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Biomedical subjects

C F Firlit

Publications and source records attributed to C F Firlit.

At least 55 records · Page 3Linked to original sources
PubMed1987

The endoscopic correction of reflux by polytetrafluoroethylene injection.

Endoscopic subureteral injection of polytetrafluoroethylene (Teflon) was done in 38 patients (55 ureters) to correct vesicoureteral reflux. Followup excretory urograms and nuclear cystograms were available in 28 patients (40 ureters) 2 to 11 months after injection. Nearly 50 per cent of the patients had a neurogenic bladder. Injection was done for all grades of reflux, although the majority of cases had at least grade III reflux. After injection reflux either was eliminated or decreased in 76 per cent of the patients with neurogenic disease and in 87 per cent of those with a normally innervated bladder. This outpatient procedure is simple and brief to perform, and it is associated with minimal morbidity. As with any new antireflux technique longer followup is indicated.

Child↗
PubMed1987

In-office ultrasonography to image the kidneys and bladder of children.

We present the first experience with in-office ultrasonography to further the office evaluation of children with urological problems. Since February 1986 we imaged prospectively the kidneys and bladders of 172 children (100 boys and 72 girls, mean age 6 years) who presented for office evaluation using a portable 5 MHz. real-time linear array scanner. Initially, we gained familiarity with in-office ultrasonography by examining 38 children who presented for evaluation of problems not recognized to be associated with renal malformations (that is undescended testis). In-office ultrasonography showed hydronephrosis in 1 boy with a buried penis that was found later to be owing to ureteropelvic junction obstruction requiring pyeloplasty. Then, in-office ultrasonography was used to supplement the office evaluation of children with a history of urine infection, voiding problems or known malformations of the kidney and/or bladder. The test showed that 12 of 24 children (50 per cent) with a history of urine infection had a thickened detrusor, large bladder capacity with or without residual urine or reduced sensation to void. In-office ultrasonography also showed that 24 of 74 children (32 per cent) with voiding problems had a thickened detrusor, large bladder capacity with or without residual urine, fecal impaction, suspected bladder neck obstruction (which later required internal urethrotomy) or small bladder capacity. In 35 children with known malformations of the urinary tract in-office ultrasonography was useful to assess the progress of hydronephrosis (29) or to clarify the etiology of the hydronephrosis (4). The diagnostic value of this test was evaluated in 98 children in whom enough data were available to compare the results to those of subsequent urography or clinical outcome. In-office ultrasonography had a 98 per cent sensitivity and an 82 per cent specificity rate. We conclude that in-office ultrasonography is a reliable means to identify incomplete bladder emptying in children with urine infection related to dysfunctional voiding, identify detrusor thickening related to the unstable bladder and indicate the likely etiology of hydronephrosis.

Child↗
PubMed1987

Use of venography as an aid in varicocelectomy.

Venography has been proposed as an aid in preventing persistent varicoceles after internal spermatic vein ligation. Since 1984, 10 patients between 4 and 18 years old underwent successful outpatient varicocelectomy with high ligation and intraoperative internal spermatic venography to assure that all appropriate veins and collaterals had been isolated before ligation.

Adolescent↗
PubMed1987

The mucosal collar in hypospadias surgery.

Formation of a mucosal collar from the inner surface of the prepuce offers the surgeon who performs hypospadias repairs the opportunity to create a cosmetically normal-appearing phallus. This technique results in transposition of mucosal membrane type of tissue to the subglandular area to complete the normal repair.

Humans↗
PubMed1986

Surgical correction of the buried penis: description of a classification system and a technique to correct the disorder.

The concealed penis is a long-standing problem that only recently has begun to receive the attention it deserves. We offer a classification for this general disorder, which facilitates the selection of appropriate surgical procedures for these patients. To correct the most common problem, the buried penis, involves removal of localized deposits of fat from the hypogastrium with open surgical or closed suction techniques followed by anchoring of the skin of the base of the penis to the periosteum of the pubis. During the last year we have used this approach successfully in 7 boys with various forms of penile concealment with good results.

