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H G Mesrobian

Publications and source records attributed to H G Mesrobian.

35 records · Page 2Linked to original sources
PubMed1992

Modified extravesical ureteral reimplantation in pediatric renal transplantation: 5 years of experience.

Numerous surgical procedures have been described to reimplant the ureter into the bladder during renal transplantation. Since November 1985 we have used a modified extravesical technique in 19 children. At the time of transplantation patient age ranged from 2 to 17 years (average age 10 years). Of these patients only 2 received a cadaveric kidney. Postoperative followup ranged from 4 to 54 months (average 32 months). No immediate or delayed urological complications were noted, and all but 1 graft has continued to function. This procedure is not only expeditious and safe but it also eliminates a long cystostomy suture line and requires a short ureteral length. Urinary leakage and ureteral obstruction, 2 of the most common urological complications, have not been observed in our patients. Although further experience and longer followup are required, this technique has become our procedure of choice for ureteral reimplantation in children undergoing renal transplantation.

Adolescent↗
PubMed1991

Radionuclide diuresis pyelography.

Radionuclide diuresis renography continues to be relied upon as a major diagnostic tool to differentiate obstructive and nonobstructive hydronephrosis. Controversy continues to exist with respect to methodology and interpretation of intermediate obstructive patterns. In this study radionuclide diuresis pyelography was performed in 11 renal units with hydronephrosis and a pre-existing percutaneous nephrostomy tube in place. The procedure consisted of the introduction per kidney of 20 muc./kg. 99mtechnetium-diethylenetriaminepentaacetic acid and sterile saline as a bolus into the renal pelvis via a percutaneous nephrostomy tube to produce a volume equal to the capacity of the hydronephrotic system. The kidney was monitored with a gamma camera and computer system. Furosemide (0.3 mg./kg.) was injected intravenously halfway into a 40-minute study. The time/activity curves thus generated were relatively independent of the cortical transport phase. The 2 types of curves were accelerated and constant. Analysis of these pyelogram curves revealed a strong correlation between the presence of an accelerated clearance rate response to furosemide and hydronephrosis without obstruction in 5 of 6 renal units. A constant clearance rate response to furosemide correlated with the presence of obstruction in 4 of 5 units. These observations may indicate that diuretic pyelogram curve dynamics may reflect not only the presence or absence of obstruction but also the ability of the hydronephrotic kidney to respond to the diuretic. More experience must be accumulated to determine the conditions under which diuresis pyelography may become useful clinically.

Child↗
PubMed1991

Renal dynamics after pyeloplasty.

Dismembered pyeloplasty was done on 12 renal units for ureteropelvic junction obstruction. Postoperatively, response of repaired kidney to standard diuretic dose of furosemide (0.3 mg/kg) was evaluated. Also renal pelvic pressures at rest and during diuresis were measured. All renal units responded to the diuretic by increasing their urine output an average of three times over baseline value. Renal pelvic pressure registration revealed no significant change after diuresis over baseline values. Diuretic technetium-99 DTPA renal scans were obtained two to six months postoperatively and compared with preoperative scans; the best results were obtained in renal units whose intrapelvic pressures did not exceed 10 cm of water in the immediate postoperative period.

Female↗
PubMed1990

Management of children with myelodysplasia: urological alternatives.

