Gerald R. Jerkins

Familial Vesicoureteral Reflux: A Prospective Study

A prospective study was established to identify the incidence of vesicoureteral reflux in the siblings of patients with reflux. Of 78 patients with reflux 104 siblings were screened with an awake voiding cystogram and 34 (32 per cent) were found to have reflux. Of these 34 siblings 25 (73 per cent) had no abnormal voiding symptoms or history of urinary tract infection. The highest incidence of reflux was found in the siblings of those patients with radiographic evidence of renal scarring. Early detection and followup in this high risk group may be a vital tool in determining more about the natural history of vesicoureteral reflux and its relationship to renal damage.

Hematuria preceding renal calculus formation in children with hypercalciuria

Five children were evaluated for painless hematuria; currently recommended diagnostic studies were unsuccessful in determining a diagnosis. A renal calculus subsequently was passed or detected radiographically in each child from 14 to 20 months after the initial evaluation. Hypercalciuria was then demonstrated by quantitation of 24-hour urinary calcium excretion or by measurement of urinary calcium/creatinine ratio. Calculi and hematuria have not recurred following thiazide therapy. We infer that idiopathic hypercalciuria was a probable cause of the unexplained painless hematuria.

Clinical experience with pediatric urolithiasis

Our clinical experience with 47 pediatric patients with stones is reviewed. Surgical therapy was standard with successful stone manipulation in 12 of 13 patients. In 91 per cent of our patients factors causing or predisposing to stone disease were discovered. A thorough metabolic evaluation, including an oral calcium loading test in 20 children, proved to be helpful. A new patient subgroup relating unexplained hematuria to eventual stone formation is described. Our protocol for metabolic evaluation and recommendations for treatment based on the results of such an evaluation are given. We have found the metabolic evaluation of the child with stones meaningful and particularly helpful in planning subsequent therapy for these patients.

Management of Neonatal Testicular Torsion

PURPOSEnWe evaluated the safety and efficacy of emergency exploration of neonatal torsion.nnnMATERIALS AND METHODSnWe retrospectively reviewed the charts of 27 neonates (30 affected testicles) in a 13-year period.nnnRESULTSnOf the 10 testicles that were explored and fixed within 6 hours of discovery 2 (20%) were normal at physical examination at 1 year of followup. Of the remaining 20 testicles 19 were removed. One patient was lost to followup after orchiopexy. No operative or perioperative complications were associated with emergency exploration.nnnCONCLUSIONSnEmergency exploration of neonatal torsion is safe and prudent, and may result in higher testicular salvage rates. Given reports of contralateral torsion, we also recommend contralateral orchiopexy.

Spermatic Cord Torsion in the Neonate

Abstract We describe 8 cases of spermatic cord torsion in the neonate, including the fifth and sixth reported cases of neonatal bilateral torsion. Early discovery of the torsion and orchiopexy resulted in near normal growth of the affected testicle in 1 patient at 1-year followup. Recommendations for surgical management of torsion and treatment of the uninvolved testicle in unilateral cases are discussed.

An Unusual Complication of Silver Nitrate Treatment of Hemorrhagic Cystitis: Case Report

A patient with severe cyclophosphamide cystitis was treated with intravesical silver nitrate instillation to control bleeding. This resulted in apparent reflux and extravasation of the silver nitrate solution with secondary retroperitoneal inflammation. Subsequently, the patient required treatment for a small, fibrotic bladder with persistent reflux. The precautions and recommendations for treatment of such difficult patients are discussed.

Cutaneous Vesicostomy Experience in Infants and Children

Cutaneous vesicostomy has proved to be a useful form of temporary diversion in children. We report our experience with 35 patients who underwent diversion for either lower tract dysfunction or obstruction. In only 1 child did vesicostomy appear to be of questionable value in adequately draining the upper urinary tracts. Renal functional improvement or stabilization was observed in the remaining 34 children. Complications occurred in 14 patients, with urinary tract infections of a clinically serious nature being observed in 6. Our experience tends to confirm vesicostomy to be an effective, simple and easily reversible means to treat selected conditions in infants and children. Complications are encountered but they have been managed effectively.

Proximal stent displacement as complication of pigtail ureteral stent

The indwelling ureteral stent recently introduced by Cook offers relative ease of placement with a self-curling end which prevents migration down the ureter. We have seen 4 cases of proximal migration of these stents. The reasons for this event are described. Our experience suggests the placement of a suture in the distal portion of the catheter to allow retrieval of the catheter should migration occur.

Hypertelorism-Hypospadias Syndrome

The hypertelorism-hypospadias syndrome has been reported previously in 19 affected male patients. In addition, 21 affected boys in 16 families have been evaluated at our center. Genitourinary anomalies other than hypospadias were observed frequently and included cryptorchidism, vesicoureteral reflux and minor upper urinary tract variations. An increased incidence of other developmental defects involving major organ systems also was observed. Since urologists are among the first physicians to evaluate these children, they should recognize this syndrome as an indication to initiate a thorough multisystem evaluation.

Unusual presentation of ureteropelvic junction obstruction in an incomplete duplex system

Ureteropelvic junction obstruction in an incomplete duplex system is seen infrequently. This case represents an unusual presentation of such an obstruction. Recommendations are made for preoperative evaluation and surgical management of these patients.