Abdominal Muscles↗
PubMed1986

Successful hypospadias repair in infants using brief urinary diversion and watertight neourethral closure.

Since July 1982, 23 children between 10 and 28 months old underwent correction of hypospadias. After chordee was resected the urethral orifice was in the perineum in 3, at the penoscrotal junction in 5, on the proximal or mid shaft in 10 or at the distal shaft in 5. The neourethra was fashioned from a transverse island pedicle of preputial skin for proximal hypospadias or by using Mustarde's technique for distal hypospadias. A perforated silicone tube was left in the urethra and a feeding tube was passed through the lumen of the urethral stent to drain the bladder. Up to 4 days later the bladder catheter was removed and the children voided per the neourethra. The urethral stent was removed between 6 and 30 days postoperatively. Voiding through a recently constructed urethra was well tolerated. The boys did not experience bladder spasms, urinary extravasation did not occur and cosmetic results were good. Meatal stenosis did not occur. Three children (13 per cent) required closure of a fistula, which was noted 1 to 2 1/2 years later. It appears that briefly diverting bladder urine after hypospadias repair ameliorated postoperative morbidity without compromising the results. This technique was found to be inappropriate in older boys because of significant dysuria.

Child, Preschool↗
PubMed1986

Guide to the history in enuretic children.

In evaluating a child with enuresis, an organized approach to the history leads to a working diagnosis and an appropriate treatment plan. Questions are grouped in nine categories: perinatal complications, complications in infancy, toilet training, voiding pattern (assessed with a voiding diary), micturition pattern, urinary infection, defecation pattern, perineal symptoms and food sensitivities. Structural abnormalities must be evaluated cautiously to assure that a functional problem is not overlooked.

Biofeedback, Psychology↗
PubMed1984

Effect of metoclopramide on ureteral motility.

Metoclopramide, a procainamide derivative that markedly stimulates peristalsis in a variety of gastrointestinal tissues, demonstrated a significant dose-dependent effect on rat, canine, and human ureters studied in vitro. A moderate increase in phasic activity was seen at low concentrations with striking inhibition noted at higher concentrations. In the dog, atropine 0.6 microgram/ml inhibited the former while procaine 400 micrograms/ml stimulated the latter. Surgically produced, chronically dilated canine ureters were also stimulated by metoclopramide. Metoclopramide may be useful in states of disordered ureteral motility.

Animals↗
PubMed1984

Pitfalls in using human chorionic gonadotropin stimulation test to diagnose anorchia.

Previous studies have concluded that surgical exploration is unnecessary in genetic male subjects with nonpalpable tests who fail to respond to human chorionic gonadotropin. Lack of response suggested absent testicular tissue. We report on 2 patients thought to have anorchia because of lack of response to human chorionic gonadotropin stimulation. Testes were found in both patients. Genetic and phenotypic male subjects with nonpalpable testes who fail to have increased testosterone after human chorionic gonadotropin stimulation should undergo laparoscopy. If testicular structures are present at laparoscopy surgical exploration is indicated. Unresponsiveness to human chorionic gonadotropin may be evidence of nonexistent or dysfunctional Leydig cells rather than evidence of complete absence of testicular tissue.

Child↗
PubMed1984

The management of children with vesicoureteral reflux and ureteropelvic junction obstruction.

We reviewed our management of children with vesicoureteral reflux and ureteropelvic junction obstruction in the same renal unit. Of the children who underwent pyeloplasty for ureteropelvic junction obstruction 9 per cent also had vesicoureteral reflux. These children were almost exclusively boys. Ureteropelvic junction obstruction was caused mostly by a stricture or fixed kinks of the upper ureter. Vesicoureteral reflux was primarily grade IV and was associated with abnormal morphology of the ureteral orifice. Pyeloplasty was the initial surgical correction and ureteral reimplantation was performed expectantly.

Child↗
PubMed1983

Genitourinary rhabdomyosarcoma.

