Occult ureteropelvic junction obstruction presenting as anuria and urinary ascites in an infant with antenatal, unilateral hydronephrosis.

Objective: To discuss an unusual case of occult ureteropelvic junction obstruction.

Case: A premature male infant with severe, unilateral hydronephrosis presented to the emergency room with 20 h of dry diapers. Placement of urethral catheter did not return urine.

Endoscopic injection of bulking agents in children with incontinence: dextranomer/hyaluronic acid copolymer versus polytetrafluoroethylene.

Purpose: Treating pediatric incontinence can be challenging. Many surgical procedures are available with variable success and complications. Endoscopic injection of bulking agents into an incompetent bladder neck was first described using Teflon and most currently using Deflux.

Extraperitoneal placement of renal allografts in children weighing less than 15 kg.

Purpose: Extraperitoneal renal transplantation is not routine in small recipients, in whom transperitoneal engraftment is the norm. The outcome of extraperitoneal placement of renal allografts in children weighing less than 15 kg. was evaluated at 2 institutions.

Erectile dysfunction in patients with spina bifida is a treatable condition.

Purpose: Now that individuals with spina bifida live well into adulthood erectile dysfunction has become a recognized associated medical disorder. To our knowledge no study has dealt specifically with treatment of erectile dysfunction in men with spina bifida. Therefore, we conducted a prospective, blinded, randomized, placebo controlled, dose escalation, crossover study to determine the ability to treat erectile dysfunction in men with spina bifida with sildenafil citrate.

The mucosal collar revisited.

Objectives: The mucosal collar was designed to achieve a cosmetically normal-appearing, circumcised phallus during hypospadias surgery. The original technique has been modified and refined since its introduction by Firlit in 1987. Herein, we provide a detailed description of the procedure as it is now performed.

Erectile dysfunction in spina bifida is treatable.

We undertook a prospective, blinded, randomised, placebo-controlled, dose escalation, crossover study that showed that erectile dysfunction in spina bifida is medically treatable, specifically with sildenafil citrate.

Myofascial wrap to treat intractable urinary incontinence in children.

Objectives: The management of intractable urinary incontinence in the patient with cloacal or bladder exstrophy/epispadias, failed bladder neck plasty, or failed augmentation cystoplasty remains a surgical challenge. The myofascial wrap, a modification of the rectus fascial wrap, was developed to treat intractable urinary incontinence due to sphincteric incompetence in these problematic cases. A full-thickness, vascularized pedicle of anterior rectus sheath, rectus abdominis muscle, and posterior rector sheath is incorporated into a bladder neck wrap to provide support, mucosal coaptation, and active muscular tone.

The prune-belly syndrome: a new and simplified technique of abdominal wall reconstruction.

Purpose: Various techniques of reconstruction have been developed to improve the cosmetic and functional status of the abdominal wall in the prune-belly syndrome. We describe a new extraperitoneal plication technique of abdominoplasty that is simplified in comparison to other established procedures in that it obviates the need for a fascial incision and/or entrance into the peritoneal cavity in patients who do not require a concurrent intra-abdominal procedure.

Materials And Methods: Since 1980 this technique of abdominoplasty has been performed in 13 patients 9 months to 11 years old (mean age 3.

Urine levels of transforming growth factor-beta 1 in children with ureteropelvic junction obstruction.

Objectives: To determine if there are measurable quantities of transforming growth factor-beta 1 (TGF-beta 1) in the urine of children with either normal or pathologic conditions of the urinary tract, specifically vesicoureteral reflux (VUR) and ureteropelvic junction obstruction (UPJO). We also sought to determine if the urine TGF-beta level could distinguish between renal obstruction and no obstruction.

Methods: Preoperative bladder urine from consecutive patients undergoing pyeloplasty (UPJO group; n = 13), ureteral reimplantation (VUR group; n = 11), or circumcision/orchiopexy (control group; n = 19) as well as urine from the renal pelvis of the UPJO group was collected.

Captopril (an inhibitor of angiotensin converting enzyme) inhibits obstructive changes in the neonatal rabbit bladder.

Objectives: To investigate whether angiotensin II has a role in the regulation of bladder smooth muscle growth and function, we developed a model of bladder neck obstruction (BNO) in the neonatal rabbit and investigated the effect of captopril (angiotensin converting enzyme inhibitor) on the obstructive changes in the developing bladder.

Methods: Partial BNO was induced in a group of 2-day-old rabbits (n = 8) by placing a loose 2-0 silk ligature around the vesicourethral junction. A second group of rabbits subjected to the identical partial BNO procedure (n = 8) was given captopril (1 mg/kg/day).

