Purpose: We evaluated the results and complications of children with reflux treated with the Politano-Leadbetter ureteroneocystostomy. In particular, we evaluated pre- and postoperative renal parenchymal scarring and the late development of hypertension. Materials and Methods: From 1965 through 1996, 666 children (814 renal units) were reimplanted by nine urologists. The average postoperative evaluation was 10.3 years, and 68.8% of all patients were evaluable 10 years after surgery. Results: Postoperative complications occurred in 7.8% and consisted of small bowel serosal injury (0.3%), vesicocutaneous fistula (0.4%) and retrovesical hematoma (0.3%). Persistent reflux was the most common postoperative complication (5.6%) and was found to occur in higher grades of vesicorenal reflux. Ureteral stricture and hydronephrosis were seen in 1.2% of children, and was corrected with a secondary reimplantation. Late stricture occurred in all but 1 patient (0.2%). Renal parenchymal scarring was found in 21.2% of patients preoperatively, and this increased over time postoperatively to 27.7%. In 8.7% of these patients, hypertension developed between the 6th and 17th postoperative year. In 6.1%, nephrectomy was carried out, which normalized blood pressures in 87.9% of these 30 patients. Conclusions: The Politano-Leadbetter ureteroneocystostomy was successful in 93.6% of all 814 renal units surgically treated. The operation is safe, but can be associated with late development of hypertension despite correction of the reflux. Copyright (C) 2000 S. Karger AG, Basel.

PURPOSE:We evaluated the results and complications of children with reflux treated with the Politano-Leadbetter ureteroneocystostomy. In particular, we evaluated pre- and postoperative renal parenchymal scarring and the late development of hypertension.MATERIALS AND METHODS:From 1965 through 1996, 666 children (814 renal units) were reimplanted by nine urologists. The average postoperative evaluation was 10.3 years, and 68.8% of all patiens were evaluable 10 years after surgery.RESULTS:Postoperative complications occurred in 7.8% and consisted of small bowel serosal injury (0.3%), vesicocutaneous fistula (0.4%) and retrovesical hematoma (0.3%). Persistent reflux was the most common postoperative complication (5.6%) and was found to occur in higher grades of vesicorenal reflux. Ureteral stricture and hydronephrosis were seen in 1.2% of children, and was corrected with a secondary reimplantation. Late stricture occurred in all but 1 patient (0.2%). Renal parenchymal scarring was found in 21.2% of patients preoperatively, and this increased over time postoperatively to 27.7%. In 8.7% of these patients, hypertension developed between the 6th and 17th postoperative year. In 6.1%, nephrectomy was carried out, which normalized blood pressures in 87. 9% of these 30 patients.CONCLUSIONS:The Politano-Leadbetter ureteroneocystostomy was successful in 93.6% of all 814 renal units surgically treated. The operation is safe, but can be associated with late development of hypertension despite correction of the reflux.

Our aim was to analyze the incidence of complications after surgical correction of vesicorenal reflux with the intravesical technique of Politano-Leadbetter. Furthermore, we investigated the pre- and postoperative prevalence of renal scars and hypertension. From 1965 to 1996, 666 children with 814 renal units were operated using a standardized technique. The mean follow-up was 10.3 (1-31) years. 68.8% of all patients could be controlled in the 10(th) postoperative year. The intra- and postoperative complication rate was 7.8% (52/666). Intraoperative complications included minor injuries to the bowel (0.3%, 2/666) as well as urinary fistulas (0.4%, 3/666) and hematomas (0.3%, 2/666). Th most frequent postoperative complications was persistence of reflux in 5.6% (37/666) which occurred especially in patients with high grade reflux. Obstructions of the upper urinary tract due to ureteral stenosis were observed in 1.2% (8/666) of the children and could be successfully corrected by reimplantation. Late ureteral obstructions were seen in only 0.2% (1/666). Renal scars were found in 21.2% (141/666) preoperatively. During the observation period, there was an increase in renal scarring up to 27.7% (127/458). In 8.7% (40/458) of the patients with renal scars, arterial hypertension occurred between 6 and 17 years postoperatively. 6.1% of all patients (28/ 458) required secondary nephrectomy due to reflux nephropathy. The ureteroneocystostomy according to Politano-Lead-better was successful in 93.6% of all 814 renal units. This operation is a safe procedure in the operative management of vesicorenal reflux. Hypertension is a complication even of successfully corrected vesicorenal reflux.

The data from this multicenter comparison of oral cefetamet pivoxil (CAT) (10 and 20 mg/kg twice daily) and amoxicillin plus clavulanic acid (30 to 50 mg/kg/d, in three divided doses) in the treatment of acute (recurrent) urinary tract infections (UTIs) in children are reported. A total of 421 children (aged 2 months to 15 years) were treated for 7 to 10 days. At follow-up (day 28), there was bacteriologic success (eradication or reinfection) in 97% of those treated with CAT and in 93% of those treated with amoxicillin plus clavulanic acid. The overall cure rate was 97% for CAT and 93% for amoxicillin plus clavulanic acid. There was no difference in outcome between the two CAT dosages. With both drugs adverse events were gastrointestinal in nature. CAT is an appropriate drug for the treatment of acute UTIs in children, being at least as effective as amoxicillin plus clavulanic acid.

