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Biomedical subjects

D A Bloom

Publications and source records attributed to D A Bloom.

At least 19 recordsLinked to original sources
PubMed1995

Long-term results and complications using augmentation cystoplasty in reconstructive urology.

One hundred and twenty-two augmentation cystoplasties performed over an 8-year period were reviewed. Mean age at surgery was 37 years (range 2-82 years). There were 82 female patients. The primary urodynamic diagnosis was reduced compliance in 92 (77%) patients and detrusor hyperreflexia/instability in the remainder. The clinical diagnostic groups were: spinal cord injury/disease in 32 (27%), myelodysplasia in 27 (22%), interstitial cystitis in 21 (17%), idiopathic detrusor instability in 13 (11%), radiation cystitis in 8 (7%), Hinman-Allen syndrome in 5 (4%), and miscellaneous in 11 (9%). A detubularized ileal augmentation was used in 82 (67%) patients. In 36 (30%) a detubularized ileocecocystoplasty was fashioned and in the remainder detubularized sigmoid was used. In 19 patients augmentation accompanied undiversion. Sixteen patients had a simultaneous fascial sling for urethral incompetence. Mean follow-up was 37 months (range 6-96 months). There was no postoperative mortality. During follow-up 4 patients died from unrelated causes, 11 have been lost to follow-up, and 5 patients await planned transplantation. Bladder capacity was increased from a preoperative mean of 108 ml (range 15-500 ml) to 438 ml (200-1,200 ml) postoperatively. Of the 106 assessable patients, 80 (75%) had an excellent result, 21 (20%) were improved, and 5 (5%) had major ongoing problems. During the period of follow-up, 17 (16%) patients underwent revision of their augmentation. Twenty-four (21%) patients developed bladder stones and 30% of these did so more than once. Urinary incontinence became manifest in 15 (13%) patients but required surgical treatment in only half of these. Pyelonephritis occurred in 13 (11%) patients. Five patients developed small bowel obstruction following discharge from hospital. There were 7 instances of reservoir rupture in 5 (4%) patients. Augmentation cystoplasty has a pivotal role in the treatment of a broad range of lower and upper urinary tract problems. Careful patient selection and close follow-up are essential.

Adolescent↗
PubMed1995

Reed Nesbit and pediatric urology.

OBJECTIVES: To ascertain the pediatric urology experience and contributions of Reed Nesbit, a urologist known primarily as an educator, transurethral resectionist, and prostate expert. METHODS: The writings of Nesbit and appropriate background references were analyzed. RESULTS: Nesbit's contributions to pediatric urology, particularly the Cabot-Nesbit orchidopexy, the buttonhole preputial transposition, the dorsal tunical tuck for chordee, and the elliptical anastomosis were significant. CONCLUSIONS: Nesbit's contributions to pediatric urology were innovative and enduring.

Cryptorchidism↗
PubMed1995

Modified dartos pouch orchiopexy.

Experimental evidence suggests that transparenchymal suture fixation may risk testicular damage. Even very small sutures can result in inflammation and tubular damage. An alternative to transparenchymal suture fixation of the testis is presented.

Child↗
PubMed1995

Outcome analysis of bilateral Cohen cross-trigonal ureteroneocystostomy.

OBJECTIVES: The perioperative and long-term outcomes of children with vesicoureteral reflux (VUR) treated by cross-trigonal ureteroneocystostomy were ascertained. METHODS: One hundred ten consecutive children with VUR who underwent bilateral cross-trigonal ureteroneocystostomy were studied retrospectively. Nineteen children with neurovesical dysfunction or megaureters requiring tapered reimplants were excluded. Outcome parameters of the remaining 91 children consisted of operative time, length of hospitalization, days of Foley catheter drainage perioperative complications, correction of reflux, subsequent morbidity, and parental satisfaction. RESULTS: Of 182 renal units, 11 (6%) had grade 0 VUR, 18 (10%) had grade I, 43 (24%) had grade II, 59 (32%) had grade III, 36 (20%) had grade IV, and 15 (8%) had grade V reflux. The mean operative and hospitalization times were 180 minutes and 5.6 days, respectively. No postoperative complications occurred. Three children were lost to follow-up, and the remaining 88 children had an extended mean follow-up in excess of 3 years. Voiding cystourethrogram documented a 98.3% (173 of 176 renal units) success rate. Sixteen children (18%) experienced nonfebrile clinically symptomatic cystitis episodes and 3 children (3%) experienced one febrile episode each. Telephone parental survey of overall surgical experience revealed a 94% very satisfied, 2% satisfied, and 3% dissatisified rate. CONCLUSIONS: Cross-trigonal ureteroneocystostomy is a safe and effective technique that is virtually complication free and has high parental satisfaction. The results of this study provide a baseline for comparison of non-operative treatment of reflux as well as laparoscopic and endoscopic techniques.

