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Biomedical subjects

C F Firlit

Publications and source records attributed to C F Firlit.

At least 73 records · Page 4Linked to original sources
PubMed1983

Cowper's syringocele: a classification of dilatations of Cowper's gland duct based upon clinical characteristics of 8 boys.

Lesions of Cowper's gland duct assume various appearances. A system to classify each of these appearances is offered to diagnose these lesions more precisely. The urethrographic and endoscopic characteristics of dilated Cowper's gland ducts noted in 8 boys are grouped as a simple classification. The dilated Cowper's duct is referred to as a syringocele (Greek syringo--tube plus cele--swelling). There are 4 groups of Cowper's syringoceles: 1) simple syringocele--a minimally dilated duct, 2) perforate syringocele--a bulbous duct that drains into the urethra via a patulous ostium and appears as a diverticulum, 3) imperforate syringocele--a bulbous duct that resembles a submucosal cyst and appears as a radiolucent mass, and 4) ruptured syringocele--the fragile membrane that remains in the urethra after a dilated duct ruptures. Marsupialization of the syringoceles cured urine infection and hematuria but voiding symptoms may persist.

Adolescent↗
PubMed1983

Bladder capacity (ounces) equals age (years) plus 2 predicts normal bladder capacity and aids in diagnosis of abnormal voiding patterns.

Standardization of the bladder capacities of children will improve the precision of urodynamic evaluation. In an attempt to develop a practical guide to predict the normal bladder capacity during childhood the bladder capacities of 132 children without a clinically abnormal pattern of voiding were measured. When the bladder capacities are correlated by age the following linear relationship exists: normal bladder capacity (ounces) equals age (years) plus 2. The bladder capacities of 68 children with primary enuresis, frequency or infrequent voiding were then measured. Children with clinically infrequent voiding demonstrated large bladder capacities and those with frequency or enuresis demonstrated small bladder capacities compared to normal children. The formula appears to be a useful guide to predict normal bladder capacity by age and also to aid in the diagnosis of abnormal voiding patterns.

Adolescent↗
PubMed1983

Management of reflux in the myelodysplastic child.

More than 75 per cent of the patients with spinal dysrhaphisms followed at our hospital are on intermittent catheterization. A previous report indicated that 62 per cent of 200 children with reflux and a neurogenic bladder either ceased to have reflux or reflux was downgraded while on intermittent catheterization and chronic antibiotics. We report on those children in whom either reflux did not stop while on the program, or who presented with high grades of reflux not amenable to cure by intermittent catheterization. During the last 4 years 25 children (40 ureters) required antireflux surgery. The criterion of repair was persistent reflux of at least grade IIB, associated with recurrent episodes of infection. A modified Leadbetter-Politano technique was used in 5 children (7 ureters) and the Cohen cross-trigonal technique was used in 20 children (33 ureters). A successful result, that is cessation of reflux and no obstruction, was achieved in 96 per cent of the patients. During the last 2 years the Cohen cross-trigonal technique has been used exclusively and there have been no failures. This successful result in 96 per cent of the children with neurogenic bladder indicates that while clean intermittent catheterization should be used primarily to relieve reflux, in a select group of children antireflux surgery should be done and clean intermittent catheterization should be continued.

Child↗
PubMed1983

The use of lower ipsilateral ureteroureterostomy to treat vesicoureteral reflux or obstruction in children with duplex ureters.

During the last 4 years lower ipsilateral ureteroureterostomy was performed to treat vesicoureteral reflux and/or obstruction in 11 children with 13 completely duplicated systems. There was reflux only to the lower segment in 11 systems, obstruction only to the upper segment in 1 and reflux with obstruction in 1 system. The procedure is technically easier than ureteroneocystotomy, avoids cystotomy and permits a brief postoperative hospitalization. The postoperative excretory urogram demonstrated improved or stable hydronephrosis in all patients. Vesicoureteral reflux persisted in 1 system associated with a golf hole orifice. Caution should be exercised when children with reflux in duplex systems associated with a golf hole ureteral orifice are treated.

Adolescent↗
PubMed1982

Urodynamic biofeedback: a new therapeutic approach for childhood incontinence/infection (vesical voluntary sphincter dyssynergia).

A major cause of urinary incontinence and/or recurrent urinary infections in neurologically intact children is vesical voluntary sphincter/urogenital diaphragm dyssynergia and/or "strain" dyssynergia. These acquired or learned mechanisms are characterized by increased striated muscle tone during micturition, residual urine, daytime wetting and/or urinary infections. Generally, pharmacotherapy is prescribed and manipulated to achieve modification of these dysfunctions. Recently, urodynamic biofeedback has surfaced as a suitable therapeutic alternative. We selected 10 children, between 6 1/2 and 16 years old, for biofeedback therapy because of age, intelligence, commitment and conviction to improve. Following inpatient biofeedback 8 of the 10 children demonstrated complete abatement of signs and symptoms in long-term surveillance (6 to 19 months after biofeedback), while 2 moderately improved. Our experience with biofeedback therapy demonstrated that all patients convert to synergistic voiding within 48 hours of therapy. Urodynamic biofeedback appears to be an extremely useful tool in the armamentarium of the urologist treating neurologically normal children with voiding disorders. The possibility that this modality may be useful for adults is intriguing.

