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Wound dehiscence in bladder exstrophy
INTERNATIONAL ABSTRACTS Testicular Venography for the Localization of the Impalpable U n d e s c e n d e d Testis. O, Khan, G. Williams, N. B.
Boley, et al. Br J Surg 69:660, 1982. Selective testicular venography using the Seldinger transfemoral technique was used to localize preoperatively an impalpable undescended testis in seven adult men. The technique was successful in five out of seven patients and this proved of considerable assistance to the surgeons at the time of exploration. The left testicular vein was found to be easier to identify than the right, and testicular venography has a higher chance of success in the case of a left undescended testis.--M. Agrawal Urethral Strictures in Children. G. W. Kaplan and He. A. Brock. J Urol 129:1200-1203, (June), 1983.
During a 12-year period, 57 children presented for treatment of urethral strictures. The patients ranged in age from 2 months to 18 years and there was only 1 girl. Of the strictures, 8 were congenital, 34 were iatrogenic, 4 were inflammatory, and 11 were traumatic. Diagnosis can be suspected from the history and physical examination (observation of the voided stream) and confirmed radiographically and endoscopically. Urethral dilation was definitive treatment in only 28.6% of the patients in whom it was used. Of 4 inflammatory strictures, 2 responded to dilation as the only treatment, while only 1 of 5 congenital strictures and 1 of 5 iatrogenic strictures responded to dilation. Direct vision urethrotomy was successful in 1 of 2 congenital and 5 of 5 iatrogenic bulbar strictures. A one-stage urethroplasty seems preferable to multistaged procedures. Only 2 of 7 patients managed with staged procedures were treated successfully in two operations, while 5 of 9 treated with a one-stage procedure have required no further intervention.--George Holcomb, Jr Wound Dehiscence in Bladder Exstrophy. F. C. Lowe and
R. D. Jeffs. J Urol 130:312 315, (August), 1983. During the last 8 years 20 patients were seen for secondary or repeat closure for exstrophy of the bladder following dehiscence after initial closure. Various factors that may have contributed to the initial problems were investigated. Wound infection (42%) and bladder prolapse (46%) were the major etiologies for initial failures. In six patients (30%) colon conduits were required for bladder augmentation or colocolostomy, which emphasized the importance of achieving a good result at the initial closure. The authors' successful protocol is outlined, and by following this protocol only 3 of 60 patients required reclosure.--George Holcomb, Jr Initial Results With The Cohen Cross-Trigonal Ureteroneocystotomy. J. Wacksman. J Urol 129:1198 1199, (June),
1983. Between January 1976 and December 1980, 109 children with 157 ureters with reflux were seen by the author. Of these ureters, 52 were operated upon using the Cohen crosstrigonal technique, while 105 were followed conservatively. The operative procedure is a complete intravesical ureteral mobilization followed by the creation of a submucosal tunnel across the base of the bladder. Follow-up studies, including
101
an excretory urogram and voiding cystourethrogram, showed minimal hydronephrosis in one ureter and persistent grade I reflux in one ureter. Evaluation of these initial results indicates that Cohen cross-trigonal ureteroneocystotomy is a safe and effective antireflux procedure.~eorge Holcomb, Jr Management of Reflux in The Myelodysplastic Child. W. E.
Kaplan and C. F. Fir~it. J Urol 129:1195-1197, (June), 1983. The authors report that during the last 4 years, 25 children (40 ureters) required antireflux surgery. The criterion of repair was persistent reflux of at least grade lIB, associated with recurrent episodes of infection. A modified LeadbetterPolitano technique was used in 5 children (7 ureters), and the Cohen cross-trigonal technique was used in 20 children (33 ureters). A successful result, that is cessation of reflux and no obstruction, was achieved in 96% of the patients. During the last 2 years, the Cohen cross-trigonal technique has been used exclusively and there have been no failures. This successful result in 96% of the children with neurogenic bladder indicates that while clean intermittent catheterization should be used primarily to relieve reflux, in a select group of children antireflux surgery should also be done.--George Holcomb, Jr Acquired Renal S c a r s in Children. A. L. Winter, B. E. Hardy,
D. J. Alton, et al. J Urol 129:1190-1194, (June), 1983. To determine the important factors involved in the etiology of renal scarring a group of 36 girls and 1 boy was studied. The average age at first detection of renal scars was 5.7 years. Acute pyelonephritic episodes, which were treated early and aggressively, infrequently led to renal scarring. However, the initial prolonged or poorly treated episode of acute pyelonephritis was followed invariably by the development of renal scarring. Fifty-five percent of these children did not have ureters with reflux on the initial studies, and 43% never did show vesicoureteral reflux during followup. The severity of renal scarring was related to the grade of vesicoureteral reflux. Neither the shape nor position of the ureteral orifice nor the ureteral tunnel length correlated with the severity of renal scarring. Treatment with prophylactic antibiotics may have lessened the severity of renal scarring, but treatment with reimplantation did not appear to alter the course of scarring. This study suggests that the key to prevention of renal scarring is the early and aggressive treatment of acute pyelonephritis.--George Holcomb, Jr Technetium--DMSA Scanning to Diagnose Pyelonephretic Scarring in Children. B. A. Cogan, R. Kay, R. J. Wasnick, el
al. Urology 21:641-644, (June), 1983. The technetium DMSA scan provides superior quality imaging of renal parenchymal detail, making it highly sensitive for the diagnosis of pyelonephritic scarring. This technique is unaffected by the presence of overlying bowel gas or boney structures. Furthermore, renal scarring can be demonstrated even before the classic gross anatomical and radiological scar is formed. The latter is true because the DMSA is bound by renal tubular cells which, if injured, produce a filling defect on the cortical image. DMSA scanning is
Boley, et al. Br J Surg 69:660, 1982. Selective testicular venography using the Seldinger transfemoral technique was used to localize preoperatively an impalpable undescended testis in seven adult men. The technique was successful in five out of seven patients and this proved of considerable assistance to the surgeons at the time of exploration. The left testicular vein was found to be easier to identify than the right, and testicular venography has a higher chance of success in the case of a left undescended testis.--M. Agrawal Urethral Strictures in Children. G. W. Kaplan and He. A. Brock. J Urol 129:1200-1203, (June), 1983.
