Urethral lengthening with anterior bladder wall flap for urinary incontinence: a new approach

Urethral irregularity (impending catheterization) and failure to achieve continence are common complications in surgery for urinary incontinence. We describe a surgical technique using an anterior bladder wall flap that is sutured to the posterior wall in an onlay fashion creating a flap valve mechanism. Experimental work in dogs demonstrated a significant increase in the leak point pressure in the surgical group when compared to controls (p= 0.019). Voiding cystourethrography and bladder inspection demonstrated an anterior flap valve with no fistula formation in all animals. Histological examination showed a viable anterior bladder wall flap in all cases. This technique was then applied to 6 patients with neurogenic bladder and low urethral resistance that failed to resolve with medical treatment. Urinary continence was achieved in 4 patients. In 1 patient a vesicourethral fistula developed 3 months postoperatively, since the mother failed to catheterize for 12 hours. This technique is a useful alternative in the treatment of urinary incontinence

Linfangioma abdominal na criança: apresentaçäo de um caso / Intraabdominal cystic lymphangioma in children: a case report

Linfangiomas säo lesöes císticas originadas de uma malformaçäo primária do sistema linfático, na qual os canais eferentes estäo obstruídos, com dilataçäo dos canais proximais. A lesäo é mais comum na cabeça, pescoço e axila; sua ocorrência no abdômen é rara. Os autores descrevem um caso de linfangioma cístico abdominal num menino de 4,5 anos de idade, enfatizando a importância de ecografia para o diagnóstico e da realizaäo de cirurgia mais conservadora possível no tratamento destas lesöes