were performed in 143 children. From 1973 to 1979, five lymphoceles were treated in 64 children. From 1979 until the present, a technique of peritoneal fenestration has been performed in 69 children, one of whom developed a lymphocele. Lymphoceles required surgical treatment in five of the remaining ten patients who were not fenestrated. This experience with peritoneal fenestration as a method of lymphocele prevention has been excellent and is recommended as a prophylactic addition to renal transplant surgery.--George Holcomb, Jr Urogenital Tuberculosis in Children. LA. Aaronson. S Afr Med J
71:424-426, (April 4), 1987. The clinical and radiologic features of 16 children (11 girls, five boys; aged 3 to 12 years) with urogenital tuberculosis (TB) presenting over a 25-year period at the Red Cross War Memorial Children's Hospital, Cape Town are reviewed. Relatively benign clinical presentation of cystitis (11 ) or pyrexia and failure to thrive (4) often hid advanced pathology. Eight children had evidence of past pulmonary disease. Five had no other evidence of tubercle infection. Radiologic (14 intravenous urograms) and ultrasound (3) findings are described in detail. Confirmation of the disease was difficult, with a positive urine culture being obtained in only eight patients, despite repeated cultures. However, pyuria was present in all but one case. Suprainfection with Escherichia coli delayed diagnosis in four patients. Medical management was able to arrest the disease process in seven. One strictured ureter required reimplantation, and eight required a nephrectomy. Pathogenesis of the disease is discussed. The author makes a strong plea for screening all children in close primary contact with open pulmonary disease to avoid a delay in diagnosis, thereby hopefully reducing the incidence of advanced renal damage seen in this series.--A.J.W. Millar Sonographic Evaluation of Ovarian Torsion in Childhood and Adolescence, M. Graifand Y. Itzchak. A JR 150: 647-649, (March),
1988. An emergency sonographic evaluation of 41 girls (aged 3 to 19 years) was carried out to evaluate possible ovarian torsion. In 17 patients, surgical exploration was carried out within 48 hours of sonography. The other 24 patients were observed in-hospital until resolution of symptoms. All patients remained symptom-free for a
INTERNATIONAL ABSTRACTS
detorsion. Another patient with epididymitis was seen on ultrasound to have an abscess that required drainage. The authors feel that the 14% of patients that had alteration of operative therapy based upon the addition of ultrasound was a sufficient amount to recommend the routine use of this additional imaging modality.--Thomas V. Whalen Urethral Prolapse
in Children--Alternative Management. M.
Wright. S Afr Med J 72:551-552, (October 17), 1987. Six children with typical urethral prolapse (aged 4 to 11 years) were seen at the Red Cross War Memorial Children's Hospital, Cape Town over a 1-year period. A 9-year-old patient with a florid prolapse had the lesion excised over a Foley catheter under general anesthesia. The other five were treated with local application of conjugated estrogen cream applied twice daily. Three had completely resolved after 3 weeks and the other two by 6 weeks. The occurrence of urethral prolapse at extremes of the reproduction cycle suggests a hormonal influence. It is known that the distal female urethra has a rich supply of estrogen receptors. Thus, estrogen deficiency may be significant. From this report, it would seem that surgical intervention has little place in the management of this condition, as local application of estrogen cream appears to be a simple and effective treatment.--A.J.W. Millar Urethral Replacement With Ureter. M.E. Mitchell, M.C. Adams,
andR.C. Rink. J Urol 139:1282-1285, (June), 1988. Proximal or total urethral replacement was performed in eight patients using the distal ureter. This was accomplished by basing the ureteral segment solely on a vascular pedicle arising from the internal iliac artery. Diagnoses included classical bladder exstrophy in four patients, cloacal exstrophy in three, and an imperforate anus with hypoplasia of the bladder neck and urethra in one. Continence was achieved by a tunneled submucosal reimplantation into either the bladder (4), gastric reservoir (2), or colonic reservoir (2). Although an isolated distal segment of ureter was used in each case, all segments have remained viable. With limited follow-up (5 to 44 months), continence with either normal voiding or intermittent catheterization has been achieved in seven of the eight patients. A distal ureteral segment should be considered potentially useful in the construction or reconstruction of the proximal (male) or total (female) urethra in patients with congenital urethral malformations.--George Holcomb Jr Vesical Neck Reconstruction in Patients With Episadias-Exstrophy. M.L. Ritchey, S.A. Kramer, and P.P. Kelalis. J Urol 139:1278-
1280, (June), 1988. Vesical neck reconstruction was performed in 50 male and 12 female patients with the epispadias-exstrophy complex. Of these patients, 45 had epispadias and 17 had classical exstrophy. Ages ranged from 3 to 27 years (mean, 12.6 years). Follow-up after vesical neck reconstruction averaged 11.6 years. Of the 45 patients with epispadias, 35 (78%) are continent. Of the 17 with bladder extrophy, 13 (76%) are continent. The overall continence rate is 77%. An adequate bladder capacity was one of the most important determinants of continence. In 11 patients with a small capacity or poorly compliant bladder augmentation, cystoplasty was combined with vesical neck reconstruction to increase vesical capacity and to produce complete urinary continence.--George Holcomb, Jr Augmentation Cystoplasty in the Failed Exstrophy Reconstruction.
