You have accessJournal of UrologyModerated Poster, Monday, May 23,2005, 8:00 - 10:00 am1 Apr 2005707: The Cost-Effectiveness of Deflux Injection as a Substitute for Ureteral Reimplantation in the Management of Vesicoureteral Reflux Ronald M. Benoit, and Steven G. Docimo Ronald M. BenoitRonald M. Benoit More articles by this author , and Steven G. DocimoSteven G. Docimo More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35939-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "707: The Cost-Effectiveness of Deflux Injection as a Substitute for Ureteral Reimplantation in the Management of Vesicoureteral Reflux." The Journal of Urology, 173(4S), p. 193 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 193 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Ronald M. Benoit More articles by this author Steven G. Docimo More articles by this author Expand All Advertisement PDF DownloadLoading ...

Objective To combine and analyse the results from centres with a large experience of laparoscopy for the impalpable testis with small series, to determine the expected success rate for laparoscopic orchidopexy.Methods A questionnaire was distributed to participating paediatric urologists: each contributor retrospectively reviewed the clinical charts for their cases of therapeutic laparoscopy for an impalpable testis, detailing 36 variables for each patient. The data were collated centrally into a computerized database. For inclusion, the testis was intra-abdominal (including 'peeping' at the internal ring) at laparoscopic examination, was not managed through an open approach and did not undergo orchidectomy. Three surgical groups were assessed. with success defined as lack of atrophy and intrascrotal position: group 1. primary laparoscopic orchidopexy: group 2, a one-stage Fowler-Stephens (F-S) orchidopexy: and group 3, a two-stage F-S orchidopexy.Results Data were gathered from 10 centres in the USA, covering the period 1990-1999: 252 patients representing 310 testes were included and overall, 15.2'%, were lost to follow-up. There was no significant difference between success rates in the larger and smaller series. Atrophy occurred in 2.2% of 178 testes, 22.2% of 27 testes and 10.3% of 58 testes in groups 1-3, respectively. Testes were not in a satisfactory scrotal position in 0.6%, 7.4% and 1.7%, of groups 1-3, respectively. The mean follow-up for each group was 7.7, 8.6 and 20.0 months, respectively. The overall success for all groups was 92.8% (97.2% group 1; 74.1% group 2: 87.9% group 3), with an atrophy rate of 6.1%.Conclusion Laparoscopic orchidopexy for the intra-abdominal testis, in both large and small series, can be expected to have a success rate higher than that historically ascribed to open orchidopexy. Within this series, single-stage F-S laparoscopic orchidopexy resulted in a significantly higher atrophy rate than the two-stage repair, However, when considering both F-S approaches. the laparoscopic approach gave greater success than previously reported for the same open approaches. Despite the weaknesses inherent in a retrospective unrandomized study, we conclude that laparoscopic orchidopexy is, if not the procedure of choice. an acceptable and successful approach to the impalpable undescended testicle.

A 3-year-old boy with hydrocephalus was observed to have a painless 2.0-cm right scrotal mass. Abdominal radiograph showed ventriculoperitoneal shunt tubing in the right scrotal sac, Removal of a detached shunt catheter and inguinal hernia repair resolved the problem. J Pediatr Surg 35:1407-1410, Copyright (C) 2000 by W.B. Saunders Company.

Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. Physical examination of the testicle can be difficult; consultation should be considered if a normal testis cannot be definitely identified. Observation is not recommended beyond one year of age because it delays treatment, lowers the rate of surgical success and probably impairs spermatogenesis. By six months of age, patients with undescended testicles should be evaluated by a pediatric urologist or other qualified subspecialist who can assist with diagnosis and treatment. Earlier referral may be warranted for bilateral nonpalpable testes in the newborn or for any child with both hypospadias and an undescended testis. Therapy for an undescended testicle should begin between six months and two years of age and may consist of hormone or surgical treatment. The success of either form of treatment depends on the position of the testicle at diagnosis. Recent improvements in surgical technique, including laparoscopic approaches to diagnosis and treatment, hold the promise of improved outcomes. While orchiopexy may not protect patients from developing testicular malignancy, the procedure allows for earlier detection through self-examination of the testicles.

