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William Defoor

Publications and source records attributed to William Defoor.

7 recordsLinked to original sources
PubMed2006

Safety of gentamicin bladder irrigations in complex urological cases.

PURPOSE: Recurrent urinary tract infections are common in complex pediatric urological cases, particularly those requiring clean intermittent catheterization. At our institution gentamicin bladder irrigations have been used for antimicrobial prophylaxis and to treat symptomatic bacteriuria, particularly when the infection does not involve the upper urinary tract. The purpose of this study was to assess the safety of this therapy. MATERIALS AND METHODS: A retrospective study was performed of all children treated with gentamicin bladder irrigations from 1999 to 2004. The dose was 14 mg gentamicin in 30 ml saline instilled via catheter once or twice daily. Serum creatinine and random gentamicin levels were obtained according to a protocol based on risk of gentamicin toxicity. Patient demographics, laboratory results and outcomes were abstracted from the medical records. RESULTS: A total of 80 patients (38 males and 42 females) were identified. Median patient age was 10 years and median duration of treatment was 90 days. No patient had detectable serum gentamicin levels greater than 0.4 mg/dl. Small increases in serum creatinine were seen in 3 patients, all of whom had chronic renal insufficiency. A total of 21 patients (26%) had breakthrough UTIs, of which 5 (24%) were gentamicin resistant. No adverse events were documented. CONCLUSIONS: Gentamicin bladder irrigations are a helpful adjunct in the management of complex pediatric urological cases involving recurrent symptomatic bacteriuria. We no longer require intensive laboratory monitoring of low risk patients at our institution.

Adolescent↗
PubMed2005

Use of mobile extracorporeal shock wave lithotripter: experience in a pediatric institution.

OBJECTIVES: To present our results of the past 3 years using a mobile lithotripter in a pediatric institution. The low incidence of pediatric urinary calculi, along with the high cost of lithotripsy units, has limited the use of extracorporeal shock wave lithotripsy in pediatric institutions. METHODS: A retrospective cohort study was performed of all children who had undergone extracorporeal shock wave lithotripsy at two institutions from 1999 to 2003. All patients were treated with a Dornier Compact Delta mobile lithotriptor with a universal urologic table. RESULTS: A total of 88 patients (38 males and 50 females) underwent a total of 119 outpatient treatments. The mean patient age was 12 years, and the mean follow-up was 20 months. The mean stone size was 6 mm. An average of 1600 shocks per procedure was performed. Overall, 68% were stone free after one treatment, and 74% were stone free after one or two treatments. Of the patients with a solitary stone, 72% were stone free after one treatment and 78% were after one or two treatments. Fifteen patients had multiple stones treated simultaneously on the same side. Of these, 47% were stone free after one treatment and 53% after one or two treatments. Two patients subsequently required ureteroscopy and laser lithotripsy for obstructing ureteral calculi. CONCLUSIONS: The results of our study have shown that the new-generation mobile lithotripter is safe and effective in treating pediatric nephrolithiasis. The success rate was greater for solitary stones than for multiple stones treated at the same setting. Additional endoscopic procedures can be performed simultaneously on the same table.

Adolescent↗
PubMed2005

Ureteroscopy is safe and effective in prepubertal children.

PURPOSE: We present our experience performing ureteroscopy in prepubertal children. MATERIALS AND METHODS: We performed a retrospective cohort study of children 12 years or younger who underwent ureteroscopy at 2 institutions between 1993 and 2003. Patient demographics, indications for surgery, operative technique, surgical outcomes and complications were recorded. RESULTS: A total of 39 boys and 32 girls underwent 34 flexible and 47 rigid ureteroscopies. Retrograde access was obtained in 77 procedures, while 4 were performed via an antegrade approach. Mean age was 7.5 years (range 1 to 12) and mean followup was 2.2 years (0.5 to 10). Endoscopic lithotripsy was performed in 65 cases, with a success rate of 98%. A ureteral stent was placed postoperatively in 55 patients. Endoscopic incision was performed for a ureteral stricture in 3 patients and for ureteropelvic junction obstruction in 6. An obstructing fibroepithelial polyp was found in 2 patients, 1 underwent removal of a foreign body and 4 did not have intraluminal pathology. Dilation of the ureteral orifice was required in 23 cases (30%). There were no intraoperative ureteral injuries. One patient had development of a ureteral stricture (complication rate 1.3%) that was successfully treated endoscopically. CONCLUSIONS: Rigid and flexible ureteroscopy can be performed safely and effectively in prepubertal children. Successful outcomes can be obtained for calculi that are similar to those in the adult population. Ureteroscopic treatment can be effective in selected children with intraluminal obstruction. To our knowledge this is the largest series in the literature to document outcomes of ureteroscopy in this age group.

