Partial nephrectomy for pediatric renal cell carcinoma: an unusual case presentation.

Nine years after successful treatment of Stage IV neuroblastoma, a 10-year-old white girl was demonstrated to have a complex cystic mass in the upper pole of her solitary right kidney. Partial nephrectomy was performed, disclosing a renal cell carcinoma, predominantly clear cell type. No metastases were detected.

Kinetic characterization and X-ray structure of a mutant of haloalkane dehalogenase with higher catalytic activity and modified substrate range.

Conversion of halogenated aliphatics by haloalkane dehalogenase proceeds via the formation of a covalent alkyl-enzyme intermediate which is subsequently hydrolyzed by water. In the wild type enzyme, the slowest step for both 1,2-dichloroethane and 1,2-dibromoethane conversion is a unimolecular enzyme isomerization preceding rapid halide dissociation. Phenylalanine 172 is located in a helix-loop-helix structure that covers the active site cavity of the enzyme, interacts with the C1 beta of 1,2-dichloroethane during catalysis, and could be involved in stabilization of this helix-loop-helix region of the cap domain of the enzyme.

Characterization of small intestinal submucosa regenerated canine detrusor: assessment of reinnervation, in vitro compliance and contractility.

Purpose: We characterized small intestinal submucosa regenerated canine bladder.

Materials And Methods: We subjected 15-month small intestinal submucosa regenerated canine bladder strips to in vitro muscle bath compliance, contractility testing and immunohistochemical staining.

Results: Compliance studies demonstrated no significant difference between small intestinal submucosa regenerated and control bladders, which were 30-fold more compliant than native small intestinal submucosal graft material.

Penile orthoplasty using dermal grafts in the outpatient setting.

Objectives: To review and evaluate our extensive outpatient experience in the use of dermal grafts for the correction of significant residual chordee in patients requiring penile orthoplasty.

Methods: The medical records of all patients requiring surgical correction for severe penile curvature over the past 5 years were reviewed. Among these, 51 patients were identified in whom dermal grafts were used to correct severe residual chordee.

Regenerative urinary bladder augmentation using small intestinal submucosa: urodynamic and histopathologic assessment in long-term canine bladder augmentations.

Purpose: To evaluate small intestinal submucosa (SIS) as a possible bladder augmentation material.

Materials And Methods: Nineteen male dogs underwent 35 to 45% partial cystectomy with immediate augmentation with SIS grafts. All dogs were evaluated pre- and postoperatively with blood chemistries, urine cultures, intravenous urograms, cystograms and cystometrograms.

Experimental assessment of small intestinal submucosa as a bladder wall substitute.

Objectives: This study determined the feasibility of promoting urinary bladder regeneration with porcine-derived small intestinal submucosa (SIS).

Methods: Twenty-two Sprague-Dawley rats underwent partial cystectomy with immediate bladder augmentation with SIS. Bladders were harvested for histologic evaluation at 2, 4, 8, 12, 24, and 48 weeks.

Stomach in combination with other intestinal segments in pediatric lower urinary tract reconstruction.

Purpose: We report the results of combining gastric and ileal segments in a small group of predominantly pediatric patients.

Materials And Methods: We retrospectively reviewed the records of 6 children and 1 adult who underwent lower urinary tract reconstruction using stomach and ileum, including 3 simultaneous and 4 staged procedures. Followup was 13 to 59 months.

Cloacal exstrophy: the neurological implications.

Congenital anomalies commonly accompany the abdominal wall defects of cloacal exstrophy with an incidence as high as 100% in some series. The urological literature cites an incidence of vertebral and/or spinal cord anomalies in 75% of cases. We reviewed the records of the 17 patients with cloacal exstrophy treated at our institution since 1978.

Posterior urethral valves, pressure pop-offs and bladder function.

The pop-off mechanisms that sometimes occur with posterior urethral valves have well recognized implications for renal function, such that 1 or both kidneys can be protected from the deleterious effects of elevated bladder pressures. What has not been defined is the significance, if any, of pressure pop-offs to the developing bladder and ultimate bladder function. To answer this question we reviewed the records of 63 boys with posterior urethral valves.

The flip-flap technique to lengthen the urethra (Salle procedure) for treatment of neurogenic urinary incontinence.

We report the clinical results of a urethral lengthening procedure for neurogenic urinary incontinence. The urethra is lengthened by using a full thickness anterior bladder wall flap that is based at the urethra. This flap is approximated to a longitudinal strip of the trigonal mucosa and musculature.

Long-term histopathological changes observed in rats subjected to augmentation cystoplasty.

Possible development of proliferative lesions in bladders subjected to augmentation cystoplasty is a matter of concern for many clinicians. We have previously reported on the development of bladder papillomas in 5 of 15 rats approximately 18 months after gastrocystoplasty. We now report a followup study designed to investigate histopathological changes occurring in rat bladders approximately 2 years after augmentation cystoplasty using various gastrointestinal segments.

