Biomedical subjects

V Vukadinović

Publications and source records attributed to V Vukadinović.

7 recordsLinked to original sources

PubMed2001

Surgical treatment of the Müllerian duct remnants.

BACKGROUND: Persistent Müllerian duct tissue in male individuals may result in an enlarged prostatic utricle (utricular cysts and utricle) or a Müllerian duct cysts, either distinctively or synonymously. In intersex patients Müllerian duct remnants (MDR) are an usual occurrence. Surgical excision is the definitive treatment of symptomatic remnants, as well as during the reconstruction of intersexual genitalia. Many approaches have been described. The authors review their experience in intersex patients. METHODS: From 1986 to 1999, the authors treated 111 patients with intersex disorders. The records of 47 patients raised as boys with MDR were reviewed. Based on the symptoms and the size of the remnants, in 32 patients the structures were removed. In 13 patients extirpation was done by perineal approach, in 9 by transperitoneal approach, and in the remaining 9 patients the combined abdominal and perineal approach were undertaken. In one patient the large prostatic utricle was extirpated by a posterior sagittal pararectal approach. Perineal approach was mainly used in younger asymptomatic children, with the prostatic utricle disclosed incidentally during genitography because of intersex disorders. Operation was performed only in cases in which the prostatic utricle was observed by cystoscopy or identified by Fogarty balloon catheter introduction into the prostatic utricle. In older patients these structures were discovered frequently after failed urethroplasty, or after symptoms of urinary infection, urinary retention, or epididymitis. We elected to use the transperitoneal approach based on the extension of these structures into the pelvis. The average age of patients at the time of surgery was 8.6 years, with a range of 1 to 30 years. RESULTS: There were no rectal or bladder injuries during surgery. An older patient had temporary impotence after abdomino-perineal extirpation. The lack of ejaculation, seen in 5 patients, was related to frequent intra-utricular termination of the vas deferens. Posterior sagittal pararectal approach certainly enabled complete exposure and exact visualization of all structures, with considerably decreased bleeding. If gonadal biopsy or gonadectomy were necessary, the transperitoneal approach could not be avoided. CONCLUSIONS: Surgical treatment of MDR in intersex patients varies according to the size of the utricle, and a double approach is often necessary. A high degree of success may be achieved with minimal morbidity. J Pediatr Surg 36:870-876.

Adolescent↗

PubMed1996

Extravesical detrusor tunneling: a variant of antireflux procedure.

Detrusor tunneling procedure is an extravesical technique, which provides antireflux implantation of different tube systems (ureter, appendix, tubularized preputial flap, tapered ileum). The main characteristic of the technique is the formation of extravesical submucosal tunnel by creating a bridge from the unresected bladder muscle under which the tube is passed. During the period from January 1987 to July 1995, the technique was performed on 442 different tube systems: 402 ureters, 12 appendices, 26 tubularized preputial flaps and 2 tapered ileums. Patients were aged from 15 days to 42 years (mean 39 months). Follow-up was from 2 months to 8 years (mean 2.9 years). Postoperative complications occurred in 11 cases. There were 3 stenoses and 5 refluxes in ureteroneocystostomies, and one stenosis and 2 urine leakages in continent cutaneous vesicostomies. The extravesical detrusor tunneling procedure could be a very useful method for antireflux implantation of various tube systems.

Adolescent↗

PubMed1996

[Surgical treatment of vesicoureteral reflux by tunnelling of the detrusor muscles].

