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Biomedical subjects

W E Kaplan

Publications and source records attributed to W E Kaplan.

At least 19 recordsLinked to original sources
PubMed1992

Contrast-induced central nervous system toxicity after radiographic evaluation of the lower urinary tract in myelodysplastic patients with ventriculoperitoneal shunts.

Routine urological evaluation of children with myelomeningocele helps to identify those at risk for upper urinary tract deterioration. We report on 2 patients with ventriculoperitoneal shunts who had intraperitoneal rupture of the bladder. Reflux of contrast media via or around the ventriculoperitoneal shunt into the cerebral ventricles occurred in both patients, resulting in severe neurological insult.

Brain Diseases↗
PubMed1992

Selective sacral rhizotomy in children with high pressure neurogenic bladders: preliminary results.

Recent successful introduction of selective rhizotomy in the management of lower extremity spasticity in patients with myelodysplasia has prompted us to use it as a means of managing high pressure neurogenic bladders occasionally encountered in myelodysplastic patients. During the last 1 1/2 years 8 children have undergone selective sacral rhizotomy in an attempt to avert urinary diversion or bladder augmentation. Patient age ranged from 6.5 to 18.5 years. The level of the respective lesions was evenly distributed throughout the spine. At spinal surgery each patient had an electrode placed in the detrusor of the bladder via a suprapubic approach, electromyography electrodes were placed in the perineum and slow fill water cystometry was performed throughout the procedure. Standard electrophysiological stimulation of the nerve roots was performed to identify the rootlets that would only affect the detrusor and spare the external sphincter. Postoperative followup has been obtained on all patients. Of the patients 4 have exhibited significant improvement and they have not required augmentation, 2 have not shown any further deterioration in bladder function, 1 has demonstrated deterioration and 1 still lacks urodynamic followup. Postoperative cystometric studies have revealed a bladder capacity increase of 69% for the group. Uninhibited bladder contractions were abated in all but 1 patient. No patient has been rendered incontinent of urine from the procedure and no patient has had a problem with stool continence as a result of the rhizotomy. It appears that selective rhizotomy of the sacral roots has been able to increase bladder capacity as well as compliance in patients who normally would have been relegated to either bladder augmentation or urinary diversion. While these are encouraging results, some further followup is required to ascertain if the early improvements will be long-lasting.

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↗
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

Intravesical transurethral bladder stimulation to increase bladder capacity.

Intravesical transurethral bladder stimulation is a diagnostic rehabilitative procedure that has been successful in initiating sensory-induced detrusor contractions. However, of greater significance has been the recognition that the process also will increase bladder capacity while maintaining low filling and leak pressures. Data are available on 88 patients. In 80 per cent of the children treated a greater than 50 per cent increase in bladder capacity was noted. We evaluated 46 patients who underwent long-term treatment. The beneficial effects on bladder capacity have been maintained. Exploration into whether this technique could be used, rather than augmentation procedures, is for future examination.

Child↗
PubMed1989

The therapy of genital trauma by dog bite.

Genital trauma by dog bite rarely is reported. We present 2 cases of dog bite to the external genitalia involving male infants. Rabies precautions, tetanus prophylaxis and antimicrobial therapy are reviewed. Both children required surgical debridement and split thickness skin grafts for repair. Since pediatric genital trauma may be the result of negligence or even deliberate abuse, a thorough investigation of the child's environment is mandatory in such situations.

Amputation, Traumatic↗
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↗
PubMed1988

Maternal cocaine use and genitourinary tract malformations.

A specific fetal disruption syndrome associated with maternal cocaine use has not as yet been documented. In the first 23 pregnancies evaluated in our program for chemically dependent women, one infant with prune belly syndrome and one infant with hypospadias were delivered to cocaine-using women. In the present study, all infants delivered in our program received a renal ultrasound at 2-3 days of life. Fifty infants born to cocaine-using women (group I) and 30 born to polydrug, noncocaine-using women (group II) were evaluated. The two groups of women were similar for age, gravidity, and race. Mean birth weight of the infants in the two groups was similar. Seven infants in group I demonstrated genitourinary tract malformations while there were no infants with such malformations in group II. It is hypothesized that the vasoconstrictive effects of cocaine could explain the abnormalities of the genitourinary tract found in the cocaine-exposed infants.