Adolescent↗
PubMed1995

Percutaneous endopyelotomy in infants and young children after failed open pyeloplasty.

PURPOSE: We assessed the efficacy and safety of percutaneous endopyelotomy in infants and young children with secondary ureteropelvic junction obstruction after previous open pyeloplasty. MATERIALS AND METHODS: Three boys and 2 girls with persistent ureteropelvic junction obstruction after open pyeloplasty underwent percutaneous antegrade cold knife endopyelotomy via an 18F nephrostomy tract. RESULTS: Percutaneous endopyelotomy was successfully performed in all 5 children with minimal complications. At a mean followup of 2.5 years endopyelotomy was successful in 4 of the 5 children based on the absence of symptoms, normal pressure-perfusion studies and normal or improved diuretic renal scintigraphy studies. One child in whom endopyelotomy failed underwent successful ureterocalicostomy. CONCLUSIONS: Percutaneous antegrade endopyelotomy is a safe and efficacious method of treating secondary ureteropelvic junction obstruction in children. This method offers a minimally invasive alternative to conventional repeat open pyeloplasty.

Child, Preschool↗
PubMed1995

Long-term outcome evaluation of patients undergoing the meatal advancement and glanuloplasty procedure.

A total of 100 consecutive children with distal hypospadias who underwent a variation of the Duckett procedure of meatal advancement and glanuloplasty between 1985 and 1990 was evaluated for outcome in terms of urinary stream, erection, cosmetic appearance and overall parental satisfaction. Minimum interval between procedure and reevaluation for this study was 3 years. Parents of 90 of the 100 children were surveyed by surgeons via telephone and 89 (99%) expressed a high level of satisfaction with the outcome.

Child, Preschool↗
PubMed1995

Retroperitoneal laparoscopic nephrectomy in children.

Retroperitoneal pediatric laparoscopic nephrectomy is described in 3 patients requiring 3 to 5 hours with an estimated blood loss of 10 to 60 cc. The children returned to school within 7 days postoperatively. Advantages of this procedure include the avoidance of intraoperative repositioning of the patient and easy conversion to an open lumbodorsal approach, if necessary; early laparoscopic visualization of the renal artery; applicability in cases of previous abdominal surgery, and avoidance of intraperitoneal adhesion.

Adolescent↗
PubMed1995

The undescended testis. Theory and management.

Surgical techniques and research efforts to define the pathophysiology of cryptorchid testes have progressed rapidly in recent decades. Medical and surgical treatment modalities have focused on the young patient with an undescended testis. The potential adult complications of cryptorchidism, infertility, and malignancy should not be forgotten or dismissed.

Child, Preschool↗
PubMed1995

Postoperative adhesion formation after urological laparoscopy in the pediatric population.

The risk of intraperitoneal adhesion formation is a concern with transperitoneal laparoscopic surgery. To evaluate the incidence of adhesions after interventional urological laparoscopy, we reviewed 41 pediatric patients who had undergone second-look procedures. The number of adhesions and quantitation of the degree of each adhesion were assessed. Major laparoscopic procedures were performed previously in 8 patients, moderate in 29 and minor in 4. Adhesions were noted in 4 patients (9.8%), including 2 adhesions at the operative site and 2 at trocar sites. The risk of adhesions increased with the extent of dissection. Two adhesions developed after major procedures but the grade and extent of these adhesions were minimal. In the majority of patients re-peritonealization occurred with minimal or no scarring noted. Although adhesions may occur with pediatric urological laparoscopic procedures, the incidence appears lower than what one would expect with open exploration.

