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Biomedical subjects

M G Packer

Publications and source records attributed to M G Packer.

29 records · Page 2Linked to original sources
PubMed1989

Urethral strictures after hypospadias repair.

Over a 16 years period, we have treated 34 cases of urethral stricture after hypospadias repair. Seventeen patients were successfully treated with one procedure, while 16 patients required two or more procedures; one patient was lost to follow-up. Eighteen patients who presented with symptoms attributable to their stricture within 3 months of their original operation for hypospadias were designated as having early strictures. Those strictures presenting later than 3 months were termed late strictures. Manipulative therapy (dilation, direct vision internal urethrotomy) was successful in 46% of early strictures, but in only 16% of late strictures. Open surgical procedures were employed primarily in some cases or after failed manipulation in others and were successful in 82% of cases. All 4 failures of open procedures were salvaged with manipulative therapy. We conclude that treatment of post hypospadias repair urethral strictures should initially be manipulative. Open surgical repair will usually be successful but should be reserved for difficult strictures, late strictures, or failures of manipulation.

Adolescent↗
PubMed1988

Follow-up of infants with bilateral renal disease detected in utero. Growth and renal function.

We studied 69 infants who had urinary tract abnormalities detected by antenatal ultrasound examination. There were 21 intrauterine or immediate neonatal deaths; in all 21 infants, severe bilateral renal disease incompatible with life was found at autopsy. Six of the live-born infants with abnormal results of antenatal ultrasound examinations had a normal urinary tract after birth. Of the remaining 42 infants, the prenatal diagnosis was confirmed with renal ultrasound and other studies during the first week of life. Twenty-one of 42 infants had bilateral renal disease. We obtained follow-up data on 19 of 21 of these infants. Twelve of 19 had obstructive uropathy that was treated surgically. After one to 51 (mean, 18) months of follow-up, renal function varied. Ten of 19 patients had a calculated glomerular filtration rate greater than or equal to 79 mL/min/1.73 m2. One infant required long-term ambulatory peritoneal dialysis. Renal function (glomerular filtration rate, 74 +/- 5 mL/min/1.73 m2) and growth (height percentile, 41 +/- 8) were unexpectedly good considering the severity of the urinary tract abnormalities. Prenatal detection of bilateral renal disease followed by careful medical and surgical management results in a favorable outcome with good growth and renal function.

Adolescent↗
PubMed1988

Detection of testicular torsion by magnetic resonance imaging in a rat model.

Testicular torsion is one of the most common pediatric urological emergencies. Incorrect or delayed diagnosis contributes significantly to morbidity. We previously have shown that magnetic resonance displays scrotal contents with great detail using hydrogen concentration weighted and T2 weighted images. Sprague-Dawley rats underwent either unilateral 720-degree testicular torsion or a sham procedure. Magnetic resonance images were obtained at intervals with a 3 or 5-inch surface coil. Scans after surgical torsion showed a characteristic spiral distortion of the fascial planes of the spermatic cord, not seen in the sham animals, as well as a decrease in testicular size with prolonged torsion.

Animals↗
PubMed1988

Post-hypospadias repair urethral strictures: a review of 30 cases.

During a 16-year period we treated 30 patients with urethral stricture after hypospadias repair. Of the patients 16 were treated successfully with 1 procedure, while 13 required 2 or more procedures and 1 was lost to followup. A good result was achieved in 83 per cent of the patients. Fourteen patients who presented with symptoms attributable to the stricture within 3 months of the original operation for hypospadias were designated as having early strictures. Those with strictures presenting later than 3 months were considered to have late strictures. Manipulative therapy (dilation and direct vision internal urethrotomy) was successful in 55 per cent of the early strictures but in only 16 per cent of the late strictures. An open operation was performed primarily in some cases or after failed manipulation in others and it was successful in 79 per cent. All 4 failures of open procedures were salvaged with manipulative therapy. We conclude that treatment of post-hypospadias repair urethral strictures initially should be manipulative. Open repair usually will be successful but should be reserved for difficult strictures, late strictures or failures of manipulation.

Adolescent↗
PubMed1987

Magnetic resonance imaging of the cryptorchid testis.

