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Biomedical subjects

G U Coleman

Publications and source records attributed to G U Coleman.

16 recordsLinked to original sources
PubMed1996

Treatment of urinary incontinence in children by endoscopically directed bladder neck injection of collagen.

PURPOSE: We assessed optimal selection criteria for and expected outcome of bladder neck injection of collagen in children with intrinsic sphincteric deficiency. MATERIALS AND METHODS: We retrospectively reviewed the charts of children with intrinsic sphincteric deficiency treated with bladder neck injection of collagen at 3 pediatric urology centers. RESULTS: We reviewed the records of 12 boys and 6 girls 6 to 18 years old (median age 10.5). The underlying etiology of incontinence was neurogenic bladder in 10 patients, the epispadias-exstrophy complex in 6, ureterocele in 1 and trauma in 1. Previous surgery included bladder augmentation in 4 cases, bladder neck plasty in 7 and epispadias repair in 4, and concurrent medical management comprised anticholinergics in 8, alpha-agonists in 1 and intermittent catheterization in 9. Skin tests in all patients were negative for collagen. Seven patients had 1 injection, 9 had 2 and 2 had 3. The volume of collagen injected ranged from 2.4 to 13 cc (median 5) per treatment and 3 to 28 cc (median 7) per patient. Followup ranged from 5 to 21 months (median 15). Of the 14 patients evaluated 5 are dry, 4 are improved, 1 is unchanged and 4 underwent further continence surgery. No treatment related morbidity was seen. CONCLUSIONS: Endoscopically directed injection of collagen around the bladder neck is successful in 64% of children with intrinsic sphincteric deficiency. It is an outpatient treatment with no significant morbidity. Further continence surgery is not precluded when necessary. Patients with adequate capacity and compliant neurogenic bladders, and those with the exstrophy-epispadias complex and failed bladder neck plasty seem to be optimal candidates for collagen injection.

Administration, Intravesical↗
PubMed1996

Endoscopic treatment of vesicoureteral reflux with collagen: preliminary report and cost analysis.

PURPOSE: We determined therapeutic and operative cost efficacy of endoscopic collagen injection for vesicoureteral reflux. MATERIALS AND METHODS: We performed a multicenter study of 10 male and 23 female sequential patients (45 renal units) with vesicoureteral reflux and a surgical indication. Patients were skin tested with collagen and when negative, they underwent endoscopic injection. Renal ultrasound/cystography was done 3 months after treatment. Cost analysis was performed at 1 institution. RESULTS: Reflux was grade I in 2 renal units, II in 18, III in 15 and IV in 10. The majority of cases were single systems with primary reflux. We performed 1 treatment in 32 renal units, 2 in 6, 3 in 6 and 4 in 1. Cure was evident in 31 of 38 renal units (81.6%) and 21 of 27 patients (78%) 3 months after the last injection. Patient morbidity was minimal. Operative cost per renal unit was $1,599.68 for collagen injection and $9,144.47 for reimplantation. CONCLUSIONS: Endoscopic injection of collagen is effective treatment for vesicoureteral reflux. Furthermore, it causes minimal morbidity and may effect cost savings in health care management.

Adolescent↗
PubMed1990

Augmentation ileocystoplasty in children with myelodysplasia.

Over the past 8 years 20 children suffering from myelodysplasia were selected to undergo augmentation ileocystoplasty for urinary incontinence refractory to treatment by clean, intermittent catheterization and anticholinergic agents, or as part of urinary undiversion. The children ranged in age from 5 to 17 years, and the follow-up ranged from 6 months to 7 years. Three children underwent undiversion, two had vesicostomy closure and six had bladder outlet repair at the time of augmentation. In one patient, surgery was technically impossible. Postoperatively 16 children were fully continent on clean, intermittent catheterization and anticholinergic medication. Three boys failed to achieve satisfactory continence. Delayed perforation, a potentially serious complication, occurred in two patients several months postoperatively.

Adolescent↗
PubMed1989

Wilms tumorlet, nodular renal blastema and multicystic renal dysplasia.

We reviewed 60 cases of multicystic renal dysplasia collected during a 10-year period. Differentiated nonproliferative nodular renal blastema occurred in 6.7 per cent of the cases, which is similar to the incidence of nodular renal blastema in kidneys of other infants with congenital obstructive uropathy. A unique case of cystic dysplasia containing nodular renal blastema and Wilms tumorlet indicates the possibility that a persistently proliferative nephroblastomatous lesion may rarely occur.

Child↗
PubMed1988

Dicentric Y chromosome and mixed dysgenesis.

We report 4 cases of mixed gonadal dysgenesis with a karyotype containing a dicentric Y chromosome. All cases were mosaic with 45X and 46X, dic(Y) cell lines. Of the patients 1 had ambiguous genitalia and some features of Turner's syndrome, 2 had classical features of Turner's syndrome with normal female external genitalia and 1 had no features of Turner's syndrome but he presented with penoscrotal hypospadias, inguinal hernia and cryptorchidism. Female gender assignment and early total gonadectomy should be considered when a dicentric Y chromosome is present in cases of mixed gonadal dysgenesis.

