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Vesicoureteral reflux in boys
INTERNATIONAL ABSTRACTS
from 45% to 67% over the period of the study. Finally, and interestingly, torsion was significantly (P < .01) more common in the winter months of December and January.--Richard R. Turnock Transscrotal Orchidopexy: Orchidopexy Revised. A. Bianchi and B.R. Squire. Pediatr Surg Int 4:189-192, (April), 1989.
In a study of 120 orchidopexies for palpable undescended testes, the observation that most testicular undescent was associated with a shorter than normal processus vaginalis was confirmed. Division of the processus vaginalis allowed 1.5 to 3.5 cm of further testicular descent. The testicular vascular pedicle was always long enough to allow tension-free placement of the testis in an ipsilateral extradartos pouch except in those testes that had been retained at a high level within the inguinal canal. It is proposed that the majority of orchidopexies for palpable undescended testes should commence with a scrotal incision, and that an additional groin incision and retroperitoneal vascular pedicle mobilization be reserved for the few high testes that will not otherwise reach the scrotum. The technique has the advantage of a single incision, much less dissection and disruption of tissue, greater comfort for the "day-case" child, rapid healing with excellent comesis, and a well maintained testicular position in the scrotum. The high scrotal incision allows such easy direct access to the processus vaginalis and external inguinal ring that the investigators also recommend this approach for routine inguinal herniotomy in ehildren.--Prem Purl The Acute Scrotum in Childhood. V.L. Clift and J.M. Hutson.
Pediatr Surg Int 4:185-188, (April), 1989. A review was made of 771 children with an acutely inflamed scrotum presenting during the 10 years from 1976 to 1985. The relative incidence and age distribution of testicnlar torsion, torsion of an appendage, and epididymitis were compared. Epididymitis (13%) had a peak incidence in the first 2 years of life when urinary tract infections were common. The incidence of epididymitis was significantly lower than previously, and may reflect a changing pattern of disease. In addition, some patients with a diagnosis of epididymitis may have had infarction of a testicular appendage without hemorrhage. Torsion of a testicular appendage (58%) was most frequent at 11 years of age, 2 years before the maximum incidence of torsion of the testis (29%) at 13 years. This difference in timing may reflect a response by the cranial remnant of the mullerian duct to an increase in circulating estrogens at the onset of puberty.--Prem Purl Congenital Urethral Fistula With Incomplete Penoscrotal Transposition. J.H. Chuang. Pediatr Surg Int 4:211-213, (April), 1989.
A unique case of congenital urethral fistula at the penoscrotal junction with incomplete penoscrotal transposition is reported. The embryological basis and surgical repair of the abnormality are briefly discussed.--Prem Purl Vesicoureteral Reflux in Boys. E.T. Gonzales, Jr, R.M. Decter, and
D.R. Roth. Pediatr Surg Int 4:154-155, (April), 1989. Vesicoureteral reflux is seen less frequently in boys than in girls but is more likely to present as a higher grade than in girls. In this series, 65% of the patients presented with reflux of grade III or greater. Despite this higher grade, recurring urinary infection was less frequently encountered in these boys. This has prompted the investigators to be more comfortable in following these patients expectantly--without surgery or chemoprophylaxis--especially in older boys with milder grades of reflux. Prem Purl
175 Limitations and Alternatives to Endoscopic Correction of Vesicoureteral Reflux With Polytef Paste. D.A. Canning and J.P.
Gearhart. Pediatr Surg lnt 4:149-153, (April), 1989. Despite increased use with encouraging success rates, endoscopic correction of vesicoureteral reflux in children has persistent limitations. While many patients may be managed with this technique, a few with complete ureteral duplication or paraureteral diverticulum will not be successfully corrected. Nevertheless, precise placement of the implant beneath the ureteral orifice has resulted in success even in patients with high grade reflux, patients with neuropathic bladder, and in patients who have failed previous ureteroneocystostomy. Concern remains regarding the safety of the injectable Teflon substance which elicits a local and distant foreign-body granuloma response. This has been noted in animal models and in a few human patients. Alternative substances such as glutaraldehyde cross-linked collagen and transplanted autologous fat may eliminate concern regarding the safety of the implant while preserving the excellent results reported with injectable Teflon.--Prem Purl Ureterocelas in Infancy and Childhood: In Search of the Correct
Surgical Approach. P. Frey and S.J. Cohen. Pediatr Surg Int 4:175-184, (April), 1989.
