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J S Barthold

Publications and source records attributed to J S Barthold.

34 records · Page 2Linked to original sources
PubMed1999

Orthotopic urethral substitution in female patients using the mitrofanoff principle.

PURPOSE: We present our experience with orthotopic urethral substitution in female patients using the Mitrofanoff principle. MATERIALS AND METHODS: We performed orthotopic urethral substitution using the Mitrofanoff principle in 18 female patients 1 to 29 years old (mean age 10). The conduit was constructed with appendix in 13 cases, tapered ileum in 4 and fallopian tube in 1. The etiology of incontinence included exstrophy in 8 patients, neurogenic bladder in 3, urogenital sinus in 3, and bilateral ectopic ureter, ectopic ureterocele, the prune-belly syndrome and post-cystectomy undiversion in 1 each. RESULTS: Mean followup was 29 months (range 9 to 72). A total of 16 patients achieved continence following a program of clean intermittent catheterization. There were 2 unsuccessful operations. In 1 case the appendix become ischemic and in 1 a vesicoperineal fistula developed. One patient catheterizes every 2 hours to avoid leakage. Catheterization was temporarily difficult in 5 patients, of whom 2 had an appendiceal and 3 had a tapered ileal conduit. Two patients with an ileal conduit have had chronic difficult catheterization. CONCLUSIONS: Orthotopic replacement of the urethra using the Mitrofanoff principle is suitable in highly select female patients who need continent diversion or a catheterizable conduit but who will not accept an abdominal stoma. It is particularly suited to patients in whom exstrophy reconstruction has failed.

Adolescent↗
PubMed1999

Results of the rectus fascial sling and wrap procedures for the treatment of neurogenic sphincteric incontinence.

PURPOSE: We assessed the early results of the rectus fascial sling and modified rectus fascial wrap for treating neurogenic sphincteric incontinence in a pediatric population. MATERIALS AND METHODS: We retrospectively reviewed the charts of all patients who underwent a rectus fascial sling or wrap procedure for neurogenic incontinence at our institution. Most recent status was confirmed by telephone interview as successful-complete day and night dryness, partially successful-occasional daytime wetting and/or nocturnal enuresis and failed-frequent daytime incontinence. Results were analyzed with regard to patient sex, associated bladder augmentation and previous or subsequent anti-incontinence surgery. RESULTS: A total of 27 patients underwent 10 sling and 18 wrap procedures. Five patients in each group were dry after 1 to 4.5 years of followup. Six of the 7 boys were wet and 1 was partially dry postoperatively, while 10 of the 20 girls became dry (p = 0.026 Fisher's exact test), resulting in an overall 36% success rate. In failed cases continence was achieved after periurethral collagen injection and artificial urinary sphincter placement in 0 of 5 and 5 of 6, respectively. CONCLUSIONS: Total continence was achieved even after a brief followup in a minority of patients in whom rectus fascia was used to correct neurogenic incontinence. However, our early data suggest that cases in which these procedures fail may be salvaged by artificial urinary sphincter implantation but not by periurethral collagen injection.

Child↗
PubMed1998

Prognostic value of initial renal ultrasound in patients with posterior urethral valves.

PURPOSE: Increased cortical echogenicity and loss of corticomedullary differentiation on the initial renal ultrasound study are said to be predictive of poor renal function in patients with posterior urethral valves. We reviewed ultrasound results in a group of patients with posterior urethral valves to test this hypothesis. MATERIALS AND METHODS: We reviewed the radiology records of 19 patients in year 1 of life with posterior urethral valves seen since 1976 for whom records were available. The degree of corticomedullary differentiation and cortical echogenicity was compared with serum creatinine after 4 days of catheter drainage and creatinine clearance at the most recent followup. RESULTS: Median followup was 96 months. At the last followup the sensitivity, specificity, and positive and negative predictive values of increased cortical echogenicity and loss of corticomedullary differentiation for predicting creatinine clearance less than 69 ml. per minute per 1.73 m.2 were 90, 57, 75 and 80, and 100, 33, 71 and 100%, respectively. CONCLUSIONS: Increased cortical echogenicity and loss of corticomedullary differentiation are relatively insensitive predictors of eventual renal function in boys with posterior urethral valves. In a significant proportion of patients with normal renal function the initial renal ultrasound study revealed echogenic kidneys, although only a small proportion with poor renal function had normal kidneys.

