Abdominal wall hernia: an uncommon complication of in utero vesicoamniotic shunt placement.

Three cases are reported in which placement of a vesicoamniotic shunt in utero for the treatment of obstructive uropathy led to the rare complication of abdominal wall hernia. All 3 patients underwent vesicoamniotic shunt placement for severe oligohydramnios and a markedly dilated bladder in an effort to preserve renal function and to prevent pulmonary hypoplasia. All three shunts were initially placed at or above the umbilicus.

Appendicovesicostomy and newer alternatives for the Mitrofanoff procedure: results in the last 100 patients at Riley Children's Hospital.

Purpose: We present our experience using the various Mitrofanoff techniques to create a continent catheterizable stoma as an adjunct to continent urinary tract reconstruction in children and young adults.

Materials And Methods: Between 1990 and 1998 a Mitrofanoff procedure was performed at our institution in 55 male and 45 female patients with a mean age of 10.5 years.

A long continent ileovesicostomy using a single piece of bowel.

Purpose: In 1981 Mitrofanoff presented a procedure to create a continent urinary stoma for intermittent catheterization. Since then, several other methods have been introduced, including the Yang-Monti ileovesicostomy. The length of these ileovesicostomies is limited by the circumference of the bowel segment used, which is inadequate in some cases.

Repair of hypospadias complications using the previously utilized urethral plate.

Objectives: To review our results of patients who underwent repeat hypospadias surgery using local skin flaps with preservation of the urethral plate.

Methods: We retrospectively reviewed the medical records of all patients who underwent a reoperative hypospadias repair using the urethral plate between 1988 and 1996. A total of 53 patients were identified who developed either a large fistula (47 patients) or severe stricture (6 patients) after the initial repair.

Concealed penis in childhood: a spectrum of etiology and treatment.

Purpose: Concealed penis is an uncommon condition due to poor skin fixation at the base of the penis, cicatricial scarring after penile surgery and excessive obesity. The condition varies in severity and several surgical options are available, such as excision of previous scarring, degloving the penile shaft, reconstructing the penile shaft skin with flaps, fixing the penile skin at the penopubic and penoscrotal angles, and removing excess suprapubic fat.

Materials And Methods: We reviewed the records of 43 patients treated for concealed penis from 1993 to 1998.

alpha-Adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction.

Purpose: Inadequate bladder emptying is a common urinary dysfunction in children. The role of alpha-blockers for managing bladder outlet obstruction remains relatively unexplored in children. Because of the well established impact of alpha-blocker therapy in men, we investigated its use for treating inadequate bladder emptying in the pediatric population.

The Young-Dees-Leadbetter bladder neck repair for neurogenic incontinence.

Purpose: We review our experience with the Young-Dees-Leadbetter bladder neck repair among patients with neurogenic incontinence.

Materials And Methods: Between 1978 and 1997, 25 girls and 13 boys with a mean age of 10.5 years (range 5 to 25) underwent a standard Young-Dees-Leadbetter bladder neck repair for neurogenic incontinence.

Genitourinary anomalies in the CHARGE association.

Purpose: We identified the incidence and types of genital and urinary anomalies, and established a plan for evaluating the urinary system in the CHARGE association.

Materials And Methods: We retrospectively reviewed the charts of 32 patients in whom the CHARGE association was diagnosed.

Results: Of the 32 patients identified 22 (69%) had genitourinary abnormalities.

Prenatal bladder outlet obstruction secondary to ureterocele.

We present 2 cases of prenatal hydroureteronephrosis and bladder outlet obstruction due to an obstructing ureterocele. Both neonates were stabilized and managed with early endoscopic decompression. Neither infant demonstrated significant function in the kidney ipsilateral to the ureterocele either before or after ureterocele puncture.

Initial experience using a catheterizable ileovesicostomy (Monti procedure) in children.

Objectives: To present a review of our experience using the recently described Monti ileovesicostomy as an alternative to appendicovesicostomy as a continent catheterizable stoma in children.

Methods: Between January and December 1997, a Monti ileovesicostomy was performed as part of a reconstructive procedure in 13 children. Mean patient age was 1 1 years, and diagnosis included neurogenic bladder in 11 patients, cloacal exstrophy in 1, and cloacal anomaly in 1 patient.

Augmenting the augmented bladder: treatment of the contractile bowel segment.

Purpose: Bowel used for bladder reconstruction regardless of detubularization occasionally retains its contractile properties. Of 323 patients who underwent primary enterocystoplasty we identified 19 who continue to have high pressure bladder contractions and required augmentation of the previously augmented bladder.

Materials And Methods: Reason for repeat augmentation, upper tract changes, original and secondary bowel segments used, and urodynamic findings were evaluated in all patients.

Etiology, management and surgical complications of congenital chordee without hypospadias.

Purpose: We comprehensively evaluated the etiology, management and surgical complications of chordee without hypospadias.

Materials And Methods: We reviewed the records of patients who underwent chordee correction between January 1985 and December 1996. A total of 87 patients with a median age of 14 months were treated for chordee without hypospadias.

Bladder calculi in the pediatric augmented bladder.

