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Biomedical subjects

D A Bloom

Publications and source records attributed to D A Bloom.

At least 91 records · Page 5Linked to original sources
PubMed1994

Pubovaginal slings for the management of urinary incontinence in female adolescents.

A pubovaginal sling is an effective treatment for type III incontinence secondary to poor proximal urethral sphincter function. We used a pubovaginal sling to treat incontinence in 15 female adolescents. The etiology of incontinence was spinal dysraphism in 10 patients and prior trauma in 3. Simultaneous bladder augmentation was performed in the remaining 2 patients for poor bladder compliance. Three patients required additional procedures including repeat slings in 2 and repeat augmentation in 1. Of 13 patients followed for more than 6 months 11 remain dry, 1 leaks small amounts and wears 1 pad per day, and 1 did not achieve acceptable continence and was subsequently managed with bladder augmentation and a Mitrofanoff procedure. The upper urinary tracts have remained normal in all 13 patients. The pubovaginal sling has proved to be safe and successful in these children. The overall continence rate of 92% compares favorably to other available modalities.

Adolescent↗
PubMed1994

Treatment of pediatric urethral stricture disease with the neodymium:yttrium-aluminum-garnet laser.

OBJECTIVES: The aim of this study was to assess the efficacy and safety of the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in the treatment of pediatric urethral stricture disease. METHODS: Twelve boys who had previously undergone unsuccessful cold-knife internal urethrotomy or serial urethral dilation for urethral stricture disease underwent endoscopic laser internal urethrotomy utilizing a contact-tip fiber for recurrent urethral stricture. RESULTS: At a mean follow-up of 12 months, 10 of the 12 boys are free of stricture disease for an overall success rate of 83%. Two boys were considered failures and underwent successful open urethroplasty. There were no treatment complications. CONCLUSIONS: The Nd:YAG laser utilizing the contact-tip fiber was successful in treating recurrent urethral stricture disease. The hemostatic characteristic of the laser allowed bloodless urethrotomy, which was particularly useful when operating with the smaller pediatric endoscopic instruments.

Adolescent↗
PubMed1994

Normal and abnormal pelviscopic anatomy at the internal inguinal ring in boys and the vasal triangle.

OBJECTIVES: We sought to explain and define normal and abnormal laparoscopic pelvic anatomy, which has only recently become the target of much attention. METHODS: The embryology, normal anatomic landmarks, and abnormal findings of the male pelvis, as discerned from more than 350 laparoscopic investigations in boys, were analyzed. RESULTS: The medial umbilical ligament, the wishbone at the internal inguinal ring, the transverse vesical fold, and the vasal triangle are principal laparoscopic landmarks of the male pelvis. Deficient spermatic vessels, abnormal gonadal locations, patent processus vaginalis, single medial umbilical ligament, and transverse testicular ectopia were the abnormal findings. CONCLUSIONS: Laparoscopic familiarity with the male pelvis permits safe and efficient diagnostic and therapeutic navigation in this new surgical arena.

Child↗
PubMed1994

Urologic manifestations of Goldenhar syndrome.

OBJECTIVE: Goldenhar syndrome (oculoauriculovertebral dysplasia) is associated with anomalies in multiple organ systems. Renal abnormalities have also been reported with the complex, but the incidence of associated genitourinary malformations has not been defined. METHOD: We have reviewed our experience with 28 children with Goldenhar syndrome evaluated during the past twelve years. Twenty children underwent imaging evaluation of the urinary tract and 14 (70% of those imaged) children had urinary tract anomalies. RESULTS: The majority of anomalies presented as an incidental finding on a screening ultrasound (8 patients) or during cardiac catheterization (2 patients). Two children presented with urinary tract infection, 1 child presented with renal failure, and another was diagnosed antenatally. The genitourinary anomalies included the following: ectopic and/or fused kidneys (8 patients), renal agenesis (7), vesicoureteral reflux (5), ureteropelvic junction obstruction (2), ureteral duplication (2), and multicystic kidney (1 patient). Four children have undergone surgical intervention. CONCLUSION: Our experience in children with Goldenhar syndrome suggests that the incidence of genitourinary anomalies is higher than previously reported. A screening ultrasound in the neonatal period allows for early intervention in those children with significant urologic abnormalities.

Abnormalities, Multiple↗
PubMed1994

Bladder diverticula in children.

