The Journal of urology
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Percutaneous nephrolithotomy is an established technique used in children with renal calculi. We review our experience with percutaneous nephrolithotomy for treating nephrolithiasis in childhood. ⋯ Percutaneous nephrolithotomy is safe and effective in children, and should be considered a viable management option. However, staghorn calculi may require alternative management, particularly in the setting of underlying anatomical abnormalities. Children with renal calculi should undergo a complete anatomical and metabolic assessment with the institution of medical therapy, as appropriate.
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The Journal of urology · Oct 1999
Retroperitoneoscopic surgery is not associated with increased carbon dioxide absorption.
Previous studies have suggested that retroperitoneal laparoscopy is associated with greater carbon dioxide absorption and related postoperative morbidity, such as subcutaneous emphysema and pneumothorax. We prospectively compared the effects of carbon dioxide absorption during transperitoneal and retroperitoneal laparoscopic renal and adrenal surgery at our institution. ⋯ In contrast to previous reports our prospective nonrandomized study suggests that retroperitoneoscopy is not associated with greater carbon dioxide absorption compared to transperitoneal laparoscopy. Patients with subcutaneous emphysema exhibited only transient increases in carbon dioxide absorption above control levels.
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The Journal of urology · Sep 1999
"Skin-CNS-bladder" reflex pathway for micturition after spinal cord injury and its underlying mechanisms.
A "skin-CNS-bladder" reflex pathway for inducing micturition after spinal cord injury has been established in cat. This reflex pathway which is basically a somatic reflex arc with a modified efferent limb that passes somatic motor impulses to the bladder, has been designed to allow spinal cord injured patients to initiate voiding by scratching the skin. ⋯ The cross-wired somato-autonomic bladder reflex is effective in initiating bladder contractions and coordinated voiding in cats with an intact neuraxis and can also induce bladder contractions after acute transection of the lumbar spinal cord. The new pathway is mediated by cholinergic transmission involving both nicotinic and muscarinic receptors. It is concluded that somatic motor axons can innervate bladder parasympathetic ganglion cells and thereby transfer somatic reflex activity to the bladder smooth muscle.
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The Journal of urology · Sep 1999
ReviewPediatric management of ambiguous and traumatized genitalia.
The present standard of practice in the management of ambiguous and traumatized genitalia was evaluated. ⋯ A moratorium on sex reassignment cosmetic surgery is recommended. Also recommended are that followup studies should be instituted on past cases, and honesty and counseling should be the core of initial and subsequent treatment.
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The Journal of urology · Sep 1999
Reexamining the value of hematuria testing in patients with acute flank pain.
Hematuria testing is routinely performed in patients with acute flank pain to screen for ureterolithiasis and to help determine the need for excretory urography. Unenhanced helical computerized tomography (CT) has recently been shown to be superior to excretory urography in diagnosing ureteral obstruction and can evaluate many other causes of flank pain. Given the speed, accuracy and safety of CT the value of hematuria testing for acute flank pain should be reexamined. ⋯ Absence of hematuria in the setting of acute flank pain cannot exclude a diagnosis of ureterolithiasis and should not obviate other diagnostic testing. Even when strongly positive on microscopy, hematuria has insufficient positive predictive value for diagnosing ureterolithiasis and may be misleading as other serious conditions resulting in acute flank pain may yield a positive test.