Between 1967 and 1986, 61 patients with 63 ureteroceles .were treated, of which 53 ureteroceles were associated with duplex and 10 with single collecting systems. Antenatal and postnatal presentation and the means and limits of the possible investigations (intravenous urography, ultrasound, cystoscopy, micturition eystogram, isotope renography) are discussed. Thirty-nine ureteroceles were enucleated either with or without ureteric reimplantation. In patients with duplex systems this procedure was followed by heminephrouretcrectomy. The operative technique of the enueleation is discussed and the pros and cons of urinary diversion are mentioned. Eight ureteroceles were treated by primary heminephrouretereetomy only. However, in 75% of patients secondary enucleation or ureteric reimplantation to stop reflux and infection became necessary, and 12.5% developed a diverticulum. The remaining 16 ureteroceles were mainly treated by unroofing or incision. The overall long-term results regarding reflux, urinary tract infections, and continence were excellent. In the majority of cases this was only after full reconstruction of the lower urinary tract. The function of the renal units involved remained constant or improved in 82% of the cases. The investigators are aware that the "enucleation procedure" is technically very demanding and time consuming. Nevertheless, they highly recommend it. It follows the principles and philosophy of surgical correction, and achieves as nearly normal results as possible.--Prem Purl Pelviureteric Obstruction in Children Treated by Retrograde Ure-
teroplasty. G.R. Doraiswamy and M.S.K. Bader. Br J Uro163:141143, (February), 1989. Fogerty balloon catheter dilatation, performed in two children with pelviureteric junction obstruction, resulted in improved drainage and renal function at follow*up. The technique and its application in children is discussed.--Amir Azmy Intrarenal Duplication. J.R. MacKenzie and A.F. Azmy. Br J Urol
63:122-123, (February), 1989. This is a report of the anomaly of intrarenal duplication seen in six children where the superior calyx drains the upper half of the kidney through a long narrow pelvis into the middle calyx or lower pelvis with a single extra renal ureter. The embryological basis is described.--Amir Azmy
from 45% to 67% over the period of the study. Finally, and interestingly, torsion was significantly (P < .01) more common in the winter months of December and January.--Richard R. Turnock Transscrotal Orchidopexy: Orchidopexy Revised. A. Bianchi and B.R. Squire. Pediatr Surg Int 4:189-192, (April), 1989.
In a study of 120 orchidopexies for palpable undescended testes, the observation that most testicular undescent was associated with a shorter than normal processus vaginalis was confirmed. Division of the processus vaginalis allowed 1.5 to 3.5 cm of further testicular descent. The testicular vascular pedicle was always long enough to allow tension-free placement of the testis in an ipsilateral extradartos pouch except in those testes that had been retained at a high level within the inguinal canal. It is proposed that the majority of orchidopexies for palpable undescended testes should commence with a scrotal incision, and that an additional groin incision and retroperitoneal vascular pedicle mobilization be reserved for the few high testes that will not otherwise reach the scrotum. The technique has the advantage of a single incision, much less dissection and disruption of tissue, greater comfort for the "day-case" child, rapid healing with excellent comesis, and a well maintained testicular position in the scrotum. The high scrotal incision allows such easy direct access to the processus vaginalis and external inguinal ring that the investigators also recommend this approach for routine inguinal herniotomy in ehildren.--Prem Purl The Acute Scrotum in Childhood. V.L. Clift and J.M. Hutson.
Pediatr Surg Int 4:185-188, (April), 1989. A review was made of 771 children with an acutely inflamed scrotum presenting during the 10 years from 1976 to 1985. The relative incidence and age distribution of testicnlar torsion, torsion of an appendage, and epididymitis were compared. Epididymitis (13%) had a peak incidence in the first 2 years of life when urinary tract infections were common. The incidence of epididymitis was significantly lower than previously, and may reflect a changing pattern of disease. In addition, some patients with a diagnosis of epididymitis may have had infarction of a testicular appendage without hemorrhage. Torsion of a testicular appendage (58%) was most frequent at 11 years of age, 2 years before the maximum incidence of torsion of the testis (29%) at 13 years. This difference in timing may reflect a response by the cranial remnant of the mullerian duct to an increase in circulating estrogens at the onset of puberty.--Prem Purl Congenital Urethral Fistula With Incomplete Penoscrotal Transposition. J.H. Chuang. Pediatr Surg Int 4:211-213, (April), 1989.