Recent reports have suggested that the prophylactic use of clean intermittent catheterization in selected infants with myelodysplasia and with normal upper tracts may prevent their deterioration. The selection of these patients at risk depends on urodynamic criteria. We reviewed our experience with clean intermittent catheterization instituted when upper tract deterioration was found. Of 130 patients with myelodysplasia followed at our clinic 25 (19%) had or presented with radiological upper urinary tract deterioration. A total of 21 patients had vesicoureteral reflux and 4 had hydronephrosis without reflux. Treatment consisted of clean intermittent catheterization alone in 5 patients and combined with anticholinergic medication in 16. Four patients with no post-void residual urine were carefully observed without intervention. Urodynamic evaluation was performed selectively in 11 of these 25 patients for persistence of upper urinary tract deterioration or urinary incontinence after institution of treatment. Of the 21 children with reflux 19 (90%) had resolution or improvement for an average followup of 47 months. Hydronephrosis completely resolved in the 4 patients without reflux. Thus, the over-all resolution or improvement rate was 92% for an average of 41 months. Although these excellent results may not be superior to the prophylactic use of clean intermittent catheterization, they validate the assumption that upper tract deterioration can be reversed. The application of current urodynamic selection criteria may result in overtreating a significant number of infants who otherwise may not have upper tract deterioration. Further refinements in these criteria may be necessary to select better not only patients at risk but also to determine the frequency of imaging necessary in this urologically heterogeneous population. In addition, careful consideration should be given to urethral dilation as a third and equally viable alternative to prevent upper tract deterioration.

Child↗
PubMed1989

Ureterocalicostomy: indications and results in 21 patients.

Ureterocalicostomy was performed in 21 patients for ureteropelvic junction obstruction. Ten patients had failed pyeloplasty, 10 had anomalies of renal fusion, ascent or rotation in conjunction with ureteropelvic junction obstruction and 1 had failed prior ureterocalicostomy. Patient age at operation ranged from 6 months to 17 years and averaged 9 years. Of the 21 patients in this series 19 had excellent results after ureterocalicostomy with decrease or total elimination of hydronephrosis. There were 2 postoperative complications in 2 patients: prolonged anastomotic urinary leakage in 1 and a Candida perinephric abscess in 1. Ureterocalicostomy should be considered in selected patients with previous unsuccessful pyeloplasty, ureteropelvic junction obstruction associated with anomalies of renal fusion, rotation or ascent, an intrarenal pelvis or a short ureter. Although endopyelotomy or ureteropelvic junction dilation should be considered in patients who fail pyeloplasty, ureterocalicostomy continues to be a reliable salvage procedure in these patients; it bypasses extensive peripelvic scarring, provides for dependent drainage and compensates for lack of adequate ureteral length.

Adolescent↗
PubMed1989

Pyeloureterostomy with appendiceal interposition.

We report a case of renal salvage after total right ureteral loss using the isolated vermiform appendix with preservation of the blood supply. The appendix was used to bridge the gap between the right renal pelvis and left ureter. Followup revealed satisfactory function of the appendiceal conduit with preservation of renal function. The appendix, used in this fashion, is an attractive alternative to other surgical modalities after total or near total ureteral loss. The excellent contractility combined with the relatively small size eliminates the problems associated with urinary stasis and electrolyte reabsorption. However, its use is limited by its availability and length.

Appendix↗
PubMed1989

Continuous venous access in children with urological diseases.

The placement of multipurpose silicone right atrial catheters for continuous venous access in children with complex urological diseases has become increasingly necessary. Between September 1985 and September 1987, 26 children with a variety of urological diseases required long-term central venous access, primarily for delivery of chemotherapy and blood products in 13 patients with malignancies, hemodialysis access in 7 undergoing renal transplantation, total parenteral nutrition in 5 (2 of whom were born with cloacal exstrophy), and fluid and antibiotic administration in 1 with dermatomyositis and acute pyelonephritis. Patient age at catheter placement ranged from 1 day to 15 years. A total of 11 complications was encountered during 4,500 catheter days: 10 were mechanical and 1 was infectious in nature. These complications led to replacement of the catheter in 3 patients and the remainder were managed successfully nonoperatively. The surgical techniques involved in placement of these catheters are discussed. The catheters not only allowed many of these patients to receive treatment on an outpatient basis but also ensured their survival. Our favorable experience with prolonged venous access in children should encourage urologists to include these techniques in their armamentarium.

Antineoplastic Agents↗
PubMed1989

Human Sertoli-spermatogenic cell cocultures prepared from biopsies of cryptorchid testes performed during orchidopexy.