Detrusor tunnelling is an extravesical surgical procedure of ureteral reimplantation. It is surely the least traumatic method of surgical correction of vesico-ureteral reflux because antireflux mechanism is achieved with minimal detrusor muscle dissection. This procedure simplifies implantation of dilated ureters, double ureters as well as the ureters shortened by previous antireflux surgical procedures. Ureteral tapering is unnecessary. One hundred and forty detrusor tunnelling uretero-cysto-neostomies in 102 patients have been performed in the University Children's Hospital between January 1990 and September 1994. The youngest patient was 1 month old and the eldest was 15 years (mean age 6.8 years). Indications for surgical treatment were primary (45.0%) and secondary (26.4%) megaureter as well as grade IV & V (international classification) vesico-ureteral reflux (28.6%). Follow up was 1-40 months (mean 26 months). Excellent postoperative results were achieved in 130 detrusor tunnelling uretero-cysto-neostomies, i.e. more than 90% of patients. Complication rate was 7.1% (6 patients-10 ureteral units) and about one third were classified as major-postoperative relapses or stenosis or minor-intraoperative mucosal perforation, hematuria, parahiatal diverticulum, spontaneous proximal migration of ureteral double J stent-about two thirds.

Adolescent↗

PubMed1994

Onlay island flap urethroplasty for severe hypospadias: a variant of the technique.

A variant of the onlay island flap urethroplasty in severe hypospadias repair is described. The principles of the technique include mobilization of the urethral plate without dividing it, release of chordee, creation of a pedicle island flap on the dorsal penile skin with redundant vascularized tissue that is transposed to the ventral side of the penis by a buttonhole maneuver, and onlay of the flap to the mobilized urethral plate, covering all suture lines with a wide pedicle of flap. During the last 3 years this operation was performed in 92 patients 12 months to 19 years old with severe hypospadias. The complication rate was 5%.

Adolescent↗

PubMed1992

Penoscrotal transposition with hypospadias: 1-stage repair.

A 1-stage surgical repair of penoscrotal transposition with hypospadias is described. The basic principles are correction of hypospadias with the best vascularized island penile skin flap used for a new urethra and 2 vascularized sliding skin flaps used for reconstruction of the penile skin, and transposition of the penis to the suprascrotal position in the area of the mons pubis, with mobilization plus midline testicular fixation (inter-orchiopexy) and scrotoplasty. This technique was applied in 42 patients 2 to 9 years old between 1986 and 1991. The complications were 2 urethral stenoses on the proximal anastomosis (1 was treated successfully by urethrotomy and 1 by an open operation) and 2 fistulas (successfully treated by surgery), while 2 patients required additional correction of penoscrotal transposition.

Child↗

PubMed1992

Epispadias surgery--Belgrade experience.

From 1987 to 1991, 46 patients underwent surgical treatment for epispadias. Of these, 14 had isolated epispadias and 22 had epispadias within the exstrophy/epispadias complex. The patients ranged in age from 6 months to 20 years. To correct the genital aspect of the anomaly the basic principles of Ransley's technique were used. In addition, the island flap technique was used for the most severe, so-called "cripple" form. In patients with exstrophy/epispadias complex, only elongation of the penis was performed during primary reconstruction, while the correction of epispadias, using the above techniques, was performed in the second-stage operation. Complications occurred in 6 patients.

Adolescent↗

PubMedDate not supplied

[Ultrasound in the diagnosis of hypertrophic pyloric stenosis].

The paper deals with the advantages of ultrasound diagnosis of hypertrophic pyloric stenosis in newborns. Ultrasound decreases the number of radiological examinations of gastroduodenum and reduces diagnostic exposure of children to X-rays. In the last three years 107 children had manifested clinical signs of hypertrophic pyloric stenosis. The ultrasound studies revealed hypertrophic pyloric stenosis in 55 patients (51.4%). There were 48 boys (87.3%) and 7 girls (12.7%). Patients were aged 17 to 75 days (average about 40 days). The sonogram finding was typical for hypertrophic pylorus, which made the diagnosis easier. There were no false positive or false negative ultrasound findings. All patients with hypertrophic pyloric stenosis were operated on and diagnosis was confirmed. Ultrasound is reliable in diagnosis of hypertrophic pyloric stenosis. Ultrasound examination is technically easy and fast, what is important for urgent surgical therapy. In children with persistent projectile vomiting, suspected of hypertrophic pyloric stenosis, ultrasound is the method of choice and should replace X-ray examinations.

Female↗