Search PubMed⌕ Search

Biomedical subjects

A H Colodny

Publications and source records attributed to A H Colodny.

At least 37 records · Page 2Linked to original sources
PubMed1989

Genitourinary rhabdomyosarcoma in children.

Although rhabdomyosarcoma of the genitourinary tract occurs infrequently in children, it presents a challenging problem to the surgeon, radiotherapist, and oncologist. Thirty-six children with genitourinary rhabdomyosarcoma were treated at our institutions from 1957 to 1985. The primary site of tumor involved the bladder, prostate, or both in 15 patients, the paratesticular structures in 12, and female reproductive organs in nine. Although treatment modalities and philosophies of care varied over the past 27 years, the majority of patients were treated with a combination of surgery, chemotherapy, and radiation therapy. The event-free survival for all patients is 74%. Patients with paratesticular tumors had the best prognosis (88% event-free survival). Regional nodal radiation therapy is not necessary in this favorable group if the retroperitoneal lymph node dissection is negative. Of 15 children with bladder/prostate tumors nine had initial conservative surgery. Of these nine six are long-term survivors, but only three patients have intact bladders. The girls with tumors of the reproductive organs had an event-free survival of 63%; all patients in this group had hysterectomies. Chemotherapy and radiotherapy have not substituted for radical surgical procedures in most children with bladder or prostate rhabdomyosarcomas. Innovative therapeutic approaches are necessary for this group of patients.

Adolescent↗
PubMed1989

Congenital midureteral obstruction.

Congenital midureteral obstruction, caused either by a ureteral valve or stricture, is an exceedingly rare entity. When encountered, it is generally misdiagnosed as either primary megaureter or ureteropelvic junction obstruction, leading to a less than optimal surgical approach. Seven children with midureteral obstruction were seen over the past 17 years. Two of the patients presented with hydronephrosis on prenatal ultrasonography, and five with urinary tract infection. In only three was the diagnosis suspected on intravenous urography and voiding cystourethrography alone. Five of the seven cases had either antegrade or retrograde pyelography, prior to or at the time of their operative procedure, and in four of these a correct diagnosis was made. Notably, in five of the seven cases, recognition of the midureteral lesion prior to the surgical incision allowed the approach to be modified and a more appropriate technique (ureteroureterostomy) to be performed. The etiology of midureteral valve and stricture has been attributed to improper recanalization, insufficient vascular supply, or persistence of ureteral folds. Three of our patients had contralateral renal dysgenesis, suggesting an underlying ureteral bud abnormality.

Child↗
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

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

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↗
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

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↗
PubMed1987

Antenatal diagnosis and management of urinary abnormalities.

Although much time, effort, and money have been expended in the area of fetal surgery and even though considerable unfortunate media publicity has resulted, the actual clinical problem is not one of great magnitude. Currently all those interested in this area agree that consideration of any intrauterine manipulation or surgery should be reserved for a fetus who has bilateral involvement that is progressive, destructive, and associated with oligohydramnios. Except for rare instances, this eliminates all fetuses except those with some type of urethral obstruction. Significant urethral obstruction accounts for approximately 10 per cent of all patients who have a prenatal diagnosis of a urologic abnormality. Of this 10 per cent, some will not be progressive, some will not be destructive, some will not involve both kidneys, and some will not develop oligohydramnios. Some of these patients will be diagnosed early enough in pregnancy to allow termination of the pregnancy if the involvement is significant and if termination is acceptable to the family. Some will be diagnosed late enough in pregnancy so that if the lungs are mature or can be stimulated to mature, early delivery and postnatal management can be elected. Some will have other associated lethal anomalies that can be diagnosed and would preclude any consideration of intrauterine manipulation or therapy. Some will have irreversible renal failure. Occasionally, the mother may refuse any proposed intrauterine therapy. Thus we are probably considering, on a theoretic basis, well under 1 per cent of all fetuses who have a prenatal diagnosis of urologic abnormalities. There may be some unusual situations that justify intrauterine manipulation. One that we encountered involved a fetus with an abdominal mass so large that a cesarean section was deemed necessary (Figs. 12 and 13). Aspiration of the mass just before delivery was performed to allow a vaginal delivery. Another case involved a pregnant woman who developed severe toxemia. The fetus was found to have a solitary renal cyst. Repeated aspirations of the cyst resulted in resolution of the toxemia, which promptly recurred when fluid reaccumulated in the fetal renal cyst. Insertion of a double-universe catheter from the cyst into the amniotic cavity allowed completion of the pregnancy, with the delivery of an otherwise normal fetus without recurrence of the toxemia. A recent report on fetal surgery from the International Fetal Surgery Registry, coauthored by the strongest advocate of intrauterine intervention, reached these conclusions.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnostic Errors↗
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↗
PubMed1986

Detrusor instability: a delayed complication in association with the artificial sphincter.

Of 45 children with an artificial sphincter 6 had elevated filling pressure of the detrusor and/or uninhibited contractions of the bladder after the implantation surgery, which produced hydronephrosis in 3 and urinary incontinence in 3. All affected individuals had myelodysplasia (17 per cent of this subgroup), 3 had evidence of tethering of the spinal cord and 3 may have had unrecognized detrusor hypertonicity, which was masked by the low outlet resistance before sphincter implantation. Corrective surgery consisted of either decompressive laminectomy with untethering of the spinal cord or augmentation cystoplasty when indicated. Factors affecting the change in the detrusor postoperatively, and recommendations for improved selection and surveillance of individuals undergoing implantation of the artificial device are promulgated.

Child↗