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At least 955 records · Page 53Linked to original sources
PubMed1997

Pregnancy after Mainz pouch urinary diversion.

PURPOSE: We report on our experience with pregnancies and deliveries in patients with a continent ileocecal reservoir with catheterizable stoma (Mainz pouch). MATERIALS AND METHODS: Six women aged 18 to 33 years (mean age 26.8 years) became pregnant after undergoing urinary diversion. A continent ileocecal reservoir was made comprising 5 umbilical stomas and 1 stoma in the left lower abdominal quadrant. Underlying diseases were bladder exstrophy in 4, meningomyelocele in 1 and urogenital sinus in another patient. Cesarean section was jointly performed by the obstetricians and urologists in all patients. RESULTS: Seven pregnancies occurred in a total of 6 women. Three pregnancies were completely uneventful. Pregnancy complications were ureteral dilatation in 4 cases with pyelonephritis and premature labor in 1 case. A nipple prolapse in the patient with the stoma in the left lower abdominal quadrant was easily corrected during cesarean section. All patients underwent cesarean section without complications. Seven healthy children were born. CONCLUSIONS: In women with Mainz pouch urinary diversion there appears to be no contraindication to pregnancy, while other forms of continent diversion await further evaluation. Urologists and obstetricians should be aware of the potential complications of this high risk pregnancy and delivery, and their interdisciplinary cooperation is essential for successful outcome.

Adolescent↗
PubMed1998

[Ureterosigmoidostomies. 35 cases].

35 patients underwent ureterosigmoidostomy between 1986 and 1996, corresponding to 25 males (71%) and 10 females (29%) with a mean age of 48 years (range: 21 to 81 years). 25 (71%) of these patients had invasive bladder cancer, 4 (12%) had a vesicovaginal fistula, 3 (9%) had bladder exstrophy and 3 (9%) had urethral trauma. All patients had normal renal function. In 2 patients, the ureter was dilated and in 3 other patients, one kidney was silent. The postoperative course are marked by death in 2 cases (6%) due to myocardial infarction, mechanical obstruction in 2 cases (6%), anastomotic dehiscence in 2 cases (6%). The mean follow-up was 4 years (range: 2 to 10 years). Eight patients (22%) developed impaired renal function, isolated hyperchloraemic acidosis was observed in 10 cases (28%), hypokalaemia was observed in 2 cases (6%), and episodes of acute pyelonephritis were reported in 4 cases (11%). Radiological signs of upper urinary tract deterioration were observed in 6 cases (17%). A tumour of the sigmoid colon was observed in one case after a follow-up of 10 years. 25 patients (72%) remain dry throughout the night, while 8 (22%) need to empty their rectum during the night. The poorly tolerated Coffey diversion was replaced in 6 patients (17%). The objective of this study is to analyse the results of ureterosigmoidostomy and to emphasize the advantages and disadvantages of this urinary diversion technique.

Adult↗
PubMed1998

[Surgical repair of male epispadias by the Cantwell-Ransley procedure: technical aspects and functional results in a series of 40 patients].

From 1989 to 1997, 40 patients underwent primary (n = 29) or a secondary (n = 11) epispadias repair according to the Cantwell Ransley Procedure. 23 patients had bladder exstrophy, 6 had penopubic epispadias, and 11 had penile epispadias. The mean age at surgery was 5 years (1-28 years); 23 patients were prepubertal and 17 were postpubertal. The procedure associated an IPGAM meatoplasty, ventral transposition of the urethra, and dorsal rotation and approximation of the corpora with (16) or without (24) caverno-cavernostomy. With a mean follow-up of 4 years, 19 patients (47.5%) achieved a good cosmetic and functional result after a single procedure. 18 patients (45%) developed complications that required minor revision (8 patients) or a more major procedure (10 patients). Finally 3 patients (7.5%) had a complete failure. 3 patients also had a loss of continence (complete in one case) after the procedure. The complication rate was slightly higher in the postpubertal group (58%) than in the prepubertal group (47%). A prior urinary diversion did not increase the complication rate. All 17 patients in the postpubertal group reported satisfactory erections. All 16 patients who had minor to major urethral complications had previously undergone transection of the urethral plate. Overall 35 patients (87.5%) achieved a satisfactory cosmetic and functional result. The Cantwell Ransley procedure is an excellent procedure for the repair of male epispadias. However the complication rate is significant, mainly related to previous operations compromising the blood supply to the posterior penile urethra.

