Biomedical subjects

A B Retik

Publications and source records attributed to A B Retik.

At least 91 records · Page 5Linked to original sources

PubMed1989

The use of rectus fascia to manage urinary incontinence.

The surgical management of urinary incontinence in children is one of the most difficult challenges facing pediatric urologists today. We have critically looked at our experience using a rectus fascial sling to prevent incontinence. Eleven girls (6 to 22 years old) with urinary incontinence from neurogenic bladder dysfunction (9), surgical injury to the bladder (1) or urogenital sinus abnormality (1) comprise this study. All had failed regimens of pharmacological therapy and intermittent catheterization. Three patients had undergone prior bladder neck reconstruction and 2 an augmentation cystoplasty in an attempt to control the incontinence. Urodynamic studies revealed several reasons for the continued wetting in these individuals: a changing neurological lesion leading to a loss of innervation and concomitantly lowered urethral resistance in 2 patients, adequate urethral resistance at rest but decreasing resistance with bladder filling in 4, no increase in urethral resistance with increases in abdominal pressure in 4 and urethral instability (a decrease in resistance following a cough or Valsalva's maneuver) in 1 apparently neurologically normal girl. Eight patients are dry 3 to 24 months postoperatively on intermittent catheterization. All have demonstrated either an increase in urethral resistance at rest or an adequate level of resistance during filling of the bladder or a sudden increase in abdominal pressure. Of the remaining 3 patients 1 is dry for 2 to 3 hours but then leakage occurs, 1 is improved but damp and 1 patient is wet 3 months postoperatively. The use of rectus fascia to improve outlet resistance seems to be a viable alternative in the management of incontinence in selected female subjects.

Adolescent↗

PubMed1989

The unrecognized neuropathic bladder of infancy.

Four infants presented with hydroureteronephrosis and incomplete emptying of the bladder secondary to detrusor-sphincter dyssynergia. None of the patients had other signs suggestive of neurological dysfunction. It is presumed but not proved that these infants manifested a urodynamic reaction in response to a perinatal insult involving the brainstem area. Long-term followup has demonstrated a persistent but nonprogressive neurourological disturbance.

Electromyography↗

PubMed1989

Congenital obstructed megaureters in early infancy: diagnosis and treatment.

Fetal screening during maternal ultrasonography has changed the mode and age of presentation of congenital uropathies, particularly congenital obstructed megaureter. We studied 47 infants less than 8 months old with primary obstructed megaureter. Surgical correction in 42 patients with moderate to severe obstruction was performed at a mean age of 1.8 months in those detected prenatally and 3.8 months in those presenting after birth. All infants showed functional and structural urographic improvement with a mean followup of 2.3 years. Reflux was seen postoperatively in 8 patients, which subsided spontaneously in 3, continues to be followed in 2 and resulted in repeat reimplantation in 3. Five infants had mild obstruction, which was managed nonoperatively and 2 showed progressive obstruction, which required repair at ages 20 and 28 months. Repair of obstructed megaureters in early infancy improves renal drainage and offers the potential for preventing renal damage before the development of symptoms or infection. With proper attention to detail, excellent results may be achieved.

Dilatation, Pathologic↗

PubMed1989

Pulmonary development in the fetal lamb with severe bladder outlet obstruction and oligohydramnios: a morphometric study.