J.P. Gearhart and R.D. Jeffs. J Urol 139:790-793, (April), 1988. Of the 148 patients with bladder exstrophy seen during the last 10 years, 12 have ultimately required bladder augmentation. In four cases, augmentation was performed for an inadequate bladder capacity, upper tract decompensation, and dry interval of < one hour
after bladder neck reconstruction and epispadias repair. Likewise, three patients underwent augmentation for an inadequate bladder capacity and dry interval of < two hours after bladder neck reconstruction and epispadias repair. Of these seven patients, three had undergone two previous bladder neck reconstructions, while four had undergone one prior repair. Five augmentations were performed for an inadequate bladder capacity before any type of continence procedure had been done. Nine patients underwent adjunctive procedures in addition to bladder augmentation, including a YoungDees-Leadbetter procedure in four, an artificial urinary sphincter in three, transureteroureterostomy and psoas hitch in one, andf a Mitrofanoff procedure and bladder neck closure in one. Of the 12 patients, 11 are continent, although nine require intermittent catheterization. There were no major complications. However, one artificial urinary sphincter was removed for erosion 2 years after placement. Augmentation cystoplasty has provided prolonged stability of the upper tracts and continence in these patients, and it has proven to be a successful alternative to urinary diversion in this select group of exstrophy failures.--George Holcomb, Jr Pelvic Lymphocele After Pediatric Renal Transplantation: A Successful Technique for Prevention. M.R. Zaontz and C.F. Firlit. J
Urol 139:557-559, (March), 1988. Pelvic lymph accumulation (lymphocele) is a recognized complication of renal transplantation. During a 12-year period, 166 renal transplants were performed in 143 children. From 1973 to 1979, five lymphoceles were treated in 64 children. From 1979 until the present, a technique of peritoneal fenestration has been performed in 69 children, one of whom developed a lymphocele. Lymphoceles required surgical treatment in five of the remaining ten patients who were not fenestrated. This experience with peritoneal fenestration as a method of lymphocele prevention has been excellent and is recommended as a prophylactic addition to renal transplant surgery.--George Holcomb, Jr Urogenital Tuberculosis in Children. LA. Aaronson. S Afr Med J
71:424-426, (April 4), 1987. The clinical and radiologic features of 16 children (11 girls, five boys; aged 3 to 12 years) with urogenital tuberculosis (TB) presenting over a 25-year period at the Red Cross War Memorial Children's Hospital, Cape Town are reviewed. Relatively benign clinical presentation of cystitis (11 ) or pyrexia and failure to thrive (4) often hid advanced pathology. Eight children had evidence of past pulmonary disease. Five had no other evidence of tubercle infection. Radiologic (14 intravenous urograms) and ultrasound (3) findings are described in detail. Confirmation of the disease was difficult, with a positive urine culture being obtained in only eight patients, despite repeated cultures. However, pyuria was present in all but one case. Suprainfection with Escherichia coli delayed diagnosis in four patients. Medical management was able to arrest the disease process in seven. One strictured ureter required reimplantation, and eight required a nephrectomy. Pathogenesis of the disease is discussed. The author makes a strong plea for screening all children in close primary contact with open pulmonary disease to avoid a delay in diagnosis, thereby hopefully reducing the incidence of advanced renal damage seen in this series.--A.J.W. Millar Sonographic Evaluation of Ovarian Torsion in Childhood and Adolescence, M. Graifand Y. Itzchak. A JR 150: 647-649, (March),
1988. An emergency sonographic evaluation of 41 girls (aged 3 to 19 years) was carried out to evaluate possible ovarian torsion. In 17 patients, surgical exploration was carried out within 48 hours of sonography. The other 24 patients were observed in-hospital until resolution of symptoms. All patients remained symptom-free for a