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Biomedical subjects

P C Cartwright

Publications and source records attributed to P C Cartwright.

34 records · Page 2Linked to original sources
PubMed1995

Complications of pregnancy in women after childhood reimplantation for vesicoureteral reflux: an update with 25 years of followup.

Surgery for the correction of vesicoureteral reflux has been performed routinely since the early 1960s. In 1986 a large group of women who underwent childhood ureteral reimplantation surgery was contacted and surveyed concerning infections, pregnancies and other complications. A notably high rate of cystitis and pyelonephritis was found during pregnancy. Because 9 years have passed and many more pregnancies have occurred, we contacted this cohort again as well as a new cohort of historical controls to reassess long-term complications of childhood ureteral reimplantation in children. Of 67 women who underwent reimplantation with an average followup of 25 years 62 were contacted of whom 75% had urinary tract infections after becoming sexually active and 65% had urinary tract infections with pregnancies. Of 141 pregnancies 57 (40%) were complicated by urinary tract infections and 21 (15%) terminated in spontaneous abortion. Of 37 women with primary vesicoureteral reflux and no surgery with an average followup of 25.5 years there was a 15% prevalence of urinary tract infections with pregnancy in 21. Of 75 pregnancies in this group 14 (18%) terminated in spontaneous abortion. Women with urinary tract infections and reflux as children have high rates of cystitis with the onset of sexual activity whether or not they underwent reimplantation as children. Those who underwent reimplantation as children are at significant risk of urinary tract infection in pregnancy but not at a higher risk of miscarriage than the general population. Education, screening and antibiotic prophylaxis during pregnancy should be considered.

Abortion, Spontaneous↗
PubMed1995

Bilateral testis tumors in an infant: synchronous teratoma and epidermoid cyst.

Teratoma ranks second in frequency to yolk sac carcinoma among testicular germ cell tumors in infants, accounting for 25% of cases. Testicular teratomas are uniformly benign in children younger than 24 months old. Epidermoid cysts are tumor-like lesions of unknown etiology, probably monodermal teratomas, comprising 3% of all pediatric testis tumors. Bilaterality is rare for both tumors. We report a case of a synchronous left testis teratoma and a right testis epidermoid cyst. Appropriate therapy is discussed.

Epidermal Cyst↗
PubMed1994

Yoke hypospadias repair.

A new one-stage operation for correction of the more severe degrees of proximal hypospadias is described. This allows for the correction of chordee and maintains a dual vascular supply to the urethral flap derived from periurethral and pedicle blood vessels. This technique allows for correction of chordee and urethroplasty, and avoids the need for combination or staged repairs.

Humans↗
PubMed1994

Repair of urethral diverticulum by plication.

OBJECTIVES: To develop a new technique to repair congenital and acquired megaurethra without opening the enlarged urethra. METHODS: A urethral plication similar to the Starr ureteral plication was developed, which allows the urethra to be plicated without opening into the lumen. This technique also allows the operation to be done in conjunction with hypospadias repairs. RESULTS: Eight of 10 patients had uneventful recoveries. One had obstruction and infection that resolved with drainage and antibiotics. A coronal margin fistula developed in a patient who had urethral plication as well as urethral advancement. CONCLUSIONS: This new urethral plication eliminates the need for opening the urethra and its associated complications while preserving urethral blood supply and allowing associated hypospadias repairs to be simultaneously performed.

Child, Preschool↗
PubMed1993

Urological manifestations of sacrococcygeal teratoma.

A review was done of 29 patients diagnosed with sacrococcygeal teratoma between 1978 and 1991. Urological disorders included total urinary retention (6 patients), hydronephrosis (6), hydrocele (4) and undescended testis (1). Ultrasonography and voiding cystourethrography were performed on the 6 patients in total urinary retention. These studies revealed cystic retrorectal lesions frequently with intralesional calcifications, and anterior and superior displacement of the bladder. Bladder wall trabeculation occurred in 2 of these 6 patients, and 4 had moderate or severe hydronephrosis. Upper urinary tract dilatation was found in 2 patients not in total retention. Hydronephrosis appeared to be related to poor bladder emptying and presumably high intravesical pressures, since each case resolved spontaneously after tumor resection. No primary upper tract anomalies were identified.

