ABSTRACT
Buccal mucosal grafts are being utilized increasingly in urethral reconstruction for hypospadias and urethral stricture disease. We describe our technique for harvesting and utilizing buccal mucosal grafts in cases of severe proximal hypospadias anomalies or failed prior hypospadias repair.
Subject(s)
Hypospadias/surgery , Mouth Mucosa/transplantation , Plastic Surgery Procedures , Urethra/abnormalities , Urologic Surgical Procedures/methods , Cheek , Follow-Up Studies , Humans , Male , Postoperative Complications , Urethra/surgeryABSTRACT
OBJECTIVE: To present several case reports of children with 'pseudoureteroceles'. Familiarization with this entity should help to avoid an error in diagnosis and possible improper therapy. PATIENTS AND METHODS: Three girls with ectopic ureters entering mesonephric duct cysts are presented for review. RESULTS: Misdiagnosis of the pseudoureterocele as an ectopic ureter was made in two children. The 'pseudoureterocele' may lie dormant for many years and often presents with acute urinary incontinence and/or onset of urinary tract infections. Resection of the dysplastic kidney and ipsilateral ureter, marsupialization of the cyst into the vagina, and closure of the vesical fistula is the preferred treatment. CONCLUSION: An ectopic ureter draining into a Gartner's duct cyst can be confused with an ectopic ureterocele. Correct diagnosis is vital to ensure proper treatment.
Subject(s)
Ureter/abnormalities , Ureterocele/diagnosis , Adolescent , Child, Preschool , Diagnosis, Differential , Female , Humans , Infant , Recurrence , Urinary Tract Infections/etiologyABSTRACT
Reconstruction of the umbilicus has cosmetic and functional value in the surgical treatment of the child with bladder exstrophy. We report on 12 patients who underwent creation of a neoumbilicus as part of genitourinary reconstruction.
Subject(s)
Bladder Exstrophy/surgery , Surgical Flaps/methods , Umbilicus/surgery , Adolescent , Child , Child, Preschool , Follow-Up Studies , HumansABSTRACT
The use of stomach for bladder reconstruction is an important tool for the urologic surgeon. Just as one would not perform hypospadias repair knowing only one technique, one should not consider bladder reconstruction with only one option for augmentation available. The advantages, disadvantages and a brief overview of our operative technique are presented. We have been very pleased with our experience with the use of stomach in the appropriate clinical situation.
Subject(s)
Urinary Bladder/surgery , Urinary Diversion/methods , Urinary Reservoirs, Continent/methods , Child , Humans , Postoperative Care , Postoperative Complications/epidemiology , Stomach/surgery , Surgical Flaps/methodsABSTRACT
We report the use of the Mitrofanoff principle to achieve urinary continence in 47 patients. A catheterizable channel can be used as the primary continence mechanism, or as an adjunct to ensure complete bladder emptying if urethral catheterization or voiding is inadequate. Appendico-vesicostomy was performed in 25 of 47 patients (55%). Satisfactory continence was achieved in 45 patients (96%). Bladder emptying by clean intermittent catheterization was performed in all patients. Early complications included peristomal abscess (1 patient) and small bowel obstruction (1). Late complications included difficulty with catheterization (5 patients), stomal stenosis (9) and persistent incontinence (2). Our results support use of the appendix as the catheterizable segment of choice. We describe the technique and discuss the management of complications.
Subject(s)
Appendix/surgery , Cystostomy/methods , Urinary Catheterization , Urinary Reservoirs, Continent/methods , Bladder Exstrophy/surgery , Child , Cloaca/abnormalities , Female , Follow-Up Studies , Humans , Male , Neural Tube Defects/surgery , Postoperative Complications/epidemiology , Self Care , Time FactorsABSTRACT
The treatment of autosomal recessive polycystic kidney disease (ARPKD) is evolving. Overall prognosis is difficult to determine, but most neonates without severe pulmonary hypoplasia will survive. It is difficult to predict which neonates with ARPKD requiring immediate ventilatory support have pulmonary hypoplasia incompatible with survival. Massively enlarged kidneys restricting diaphragmatic excursion can cause respiratory distress in addition to pulmonary hypoplasia. Three infants with ARPKD underwent bilateral nephrectomies and institution of peritoneal dialysis in an attempt to improve ventilatory status and assess long-term pulmonary function. Two children are alive at twelve and thirty months postoperatively and awaiting renal transplantation. One infant died of acute cardiorespiratory complications.
Subject(s)
Polycystic Kidney, Autosomal Recessive/surgery , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Lung/abnormalities , Male , Nephrectomy , Peritoneal Dialysis , Polycystic Kidney, Autosomal Recessive/complications , Prognosis , Respiration, Artificial , Respiratory Insufficiency/etiologyABSTRACT
An experimental canine model was designed to examine the potential use of the artificial urinary sphincter around a gastric tube. The artificial urinary sphincter was placed around a tubularized gastric flap as part of a continent gastric reservoir in 4 dogs and in 2 additional dogs the gastric tube was anastomosed to the native bladder. Two dogs underwent placement of the artificial urinary sphincter around the gastric tube 4 weeks postoperatively and the remainder had the sphincter placed simultaneously with creation of the gastric tube. All dogs with the gastric reservoir underwent urodynamics before and after activation of the sphincter. Only 61 to 70 cm. water pressure balloons were used. All dogs were continent postoperatively on clean intermittent catheterization every 8 hours. There were no erosions or problems with catheterization. Urodynamics confirmed a complaint system and an average increase of capacity of 410% after artificial urinary sphincter activation (4 dogs). There was no leakage at capacity. Histology of the artificial urinary sphincter and neighboring (control) regions, and of the reservoir at 1 (2 dogs), 3 (3 dogs) and 6 months (1 dog) was obtained. Microscopic examination of the cuff site showed mild serosal hyperplasia and fibrosis, a well preserved muscularis and mild to moderate focal mucosal atrophy. These changes were slightly more evident at 6 months. Mucosal folds were well preserved with normal submucosa and lamina propria. In the control region histology was well preserved and similar to native stomach. We conclude that the artificial urinary sphincter around a gastric tube can provide urinary continence. The minimal changes in histology under the cuff are encouraging and support the potential for use of the gastric tube with the artificial urinary sphincter, although longer term effects are unknown.
Subject(s)
Stomach/transplantation , Urinary Incontinence/surgery , Urinary Reservoirs, Continent/methods , Urinary Sphincter, Artificial , Animals , Dogs , Female , Postoperative Complications , Urinary Bladder/pathology , Urinary Bladder/surgery , UrodynamicsABSTRACT
A prospective study of 18 consecutive patients undergoing unilateral, partial-thickness, distal, internal sphincterotomy for the treatment of chronic anal fissure was performed. Biopsies were taken from the base of the fissure and from the lateral muscle before division. Normal specimens were taken from the internal anal sphincter of patients undergoing abdominoperineal resection. Specimens confirmed the presence of fibrosis throughout the internal anal sphincter in patients with anal fissures, but none in controls.
