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Mesrobian HGO. Complete primary repair of bladder exstrophy is associated with detrusor underactivity type of neurogenic bladder. Urology 2014; 83:1139-44. [PMID: 24485361 DOI: 10.1016/j.urology.2013.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/04/2013] [Accepted: 11/09/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To test the hypothesis that complete primary repair of bladder exstrophy (CPRE) is associated with detrussor underactivity. For this purpose, we review (1) our experience, (2) the results of the published literature as it pertains to bladder function, and (3) the known anatomic basis on which the mechanism of the observed outcome can be understood. METHODS The medical records of all patients who underwent CPRE by the author between 2004 and 2010 were reviewed. Attention was focused on the clinical, imaging, and urodynamic findings. RESULTS Four men and 2 women underwent CPRE. Follow-up ranges from 2 to 8 years. Four underwent bilateral ureteral reimplantation combined with bladder neck repair in 3. Detrusor activity (or overactivity) was not recorded in the 5 patients who underwent urodynamic studies. Four patients achieved short periods of urinary continence. The percent predicted bladder capacity, adjusted for age, ranged from 25 to 70, with a median of 60. Of the 68 publications on CPRE since 1999, none reports the presence of detrusor activity. A description of the pelvic plexus anatomy by Walsh and Donker provides a basis for the mechanism of injury resulting in the previously mentioned results: (1) complete penile disassembly eliminates the distal fixation point of the bladder-urethral plate, (2) the subsequent dissection and mobilization result in shearing injury to the microscopic pelvic plexus branches to the bladder, external sphincter, and prostatic urethra. CONCLUSION CPRE results in disruption of the branches of the pelvic plexus and a neurogenic bladder (detrussor underactivity).
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Mesrobian HGO, Kryger JV, Groth TW, Fiscus GE, Mirza SP. Urinary Proteome Analysis in Patients With Stable SFU Grade 4 Ureteropelvic Junction Obstruction Differs From Normal. Urology 2013; 82:745.e1-10. [DOI: 10.1016/j.urology.2013.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/29/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
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Mesrobian HGO. Editorial comment. Urology 2013; 82:428-9; discussion 429. [PMID: 23639238 DOI: 10.1016/j.urology.2013.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Unilateral ureteropelvic junction obstruction (UPJO) is the most common prenatally detected disease leading to hydronephrosis. The obstructive anatomic lesion leads to varying degrees of hydronephrosis, ranging from no apparent effect on renal function to atrophy. Furthermore, the natural course of hydronephrosis varies from spontaneous resolution to progressive deterioration and may take upwards of 3 years for a kidney to declare itself. The objectives of this article are to update our knowledge regarding the evaluation and management of UPJO in depth and to discuss the emerging value of urinary proteome analysis to the clinical arena.
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Affiliation(s)
- Hrair-George O Mesrobian
- Division of Pediatric Urology, Department of Urology, Medical College and Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
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Mesrobian HGO, Canning DA. Surgical technique for antegrade dissection of the preputial vascular pedicle during hypospadias repair. J Pediatr Urol 2012; 8:282-4. [PMID: 21596623 DOI: 10.1016/j.jpurol.2011.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 03/29/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Both layers of the prepuce can be used as vascularized flaps in hypospadias repair. The aim of this communication is to describe an antegrade approach to the harvesting of the vascular pedicle. SURGICAL TECHNIQUE The vascular pedicle is isolated at the level of the penopubic junction where it is most robust. Dissection then proceeds distally towards the prepuce fanning laterally. RESULTS Of 306 boys presenting for hypospadias repair in 2002-2008, this approach was utilized in 235 (77%). The vascularized flap was used as 1) a classic single or double faced onlay flap in 95, 2) a vascularized layer to cover a tubularized incised plate urethroplasty in 68, 3) a tube-onlay in 39, 4) a tubularized urethroplasty in 23, 5) for ventral skin coverage alone in 7, and 6) for a planned first stage repair in 3. Age at repair averaged 12 months (range 2-160) and follow up 36 months (range 2-68). CONCLUSIONS Antegrade dissection of the vascular pedicle is a simple, expeditious and reliable way of isolating the prepuce on its blood supply. The versatility of the resulting flaps allows the repair to be adapted to the individual anatomic conditions as opposed to one type of repair being used for all variants.