The lethal feature of male newborns with severe bladder outlet obstruction and oligohydramnios is pulmonary hypoplasia. We report a fetal lamb model of bladder outlet obstruction created in the early second trimester, and morphometric analysis of the profound pulmonary hypoplasia that resulted. At 55 to 65 days of gestation 8 consecutive male fetuses underwent surgical clipping of the urethra and urachus near the abdominal wall. A sham operation was performed in 1 female fetus. The lambs were delivered by cesarean section 10 weeks later. The right lungs were immediately fixed at a distending pressure of 25 cm. water. The results of the morphometric studies were compared to control animals from our earlier study of normal fetal lamb lung development; slides for both studies were scored in a blind, randomized fashion by 1 of us (S. G. D.). Although mean body weights for the groups were similar, mean right lung volume in the operated lambs was 63.8 cM.3 compared to 158 cM.3 in the control animals and 137 cM.3 in the sham operated fetus (p less than 0.0005). Relative volume of respiratory tissue was 87 per cent in the operated animals, and 92 per cent in the controls and the sham operated fetus (p less than 0.0005). Microscopic morphometry revealed an increased relative volume of inter-alveolar tissue in the experimental animals (35 compared to 23 per cent in the normal lambs, p less than 0.05), with a corresponding decrease in relative airspace volume. Alveolar numerical density and alveolar surface density were not statistically different between the groups, although total alveolar number and surface area were substantially decreased in the operated lambs due to the reduced mean lung volume. Mean alveolar wall thickness was increased at 3.6 microM. in the operated group versus 2.1 microM. in the normal group (p less than 0.0005) and 2.8 microM. in the sham operated fetus. Thus, the lung in the lamb with severe bladder outlet obstruction is hypoplastic and immature.

Amniotic Fluid↗

PubMed1989

Strictures in the ileal portion of ileocecal conduits in children and young adults.

Patients with ileocecal conduits are at risk for development of late complications. We present 3 patients who had strictures in the ileal portion of the ileocecal conduit, leading to deterioration of the upper urinary tract. The pathogenesis of these strictures appears to result from chronic inflammation. Long-term periodic upper urinary tract screening with ultrasonography is important for early detection of this complication. When new or increasing hydronephrosis is found a loopogram or antegrade pyelogram (if the ileocecal valve is competent) should be performed to evaluate the ileal portion of the ileocecal conduit.

Adolescent↗

PubMed1989

Lower pole ureteropelvic junction obstruction and incomplete renal duplication.

The rare finding of lower pole ureteropelvic junction obstruction and incomplete renal duplication is discussed in 5 children. The children were divided into 2 groups, with short (less than 0.5 cm.) and long (greater than 4 cm.) lower ureteral segments. Short ureteral segment obstruction was managed by total excision of the narrow ureteral segment and end-to-side pyeloureterostomy. Obstructions associated with long lower ureteral segments were treated by excising the ureteropelvic junction and performing a standard Anderson-Hynes pyeloplasty. A thorough preoperative evaluation is helpful for successful management.

Child↗

PubMed1989

Clean, intermittent catheterization of infants with neurogenic bladder.

Clean, intermittent catheterization was instituted in 38 babies with myelodysplasia who were thought to be at risk for upper urinary tract deterioration because of neurogenic bladder dysfunction. There were 19 patients 2 weeks to 12 months of age, 11 were 1 to 2 years of age, and 8 were older than 2 years. Effectiveness of clean, intermittent catheterization was determined by maintenance of upper urinary tract stability. Upper urinary tracts improved or remained stable in 13 of 16 infants (81%) with reflux and 16 of 18 infants (89%) with detrusor-sphincter dyssynergia. Bacteriuria was present in 16 (42%), with only 2 infants (5%) having a febrile episode; no infant required hospitalization because of urinary tract infections. No further complications were identified in infants who were cleanly and intermittently catheterized. Most families found clean, intermittent catheterization of their infants easy to master and not stressful, and their children adjusted to it at an early age.

Bacteriuria↗

PubMed1988

Ureteropelvic junction obstruction in the neonate.

The widespread use of maternal ultrasonography has resulted in an increasing number of asymptomatic newborns being diagnosed with hydronephrosis. A total of 89 neonates with hydronephrosis secondary to ureteropelvic junction obstruction have been referred for evaluation and treatment during the last 6 years. In the majority the condition was diagnosed readily with ultrasonography, voiding cystography and excretory urography. Twenty-five per cent underwent more quantitative assessment using nuclear renal imaging. Only 2 patients (8 per cent) had a percutaneous study. Early reconstruction was performed in 75 per cent of the patients and it proved to be safe and effective. Twenty-three neonates were followed nonoperatively. One patient (4 per cent) demonstrated clinical deterioration necessitating later surgical intervention. Careful surveillance is mandatory in all infants followed nonoperatively.

