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Biomedical subjects

A D Perlmutter

Publications and source records attributed to A D Perlmutter.

At least 19 recordsLinked to original sources
PubMed1999

Functional, social and psychosexual adjustment after vaginal reconstruction.

PURPOSE: We assessed the long-term functional, social and psychosexual outcome in children who underwent vaginal reconstruction. MATERIALS AND METHODS: We interviewed and assessed the psychological development of 16 women 17 to 28 years old (mean age 22) who underwent vaginal reconstruction only or in combination with other urogenital reconstructive procedures at ages 11 months to 18 years (mean 8.8). Psychological measures included the Beck Depression Inventory, Draw-a-Person test and Linkowski acceptance of disability scale as well as a standard questionnaire evaluating the sexual adjustment, social adjustment and ability for self-support of these women. RESULTS: Mean Beck Depression Inventory was 8.5 with less than 9 defined as minimal depression. Mean acceptance of disability score was 83.9 (range 54 to 94), indicating that patients were well adjusted with respect to the disability. Functionally 10 women were satisfied with the appearance of the vagina, 4 were neutral and 2 were dissatisfied. A total of 12 patients had no doubts about their female identity but 2 had occasional, 1 had significant and 1 had chronic doubts. Of the 16 patients 12 have completed high school, 3 are still in high school and 1 has withdrawn from high school. Of the 12 women who have completed high school 9 are currently in college and 3 have completed college. Socially all 16 participants rated family relationships as good and 13 were at least satisfied with their social life. Of the 16 women 12 have had a sexual encounter, including 1 who did not achieve orgasm. Six women are involved in long-term relationships, of whom 1 is married. In regard to the future all patients believe that they will be independent and financially stable with a fulfilling career. CONCLUSIONS: While women who have undergone vaginal reconstruction may be at risk for avoiding interpersonal relationships and sexual intimacy, we did not note this finding in our series. The majority of these patients were well adjusted to their physical condition, and had a high level of education and a stable family life.

Adaptation, Physiological↗
PubMed1998

Urinary tract infections and pregnancy in women who underwent antireflux surgery in childhood.

PURPOSE: For several decades ureteroneocystostomy has been performed in children to correct primary vesicoureteral reflux. A purported indication for antireflux surgery is to prevent significant upper urinary tract infection during pregnancy. We performed a long-term followup of women who underwent antireflux surgery during childhood to determine outcome in regard to urinary tract infection history and pregnancy. MATERIALS AND METHODS: We identified 227 women of childbearing age who underwent ureteral reimplantation for primary vesicoureteral reflux from 1964 through 1981. Of the 122 women contacted 41 had been pregnant (77 total pregnancies). Cystitis or asymptomatic bacteriuria and pyelonephritis developed during 18 and 5 pregnancies, respectively. The 77 pregnancies resulted in 57 term births, 7 voluntary pregnancy interruptions and 13 spontaneous abortions. RESULTS: Patients who previously underwent successful antireflux surgery continued to have a significant number of urinary tract infections through the intervening years. Despite a higher than expected incidence of pyelonephritis, they had relatively little hypertension and renal insufficiency. During pregnancy the incidence of pyelonephritis was only slightly higher than that of the general population. However, severe complications of pregnancy, such as preeclampsia, premature birth and acute renal failure, occurred more frequently in women with a history of renal scarring or hypertension (7 of 12) than in those with a history of recurrent infection alone (3 of 10). CONCLUSIONS: When renal scarring is present, reflux should be corrected before pregnancy to minimize maternal and fetal morbidity. When scarring is not present, the literature suggests that women with a history of reflux are at increased risk for pyelonephritis during pregnancy whether or not ureterocystostomy was performed. Pregnant women with a history of reflux may benefit from prophylactic antibiotics and women with reflux nephropathy should be followed throughout life.

Child↗
PubMed1996

Renal cell carcinoma in children: the Detroit experience.

