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Biomedical subjects

R C Rink

Publications and source records attributed to R C Rink.

89 records · Page 5Linked to original sources
PubMed1988

Symphyseal diastasis in the absence of the exstrophy-epispadias complex.

Symphyseal diastasis in the absence of exstrophy or epispadias is rare. We reviewed 11 reported cases and present 2 of our own. Based upon our findings, we recommend a thorough physical examination in all patients. A voiding cystourethrogram in those with the radiographic finding of symphyseal diastasis in the absence of exstrophy or epispadias may be helpful. A significant number of patients have associated congenital anomalies.

Child↗
PubMed1988

Chronic renal failure and bladder augmentation: stomach versus sigmoid colon in the canine model.

A canine model for chronic renal failure and bladder augmentation with a segment of stomach or sigmoid colon (or control) was developed to evaluate the possible benefit of net chloride ion excretion noted in an earlier canine model for gastrocystoplasty. Gastrocystoplasty animals behaved similar to control animals relative to the sigmoid cystoplasty animals, tolerated significantly greater acid loading, did not have hyperchloremia with acidosis and had less weight loss with acidosis. Gastrocystoplasty seems to be superior to sigmoid cystoplasty in the azotemic canine.

Acidosis↗
PubMed1988

Gastrocystoplasty: an alternative solution to the problem of urological reconstruction in the severely compromised patient.

An isolated segment of stomach was used for bladder augmentation in 10 patients or construction of a continent urinary reservoir in 3. Diagnosis in these 13 patients included cloacal exstrophy (5), myelodysplasia (4), posterior urethral valves (2), radiation cystitis (1) and neurogenic bladder secondary to a rectal pull-through procedure (1). Indications for the use of stomach in bladder reconstruction were decreased renal function and acidosis (6 patients), insufficient large and small bowel (6) and decreased mucus production (1). Postoperative followup averaged 13 months (range 6 to 23 months). All patients have stable upper tracts radiographically and stable or improved renal function. Of 13 patients 10 require intermittent clean catheterization to empty and 11 are completely continent. Nine patients have remained free of infection, while 4 had asymptomatic bacteriuria. Mucus production is reduced relative to other intestinal segments and 10 patients require no bladder irrigations. Postoperative urodynamic evaluation is similar to that of ileocystoplasty or colocystoplasty. Use of stomach has protected these patients from the development of new or worsened hyperchloremic acidosis. Serum chloride values have decreased and serum total carbon dioxide values have increased after bladder reconstruction, particularly in patients with impaired renal function. Stomach should be considered when lower urinary tract reconstruction is necessary in such compromised patients.

Adolescent↗
PubMed1988

Neurourological implications of the changing approach in management of occult spinal lesions.

Occult lesions of the spine in children are a rare but recognizable cause of neurogenic dysfunction involving the lower extremities, and lower urinary and gastrointestinal tracts. We report the preoperative and postoperative urodynamic findings in 40 children with varying spinal abnormalities. Of these patients 28 were neonates or infants (average age 8.7 months) and 12 were older children (average age 11.7 years). Preoperative urodynamic testing revealed normal function in 18 of 28 children (64 per cent) in the younger age group in contrast to 1 of 12 (8 per cent) in the older age group. Of the 10 infants with abnormal studies postoperative urodynamic findings returned to normal in 6, while 2 others remained abnormal but were improved. In contrast, of 11 older children with abnormal preoperative evaluations 3 (27 per cent) reverted to normal postoperatively. The neurourological changes seen in these occult lesions are variable, may occur at any age, are progressive and are potentially reversible by surgical correction but this reversibility diminishes with age.

Adolescent↗
PubMed1988

Collateral urethral duplication in the frontal plane: a spectrum of cases.

Collateral urethral duplication in the frontal plane is a rare anomaly. We report 3 cases of this variant of urethral duplication and review the literature. Double stream was the most frequent complaint and associated midline defects were common. Management, including a unique method of surgical intervention, is discussed.

