Ectopic Ureter: Surgical Management

2019 ◽  
Author(s):  
Austin Hester ◽  
Anthony Atala
Keyword(s):  
Surgical Management ◽  
Conservative Management ◽  
Pediatric Population ◽  
Ectopic Ureter ◽  
Renal Unit ◽  
Ureteral Reimplantation ◽  
Live Births ◽  
Uncommon Presentation ◽  
Surgical Options ◽  
Cutaneous Ureterostomy

The ectopic ureter is an uncommon presentation in the pediatric population, seen in approximately one in 2,000 live births with a female prevalence. However, observation and conservative management have a short-lived role as many of these children are incontinent or symptomatic from an obstructed system. Urgent decompression of an infected system may be required as a temporizing measure before definitive surgical management can be pursued. In this review, we discuss the surgical options available for the ectopic ureter. This includes heminephrectomy of the nonfunctioning renal unit and reconstructive measures such as ureteral reimplantation, ureteroureterostomy, and ureteropyelostomy. We also discuss the management of the remnant ureteral stump and concomitant vesicoureteral reflux.   This review contains 1 figure and 35 references. Key words: cutaneous ureterostomy, ectopic ureter, renal duplication anomalies, heminephrectomy, ureteral reimplantation, ureteropyelostomy, ureteroureterostomy

scholarly journals Conservative management of periapical cysts – A case series

2021 ◽  
Vol 12 (6) ◽  
pp. 122-125
Author(s):  
Devakumari Shanmugam ◽  
Vijhayapriya Thanasekar ◽  
Nandini Biradar ◽  
Bhavanirekha Natarajan ◽  
Neil Dominic
Keyword(s):  
Bone Formation ◽  
Surgical Management ◽  
Conservative Management ◽  
Root Canal ◽  
Periodontal Ligament ◽  
Case Series ◽  
Root Canal Therapy ◽  
Tooth Mobility ◽  
Surgical Options

Non vital teeth with periapical cysts do not respond to routine root canal therapy alone. Conventional RCT (root canal therapy) should be combined with conservative management of cysts or surgical management. Contemporary options for non-surgical management are repeated intra canal dressing with Ca (OH)2, aspiration and decompression techniques. Repeated intra canal dressing with Ca(OH)2 and Iodoform (Metapex) was advocated in 15 of our patients for a period of eight years from 2011-2019. The healing of the lesions was excellent with respect to bone formation, reestablishment of periodontal ligament and reduction in tooth mobility on follow up of six months to one and a half years. This case series gives insight of successful non-surgical management of periapical cysts. We reiterate the effectiveness of non-surgical management of periapical cysts as it was well observed in our case series. The promising prognosis of non-surgical management of periapical cysts can render the surgical options antediluvian.

Ectopic Ureter: Diagnosis and Medical Management

2019 ◽  
Author(s):  
Austin Hester ◽  
Anthony Atala
Keyword(s):  
Medical Management ◽  
Pediatric Population ◽  
Urogenital Sinus ◽  
Voiding Cystourethrography ◽  
Ectopic Ureter ◽  
Ureteral Orifice ◽  
Nuclear Scintigraphy ◽  
Key Words Ct ◽  
Uncommon Presentation ◽  
Multiple Imaging

The ectopic ureter is an uncommon presentation in the pediatric population with a 6 to 1 female-to-male prevalence. From an embryologic standpoint, ectopic ureters form as a result of failure of proper development of the urogenital sinus with ectopic development of the ureteral orifice. They are most often associated with a duplicated collecting system. The location of the orifice is most commonly in the posterior urethra. Diagnosis is usually made with a combination of multiple imaging modalities, including ultrasonography, voiding cystourethrography, nuclear scintigraphy, and sometimes CT or MRI. In this review, we detail the origin of the ectopic ureter and discuss diagnosis and medical management.  This review contains 3 figures, and 29 references. Key words: CT, cystourethrography, ectopic ureter, MRI, renal duplication anomalies, ultrasonography, voiding nuclear scintigraphy

Surgical Management of Pediatric Lymphedema: A Systematic Review

2019 ◽  
Vol 35 (06) ◽  
pp. 462-470 ◽  
Author(s):  
Aditi M. Kanth ◽  
Max Krevalin ◽  
Oluwaseun A. Adetayo ◽  
Ashit Patel
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Conservative Management ◽  
Pediatric Patients ◽  
Lymphatic System ◽  
Pediatric Population ◽  
Small Population ◽  
Protein Rich ◽  
Genital Lymphedema