PURPOSE: We analyzed the presentation, treatment and survival of 6 children with renal cell carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the pathological and hospital records of 6 children diagnosed with renal cell carcinoma at Children's Hospital of Michigan (5) and Henry Ford Hospital (1) from 1980 to 1995. RESULTS: The most common presenting complaints were flank pain (50%) and a palpable abdominal mass (50%), while gross hematuria was present in only 1 patient (16%). No patient had the classic triad of flank pain, hematuria and palpable mass. Only 1 patient had localized disease (stage II), while 5 of the 6 presented with stage III or IV disease. While followup is limited, all patients with stage III disease are without evidence of recurrence at a mean 38.5 months and 1 of 2 with stage IV disease is without evidence of disease at 22 months. CONCLUSIONS: Although renal cell carcinoma in childhood often presents at an advanced stage, the prognosis for those with isolated regional lymph node involvement appears to be encouraging.

Adolescent↗
PubMed1996

Priapism associated with sickle cell hemoglobinopathy in children: long-term effects on potency.

PURPOSE: Children with sickle cell priapism have traditionally been treated conservatively with surgery done as a last resort. Only sparse subjective data are available on the long-term assessment of potency in these patients. MATERIALS AND METHODS: We retrospectively reviewed the charts of all pediatric patients with sickle cell priapism who presented to Children's Hospital of Michigan between 1972 and 1992, and subsequently assessed erectile capabilities subjectively by questionnaire and objectively by RigiScan. RESULTS: Of the 15 patients interviewed 5 had undergone shunt procedures. The return of potency tended to vary inversely with patient age at onset and duration of priapism. CONCLUSIONS: Shunts performed within 48 hours, especially in postpubertal children, seemed more likely to preserve potency.

Adolescent↗
PubMed1996

Long-term intravesical oxybutynin chloride therapy in children with myelodysplasia.

PURPOSE: We evaluated the clinical use of long-term intravesical oxybutynin chloride in the treatment of neurogenic bladder dysfunction in children with myelodysplasia who could not tolerate oral anticholinergics. MATERIALS AND METHODS: We retrospectively reviewed the records of all patients recommended for intravesical oxybutynin chloride therapy. A total of 12 girls and 18 boys 1 to 17 years old was recruited for study. Oxybutynin chloride (5 mg.) was instilled 2 times daily and pretreatment cystograms were compared to followup urodynamic studies. Duration of therapy was 2 to 26 months (mean 13, median 12). RESULTS: Mean total capacity plus or minus standard deviation increased from 209 +/- 103 to 282 +/- 148 ml. (p < 0.01), mean safe capacity increased from 157 +/- 105 to 234 +/- 147 ml. (p < 0.01) and mean age adjusted safe capacity increased from 76 +/- 36 to 115 +/- 62%. Of the 29 patients who were incontinent 3 (10%) achieved continence and 19 (65%) reported a decreased use of sanitary pads. None of the patients had systemic side effects related to intravesical treatment. CONCLUSIONS: We believe that intravesical oxybutynin chloride is a viable treatment option for patients with myelodysplasia in whom oral therapy fails.

Administration, Intravesical↗
PubMed1995

Acquired rectourethral fistula: methods of repair.

Rectourethral fistulas are a rare but devastating complication of urinary or rectal surgery, trauma or inflammation. Historically repair has posed a challenge because of technical difficulties and the high incidence of recurrent fistulas. We report 7 cases of acquired rectourethral fistulas of varying etiology (3 after prostatectomy, 3 after trauma and 1 after recurrent perineal abscess), which were managed by various means. Our data and those in the literature suggest that the first attempt at repair is the best and subsequent repairs become increasingly difficult; the York Mason approach allows easy accessibility with minimal risk of complications and the best chance for a functionally successful outcome when a vascularized flap is not required, and some cases may have such a low probability of successful resolution of the fistula as well as maintenance of urinary continence that cystectomy and supravesical diversion are appropriate considerations.

Adolescent↗
PubMed1994

Reduction cystoplasty in the prune belly syndrome: a long-term followup.