Child, Preschool↗
PubMed1988

Urethral replacement with ureter.

Proximal or total urethral replacement was performed in 8 patients using distal ureter. This was accomplished by basing the ureteral segment solely on a vascular pedicle arising from the internal iliac artery. Diagnoses included classical bladder exstrophy in 4 patients, cloacal exstrophy in 3 and an imperforate anus with hypoplasia of the bladder neck and urethra in 1. Continence was achieved by a tunneled submucosal reimplantation into either the bladder (4 cases), gastric reservoir (2) or colonic reservoir (2). Although an isolated distal segment of ureter was used in each case, all segments have remained viable. With limited followup (5 to 44 months) continence with either normal voiding or intermittent catheterization has been achieved in 7 of the 8 patients. A distal ureteral segment should be considered potentially useful in the construction or reconstruction of the proximal (male) or total (female) urethra in patients with congenital urethral malformations.

Anus, Imperforate↗
PubMed1987

Focal salmonella enteritidis infection of urinary tract.

A case of upper urinary tract infection with Salmonella enteritidis is presented. The patient was diabetic which may have resulted in diminished immunocompetence, but no other predisposing factor was uncovered. Thorough search for an extraurinary primary source of this infection was unrevealing. The implications of this type of infection are reviewed.

Aged↗
PubMed1987

Vesical endometriosis: medical or surgical treatment.

A case report of endometriosis of the bladder is presented, with special reference to treatment options. Recent experience with this lesion illustrates the dilemma facing the physician who must determine a course of treatment. It seems that removal of the bladder lesion by segmental cystectomy is the preferred treatment.

Adult↗
PubMed1987

Gastrocystoplasty and colocystoplasty in canines: the metabolic consequences of acute saline and acid loading.

An experimental canine model was developed to quantitate the net transmural ion flux of colon and gastric segments used for augmentation cystoplasty. Gastrocystoplasty (4) or colocystoplasty (4) was constructed in 8 female mongrels. Acute intravenous saline and acid loading experiments were performed 2 to 4 weeks after cystoplasty. The mean solute excretion rates for sodium, chloride, phosphorus and ammonia exhibited opposite trends during acute saline and acid loading in this experimental model. The net flux of chloride, ammonia, phosphorus and sodium ions in the colocystoplasty animals was from the mucosa/urine surface to the serum (reabsorption). The opposite trend was true for the gastrocystoplasty. By not reabsorbing ammonium chloride, the gastrocystoplasty preserved an important renal mechanism for systemic acid elimination. This may help to prevent the hyperchloremic metabolic acidosis that can develop when urine comes in contact with small or large bowel segments.

Acid-Base Equilibrium↗
PubMed1987

Pediatric urinary diversion and undiversion.

Many things have changed in our management of the urinary tract of children and young adults. Important contributions from many sources have resulted in the refinement of therapy and the progression from diversion to undiversion and reconstruction. Primary urinary diversion is now uncommon. Patients with exstrophy, for example, are treated with primary bladder closure as newborns, and newborns with valves often are treated with primary valve ablation. Children with neurogenic bladder dysfunction resulting from myelodysplasia are rarely diverted, but are started at an early age with ICC. It is hoped that in future the contents of this article on diversion techniques and undiversion will be of historical interest, however. Note: The editors also have found the use of the Mitrofanoff procedure, utilizing a nonrefluxing tunnel and a catheterizable stoma made out of the ureter or appendix, to be a very valuable addition to the reconstructive surgeon's armamentarium. We also feel that use of detubularized bowel for either bladder augmentation or replacement provides more efficient storage capability. Occasional reports of extremely significant diarrhea after removal of the ileocecal segment from the intestinal tract have been reported in children with myelodysplasia.

Adolescent↗
PubMed1987

Subepithelial pyeloureteric lesions in patients with nephrostomy tubes.

