Publications by authors named "Georgios Korakianitis"

2 Publications

  • Page 1 of 1

The large bladder diverticulum in children.

J Pediatr Urol 2005 Aug;1(4):267-72

Department of Pediatric Urology, Aghia Sophia Children's Hospital, Thivon and Mikras Assias, Goudi 11527 Athens, Greece.

Objective: Large bladder diverticulae, i.e. with a diameter measuring at least one-third of the bladder diameter on voiding cystourethrography, constitute an unusual but serious cause of obstructive uropathy in childhood. Their operative management entails meticulous reconstruction of the lower urinary tract. We report our experience with the management and long-term outcome of large bladder diverticulae in children during a 20-year period.

Patients And Methods: Twenty-two children (21 boys and 1 girl) aged 13 days to 14 years old (median age 2 years) at diagnosis of a large bladder diverticulum were treated in our department between April 1982 and December 2001. Presenting symptoms were: acute pyelonephritis in 10 patients, acute or chronic urinary retention in five, recurrent non-febrile bacteriuria in four and macroscopic hematuria in one patient. In the remaining two cases the diverticulae were diagnosed incidentally. Vesicoureteral reflux due to incorporation of the ureter within the diverticulum occurred in three children (four ureters). Transvesical diverticulectomy was performed as primary treatment in 20 patients. In the remaining two who presented at the age of 2 weeks with acute retention, cutaneous vesicostomy was the primary management followed after 1 year by diverticulectomy. Diverticulectomy was combined with ureteral reimplantation in 14 ureters (four refluxing and 10 non-refluxing) which were incorporated within the diverticular sac. In two children with bladder-neck hypertrophy, a bladder neck incision was additionally performed.

Results: There were two postoperative complications. In one case of bladder-neck stenosis with a thick trabeculated bladder ureterovesical obstruction occurred following ureteral reimplantation. Another patient presented with severe hematuria and clot retention, which was controlled by clot evacuation, continuous bladder irrigation and administration of factor VIII. In the five patients with retention preoperatively, complete bladder emptying was achieved postoperatively. Seventeen patients who at their last follow up had reached school age had a normal uroflow and normal voiding patterns. None of the patients had recurrence of the diverticulum, and all have remained free of urinary infection postoperatively during a mean (range) follow-up period of 16 (2-20) years.

Conclusion: Large bladder diverticulae present a serious urological problem in childhood. Urinary infection and urinary retention are the most common presenting symptoms. Transvesical diverticulectomy is a reliable technique for surgical treatment, and can effectively be combined with ureteral reimplantation or with the management of associated bladder-neck pathology whenever necessary. In neonates a staged approach with primary cutaneous vesicostomy followed by diverticulectomy is recommended as a safer but equally effective treatment.
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August 2005

Analysis of 39 cases of xanthogranulomatous pyelonephritis with emphasis on CT findings.

Scand J Urol Nephrol 2003 ;37(4):342-7

Department of Urology, Evangelismos Hospital, Athens, Greece.

Objective: In this retrospective study a review of the clinical, laboratory and radiologic features of 39 cases of xanthogranulomatous pyelonephritis (XGP) is presented. CT characteristics of XGP are analyzed in detail and the relevant literature is reviewed in order to determine the most typical among them.

Material And Methods: Pathologic material from 39 patients suffering from XGP was reviewed in order to confirm the initial diagnosis. Data compiled from the previous history of the patients, clinical, laboratory, urographic and CT findings, preoperative diagnosis, operative findings and postoperative period were analyzed.

Results: Diffuse and focal forms of XGP were recognized in 38 and 1 cases, respectively. Fever, pain in the flank or abdomen, chills and malaise were the commonest symptoms. A non-functioning kidney and/or staghorn calculus were the commonest urographic findings. When available (15 cases), CT revealed multiple fluid-filled cavities in the affected kidney and demonstrated the extension of the disease to the perinephric spaces in all cases. All patients had undergone nephrectomies, which were characterized as difficult in 60% of cases, whereas two patients developed postoperative complications requiring re-exploration.

Conclusions: Nephrectomy for XGP may be followed by severe complications and appropriate patient preparation and operation planning is of great importance. CT is considered the imaging technique of choice for diagnosing the disease preoperatively and a plethora of CT characteristics have been described to date. Low-density fluid-filled areas within the renal parenchyma and findings indicating perinephric extension should be considered the most typical CT features of XGP.
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April 2004