Child, Preschool↗
PubMed1988

Clinical follow-up of fetal urinary tract anomalies diagnosed prenatally by ultrasound.

This retrospective review identified 122 cases with a prenatal diagnosis of genitourinary anomalies and categorized them into parenchymal and collecting system abnormalities. Comparisons were made between the anatomical groups for indications for ultrasound, average gestational age at positive and negative renal ultrasound diagnosis, amniotic fluid volume and pregnancy outcome with postnatal diagnosis. The results indicated that parenchymal abnormalities were detected earlier in gestation than collecting system anomalies. Additional fetal anomalies were more often present in the parenchymal group. Chromosome abnormalities were present in 5% of the urinary tract abnormalities. Parenchymal abnormalities were more likely to have oligohydramnios and a higher morality rate.

Female↗
PubMed1988

Bladder-outlet reconstruction in neurogenic bladder due to myelomeningocele.

In a subgroup of children with myelomeningocele, urinary incontinence cannot be managed by clean intermittent catheterization and anticholinergic medication. The authors report on 24 such children who required bladder-outlet reconstruction. Twelve boys underwent the Young-Dees/Leadbetter procedure, 8 girls underwent the Burch procedure and the remaining 4 had a combination of the two. Augmentation cystoplasty was also carried out in seven girls and one boy. Results were most favourable in the girls, with improvement in 92%, in contrast to the boys in whom only 58% were improved. Artificial sphincter placement may be a more beneficial alternative for boys.

Adolescent↗
PubMed1987

Neonatal renomegaly.

A retrospective clinical review was done to study the value of ultrasound and renography in the investigation of 100 neonates with renomegaly. Abnormalities in 73 patients were detected antenatally with ultrasonography. Of the neonates 47 had lower urinary tract pathological conditions and ultrasound was more than 90 per cent accurate in identifying the accompanying ureteral dilatation. A total of 53 neonates had upper tract anomalies (ureteropelvic junction obstruction or cystic dysplasia). With ultrasonography the degree of pyelocaliectasis in patients with ureteropelvic junction obstruction was classified as mild (22 units), moderate (13) or severe (7). Initial treatment and followup were reviewed to study the clinical course of neonates with mild to moderate degrees of pyelocaliectasis followed nonoperatively, and to determine whether the diuretic renogram had a predictive role in identifying which kidneys were most likely to deteriorate.

Dilatation, Pathologic↗
PubMed1985

Megalourethra.

We present 5 examples of megalourethra. All 5 cases were associated with the spectrum of the triad syndrome, ranging from minor hydronephrosis and undescended testis to gross hydronephrosis incompatible with survival. Initial management of this urethral defect is drainage followed later by reconstruction.

Child, Preschool↗
PubMed1982

The development of microsurgical techniques in experimental and clinical repair of urethrocutaneous fistulas.

We reviewed 60 urethral fistulas in 50 patients seen between 1974 and 1979. After the results of this study were assessed technical aspects of the repair were incriminated to account for the 40 per cent failure rate for first-time closure of urethral fistulas in our area. To study this problem an animal model was created in the laboratory. A comparison was made between classically repaired fistulas and those repaired with microsurgical equipment and techniques. In the group repaired by a classical macrosurgical technique only 20 per cent of the repairs were successful, while 90 per cent of the repairs under the microscope succeeded. Techniques and material, as well as histology involved, are presented in detail. Some of the causes of fistula repair breakdown clarified in this study include tissue trauma "para fistula" fistulas due to needle trauma and nonrecognition of multiple small additional fistulas. Details of 25 fistulas in 19 patients in whom closures were done with microsurgical techniques are presented. Success rate for primary closure was 88 per cent.

Animals↗
PubMed1981

Comparison of microscopic and macroscopic repair in rabbit urethral fistulae.

Two fistulae were created in each of 26 adult male New Zealand rabbits. In six, no closure was carried out. In 20 rabbits subsequent closure was carried out using, alternately, a macroscopic and microscopic technique. We were then able to evaluate a total of 26 repaired fistulae using several parameters. Patency of the fistulae was present after 3 months in all six rabbits in which no closure was carried out. Comparison of the two techniques showed nine recurrences or persistent fistulae in the ten repaired by standard macroscopic techniques, and one fistulae still present after closure of 16 fistulae using microsurgical principles. This preliminary study emphasizes the potential improvement in urethral fistula repair using the operating microscope. Direct transfer into the clinical setting is underway with the use of techniques used in the Microsurgical Laboratory at the University of British Columbia.

Animals↗
PubMed1975

Solitary epididymal schistosomiasis.

A 54-year-old Canadian presented with a 1-month history of painless swelling in the right testis. The diagnosis was thought to be a sperm granuloma, a leiomyoma, or an adenomatoid tumour of the epididymis; histologic examination, however, revealed evidence of schistosomiasis, probably due to Schistosoma haematobium. Solitary schistosomiasis of the epididymis has been reported previously in only two cases. Epididymal schistosomiasis has never been diagnosed preoperatively because it is so rare, but even if it were suspected preoperatively and confirmed by biopsy, chemotherapy alone would not prevent impairment of epididymal function due to scarring. Surgical excision of the lesion, therefore, is recommended.

Adult↗