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Urologic manifestations of childhood leukemia
567
ABSTRACTS
pyema cystis in children suggests that cystectomy is seldom necessary. He also notes that successful reconstruction may be carried out at a later date, and preservation of the bladder is essential. The author notes that proteus infection and the presence of vesical calculi are significant factors in the development of empyema cystis in adult patients--S. Kim Childhood Urologic Manifestations of Leukemia. L. Persky. A. J. Newman, and A. S. Tucker. J Ural 107: 1073-1077 (June), 1972. Six cases are presented of various clinical presentations of leukemia involving the urogenital tract. There can be direct leukemic infiltration of the renal parenchyma, extrinsic obstruction secondary to adenopathy in the retroperitoneum, infiltration of adjacent viscera such as the uterus with mechanical obstruction, and direct bladder infiltration. Manifestations due to the chemotherapeutic agents used include massive ,hematuria. Complete mucosal slough secondary to infiltration, as well as stone formation, has also been found.--S. Kim Studies of Enuresis III. Vesical Hyperuropiresia as a Hazardous Side Effect of Sphincter Repair Surgery. D. T. Mahony. J Urol 107:1059-1063 (June), 1972. The author discusses the problem of urinary incontinence in childhood. Sphincter dilatation and detrusor hypercontractility are usually secondary to a distal obstructive lesion. Congenital obstruction may be due to impaired internal sphincter development. Persistence of incontinence following repair of the obstructive lesion may lead to urethral lengthening procedures if symptomatology is severe. The author cites two cases to point out the obstructive potential of reparative sphincter operations. Both cases demonstrated successful sphincter repairs with normal urinary control, but with significant elevations in intravesical pressures. This may lead to difficult-to-irradicate bacterial infection, and/or the development of vesicoureteral reflux.--S. Kim Studies of Enuresis IV. Multiple Detrusor Myotomy: A New Operation for the Rehabilitation of Severe Detrusor Hypertrophy and Hypercontractility. D. T. Mahony and R. 0. Luferre. J Urol 107:1064-1067 (June), 1972. The authors describe a procedure called mul-
tiple detrusor myotomy in a single case report of a young female child with severe urinary incontinence. The loss of continence is usually a consequence of sphincter decompensation and detrusor hypercontractility, both usually related to distal abstructive lesion. When the latter is corrected, most cases will gain satisfactory control. Those cases that do not respond, however, are felt to be related to residual detrusor/sphincter imbalance. The multiple detrusor myotomy interrupts the hypertrophied muscle bands, weakening the detrusor, diminishing contractility, and allowing for increased bladder volume. At the same time, if necessary, the authors will do a sphincter repair.--S. Kim Retroperitoneal Approach to Orchiopexy. J. S. Redman. J Urol 108:107-108 (July), 1972. The author describes a technique of orchiopexy that leaves the inguinal floor, deep epigastric vessels, and abdominal musculature intact. This is done through a muscle-splitting approach cephalad to the inguinal canal--S. Kim MUSCULOSKELETAL
SYSTEM
Tuberculosis of the Spine in Children: Operative Findings and Results in One-Hundred Consecutive Patients Treated by Removal of the Lesion and Anterior Grafting. H. L. Bailey. M. Gabriel, A. R. Hodgson, and J. S. Shin. J Bone Joint Surg 54:Al633-1657
(December), 1972. One hundred consecutive children, treated from 195.5to 1959 with tuberculosis of the spine, were treated surgically by anterior excision of the involved material with anterior fusion, performed simultaneously. Thirteen patients had a combined anterior and posterior fusion. All patients subsequently had chemotherapy and were treated with bed rest and plaster shell immobilization until the clinical picture was stable. The material was studied in terms of incidence and location of the lesion and its relationship to paraplegia. Complications included five wound infections, four readily controlled and superficial and the fifth a recurrence of the tuberculosis. Three chest complications occurred in thoracic lesions, responding to conservative treatment. Twelve patients fractured their grafts and five displaced their grafts, although four went on to subsequent fusion. Horner’s syndrome developed in two patients and two patients had convulsions postopera-
