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David R. Vandersteen - One of the best experts on this subject based on the ideXlab platform.
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mini Ureteroneocystostomy a safe and effective outpatient treatment for unilateral vesicoureteral reflux
The Journal of Urology, 2008Co-Authors: Richard A. Ashley, David R. VandersteenAbstract:Purpose: Medically refractory vesicoureteral reflux is a common condition that can be cured by open surgery. Extravesical Ureteroneocystostomy is a safe and effective surgical procedure. We determined whether this could be accomplished with limited dissection via an approximately 2 cm inguinal incision (mini-Ureteroneocystostomy).Materials and Methods: All patients with unilateral vesicoureteral reflux who underwent mini-Ureteroneocystostomy from 2003 to 2007 were evaluated. We present preoperative characteristics, surgical technique and outcomes in this analysis.Results: From 2003 to 2007, 57 children underwent mini-Ureteroneocystostomy for unilateral vesicoureteral reflux. The group was predominantly female (48 of 57 patients or 84%) with median age of 4.8 years. Median vesicoureteral reflux grade was 3 (range 2 to 5). Duplication anomalies were present in 8 patients, while 5 had a Hutch diverticulum and 5 had a solitary kidney. A total of 47 patients (82%) underwent postoperative voiding cystourethrogr...
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outcome analysis of mini Ureteroneocystostomy versus dextranomer hyaluronic acid copolymer injection for unilateral vesicoureteral reflux
The Journal of Urology, 2008Co-Authors: Richard A. Ashley, David R. VandersteenAbstract:Purpose: Injecting dextranomer/hyaluronic acid copolymer has gained popularity as first line treatment for vesicoureteral reflux. However, Ureteroneocystostomy has typically been more successful than endoscopic treatments. We evaluated the outcome of dextranomer/hyaluronic acid copolymer injection vs that of extravesical Ureteroneocystostomy via a 2 cm inguinal incision (mini-Ureteroneocystostomy) for unilateral vesicoureteral reflux.Materials and Methods: The records were analyzed of all patients from 2003 to 2007 with unilateral vesicoureteral reflux who underwent mini-Ureteroneocystostomy or dextranomer/hyaluronic acid copolymer injection. Mini-Ureteroneocystostomy was performed via a 2 cm inguinal incision. Of the injections 66% were delivered via an intraureteral tunnel technique. Statistical analysis was done to compare differences in clinical features and success rates. All p values were 2-sided with significance at p <0.05.Results: From 2003 to 2007, 99 children underwent operative repair of unila...
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histopathological changes associated with dextranomer hyaluronic acid injection for pediatric vesicoureteral reflux
The Journal of Urology, 2007Co-Authors: Jonathan C. Routh, Richard A. Ashley, Thomas J. Sebo, David R. Vandersteen, Jeffrey M. Slezak, Yuri ReinbergAbstract:Purpose: Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux®). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing Ureteroneocystostomy after failed dextranomer/hyaluronic acid injection.Materials and Methods: All patients undergoing Ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical ex...
Richard A. Ashley - One of the best experts on this subject based on the ideXlab platform.
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mini Ureteroneocystostomy a safe and effective outpatient treatment for unilateral vesicoureteral reflux
The Journal of Urology, 2008Co-Authors: Richard A. Ashley, David R. VandersteenAbstract:Purpose: Medically refractory vesicoureteral reflux is a common condition that can be cured by open surgery. Extravesical Ureteroneocystostomy is a safe and effective surgical procedure. We determined whether this could be accomplished with limited dissection via an approximately 2 cm inguinal incision (mini-Ureteroneocystostomy).Materials and Methods: All patients with unilateral vesicoureteral reflux who underwent mini-Ureteroneocystostomy from 2003 to 2007 were evaluated. We present preoperative characteristics, surgical technique and outcomes in this analysis.Results: From 2003 to 2007, 57 children underwent mini-Ureteroneocystostomy for unilateral vesicoureteral reflux. The group was predominantly female (48 of 57 patients or 84%) with median age of 4.8 years. Median vesicoureteral reflux grade was 3 (range 2 to 5). Duplication anomalies were present in 8 patients, while 5 had a Hutch diverticulum and 5 had a solitary kidney. A total of 47 patients (82%) underwent postoperative voiding cystourethrogr...
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outcome analysis of mini Ureteroneocystostomy versus dextranomer hyaluronic acid copolymer injection for unilateral vesicoureteral reflux
The Journal of Urology, 2008Co-Authors: Richard A. Ashley, David R. VandersteenAbstract:Purpose: Injecting dextranomer/hyaluronic acid copolymer has gained popularity as first line treatment for vesicoureteral reflux. However, Ureteroneocystostomy has typically been more successful than endoscopic treatments. We evaluated the outcome of dextranomer/hyaluronic acid copolymer injection vs that of extravesical Ureteroneocystostomy via a 2 cm inguinal incision (mini-Ureteroneocystostomy) for unilateral vesicoureteral reflux.Materials and Methods: The records were analyzed of all patients from 2003 to 2007 with unilateral vesicoureteral reflux who underwent mini-Ureteroneocystostomy or dextranomer/hyaluronic acid copolymer injection. Mini-Ureteroneocystostomy was performed via a 2 cm inguinal incision. Of the injections 66% were delivered via an intraureteral tunnel technique. Statistical analysis was done to compare differences in clinical features and success rates. All p values were 2-sided with significance at p <0.05.Results: From 2003 to 2007, 99 children underwent operative repair of unila...
