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John W Jr Duckett: Influence Statistics

PURPOSE: The management of the nonpalpable testis permits an individualized operative approach. We analyze the results of surgical management of a large series of patients with a nonpalpable testis.

MATERIALS AND METHODS: Between January 1986 and June 1994 we treated 1,866 boys with undescended testes. There were 447 testes (24%) that were not palpable at presentation. Intra-operative data on these patients were collected for age at presentation, bilateral testes position, testicular ...

OBJECTIVES: Laser tissue soldering (LTS) with the diode laser and human albumin-hyaluronate-indocyanine green solder is a safe and effective method of providing an immediate leak-free closure during hypospadias repair. In this report, we compare the physiology, histology, and immunohistochemistry of wound healing following LTS and suturing in a rat skin flap model.

METHODS: A 4 x 5-cm skin flap was raised and bisected (4 cm) on the dorsum of 48 Sprague-Dawley rats. The central wound was ...

Immunohistochemistry using monoclonal and polyclonal antibodies to extracellular matrix proteins is a highly sensitive tool for the characterization of matrix components. For the first time in the normal and noncompliant human bladder we have used antibodies to collagen types I, III and IV, and elastin to provide morphological correlation with mechanical properties noted clinically. In the normal bladder elastin and collagen types I and III showed intense localization in the lamina ...

PURPOSE: We believe that primary valve ablation with observation is the preferred management for posterior urethral valves. However, debate continues as to the role of high diversion. We examined the long-term outcome of a large series of patients treated with primary valve ablation, and compared it to the outcome of high diversion and vesicostomy.

MATERIALS AND METHODS: We reviewed the records of 100 patients treated with primary valve ablation (74%), vesicostomy (13%) or high diversion ...

Patients with posterior urethral valves may present with or contract renal insufficiency. High intravesical pressure that is transmitted to the upper urinary tract in utero is a likely contributing cause. We have identified 3 anatomical associations with posterior urethral valves that provide a pressure "pop-off" mechanism resulting in preservation of better renal function: 1) the syndrome of posterior urethral valves, unilateral vesicoureteral reflux and renal dysplasia; 2) large ...

The onlay island flap urethroplasty, a variant of the transverse preputial (tubularized) island flap, was originally described for repair of anterior hypospadias. However, many cases of mid and proximal hypospadias have a well developed urethral plate and exhibit little or no chordee after release of skin tethering. Patients with this combination of findings are ideal candidates for onlay island flap urethroplasty regardless of initial meatal position. During the last 5 years the onlay ...

The contractile response of the rabbit urinary bladder to field stimulation consists of both cholinergic and purinergic components. In general, approximately 60% of the contractile response to field stimulation is cholinergic and 40% is purinergic. Although the purinergic response represents a significant proportion of the initial (phasic) pressure response to field stimulation of the isolated whole bladder, it contributes only 10-15% of the ability of field stimulation to empty the ...

A total of 51 children, mostly less than 2 years old, underwent endoscopic incision of ureteroceles as a primary form of treatment. In 73% no further surgery was required. Of the patients 19 were diagnosed by prenatal ultrasound, with a urinary tract infection the usual presenting symptom in the remainder. Of 27 intravesical cases endoscopic incision resulted in decompression of the ureterocele in 93%, with preservation of upper pole function in 96%, and secondary surgical procedures ...

Abstract Purpose The management of the nonpalpable testis permits an individualized operative approach. We analyze the results of surgical management of a large series of patients with a nonpalpable testis. Materials and Methods Between January 1986 and June 1994 we treated 1,866 boys with undescended testes. There were 447 testes (24%) that were not palpable at presentation. Intraoperative data on these patients were collected for age at presentation, bilateral testes position, ...

Of 260 patients being actively followed in a myelodysplasia clinic 48 have had a vesicostomy. Vesicostomy was done because of hydroureteronephrosis in 44 cases, infection in 3 and failure of clean intermittent catheterization in 1. Of the 48 patients 16 underwent closure of the vesicostomy, generally between ages 6 and 10 years, an age when the child is prepared to begin clean intermittent catheterization and is motivated to achieve continence. Two children underwent early vesicostomy ...

The coexistence of ureteropelvic junction obstruction and vesicoureteral reflux was seen in 17 (14 per cent) of 147 consecutive patients undergoing pyeloplasty. These patients were analyzed to determine the therapeutic implications of this association. They fell into 3 clinical groups: group 1--primary ureteropelvic junction obstruction, group 2--ureteropelvic junction obstruction secondary to high grade reflux and group 3--pseudo-ureteropelvic junction obstruction. There were 11 ...

Infants with posterior urethral valves and persistent unilateral reflux after valve resection often have an associated nonfunctioning, dysplastic kidney. Spurious function of the unit with reflux may be apparent on the delayed films of the excretory urogram. Misinterpretation of the initial radiographic studies performed without coincident bladder drainage results in the missed diagnosis of this syndrome and misguided surgical management. Of 82 patients with urethral valves 17 (21 per ...

PURPOSE: While it may lack the classic morphological pattern in striated muscle systems, there is ample evidence that smooth muscle also contains sarcoplasmic reticulum. These intracellular storage sites release calcium into the cytosol to generate contractile force in response to various stimuli. A major component of the sarcoplasmic reticulum is an adenosine triphosphate dependent ion pump, which serves to drive free calcium out of the cytosol back into this intracellular reservoir. ...

Although numerous experimental studies have addressed urinary bladder innervation, physiology and pharmacology, little information is available concerning the ontogeny of bladder function. The present study describes the developmental aspects of bladder mass, bladder capacity, pressure development and emptying in white New Zealand rabbits one day of age through maturity (11 to 15 weeks of age). The following studies were performed: Cystometry, pressure generation, rate of pressure ...

Classic management of cloacal exstrophy has emphasized primary closure of the omphalocele, end ileostomy, and delayed genitourinary reconstruction. The resultant mortality from “short-bowel syndrome” and urinary sepsis, and morbidity from inappropriate gender assignment has prompted us to reexamine the operative approach to this problem. Our experience involves 15 cases from 2 days to 21 years after repair. All had initial closure of their omphalocele. Nine of the 15 had closure of the ...