Female↗
PubMed1993

A surgical approach to reoperative orchiopexy.

While techniques for initial orchiopexy are well known, descriptions of a surgical approach to the more difficult reoperative case are scarce. We describe 25 patients undergoing reoperative orchiopexy following prior herniorrhaphy, hydrocelectomy or attempted orchiopexy. A technique of en bloc spermatic cord mobilization from an inferior approach is detailed. This approach is designed to minimize the potential for spermatic cord injury during reoperation, and has proved to be safe and reliable.

Child↗
PubMed1992

Tunica vaginalis urethroplasty.

Tunica vaginalis on a vascular pedicle was tubularized and used as a urethra to repair hypospadias in three difficult cases. This is the first report of tunica vaginalis utilized for a urethral reconstruction in humans. This new surgical technique is described.

Child↗
PubMed1992

The predictive value of ultrasonography in evaluation of infants with posterior urethral valves.

Between 1981 and 1989, 28 infants less than 6 months old with posterior urethral valves underwent ultrasound evaluation as part of the initial evaluation at our hospital. The single ultrasound feature that correlated with subsequent renal function was the status of corticomedullary differentiation. The presence of corticomedullary junctions in at least 1 kidney in 17 infants was always associated with a serum creatinine level of 0.8 mg./dl. or less in long-term followup. Of 11 patients with absent corticomedullary differentiation 7 had eventual creatinine levels of greater than 0.8 mg./dl. with 5 of them suffering clinically significant renal insufficiency. An association between vesicoureteral reflux and absent corticomedullary junctions was also found.

Follow-Up Studies↗
PubMed1992

Managing apparent ureteropelvic junction obstruction in the newborn.

A total of 97 newborns with apparent ureteropelvic junction obstruction was evaluated from mid 1984 to 1989. Evaluation and management are described. Of these patients 39 with an affected kidney showing good initial differential function (greater than 35%) by diethylenetriaminepentaacetic acid scan and 2 showing diminished function (less than 35%) were followed nonoperatively. Six patients (15%) eventually required pyeloplasty for diminishing function (4), urinary tract infections (1) or symptoms of colic (1). The 4 patients with diminishing function improved after pyeloplasty to at least the initial level. A total of 12 patients with good initial function (greater than 35%) of the affected kidney underwent early pyeloplasty (within 6 weeks of diagnosis). They were compared to the similar group of patients managed nonoperatively and followed by sequential renal scans. Eventual changes in percentage differential function in the nonoperative and early surgery groups were +2.8% and +4.1%, respectively. Changes in extraction factor were +0.8% (nonoperative group) and +0.9% (surgery group). No statistically significant difference was found. In the kidney with apparent ureteropelvic junction obstruction and good function, an initial nonoperative approach with sequential renal scan followup and pyeloplasty as needed appears to be reasonable and has resulted in no permanent loss of function.

Follow-Up Studies↗
PubMed1989

Bladder autoaugmentation: early clinical experience.

A surgical technique is described in which detrusor muscle over the entire dome of the bladder is excised while leaving the bladder epithelium intact. A large epithelial bulge is created, which functions to augment the storage properties of the bladder without using bowel, and it is referred to as "autoaugmentation". Seven patients have undergone autoaugmentation of whom 5 have excellent clinical results while 1 has modest improvement. The remaining patient was a technical failure. Postoperative urodynamics in 5 patients demonstrated improved bladder capacity in 3 and markedly improved bladder storage pressures in 4 compared to preoperative studies. The technical aspects of the procedure and patient management are discussed. Autoaugmentation offers potential advantages over enterocystoplasty, is simple to perform, does not preclude future enterocystoplasty if needed and may be a reasonable alternative to conventional augmentation in selected patients.

Adolescent↗
PubMed1989

Bladder autoaugmentation: partial detrusor excision to augment the bladder without use of bowel.

A surgical technique of partial detrusorectomy (autoaugmentation) for creation of a diverticular bulge of the dog bladder is described. The method is designed to serve as a bladder augmentation without using bowel. We describe the technique, results with dogs and its clinical application. Partial detrusorectomy appears to function as an autoaugmentation that can be performed reliably in dogs, offers potential advantages over bowel segments, and is a potential alternative to enterocystoplasty in selected patients.

Animals↗