Child↗
PubMed1995

Incidence of vesicoureteral reflux in children with unilateral renal agenesis.

We retrospectively reviewed 51 pediatric cases of unilateral renal agenesis to determine the incidence of contralateral vesicoureteral reflux. Initial diagnosis of unilateral renal agenesis was made by evaluation of associated congenital abnormality in 21 patients, evaluation of prenatally detected abnormality in 11, evaluation of urinary tract infection in 7, sibling screening in 3, hypertension in 2 and other methods in 7. A voiding cystourethrogram was obtained in 44 cases. Indications for the study included urinary tract infection in 11 patients, hydronephrosis in 18 and screening in 15. Overall, vesicoureteral reflux occurred in 19 of the 51 patients (37%). The highest incidence of contralateral reflux was in those with a prenatal abnormality with or without hydronephrosis (77%) although 5 of 15 patients (33%) who underwent a screening voiding cystourethrogram had reflux. Mean followup was 50 months. Of the patients with vesicoureteral reflux reimplantation was performed in 9, reflux spontaneously resolved in 3 and reflux persisted in 7. There is a high incidence of vesicoureteral reflux in children with unilateral renal agenesis and a voiding cystourethrogram is recommended even in the absence of hydronephrosis or urinary tract infection. Although 50% of children in our series underwent surgical intervention, a period of nonoperative observation is warranted.

Child, Preschool↗
PubMed1994

Intravesical oxybutinin chloride in children with intermittent catheterization: sonographic findings.

The sonographic findings in the bladder are presented in four children with myelomeningocele and neurogenic dysfunction of the bladder, who were treated with intermittent self-catheterization and intravesical oxybutinin chloride. All were referred for routine sonography of the urinary tract. Each had infused a crushed tablet of oxybutinin chloride intravesically 30-120 min before the examination. In two children, brightly echogenic, non-shadowing particles were suspended in the bladder urine. In one of these, the particles swirled giving the impression of a "snowstorm"; in the other, most of the particles gradually settled forming an irregular clump on the bladder base. In the remaining two children, the urine appeared diffusely hazy with innumerable tiny particles giving the impression of a fine mist filling the bladder. The sonographic appearance of the urine in the bladder after intravesical instillation of crushed tablets can be dramatic and can simulate pus, blood, fungus, or other debris in the bladder lumen. In the absence of clinical symptoms or hematuria, a history of recent infusion of medication into the bladder should be sought.

Administration, Intravesical↗
PubMed1994

Outcome of reflux in children with myelodysplasia managed by bladder pressure monitoring.

From June 1984 to December 1992 voiding cystourethrography performed on 209 patients with myelodysplasia revealed vesicoureteral reflux in 57 (27%). High grade reflux (3 to 5/5) occurred in 33 patients (58%). Bladder pressure at typical capacity, defined as the pressure at average catheterization volume or bladder leak point pressure, was determined urodynamically. After a mean of 56 months vesicoureteral reflux resolved or improved in 55% of patients and remained unchanged in 28%. There was no correlation between the grade of reflux and the rate of spontaneous resolution. Pressure at typical capacity of 40 cm. water or more was significantly more common in patients with reflux (44%) than in those with no reflux (20%) (p < 0.001). There was a strong association between pressure at typical capacity of 40 cm. water or more and upper tract deterioration (p < 0.0001). However, there was no correlation between pressure at typical capacity and grade of reflux (p = 0.18). Treatment of pressure at typical capacity of 40 cm. water or more led to resolution or improvement of vesicoureteral reflux in 8 of 10 reevaluated patients. Hydronephrosis resolved (7) or improved (1) in 8 of 9 cases. Measurement of intravesical pressure is of paramount importance in the management of spina bifida patients with vesicoureteral reflux. Maintaining the pressure at typical capacity at less than 40 cm. water is associated with increased spontaneous resolution of vesicoureteral reflux and a lower incidence of upper tract deterioration.