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Mesrobian HGO, Mitchell ME, See WA, Halligan BD, Carlson BE, Greene AS, Wakim BT. Candidate Urinary Biomarker Discovery in Ureteropelvic Junction Obstruction: A Proteomic Approach. J Urol 2010; 184:709-14. [DOI: 10.1016/j.juro.2010.03.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Indexed: 01/30/2023]
Affiliation(s)
| | - Michael E. Mitchell
- Department of Urology, Medical College and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - William A. See
- Department of Urology, Medical College and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Brian D. Halligan
- Biotechnology and Bioengineering Center, Medical College and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Brian E. Carlson
- Biotechnology and Bioengineering Center, Medical College and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Andrew S. Greene
- Biotechnology and Bioengineering Center, Medical College and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Bassam T. Wakim
- Department of Biochemistry, Medical College and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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Mesrobian HGO. RE: Obaidah et al.: Our experience of ureteral substitution in pediatric age group (Urology 2010;75:1476-1480). Urology 2010; 76:255. [PMID: 20599125 DOI: 10.1016/j.urology.2009.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Revised: 08/09/2009] [Accepted: 08/10/2009] [Indexed: 11/26/2022]
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Mesrobian HGO, Wang T, Halligan B, Wakim BT. LIQUID CHROMATOGRAPHY/MASS SPECTROMETRY URINARY PROTEOME ANALYSIS DISCRIMINATES BETWEEN HEALTHY INFANTS AND AGE MATCHED PATIENTS WITH UNILATERAL GRADE 4 URETEROPELVIC JUNCTION OBSTRUCTION. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60716-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
INTRODUCTION AND OBJECTIVE Dismembered pyeloplasty is the surgical technique of choice for open, laparoscopic and/or robot-assisted repair of ureteropelvic junction obstruction (UPJO). We describe a new technique, bypass pyeloplasty, ideally suited for the high inserting ureter, and present initial results. PATIENTS AND METHODS A wide 1-2-cm side-to-side anastomosis is created between the dilated and elastic portion of the ureter just distal to the UPJO and the lower and dependent portion of the hydronephrotic renal pelvis. The UPJ is not disturbed and the renal pelvis is not surgically reduced. Since 2004, of 27 patients requiring surgery for UPJO, 7 underwent bypass pyeloplasty. The indications for surgery included increasing hydronephrosis or decreasing individual renal function in four, pain in two and pyelonephritis in one. The remaining 20 underwent a classic dismembered pyeloplasty. RESULTS During a mean follow-up of 26 months, the anteroposterior diameter of the repaired kidney decreased by a mean of 55%. The individual renal function in the repaired kidney improved in two and remained stable in the remainder. CONCLUSION These favorable initial results justify further exploration of this simplified technique and its adaptation for laparoscopic and robot-assisted approaches. Bypass pyeloplasty may be a more physiologic procedure in patients with mid to high insertion of the ureter.
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Mesrobian HGO. The value of newborn urinary proteome analysis in the evaluation and management of ureteropelvic junction obstruction: a cost-effectiveness study. World J Urol 2008; 27:379-83. [DOI: 10.1007/s00345-008-0355-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 10/24/2008] [Indexed: 11/29/2022] Open
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Mesrobian HGO. Re: A critical assessment of the quality of reporting of randomized, controlled trials in the urology literature. C. D. Scales, Jr., R. D. Norris, s. A. Keitz, B. L. Peterson, G. M. Preminger, J. Vieweg and P. Dahm. J Urol 2007; 177: 1090-1095. J Urol 2008; 179:2488-9; author reply 2489. [PMID: 18439625 DOI: 10.1016/j.juro.2008.01.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Indexed: 12/18/2022]
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Abstract
During the last 2 decades of the twentieth century, maternal sonography became integrated into routine prenatal care. As a result, numerous anomalies are now detected in the fetus. This practice has had a profound influence on the presentation and natural history of urologic problems in the neonate. In an attempt to reflect the clinical scenario, this article is divided into two main parts: the first includes clinical questions raised by prenatally detected anomalies, abdominal masses, urosepsis, urinary retention, scrotal masses, and abnormal external genitalia; the second part is a discussion of specific anomalies with respect to evaluation and management, including controversies, and optimum timing for referral to a tertiary care center. Our knowledge regarding the pathophysiology and therefore treatment of these conditions is constantly expanding and changing.
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Affiliation(s)
- Hrair-George O Mesrobian
- Department of Urology, Division of Pediatric Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Children's Hospital Office Building, Suite 606, Milwaukee, WI 53226, USA.
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Abstract
Vesicoureteral reflux, the abnormal flow of urine from the bladder into the ureter, is one of the most common congenital anomalies found in children. The association of vesicoureteral reflux with urinary tract infections and renal scarring has important clinical implications. New insights into pathogenesis and new surgical techniques are changing the approach to the management of this disorder.