During a 12-year period, 57 children presented for treatment of urethral strictures. The patients ranged in age from 2 months to 18 years and there was only 1 girl. Of the strictures, 8 were congenital, 34 were iatrogenic, 4 were inflammatory, and 11 were traumatic. Diagnosis can be suspected from the history and physical examination (observation of the voided stream) and confirmed radiographically and endoscopically. Urethral dilation was definitive treatment in only 28.6% of the patients in whom it was used. Of 4 inflammatory strictures, 2 responded to dilation as the only treatment, while only 1 of 5 congenital strictures and 1 of 5 iatrogenic strictures responded to dilation. Direct vision urethrotomy was successful in 1 of 2 congenital and 5 of 5 iatrogenic bulbar strictures. A one-stage urethroplasty seems preferable to multistaged procedures. Only 2 of 7 patients managed with staged procedures were treated successfully in two operations, while 5 of 9 treated with a one-stage procedure have required no further intervention.--George Holcomb, Jr Wound Dehiscence in Bladder Exstrophy. F. C. Lowe and
R. D. Jeffs. J Urol 130:312 315, (August), 1983. During the last 8 years 20 patients were seen for secondary or repeat closure for exstrophy of the bladder following dehiscence after initial closure. Various factors that may have contributed to the initial problems were investigated. Wound infection (42%) and bladder prolapse (46%) were the major etiologies for initial failures. In six patients (30%) colon conduits were required for bladder augmentation or colocolostomy, which emphasized the importance of achieving a good result at the initial closure. The authors' successful protocol is outlined, and by following this protocol only 3 of 60 patients required reclosure.--George Holcomb, Jr Initial Results With The Cohen Cross-Trigonal Ureteroneocystotomy. J. Wacksman. J Urol 129:1198 1199, (June),
1983. Between January 1976 and December 1980, 109 children with 157 ureters with reflux were seen by the author. Of these ureters, 52 were operated upon using the Cohen crosstrigonal technique, while 105 were followed conservatively. The operative procedure is a complete intravesical ureteral mobilization followed by the creation of a submucosal tunnel across the base of the bladder. Follow-up studies, including
101
an excretory urogram and voiding cystourethrogram, showed minimal hydronephrosis in one ureter and persistent grade I reflux in one ureter. Evaluation of these initial results indicates that Cohen cross-trigonal ureteroneocystotomy is a safe and effective antireflux procedure.~eorge Holcomb, Jr Management of Reflux in The Myelodysplastic Child. W. E.
Kaplan and C. F. Fir~it. J Urol 129:1195-1197, (June), 1983. The authors report that during the last 4 years, 25 children (40 ureters) required antireflux surgery. The criterion of repair was persistent reflux of at least grade lIB, associated with recurrent episodes of infection. A modified LeadbetterPolitano technique was used in 5 children (7 ureters), and the Cohen cross-trigonal technique was used in 20 children (33 ureters). A successful result, that is cessation of reflux and no obstruction, was achieved in 96% of the patients. During the last 2 years, the Cohen cross-trigonal technique has been used exclusively and there have been no failures. This successful result in 96% of the children with neurogenic bladder indicates that while clean intermittent catheterization should be used primarily to relieve reflux, in a select group of children antireflux surgery should also be done.--George Holcomb, Jr Acquired Renal S c a r s in Children. A. L. Winter, B. E. Hardy,
D. J. Alton, et al. J Urol 129:1190-1194, (June), 1983. To determine the important factors involved in the etiology of renal scarring a group of 36 girls and 1 boy was studied. The average age at first detection of renal scars was 5.7 years. Acute pyelonephritic episodes, which were treated early and aggressively, infrequently led to renal scarring. However, the initial prolonged or poorly treated episode of acute pyelonephritis was followed invariably by the development of renal scarring. Fifty-five percent of these children did not have ureters with reflux on the initial studies, and 43% never did show vesicoureteral reflux during followup. The severity of renal scarring was related to the grade of vesicoureteral reflux. Neither the shape nor position of the ureteral orifice nor the ureteral tunnel length correlated with the severity of renal scarring. Treatment with prophylactic antibiotics may have lessened the severity of renal scarring, but treatment with reimplantation did not appear to alter the course of scarring. This study suggests that the key to prevention of renal scarring is the early and aggressive treatment of acute pyelonephritis.--George Holcomb, Jr Technetium--DMSA Scanning to Diagnose Pyelonephretic Scarring in Children. B. A. Cogan, R. Kay, R. J. Wasnick, el
al. Urology 21:641-644, (June), 1983. The technetium DMSA scan provides superior quality imaging of renal parenchymal detail, making it highly sensitive for the diagnosis of pyelonephritic scarring. This technique is unaffected by the presence of overlying bowel gas or boney structures. Furthermore, renal scarring can be demonstrated even before the classic gross anatomical and radiological scar is formed. The latter is true because the DMSA is bound by renal tubular cells which, if injured, produce a filling defect on the cortical image. DMSA scanning is