Ureteral Transplantation in the Very Young

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The most frequent indication for transplantation of the ureters into the rectosigmoid in young children is exstrophy of the urinary bladder. Time will not correct the condition nor will the deformity improve with years. Unlike some other deformities, no compensatory function is to be expected; on the contrary, the situation becomes worse for both the child and parents as the child grows older. In addition, the danger of damage to the kidneys increases with years.

At what age, then, can a successful transplantation be accomplished? Formerly we were of the opinion that one should wait until the child had been taught voluntary control of the anal sphincter or from three to five years of age. If the anal sphincter is functioning, we now believe the earlier the ureters are transplanted the less will be the danger of complications, such as ascending infection of the urinary tract. We know that very young children tolerate surgical procedures remarkably well as is attested by operations for cleft palate, harelip, pyloric stenosis, intussusception, etc. As an example of the tolerance and result of early operation for exstrophy, the following case is presented in which operation for exstrophy of the bladder was performed on a patient four and one-half months of age.

This patient, a baby boy 4 months of age, was first seen in the Clinic on June 22, 1936, with marked epispadias and exstrophy of the bladder. The baby was a full term child and the delivery was uncomplicated. He was breast fed, . . .



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