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Biomedical subjects

M R Zaontz

Publications and source records attributed to M R Zaontz.

At least 37 records · Page 2Linked to original sources
PubMed1990

Urinoma formation in posterior urethral valves: relationship to later renal function.

A retrospective analysis of radiologically determined individual renal function was performed in five boys who presented in the neonatal period with posterior urethral valves, vesicoureteral reflux and documented urinoma formation. Renal function was evaluated with scintigraphy. There was reflux in eight of ten ureters. Six of these ureters had an associated urinoma and compromised renal function in the neonatal period. In two of the boys the kidney with urinoma functioned better than the contralateral kidney with reflux alone. In two other boys with unilateral urinoma the contralateral ureter did not reflux and the affected kidney functioned less well. In follow up (20 to 36 months) seven of the ten kidneys have a near normal appearance or function. Those kidneys which are now abnormal were noted to be abnormal in the neonatal period.

Follow-Up Studies↗
PubMed1990

Insertion of testicular prosthesis: use of vaginal speculum.

We have used a vaginal speculum to insert a testicular prosthesis through the inguinal approach over the past four years. We have found this technique to be easily performed and reproducible in allowing the testicular prosthesis to be placed in the normal dependent position in the scrotum.

Adolescent↗
PubMed1990

Use of distal Thiersch-Duplay urethroplasty for proximal hypospadias repairs in conjunction with short island pedicle flap.

Experience with 8 boys having proximal hypospadias with severe chordee and a foreshortened dorsal hooded foreskin is presented. Use of a distal Thiersch-Duplay tube was incorporated in addition to an island pedicle flap to achieve the correct meatal location on the glans. One boy with perineal hypospadias required both proximal and distal Thiersch tube with an island flap interposition. Follow-up of nine months to 3.5 years demonstrated excellent cosmetic and functional results with no recurrent chordee or urethral stenosis. The only fistula noted developed at the proximal Thiersch tube-island flap anastomosis in the boy with perineal hypospadias. Advantages of the aforementioned procedure include decreasing the risk of chordee on the basis of a foreshortened island pedicle flap, use of vascularized flaps, and completing the procedure in one stage with a satisfactory result.

Anastomosis, Surgical↗
PubMed1990

Role of in-office ultrasonography in screening infants and children for urinary obstruction.

With the availability of machines suitable for the office, we studied whether in-office ultrasonography could assist in the management of children with known or suspected hydronephrosis. Of 509 children examined, 81 (16 per cent) had hydronephrosis. In 56 (70 per cent) of these children, ultrasonography was helpful in expediting the diagnosis (9 cases), clarifying the etiology (16 cases), evaluating the condition postoperatively (26 cases), and screening (5 cases). Three incorrect ultrasound diagnoses were encountered. The authors believe that ultrasound is the best initial imaging method for the urinary tract and have shown that it is practical and effective in an office setting.

Child↗
PubMed1989

Ultrasonography and diagnosis of pediatric genitourinary rhabdomyosarcoma.

Rhabdomyosarcoma is the most common tumor of the lower genitourinary tract in children during their first two decades of life. Four patients with genitourinary rhabdomyosarcoma are presented, with ultrasonographic and radiographic findings. The utility of ultrasound in the diagnosis of this pediatric tumor is emphasized.

Child↗
PubMed1989

Silicone foam dressing for penis after reconstructive pediatric surgery.

Although silicone foam has been used abroad as an effective means to dress the penis after hypospadias surgery, its use has not been widespread in the United States. We have modified the method to apply the foam in order to facilitate its use. We used this method to dress the penis with silicone foam in 50 boys after reconstructive surgery. The dressing appeared to be effective in restricting edema and hematoma formation. Also, the dressing stabilized the indwelling urethral catheter thereby preventing disruption of the glansplasty. The urethrocutaneous fistula rate (10%) was not reduced by use of the foam. The dressings uncommonly fell off prematurely. The boys appeared to experience little discomfort while the foam was in place and during its removal.

Bandages↗
PubMed1989

Surgery for duplex kidneys with ectopic ureters: ipsilateral ureteroureterostomy versus polar nephrectomy.

Conventional surgery for the ectopic ureter stresses polar nephrectomy, while preserving a functioning upper pole by ipsilateral ureteroureterostomy is performed less commonly. During the last 15 years we operated on 35 children for ectopic ureter. High ipsilateral ureteroureterostomy (15 patients) was performed when the upper pole cortex appeared to be smooth and pink, and the anastomosis was surgically feasible. Upper pole nephrectomy and upper ureterectomy (21 patients) were performed when the involved segment appeared grossly to be pale, cystic or otherwise abnormal. One low ipsilateral ureteroureterostomy was performed concomitant with contralateral ureteral reimplantation. Complications after ipsilateral ureteroureterostomy and partial nephrectomy were similar. Histological evidence of dysplasia of the polar nephrectomy specimens was focal in 7 patients (33 per cent), marked in 2 (10 per cent) and not detected in 12 (57 per cent). Ipsilateral ureteroureterostomy is an appropriate means to manage the ectopic ureter in selected cases because dysplasia in these upper pole renal units seldom is significant, and because ipsilateral ureteroureterostomy and polar nephrectomy have similar postoperative morbidity rates.