Creatinine↗
PubMed1998

Alternative techniques for augmentation cystoplasty.

PURPOSE: We discuss conventional intestinal cystoplasty and show how concern about potential complications has led to an interest in alternative methods for cystoplasty. Techniques such as gastrocystoplasty, ureterocystoplasty, vesicomyomectomy (autoaugmentation), seromuscular augmentation, alloplastic replacement and bioprosthetic materials are reviewed. Laboratory and clinical results of these techniques are examined critically to compare advantages, disadvantages and potential applications. MATERIALS AND METHODS: Computer searches of available medical data bases were used to generate a list of relevant publications, including original contributions and review articles, which were then reviewed, compared and summarized. RESULTS: Augmentation cystoplasty is used routinely for treatment of reduced bladder compliance and capacity secondary to infectious, inflammatory, neurogenic and congenital disorders. Sigmoidocystoplasty and ileocystoplasty have become standard techniques but there is renewed interest in alternative techniques due to the relatively high morbidity of intestinal cystoplasty. Alternative techniques have been described to avoid inclusion of intestinal mucosa in the urinary tract while creating a compliant bladder of adequate capacity. These techniques include gastrocystoplasty, vesicomyotomy, seromuscular augmentation, various alloplastic or biodegradable scaffolds and in vitro culture with subsequent grafting of autologous urothelium. Although encouraging animal and human results have been reported, each technique is associated with its own limitations and disadvantages. CONCLUSIONS: While intestinal cystoplasty remains the standard, several alternative techniques show promise. At present only gastrocystoplasty, ureterocystoplasty and seromuscular augmentation should be considered clinically useful.

Animals↗
PubMed1998

Management of urethral strictures after hypospadias repair.

PURPOSE: We conducted a retrospective study of patients with strictures after hypospadias repair to identify factors contributing to the development of strictures and to attempt to define an optimal strategy for management. MATERIALS AND METHODS: Patients with the diagnosis of hypospadias who had undergone direct vision internal urethrotomy, urethral dilation or urethroplasty were identified. The original location of the meatus, type of initial repair, subsequent procedures and outcome of the interventions were recorded. RESULTS: A total of 38 patients were identified. Of the 29 patients who were initially treated with direct vision internal urethrotomy or urethral dilation 23 (79%) ultimately required open urethroplasty and did well. Of the 8 patients treated with initial urethroplasty 7 had successful outcomes. Overall success, defined as asymptomatic voiding without fistula or residual stricture, was 78% at a mean followup of 6.3 years. CONCLUSIONS: Stricture disease continues to be a significant complication of hypospadias reconstruction. Initial therapy should be urethral dilation but it should be recognized that the majority of these patients will ultimately require open urethroplasty.

Child, Preschool↗
PubMed1997

Benefits of laparoscopy and the Jones technique for the nonpalpable testis.

PURPOSE: We report on the role of diagnostic laparoscopy combined with the Jones suprainguinal approach to orchiopexy in the treatment of abdominal testes. MATERIALS AND METHODS: A retrospective review was done of 209 boys with 265 cryptorchid testes who underwent orchiopexy between January 1994 and March 1996. A subset of patients with nonpalpable testis underwent diagnostic laparoscopy and according to the laparoscopic findings either standard inguinal or suprainguinal extraperitoneal orchiopexy. RESULTS: Of 209 patients 47 had 63 impalpable testes. Laparoscopy was done on 31 patients (42 testes). Findings at laparoscopy revealed 29 (69%) abdominal, 7 (17%) intracanalicular and 6 (14%) vanishing testes. A satisfactory result with scrotal position of the testis and no atrophy was obtained in 18 of 19 patients operated via the Jones approach combined with diagnostic laparoscopy. The only patient with unsatisfactory result underwent ligation of the spermatic vessels at the time of operation. In contrast, satisfactory results were achieved for only 7 of 10 intra-abdominal testes after diagnostic laparoscopy and standard inguinal orchiopexy despite universal spermatic vessel ligation. Of these 10 testes 2 ended in an inguinal location and 1 atrophied. CONCLUSIONS: Laparoscopy was helpful in determining surgical approach in most cases. The suprainguinal approach allowed most abdominal testes to be placed in the scrotum without vascular ligation.

Adolescent↗
PubMed1997

Early prognostic value of serum creatinine levels in children with posterior urethral valves.