Background Lymphedema is a rare, progressive, and debilitating condition caused by failure of the lymphatic system to adequately drain the protein-rich fluid exiting the capillaries. Conservative management is often emphasized in pediatric patients, resulting in a paucity of literature describing surgical treatment in this population. Methods A systematic review was performed using PubMed, ScienceDirect, and Google Scholar to identify all studies describing surgical management of lymphedema in the pediatric population. Results Of the 343 relevant articles identified, 14 met the criteria for full review. Articles were divided into the following treatment categories: genital lymphedema, excisional procedures for extremity lymphedema, and physiologic procedures for extremity lymphedema. Outcomes for genital lymphedema were overall positive. For extremity lymphedema, excisional procedures yielded good results overall and included the majority of patients in this study. Physiologic procedures had mixed outcomes in the small population included in this study, but definitive conclusions cannot be drawn due to the paucity of existing data. Conclusion While conservative management of pediatric lymphedema is well described, the literature remains sparse regarding surgical treatment. Further studies are needed to evaluate efficacy and outcomes in all three categories in this population.

scholarly journals ARE SPORTS INJURIES THE MOST COMMON CAUSE OF MOREL-LAVALLEE LESIONS IN THE PEDIATRIC POPULATION?

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0002
Author(s):  
Indranil Kushare ◽  
Ramesh Babu Ghanta ◽  
Nicole A. Wunderlich
Keyword(s):  
Lower Extremity ◽  
Conservative Management ◽  
Sports Injuries ◽  
Pediatric Population ◽  
Case Series ◽  
Lower Leg ◽  
Functional Score ◽  
Imaging Features ◽  
Associated Injuries ◽  
Common Cause

Background: Traumatic internal degloving injury i.e. Morel-Lavallée lesion (MLL) develops as a result of blunt trauma with tangential shear forces. In the pediatric population, these have been described only as small case reports till date. Purpose: To describe the largest case series of lower extremity Morel-Lavallée lesion (MLL) in the pediatric population, to determine its etiology (especially its relationship to sports), treatment and outcomes. Methods: Retrospective study of patients <18 years presenting to a tertiary children’s hospital with MLL between 2013-2019. Demographics, clinical data, imaging features, treatment and outcomes data was collected. Descriptive statistical analysis was conducted. Results: 38 patients (21 males, 17 females) having MLL with mean age 14.6 years were classified into 2 groups- hip/thigh MLL (9 patients) and lower leg MLL (29) (Table 1.1). Most common cause of lower leg MLL was sports injury (79%). Most commonly implicated sports in MLL were football and baseball(24% each). Associated injuries were seen in 9 (23%) patients. Radiographs done in 58% of patients showed no bony abnormalities. Imaging modality of choice was MRI for lower leg MLLs (72%) and US for hip/thigh MLL (67%)(Fig.1.2). MLL size was larger for hip/thigh MLL (168 cm3) as compared to leg MLL (38.6 cm3). 25 (65.8%) of MLLs were treated with conservative management,12 (31.5%) with minimally invasive methods and 1(2.6%) needed surgical management. 2/9 (22.2%) of the associated injuries required operative management. 2/38 (5%) patients were given prophylactic antibiotics. 72.4% Lower leg MLLs were treated with conservative management while intervention was needed more in hip/thigh MLLs (55.6%). Patients returned to activities at 14.3 weeks for hip/thigh MLL;9.1 weeks for lower leg MLL. 24 patients with adequate documentation demonstrated lower extremity functional score (LEFS) and pain level of 74/80 (92.5%) and 0.7/10 respectively at mean 12.5 months follow-up. Leg cellulitis was seen as a complication in one patient. Conclusion: The largest case series on MLL exclusively in the pediatric population suggests that they are more common in knee/leg region region and usually caused by sports injuries which is notably different as compared to adult population. Most pediatric injuries are treated conservatively, especially sports related MLLs. Although return to activities takes longer for hip/thigh injuries, majority of patients regain satisfactory functionality post-injury. [Table: see text][Figure: see text]

scholarly journals Patient Related Outcome Measures (PROMs) in Morton’s Neuroma: Conservative vs. Surgical Management at One-Year Follow-Up

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0002
Author(s):  
Alastair Faulkner ◽  
Alistair Mayne ◽  
Fraser Harrold
Keyword(s):  
Outcome Measures ◽  
Surgical Management ◽  
Conservative Management ◽  
Morton’S Neuroma ◽  
Significant Difference ◽  
Morton's Neuroma ◽  
One Year ◽  
Patient Related Outcome ◽  
Eq Vas

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.

Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population

2016 ◽  
Vol 12 (3) ◽  
pp. 169.e1-169.e6 ◽  
Author(s):  
Angela M. Arlen ◽  
Kristin M. Broderick ◽  
Curtis Travers ◽  
Edwin A. Smith ◽  
James M. Elmore ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Ureteral Reimplantation ◽  
Robot Assisted

scholarly journals Surgical Management of Pediatric Gastroesophageal Reflux Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Hope T. Jackson ◽  
Timothy D. Kane
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Surgical Management ◽  
Reflux Disease ◽  
Clinical Presentation ◽  
Pediatric Population ◽  
Treatment Options ◽  
Failure To Thrive ◽  
Solid Diet ◽  
Esophageal Sphincter

Gastroesophageal reflux (GER) is common in the pediatric population. Most cases represent physiologic GER and as the lower esophageal sphincter (LES) matures and a solid diet is introduced, many of these patients (>65%) experience spontaneous resolution of symptoms by two years of age. Those who continue to have symptoms and develop complications such as failure to thrive, secondary respiratory disease, and others are classified as having gastroesophageal reflux disease (GERD). Goals of GERD treatment include the resolution of symptoms and prevention of complications. Treatment options to achieve these goals include dietary or behavioral modifications, pharmacologic intervention, and surgical therapy. This paper will review the clinical presentation of GERD and discuss options for surgical management and outcomes in these patients.

scholarly journals Isolated Duodenal Crohn's Disease: A Case Report and a Review of the Surgical Management

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Faruk Karateke ◽  
Ebru Menekşe ◽  
Koray Das ◽  
Sefa Ozyazici ◽  
Pelin Demirtürk
Keyword(s):  
Crohn’S Disease ◽  
Case Report ◽  
Gastrointestinal Tract ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Immunosuppressive Therapy ◽  
Surgical Management ◽  
Surgical Intervention ◽  
Surgical Options ◽  
Crohn’S Diseases

Crohn's disease may affect any segment of the gastrointestinal tract; however, isolated duodenal involvement is rather rare. It still remains a complex clinical entity with a controversial management of the disease. Initially, patients with duodenal Crohn' s disease (DCD) are managed with a combination of antiacid and immunosuppressive therapy. However, medical treatment fails in the majority of DCD patients, and surgical intervention is required in case of complicated disease. Options for surgical management of complicated DCD include bypass, resection, or stricturoplasty procedures. In this paper, we reported a 33-year-old male patient, who was diagnosed with isolated duodenal Crohn’s diseases, and reviewed the surgical options in the literature.

scholarly journals Resolution of congenital nasolacrimal duct obstruction with conservative management

2017 ◽  
Vol 6 (1) ◽  
pp. 12-15
Author(s):  
J B Shrestha
Keyword(s):  
Congenital Anomaly ◽  
Conservative Management ◽  
Pediatric Population ◽  
Clinical Signs ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Topical Antibiotics ◽  
Appropriate Treatment

Congenital nasolacrimal duct obstruction is the commonly encountered congenital anomaly in pediatric population occurring in as many as 30% of new borns. Conservative management of such condition with topical antibiotics and properly performed massage of the nasolacrimal sac is appropriate treatment during the first few months of age. The purpose of this study was to determine the rate of resolution of nasolacrimal duct obstruction with conservative management in infants up to 10 months of age. A total of 181 infants of age up to 10 months old with the diagnosis of Congenital nasolacrimal duct obstruction were advised nasolacrimal duct massage with or without the prescription of topical antibiotics. Resolution of nasolacrimal duct obstruction was assessed at 3 month and 6 month and was defined as the absence of all clinical signs of nasolacrimal duct obstruction. At the 6-month examination, 163 eyes (83%) of 181 children showed resolution with conservative management. The overall success rate of Congenital nasolacrimal duct obstruction with conservative management was high and this form of management can be considered as one of the best options in infants.

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