Kidney stones have been associated with use of the ketogenic diet in children with refractory seizure disorders. We performed a case-control study examining risk factors for the development of stones on the ketogenic diet, and prospectively followed children initiating the ketogenic diet to evaluate the incidence of urolithiasis. Clinical characteristics of 18 children presenting with stones (8 uric acid stones, 6 mixed calcium/uric acid stones, 1 calcium oxalate/phosphate stone, 3 stones not evaluated) were compared with characteristics of non-stone-forming children initiating the ketogenic diet at Johns Hopkins since July 1996. Since July 1996, 112 children initiating the ketogenic diet have been followed for development of stones. Follow-up times on the diet range from 2 months to 2.5 years. Of 112 children, 6 have developed stones (3 uric acid, 3 mixed calcium/uric acid stones) (0.8 children developing stones/ 100 patient-months at risk). Comparisons of children presenting with stones on the ketogenic diet with characteristics of the entire cohort initiating the ketogenic diet suggest younger age at diet initiation and hypercalciuria are risk factors for the development of stones. Prospective evaluation of children initiating the ketogenic diet revealed that almost 40% of patients had elevated fasting urine calcium: creatinine ratios at baseline; this increased to 75% after 6 months on the diet. Median urine pH was 5.5 at diet initiation, and remained at 6.0 thereafter. In a subset of patients tested, urinary citrate excretion fell from a mean of 252 mg/24 h pre diet initiation to 52 mg/24 h while on the diet. Uric acid excretion remained normal. Patients maintained on the ketogenic diet often have evidence of hypercalciuria, acid urine, and low urinary citrate excretion. In conjunction with low fluid intake, these patients are at high risk for both uric acid and calcium stone formation.

Objectives. To delineate the clinical outcomes of color Doppler ultrasound (US) in the equivocal torsion patient.Methods. From 1992 to 1997, 130 patients (<23 years old) from 2 institutions underwent US imaging using a 7.5-mHz linear transducer to evaluate an acute scrotum equivocal, or of low suspicion, for torsion. The US reports and hospital charts of these patients were retrospectively reviewed.Results. After clinical and radiologic evaluation, torsion was excluded in 110 patients without surgical exploration. In 3 patients, intermittent testicular torsion was diagnosed and in 17 patients, emergent exploration was performed for US diagnosis of testicular torsion. Twenty-five patients (22.7%) were subsequently lost to followup. Follow-up of 85 patients with US negative for torsion (mean length of follow-up = 466.9 days) revealed no testicular atrophy in 83. Two patients underwent delayed orchiectomy/contralateral orchiopexy for missed testicular torsion. Of 17 patients with US positive for torsion, 9 underwent orchiectomy for a necrotic torsed testis, 7 viable torsed testes were found, and 1 torsed appendix testis was found. Therefore, color Doppler US for the equivocal acute scrotum yielded a 1% false-positive rate, sensitivity of 88.9%, and specificity of 98.8%.Conclusion. When faced with ruling out testicular torsion, it is necessary to integrate the multiple pieces of patient data, knowing that each piece of data may have inaccuracies. With this in mind, this analysis of outcomes verifies that color Doppler US is an excellent adjunctive study in the clinically real situation in which the clinical evaluation is equivocal or low suspicion.