The role of reduction cystoplasty in the management of severe prune belly syndrome is controversial. From 1973 to 1990, 11 boys with severe prune belly syndrome underwent comprehensive urinary tract reconstruction, including overlapping reduction cystoplasty. Followup ranged from 1.5 to 18 years and 6 boys are now older than 18 years. Nine had sepsis or progressive renal failure as neonates; 7 had upper tract diversion as an initial procedure, of whom 2 have chronic renal failure. Currently 9 boys are voiding, including 1 who could not void preoperatively, with less than 50 cc residual after double or triple voiding. One boy underwent transplantation to an ileal conduit and 1 continues on intermittent catheterization. In the 9 cases in which bladder volume data were available average reduction in volume at operation was 52%. At an average of 7.7 years later (range 1.5 to 14) bladder volumes corrected for age were essentially unchanged or greater than corrected preoperative volumes. Since reflux was corrected in 7 of 9 boys it cannot account for the redevelopment of large bladder capacities (range 740 to 2,300 cc). In cases of the prune belly syndrome reduction cystoplasty has helped to improve voiding and minimize infection during early childhood but it does not seem to decrease bladder capacity or improve voiding dynamics in the long-term.

Child↗
PubMed1994

Acute renal failure secondary to ciprofloxacin use.

We report on a 22-year-old woman with a continent urinary diversion in whom acute renal failure developed on ciprofloxacin therapy for pelvic osteomyelitis. Renal failure resolved rapidly once the drug was withheld. Because ciprofloxacin is used extensively by the urological community, we believe that it is important to be aware of this potential complication of therapy. We review the literature on the association of ciprofloxacin and renal failure.

Acute Kidney Injury↗
PubMed1994

Early cystometrograms can predict the response to intravesical instillation of oxybutynin chloride in myelomeningocele patients.

Recent reported experiences with intravesical medications in neurogenic bladder patients prompted us to evaluate this form of therapy in 28 myelomeningocele patients who could not tolerate oral anticholinergic agents or did not have adequate control on these agents. A pretreatment cystometrogram was performed followed by intravesical administration of oxybutynin chloride, with a repeat cystometrogram 3 hours later. Patients then began twice daily intravesical oxybutynin for a minimum of 4 months. The mean bladder capacity increased by 41%, the mean intravesical pressure decreased by 47% and compliance improved. Five patients achieved continence and 62% had less wetting while on intravesical therapy. The immediate posttreatment cystometrogram was predictive of the response to intravesical therapy on followup studies. Unfortunately, patient compliance was poor, with only 13 of the 28 patients remaining on therapy for the duration of the study.

Administration, Intravesical↗
PubMed1991

Vesical neck reconstruction in patients with epispadias-exstrophy complex.

The achievement of satisfactory continence in the management of patients with the epispadias-exstrophy complex remains a challenge. Between 1971 and 1989, 22 children underwent vesical neck reconstruction at our hospital. Satisfactory continence was achieved in 17 of the 22 patients (77%), including 8 (36%) who are continent after a single vesical neck reconstruction and 9 of 13 who achieved continence after additional and/or adjunctive procedures. Additions and/or adjunctive procedures included revision of the vesical neck reconstruction, bladder augmentation and/or placement of an artificial urinary sphincter. We conclude that vesical neck reconstruction with or without additional and/or adjunctive procedures can result in an acceptable continence rate in patients with the epispadias-exstrophy complex.

Adolescent↗
PubMed1990

Sleeve advancement distal hypospadias repair.

We report the technique and late results of a procedure for selected cases of distal hypospadias called sleeve advancement urethroplasty. This procedure incorporates correction of chordee, distal urethral mobilization and glans plasty in patients with coronal or distal subcoronal hypospadias. A total of 69 boys underwent this procedure at our institution: 59 as a primary repair and 10 for correction of meatal retraction after a previous failed reconstruction. Cosmetic results were excellent in most patients. Complications included meatal retraction in 2 patients and mild meatal stenosis in 2 in the primary repair group, and meatal stenosis in 3 (with associated fistula in 1) in the secondary repair group. Although not a replacement for meatal-based flap procedures, and more tedious to perform than the meatal advancement and glanuloplasty procedure, we have been impressed with the superior cosmetic results and minimal morbidity of the sleeve advancement urethroplasty.

Child↗
PubMed1990

Experience with 81, 1-stage hypospadias/chordee repairs with free graft urethroplasties.

We performed 81, 1-stage hypospadias/chordee repairs with preputial free graft urethroplasty between January 1981 and July 1988 using a modified Horton-Devine technique. Of the free grafts 37 were fashioned as patches, 42 as tubes, and 4 as a combination patch and tube. Of the patients 58 (72%) underwent single or multiple dorsal plications, in addition to the usual procedures, to correct chordee completely. A total of 35 patients (43%) required a second procedure: 28 (34%) for persistent fistula and 7 (9%) for stricture. These reoperations were typically minor outpatient procedures. All patients had an excellent functional and cosmetic outcome. Although the need for reoperation unfortunately is high, we believe the use of free grafts allows for a better functional and cosmetic outcome because the secondary torsion and bulkiness of the penile shaft caused by the vascular pedicle are eliminated. This is especially noticeable in patients with a small penis.