Magnetic resonance imaging was used to evaluate seven patients with undescended testes. In six patients the presence or absence of testicular tissue was predicted correctly prior to surgery. Spermatic cord structures, if present, were accurately visualized in all patients.

Cryptorchidism↗
PubMed1987

Ipsilateral ureteroureterostomy and pyeloureterostomy: a review of 15 years of experience with 25 patients.

We reviewed our 15-year experience with pyeloureterostomy and ureteroureterostomy in 25 children with ureteral duplication. Pyeloureterostomy was performed in 5 patients, including 4 with reflux and 1 with upper pole obstruction. The results were good in 4 and in 1 patient postoperative anastomotic obstruction developed. Ipsilateral ureteroureterostomy was performed in 20 patients, including 8 with reflux into 1 or both ipsilateral ureters, 7 with obstructed ectopic upper pole ureters without ureterocele, 4 with ectopic ureteroceles and 1 with incomplete ureteral duplication and obstruction of the common distal ureteral segment. At followup, which ranged from 3 months to 6 years, 17 patients had good postoperative results as demonstrated by improved upper tract drainage and absence of reflux. Of 6 patients who underwent simultaneous ipsilateral ureteral reimplantation at the time of ureteroureterostomy postoperative reflux was noted in 1, necessitating a second procedure. Ureteral stumps were left in 13 patients. Postoperative urinary infection occurred in only 3 of these patients, all as single episodes and 2 associated with persistent contralateral reflux. Significant luminal disparity at the time of ureteroureterostomy was noted in 18 patients and did not adversely affect results.

Child↗
PubMed1987

Anterior urethral valves in the fossa navicularis in children.

Anterior urethral valves are an uncommon cause of lower urinary tract obstruction in children. They have been noted in the bulbous (40 per cent) and penile (30 per cent) urethra, and at the penoscrotal junction (30 per cent). None has been reported in the fossa navicularis. We encountered 3 cases in which anterior valves were located in the glanular urethra. This entity may be misdiagnosed as meatal stenosis and without a high index of suspicion it might be overlooked. The combination of distal obstruction and a normal urethral meatus should lead one to suspect this entity. Observation of the voided stream is extremely helpful in the diagnosis, since voiding urethrography often fails to include the penile tip and urethroscopy of the distal urethra often is unsatisfactory. Treatment can be performed either transurethrally or by excision through the meatus.

Child↗
PubMed1984

Prophylactic antibiotics and Foley catheter use in transperineal needle biopsy of the prostate.

We studied retrospectively 162 patients undergoing transperineal needle biopsy of the prostate. All patients had urine cultures before biopsy. Patients were divided into 4 groups: group 1--no antibiotics (44), group 2--antibiotics before and after biopsy (69), group 3--antibiotics after biopsy only (42) and group 4--antibiotics before biopsy only (7). Groups were similar in average age (65 years) and pathologic diagnosis (prostatic cancer in 28 per cent and a benign prostate in 72 per cent). Of the 162 patients 4 (2.5 per cent) had positive urine cultures preoperatively. Post-biopsy urine cultures were obtained in 86 patients and 2 (2 per cent) were positive. Only 12 patients (11 per cent) required catheters for postoperative urinary retention. Complications occurred in 9 patients (5.5 per cent): 7 (4.3 per cent) had febrile episodes, 1(0.6 per cent) had a documented postoperative urinary tract infection and 1(0.6 per cent) sustained a large pelvic hematoma. No statistically significant difference could be found among the 4 groups in regard to complication rate. This study demonstrates no advantage to the routine use of antibiotics or Foley catheters in transperineal needle biopsy of the prostate, provided the urine is sterile before biopsy. Cost analysis of these data demonstrates a considerable savings when routine antibiotics and Foley catheters are not used.

Aged↗
PubMedDate not supplied

Prenatal diagnosis of severe urinary tract anomalies improves renal function and growth.

The clinical course of 14 children with bilateral renal disease diagnosed on prenatal ultrasound examination (prenatal group) was compared with a control group of 14 children who presented postnatally (postnatal group). The children in the prenatal group had earlier evaluation and treatment of their renal disease and fewer complications prior to diagnosis. Prenatally diagnosed children had a lower incidence of reduced renal function and better growth than matched controls.

Child, Preschool↗