PURPOSE: The frequency, number, and underlying associations of bladder diverticula were studied in a pediatric population. MATERIALS AND METHODS: Eighty-five children with bladder diverticula (31 girls and 54 boys) were retrospectively identified in a pediatric genitourinary data base of 5,084 children. RESULTS: Primary bladder diverticula were seen in 20 children with vesicoureteral reflux and 14 children without reflux. Fifty-one of the 85 children (60%) had associated neurogenic dysfunction of the bladder (n = 26), outlet obstruction (n = 14), or a syndrome (n = 9) or were postoperative (n = 2). A single child of the 26 with multiple bladder diverticula had no associated condition. CONCLUSION: In this population, bladder diverticula were found in 1.7% of the children. The presence of more than one diverticulum on a side was usually associated with neurogenic dysfunction of the bladder, bladder outlet obstruction, or syndromes such as Williams, Menkes, prune-belly, or Ehlers-Danlos type 9 syndromes.

Abnormalities, Multiple↗
PubMed1994

Small (< or = 3 cm) renal masses: correlation of spiral CT features and pathologic findings.

OBJECTIVE: We describe our 3-year experience using spiral CT in the evaluation of small renal masses in order to determine the usefulness of this technique for classifying the lesions and to correlate specific CT features with pathologic findings. MATERIALS AND METHODS: We retrospectively analyzed spiral CT scans and results of pathologic examinations of surgically extirpated small (< or = 3 cm) renal masses in 35 patients. The masses included 27 renal cell carcinomas, two transitional cell carcinomas, one leiomyoma, one angiomyolipoma, and four benign cysts. Several imaging features, including attenuation, pattern of contrast enhancement, presence and type of calcification, cyst wall, and septation, were correlated with pathologic findings. RESULTS: Most renal cell carcinomas had a solid growth pattern (n = 19), had attenuation values on unenhanced scans of 20 H or greater (n = 26), and had attenuation values that increased by at least 10 H with contrast enhancement (n = 26). Only three renal cell carcinomas were mostly cystic on pathologic examination. Heterogeneous enhancement correlated with the presence of acellular regions (p = .02). Of 12 cystic masses, spiral CT showed the absence of a thick or nodular fibrous capsule in seven of nine masses (specificity, 0.78) and the absence of several (or nodular) septations in six of seven masses (specificity, 0.86) but was not as sensitive in detecting these features. CONCLUSION: Spiral CT can show many of the key imaging features of small renal masses used to distinguish between benign and malignant lesions. However, despite the theoretical benefits of volumetric CT, some lesions remain indeterminate and require surgical removal for diagnosis.

Carcinoma, Renal Cell↗
PubMed1993

Distal intussusception of processus vaginalis: a cause of acute hydrocele.

Acute obstruction of a patent processus vaginalis occurred in two boys, mimicking incarceration of an inguinal hernia. In fact, obstruction was caused by an intussusception of the processus vaginalis forming an intussuscipiens that occluded the hernia sac. This lesion, described previously in 1896 and in 1974, is one of the mechanisms by which an asymptomatic hernia or hydrocele becomes acutely symptomatic.

Acute Disease↗
PubMed1993

Labial fusion causing upper urinary tract obstruction.

An infant with dense and nearly complete labial fusion had marked hydroureteronephrosis which resolved after incision of the adherent labia. Although this is an unusual consequence of labial fusion, it argues for upper urinary tract screening in these children.

Female↗
PubMed1993

Stress leak point pressure: a diagnostic tool for incontinent children.

The stress leak point pressure is the lowest bladder pressure at which leakage occurs during prompted increases in intra-abdominal pressure. The stress leak point pressure is distinct from the simple bladder leak point pressure and can be determined using simple urodynamic equipment without fluoroscopy. In 15 incontinent girls and boys 2.5 to 15 years old the mean stress leak point pressure was 54.7 cm. water (range 11 to 100), whereas the mean leak point pressure was 19.9 cm. water (range 5 to 50, paired t test p < 0.0001). The stress leak point pressure is a useful diagnostic tool that provides specific data on bladder neck and proximal urethral function.

Adolescent↗
PubMed1993

Renal sonography is not a reliable screening examination for vesicoureteral reflux.