PURPOSE: We evaluated the prognostic value of serum creatinine level at initial treatment for future renal function in children with posterior urethral valves. MATERIALS AND METHODS: We reviewed the records of 35 patients with posterior urethral valves presenting in the first year of life and treated initially at our institution between 1973 and 1990 with valve ablation or vesicostomy. Initial assessment included serum creatinine determination, urine culture, renal ultrasonography and voiding cystourethrography. After 4 or 5 days of catheter bladder drainage renal ultrasound and serum creatinine measurement were repeated. At the end of followup patients were divided into 2 groups according to glomerular filtration rate calculated by the Schwartz formula: group 1--69 ml. or less per minute per 1.73 m.2 (median 15) and group 2--greater than 70 ml. per minute per 1.73 m.2 (median 110). Median followup was 102 months (8.5 years, range 50 to 219 months). RESULTS: Mean serum creatinine at diagnosis plus or minus standard deviation was 3.60 +/- 2.01 and 1.3 +/- 0.7 mg./dl. in groups 1 and 2, respectively (normal 0.1 to 0.6, p < 0.01). Mean serum creatinine after catheterization was 2.4 +/- 1.1 and 0.6 +/- 0.2 mg./dl. in groups 1 and 2, respectively (p < 0.01). Mean nadir creatinine during the first year of life was 1.7 +/- 0.6 and 0.4 +/- 0.2 mg./dl. in groups 1 and 2, respectively (p < 0.01). All differences were statistically significant. Linear regression analysis of creatinine after catheterization and glomerular filtration rate at last followup demonstrated a correlation coefficient of -0.7 (p < 0.01). CONCLUSIONS: Although it is well known that nadir creatinine in the first year of life correlates with prognosis, the correlation of long-term renal function with creatinine at valve ablation or vesicostomy is more useful to the clinician. These data indicate that serum creatinine level 4 to 5 days after the initial diagnosis correlates strongly with long-term renal function in children with posterior urethral valves.

Creatinine↗
PubMed1996

Lack of feminization of the cremaster nucleus by prenatal flutamide administration in the rat and pig.

PURPOSE: The sexually dimorphic cremaster nucleus contains motoneurons that project via the genitofemoral nerve and theoretically direct androgen dependent testicular descent. The effects of flutamide on descent and masculinization of the cremaster nucleus were studied in the rat and pig. MATERIALS AND METHODS: Flutamide was given to pregnant rats and pigs on days 16 to 22 and 65 to 113 of gestation, respectively. Tissues were perfused and examined at birth (pigs) or at age 30 days (rats). Spinal cords were removed, sectioned and immunohistochemically stained for serotonin (rats) or substance P (pigs) to demarcate the position of the cremaster nucleus and allow the determination of cremaster motoneuron number. RESULTS: After exposure to flutamide testes were undescended in 6 of 9 rats and 7 of 10 pigs. Cremaster motoneuron number per nucleus were 288 +/- 22 in control versus 250 +/- 27 in flutamide treated rats, and 165 +/- 28 in control versus 148 +/- 24 in flutamide treated pigs. The decrease in motoneuron number by flutamide was significant in both species (p < 0.02) but it did not approach the levels in female rats (93 +/- 11) and pigs (57 +/- 12). Cremaster motoneuron number did not correlate with testicular position. Porcine undescended testes were associated with a significant increase in mean gubernacular volume. CONCLUSIONS: Unlike other sexually dimorphic spinal cord nuclei masculinization of the cremaster nucleus appears to be largely androgen independent and it does not correlate with ipsilateral testicular descent. These data suggest that androgens do not mediate descent of the testes via the efferent limb of the genitofemoral nerve.

Androgen Antagonists↗
PubMed1996

Experience with ileal augmentation cystoplasty using a short pfannenstiel incision.

PURPOSE: Our study was done to evaluate the efficacy of performing ileal augmentation cystoplasty through a short Pfannenstiel incision. MATERIALS AND METHODS: From December 1986 to June 1988, 7 patients with neurovesical dysfunction secondary to myelodysplasia underwent ileal augmentation cystoplasty via a lower abdominal incision. From July 1989 to July 1993, 12 similar patients underwent ileal augmentation cystoplasty via a short Pfannenstiel incision. RESULTS: Operative time was slightly shorter and mean recovery time, as measured by the return of gastrointestinal function and hospital stay, was shorter in the Pfannenstiel incision group. CONCLUSIONS: In select patients a short Pfannenstiel incision is the incision of choice for ileal augmentation cystoplasty.