Child↗
PubMed1994

Significance of spina bifida occulta in children with diurnal enuresis.

We reviewed retrospectively 456 patients with diurnal enuresis to determine the relationship between spina bifida occulta and attainment of continence. Of these patients 127 had undergone x-rays of the spine and 48 children (48%) had spina bifida occulta. The clinical course of these patients was compared to 79 enuretic children with normal spine films. All patients were initially treated with a timed voiding program and 28 with persistent enuresis were given anticholinergic medication. Findings on urodynamic studies were similar for both groups. Uninhibited bladder contractions were found in the majority of patients and 2 children in each group had hypertonic filling curves. Of 10 children with spina bifida occulta magnetic resonance imaging or ultrasound of the spine revealed lipoma and tethering of the cord in 1. Mean followup for both groups was 3 years. The outcome for enuretic children with spina bifida occulta was comparable to those with normal spine x-rays. The majority of patients had resolution of the enuresis with conservative management. Spinal ultrasound or magnetic resonance imaging may be warranted in those children with abnormal neurological findings on examination or hypertonic filling curves, or those who fail to respond to medical treatment. However, neurosurgical intervention to achieve continence appears necessary in only a small percentage of enuretic children with spina bifida occulta.

Child↗
PubMed1994

Pubovaginal slings for the management of urinary incontinence in female adolescents.

A pubovaginal sling is an effective treatment for type III incontinence secondary to poor proximal urethral sphincter function. We used a pubovaginal sling to treat incontinence in 15 female adolescents. The etiology of incontinence was spinal dysraphism in 10 patients and prior trauma in 3. Simultaneous bladder augmentation was performed in the remaining 2 patients for poor bladder compliance. Three patients required additional procedures including repeat slings in 2 and repeat augmentation in 1. Of 13 patients followed for more than 6 months 11 remain dry, 1 leaks small amounts and wears 1 pad per day, and 1 did not achieve acceptable continence and was subsequently managed with bladder augmentation and a Mitrofanoff procedure. The upper urinary tracts have remained normal in all 13 patients. The pubovaginal sling has proved to be safe and successful in these children. The overall continence rate of 92% compares favorably to other available modalities.

Adolescent↗
PubMed1994

Treatment of pediatric urethral stricture disease with the neodymium:yttrium-aluminum-garnet laser.

OBJECTIVES: The aim of this study was to assess the efficacy and safety of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in the treatment of pediatric urethral stricture disease. METHODS: Twelve boys who had previously undergone unsuccessful cold-knife internal urethrotomy or serial urethral dilation for urethral stricture disease underwent endoscopic laser internal urethrotomy utilizing a contact-tip fiber for recurrent urethral stricture. RESULTS: At a mean follow-up of 12 months, 10 of the 12 boys are free of stricture disease for an overall success rate of 83%. Two boys were considered failures and underwent successful open urethroplasty. There were no treatment complications. CONCLUSIONS: The Nd:YAG laser utilizing the contact-tip fiber was successful in treating recurrent urethral stricture disease. The hemostatic characteristic of the laser allowed bloodless urethrotomy, which was particularly useful when operating with the smaller pediatric endoscopic instruments.

Adolescent↗
PubMed1994

Normal and abnormal pelviscopic anatomy at the internal inguinal ring in boys and the vasal triangle.

OBJECTIVES: We sought to explain and define normal and abnormal laparoscopic pelvic anatomy, which has only recently become the target of much attention. METHODS: The embryology, normal anatomic landmarks, and abnormal findings of the male pelvis, as discerned from more than 350 laparoscopic investigations in boys, were analyzed. RESULTS: The medial umbilical ligament, the wishbone at the internal inguinal ring, the transverse vesical fold, and the vasal triangle are principal laparoscopic landmarks of the male pelvis. Deficient spermatic vessels, abnormal gonadal locations, patent processus vaginalis, single medial umbilical ligament, and transverse testicular ectopia were the abnormal findings. CONCLUSIONS: Laparoscopic familiarity with the male pelvis permits safe and efficient diagnostic and therapeutic navigation in this new surgical arena.

Child↗