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Biomedical subjects

A Decter

Publications and source records attributed to A Decter.

10 recordsLinked to original sources
PubMed1998

Endoscopic subureteral collagen injection: are immunological concerns justified?

PURPOSE: We evaluated the humoral immune response in children treated with subureteral collagen injection for vesicoureteral reflux by analyzing serum for anticollagen antibodies. MATERIALS AND METHODS: We obtained serum before skin testing and at intervals after subureteral collagen injection in 7 girls and 3 boys with a mean age plus or minus standard error of 9.2+/-1.4 years. Serum antibody titers to bovine collagen, and human collagen types I and III were determined by indirect enzyme-linked immunosorbent assay. Patients were assessed for adverse reactions related to an immune response to collagen. RESULTS: Followup ranged from 14 to 40 months (mean 24.6) after the initial subureteral collagen injection. One to 4 subureteral collagen injections were given with cumulative collagen volume per patient ranging from 0.15 to 5.1 cc (mean 2.1). In 2 cases no baseline serum sample was obtained. Antibody titers measured in the 8 other patients before skin testing revealed equivocal and negative results in 5 and 3 for antibovine collagen, and in 1 and 7 for antihuman collagen types I and III, respectively. At the last followup results were positive, equivocal and negative in 3, 5 and 2 for antibovine collagen, and in 0, 2 and 8 for antihuman collagen types I and III, respectively. Seroconversion developed 13 to 24 months after the initial subureteral collagen injection in antibovine collagen seropositive patients, including 1 with a limited episode of bladder irritability after seroconversion. No other patient had adverse events considered to be immunological. CONCLUSIONS: In 3 of the 10 children treated with subureteral collagen injection for vesicoureteral reflux serum antibodies to bovine collagen developed. The volume of collagen injected was small, suggesting that volume is not a major determinant of immunogenicity. In 1 patient with seroconversion a local reaction may have been immunogenic. No patient had systemic symptoms of autoimmune disease and there was no seroconversion to antibodies cross-reacting with human collagen.

Adolescent↗
PubMed1996

Treatment of urinary incontinence in children by endoscopically directed bladder neck injection of collagen.

PURPOSE: We assessed optimal selection criteria for and expected outcome of bladder neck injection of collagen in children with intrinsic sphincteric deficiency. MATERIALS AND METHODS: We retrospectively reviewed the charts of children with intrinsic sphincteric deficiency treated with bladder neck injection of collagen at 3 pediatric urology centers. RESULTS: We reviewed the records of 12 boys and 6 girls 6 to 18 years old (median age 10.5). The underlying etiology of incontinence was neurogenic bladder in 10 patients, the epispadias-exstrophy complex in 6, ureterocele in 1 and trauma in 1. Previous surgery included bladder augmentation in 4 cases, bladder neck plasty in 7 and epispadias repair in 4, and concurrent medical management comprised anticholinergics in 8, alpha-agonists in 1 and intermittent catheterization in 9. Skin tests in all patients were negative for collagen. Seven patients had 1 injection, 9 had 2 and 2 had 3. The volume of collagen injected ranged from 2.4 to 13 cc (median 5) per treatment and 3 to 28 cc (median 7) per patient. Followup ranged from 5 to 21 months (median 15). Of the 14 patients evaluated 5 are dry, 4 are improved, 1 is unchanged and 4 underwent further continence surgery. No treatment related morbidity was seen. CONCLUSIONS: Endoscopically directed injection of collagen around the bladder neck is successful in 64% of children with intrinsic sphincteric deficiency. It is an outpatient treatment with no significant morbidity. Further continence surgery is not precluded when necessary. Patients with adequate capacity and compliant neurogenic bladders, and those with the exstrophy-epispadias complex and failed bladder neck plasty seem to be optimal candidates for collagen injection.

Administration, Intravesical↗
PubMed1996

Endoscopic treatment of vesicoureteral reflux with collagen: preliminary report and cost analysis.

PURPOSE: We determined therapeutic and operative cost efficacy of endoscopic collagen injection for vesicoureteral reflux. MATERIALS AND METHODS: We performed a multicenter study of 10 male and 23 female sequential patients (45 renal units) with vesicoureteral reflux and a surgical indication. Patients were skin tested with collagen and when negative, they underwent endoscopic injection. Renal ultrasound/cystography was done 3 months after treatment. Cost analysis was performed at 1 institution. RESULTS: Reflux was grade I in 2 renal units, II in 18, III in 15 and IV in 10. The majority of cases were single systems with primary reflux. We performed 1 treatment in 32 renal units, 2 in 6, 3 in 6 and 4 in 1. Cure was evident in 31 of 38 renal units (81.6%) and 21 of 27 patients (78%) 3 months after the last injection. Patient morbidity was minimal. Operative cost per renal unit was $1,599.68 for collagen injection and $9,144.47 for reimplantation. CONCLUSIONS: Endoscopic injection of collagen is effective treatment for vesicoureteral reflux. Furthermore, it causes minimal morbidity and may effect cost savings in health care management.

Adolescent↗
PubMed1983

Antepartum chronic fetal vesicoamniotic shunts for obstructive uropathy: A report of two cases.

Two fetuses with obstructive uropathy characterized by striking oligohydramnios and dilatation of the urinary collecting system were identified by ultrasound and treated by percutaneous insertion of a long-term vesicoamniotic silicone rubber shunt. Both fetuses were less than 16 weeks' gestation at diagnosis and less than 18 weeks at treatment. One fetus was delivered at 35 weeks and is alive and well; the other died early in the neonatal period at 31 weeks with pulmonary hypoplasia.

Adult↗
PubMed1982

The Kraske approach to the repair of recurrent rectourethral fistula.

Rectourethral fistula is an uncommon surgical complication that may follow correction of anorectal anomalies. Previously described operations to repair the fistula have a high incidence of failure. Operative success is measured by achieving permanent separation of rectum from urethra, preventing urethral injury, and preserving urinary and fecal continence. Two patients with recurrent rectourethral fistula were repaired successfully. The operation described is performed through a posterior transsphincteric Kraske approach with direct repair of the fistula and resection of the fistula containing anorectal tube.

Child, Preschool↗
PubMed1981

Carcinoma of the colon arising at ureteral implant sites despite early external diversion: pathogenetic and clinical implications.

Colon carcinomas develop at the site of implantation in approximately 6% of patients who undergo ureterosigmoidostomy for benign conditions. Generally, the obstruction of a long-functioning ureterosigmoidostomy heralds the presentation of the malignancy. The development of a carcinoma of the colon at the site of the ureteral stump 22 years after conversion to ileal conduit in a ureterosigmoidostomy, which had been in place for only nine months, raises fundamental questions about the pathogenesis of the tumor. The long-assumed role of urine in the induction of these iatrogenic tumors must be questioned. This issue and suggestions for management and prevention are discussed.

Adult↗