Bert Vorstman

Polytetrafluoroethylene Injection for Urinary Incontinence in Children

We have treated 11 children for urinary incontinence with one or more endoscopic injections of polytetrafluoroethylene (Teflon) into the external urethral sphincter region. The procedure is simple to perform and without significant complications. Long-term results have been gratifying, with cure or improvement in 8 of the 11 patients.

Sphincterotomy Failure in Neurogenic Bladder Disease

Among 60 spinal cord injury patients who underwent external urethral sphincterotomy 45 experienced success and 15 failed. Failure was established when symptomatic urinary tract infections and high vesical residuals persisted. Urodynamic findings demonstrated detrusor areflexia in 10 patients (66 per cent), detrusor-sphincter dyssynergia in 2 (13.2 per cent), detrusor hyperreflexia with unsustained bladder contractions in 1 (6.6 per cent), and detrusor hyperreflexia and bladder neck obstruction in 2 (13.2 per cent). Among these failures poor detrusor contractility predominated. Detrusor-sphincter dyssynergia may indicate an inadequate surgical relief of obstruction. Bladder neck obstruction may indicate that a bladder neck incision should be considered when an external sphincterotomy is performed.

The Management of Spermatic Cord Liposarcomas

We review 3 cases of spermatic cord liposarcoma that have been followed for 12 months to 5 years after diagnosis. Inguinal orchiectomy rendered adequate treatment. Preoperative diagnosis of liposarcoma of the spermatic cord is unusual although gray scale sonography may be of some assistance. A review of the literature reveals that adjunctive medical or surgical treatment appears to be superfluous.

Postmenopausal vesical endometriosis

Vesical endometriosis in a postmenopausal patient is reported. An abdominal hysterectomy had been performed twenty-four years previously, and exogenous estrogens had not been administered. The patient was treated surgically with a partial cystectomy.

Investigations on urinary bladder reinnervation: Historical perspective and review☆

Although nerve crossover surgery to bypass a spinal cord lesion and recentralize the decentralized bladder was first conceptualized in 1907, surprisingly few studies concerning this goal have been reported since. In addition to direct implantation of nerves into the detrusor, the studies reviewed have investigated the crossover of mixed roots (with and without nerve grafts), dorsal roots, ventral roots, pelvic, obturator and hypogastric nerves both in animal models, in human cadavers, and in human patients. Restoration of the micturition reflex through the use of nonsacral nerves has been achieved in cats. In addition, we have shown that the axons of a suprasacral mixed root (L7) when anastomosed to a sacral mixed root (S1) via a nerve graft can regenerate and recentralize the unilaterally decentralized bladder in the cat. The return of the micturition reflex after reconstruction of severed pelvic nerves has been documented, while the results of obstruction or hypogastric crossover have given diminished returns of bladder function. The direct implantation of nerves into the detrusor has not resulted in restoration of function. In addition, return of useful bladder function in humans after nerve crossover surgery has not been predictable. In part, present inability to achieve restoration of urinary bladder function may be a consequence of the complexity of micturition reflex organization and the inability to use techniques in humans that have given success in animals. Although, some of the technical aspects of nerve crossover surgery to bypass a spinal cord injury and restore functional micturition in those with neurogenic bladder dysfunction have been elucidated, further work is required to develop techniques that will enhance appropriate axonal regeneration to achieve reinnervation and return of useful function. Indeed, restoration of function may be limited by current microsurgical methodologies. Studies directed at understanding the neuropathophysiology of nerve injury and nerve surgery may be more fruitful in identifying factors than can be manipulated to achieve consistent return of useful function. In general, however, the results of the animal and human studies surveyed may be viewed with cautious optimism.

Spermatic Cord Torsion Following Previous Surgical Fixation

AbstractWe report a case of spermatic cord torsion following previous surgical fixation. A diagnosis of torsion must be excluded in a patient who presents with a painful testis and who has had a previous fixation. The use of silk suture material in the fixation at the initial presentation is strongly recommended.

Nerve Crossover Techniques for Urinary Bladder Reinnvervation: Animal and Human Cadaver Studies

Interruption of spinal pathways integrating central and peripheral bladder control mechanisms will result in neurogenic bladder dysfunction. If central pathways could be restored to the decentralized bladder through a microneural reconstructive technique a return of useful function might be achieved. This anatomical study describes the nerve crossover techniques used in human cadaver dissections for connecting intercostal nerves to sacral roots intraspinally. The techniques were modified from and compared to similar procedures used in an animal model where adjacent extradural roots were connected through a nerve graft. We have shown previously that the unilaterally decentralized bladder of the cat can be recentralized after a nerve crossover procedure. If additional laboratory studies can document return of useful bladder function we anticipate that selected patients may benefit from similar nerve crossover techniques to bypass a spinal cord lesion to recentralize the bladder.

Wilms tumor in adult patient

Abstract The pathology of Wilms tumor in adults is similar to that in infants. Aggressive multidisciplinary therapy already established for children may give similar survival figures for adults. We report on a case of Wilms tumor in an adult who underwent radical nephrectomy and inferior vena cava resection.