In order to conduct molecular typing of Eikenella corrodens strains by macrorestriction fingerprinting, we evaluated different restriction enzymes for digestion of genomic DNA and determined the optimal parameters for separating E. corrodens DNA by pulsed-field gel electrophoresis. Ten E. corrodens strains isolated from oral and extraoral infection sites in different individuals were analyzed. The rare-cutting restriction endonucleases DraI, SmaI and XbaI usually used for pulsed-field gel electrophoresis analyses were not suitable for digestion of E. corrodens genomic DNA because they either did not digest the DNA or produced bands of similar molecular weights that could not be separated. Accordingly, among additional enzymes including BamHI, BglII, EcoRI and Hind III, we found BamHI and BglII to be the most suitable rare-cutting enzymes for pulsed-field gel electrophoresis analysis. They cleaved the genomes of all the above strains into 15-20 fragment bands that were clearly separated by the following pulsed-field gel electrophoresis conditions: 140 V with a running time of 40 h, pulse times of 5 to 50 s with linear ramping and an electrical field angle of 120 degrees. These conditions enabled us to distinguish 8 individual pulsed-field gel electrophoresis patterns from the 10 strains analyzed. However, only 4 identical outer membrane protein profiles were differentiated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The data obtained in this analysis showed clonal divergence among members of the E. corrodens species, at the same time revealing this pulsed-field gel electrophoresis as being a highly attractive procedure for epidemiological investigation of this organism, including its acquisition and transmission.

A man in whom urinary diversion (colon conduit) was performed after 2 unsuccessful implantations of artificial urethral sphincters for treatment of iatrogenic incontinence became continent again after implantation of an alloplastic sling. Three months later the patient underwent urinary undiversion with augmentation cystoplasty. After 3 years ureteroneocystostomy was necessary due to distal ureteral stenoses. At 7-year followup the patient is continent. He has good bladder capacity, bladder emptying and a normal upper urinary tract.

Nach zwei erfolglosen Implantationen artifizieller Harnröhrensphinkter aufgrund einer iatrogenen Harninkontenz und nach einer Harnableitung mittels Kolon-Conduit wurde bei einem 51jährigen Mann die Harnkontinenz durch eine Suspensionsplastik mittels Polyesterband wiederhergestellt. Drei Monate später erfolgte eine Harnumleitung mit Augmentation-Zystoplastik. Nach drei Jahren wurde eine Ureterozystoneostomie wegen distaler Ureterstenosen erforderlich. Nach einem sechseinhalbjährigen Beobachtungszeitraum ist der Patient kontinent, hat eine gute Blasenkapazität, entleert seine Blase restharnfrei und weist einen normalen oberen Harntrakt auf.

Cefetamet pivoxil was investigated in an open, randomized comparative study involving a total of 37 children with acute pyelonephritis, whose ages ranged from 2 to 14 years. The patients received either 10 mg/kg ( n = 18) or 20 mg/kg ( n = 8) cefetamet pivoxil twice daily, or 30–50 mg/kg amoxycillin/clavulanic acid three times daily ( n = 11) for a period of 7–10 days. Escherichia coli was the main causative agent isolated in 28 (75.7%) of the patients; other pathogens included Proteus mirabilis (three patients), Proteus species (one patient), Klebsiella pneumoniae (two patients), Pseudomonas diminuta (one patient) and mixed infections (three patients). No differences in the overall treatment outcome could be observed between the treatment regimens used and, at the end of treatment, all pathogens were eradicated with neither relapse, nor persistence of the isolated pathogen, nor reinfection occurring. The clinical signs and symptoms had subsided in all patients at treatment end and the tolerability of the trial drugs was found to be satisfactory with no premature treatment withdrawal required. It is concluded that cefetamet pivoxil in the standard twice-daily dose of 10 mg/kg was equally effective and as well tolerated as 20 mg/kg cefetamet pivoxil given twice daily or 30–50 mg/kg amoxycillin/clavulanic acid given three times daily.

Our experience with a suspension plasty we introduced in 1965 for the treatment of postoperative male urinary incontinence is presented. In all, 125 patients were operated using a stable, radiopaque non-resorbable polyester sling which leads to a functional extension of the prostatic urethra and an increase in urethral resistance. The 5 important stages of development as well as results, complications and revisions are reported. After 23 years of clinical experience with a long-term continence rate of 68 %, we have now reached a continence rate of 92 % in a new series of patients treated from 1/85 to 10/88. This is due to a modified technique and a new sling material.