Mural filling defects were identified in the renal pelves or ureters in five patients with nephrostomy tubes. In two patients, infection was documented. In the remaining patients, the urine was sterile. While typical ureteritis cystica associated with infection may be seen in patients with nephrostomy tubes, in some patients, other mechanisms are responsible for this appearance.

Adult↗
PubMed1985

Induction of cloacal exstrophy in the chick embryo using the CO2 laser.

We have developed a model for cloacal exstrophy in the chick embryo using the Cavitron AO 300 CO2 laser. Embryos between 68 and 76 hours of development have been injured caudal to the omphalomesenteric vessels in the region of the tail bud in ovo. This has resulted in the induction of cloacal exstrophy in 5 of 59 chicks that survived ten days after injury. Evidence from this model suggests that cloacal exstrophy is caused by early disruption of the cloacal membrane or that group of cells responsible for its subsequent development.

Animals↗
PubMed1985

Urinary diversion and undiversion.

Urinary diversion as a permanent mode of therapy in childhood is becoming uncommon. Indications for temporary diversion are also few, particularly since the advent of percutaneous placement of tubes for temporary diversion. In the same sense, techniques and principles applied to urinary undiversion that are outlined in this article are now used for primary reconstruction in patients who previously would have been diverted.

Adolescent↗
PubMed1984

Surgical correction of urinary incontinence.

Over the last 6 years, 114 patients have undergone surgery for urinary incontinence. The majority (79%) had neurologic dysfunction of the bladder because of spinal malformation (myelodysplasia, sacral agenesis, or trauma) and the remaining were a mixed group including exstrophy/epispadias, urethral valves, pelvic fractures, etc. The patients were grouped in six categories. Those with lower urethral resistance underwent bladder neck reconstruction with Young-Dees-Leadbetter procedure (five patients) or had placement of an artificial urinary sphincter (27 patients). Those with poor bladder compliance underwent primary bladder augmentation (21 patients). Those with combined urethral problems and poor compliance had combined procedures (14 patients). Thirty-seven patients previously diverted for incontinence and undergoing undiversion were considered separately, as were ten patients without any bladder precluding preoperative assessment. Of the entire group, continence was achieved in 83 patients with the initial procedure (73%). Secondary procedures have resulted in continence in 101 patients (89%). Three patients were improved but unsatisfactory, and nine remain wet; one is unknown.

Child↗
PubMed1983

Experience with the artificial urinary sphincter in children and young adults.

The artificial urinary sphincter (model AS 791-792), American Medical Systems, Minnetonka, Minn.) has been implanted in 41 patients (mean age 13.9 years) who were incontinent in spite of intensive efforts with other modes of management. Neurogenic bladder dysfunction is present in 34 patients. Seven patients have non-neuropathic dysfunction of the bladder neck and urethra (3 with exstrophy/epispadias, 3 incontinent after multiple bladder and urethral procedures, and 1 incontinent after a pelvic fracture). Twenty-two patients have had intestinocystoplasty performed and 11 patients had previous urinary diversion. Mean follow-up for a given device is 23 months (range 6 to 47 months). Of these patients, 80.5% are totally or acceptably dry. Five patients (12.2%) were rated as fair, and three were failures (7.3%). Complications have been significant in that reoperation has been necessary in 16 patients. Indications for patient selection is emphasized.

Adolescent↗
PubMed1983

Genitourinary neurofibromatosis in childhood.

Neurofibromatosis in children occurs uncommonly and involvement of the bladder is exceedingly rare. The syndrome is transmitted as an autosomal dominant trait and is characterized by cutaneous pigmentation and tumors of neural crest origin. Hypertension has been documented in association with neurofibromatosis in the form of renovascular disease in children and with pheochromocytomas in adults. We report on 2 children with extensive neurofibromas of the bladder, upper tract damage and genital enlargement. One case was misdiagnosed as posterior urethral valves and the other case as clitoral hypertrophy. The literature of urogenital neurofibromatosis is reviewed with particular attention to bladder lesions, hypertension, malignant potential and treatment options.

Child, Preschool↗