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histopathological changes associated with dextranomer hyaluronic acid injection for pediatric vesicoureteral reflux
The Journal of Urology, 2007Co-Authors: Jonathan C. Routh, Richard A. Ashley, Thomas J. Sebo, David R. Vandersteen, Jeffrey M. Slezak, Yuri ReinbergAbstract:Purpose: Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux®). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing Ureteroneocystostomy after failed dextranomer/hyaluronic acid injection.Materials and Methods: All patients undergoing Ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical ex...
Stephen A. Kramer - One of the best experts on this subject based on the ideXlab platform.
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febrile urinary tract infections after Ureteroneocystostomy and subureteral injection of dextranomer hyaluronic acid for vesicoureteral reflux do choice of procedure and success matter
The Journal of Urology, 2011Co-Authors: Moira Dwyer, Douglas Husmann, Suzanne R. Rathbun, Christopher J. Weight, Stephen A. KramerAbstract:Purpose: Despite success rates favoring Ureteroneocystostomy over subureteral injection of dextranomer/hyaluronic acid for correction of vesicoureteral reflux, the reported incidence of postoperative febrile urinary tract infection favors the latter. We evaluated contemporary treatment cohorts for an association between correction of vesicoureteral reflux and risk of postoperative febrile urinary tract infection.Materials and Methods: We retrospectively reviewed the records of 396 consecutive patients who underwent Ureteroneocystostomy or subureteral injection of dextranomer/hyaluronic acid between 1994 and 2008. Time to event multivariate analyses included preoperative grade of vesicoureteral reflux and bladder/bowel dysfunction.Results: Of 316 patients meeting study criteria 210 underwent Ureteroneocystostomy (356 ureters) and 106 underwent subureteral injection of dextranomer/hyaluronic acid (167). Median patient age was 5.7 years (IQR 3.4 to 8.3). Median followup was 28 months (IQR 8 to 61). Ureteral ...
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management of nephrolithiasis after cohen cross trigonal and glenn anderson advancement Ureteroneocystostomy
The Journal of Urology, 2006Co-Authors: Amy E Krambeck, Stephen A. Kramer, Douglas A. Husmann, Matthew T Gettman, Ahmad H Banihani, Joseph W SeguraAbstract:Purpose: Ureteroneocystotomy is frequently performed for ureteral injury or vesicoureteral reflux. The Glenn-Anderson technique advances the ureteral orifice distal to its native position, while the Cohen technique crosses the orifice to the opposite trigone. Each treatment can alter access to the upper genitourinary tracts. We report our experience with subsequent nephrolithiasis in these patients.Materials and Methods: We performed a retrospective chart review of all patients treated with ureteroneocystotomy since 1980 who had nephrolithiasis.Results: Nephrolithiasis developed in 9 patients with prior Cohen ureteroneocystotomy and in 15 with prior Glenn-Anderson ureteroneocystotomy. Stones size was 2 to 20 mm (mean 6.4). In the Cohen group ureteroscopy was attempted and failed in 2 patients, requiring percutaneous nephrolithotomy. Attempted shock wave lithotripsy failed in 2 patients, of whom 1 required percutaneous nephrolithotomy and 1 required observation. Primary percutaneous nephrolithotomy was per...
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Continuous epidural anesthesia after Ureteroneocystostomy in children.
The Journal of urology, 1995Co-Authors: Mark P. Cain, Douglas A. Husmann, Robert H. Mclaren, Stephen A. KramerAbstract:AbstractWe retrospectively reviewed the records of 101 pediatric patients who underwent uncomplicated ureteral reimplantation and were treated with postoperative epidural catheters for pain management. A total of 50 pediatric patients treated without epidural anesthesia was used as the control group. Length of hospital stay, time to first bowel activity, doses of narcotics, incidence of postoperative fever and evidence of epidural catheter related morbidities were documented. The costs of postoperative epidural anesthesia versus standard analgesics were compared.There was no significant difference in length of hospital stay or return of bowel function between treatment groups. Total doses of narcotics given during the hospital stay were significantly less for the epidural group (p less than 0.05). The children given epidural anesthesia also had a significant increase in the incidence of postoperative fever (p less than 0.05) and 25 percent had catheter related problems that often resulted in early removal...
Yuri Reinberg - One of the best experts on this subject based on the ideXlab platform.
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histopathological changes associated with dextranomer hyaluronic acid injection for pediatric vesicoureteral reflux
The Journal of Urology, 2007Co-Authors: Jonathan C. Routh, Richard A. Ashley, Thomas J. Sebo, David R. Vandersteen, Jeffrey M. Slezak, Yuri ReinbergAbstract:Purpose: Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux®). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing Ureteroneocystostomy after failed dextranomer/hyaluronic acid injection.Materials and Methods: All patients undergoing Ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical ex...
Jonathan C. Routh - One of the best experts on this subject based on the ideXlab platform.
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histopathological changes associated with dextranomer hyaluronic acid injection for pediatric vesicoureteral reflux
The Journal of Urology, 2007Co-Authors: Jonathan C. Routh, Richard A. Ashley, Thomas J. Sebo, David R. Vandersteen, Jeffrey M. Slezak, Yuri ReinbergAbstract:Purpose: Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux®). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing Ureteroneocystostomy after failed dextranomer/hyaluronic acid injection.Materials and Methods: All patients undergoing Ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical ex...
