Thomas S. Parrott

Reconstruction of the Urinary Tract in Prune Belly Uropathy

Ten patients with prune bell uropathy, including 7 neonates, were treated with extensive surgical tailoring of the upper urinary tracts using primarily the upper ureteral segment. Simultaneous transabdominal orchiopexy, particularly in the neonate, is described as a useful adjunct. Our early results in these patients justify this aggressive approach.

The Role of Vesicostomy in the Management of Anterior Urethral Valves in Neonates and Infants

We performed vesicostomy as the initial form of management in 2 male newborns and 1 infant with anterior urethral valves associated with proximal urethral diverticula and bilateral hydronephrosis. Prompt improvement in the degree of hydronephrosis was noted after vesicostomy in all 3 patients along with improvement in renal function in 2 who had presented with renal insufficiency. Subsequently, 2 patients have undergone vesicostomy closure and transurethral valve fulguration, and 1 also required ureteral reimplantation for persistent vesicoureteral reflux. The use of vesicostomy in the newborn period rather than transurethral fulguration prevented the potential complications of urethral stricture and inadequate valve resection that can occur owing to the small size of the neonatal urethra. Furthermore, a period of vesicostomy drainage before eventual ureteral reimplantation for severe vesicoureteral reflux obviated the need for ureteral tailoring.

Reflux in opposite ureter after successful correction of unilateral vesicoureteral reflux

Reflux developed in the contralateral ureter in 20 per cent of our patients undergoing unilateral ureteral reimplantation for reflux. This occurrence was not predictable from the preoperative evaluation. Bilateral reimplantation may be indicated in some patients requiring surgical correction for demonstrated reflux.

Pyeloplasty in the Young Infant

The urgency, safety and benefits of performing pyeloplasty during the first weeks of life currently are being questioned. We reviewed our experience with 114 pyeloplasties in 103 infants and young children performed between 1983 and 1987. The 34 patients who underwent an operation before they were 3 months old were compared to 69 operated upon after 3 months. The surgical results in the 2 groups were equally good, with 90 per cent of the cases having an improved or stable postoperative excretory urogram or renal scan. Complications were few and were more common in the older age group, in which 7 children required a secondary procedure, including 2 for recurrent obstruction at the ureteropelvic junction. No patient in the younger age group required a secondary procedure for treatment of a complication or recurrent obstruction. Our findings indicate that the success of pyeloplasty performed during the first weeks of life is equal to that performed at a later patient age and were not more likely to be followed by a complication.

Ureteral Tailoring: A Comparison Of Wedge Resection With Infolding

A retrospective analysis of 44 consecutive pediatric ureteral reimplantations in 42 patients (51 ureters reimplanted) is presented, in which the ureter was tapered by infolding or wedge resection. Few postoperative complications occurred and the results were essentially comparable for the 2 groups, although slightly more postoperative ureteral obstruction occurred in the wedge resection group. Over-all success rate (no postoperative reflux and no obstruction) was 95% for the infolded group and 90% for wedge resection group. Stent time and hospital stay were significantly less for the infolded group.

Segmental renal vein renins and partial nephrectomy for hypertension in children

Hypertension in children often is curable surgically. In many instances the causative lesion will be segmental and either vascular or parenchymal. We report on 5 children with a segmental lesion in whom the elevated segmental renal vein renins correctly predicted cure of the hypertension following partial nephrectomy.

The Expanded Role of Transureteroureterostomy in Pediatric Urology

Transureteroureterostomy was used in 31 patients as a component in urinary undiversions, salvage procedures for failed reimplants/reconstructions and diversions with a sigmoid antirefluxing conduit or end cutaneous ureterostomy, as well as an adjunct to reimplantation procedures complicated by an abnormal bladder that precluded reimplantation of more than 1 ureter. Reconstruction in 29 patients involved procedures that changed the drainage of the recipient ureters for various reasons, including obstruction, reflux, undiversion and diversion. A neurogenic bladder was present in 26 patients and an additional 4 patients had a significant bladder pathological condition. Both ureters were dilated in 17 patients, while 1 was dilated in another 6. This series illustrates the versatility and confirms the success of transureteroureterostomy in high risk, complicated reconstructive urological procedures in children.

Importance of cystourethrography in neonates with imperforate anus

Infants born with imperforate anus have a high incidence of genitourinary anomalies. Vesicoureteral reflux was the most common abnormality in this series. Since these patients often have bacteriuria, this is an important finding. An intravenous pyelogram and voiding cystourethrogram should be part of the evaluation of each neonate with imperforate anus. Persistent cloaca, a frequent finding in the female patients, may require special diagnostic attention.

Urologic Surgery in the Neonate

AbstractFor urologists the most challenging problem offered by the neonate is obstructive uropathy, which comprises more than half of the urologic diseases in newborns. In most instances a good result can be attained by surgical correction of these anomalies. Morbidity and mortality are acceptable. The use of preliminary, temporary diversion for obstructive uropathy did not, in our experience, enhance the chances for a good long-term result.

Electronic Bladder Stimulation in the Management of Children with Myelomeningocele

Mentor electronic bladder stimulators were implanted in 8 children with myelomeningocele who were being managed successfully with intermittent catheterization. Satisfactory clinical performance was obtained in only 3 of these children. In the 5 failures urine flow was sporadic and unreliable. In 6 patients electrode lead wires broke where they entered the anterior abdominal fascia. None of the 8 units functioned more than 29 months. Many technical problems must be resolved before bladder stimulators will have a significant role in the management of children with myelomeningocele.