Cocaine↗
PubMed1988

Intravesical bladder stimulation in myelodysplasia.

Intravesical transurethral bladder stimulation has been used as a diagnostic and rehabilitative technique in children with a neurogenic bladder for 3 years. The program has expanded from 10 to 42 patients undergoing a significant number of therapy sessions. The technique presently is done on an outpatient basis. The child is catheterized for 90 minutes and undergoes electrotherapy for 60 minutes, ideally 3 to 5 days per week. An individual series consists of 15 to 30 daily sessions. Presently, 62 patients have been evaluated and 42 have had a least 1 complete series. This ongoing program has provided more data to classify better patients who can expect success with the program. Of the patients who presented initially with detrusor contractions and areflexia 80 and 33 per cent, respectively, can expect to void to completion or have full sensation so as to perform timely clean intermittent catheterization. A total of 21 patients underwent at least 3 series, and 38 per cent void with low pressure and total continence.

Adolescent↗
PubMed1988

The urological manifestations of the tethered spinal cord.

The tethered spinal cord is an entity with potentially grave neurourological implications. Presenting urological symptoms include incontinence, symptomatic urinary tract infections and stool soiling. These symptoms may be the first to herald a tethered cord. The patients with previously repaired myelodysplastic defects are particularly prone to development of this lesion. We correlated urological history with preoperative and postoperative cystometry in 20 myelodysplastic children. In this study we noted that clinical symptomatology and urodynamic parameters improved in 60 per cent of those children who underwent cord untethering. A better result was evident in children whose condition was repaired promptly.

Fecal Incontinence↗
PubMed1987

The endoscopic correction of reflux by polytetrafluoroethylene injection.

Endoscopic subureteral injection of polytetrafluoroethylene (Teflon) was done in 38 patients (55 ureters) to correct vesicoureteral reflux. Followup excretory urograms and nuclear cystograms were available in 28 patients (40 ureters) 2 to 11 months after injection. Nearly 50 per cent of the patients had a neurogenic bladder. Injection was done for all grades of reflux, although the majority of cases had at least grade III reflux. After injection reflux either was eliminated or decreased in 76 per cent of the patients with neurogenic disease and in 87 per cent of those with a normally innervated bladder. This outpatient procedure is simple and brief to perform, and it is associated with minimal morbidity. As with any new antireflux technique longer followup is indicated.

Child↗
PubMed1987

The urologic manifestation of the tethered spinal cord.

The tethered spinal cord is an entity with potentially grave neurologic implications. Presenting urologic symptoms include incontinence, symptomatic urinary tract infections and stool soiling. These symptoms may be the first to herald a tethered cord. The patients with previously repaired myelodysplastic defects are particularly prone to develop this lesion. This study was designed to correlate urologic history with pre and post operative cystometry in 20 myelodysplastic children. In this study, it was noted that clinical symptomatology and urodynamic parameters improved in 60% of those children who had cord untethering. A better result was evident in children who were repaired promptly.

Child↗
PubMed1986

Intravesical transurethral electrotherapy for the neurogenic bladder.

Intravesical transurethral bladder stimulation is a rehabilitative and diagnostic technique for the neurogenic bladder. The goal of therapy is 3-fold: 1) to achieve the sensation of bladder filling or the urge to void, 2) to initiate a detrusor contraction and 3) to achieve conscious urinary control. The procedure combines direct electrical stimulation of bladder receptors with visual biofeedback using patient observance of a water manometric representation of the detrusor response. Since November 1984 we have evaluated and/or treated 24 patients with a neurogenic bladder. An electrocatheter is passed transurethrally into the bladder and the bladder is filled to a third of its capacity with normal saline. We then deliver 2 to 6 mA. every 3 seconds for 90 minutes. Full treatment usually requires 30 to 90 sessions. Of the 24 patients 13 had only 1 evaluation and 10 had 3 to 39 sessions. Of those 10 patients 7 had significant detrusor activity that had not been present before treatment and 4 have a sensation to void. The remaining child underwent 110 sessions. He has controlled detrusor contractions resulting in a normal voiding pattern. It appears that intravesical transurethral bladder stimulation may be helpful diagnostically to determine the stimulus response of bladder function and therapeutically to rehabilitate the neurogenic bladder toward full control.

Biofeedback, Psychology↗