ABSTRACTS
pyema cystis in children suggests that cystectomy is seldom necessary. He also notes that successful reconstruction may be carried out at a later date, and preservation of the bladder is essential. The author notes that proteus infection and the presence of vesical calculi are significant factors in the development of empyema cystis in adult patients--S. Kim Childhood Urologic Manifestations of Leukemia. L. Persky. A. J. Newman, and A. S. Tucker. J Ural 107: 1073-1077 (June), 1972. Six cases are presented of various clinical presentations of leukemia involving the urogenital tract. There can be direct leukemic infiltration of the renal parenchyma, extrinsic obstruction secondary to adenopathy in the retroperitoneum, infiltration of adjacent viscera such as the uterus with mechanical obstruction, and direct bladder infiltration. Manifestations due to the chemotherapeutic agents used include massive ,hematuria. Complete mucosal slough secondary to infiltration, as well as stone formation, has also been found.--S. Kim Studies of Enuresis III. Vesical Hyperuropiresia as a Hazardous Side Effect of Sphincter Repair Surgery. D. T. Mahony. J Urol 107:1059-1063 (June), 1972. The author discusses the problem of urinary incontinence in childhood. Sphincter dilatation and detrusor hypercontractility are usually secondary to a distal obstructive lesion. Congenital obstruction may be due to impaired internal sphincter development. Persistence of incontinence following repair of the obstructive lesion may lead to urethral lengthening procedures if symptomatology is severe. The author cites two cases to point out the obstructive potential of reparative sphincter operations. Both cases demonstrated successful sphincter repairs with normal urinary control, but with significant elevations in intravesical pressures. This may lead to difficult-to-irradicate bacterial infection, and/or the development of vesicoureteral reflux.--S. Kim Studies of Enuresis IV. Multiple Detrusor Myotomy: A New Operation for the Rehabilitation of Severe Detrusor Hypertrophy and Hypercontractility. D. T. Mahony and R. 0. Luferre. J Urol 107:1064-1067 (June), 1972. The authors describe a procedure called mul-
tiple detrusor myotomy in a single case report of a young female child with severe urinary incontinence. The loss of continence is usually a consequence of sphincter decompensation and detrusor hypercontractility, both usually related to distal abstructive lesion. When the latter is corrected, most cases will gain satisfactory control. Those cases that do not respond, however, are felt to be related to residual detrusor/sphincter imbalance. The multiple detrusor myotomy interrupts the hypertrophied muscle bands, weakening the detrusor, diminishing contractility, and allowing for increased bladder volume. At the same time, if necessary, the authors will do a sphincter repair.--S. Kim Retroperitoneal Approach to Orchiopexy. J. S. Redman. J Urol 108:107-108 (July), 1972. The author describes a technique of orchiopexy that leaves the inguinal floor, deep epigastric vessels, and abdominal musculature intact. This is done through a muscle-splitting approach cephalad to the inguinal canal--S. Kim MUSCULOSKELETAL
SYSTEM
Tuberculosis of the Spine in Children: Operative Findings and Results in One-Hundred Consecutive Patients Treated by Removal of the Lesion and Anterior Grafting. H. L. Bailey. M. Gabriel, A. R. Hodgson, and J. S. Shin. J Bone Joint Surg 54:Al633-1657
(December), 1972. One hundred consecutive children, treated from 195.5to 1959 with tuberculosis of the spine, were treated surgically by anterior excision of the involved material with anterior fusion, performed simultaneously. Thirteen patients had a combined anterior and posterior fusion. All patients subsequently had chemotherapy and were treated with bed rest and plaster shell immobilization until the clinical picture was stable. The material was studied in terms of incidence and location of the lesion and its relationship to paraplegia. Complications included five wound infections, four readily controlled and superficial and the fifth a recurrence of the tuberculosis. Three chest complications occurred in thoracic lesions, responding to conservative treatment. Twelve patients fractured their grafts and five displaced their grafts, although four went on to subsequent fusion. Horner’s syndrome developed in two patients and two patients had convulsions postopera-