Female↗

PubMed1988

Neurourological implications of the changing approach in management of occult spinal lesions.

Occult lesions of the spine in children are a rare but recognizable cause of neurogenic dysfunction involving the lower extremities, and lower urinary and gastrointestinal tracts. We report the preoperative and postoperative urodynamic findings in 40 children with varying spinal abnormalities. Of these patients 28 were neonates or infants (average age 8.7 months) and 12 were older children (average age 11.7 years). Preoperative urodynamic testing revealed normal function in 18 of 28 children (64 per cent) in the younger age group in contrast to 1 of 12 (8 per cent) in the older age group. Of the 10 infants with abnormal studies postoperative urodynamic findings returned to normal in 6, while 2 others remained abnormal but were improved. In contrast, of 11 older children with abnormal preoperative evaluations 3 (27 per cent) reverted to normal postoperatively. The neurourological changes seen in these occult lesions are variable, may occur at any age, are progressive and are potentially reversible by surgical correction but this reversibility diminishes with age.

Adolescent↗

PubMed1988

Congenital progressive hydronephrosis in mice: a new recessive mutation.

We describe a new autosomal recessive mutation, congenital progressive hydronephrosis (cph), that arose in the C57BL/6J inbred mouse strain. The clinical, histopathological, biochemical and radiographic characteristics, and the genetic linkage of this new mutation are discussed. Our studies indicate that the homozygous mutant mice have progressive bilateral upper urinary tract obstruction leading to azotemia and death of renal failure. The anatomical site of obstruction appears to be at the level of the ureteropelvic junction. Genetic mapping studies have localized the cph gene to the distal half of chromosome 15. The cph mouse strain provides a reproducible model for analysis of the onset and development of obstructive uropathic conditions in the neonatal period.

Animals↗

PubMed1988

The surgical management of megaureters in duplex systems: the efficacy of ureteral tapering and common sheath reimplantation.

We describe 6 children with renal duplication associated with megaureter(s) who underwent ureteral tapering and common sheath reimplantation. Of the patients 4 had complete duplication with reflux into 1 or both ureters and 2 had incomplete duplication with a short distal segment that was obstructed at the ureterovesical junction. All obstructed or refluxing ureteral segments were dilated to a degree that tapering was required at the time of common sheath reimplantation. Megaureter repair in the presence of a duplicate collecting system proved to be safe and reliable.

Adolescent↗

PubMed1988

Complications of urinary tract undiversion.

The complications of urinary tract undiversion can be divided into those associated with patient selection, choice of techniques, and early and late surgical difficulties. Patient selection must take into account the original reason for diversion (incontinence, hydronephrosis, reflux, or renal functional impairment), current renal function and bladder dynamics, upper urinary tract anatomy, and psychosocial considerations. Technical considerations require versatility and ingenuity on the part of the surgeon. Although direct uroepithelium-to-uroepithelium continuity is ideal, this often cannot be accomplished. A variety of techniques including transureteroureterostomy, psoas hitch of the bladder, bladder augmentation, ileocecal and colon interposition, and autotransplantation can be used to facilitate the refunctionalization of the urinary tract. One must monitor the patient postoperatively for potential early and late complications. Meticulous attention to surgical details will help minimize these. The ultimate goal is to achieve stable renal function and urinary continence.

Adolescent↗

PubMed1988

Complications of hypospadias repair.

Hypospadias is one of the more common and one of the most challenging problems in urologic surgery. The past two decades have ushered in an era of new operations and variations of older ones, which, when coupled with technical advancements and improvements in management, have redefined the aims of the surgeon, who now strives to create a "normal" penis with a minimum of complications. Minimization of complications is contingent on selection of an operation properly tailored to the individual's anatomy. To this end, the surgeon's armamentarium must include a variety of repairs and familiarity with the limitations and potential complications inherent in each. After describing the principles of surgical selection, technique, and postoperative management used in our institution, this article deals primarily with the avoidance and management of the immediate and long-term complications of hypospadias surgery.