Child↗
PubMed2005

Perforation of Malone antegrade continence enema: diagnosis and management.

PURPOSE: Severe bowel dysfunction often accompanies neurogenic bladder, and Malone antegrade continence enema (MACE) procedures can lead to improvement in the quality of life of these patients. However, complications such as catheter false passage with subsequent intraperitoneal instillation of irrigation can lead to significant morbidity. We present our experience with the diagnosis and management of this condition. MATERIALS AND METHODS: The records of all patients undergoing MACE procedures at pediatric institutions from 1989 to 2002 were retrospectively reviewed. The records of patients diagnosed with a perforation were assessed for presentation, initial imaging studies, management and outcomes. RESULTS: Of 187 consecutive patients treated with MACE procedures we identified 6 females and 1 male (3.7%). Mean patient age at initial surgery was 11.3 years. Of the 7 patients presented within 3 months of the initial surgery, 6 presented with abdominal pain after irrigation and 4 reported traumatic catheterization. Six patients had extravasation of contrast material on imaging studies. Two patients presented with peritonitis and underwent immediate laparotomy. In 5 patients endoscopy was performed with catheter placement which was then maintained for 6 weeks. After a mean followup of 4.7 years 4 patients have complete continence, 2 have a MACE button in place and 1 has mild fecal leakage. CONCLUSIONS: MACE procedures have a low incidence of conduit false passage and perforation. Prompt diagnosis and early intervention are crucial to management. Endoscopic evaluation with catheter placement can be helpful in preserving continence and decreasing morbidity.

Child↗
PubMed2005

Results of a prospective trial to compare normal urine supersaturation in children and adults.

PURPOSE: Urinary stone disease is relatively rare in children but is often due to metabolic abnormalities. Urinary supersaturation (SS) indices have been suggested as more precise predictors of stone recurrence. We previously reported urinary metabolic evaluations in stone-forming children using adult references. We now assess normal SS values in children. MATERIAL AND METHODS: A prospective trial was performed to assess urinary metabolic profiles in children with no personal or family history of urinary calculi. The 24-hour urine collections were performed and evaluated at an outside central laboratory. Urine chemistries were adjusted for urine creatinine. Urine pH and SS for calcium oxalate, calcium phosphate and uric acid were also assessed. The data were compared to a cohort of normal adults. RESULTS: A total of 168 samples from 168 adults (58% males) and 51 samples from 30 children (59% males) were evaluated. The mean age of the children was 8.8 years (range 5 to 18). Calcium oxalate SS was similar between children and adults, and urine pH was the major cause of differences seen in the calcium phosphate and uric acid SS indices. Children had a much higher excretion of calcium, oxalate and citrate when adjusted for creatinine. CONCLUSIONS: There are significant differences in the normal ranges of urine chemistries in children and adults. An understanding of normal supersaturation values may allow metabolic abnormalities in stone-forming children to be more precisely diagnosed and treated.

Adolescent↗
PubMed2002

Unusual bladder masses in children.

Benign and malignant bladder masses in children are extremely rare pathologic lesions. The presentation can include gross hematuria, irritable or obstructive voiding symptoms, and urinary infection. We present 2 cases in which large bladder masses suspicious for malignancy were diagnosed as benign lesions. One patient presented with abdominal pain and frequency 2 weeks after a minor bicycle accident and had a bladder wall abscess with sterile urine. Another child presented with gross hematuria and was found to have a giant cystitis glandularis lesion with no precipitating event or infection. The evaluation and differential diagnosis are discussed, and a review of the literature is presented.

Abscess↗