Child, Preschool↗
PubMed1990

Management of obstructing ectopic ureteroceles.

Ectopic ureteroceles are a common pediatric urologic problem requiring thoughtful management decisions. Although management algorithms have been proposed, they should serve only as a framework for therapy. More important is a thorough understanding of the problem and its implications. The authors discuss their management approach and provide several cases illustrating the spectrum of problems presented by ectopic ureteroceles and the variety of management options.

Female↗
PubMed1988

Optimal use of 99mtechnetium-glucoheptonate scintigraphy in the detection of pyelonephritic scarring in children: a preliminary report.

Renal scintigraphy represents the optimal modality for the detection of renal scars. 99mTechnetium-glucoheptonate is rapidly accumulated by the kidney through glomerular filtration and active transport by renal tubular cells. This permits rapid visualization of the renal parenchyma in the early phase (1 to 3-minute images) and subsequent imaging of the collecting system and ureters. About 10 to 15 per cent of the injected activity remains in the kidney, labeling the cells of the proximal convoluted tubules (late phase or 1 to 2-hour images). The late phase has been used more commonly to assess renal parenchymal damage. Early and late phase glucoheptonate scanning was performed in 42 children as part of the evaluation of recurrent febrile urinary tract infections with or without a history of vesicoureteral reflux. Inter-observer reliability to interpret glucoheptonate scans was good (early, 83 per cent agreement and late, 93 per cent agreement). The ability of glucoheptonate scanning to detect renal scarring in children with febrile urinary tract infections was equivalent with the early or late phase of the study. In 6 patients renal scarring was detected on only the early phase scan and in 7 scarring was detected only in the late phase. Although the detection rates are equivalent the over-all detection of scarring is improved by using both phases. Therefore, the early phase of the glucoheptonate scan may be a valuable adjunct to conventional glucoheptonate scan methodology used for the detection of renal scarring in children with recurrent urinary tract infections.

Adolescent↗
PubMed1988

Follow-up studies of multicystic dysplastic kidneys.

Thirty cases of multicystic dysplastic kidney (MCDK) were diagnosed over 11 years. Nine patients underwent nephrectomy: three for increasing kidney size (classic MCDK) and six because of an inconclusive diagnosis (hydronephrotic MCDK). Of the remaining 21 patients, 19 were followed up for a mean of 33.5 months (range, 2-101 months). Follow-up ultrasound examinations revealed that 16 kidneys did not change in size, one decreased in size after cyst puncture, and two disappeared (one after cyst puncture). This series included one case of non-renin-producing hypertension that was controlled medically, one case of nephroblastomatosis found in the removed dysplastic kidney, and one case of pyelonephritis in the contralateral kidney. When the diagnosis of classic MCDK is made with imaging modalities, the lesion may not have to be removed unless there is growth of the mass during the 1st year of life. Nine percent of these lesions will disappear within the first 3 years of follow-up, and the authors recommend an even longer period of follow-up.

Child↗
PubMed1987

Renal dysgenesis and cystic disease of the kidney: a report of the Committee on Terminology, Nomenclature and Classification, Section on Urology, American Academy of Pediatrics.

We believe that the confusion regarding abnormal renal development could be reduced by more precise terminology. Therefore, we suggest precise definitions for dysgenesis, hypoplasia, dysplasia, hypodysplasia, aplasia and agenesis of the kidney. We suggest the term reflux nephropathy be a generic label for any instance of abnormal renal morphology (gross or microscopic) associated with vesicoureteral reflux. Hypoplasia and hypodysplasia can be subclassified on the basis of associated urological criteria. There have been many previous attempts to classify cystic disease of the kidney but none has been accepted collectively by pathologists, urologists, nephrologists and radiologists. On the basis of known patterns of inheritance, a classification is outlined in which renal cystic disease is divided into 2 major groups: genetic and nongenetic. Each entity is discussed.

Classification↗