Adolescent↗
PubMed1999

Covered exstrophy with incomplete duplication of the bladder.

A rare exstrophy variant in a 1(1/2)-year-old girl is reported. The child had a wide, scar-like lesion over the lower central abdomen with divarication of the recti and a spread symphysis pubis. The underlying bladder was divided into two unequal chambers by a complete sagittal septum with only the right chamber communicating with the single urethra and the left draining by a vesicocutaneous fistula. Both kidneys were normal. The clitoris was bifid and the anus anteriorly placed. Preliminary surgical management consisted of dissection of the bladder from its prevesical covering, excision of the sagittal septum, and cystocystostomy. Postoperatively, the child had normal urinary continence. The literature is reviewed with special reference to the various forms of duplicate exstrophy.

Abnormalities, Multiple↗
PubMed1994

Indications for bladder augmentation in the exstrophy-epispadias complex.

OBJECTIVE: To determine whether bladder augmentation has a role in avoiding urinary diversion in patients with exstrophy-epispadias complex (EEC), whether it can improve the lifestyle in patients who have previously undergone diversion or improve the result of any single surgical step in the staged functional reconstruction of the bladder in these patients. PATIENTS AND METHODS: From 1970 to 1991, 85 patients were treated for EEC. Between 1981 and 1991, 12 bladder augmentations were performed in 11 patients (seven girls and four boys) with bladder exstrophy, male epispadias (one case) and cloacal exstrophy (one case). RESULTS: No significant early surgical complications were reported. Follow-up ranged from 18 months to 11 years. Late complications included bowel obstruction in one patient, a partial left ureteric stenosis at the level of the anastomosis with the gastric patch wall in one patient and bladder lithiasis in five patients (sigmoidocystoplasty in one and ileocystoplasties in four). No metabolic problems, no bladder perforations or malignancies were observed. The results on continence were good and, with the one exception reported, the condition of the upper urinary tract following surgery was satisfactory in all patients. CONCLUSION: Augmentation cystoplasty is of use in the treatment of patients with bladder exstrophy when staged functional reconstruction is unsuccessful. This technique greatly reduces the indications for urinary diversion and can be used in the surgical treatment of EEC. The only disadvantage is that clean intermittent catheterization must be performed, sometimes only temporarily, but patient acceptance is usually high.

Bladder Exstrophy↗
PubMed1993

The cephalotrigonal reimplant in bladder neck reconstruction for patients with exstrophy or epispadias.

A modified technique of ureteroneocystostomy with bladder neck plasty was used in 36 of 75 patients undergoing staged repair of bladder exstrophy or epispadias between 1986 and 1992. This procedure entails mobilizing the ureter while preserving the trigonal hiatus as with the cross-trigonal technique. The distal ureteral segments are directed superiorly toward the bladder dome rather than across the mid line. Of 75 patients 36 underwent cephalotrigonal reimplantation and 39 had a conventional cross-trigonal reimplant. Continence rate was 77% in the patients who underwent cephalotrigonal reimplantation and 72% in those who had a cross-trigonal reimplant. No patient had ureteral obstruction or vesicoureteral reflux. The ureter in exstrophy patients enters the bladder from an inferior position within the true pelvis. Directing the ureter superiorly rather than across the mid line provides a more gradual course through the hiatus and submucosal tunnel. The cranial course of the distal ureter frees more of the trigone for use in the rolled segment of the bladder neck and provides more muscle area for the tube. This is especially important in the patient in whom the distance between the mid prostate and trigone is particularly short.