A unique case of congenital urethral fistula at the penoscrotal junction with incomplete penoscrotal transposition is reported. The embryological basis and surgical repair of the abnormality are briefly discussed.--Prem Purl Vesicoureteral Reflux in Boys. E.T. Gonzales, Jr, R.M. Decter, and
D.R. Roth. Pediatr Surg Int 4:154-155, (April), 1989. Vesicoureteral reflux is seen less frequently in boys than in girls but is more likely to present as a higher grade than in girls. In this series, 65% of the patients presented with reflux of grade III or greater. Despite this higher grade, recurring urinary infection was less frequently encountered in these boys. This has prompted the investigators to be more comfortable in following these patients expectantly--without surgery or chemoprophylaxis--especially in older boys with milder grades of reflux. Prem Purl
175 Limitations and Alternatives to Endoscopic Correction of Vesicoureteral Reflux With Polytef Paste. D.A. Canning and J.P.
Gearhart. Pediatr Surg lnt 4:149-153, (April), 1989. Despite increased use with encouraging success rates, endoscopic correction of vesicoureteral reflux in children has persistent limitations. While many patients may be managed with this technique, a few with complete ureteral duplication or paraureteral diverticulum will not be successfully corrected. Nevertheless, precise placement of the implant beneath the ureteral orifice has resulted in success even in patients with high grade reflux, patients with neuropathic bladder, and in patients who have failed previous ureteroneocystostomy. Concern remains regarding the safety of the injectable Teflon substance which elicits a local and distant foreign-body granuloma response. This has been noted in animal models and in a few human patients. Alternative substances such as glutaraldehyde cross-linked collagen and transplanted autologous fat may eliminate concern regarding the safety of the implant while preserving the excellent results reported with injectable Teflon.--Prem Purl Ureterocelas in Infancy and Childhood: In Search of the Correct
Surgical Approach. P. Frey and S.J. Cohen. Pediatr Surg Int 4:175-184, (April), 1989.
Between 1967 and 1986, 61 patients with 63 ureteroceles .were treated, of which 53 ureteroceles were associated with duplex and 10 with single collecting systems. Antenatal and postnatal presentation and the means and limits of the possible investigations (intravenous urography, ultrasound, cystoscopy, micturition eystogram, isotope renography) are discussed. Thirty-nine ureteroceles were enucleated either with or without ureteric reimplantation. In patients with duplex systems this procedure was followed by heminephrouretcrectomy. The operative technique of the enueleation is discussed and the pros and cons of urinary diversion are mentioned. Eight ureteroceles were treated by primary heminephrouretereetomy only. However, in 75% of patients secondary enucleation or ureteric reimplantation to stop reflux and infection became necessary, and 12.5% developed a diverticulum. The remaining 16 ureteroceles were mainly treated by unroofing or incision. The overall long-term results regarding reflux, urinary tract infections, and continence were excellent. In the majority of cases this was only after full reconstruction of the lower urinary tract. The function of the renal units involved remained constant or improved in 82% of the cases. The investigators are aware that the "enucleation procedure" is technically very demanding and time consuming. Nevertheless, they highly recommend it. It follows the principles and philosophy of surgical correction, and achieves as nearly normal results as possible.--Prem Purl Pelviureteric Obstruction in Children Treated by Retrograde Ure-
teroplasty. G.R. Doraiswamy and M.S.K. Bader. Br J Uro163:141143, (February), 1989. Fogerty balloon catheter dilatation, performed in two children with pelviureteric junction obstruction, resulted in improved drainage and renal function at follow*up. The technique and its application in children is discussed.--Amir Azmy Intrarenal Duplication. J.R. MacKenzie and A.F. Azmy. Br J Urol
63:122-123, (February), 1989. This is a report of the anomaly of intrarenal duplication seen in six children where the superior calyx drains the upper half of the kidney through a long narrow pelvis into the middle calyx or lower pelvis with a single extra renal ureter. The embryological basis is described.--Amir Azmy