Adolescent↗
PubMed1996

Modified Barcat balanic groove technique for hypospadias repair: experience with 295 cases.

PURPOSE: We reviewed the results of a large series of hypospadias repairs (311) using the modified Barcat balanic groove technique. MATERIALS AND METHODS: All patients who underwent modified Barcat repair with closure of the divergent corpus spongiosum were included in our study and were seen or contacted for postoperative followup. RESULTS: Of 295 patients available for followup 94% had excellent cosmetic results. The fistula rate after primary repair was 5% for a glanular or coronal meatus and 18% for a penile meatus, and meatal stenosis was rare. After secondary repair complications were common in patients with a penile meatus. CONCLUSIONS: The Barcat technique allows anatomically superior glans reconstruction in distal hypospadias repair. Fistula rates can be reduced by tissue coverage of the neourethra.

Adolescent↗
PubMed1996

Association of epididymal anomalies with patent processus vaginalis in hernia, hydrocele and cryptorchidism.

PURPOSE: We performed a prospective study to assess the relationship between epididymal anomalies and patency of the processus vaginalis in boys presenting with hernia, hydrocele or cryptorchidism. MATERIALS AND METHODS: The degree of patency of the processus vaginalis (closed, partially closed or open) and morphology of the ipsilateral epididymis were recorded in 159 consecutive inguinal explorations. RESULTS: A closed, partially closed and open processus vaginalis was associated with an abnormal epididymis in 14, 36 and 69% of cases, respectively. Epididymal anomalies were more frequent in association with undescended (72%) than descended (34%) testes. CONCLUSIONS: These data confirm the observation of a higher incidence of epididymal anomalies associated with patency of the processus vaginalis irrespective of testicular position, and they support the theory that androgenic stimulation may be required for closure of the processus vaginalis as well as epididymal development.

Abnormalities, Multiple↗
PubMed1995

A technique for atraumatic scrotal pouch orchiopexy in the management of testicular torsion.

PURPOSE: Scrotal pouch orchiopexy without suture fixation will result in strong atraumatic fixation of the testis in the management of undescended testis. We describe a similar technique that is effective in the management of testicular torsion. MATERIALS AND METHODS: A total of 19 scrotal pouch orchiopexies was performed in 11 boys with testicular torsion. Age ranged from 10 to 17 years (mean 14). Orchiopexy was done using a scrotal pouch without transparenchymal suture fixation of the testis. The partial serosal sac was obliterated, placing the testis in a secured extravaginal position. RESULTS: Followup ranged from 17 to 33 months (mean 25.6). There were no instances of infection, hematoma, wound dehiscence, atrophy or recurrent torsion. CONCLUSIONS: Scrotal pouch orchiopexy as described is recommended to prevent torsion of the testis.

Adolescent↗
PubMed1994

Lack of feminization of the cremaster nucleus in cryptorchid androgen insensitive rats.

Androgens may control rat testicular descent via effects on the genitofemoral nerve or cranial gonadal ligaments. Androgen-mediated release of calcitonin gene-related peptide from the genito-femoral nerve (whose motoneuron cell bodies reside in the sexually dimorphic cremaster nucleus) may stimulate cremaster sac formation and testicular descent. Alternatively, androgens may cause regression of cranial gonadal ligaments and thereby allow the testes to descend. To evaluate these theories testicular position, and the cremaster sac and nucleus were studied in Tfm (androgen insensitive) rats. Testes were abdominal, inguinal and scrotal in 20%, 67% and 13% of Tfm male rats, respectively, and cranial ligaments were present in all cases. Mean cremaster nucleus motoneuron number was lower in female rats (70 +/- 14) but not significantly different between normal male (256 +/- 44) and Tfm male (231 +/- 42) rats, and it correlated poorly with testicular position. Calcitonin gene-related peptide immunoreactivity was rarely observed in cremaster motoneurons. These data suggest that the cremaster nucleus is not androgen-dependent, calcitonin gene-related peptide release from cremaster motoneurons is not the likely mechanism of testicular descent and persistent cranial ligaments may cause cryptorchidism in the Tfm rat.

Androgen-Insensitivity Syndrome↗