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Nov 1999EDITORIAL: PEDIATRIC ENDOUROLOGY—COMING INTO FOCUS Steven G. Docimo Steven G. DocimoSteven G. Docimo More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)68225-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "EDITORIAL: PEDIATRIC ENDOUROLOGY—COMING INTO FOCUS." The Journal of Urology, 162(5), pp. 1731–1732 References 1 : Comparison of early postoperative results for laparoscopic versus standard open cholecystectomy. Surg., Gynec. & Obst.1992; 174: 114. Google Scholar 2 : Laparoscopic or open fundoplication? A complete cost analysis. Surg. Endosc1998; 12: 1209. Google Scholar 3 : Outpatient nephrectomy for nonfunctioning kidneys. J. Urol.1995; 154: 712. Link, Google Scholar 4 : Postoperative adhesion formation after urological. J. Urol.1995; 153: 792. Link, Google Scholar 5 : The results of surgical therapy for cryptorchidism: a literature review and analysis. J. Urol.1995; 154: 1148. Link, Google Scholar 6 : Laparoscopic orchiopexy: procedure of choice for the nonpalable testis?. J. Urol.1998; 159: 2132. Link, Google Scholar 7 : Infant and preschool age percutaneous nephrolithotomy: experience with a new technique. Urology1998; 52: 697. Google Scholar 8 : The “mini-perc” technique: a less invasive alternative to percutaneous nephrolithotomy. World J. Urol.1998; 16: 371. Crossref, Medline, Google Scholar 9 : Balloon dilation of the distalureter to 24F: an effective method for ureteroscopic stone retrieval. J. Urol.1991; 146: 742. Link, Google Scholar 10 : Ureteroscopy without routine balloon dilation: an outcome assessment. J. Urol.1992; 147: 1238. Link, Google Scholar 11 : Minor residual fragments after extracorporeal shockwave lithotripsy: spontaneous clearance or risk factor for recurrent stone formation?. J. Endourol.1997; 11: 227. Google Scholar The James Buchanan Brady Urological InstituteThe Johns Hopkins University School of NursingBaltimore, Maryland© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 162Issue 5November 1999Page: 1731-1732 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.Keywordsurologysurgical procedures, minimally invasiveendoscopypediatricsMetricsAuthor Information Steven G. Docimo More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Oliguria during laparoscopy is a well-documented phenomenon of unknown etiology. Experimental evidence suggests that renal perfusion is reduced during pneumoperitoneum. N-acetyl-beta-D-glucosaminidase (NAG), which is present in renal tubular cells, is released into the urine in response to tubular insults. In this study, urinary NAG was measured before and after procedures to assess for ischemic renal injury.Methods: A total of 31 patients underwent laparoscopic procedures while 28 patients had conventional surgery. Urine was obtained first at the time of preoperative Foley catheter placement and later during the recovery room stay. NAG levels were measured and indexed to urinary creatinine.Results: Operative time for the laparoscopy group was 105 min (range, 15-255); for the conventional group, it was 179 min (range, 75-385) (P < 0.05). No differences were noted between pre- and postoperative NAG levels or between the groups. There was no correlation between urinary NAG levels and operative time.Conclusion: Pneumoperitoneum is not associated with a change in the urinary concentration of NAG. This. finding suggests that there is no significant renal tubular injury associated with laparoscopic surgery.

BACKGROUND AND OBJECTIVES:The aim of minimally invasive approaches to vesicoureteral reflux, such as endoscopic trigonoplasty, is to lower the morbidity of open procedures without compromising the results. Initial successes have not been sustained, mainly because of trigonal splitting, which results in the ureteral orifices returning to their preoperative positions. This study was designed to address trigonal splitting by mobilizing the ureters before repositioning them and to evaluate the feasibility of accomplishing this intravesically with 2- to 3-mm endoscopic mini-instruments.METHODS:Bilateral vesicoureteral reflux was surgically created in 10 minipigs. After radiologic confirmation of success 4 weeks later, modified trigonoplasty was performed by endoscopic intravesical mobilization of both ureters and incision of the trigonal mucosa using 2-mm instruments. The ureteral orifices were then advanced toward the midline and sutured in place. The initial surgical techniques were modified to permit the entire procedure to be performed endoscopically in the last four minipigs. Cystograms and intravenous urograms were obtained 4 weeks later.RESULTS:Two minipigs died postoperatively. Six of the remaining eight had persistent reflux, including three of the four in the group treated completely by endoscopic means. None of the dissected ureters showed evidence of stricture or necrosis.CONCLUSIONS:Although the procedure was not successful in correcting reflux in this model, this study demonstrates the feasibility of endoscopic ureteral mobilization. With current instrumentation, there is no significant technical obstacle to complete intravesical endoscopic surgery, including ureteral reimplantation.

Purpose: Approximately 10 to 30% of prenatal cases of hydronephrosis result in the postnatal diagnosis of vesicoureteral reflux. Using a new generic prenatal-postnatal data sheet developed by the Society for Fetal Urology the characteristics, natural history and outcome of prenatal hydronephrosis confirmed postnatally to be vesicoureteral reflux were documented at 3 centers.Materials and Methods: We performed a retrospective multicenter review of Society for Fetal Urology data sheets completed for each patient in whom prenatal hydronephrosis was proved to be postnatal vesicoureteral reflux from 1993 to 1998.Results: In 56 male and 15 female patients with prenatal hydronephrosis a total of 116 refluxing renal units were confirmed postnatally. Of the 116 renal units 112 were hydronephrotic prenatally. During gestation increased hydronephrosis was noted with voiding in 4 cases. Of the 112 hydronephrotic renal units only 26 ureters in 15 patients were seen prenatally. The obstetrician considered the diagnosis of vesicoureteral reflux in only 24% of the cases. Postnatally 116 refluxing renal units were identified. Initial postnatal ultrasound was normal in 25% of the cases. Bilateral reflux was present in 36 male and 9 female patients. In 10 of the 19 uncircumcised patients (53%) urinary tract infection developed despite antibiotic prophylaxis. In 15 of the 74 renal units with grades III to V reflux the condition resolved at an average patient age of 0.9 and 2.1 years in boys and girls, respectively. A total of 27 refluxing renal units were reimplanted.Conclusions: The majority of prenatal reflux occurs in boys, and it is high grade and bilateral. The data sheets designed by the Society for Fetal Urology are useful data collection instruments. The presentation and natural history of vesicoureteral reflux are different in male and female individuals. In a significant number of renal units high grade reflux resolves spontaneously. Early circumcision may decrease the incidence of breakthrough urinary tract infection in this subpopulation. In addition, the effective management of prenatally detected reflux depends on multispecialty communication.

