Edwin P. Harmon

The Value of Leak Pressure and Bladder Compliance in the Urodynamic Evaluation of Meningomyelocele Patients

A total of 61 patients with myelodysplasia underwent water cystometry and electromyography of the external sphincter. Of these patients 27 underwent video fluorourodynamics as a part of preoperative evaluation or instead of a voiding cystometrogram. Renal quantitative scintillation camera studies detected 7 patients with mild upper tract deterioration, even when other tests failed to do so. A total of 31 patients had upper tract deterioration as detected by excretory urography, ultrasound and/or renal scan studies, and were designated as group 1, while 30 had normal upper tracts and were designated as group 2. Bladder compliance in group 1 was significantly lower than that in group 2 (4.5 versus 11.3 ml./cm. water, p = 0.001). Leak pressure in group 1 was significantly higher than in group 2 (42.3 versus 26.1 cm. water, p = 0.019). In summary, patients with evidence of upper tract deterioration had lower bladder compliance and higher leak pressure than patients with normal kidneys.

Priapism as a Complication of Sickle Cell Disease

We reviewed all available reported cases and added our experience with 11 cases, as well as our data on its prevalence among the pediatric clinic patients seen at the Sickle Cell Center of Southern Louisiana

Effect of Extracorporeal Shock Wave Lithotripsy on Renal Function and Body Height in Pediatric Patients

AbstractAlthough extracorporeal shock wave lithotripsy (ESWL*) is the preferred modality for treatment of most renal and upper ureteral calculi in adults, little is known about its effect on the pediatric population. We carefully followed 12 children 2.2 to 15.3 years old (mean age 9.4) treated with the Dornier HM3 lithotriptor. Effective renal plasma flow was obtained by quantitative 131iodine hippurate scan immediately preceding ESWL and at followup (range 74 to 238 weeks, mean 149). The treated kidney received an average of 1,702 shocks (range 1,000 to 2,200). Mean effective renal plasma flow increased in the treated kidney from 185 cc per minute before ESWL to 217 at followup (p = 0.016) and in the untreated kidney from 191 to 224 (p = 0.0013). Total effective renal plasma flow increased from 376 cc per minute before ESWL to 440 at followup (p = 0.0019). In the treated kidney mean and total effective renal plasma flow increased by 31 (expected 32) and 64 (expected 68) cc per minute, respectively, whil...

Urolithiasis in children: innovations in management.

Management of urolithiasis in children remains a challenge despite newer technological innovations. During the last 3 years we have treated 19 children with a combination of extracorporeal shock wave lithotripsy, percutaneous stone extraction and ureteroscopy, as well as with traditional methods. The newer technological methods perfected in adults are equally applicable to children in experienced hands.

Ureteropelvic junction obstruction: the effect of pyeloplasty on renal function.

We studied preoperatively and postoperatively 41 children who underwent pyeloplasty for correction of unilateral ureteropelvic junction obstruction. Conventional radiological studies and quantitative radioiodine hippurate renal scans were obtained to assess the effect of pyeloplasty on the appearance of the kidney and its function. Analysis of the data suggests that the degree of improvement in renal function is related primarily to the age at which the surgical correction is accomplished and whether infection has occurred preoperatively.

Direct percutaneous pouch cystostomy with endoscopic lithotripsy for calculus in a continent urinary reservoir

Continent urinary reservoirs are an accepted mode of urinary diversion in appropriate patients. Such procedures are associated with long-term complications. A patient who underwent a continent urinary diversion (modified Indiana pouch) 4 years ago for a neurogenic bladder presented with a large irregular calculus in the pouch. Endoscopic attempts to remove the calculus through the stoma were unsuccessful and extracorporeal shock wave lithotripsy failed to fragment the pouch calculus. Finally, an endoscopic approach through a direct percutaneous pouch cystostomy, and use of ultrasonic and electrohydraulic probes resulted in successful fragmentation and removal of the calculus.

Pediatric urolithiasis: review of research and current management

The treatment of urolithiasis in children has changed dramatically in recent years. With the proven safety and efficacy of extracorporeal shock wave lithotripsy (ESWL), percutaneous lithotripsy and ureteroscopy in adults, these modalities are now in the forefront of the treatment of pediatric urinary stones. Our research in the juvenile non-human primate with ESWL indicates that renal damage in most cases is neither significant or persistent. In addition, technological advances in instrumentation have cleared the way for the use of percutaneous lithotripsy and ureteroscopy in most pediatric patients. Today, open surgical procedures for stone disease in children should be a last resort.