Construction of an expression and site-directed mutagenesis system of haloalkane dehalogenase in Escherichia coli.

Haloalkane dehalogenase from Xanthobacter autotrophicus was efficiently expressed in Escherichia coli BL21 (DE3) and E. coli JM101. After introduction of restriction sites by PCR the haloalkane dehalogenase gene (dhlA) was translationally fused behind the T7 (phi 10), trc, and tac promoters.

Seromuscular trough modification in construction of continent urinary stomas.

The creation of an effective flap-valve continent stoma requires use of supple, catheterizable conduit that is implanted in a submucosal bed having adequate backing. In some patients the backing that has been routinely used, colonic teniae or bladder detrusor for instance, is deficient or unavailable. As an alternative, the seromuscular layers of the recipient urinary reservoir can be simply reconfigured to provide the support required of a continent stoma.

Bladder outlet reconstruction: fate of the silicone sheath.

The placement of a 1.5 cm. wide silicone sheath around a newly constructed urethra/bladder neck to ensure maintenance of repair length and to facilitate future placement of a sphincter cuff was reported by our institution in 1985.

Improved results using a modification of the Young-Dees-Leadbetter bladder neck repair.

Forty-seven patients with primary total incontinence underwent bladder neck reconstruction (BNR) between 1978 and 1988. This included 31 patients with exstrophy/epispadias, 14 with myelomeningocele and 2 with caecoureteroceles. The patients were divided into 5 groups based on the type of BNR: Group 1--standard Young-Dees-Leadbetter (YDL) BNR; Group 2--YDL+Silastic sheath; Group 3--modified YDL; Group 4--Kropp BNR; Group 5--other BNRs.

Lower urinary tract reconstruction using stomach and the artificial sphincter.

We implanted the artificial urinary sphincter at gastrocystoplasty in 13 male and 5 female patients. The diagnoses were classical bladder exstrophy (8 patients), myelodysplasia (8), cloacal exstrophy (1) and bilateral ectopic ureters (1). Mean patient age was 14.

Appendicovesicostomy: a useful adjunct to continent reconstruction of the bladder.

Appendicovesicostomy is a useful adjunct to continent reconstruction of the bladder. During the last 3 years we have used this procedure in 14 children with difficult incontinence due to spina bifida (7), exstrophy/epispadias (5), imperforate anus (1) and urethral agenesis (1). In 4 patients in whom previous operations had failed to achieve continence the bladder neck was closed.

Urethral polyp presenting as interlabial mass in young girls.

We describe two young girls who presented with an interlabial mass. Histologic examination of each excised mass revealed a benign urethral polyp covered with transitional and squamous epithelium. Urethral polyps should be included in the differential diagnosis of an interlabial mass in young female patients.

Median raphe cysts of the genitalia.

We report 2 recent cases of midline cysts of the genitoperineal raphe in children, and discuss the embryogenesis, diagnosis and management. Congenital anomalies of an unclear etiology, median raphe cysts are probably more common than has been reported in the literature. Medical attention is usually sought for secondary infections or pain with intercourse.

Plasma albumin repletion after transfusion with polymerized hemoglobin.

Pyridoxalated polymerized hemoglobin (PPHG) has promise as a blood substitute for transfusing patients with hemorrhage. Exchange transfusion with PPHG depletes plasma proteins. The purpose of this study was to determine if, during the early repletion of intravascular proteins, albumin was transported from the interstitium of skin or skeletal muscle into the vascular compartment.

Long term effects of gastrocystoplasty in rats.

Twenty prepubescent rats underwent microsurgical gastrocystoplasty by a technique which is described. An equal number of control rats had their bladders opened and closed. Rats were sacrificed at 16 to 18 months postoperatively.

Cloacal exstrophy reconstruction for urinary continence.

From 1978 to 1989 we treated 16 patients with cloacal exstrophy, including 8 who have been treated since birth. To achieve urinary continence bladder reconstruction was required in 12 patients, including 3 ileocystoplasties, 4 gastrocystoplasties and 5 gastric continent urinary reservoirs. All 12 patients underwent simultaneous bladder neck/urethral continence procedures.

Physiology of lower urinary tract obstruction.

One of the major dilemmas facing pediatric urologists today is discerning obstruction in the dilated urinary tract. Apparently similar anatomic obstructions can result in very dissimilar consequences. The authors focus on the physiologic response of the bladder and upper tracts to infravesical obstruction.

An enzymatic assay for the colorimetric and fluorimetric determination of uric acid in sera.

The methods described in this paper are based on the uricase catalyzed oxidation of uric acid to allantoine and hydrogen peroxide. By making use of the catalytic activity of peroxidase the generated H2O2 is measured either spectrophotometrically with 3-methyl-benzothiazoline-2-one hydrazone (MBTH) and 3-dimethylaminobenzoic acid (DMAB) (M1) or fluorimetrically with tyramine (M2) or L-tyrosine (M3). The methods are simple, sensitive and selective.