Bandages↗

PubMed1987

The changing neurourologic lesion in myelodysplasia.

Seventy-nine newborns with myelodysplasia were followed up for 1 1/2 to six years with serial roentgenographic, neurologic, and urodynamic evaluations. Twenty-nine infants (37%) demonstrated changes in external urethral sphincter innervation during the first three years of life. Of the group who changed, 896% (25/29 infants) did so in the first year, 10% (3/29 infants) in the second year, and 4% (1/29 infants) in the third. The risk factor for change was 32%, 6%, and 2%, respectively, during each of these three years. Fifteen infants (19% of the total) experienced neurourologic deterioration while 14 infants (18%) improved. Seven newborns underwent a second neurosurgical procedure resulting in improvement in four, stabilization in two, and further deterioration in one. These findings underline the importance of early and continued neurologic and urologic surveillance in children with myelodysplasia because it is a dynamic disease process.

Electromyography↗

PubMed1987

Hamartoma of the bladder in a 4-year-old girl with hamartomatous polyps of the gastrointestinal tract.

We report on a girl with hamartomatous intestinal polyps and a large mass that involved most of the posterior wall of the bladder, which on microscopic examination had the characteristics of a hamartoma. Hamartomas are among the rarest of bladder tumors. Our case is only the third reported under this designation, although 3 other cases may fall into this category. Of the 6 patients 4 have been children. Although most polypoid bladder tumors in children are rhabdomyosarcomas of the botryoid type, our case illustrates that rarely other lesions are similar grossly. Recognition of these lesions has clinical implications with regard to therapy and prognosis.

Child, Preschool↗

PubMed1987

Small bowel augmentation in children with neurogenic bladder: an initial report of urodynamic findings.

Augmentation cystoplasty is a useful adjunct in the treatment of the neurogenic bladder. After preoperative urodynamic and clinical assessment, 10 children with neurogenic bladders underwent small bowel augmentation. Presenting clinical problems included incontinence and hydronephrosis. Urodynamic studies after small bowel augmentation demonstrated that bladder capacity increased an average of 184 per cent. Maximum intravesical pressures diminished considerably compared to preoperative values and no patient suffered significant uninhibited contractions. Nine children are totally dry and 1 has stress incontinence. Our initial findings demonstrate the efficacy of small bowel augmentation in the treatment of lower urinary tract neurogenic dysfunction owing primarily to alterations in detrusor function.

Adolescent↗

PubMed1987

Urodynamic assessment of children with cerebral palsy.

More than a third of the children with cerebral palsy present with dysfunctional voiding symptoms. Clinical evaluation and urodynamic study of cerebral palsy patients were performed to characterize the symptoms, to define the type of neurological deficit and to document its effect on voiding dynamics. We evaluated flow rate, and cystometrographic and external sphincter electromyographic findings in 57 children with cerebral palsy. Upper and lower motor neuron lesions were defined by standard criteria. Of the children 86 per cent had evidence of a pure upper motor neuron injury and 11 per cent manifested electromyographic findings suggestive of incomplete lower motor neuron sphincteric injury. The latter deficit could not be predicted on the basis of clinical neurological findings but it was suggested by a history of neonatal cyanosis. Treatment protocols achieved continence in more than 75 per cent of the children. The voiding dynamics in children with cerebral palsy have not been assessed previously. We have defined the lower urinary tract dysfunction in these patients, and provide a rational and effective plan of management.

Adolescent↗

PubMed1986

Complete patent duplication of the urethra.

We reviewed 16 patients with complete patent duplication of the urethra seen between 1945 and 1984. The clinical presentation, radiographic findings and management of each patient are presented. All 16 patients were symptomatic and a double stream was the most common complaint. An operation was necessary in 13 patients. Voiding cystourethrography and retrograde urethrography were necessary to define the anatomy completely and accurately in each patient. The ventral channel, regardless of the position of the meatus, invariably proved to be the more functional urethra.

Child↗