A procedure is described for the preparation and maintenance of human Sertoli-spermatogenic cell cocultures using biopsies of normal and undescended testis. The evaluation of cell viability and differentiation potential of cultured spermatogenic cell was monitored by [3H]thymidine labeling combined with light microscopic autoradiography. Spermatogenic cells of the same progeny, connected by intercellular bridges, display synchronous DNA synthesis when labeled at the preleptotene stage of meiotic prophase. The pattern of [35S]methionine-labeled secretory proteins was determined by two-dimensional electrophoresis and autoradiography during testicular development and compared with these observed in human Sertoli-spermatogenic cell cocultures prepared from same specimens. Both testicular tissue and cocultured Sertoli and spermatogenic cells displayed comparable patterns of secretory proteins. A discrete group of acidic polypeptides of Sertoli cell origin enhanced their radiolabeling intensity during testicular development. Results of this paper indicate that human Sertoli-spermatogenic cell cocultures could be valuable for assessing the proliferation and differentiation potential of spermatogenic cells in children with cryptorchid testis.

Biopsy↗
PubMed1988

Prostatectomy in patients with bleeding disorders.

Urological surgery is becoming increasingly necessary in patients with acquired or congenital bleeding disorders. We reviewed the management of 10 such patients who required prostatectomy. The average age of the patients at operation was 65.7 years. Seven patients underwent transurethral prostatectomy and 3 underwent suprapubic prostatectomy. Postoperative bleeding occurred in 9 patients who required secondary procedures. Bleeding occurred an average of 13 days postoperatively. The mean hospital stay was 24 days. Partial thromboplastin time when determined was uniformly elevated in all patients preoperatively. The amount of factor and blood replacement is presented. Perioperative management of these patients is discussed in detail. A rational approach for the prevention of postoperative bleeding is presented.

Adult↗
PubMed1988

Long-term followup of 103 patients with bladder exstrophy.

We reviewed 103 patients with exstrophy of the bladder. Followup was more than 15 years in 51 patients. Initial management consisted of primary bladder closure in 32 patients and urinary diversion in 71. Urinary continence, renal function, urinary tract infections and development of malignant lesions were evaluated. Factors leading to success or failure were analyzed. Although the highest continence rate (83 per cent) was achieved in 40 patients with ureterosigmoidostomy, renal functional deterioration was highest in this group, with 70 per cent of the evaluable renal units being abnormal. Furthermore, 10 per cent of this group died of renal failure and 23 per cent lost 1 kidney each. In 26 patients with an ileal conduit 69 per cent of the renal units evaluated were abnormal. Only 1 patient died of renal failure but 27 per cent lost 1 kidney each. Of 32 patients with primary bladder closure 31 had preservation of renal function. Twelve of 18 patients (67 per cent) in whom vesical neck reconstruction had been completed had total urinary continence and 3 (17 per cent) had partial continence. The incidence of significant urinary tract infections was highest in the ureterosigmoidostomy group (63 per cent) and next to the highest in the ileal conduit group (48 per cent). Malignant lesions developed in 8 patients (8 per cent).

Bladder Exstrophy↗
PubMed1987

Wilms tumor occurring as a botryoid renal pelvicalyceal mass.

Wilms tumor usually occurs as an abdominal mass arising from the renal parenchyma. A case was encountered in which the neoplasm filled the pelvicalyceal system of an 8-year-old boy as a botryoid mass, with minimal parenchymal involvement. The radiologic manifestations, pathologic features, and surgical implications are discussed.

Child↗
PubMed1986

Long-term followup of cosmetic appearance and genital function in boys with exstrophy: review of 53 patients.

Long-term results of genital function and cosmetic appearance were analyzed in 53 patients with bladder exstrophy. Satisfactory cosmetic appearance of the external genitalia, with a straight penis angulated downward in the standing position, was achieved in 55 per cent of the patients. Normal erectile function was preserved in all patients and 61 per cent of the postpubertal patients had experienced satisfactory intercourse. The recent use of formal penile elongation by partial mobilization of the crura of the corpora cavernosa from the pubic rami combined with single-stage or multistage urethroplasty has produced a significant improvement in results. Of the patients 12 are married and 5 have fathered children.