Purpose: Bladder augmentation is now a commonly accepted treatment in children with neuropathic bladder and other bladder anomalies. Bladder calculi have been reported in a third to a half of pediatric patients after bladder augmentation. We identify the incidence of bladder calculi and risk factors for stone formation in a large series of pediatric patients after bladder augmentation.

Artificial urinary sphincter in the treatment of urinary incontinence: preoperative urodynamics do not predict the need for future bladder augmentation.

Purpose: The artificial urinary sphincter has been used to treat urinary incontinence in pediatric patients with neurogenic bladders secondary to myelodysplasia. Frequently bladder augmentation is performed in conjunction with the artificial urinary sphincter implantation. Identifying patients with adequate urinary reservoirs who are candidates for implantation without bladder augmentation is a clinical challenge.

Natural history of refluxing distal ureteral stumps after nephrectomy and partial ureterectomy for vesicoureteral reflux.

Purpose: We evaluated the natural history of refluxing distal ureteral stumps after nephrectomy and partial ureterectomy.

Materials And Methods: Between 1985 to 1996, 38 patients a mean age of 37 months underwent nephrectomy and partial ureterectomy for reflux into a nonfunctioning kidney. The diagnosis included primary reflux in 23 patients, reflux associated with posterior urethral valves in 10 and ipsilateral ureterocele in 5.

Prolonged penile erection in the newborn.

An extensive review of the literature suggests that priapism or prolonged penile erection is extremely rare in the newborn. We present a term newborn whose clinical course of prolonged penile erection was a result of polycythemia. In the past, only 3 cases appear to have been associated with polycythemia.

Practice patterns of pediatric surgeons caring for stable patients with traumatic solid organ injury.

Background: Managed care financing has resulted in pressure to decrease hospital days and lower per diem costs. This influence may ultimately affect nonoperative management of blunt solid organ injuries in children (spleen, liver, kidneys).

Methods: Pediatric surgeons caring for trauma patients were surveyed regarding current practice patterns.

Management of ectopic ureters: experience with the upper tract approach.

Purpose: The necessity of removing the ureteral stump after upper tract surgery for an ectopic ureter has been debated. We reviewed the records of patients initially treated at the kidney level to evaluate indications for later stump removal.

Materials And Methods: We reviewed the medical records of 32 patients with 33 ectopic ureters treated at the kidney level during the last 10 years.

Scrotal cystic lymphangioma: the misdiagnosed scrotal mass.

Purpose: We report 7 cases of scrotal cystic lymphangioma and review the literature on this unusual lesion, which is often misdiagnosed as other conditions and treated incorrectly.

Materials And Methods: We retrospectively reviewed the medical records of 7 patients with scrotal cystic lymphangioma treated from 1984 to 1996 at 5 institutions.

Results: Mean patient age at presentation was 3 years and painless scrotal swelling was the most common symptom.

Setting of relatively low energy outputs may permit implantation of a nonthoracotomy automatic cardioverter defibrillator system when high energy outputs prove ineffective.

At intraoperative testing of defibrillation thresholds during implantation of internal cardioverter defibrillators, standard step-down approaches of energy outputs are used. If relatively high energy outputs are not successful at defibrillating the heart, the electrodes are frequently reconfigured. When attempting implantation of a nonthoracotomy lead system, high defibrillation thresholds may warrant opening of the chest cavity to place one or more epicardial electrodes.

Central and peripheral haemodynamic changes in post-term fetuses: correlation with oligohydramnios and abnormal fetal heart rate pattern.

Objective: To assess the hypothesis that the occurrence of oligohydramnios and abnormal fetal heart rate (FHR) pattern in post-term fetuses is associated with impaired fetal cardiac function.

Design: A cross sectional study was performed on post-term and term fetuses. Fetal tests included a computerised analysis of the FHR, a biophysical profile and Doppler studies of the abdominal aorta, umbilical artery, middle cerebral artery and the fetal heart.

Coronary perforation complicating rotational ablation: the U.S. multicenter experience.

This study retrospectively analyzed the data within the U.S. Multicenter Registry for Rotational Ablation to determine the incidence of coronary perforation during rotational ablation, its angiographic predictors and clinical outcomes during 2953 consecutive patients, 3717 lesions.

Indicators of genitourinary tract injury or anomaly in cases of pediatric blunt trauma.

Purpose: Microscopic hematuria (> or = 20) RBCs per high-power field [HPF] has been used frequently as an indicator for genitourinary (GU) tract injury in pediatric cases of blunt trauma. The aim of this study was (1) to determine whether a certain threshold of microscopic hematuria was associated with GU tract injury in our patient population, and (2) to identify additional factors warranting evaluation of the GU tract.

Methods: The records of 100 patients under 18 years of age whose discharge diagnosis in the trauma registry included hematuria or GU tract injury were reviewed retrospectively (1989 through 1993).

Occult filum terminale syndrome.

Thirty-two pediatric patients presenting with symptoms of urinary dysfunction, stool incontinence and/or severe back and/or leg pain are described. In patients with urological dysfunction, urodynamic testing was consistent with a neurogenic etiology. Imaging studies demonstrated the tip of the conus medullaris to lie above the L2 vertebral body, and the filum terminale to be of normal diameter ( < 2 mm) in all patients.