A retrospective analysis of 493 infants and children was performed to determine the reliability of renal sonography for identifying vesicoureteral reflux. Sonography was done in all cases within 8 hours of a voiding cystourethrogram. Vesicoureteral reflux was documented in 272 of 986 kidneys on voiding cystourethrography and there were 201 refluxing kidneys with normal ultrasound (25 with grade I reflux, 119 with grade II, 50 with grade III, 6 with grade IV and 1 with grade V). In 71 of the refluxing kidneys the ultrasound was abnormal due to pelvicaliceal dilatation in 45, a duplication anomaly in 6 and renal fossae abnormality in 20. Of the kidneys with vesicoureteral reflux 74% were sonographically normal. Sonography was not sufficiently sensitive or specific for detecting vesicoureteral reflux, since 28% of the missed refluxing kidneys had grade III or higher reflux.

Adolescent↗
PubMed1993

Enterocystoplasty in renal transplantation candidates: urodynamic evaluation and outcome.

In anticipation of renal transplantation 11 patients with end stage renal disease and small volume, poorly compliant bladders underwent enterocystoplasty. The etiology of bladder dysfunction included myelodysplasia in 4 patients, posterior urethral valves in 4 and vesicoureteral reflux in 3. Mean patient age at the time of bladder augmentation was 16.4 years (range 10 to 28). Detubularized bowel segments were used in all patients and included ileum in 7, ileocecal segment in 3 and sigmoid in 1. Urodynamic evaluation before and after enterocystoplasty demonstrated marked improvement in bladder capacity and compliance. These 11 patients have received 13 renal transplants with an 85% graft survival at a mean followup of 30.1 months. No bladder ruptures or other perioperative complications have occurred. All patients remain continent on clean intermittent catheterization. Our experience suggests that enterocystoplasty is a safe and effective method of restoring lower urinary tract function in the patient with end stage renal disease and a small, noncompliant bladder.

Adolescent↗
PubMed1993

Toilet habits and continence in children: an opportunity sampling in search of normal parameters.

An opportunity sampling of 1,192 children regarding parameters of toilet training and elimination status was obtained by interview and questionnaire. Toilet training ages ranged from 0.75 to 5 years, with a mean of 2.4 +/- 0.6 years (standard deviation). Voiding frequency was inversely related to age; most children between 3 and 12 years old urinated 5 to 6 times per day. Influences of gender, urinary infections and parental recall were investigated. Nocturnal and diurnal enuresis was reported in 18% and 10% of our sample, respectively. Bowel movements per week ranged from 1 to 21, with a mean of 6.8 +/- 2.5.

Age Factors↗
PubMed1993

Omental evisceration through small laparoscopy port sites.

Two children developed omental evisceration through small periumbilical port sites after peritoneal endoscopy for nonpalpable testes. Factors that predispose to this complication include decompression of the pneumoperitoneum by suction. These factors and steps to avoid it such as closure of all endoscopic fascial defects under direct vision are described.

Child, Preschool↗
PubMed1993

Bladder capacity as measured at voiding cystourethrography in children: relationship to toilet training and frequency of micturition.

To assess the reliability of a frequently used formula for calculating bladder capacity in children, bladder capacity was measured prospectively at voiding cystourethrography in 274 consecutive healthy infants and children. Bladder volume index (BVI) was then calculated by dividing the measured capacity by the predicted capacity. Bladder capacity increased dramatically after 18 months and reached a plateau between 3 and 4 months of age, after which there was no further significant increase in capacity until approximately 9 years. BVI abruptly increased from 1.03 in children aged less than 18 months to 1.50-1.60 in children aged between 18 months and 4 years (P < or = .0001). Because bladder capacity increases sharply during infancy and early childhood and levels off once toilet training is complete, linear models used to predict bladder capacity on the basis of age alone significantly underestimate bladder capacity in infants and younger children.

Adolescent↗
PubMed1993

The American experience with desmopressin.

Conclusive evidence of a polyuric etiology from a failure of vasopressin elevation led to a new pharmacologic approach to the treatment of childhood nocturnal enuresis. Desmopressin acetate, a vasopressin analogue, has been used successfully since 1978 to treat this condition. Desmopressin's efficacy at doses of 5 to 40 micrograms has been demonstrated in Europe and the United States. Similarly, its safety has been established, and it is a first-line choice for physicians worldwide.

Child↗