INTRODUCTIONTelesurgical laparoscopic telementoring has successfully been implemented between the Johns Hopkins Bayview Medical Center and the Johns Hopkins Hospital in 27 prior operations. In this previously reported series, telerobotic mentoring was achieved between two institutions 3.5 miles away. We report our experience in performing two international surgical telementoring operations.PURPOSETo determine the clinical utility of international surgical telementoring during laparoscopic surgical procedures.METHODA laparoscopic adrenalectomy was telementored between Innsbruck, Austria (5,083 miles) and Baltimore, MD. As well, a laparoscopic varicocelectomy was telementored between Bangkok, Thailand and Baltimore, MD (10,880 miles) both over three ISDN lines (384 kbps) with an approximate 1 sec delay.RESULTSBoth procedures were successfully accomplished with an uneventful postoperative course.CONCLUSIONInternational telementoring is a viable method of instructing less experienced laparoscopic surgeons through potentially complex laparoscopic procedures, as well as potentially improving patient access to specialty care.

PURPOSE:Exstrophy of the cloaca is a multisystem anomaly involving the gastrointestinal, nervous, musculoskeletal and genitourinary tracts which should be managed with a multidisciplinary approach. Improvement in management has led to survival for the majority of infants, and the focus has shifted to improvement in quality of life. The experience with management of cloacal exstrophy at a large center is evaluated.MATERIALS AND METHODS:Demographic data as well as functional results of management of the multiple anomalies in 37 patients with cloacal exstrophy were evaluated. Surgical reconstruction was aimed at providing the best functional and cosmetic results.RESULTS:Average patient age at review was 13.6 years. Most patients (32 of 37) had undergone an initial attempt at bladder closure from birth to greater than 24 months of age. Colostomy was performed when possible and if initial ileostomy was performed, the bowel was augmented later with the hindgut segment. When the hindgut segment was not used for bowel reconstruction, it was preserved for bladder augmentation or genital reconstruction. While urinary continence was achievable in many children, it was usually after augmentation and/or continent diversion.CONCLUSIONS:Improvements in perinatal management have increased survival in cloacal exstrophy. Therefore, the focus of reconstruction has shifted to reduction in the numbers of incontinent stomas, assistance with ambulation and improved cosmesis. All of these goals are achievable using a multidisciplinary approach to the management of this complex anomaly.

No AccessJournal of UrologyUrological Survey: Abstracts: Urolithiasis, Endourology and Laparoscopic Surgery1 Aug 1998Telesurgical Mentoring. Initial Clinical Experience P.G. Schulam, S.G. Docimo, W. Saleh, C. Breitenbach, R.G. Moore, and L. Kavoussi P.G. SchulamP.G. Schulam More articles by this author , S.G. DocimoS.G. Docimo More articles by this author , W. SalehW. Saleh More articles by this author , C. BreitenbachC. Breitenbach More articles by this author , R.G. MooreR.G. Moore More articles by this author , and L. KavoussiL. Kavoussi More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62998-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Telesurgical Mentoring. Initial Clinical Experience." The Journal of Urology, 160(2), pp. 632–633 Applied Physics Laboratory and Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 160Issue 2August 1998Page: 632-633 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information P.G. Schulam More articles by this author S.G. Docimo More articles by this author W. Saleh More articles by this author C. Breitenbach More articles by this author R.G. Moore More articles by this author L. Kavoussi More articles by this author Expand All Advertisement PDF downloadLoading ...