to determine which cases require surgery, as it is difficult to diagnose obstruction m the neonate. Sixteen of the authors’ 19 patients underwent surgery because conservative treatment failed, and they suggest that surgery may be the treatment of choice for patients with nonrefluxing megaureter.--L Wester The Single Ectopic Br J Urol82:246-251,
Ureter. A. Wakhlu, (August), 1998.
Forty-four patients (41 female, 3 male), aged 1.5 months to 20 years, with single ectopic ureter were reviewed. Thirty-eight had unilateral ectopic ureter, and six had bilateral. For those with unilateral ectopic ureter, the girls usually presented with typical continuous wetting with intermittent normal micturition. The ectopic orifice was located in the vagina (12), vestibule (9), bladder neck (3), seminal vesicle (1). or an undetermined location (3). Twenty-one had renal andfor ureteric abnormalities, two had hypospadias (1 boy. 1 girl), three had anorectal malformation, two had skeletal abnormalities, two had cryptorchidism, and one had a unilateral cystic ovary. In 15, renal function was considered sufficient to justify reimplantation. Six (5 girls, 1 boy) had bilateral single ectopic ureters, 5 of whom had normal renal function. There was no clear correlation of renal function with the site of the orifice because most girls who had a vaginal ectopic orifice had sufficient function to warrant reimplantation. Reimplantation preserved function, although the improvement in function after surgery was related to the degree of renal dysplasia.-MN de la Hunt Urological Consequences of Incomplete Cord Lesions in Patients With Myelomeningocele. AS. Keshtgar and A.M.K. Rickwood. Br J Urol82:258-260, (August), 1998. Of 407 patients with myelomenmgocele and neuropathic bladder, 3 1 were identified as having incomplete cord lesions, defined as a combmation of sacral sensory or motor sparing, and positive conus reflexes. Lesions were sacral (11) lumbar (6), lumbosacral (9), thoracolumbar (3). and thoracic (2). At presentation, 14 had incontinent episodes day and night, IO by day only, and 7 at night only. The upper tracts were dilated in 8 (26%). Most were constipated, but only one had fecal incontinence. Urodynamics in 18 showed sphincter competence and detrusor hyper-reflexia in all and detrusor sphincter dyssynergia in 11 Patients were managed with intermittent catheterization and/or oxybutymn. Thirty were reliably dry by day and 26 also by night. Five have had surgery for vesicoureteric reflux, three a Mitrofanoff. and two augmentation cystoplasty. The authors conclude that, although these patients may gain some measure of urinary continence. they still have a high risk for the development of upper tract complications. They require hfelong surveillance.-M.N. de la Hunr Paediatric Ureteric Calculi: Efficacy of Primary In Situ Extracorporeal Shock Wave Lithotripsy. S.S. Al Busaidy, A.R. Prem, M. Medhat, et al. Br J Urol82:90-96, (July). 1998. Seventy-six ureteric stones were treated in 63 children, aged 4 months to 12 years, by extracorporeal shock wave lithotripsy (ESWL) using the Wolf 2500 Piezolith. Fourteen stones were in the upper ureter, 13 in the midureter. and 44 in the lower ureter. Ten were impacted. All children less than 10 years old were treated under general anesthesia. At 3 months, the overall success rate was 87% (12 of 13 upper, 8 of 9 mid, 35 of 41 lower ureteric stones, and 9 of 10 impacted stones). Retreatment was needed in 20 (36%) cm&en. Auxiliary procedures after ESWL were needed in 3 (6%) The major complications encountered were obstruction, infection, and urinary retention. The authors consid-
ered the treatment effective for ureteric stones at all levels m the short term, but noted that late effects need further assessment.-MN. de la HCWlt Laparoscopic Schier: Pediatr
Anderson-Hynes Surg Int 13:497-500,
The author reports on two patients who underwent laparoscopic Anderson-Hynes pyeloplasty. The first was a 14.year-old boy with abdominal pain and hydronephrosis. Scmtigraphy demonstrated delayed excretion. The second patient was 7 years old and also presented with abdominal pain as well as a palpable abdominal mass. Scintigraphy showed decreased function of the affected kidney to 34% of the total function. The laparoscopic procedure was performed via a lateral approach. In the first case the Veressneedle was introduced via the umbilicus. which was too low: in the second case the needle was inserted lateral to the umbilicus, which was more appropriate. Two additional trocars were used. In the first patient a perirenal urinoma developed postoperatively, and percutaneous pyelostomy was performed. In the second case a transanastomotic pyelostomy was used during the early postoperative period. Operation duration was 6.5 hours for the first case and 2.5 hours for the second case. Both patients still had dilatation of the upper urinary tract at ultrasonography 3 months postoperatively. The author concludes that if the suture of the pyeloplasty had not been so complicated, this would be an attractive altemative to the conventional open pyeloplasty procedure.-+? Pun’ Techniques of Endopyelotomy. E.R. Goldjischel; K.G. Sfravodimos, ef al. Br J Urol82:1-7, (July), 1998.
This review article discusses open and laparoscopic pyelolasty. antegrade endopyelotomy, ureteroscopic endopyelotomy. Acucise endopyelotomy. and endoballoon rupture. Although conventional pyeloplasty is becoming less favorable in adult practice, it still remains the gold standard. Other techniques may be considered less invasive but are less likely to achieve cure (eg, antegrade endopyelotomy ?50%, ureteroscopic endopyelotomy ~70%). The authors remind us that the rapid recovery of infants makes conventional surgery more acceptable and that endo-techniques in this age group are less effective.-M.N. de la Hunt Long-Term Follow-Up of Renal Functional Reserve Capacity After Unilateral Nephrectomy in Childhood. B.M. Regazzonz, N. Genton, J. Pelet, et al. J Urol 160:844-848. (September). 1998. Thirty-seven subjects who underwent unilateral nephrectomy during childhood (age less than 16 years) were studied to determine glomerular filtration rate, renal plasma flow. and functional renal reserve capacity after oral protein loading. The mterval since nephrectomy was 0.5 to 10 years in ten cases, 11 to 20 in thirteen, and more than 20 years in fourteen, during which regular repeated renal function tests were performed. None of the patients had hypertension or significant proteinuria, and all developed normally mto adults. A group of seven healthy normal subjects with two kidneys served as controls This long-term follow-up study shows that a single remnant human kidney continues to function normally for more than 20 years The prolonged mcreased workload does not interfere with normal development and maturation. However, the renal reserve capacity, which decreased significantly during the years, may indicate a vulnerability of the single kidney and raises the possibility of renal functional impairment with much longer follow-up.-George W: Holcomb, JY