Adolescent↗
PubMed1986

Ureteropelvic junction obstruction of the upper pole moiety in complete ureteral duplication.

Ureteropelvic junction obstruction of the upper pole moiety is reported in 2 patients with complete ureteral duplication. A normal upper pole ureter of a duplicated system in conjunction with upper pole dilatation should alert the urologist to the presence of an upper pole ureteropelvic junction obstruction. Traditional pyeloplasty techniques can be applied to this anomaly with successful salvage of renal parenchyma. The embryological implications of this combination of anomalies occurring in a single patient are discussed briefly.

Child↗
PubMed1986

Long-term followup of cosmetic appearance and genital function in male epispadias: review of 70 patients.

In male patients who undergo surgery for epispadias the major postoperative complaint often concerns the cosmetic appearance of the penis and the failure to correct the dorsal chordee rather than the urinary incontinence. In the past straightening and lengthening of the penis were not given adequate consideration, and penile elongation was limited to release of dorsal skin chordee only. Recently, however, additional penile length has been achieved by partial mobilization of the crura of the corpora cavernosa from the pubic rami. In a series of 70 patients penile lengthening and urethroplasty were performed separately or were combined as a 1-stage procedure with full thickness grafts or preputial flaps. The recent use of hair-bearing groin flaps has provided excellent skin coverage for the large dorsal defect at the penoabdominal angle. A satisfactory cosmetic appearance of the external genitalia, with a straight penis angulated downward in the standing position, was achieved in 67 per cent of the patients. Normal erectile function was preserved in all patients, 80 per cent of whom have had a straight penis with erection and satisfactory intercourse. Of the patients 29 are married and 19 have fathered children. Meticulous attention to the technical aspects of reconstructive surgery usually can result in a gratifying cosmetic appearance, normal genital function and preservation of fertility potential in most patients.

Adolescent↗
PubMed1985

Reoperative ureteroneocystostomy: review of 69 patients.

Reoperative ureteroneocystostomy in 69 patients with primary vesicoureteral reflux was reviewed. Of the renal units 49 were obstructed and 48 had reflux. Postoperative obstruction was caused by mechanical factors in 61 per cent of the renal units, distal ureteral scarring in 31 per cent and a previously unrecognized functionally neurogenic bladder (without a neurological lesion) in 8 per cent. Persistent postoperative reflux was secondary to a short submucosal tunnel in 94 per cent of the renal units and occult neurogenic bladder in 6 per cent. Reoperative ureteroneocystostomy was successful in 79 per cent of the renal units, with a mean followup of 33 months. The modified Paquin technique (omitting the ureteral cuff) yielded consistently superior results in children undergoing reoperation for ureterovesical junction obstruction. In patients with postoperative vesicoureteral reflux a variety of techniques produced similar and gratifying results. That 52 per cent of our patients had no symptoms indicates clearly the absolute necessity of careful followup after ureteral reimplantation. Furthermore, 20 per cent of our patients had late failure (4 to 10 years after initial ureteroneocystostomy), which suggests the need for careful monitoring of the reimplanted ureter past puberty.

Adolescent↗
PubMed1985

Wilms tumor in horseshoe kidneys: a report from the National Wilms Tumor Study.

An analysis of information on 2,961 patients with Wilms tumor entered in the National Wilms Tumor Study up to July 1983 revealed 13 tumors occurring in horseshoe kidneys. The correct preoperative diagnosis was made in 6 of the 13 patients. At presentation 5 patients had stage 1, 3 stage 2 and 5 stage 3 disease. Major preoperative or intraoperative tumor spillage occurred in 3 patients. The over-all survival rate was 85 per cent after a mean followup of 45 months. The surgical, pathological and therapeutic aspects of Wilms tumor in horseshoe kidneys were analyzed carefully. The frequency of horseshoe kidneys in patients with Wilms tumor registered with the National Wilms Tumor Study was determined and was used in conjunction with population data to estimate the relative risk of Wilms tumor occurrence in children with horseshoe kidneys.

Child↗