Biomedical subjects
Publications and source records attributed to J L Weingarten.
The creation of a continent, catherizable stoma is an integral component of successful continent urinary diversion. A technique is described which allows lengthening of a continent appendicovesicostomy. This technique extends the applications for the Mitrofanoff principle of urinary tract reconstruction.
A case of synchronous bilateral spermatic cord torsion in a neonate is presented. While testicular salvage is variable in this entity, surgical intervention is necessary for any hope of testicular preservation.
The use of isolated intestinal segments is currently the best method of augmenting bladder capacity. The ability to perform a successful augmentation cystoplasty using nonintestinal tissue would decrease the morbidity of the operation. We studied the use of skeletal muscle-backed parietal peritoneal tissue in augmentation cystoplasty. In the experimental group animals, bladder capacity increased by 67% and urothelial regeneration was observed histologically. Problems with electrolyte abnormalities, urosepsis, or excessive mucous production were not encountered. In conclusion, a myoperitoneal flap may serve as a template for augmentation cystoplasty. Further investigation using this technique is warranted.
Eosinophilic cystitis is an uncommon condition with an unknown etiology. A case of eosinophilic cystitis in a patient with chronic rejection of a cadaveric renal transplant is presented. The pathogenesis of this disease is discussed.
Testicular torsion represents a continuing source of morbidity among male patients. Early diagnosis and surgical exploration improve testis salvage but even this approach will result in orchiectomy if there is excessive delay in patient presentation. A 10-year retrospective review of testicular torsion was performed. The interval between onset of scrotal pain and presentation to the emergency department was determined. A specific age-related delay in presentation was identified between patients less than 18 years old (group 1, median delay 20 hours) and those greater than 18 years old (group 2, median delay 4 hours, p less than 0.001). At exploration 44 per cent of the group 1 patients required orchiectomy versus 8 per cent in group 2. Patients less than 18 years old are a high risk group for testicular loss after torsion and represent more than 90 per cent of the orchiectomies performed. We believe that this group should be targeted for improved health education, emphasizing early evaluation of scrotal pain to improve testicular salvage.
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The Mitrofanoff procedure for continent urinary diversion was described in 1980. This principle has been expanded upon and used to achieve continent urinary diversion in virtually any indicated clinical setting. We report 3 cases treated by the Mitrofanoff principle to illustrate the spectrum of clinical situations to which it is applicable. The Mitrofanoff principle represents a viable form of continent urinary diversion.