Journal Archives - Volume 2
Abstract: In both infants, children and adults, natural fill cystometry shows a lower pressure rise during filling, a higher incidence of detrusor overactivity, a higher detrusor pressure on micturition, and a lower voided volume than is found at conventional cystometry, Since natural fill urodynamics does not use artificial filling, and since it causes minimal psychological trauma, especially important for the paediatric patient, it no doubt delivers the more authentic reflection of true bladder physiology. It will become the future golden standard in paediatric urodynamics, not for all children considered for urodynamic investigation, but certainly for those with complicated disorders of their lower urinary tract.
Abstract: With the advent of antenatal sonography much progress has been made in understanding the natural history of hydronephrosis. The dismembered pyeloplasty remains the gold standard of surgical management, in paediatric urological practice. Advances in radiological imaging and instrumentation has resulted in the development of a number of endourological procedures. With greater experience and further refinements in technique and instrumentation, endourological methods promise to play a bigger role in management of PUJ obstruction.
Abstract: Each case of hypospadias must be treated on an individual basis but invokes five basic elements; glanulo-meatoplasty, orthoplasty, urethroplasty, skin cover, and scrotoplasty. Adherence to the basic principles of plastic surgery and tissue handling, and a working knowledge of wound healing assures success in the majority of cases. The hypospadiologist needs familiarity with a variety of surgical techniques. The most common techniques used today include the MAGPI, the Snodgrass procedure (tubularized incised plate urethroplasty), and the onlay island flap. Herein we describe the selection and methodology of performing each of these techniques.
Abstract: Epispadias in the male is an uncommon anomaly when not associated with bladder exstrophy and can present in forms ranging from the glandular defect to complete epispadias with urinary incontinence. The epispadic penis can be reconstructed by several methods, but the modified Cantwell–Ransley epispadias repair has enjoyed widespread application with the ggreatet success. If urinary incontinence is also present, a Young-Dees -Leadbetter bladder neck reconstruction with suspension and ureteral reimplantation are performed when a sufficient bladder capacity is attained. With carefully planned and executed surgical techniques, the reconstruction should yield a straight, dependent, potent penis with urinary continence and preservation of renal function.
Abstract: Genital development is a complex process involving multiple steps which must occur in an orderly sequence to result in normal development. When an error in such development occurs, the consequences can be devastating. The reconstructive surgeon in often the first to be notified following delivery of a child with abnormal genitalia and must not only be prepared to reconstruct the genitalia but to assist in the education of the parents and direct the overall evaluation and management of the child. It is from the viewpoint of the surgeon that we direct the remainder of our comments. The reconstruction of ambiguous genitalia will only be discussed along female lines as male reconstruction (hypospadias repair and orchiopexy) is well covered in other sources.
Abstarct: Improvements in preoperative preparation, surgical techniques and post-operative management have made complex reconstruction of genital ambiguity possible. Management of patients with genital ambiguity involves a multidisciplinary approach by individuals familiarly with these complex anomalies, who can counsel the patient and her immediate family on the surgical and psychological issues related to vaginal reconstruction. Efforts to create a viable vaginal substitute have been directed to improving cosmesis and functionally. This article will describe the techniques available for vaginal substitution and evaluate the pros and cons of each.
Abstract: The devastation caused by foetal obstructive uropathy is now well-known. At the most severe end of the spectrum of obstructive uropathy not only is the developing kidney damaged but the resultant oligohydramnios prevents pulmonary development and causes skeletal defects he most significant changes are noted in patients with posterior urethral valves (PUV) as demonstrated by Nakayama, et al. (1). They reviewed 11 cases of PUV diagnosed in the neonatal period and found that five of these babies died. Three who died within a few hours of birth had severe pulmonary hypoplasia. Another two died within the next 3 weeks due to rapidly progressing renal failure. Of the six surviving patients, four exhibited respiratory problems, three developed renal failure in spite of early urinary diversion and one demonstrated renal tubular dysfunction. Only two infants maintained normal renal function after surgical reconstruction. Furthermore, of patients who are treated in the neonatal period and appear to do well initially, one in four develop end-stage renal failure 2). Finally, there is an intermediate group that maintains enough renal function to avoid transplantation but these children demonstrate stunted growth and development (3,4). The obvious solution to the problem is to either correct or bypass the obstruction prior to the development of permanent changes. Unfortunately, this simple concept is not easy to apply since it, raises numerous ethical, legal economic and technical problems.
Abstract: Common urogenital in children include: rhabdomyosarcoma, Wilm's tumour, neuroblastoma and germ cell involving in the treatment of these with the combined efforts of surgeons, paediatric oncologists and radiation oncologists. This article will outline the newer approaches in classification, diagnosis and treatment.
Abstract: Tremendous advances in songraphy have taken place in the last few decades. Duplex imaging and later the addition of color (color duplex imaging) have enabled the radiologists to explore different facets of a clinical problem not feasible with black and white, 2-D imaging available earlier. This has opened up entirely new fields of investigation never even dreamed of only a couple of decades earlier e.g., assessment of renal perfusion; evaluation of renal artery stenosis, tumor vascularity and post biopsy complications assessment, etc.
Abstract: The management of renal failure in children and infants has been a therapeutic challenge and its solution is now well beyond the experimental stage. The condition presents unique problems of medical and surgical management and the adaptation of special techniques. Renal transplantation has become the preferred modality of treatment to complement management with dialysis. Careful selection and special expertise can provide rehabilitation and a remarkably improved quality of life. Recent advances in immunosuppression have facilitated the improvement in results that are obtained in many centres today.
Telemedicine has been catapulted to the forefront of medical discussion in recent years, both at a clinical and societal level. Despite the attention it has received, there have been few ongoing, practical applications of telemedicine useful to the urologist. There are three possible reasons for this. First, there may be few realistic applications for telemedicine in urology. Second, the technology may simply, not have caught up with the needs of urologists or third, urologists have been slow to take advantage of the currently existing technology. The purpose of this chapter will be to review appellations of telemedicine in other fields, as well as the application of telementoring and telerobotic surgery as applied to urology at the author's institution over recent years.
Telemedicine has been catapulted to the forefront of medical discussion in recent years, both at a clinical and societal level. Despite the attention it has received, there have been few ongoing, practical applications of telemedicine useful to the urologist. There are three possible reasons for this. First, there may be few realistic applications for telemedicine in urology. Second, the technology may simply, not have caught up with the needs of urologists or third, urologists have been slow to take advantage of the currently existing technology. The purpose of this chapter will be to review appellations of telemedicine in other fields, as well as the application of telementoring and telerobotic surgery as applied to urology at the author's institution over recent years.