Bladder neck incision in infants

Among 36 children, mostly less than 1 year of age, referred for a complete duplex-system anomaly, 18 were diagnosed before birth by obstetrical ultrasonography where a diagnosis of dilated upper urinary tract was the most frequent report; in the remaining cases urinary tract infection was the main presenting symptom. Five children had bilateral anomalies. Principal diagnoses associated with the complete duplex system were: 18 ureteroceles (UC) (11 extravesical [EUC] with bladder-neck or urethral extension, 7 intravesical [IUC]), 5 ectopic ureters without UC and 28 lower-polar vesicoureteral reflux (VUR) associated in 6 with upper polar VUR...

PURPOSE: Ureteral ectopia is frequently associated with dysplasia of the associated renal segment in girls with ureteral duplication. However, single system ureteral ectopia is an uncommon anomaly more frequently noted in boys. We report on 6 boys with single system ureteral ectopia into the prostatic urethra above the verumontanum, who presented with radiological and clinical findings of bladder outlet obstruction. MATERIALS AND METHODS: Antenatal ultrasound in 3 boys demonstrated renal abnormalities and postnatal studies suggested the diagnosis of posterior urethral valve obstruction...

OBJECTIVES: The value of primary transurethral ureterocele incision was investigated in the treatment of ureteroceles in infants and children. METHODS: The charts and radiographic studies of 13 patients between the ages of 2 weeks and 8 years who underwent transurethral incision of 14 ureteroceles as primary surgical therapy at our institution were reviewed. RESULTS: 57% of the ureteroceles were intravesical and 43% extravesical. 64.3% were associated with the upper pole of a duplicated system...

The experience with 32 patients with functional bladder neck obstruction is presented and this condition is discussed. This disease occurred mainly in males from the age of 6 months to 50 years. There was only one female patient. The most important investigations were the micturating cystogram, the flow-rate and the measurement of the residual urine. The bladder neck incision, as proposed by Turner-Warwick, relieved symptoms and obstruction in all patients efficiently.

Intermittent catheterization is used commonly to treat bladder dysfunction. We treated 10 patients who were experiencing difficulty with intermittent catheterization, 9 of whom had a false urethral passage. Of these patients 6 had previously undergone a bladder neck or urethral operation. Endoscopy was helpful to diagnose the condition. Treatment consisted of stenting in 3 patients, transurethral incision and stenting in 3, and fulguration and stenting in 4. An indwelling catheter was left in place for 2 to 3 weeks, after which intermittent catheterization was resumed with a softer catheter...

A case of cecoureterocele in a 22-month-old girl is reported. She was admitted because of recurrent urinary tract infection associated with fever and dysuria. Excretory urogram showed a left duplex kidney with hydroureteronephrosis of the upper and lower moieties. Although the left upper moiety was hypofunctioned, some excretion of contrast medium was noted. Voiding cystourethrography demonstrated reflux into the left upper moiety, and a prominent dilation of the bladder neck and the urethra. Bladder sonography demonstrated an ectopic ureterocele at the bladder neck, and it was diagnosed as a cecoureterocele by endoscopic examination...

The total number of inpatients was 1,309. There were 1020 males and 289 females, the male to female ratio being 3.5: 1. The major diseases seen in inpatients were benign prostatic hypertrophy, bladder tumor, prostatic carcinoma, ureteral stone, urethral diverticulum, bladder neck contracture, inguinal hernia and renal tumor. The total number of patients operated on was 1,211; 953 males and 258 females. These operations were performed at 11 hospitals using a semi-open system. Major operations were transurethral resections of prostatic and bladder tumor, subcapsular prostatectomy, castration, urethral diverticulectomy, nephrectomy, inguinal hernioplasty, ureterolithotomy, radical cystectomy and transurethral ureterolithotripsy...

We reviewed the cases of 95 children with duplex ureteroceles treated in this department over an 18-year period. There were 101 ureteroceles (6 bilateral). Diagnosis and treatment were analyzed. Special attention was paid to newborns screened in utero. We always strove to preserve functional renal tissue whenever possible. In keeping with this goal, three surgical techniques were used: (1) upper pole heminephrectomy; (2) ureterocele excision, bladder neck reconstruction, and ureter reimplantation with or without cutaneous ureterostomy of the upper pole ureter; and (3) endoscopic ureterocele incision...

Cystoscopy has been a well established procedure in adult urology for years and more recently for the endoscopic evaluation of the lower urinary tract of infants and children. Utilizing small caliber cold light endoscopes and resectoscopes, therapeutic manipulations are readily possible. Among these are extraction of ureteral stones, lithotripsy of bladder calculi, transurethral resection of bladder tumors, as well as transurethral incision and resection of bladder-neck obstructions, urethral valves and urethral stenoses...