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Biomedical subjects

A D Perlmutter

Publications and source records attributed to A D Perlmutter.

At least 37 records · Page 2Linked to original sources
PubMed1987

Experience with free grafts in urethral reconstruction.

A total of 33 patients underwent hypospadias or epispadias repair by patch or tubular grafts of skin or bladder epithelium from July 1980 to January 1985. Indications included previous circumcision, proximal primary hypospadias, severe chordee alone, inadequate local skin during extended urethroplasty at 2-stage hypospadias repair, multiple previous reconstructions and failed epispadias repair. Genital skin grafts were used in 25 patients, extragenital skin grafts in 4 and bladder epithelial grafts in 4. Complications occurred in 13 patients (39.4 per cent): 8 required reoperation for a fistula, stricture or diverticulum, and 5 underwent internal urethrotomy or urethral dilation. Of the 8 patients 3 needed more than 1 revision. These revisions were short and generally uncomplicated. Final results uniformly were good functionally and cosmetically. Based on our experience and that of others we believe that despite a high incidence of minor complications a free graft serves as an excellent substitute urethra for treatment of a variety of urethral problems in children.

Adolescent↗
PubMed1987

Reflux nephropathy.

This article reviews current concepts of reflux nephropathy, including the pathophysiology, diagnosis, relationship to infection, role in causing end-stage renal disease, and appropriate treatment and management. The condition is defined from a epidemiologic point of view herein, and attention also is given to possible progressions this condition can take.

Adolescent↗
PubMed1986

Outpatient surgery in pediatric urology.

Indications for ambulatory pediatric urological surgery have been broadened to include most inguinal and scrotal surgery, many endoscopic procedures and distal hypospadias repairs with or without chordee or urethroplasty. We have reviewed a 1-year experience with the 440 outpatient urological procedures performed at Children's Hospital of Michigan in 1984, and found a low (3.4 per cent) incidence of postoperative hospitalization and only a single complication. We conclude that outpatient surgery in well selected patients and procedures is safe, timely and economical.

Adolescent↗
PubMed1986

Urinary tract deterioration associated with the artificial urinary sphincter.

In most recent series of artificial sphincter implantations there has been a reduction in mechanical and surgical complications, with continence rates approaching 90 per cent. Despite initially excellent results in 47 children, with increasing durations of followup we noted a transient hydronephrosis related to incomplete bladder emptying in 5 and a persistent physiological alteration of detrusor dynamics consisting of a rigid, noncompliant bladder in 7. Preoperatively, all patients had had indepth radiological studies and most had a urodynamic evaluation, and were considered to be excellent candidates. The etiology of these alterations is not understood at this time. Bladder and even upper tract deterioration can occur without the appearance of urinary leakage. Therefore, children with an artificial sphincter must be monitored indefinitely with semiannual assessment of the upper tracts and periodic urodynamic evaluation.

Adolescent↗
PubMed1985

Tunica vaginalis free graft for the correction of chordee.

Tunica vaginalis free grafts were used to correct severe chordee not amenable to other surgical maneuvers in 11 boys. Postoperatively, the penis was straight in 10 patients and had some degree of downward angulation in 1 boy. The tunica vaginalis free graft seems to be a useful technique for the correction of severe chordee.

Child, Preschool↗
PubMed1985

Noncompliant bladder resulting from posterior urethral valves.

We report on 4 boys with abnormally functioning, poorly compliant bladders and residual urine associated with posterior urethral valves. All 4 boys have been managed with clean intermittent self-catheterization and have shown stabilization or improvement in renal function, and improvement in upper tract drainage and urinary continence. The pathophysiological findings of this type of bladder dysfunction are discussed.

Child↗
PubMed1985

Orchiopexy: planned 2-stage technique.

Planned unilateral 2-stage orchiopexy was undertaken in 14 of 919 primary inguinal explorations for an undescended or nonpalpable testis. In 9 of the 14 cases a silicone sheath was placed around the spermatic cord to protect the cord structures from injury at the time of the second stage. An adequate-sized scrotal testis resulted in 83 per cent of these planned 2-stage orchiopexies. Our impression is that the silicone sheath greatly facilitates the second stage.

Child↗
PubMed1985

Simple renal cysts in infants.

Two cases of renal cysts in infants less than one year of age are presented. In both instances percutaneous puncture of the cyst aided in establishing the diagnosis without the need for an operative procedure.

Contrast Media↗
PubMed1984

Management of unresectable Wilms tumor.

Wilms tumor has become a model of highly curable cancer. With the addition and refinement of chemotherapy protocols, survival rates have risen from 20 per cent three decades ago to 80 per cent or greater in the past decade. Surgery remains an integral part of the management of Wilms tumor both as a diagnostic tool and for removal of tumor bulk. Few primary tumors cannot be surgically removed during the initial phase of therapy. However, bilateral Wilms tumor and large unilateral tumors may occasionally be initially unresectable without prohibitive loss of renal or nonrenal organ function. The National Wilms Tumor Study group has no protocol for management of these tumors but does offer guidelines unsupported by large numbers of patients. Two cases are presented in which the tumors were initially deemed surgically unresectable. Initial management with chemotherapy (both cases) and radiotherapy (1 case) followed by surgical removal of tumor left both patients free of gross tumor, with relapse-free survivals of two and one-half years and six years thus far. Based on our experience and that found in the literature, we believe that preoperative chemotherapy is indicated for children suspected of having Wilms tumors judged surgically unresectable.

