ABSTRACT
Augmentation cystoplasy using the gastrointestinal tract has disadvantages related to the intestinal resection and its incorporation into the urinary tract. To preclude both sets of complications, we performed augmentation ureterocystoplasty in a 5 1/2-year-old meningomyelocele patient with urinary incontinence, a low capacity bladder, severe vesicoureteral reflux and a poorly functioning kidney. After nephrectomy the ureter was incised longitudinally, folded over and placed onto the bladder as a patch. Bladder capacity, only 60 cc without the contribution from the refluxing upper tract, increased to 200 cc 6 months postoperatively. The patient is continent. Augmentation ureterocystoplasty is an option for bladder enlargement that obviates many of the risks associated with enterocystoplasty.
Subject(s)
Ureter/surgery , Urinary Bladder/surgery , Urination Disorders/surgery , Child, Preschool , Humans , Male , Meningomyelocele/complications , Postoperative Complications , Urination Disorders/etiologyABSTRACT
Primary extranodal lymphoma of the female urethra is rare. We present case 10 and review the literature. Management in the past has varied markedly. Strategies have included simple excision, external beam and intracavitary radiation therapy, and multiple agent chemotherapy. The majority of patients have done well: 7 of 10 are alive with no evidence of disease. Newly diagnosed patients should undergo complete staging with the Ann Arbor staging system and the tumors should be classified histologically according to the Working Formulation for Clinical Usage. Therapy must be individualized but in most cases we recommend that patients be treated as if they have systemic illness, with multimodality therapy.
Subject(s)
Lymphoma, Large B-Cell, Diffuse , Urethral Neoplasms , Adult , Female , Humans , Lymphoma, Large B-Cell, Diffuse/diagnosis , Urethral Neoplasms/diagnosisABSTRACT
Necrotizing fasciitis of the perineum and genitalia is a rare, rapidly progressive, often fatal infection whose unique bacterial involvement has frequently been ignored. From our experience with 14 patients, we recommend the following: early, aggressive surgical debridement and drainage to reduce morbidity and mortality; prompt institution of antimicrobial therapy directed at both aerobic and anaerobic organisms, with subsequent tailoring to the specific bacteria cultured, and early surgical reconstruction to avoid extensive scarring and cosmetic deformity and to allow earlier skin closure and a reduced hospital stay. In our series, long-term complications occurred in 3 patients, and 3 of the 14 died.