Bladder Exstrophy↗
PubMed1991

[Formation of a urinary reservoir from a small intestinal graft in children with exstrophy of the urinary bladder].

The authors suggest a new approach to the treatment of patients with exstrophy of the urinary bladder-the formation of an urinary reservoir from a detubulerized intestinal graft after II Kocks' method. This method, as well as its analogues, is mainly used in adults after radical cystectomy. Improved surgical techniques have been suggested on the basis of experimental works which allow the age features and the peculiarities of the functional condition of the formed reservoir to be taken into account. Analysis of the results of clinical use of the suggested method showed it to be effective in solving the problem of rehabilitation of patients with exstrophy of the urinary bladder, which allows it to be recommended as the operation of choice in the management of this developmental anomaly.

Bladder Exstrophy↗
PubMed1993

Evaluation and treatment of incontinence after bladder neck reconstruction in exstrophy and epispadias.

Twenty-five children with exstrophy/epispadias who had had at least one bladder neck operation (but no augmentation) for incontinence underwent cystometrography (CMG) and urethral pressure profile (UPP) studies. The purpose of this study was to examine all components of lower urinary tract function and to determine how the properties of the bladder and the properties of the bladder neck/urethra interacted to achieve continence or to result in incontinence in the individual child. Examination of detrusor function during filling revealed involuntary contractions in 12 children and an end-fill pressure > 10 cm H2O in 8. Of the 21 children in whom voiding could be evaluated only 6 could initiate a detrusor contraction. In the 18 incontinent children leak pressure could be measured and was > or = 15 cm H2O in 12. Five of the 7 continent children also demonstrated at least one abnormality in lower tract function. The maximum pressure of the UPP did not agree with the leak pressure and may not be a valid measure of the closing pressure of the bladder neck/urethra in this patient population. Detailed urodynamic investigation is necessary in these children to guide the next step of management and to evaluate objectively each form of treatment.

Adolescent↗
PubMed1975

[An assessment of the functional results of various forms of surgery for epispadias and exstrophy (author's transl)].

Urinary continence can be achieved by total reconstruction in perhaps 20 percent of patients born with exstrophy of the bladder. Uretero-rectal anastomosis offers a reasonalbe alternative but carries a high morbidity. Cutaneous diversion is the safest form of long-term management, but this involves the life-long penalty of a stoma and the need for appliances. Conservative reconstructive surgery is advocated in the first instance, but repeated surgical procedures may be necessary for a successful result.

Bladder Exstrophy↗
PubMed1989

[Endoscopic treatment of vesico-ureteral reflux using a sub-mucous injection of Teflon paste in children. Apropos of 337 patients (491 ureters)].

We reviewed our experience with endoscopic sub-ureteral injection of polytetrafluoroethylene (PTFE) in 337 children (84% females, 16% males). Four hundred and ninety one refluxing ureters were injected (93% primary reflux, 7% secondary reflux after reimplantation, correction of exstrophy of the bladder or neurogenic bladder). Reflux was: - stage I: 7.8% - stage II: 32% - stage III: 38% - stage IV: 20% - stage V: 2.2% Follow-up cystograms were performed one 428 ureters, 6 to 30 months after injection. 80% of children are cured after one injection while 4% required two injections in order to attain the same result. Improvement in the grade of reflux (minimal residual disease) was noted in 10% of the patients and in 6% the procedure failed. In the latter group, 16 children were operated on without difficulty; lymphatic migration of PTFE was noted in two cases. In the 33 patients with secondary reflux, the endoscopic treatment was associated with an 80% cure rate, in the 26 patients presenting a reflux on duplex systems, cure rate was 65%. This is a simple procedure performed on an outpatient basis; in our experience with 491 injections there were no complications at the time of injection nor there any postoperative ureteric obstruction. Endoscopic PTFE injections are less efficient than surgical reimplantation in the treatment of vesico-ureteral reflux. Teflon paste may not be the ideal material, other substances are presently being investigated. This technic is limited by the caliber of the urethra in young boys (Charrière 14).

Adolescent↗