Child↗
PubMed1982

Urethral and genital malformations in prune belly syndrome.

In addition to the typical triad of the prune belly syndrome, comprising abdominal wall muscle deficiency, urinary tract dilatation and cryptorchidism, anomalies of the lower urinary tract and genitalia can occur. Between January 1974 and December 1978 we evaluated and treated 19 boys with prune belly syndrome. All boys had an abnormally wide bladder neck and prostatic urethra, and 13 (68 per cent) also had malformations of the bulbous or pendulous urethra and/or corporeal bodies of the penis. Although the etiology of these findings is uncertain we assume that they are part of the same developmental disturbance that affects the remainder of the urinary system. Our description of these urethral and penile abnormalities in boys with prune belly syndrome should provide an impetus to develop a systematic method for seeking and recording these abnormalities, and for establishing their true incidence and clinical relevance.

Genital Diseases, Male↗
PubMed1981

Urinary undiversion in patients with myelodysplasia and neurogenic bladder dysfunction. Report of a workshop.

This workshop was conducted in an attempt to analyze critically the role of reconstruction of the myelodysplastic patient who had undergone urinary diversion and to develop guidelines for selecting those patients in whom urinary undiversion might be undertaken safely. The collective experience initially seems to be acceptable; however, the authors emphasize the gravity of the decision and the complexity of the evaluation which must be undertaken prior to embarking on such reconstructive surgery. Contrary to some reports, we believe that the defunctionalized bladder frequently can be evaluated. Further, many of the contraindications to urinary undiversion have been identified and several of the hazards involved therein can be avoided. We believe that the neurogenic bladder is no longer an absolute contraindication to undiversion. Our experience suggests that undiversion is a reasonable surgical treatment in select patient with neurogenic bladder dysfunction. But, the decision to remove a satisfactorily functioning conduit must not be undertaken lightly. Patients should be selected only after a thorough, detailed, and properly conducted evaluation. A protocol has been developed which will hopefully assist in this evaluation. Perhaps additional shared experience will further refine and delineate the circumstances appropriate for reconstruction of these patients.

Adolescent↗
PubMed1981

Epithelial lesions of bladder mucosa following ureteral reimplantation.

We report on 3 children who underwent ureteral reimplantation. Postoperatively, each patient had persistent, irritative, lower tract symptoms and continuous or recurring urinary infections, with or without gross hematuria. Because of these symptoms cystoscopy was done in 2 children and the third child under went repeat ureteral reimplantation because of persistent vesicoureteral reflux. At operation single or multiple hyperplastic, sessile lesions of the urothelium, not evident at the time of initial ureteral reimplantation, were discovered in each child. Histologically, these lesions showed proliferative and metaplastic glandular epithelial changes. Treatment consisted of transurethral fulguration and long-term antimicrobial medication plus partial cystectomy and topical intravesical chemotherapy for recurrent lesions in 1 child. The etiology of these epithelial lesions, although uncertain, is believed to be a response to long-standing inflammation.

Adolescent↗
PubMed1981

Evaluation of the inferior vena cava by sonography and venography in children with renal and hepatic tumors.

Ultrasonography was used to examine 81 children with intra-abdominal or retroperitoneal malignancies for tumor extension into the inferior vena cava (IVC). In seven of the 18 patients with Wilms tumors and three of the seven patients with hepatic tumors, the IVC ws sonographically abnormal. Venography was also performed in five patients with Wilms tumors. However, percutaneous transfemoral venacavography did not always allow differentiation between extrinsic compression and intracaval tumor. It is suggested that venacavography, when necessary, should be performed via the brachial vein route and that the catheter be advanced into the right atrium. If an injection in this chamber does not result in enough reflux into the retrohepatic IVC for adequate evaluation, the catheter should be advanced into the IVC and a second injection made. However, ultrasonography is the preferred modality for evaluation of the IVC in children because it is the most accurate method and is noninvasive. Real-time ultrasonography makes it possible to distinguish between tumor extension into the lumen of the IVC and extrinsic compression of the vessel.

Child↗
PubMed1980

Reverse tumble flap with tubed island-flap urethroplasty for hypospadias or chordee without hypospadias.

From July 1971 to April 1979, 47 children who required detachment of the meatus from more distal tissues for adequate chordee release or who needed division of the urethra underwent a 1-stage tubed island-flap procedure. In this procedure the dorsal surface of the hooded prepuce is used to form a urethral tube and the ventral surface is used for shaft skin coverage. In followup to 5 years our long-term functional and cosmetic results appear acceptable for situations requiring creation of only a moderate length of urethra. For more proximal hypospadias a high complication rate has discourged our continued use of this 1-stage procedure.

Adolescent↗