Adolescent↗
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

Treatment of testicular yolk sac carcinoma in the young child.

The majority of testicular tumors in children will be of germ cell origin and the predominant pathologic type is the yolk sac carcinoma. Initial treatment or radical orchiectomy is not in question. However, because of its presumed less virulent character, especially in children less than 2 years old, confusion remains as to adjunctive treatment for yolk sac carcinoma. We have studied retrospectively 21 children with testis tumors encountered within the last 10 years. Of these cases 12 were classified pathologically as yolk sac carcinoma. All children were less than 3 years old and 10 of 12 were less than 2 years old. Of the 12 cases 4 had positive lymph node dissections and 3 of these 4 children were less than 2 years old. Although chemotherapy is so effective its toxicity cannot be minimized. Therefore, adjunctive chemotherapy should be reserved for those patients who have lymphatic spread. Young children with yolk sac tumors are not immune to metastatic disease and should be treated with an extended unilateral lymphadenectomy for staging and appropriate treatment regimens.

Castration↗
PubMed1980

The female urethral syndrome: external sphincter spasm as etiology.

Many women suffer a constellation of urinary and pelvic symptoms commonly referred to as the urethral syndrome. Numerous medical, surgical and psychological treatment modalities have been used to alleviate the symptoms. Urodynamic techniques were used to study a group of women with the urethral syndrome. Based on the findings of external urethral sphincter spasm and/or pelvic floor hyperactivity the institution of diazepam therapy not only has provided clinical relief but also sphincter synergy as demonstrated by post-treaatment urodynamics.

Adult↗
PubMed1980

Hypospadias surgery: the X-shaped elastic dressing.

An effective, easily fashioned, adherent, long-term X elastic dressing is described. The dressing has been used predominantely in hypospadias operations. It affords excellent compression of the skin and glandular flaps, and reduces edema. The dressing provides for children comfort, freedom of motion without interference with normal bowel movements and effective compression of the genitalia, and it appears to have a broad-spectrum of application in pediatric and adult urologic surgery. Complications are rare.

Humans↗
PubMed1980

Testicular torsion: the role of radioisotopic scanning.

Radioisotopic scortal scanning was used as a triage maneuver to assess 18 boys with scrotal and/or testicular complaints. In 4 puberal boys the diagnosis was torsion and treatment consisted of orchiectomy because of testicular necrosis. This technique proved to be of value in studying infants and older children. It appears to be highly reliable and accurate. We believe that it should be used in making the diagnosis of non-operable conditions, such as epididymitis and idiopathic scrotal swelling, thereby avoiding an unnecessary operation.

Acute Disease↗
PubMed1979

Urodynamic biofeedback: a new approach to treat vesical sphincter dyssynergia.

Some children with vesical sphincter dyssynergia are refractory to conventional pharmacologic therapy. Three such patients were treated using a method of sphincter retraining, biofeedback. They observed the urinary sphincter electromyogram while voiding to appreciate visually the abnormality. Two children learned to suppress voluntarily the inappropriate sphincter contraction during voiding. This normalized the subsequent electromyographic recordings and offered subjective improvement in the voiding symptoms. Retraining the urethral sphincter dysfunction may be approached using biofeedback techniques in selected patients.

Adolescent↗
PubMed1979

Pediatric urodynamics: a clinical comparison of surface versus needle pelvic floor/external sphincter electromyography.

Urodynamic evaluations were done on 37 children to diagnose voiding pattern abnormalities and/or recurrent urinary infections. Each of 25 children had 2 sets of testing to judge a practical method of urodynamic evaluation. Bipolar anal skin electrodes were compared to bipolar perianal muscle needle electrodes as a means of monitoring the urethral sphincter/pelvic floow electromyographic activity. In addition, the urethral catheter was compared to the suprapubic catheter as a means of monitoring intravesical pressure. The results were similar and statistically significant (p less than 0.001). The remaining 12 children were evaluated based only on the results of bipolar anal skin electrodes and uroflowmetry. The results of both groups clearly demonstrated that surface perianal electrodes are practical, accurate and reliable for the diagnosis and treatment of children with voiding pattern abnormalities. We recommend the use of surface electrodes and a urethral catheter as techniques for the urodynamic evaluation of voiding pattern abnormalities of children without overt neuropathology or extensive urethral operation. Preoperative surface electromyography of the urinary sphincters may prove to be a useful screening test to detect occult dyssynergia in patients who have had failed ureteral reimplants.

Adolescent↗
PubMed1979

The cystometric nuclear cystogram.

Vesicoureteral reflux is a common clinical problem that we monitor by interval nuclear cystography. Of the children having nuclear cystograms 40% also have voiding abnormalities, including incontinence (damp pants), urgency and infrequent micturition. We have evaluated these symptoms by recording the intravesical pressure during the nuclear cystogram. This combined examination, the cystometric nuclear cystogram, has been done on 46 children. An abnormal cystometrogram was found in 61% of the children with a voiding abnormality and helped to establish a basis for successful therapy. The cystometric nuclear cystogram aids in the diagnosis and rational therapy of childhood voiding abnormalities. It is a practical method to obtain a cystometrogram in children with voiding abnormalities who are being evaluated for ureteral reflux and it has facilitated the management of childhood ureteral reflux.

Child↗