Dixon Walker

Rectus Fascial Wrap: Early Results of a Modification of the Rectus Fascial Sling

We describe an operation that increases bladder neck resistance in patients with urinary incontinence. It is a modification of the rectus fascial sling that was designed as an adjunct to augmentation cystoplasty and is used in association with clean intermittent catheterization. The operation is performed by circumferentially wrapping a rectus fascial defatted free graft around the bladder neck and suturing it to appose the bladder neck. The procedure was done in 17 patients, including 10 with myelodysplasia, 3 with sacral lipoma, 3 with bladder exstrophy and 1 with nonneurogenic neurogenic bladder. Leak point pressure improved in patients in whom it was measured preoperatively and postoperatively. Complications developed in 5 patients, including difficulty with catheterization in 2, ventral hernia at the graft harvest site in 1, bladder calculus in 1 and detrusor hyperreflexia in 1. Early results with the bladder fascial wrap indicate that it has the ability to improve continence in patients with a dysfunctional bladder neck who have undergone augmentation.

Spectrum of multicystic renal dysplasia: diagnosis and management.

Multicystic renal dysplasia represents a spectrum of pathologic states, from unilateral multicystic kidney through segmental and focal multicystic dysplasia to bilateral multicystic kidney. Diagnosis can be established with low-risk procedures with reasonable accuracy. Treatment may be nonoperative in selected cases, but the physician must be responsible for long-term follow-up of the child until more is known about the natural history of this process.

Psychological Factors in Hypospadias Repair

Children undergoing hypospadias repair and their parents have anxieties related not only to the operation but to future expectations. These anxieties are expressed by children through their drawings and by parents through interviews. They are enhanced by the fact that the hypospadias defect is only noticeable to the parents and child and is kept as secret information. Other defects, such as cleft palate, are obvious and cannot be hidden. The anxieties associated with hypospadias appear to be different whem compared to those associated with more obvious deformities.

Idiopathic priapism in the newborn.

Priapism in children usually results directly or indirectly from an underlying cause. Secondary priapism is extremely rare in neonates and idiopathic priapism has not been described previously.

Maximum urine concentration Early means of identifying patients with reflux who may require surgery

Abstract Maximum urine concentration was evaluated in 76 children with reflux. We have demonstrated that there is a significant concentrating defect in many patients with reflux, even when pyelographic changes are not present. Because of this we believe that concentrating ability is the best renal function test to use in the conservative management of patients with reflux and that, in certain instances, the persistence of a concentrating defect might be an indication for more aggressive management.

Glomerular and Tubular Function in Children with Ileal Conduit Urinary Diversion

AbstractChildren with ileal conduit urinary diversion usually have adequate postoperative assessment of glomerular but not tubular function. Deterioration of tubular function usually precedes deterioration of glomerular function in most urologic conditions. We herein assess and compare deterioration of glomerular and tubular function in children with ileal conduits. Recommendations for functional postoperative evaluation are made.

Five-hour renal functional evaluation

Children with urogenital disease frequently require evaluation of glomerular and tubular functions. Herein is presented a practical method of performing glomerular and tubular functional studies requiring short time periods and utilizing readily availabe laboratory techniques.

Elastic Characteristics of the Ureter

An explanation was sought as to why the ureter becomes tortuous with increased intraluminal pressure. Changes in ureteral diameter and length, secondary to increased intraluminal pressure, were measured in different pathologic conditions and these changes were compared to similar ones in a non-biologic material (latex rubber tubing). It was demonstrated that these changes were anisotropic and remarkably similar under quite different pathologic conditions. Ureteral tortusity occurring secondary to increased intraluminal pressure may be related to anisotropic expansion of a tube with both ends in a fixed position.