Biomedical subjects
Publications and source records attributed to M D Gibbons.
Factors determining the likelihood of urinary tract infection in children include host susceptibility, such as the presence of obstructive uropathy, neuropathic bladder or dysfunctional voiding. Bacterial virulence, as in infection by fimbriated Escherichia coli, is also a factor. With a few exceptions, diagnostic evaluation should be performed following the first infection. Early aggressive therapy has the goal of preserving renal function.
In the newborn, intraperitoneal extravasation of urine from a urachal laceration may follow an attempt at umbilical artery catheterization. Clinical results of this injury are neonatal ascites, anuria, and azotemia. Herein, we describe a case of iatrogenic bladder injury with successful management following late detection. The anatomy of the urachus and bladder in the newborn are reviewed as well as clues to the diagnosis of neonatal urinary ascites.
A newborn with female pseudohermaphroditism (profound masculinization of the external genitalia and preservation of the internal female genitalia) is presented. During pregnancy progressive hirsutism was noted in the mother, and polycystic ovaries were found at cesarean section. The serum testosterone level in the cord blood was elevated markedly (1,232 ng./dl). After birth the serum testosterone levels of the mother and newborn decreased dramatically. Over-all it appears that the polycystic ovaries were the source of the excessive androgen secretion that caused maternal and fetal masculinization during the pregnancy.
We report 3 cases of renal dysplasia related to congenital obstructive uropathy and associated with nodular renal blastema. The literature is reviewed in regard to this relationship, as well as the relationship of nodular renal blastema with Wilms tumor and Wilms tumor with congenital genitourinary anomalies. The possible implication of nodular renal blastema associated with dysplasia and obstructive uropathy is emphasized with respect to the risk of neoplastic change.
The MAGPI procedure should be the procedure of choice and is applicable for most boys with coronal/subcoronal hypospadias. The excellent results of the MAGPI are reliable and reproducible. However, careful evaluation of meatal configurations is essential, as is assessing for the existence of fibrous chordee. Should subcoronal meatal variation or possible chordee exist, the creation of a vascularized meatal-based flap provides excellent flexibility as well as many options to the surgeon.
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Since its description in 1981, the MAGPI procedure has rapidly assumed a major role in the repair of coronal and subcoronal hypospadias without chordee. Success with this procedure depends upon careful attention to detail and proper patient selection. Despite heeding these caveats the authors have noted occasional patients who, following completion of a MAGPI, have a disturbing "fishmouth" quality to the meatus. Herein is described a simple modification that seems to improve the cosmetic results when this situation is encountered.
Complications after transurethral ablation of posterior urethral valves frequently are iatrogenic because of urethral injury resulting in stricture or sphincteric incontinence. Smaller instrumentation and improved optics have made primary valve destruction safer and more reliable. The concept of early neonatal vesicostomy with delayed transurethral valve ablation allows maximal upper tract protection as well as somatic and urethral growth. This approach further reduces the possibility of urethral or sphincteric injury. We report our technique of antegrade incision of posterior urethral valves per vesicostomy, combining the advantages of early optimal neonatal vesicostomy drainage, avoidance of any anterior urethral instrumentation, and a technically easier, reliable and safe approach to posterior urethral valve destruction.
We report on 66 children who underwent repair of distal hypospadias with the meatal advancement and glanuloplasty technique. A 1-day procedure was all that was required in 52 children (80 per cent). Brief urinary diversion was used in only 3 patients. Excellent results were achieved in 63 children and in 3 boys minor cosmetic deficiencies were encountered but none required further surgery. Meatal advancement and glanuloplasty has proved to be a successful and reliable procedure in the properly selected child with distal hypospadias.
Although rare, injury to the bladder neck can occur in children following blunt lower abdominal trauma. Anterior disruption at the bladder neck (vesicoprostatic junction) may occur in boys, while rupture through the vesicovaginal septum may occur with or without vesicourethral avulsion in girls. Immediate evaluation, including excretory urography, voiding cystography, cystovaginoscopy (with a high index of suspicion of vaginal injury in girls) and retrograde urethrography (in boys), is indicated to delineate the extent of injury. Early surgical intervention is necessary to achieve realignment of the vesicourethral junction, repair a vesicovaginal injury, if present, and help assure the best chance of subsequent continence.
Correction of chordee is a basic step in hypospadias surgery. In some children with significant chordee, ventral deflection of the shaft will persist after all "chordee tissue" is excised from the surface of the corpora cavernosa. In the flaccid state, this persistent chordee may not be evident but is easily demonstrated with an artificial erection technique. The use of dorsal plication of the tunica albuginea to correct this deformity is emphasized.
There has been much recent enthusiasm for repair of subcoronal hypospadias, which is due to the positive experience with meatal advancement, glanuloplasty and its excellent cosmetic results, extremely low complication rate and brief hospitalization requirement. Although we have found the meatal advancement, glanuloplasty to be an extremely reliable procedure in the majority of boys with subcoronal hypospadias and no fibrous chordee, we have encountered 3 variants, patulous, fibrotic and hypoplastic, of the subcoronal meatus, which are not amenable to meatal advancement, glanuloplasty. We describe a logical approach to the assessment of the subcoronal meatus with use of a vascularized meatal-based flap for hypospadias repair when meatal advancement, glanuloplasty is not applicable.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We describe the successful use of an anterolateral, muscle-splitting technique. In the pediatric patient impressive exposure allows for renal pelvic and distal ureteral operations, obviating the necessity for a secondary lower incision. Additional benefits of this incision have been minimal nerve root irritation, incisional pain and muscular weakness.
A case of perirenal neuroblastoma causing intrarenal obstruction of the pelvis of the kidney presented as a small hydronephrosis at 3 days of age. The tumor grew rapidly over the next 48 hr, diagnosis was confirmed by ultrasonography, and the mass was removed surgically.