Es wird berichtet über die operative Korrektur einer bis dahin unbehandelten Blasenexstrophie eines 6½jährigen Mädchens aus Ghana/Afrika. In diesem besonderen Fall eines Kindes aus einem Entwicklungsland mußte die Korrektur aller Fehlbildungen in einer Sitzung erfolgen; auf ein feuchtes Stoma oder eine Ureterosigmoidestomie mußte verzichtet werden.

The main advantages of the Steffens lasso loop are its olive-tipped, 45 degrees-angled Tiemann guide, which allows easier and less traumatic passage above the ureteral stone, the tri-part lasso, which affords a better grasp of the stone, and the outlet for urine drainage. Between 1976 and 1986 we used this loop in 560 of 919 patients with distal ureteral stones. Immediate stone extraction was possible in 85.7% of the patients treated in 1986. Perforation of the ureter occurred in 2.3%, and 3% required ureterolithotomy. Our experience with this lasso loop has shown this instrument to be a valuable addition to other endourological methods.

672 children aged between 4 and 16 years were treated for primary or secondary enuresis between 1980 and 1986. The group included more girls than boys. A systematic diagnostic investigation, consisting of a detailed medical history, physical examination, urinalysis and sonography of the kidneys and bladder, was carried out in all cases. This investigation was followed by urodynamic tests to detect any functional disorders of the lower urinary tract. Finally, a voiding cystogram, urethral calibration and urethrocystoscopy were conducted to screen for morphological changes. Three major groups of causes of enuresis were identified. Functional miction disorders were found in 312 (46.4%) children. In these cases there was an inability to voluntarily control the detrusor, detrusor-sphincter dyssynergia and hyperactivity of the detrusor. 223 (33.2%) of the children had pathological anatomical changes of the urinary tract, such as malformations leading to vesicoureteral reflux, vesicular diverticula, duplication of the upper urinary tract, megaureter, urethral stenosis or urethral valves, with associated infection. Psychogenic disorders were diagnosed in 137 (20.4%) cases. The first group received drug treatment and biofeedback training for reestablishment of conscious control over the vegetative functions of the lower urinary tract. The second group underwent surgery for correction of the pathological anatomical changes. The third group was referred for psychotherapy.

Ambulatory autoinjection therapy of the corpus cavernosum with a vasoactive drug combination for vasculogenic and neurogenic erectile dysfunction was performed in 50 men from 10/85-6/87. Acceptance was excellent by all patients and their wives. Transitory hematomas appeared in 6/50 (12%) cases. Local infections, cavernitis or systemic side effects were not observed. In 3/50 (6%) patients prolonged erections occurred. Treatment included drainage of the intracavernous blood, manual decompression and if necessary additional application of 1 mg metaraminol under extreme caution. Only 1 (2%) patient developed a nodular tunica fibrosis at the injection site which disappeared spontaneously upon cessation of treatment within 4 weeks.

Sie hat einen 5 cm langen Verlauf mit einer olivförmigen um 45° abgewinkelten Tiemannspitze. Hierdurch wird die Passage der Schlinge am Konkrement vorbei wesentlich erleichtert oder überhaupt erst möglich. Infolge der Vorlaufstrekke ist vor einem evtl. erforderlichen zweiten Einlegen der Schlinge in den Harnleiter keine vollständige Extraktion aus dem Ostium heraus erforderlich, trotzdem kann die Schlinge in der Blase geöffnet werden.

distal to the portion of the kid ney to be resected, using atraumatic Chrome-Catgut su ture No. 3. Total hemostasis in the area to be excised is attained with the aid of a second U-shaped suture running parallel to the first, but entering on the opposite renal margin. Following excision the raw surfaces are then reapproximated by means of a continuous suture and thus sealed. To conclude the operation a temporary ne phrostomy is performed. Immediate and later follow-up results and the advantages and potential complications of the new technique are described in a large sampie of 112 patients presenting for treatment during aperiod of 12 years.

Für ambulantes Operieren werden psychologische und finanzielle Gründe ins Feld geführt, aber auch die Möglichkeit zur Vermeidung von Hospitalinfektionen. Sollen die psychologischen, ökonomischen und medizinischen Vorteile des ambulanten Operierens und Anästhesierens in vollem Umfang genutzt werden, so müssen präoperative Betreuung, Anästhesieverfahren und postnarkotische Nachsorge so gestaltet werden, daß ambulante Eingriffe ebenso risikoarm wie stationäre werden.

We report on 183 patients with urinary stress incontinence treated with bladder-neck suspension plasty according to Zoedler from 1972-1982 using the conventional nylon sling. 86.1% of the patients were continent postoperatively. Long term follow-up to 10 years however showed a continuous decrease of success rate in the first 2 postoperative years (74.9% in the 1st, 67.2% in the 2nd year). From the 3rd postoperative year there was a stable continence-rate of 50.7%. As the significant increase of incontinence relapse is due to enzymatic destruction of the nylon sling--first described in ophtalmology--we developed a new form-stable and radiopaque polyester sling. Since 1983 we implanted this new sling in 40 patients. Long term results of the conventional Zoedler procedure and first results of a modified method using the new polyester sling are discussed.