The Use of Bowel Interposed Between Proximal and Distal Ureter in Urinary Tract Reconstruction

Casale, Anthony J.; Colodny, Arnold H.; Bauer, Stuart B.; Retik, Alan B.

doi:10.1016/s0022-5347(17)47415-5

Cited by 12 publications

(2 citation statements)

References 11 publications

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“…With these advances in the medical and surgical management of the bladder and bowel dysfunction in myelodysplasia, a considerable number of patients who had been diverted during the 1970s sought to be ‘undiverted’ by having their urinary stomas refashioned back into their native urinary tract system a decade later [79]. For a time this process of urinary undiversion swept through the paediatric urology community, with numerous published reports describing indications, surgical procedures, medical approaches, newly developed techniques and advantages of undertaking these efforts [80–85]. Thus, countless adolescents and young adults were spared the ignominy of being burdened for a lifetime with a urinary collection apparatus attached to their anterior abdominal wall.…”

Section: Urinary Continencementioning

confidence: 99%

The management of the myelodysplastic child: a paradigm shift

Bauer

2003

BJU International

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study these babies urodynamically and noted several unfavourable signs which predicted increased risk factors for urinary tract deterioration [18]. McGuire et al. [19] showed that leak-point pressures of >40 cmH 2 O lead to the development of hydronephrosis and reflux in 68% of cases. A review of infants followed expectantly after having undergone kidney and bladder imaging, and urodynamic studies in the newborn period, revealed that 71% with bladder external urethral sphincter dyssynergy, with or without high detrusor filling pressure, experienced deterioration of their urinary tract function within the first 3 years of life [20]. Several other paediatric urologists were able to detect similar rates of deterioration when dyssynergy between the bladder and sphincter was present in the newborn period [21]. Interestingly, reflux was present only in those neonates who had dyssynergy on their first urodynamic study, suggesting in utero deterioration from high bladder voiding pressures [22].In the early to mid-1980s these reproducible observations and accurate predictions of deterioration caused many to reconsider that perhaps watchful waiting was not the most practical approach for these babies. This prompted a new view about how they should be treated [16,17]. By then, CIC was becoming a readily acceptable means of emptying the bladder in older children, to achieve continence with no need for urinary diversion [23]. Its application to newborns and young infants whose urodynamic values put them at risk for urinary tract deterioration was a novel approach that required a period of observation to confirm its beneficence. Over time, concerns about urethral injury and difficulty in using CIC regularly proved to be moot [23]. However, within a short period the positive effect of regular bladder emptying with a clean but not sterile catheter, with and without the use of anticholinergic agents to lower detrusor filling pressure when present, became the new mainstay of treatment [24]. Controversy raged for a time until there was overwhelming proof that very few children had upper urinary tract deterioration when aggressively managed with CIC and anticholinergic medication [17,[25][26][27]. The contention that children could be followed and CIC started after changes were noted [28,29] became irrelevant. Indeed, it was noted that the incidence of VUR was directly related to the presence of dyssynergy between the bladder and the external sphincter. In addition, reflux was detected frequently and within 6 months in those children whose neurological condition changed, with the conversion from a synergic to a dyssynergic sphincter. Thus, serial urodynamic studies proved to be a pariah in preventing the occurrence of reflux [25].

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Section: Urinary Continencementioning

confidence: 99%

The management of the myelodysplastic child: a paradigm shift

Bauer

2003

BJU International

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“…Furthermore, jejunal interposition is commonly used in the elective management of different gastrointestinal and urologic conditions, and has been found to provide a safe anastomosis even in tissues with compromised blood supply. [27][28][29][30] Therefore, it seems logical to consider the validity of such a procedure for acute colonic obstruction.…”

Section: Discussionmentioning

confidence: 99%