The influence of surgical approach and intraoperative venography on successful varicocelectomy in adolescents.

Purpose: We evaluated the importance of intraoperative venography and surgical approach on varicocele recurrence after surgical varicocelectomy in male adolescents.

Materials And Methods: The analysis was done using local data and composite data from the literature. We reviewed the records of patients undergoing varicocele ligation between 1986 and 1995 at our institution.

The effect of angiotensin converting enzyme inhibition and angiotensin II receptor antagonism on obstructed rat bladder.

Purpose: Others have demonstrated that inhibition of angiotensin II production partially ameliorates obstructive changes in the neonatal rabbit bladder. We examined the effect of angiotensin II converting enzyme inhibition and receptor antagonism on the obstructed rat bladder.

Materials And Methods: Three groups of animals were investigated.

Management considerations for treating vesicoureteral reflux in children with solitary kidneys.

Objectives: To evaluate the management approach for vesicoureteral reflux (reflux) into a solitary kidney.

Methods: Outcomes of all children with solitary kidneys and reflux managed between 1981 and 1996 were reviewed. Solitary kidneys were documented by nuclear renography and ultrasonography; reflux was graded after cystography.

Complications of intravesical oxybutynin chloride therapy in the pediatric myelomeningocele population.

Purpose: We report our experience with the intravesical administration of oxybutynin chloride with particular focus on the incidence and characterization of untoward effects and inconvenience of therapy.

Materials And Methods: From 1990 to 1995, 23 children 5 to 11 years old with myelodysplasia were treated with intravesical oxybutynin chloride. Initial dose was 1.

Angiotensin II and basic fibroblast growth factor induce neonatal bladder stromal cell mitogenesis.

Purpose: Our aims were to establish primary stromal cell cultures from the neonatal rabbit bladder and investigate the potential mitogenic effects of angiotensin II and basic fibroblast growth factor on these cells.

Materials And Methods: Primary bladder stromal cell cultures were obtained from 3-day-old rabbits, plated at a density of 3 x 10(4) cells per ml. and allowed to grow for 24 hours.

Pediatric hypospadias surgery.

The pediatric health care practitioner is a valuable resource of information for the family of an infant with hypospadias prior to the child and family's first visit to the pediatric urologist. Pediatric nurses are involved in the preoperative and postoperative care of children with surgical correction of hypospadias and should be aware of the newest advances in surgical techniques and improvements in postoperative care, particularly dressings and urethral stents. These advances have improved the outcome for children, including diminished pain and discomfort, minimal hospital stay and decreased complications.

Does early pyeloplasty really avert loss of renal function? A retrospective review.

We reviewed 75 cases of isolated, unilateral pediatric ureteropelvic junction obstruction and 167 diuretic radionuclide renograms performed during the last 8 years. Differential function of the affected kidney was calculated using scintillation count data at 1 and 3 minutes, and the area under the renogram curve between 1 and 3 minutes. There was no significant difference among the 3 measures of per cent differential function for a given patient.

Selective sacral rhizotomy in children with high pressure neurogenic bladders: preliminary results.

Recent successful introduction of selective rhizotomy in the management of lower extremity spasticity in patients with myelodysplasia has prompted us to use it as a means of managing high pressure neurogenic bladders occasionally encountered in myelodysplastic patients. During the last 1 1/2 years 8 children have undergone selective sacral rhizotomy in an attempt to avert urinary diversion or bladder augmentation. Patient age ranged from 6.

Grading nephroureteral dilatation detected in the first year of life: correlation with obstruction.

To understand better the significance of pediatric idiopathic nephroureteral dilatation the renal ultrasound images of patients less than 1 year old with hydronephrosis or hydroureteronephrosis were graded and compared to the radiological diagnosis of obstruction as determined by diuresis renography and/or urography. The study included 73 boys and 30 girls with hydronephrosis (76 patients) or hydroureteronephrosis (27). For hydronephrosis obstruction was diagnosed in 56 children (74%) and involved 61 of 97 kidneys (63%).

Favorable experience with pre-emptive renal transplantation in children.

We retrospectively examined our experience with live-related donor kidney transplants in 66 children during the 7-year period 1984-1990. We compared the clinical courses of 26 children who did not receive any dialytic therapy prior to transplantation with 40 children who were dialyzed (27 via peritoneal dialysis and 13 via hemodialysis). We did not find any statistically significant differences in patient or graft survival between these three groups with a follow-up period of 6-87 months.