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Affiliation(s)
- Larry A Greenbaum
- Division of Pediatric Nephrology, Emory University School of Medicine, Children's Healthcare of Atlanta, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA.
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Abstract
Anomalies of the urogenital sinus have been described in association with male pseudohermaphroditism, bladder and uterine duplication, and a spectrum of external genital anomalies, including a female phallic urethra. The evaluation and optimal surgical management of these anomalies can be complex. We describe a case of a female patient with an accessory phallic urethra and a urogenital sinus anomaly. The presence of stenosis of the accessory urethral meatus led to the formation of a giant diverticulum with unusual features. The complete repair of the anomaly incorporated creation of labia minora from portions of the diverticulum.
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Affiliation(s)
- Blanca M Brandes
- Division of Pediatric Urology, Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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Mesrobian HGO. Re: Complete primary repair of bladder exstrophy in children presenting late and those with failed initial closure: single center experience. J Urol 2006; 175:1174. [PMID: 16469646 DOI: 10.1016/s0022-5347(05)00332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Indexed: 11/21/2022]
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Brandes BM, Mesrobian HGO. Evaluation and management of genital anomalies in two patients with Klinefelter syndrome and review of literature. Urology 2005; 65:976-9. [PMID: 15882735 DOI: 10.1016/j.urology.2004.12.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 11/30/2004] [Accepted: 12/20/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To present the evaluation and management of cryptorchidism and varicocele in patients with Klinefelter syndrome and review the literature. Recent advances in reproductive medicine have resulted in fertility in patients with Klinefelter syndrome. However, cryptorchidism and varicocele can affect the fertility potential on their own. METHODS We present 2 cases and review the literature with an emphasis on the fertility potential. RESULTS Germ cells were present in the testicular biopsy of an infant with cryptorchidism but not in the adolescent with a varicocele. The latter biopsy showed tubular sclerosis. CONCLUSIONS The fertility potential of patients with Klinefelter syndrome and cryptorchidism may be preserved or enhanced by an early orchiopexy. However, the potential benefit of ligation of internal spermatic veins in patients with Klinefelter syndrome and a varicocele warrants further study. Cryopreservation should be considered early in adolescence or adulthood as germ cells become depleted at an accelerated rate after puberty.
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Affiliation(s)
- Blanca M Brandes
- Department of Urology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA
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Abstract
Maternal sonography is integrated into routine prenatal care, and numerous fetal anomalies are detected, with genitourinary anomalies the most common. This has profoundly influenced the presentation and natural history of neonatal urologic problems. This article is divided into two sections. The first addresses clinical questions raised by prenatally detected anomalies, abdominal masses, urosepsis, urinary retention, scrotal masses, and abnormal external genitalia. The second discusses evaluation and management of specific anomalies,including controversies, and optimum timing for tertiary care center referral. The selected anomalies include renal anomalies, tumors, the exstrophy complex, urogenital anomalies, ambiguous genitalia, posterior urethral valves, scrotal anomalies, spina bifida, and common urologic syndromes such as the triad syndrome. Readers are referred to urologic texts for additional information.
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Affiliation(s)
- Hrair-George O Mesrobian
- Department of Urology, Division of Pediatric Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Children's Hospital Office Building, Suite 606, Milwaukee, WI 53226, USA.
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Smither AR, Winthrop AL, Mesrobian HGO. Bilateral scrotal masses in an infant: remote presentation of an inflammatory reaction to surgical glove powder. J Urol 2002; 168:2592-3. [PMID: 12441992 DOI: 10.1097/01.ju.0000037720.30831.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Anna R Smither
- Division of Pediatric Urology, Medical College and Children's Hospital of Wisconsin, Milwaukee, USA
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Smither AR, Winthrop AL, Mesrobian HGO. Bilateral scrotal masses in an infant: remote presentation of an inflammatory reaction to surgical glove powder. J Urol 2002; 168:2592-3. [PMID: 12441992 DOI: 10.1016/s0022-5347(05)64224-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Anna R Smither
- Division of Pediatric Urology, Medical College and Children's Hospital of Wisconsin, Milwaukee, USA
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Affiliation(s)
- Hrair-George O. Mesrobian
- From the Division of Pediatric Urology and Department of Pediatric Surgery, Children's Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alex Zacharias
- From the Division of Pediatric Urology and Department of Pediatric Surgery, Children's Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anthony H. Balcom
- From the Division of Pediatric Urology and Department of Pediatric Surgery, Children's Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Roger D. Cohen
- From the Division of Pediatric Urology and Department of Pediatric Surgery, Children's Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin
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