Child↗
PubMed1989

The GAP (glans approximation procedure) for glanular/coronal hypospadias.

A modified glanuloplasty is described for the selective repair of glanular and coronal hypospadias with a wide, deep glanular groove and noncompliant urethral meatus. No urinary diversion is required, and cosmetic and functional results are excellent. A total of 24 children underwent the GAP (glans approximation procedure) during 20 months. Followup ranged from 3 months to 1.5 years with no evidence of meatal or urethral stenosis. One distal glanular fistula developed that required division of a 2 mm. skin bridge that separated the fistulous opening from the neomeatus.

Child↗
PubMed1989

Radiographic evaluation of subureteric injection of teflon to correct vesicoureteral reflux.

The imaging studies of 83 children (115 ureters) with vesicoureteral reflux who were treated by subureteric injection of Teflon (STING) were reviewed. On plain films, the Teflon rarely may be seen as faintly radiodense. On sonography, it is echogenic and has variable acoustic shadowing. On CT it is dense (160-466 H). Postsurgical cystography showed cessation of reflux in 83 ureters (72%). Complications of STING were uncommon. No granulomatous masses were identified in the region adjacent to the STING. Transient, free peritoneal fluid developed in three children and ureteral dilatation in six, three of whom required intervention. In one child, most of the Teflon disappeared from the original site of injection, as noted on a follow-up CT scan; possibly it had been extruded into the bladder. The STING procedure probably will become more popular. Knowledge of its radiologic appearance is important for the radiologist in order to effectively evaluate these children postoperatively.

Adolescent↗
PubMed1989

Hypospadias hidden by a complete prepuce.

Nine boys were found to have hypospadias despite the presence of a complete prepuce. The urethral meatus was in the subcoronal position in six boys, the distal shaft position in one boy and on the corona glandis in two boys. Although it is generally thought that boys with hypospadias have a dorsal hooded prepuce resulting from incomplete development of the ventral phallus, we have found hypospadias in boys with complete preputial development. Thus, physicians who perform circumcision should fully retract the prepuce to detect occult hypospadias before completing the procedure. Parents of newborns with hypospadias and a complete prepuce should be told, before circumcision, that preputial tissues may be needed to repair the hypospadias.

Child↗
PubMed1988

Fibrous hamartoma of infancy masquerading as a rhabdomyosarcoma of the spermatic cord.

Fibrous hamartoma of infancy is an uncommon nonmalignant fibroproliferative tumor found predominantly in the upper torso within the first 2 years of life. We report a case of fibrous hamartoma of infancy, which presented as a rapidly growing scrotal mass clinically indistinguishable from a rhabdomyosarcoma of the spermatic cord. The clinical characteristics of this neoplasm as well as management are discussed.

Diagnosis, Differential↗
PubMed1988

Urological complications in pediatric renal transplantation: management and prevention.

From 1973 through 1986, 166 consecutive renal transplants were performed in 143 patients. Urological complications included ureteral leakage/obstruction/necrosis, urinary tract infection, pyelonephritis, pelvic lymphocele, pelvic abscess, pelvic hematoma, infected hydrocele, bladder calculus, labial edema, renal artery/segmental stenosis, hydronephrosis, urinary incontinence, renal allograft malrotation and kidney rupture. Management options and preventive measures to avoid some of these dilemmas are highlighted.

Adolescent↗
PubMed1988

Pelvic lymphocele after pediatric renal transplantation: a successful technique for prevention.

Pelvic lymph accumulation (lymphocele) is a recognized complication of renal transplantation. During a 12-year period 166 renal transplants were performed in 143 children at our institution. From 1973 to 1979, 5 lymphoceles were treated in 64 children. From 1979 until the present a technique of peritoneal fenestration has been performed in 69 children, in whom 1 lymphocele developed. Lymphoceles required surgical treatment in 5 of the remaining 10 cases that were not fenestrated. Our experience with peritoneal fenestration as a method of lymphocele prevention has been excellent, and we recommend it as a prophylactic addition to renal transplant surgery.

Child↗
PubMed1988

Office urologic ultrasound in pediatric patients.

We use office ultrasound to supplement the pediatric urologist's office examination and follow the European model (J. Cukier, personal communication). The study can better serve the child and the family in this setting. We have shown that office ultrasound is an excellent primary screening modality, being both practical and accurate. The portable ultrasound machines now available should permit widespread use of office ultrasonography. However, office studies are not intended to replace studies with the more sophisticated and costly ultrasound machines used in radiology departments, only to complement them. We believe the primary uses of in-office examination in children at present are evaluating for detrusor thickness, residual urine volume, bladder capacity, hydronephrosis, and hydroureter; postoperative follow-up of hydronephrosis; screening for sibling uropathology; screening for occult uropathology in cases of gross hematuria; and study of voiding dysfunction or urinary infection. Experience has taught us that the better we become in performing inoffice ultrasound examinations, the better we use ancillary radiologic tests.

Ambulatory Care↗