Rhabdomyosarcoma is the most common soft tissue malignant neoplasm involving the pelvis of children. Debate still exists over whether the best treatment is pelvic exenteration, radiation and chemotherapy or chemotherapy as the cornerstone to treatment, with diminished needs for extensive surgery and prolonged radiotherapy. Contrariwise, there is little debate over the combined treatment modality for paratesticular rhabdomyosarcoma. We have evaluated and treated 19 children with rhabdomyosarcoma, including 17 with pelvic rhabdomyosarcoma and 2 with paratesticular rhabdomyosarcoma. This retrospective study was done to evaluate treatment regimens for patients with genitourinary rhabdomyosarcoma. For patients with pelvic rhabdomyosarcoma the study was divided into 2 series. In an early series 6 of 7 children had a pelvic exenteration with or without chemotherapy. Of these 7 children 3 are well 15 to 27 years following diagnosis. In a later series of 10 children, when chemotherapy was used more commonly, none underwent pelvic exenteration. Of these 10 patients 7 had chemotherapy or chemotherapy and biopsy only. Only 1 child, who presented with stage IV disease, died in this series. Another child with stage III disease had progressive disease despite chemotherapy and subsequent cystoprostatectomy. Thus, of 9 remaining patients 8 are well from 1 to 8 years. It appears that pelvic rhabdomyosarcoma can be treated effectively with chemotherapy, and limited surgery and radiation. Fortunately, pelvic exenteration can now be limited to a select few.

Antineoplastic Agents↗
PubMed1983

Surgical correction of the failed orchiopexy.

The reasons for failure of orchiopexy were investigated by reviewing the records of 350 boys with undescended testis. There were 36 boys (10 per cent) who had experienced failure of an initial surgical procedure. We found that the standard surgical techniques of local inguinal dissection, high ligation of a patent processus vaginalis, extensive retroperitoneal mobilization of the spermatic vessels and vas deferens, and/or creation of a dartos pouch were sufficient to correct these failures. Retroperitoneal dissections were required to correct the undescended testes in 58 per cent of the boys. Only 37 per cent of the boys could be treated satisfactorily by localized inguinal dissection. It appears that standard surgical techniques, especially aggressive retroperitoneal dissection, are adequate to correct even troublesome cases of undescended testis.

Adolescent↗
PubMed1983

Bilateral cecoureteroceles causing urinary retention in the newborn.

The cecoureterocele differs from the usual ectopic ureterocele because it extends outside the bladder and may obstruct the urethra. The differentiation requires careful examination of the urethra by a voiding cystourethrogram and cystoscopy. We describe the management of a girl with bilateral cecoureteroceles who presented as a newborn with urinary retention and sepsis. Surgical correction of the cecoureterocele may differ from that required for the usual ectopic ureterocele.

Escherichia coli Infections↗
PubMed1983

The vesical sphincter electromyogram in children with normal and abnormal voiding patterns.

Recording the vesical sphincter electromyogram clarifies abnormal patterns of voiding in children. Since the electromyogram patterns in children with normal voiding patterns have not yet been evaluated, we recorded the sphincter electromyograms during voiding of 39 children with normal voiding patterns. These normal electromyograms were compared to those recorded in 86 children with abnormal voiding patterns. Each of the 39 children with a normal voiding pattern demonstrated synergy of the vesical sphincter during voiding. Of the 86 children with an abnormal voiding pattern 69 per cent demonstrated synergy and 31 per cent demonstrated dyssynergia of the vesical sphincter during voiding. Of the children with dyssynergia 89 per cent were girls and only 11 per cent were boys. Sphincter dyssynergia was demonstrated only by children with an abnormal pattern of voiding and those with a history of a normal pattern of voiding demonstrated only sphincter synergy (p less than 0.005). The electromyographic diagnoses of vesical sphincter synergy and dyssynergia obtained by surface electrode recordings correlated with the clinical voiding patterns of the children.

Adolescent↗