John P. Smith

Results in children managed by cutaneous ureterostomy.

A review of 59 children with severe hydronephrosis managed by cutaneous ureterostomy reveals that the procedure is safe, quick, and effective in draining the kidney. Although chronic bacteriuria is common, pyelonephritis is rare. The major drawback of this technique for temporary urinary diversion in children is that the subsequent urinary reconstruction is formidable and more difficult than primary repair. The complications of urinary diversion using this technique are low, however, and it may remain the safest form of diversion available for long-term use in children with dilated ureters.

Surgical dressing for hypospadias repair.

The repair of hypospadias is considered a plastic surgical procedure. It is disconcerting to the surgeon and to the child’s parents to see carefully constructed skin flaps and z-plastics disrupted in the immediate postoperative period by a normally active boy.* -____ *CUI.P, 0. S.: Struggles and triumphs with hypospadias and associated anomalies, J. Ural. 96: 339 (1966). The dressing is applied while the patient is still anesthetized. The penis is stabilized in an outstretched position by passing a suture through the glans penis and the skin of the lower abdomen (Fig. 1A). Cotton balls immersed in saline are placed one by one around the sides of the penis (Fig. 1B). No attempt is made to squeeze the saline from the cotton balls. Approximately eight

Achalasia in children and adults

Abstract Achalasia or primary megaloureter is a relatively rare disorder characterized by a functional obstruction of the distal ureter. The etiology and pathophysiology are presently obscure, and the diagnosis is established on clinical, radiographic, and surgical findings. Review of 22 cases in children and adults demonstrated a high incidence of associated congenital anomalies. Many of these patients had symptoms of infection or hematuria during infancy or early childhood. In adults the disease often is stabilized and can be treated without surgery. In childhood, operative intervention by excision of the anomalous segment and reimplantation of the ureter into the bladder with an antireflux procedure is the treatment of choice.