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Coexisting pelviureteral and vesicoureteral junction obstruction in children
1740
INTERNATIONAL ABSTRACTS
avoiding new formation of renal scars. However, there are generally accepted indications for operative interventions, including bilateral high-grade VUR, especially in young children. Ureteral reimplantation (UCN) is the treatment of choice in cases of high-grade VUR. Alternatively, injection of bulking agents under the refluxing orifice can be performed. It is also generally accepted that UCN with extravesical preparation of the ureter and the bladder should not be done bilaterally in a 1-stage procedure. Postoperative bladder dysfunction may result owing to detrimental neurogenic effects. The authors report on their operative procedure in cases of bilateral high-grade VUR, during which intra/extravesical UCN (mod.Leadbetter-Politano) of the higher-grade refluxive ureter and open subureteral collagen injection (SCIN) of the lower-grade refluxive orifice are combined as 1-stage procedure. Fifty percent of the patients of this study had no VUR on either side after the combined procedure. Fifteen percent showed significant downgrading of VUR on the injected side. These patients underwent a second endoscopic SCIN. Thirty five percent of patients showed no change of VUR on the injected side after the first procedure; these patients underwent reimplantation. Accordingly, 50% of patients with bilateral high-grade VUR required a second operative procedure to achieve full relieve of VUR on both sides. None of the patients showed bladder dysfunction postoperatively. — Thomas A. Angerpointner Coexisting Pelviureteral and Vesicoureteral Junction Obstruction in Children. C. Pesce, L. Musi, P. Campobasso, et al. Eur J Pediatr Surg 13:367–371, (December), 2003. The aim of this study was to adress the reasons for diagnostic failure in children with coexisting pelviureteral and vesicoureteral junction obstruction. A total of 11 children are reported. This anomaly was recognized at presentation in only 5 (45%) of the cases. In the remainder, correct diagnosis was made after initial pyeloplasty, and a significant delay occurred in 3 children. In all 11 patients, treatment consisted of pyeloplasty and subsequent reimplantation. A satisfactory postoperative course with improvement of urinary tract dilatation was noted in all 11 patients, whereas 8 children showed preserved renal function at late follow-up. These data confirm the difficulty in diagnosing pelviuereteral and coexisting vesicoureteral junction obstruction in children. Prompt recognition and relief of urinary tract obstruction is mandatory to prevent deterioration of renal function. — Thomas A. Angerpointner
NERVOUS SYSTEM Late Results Concerning Slit Ventricles and Slit Ventricle Syndrome. P. Linjger, S. Marchland, and G. L. Kaiser Eur J Pediatr Surg 13/Suppl 1: S3–S6, (December), 2003. The aims of this study were first, to investigate the time course of development of slit ventricles (SV) and slit-ventricle syndrome (SV syndrome) in hydrocephalic patients shunted as infants, and second, to assess the difference in incidence of SV and SV syndrome in 2 groups of patients — group A with a conventional valve and group B with an antisiphon device. Twenty-seven infants with hydrocephalus received a ventriculoperitoneal shunt and were followed up prospectively with annual clinic visits and at least 2 CT or MRI scans postoperatively. The
scans were assessed for SV, and ventricular and parenchymal surface and cortical mantle thickness were measured. Revisions for shunt malfunction were recorded. SV were more frequent than SV syndrome and developed within 6.5 months postoperatively in 21% of patients and in 48% after 6 years. No significant differences in incidence of SV or in the surface and cortical mantle thickness were found between the 2 groups. Two patients (40%) with early development of SV had SV syndrome, and the relative risk for shunt revision was significantly higher in patients in whom SV developed early. Forty-eight percent of patients did not need emergency shunt revision during the first 9 years. It is concluded that SV develop over years. The majority of patients with SV remain asymptomatic. No significant difference between the 2 groups was found concerning SV and SVsyndrome. If SV develop early in the postoperative period, complications are more frequent in the long term, so elective value adjustment should be considered. — Thomas A. Angerpointner A Study of Prenatal Ultrasound Scan and Postnatal Magnetic Imaging in the Diagnosis of Central Nervous System Abnormalities. T. R. Patel, C. M. Bannister, and J. Thorne Eur J Pediatr Surg 13/Suppl 1: S18 –S22, (December), 2003. Accurate prenatal diagnosis of central nervous system (CNS) abnormalities is essential in counseling parents, because they are the most common developmental abnormalities causing considerable mortality. Currently, the standard in prenatal imaging is ultrasound scanning (USS). The introduction of fast acquisition magnetic resonance imaging (MRI) has led to increased diagnostic confidence and information available for parents. Frequently, USS initially identifies CNS abnormalities as ventriculomegaly (VM) alone. However, it is known that ventriculomegaly is associated commonly with other CNS pathologies, which may adversely affect the prognosis. Because MRI has superior soft tissue resolution and can be used at any time postnatally, it is expected to identify disorders of myelination that may result from prenatal ventriculomegaly. This study evaluated the role of MRI as a postnatal imaging tool in patients that had prenatal USS diagnosis of isolated ventriculomegaly. The postnatal MRI study group consisted of 9 patients who had initial diagnosis of prenatal isolated ventriculomegaly on USS (cases of spina bifida and Dandi-Walker syndrome were excluded). Both MRI and USS gave the same information in 55.6% of the patients. In the remaining 44.4%, MRI added to the information provided by prenatal USS. An interesting finding was that MRI missed a small fluid-filled cyst and an arachnoid cyst in 2 cases. Fifty-six percent of patients went on to develop other CNS abnormalities prenatally, whereas 33.3% showed prenatal regression of VM with no other pathology. Eleven percent showed postnatal persistence of isolated VM. Because USS has the advantage of being inexpensive and easy to perform, it will remain the primary imaging tool in obstetric care. MRI can provide significant additional information that can affect parent counseling, prenatal intervention, and postnatal management. Postnatally, MRI can give some idea of prognosis by evaluating myelination patterns, which is not possible with USS. — Thomas A. Angerpointner
INTERNATIONAL ABSTRACTS
avoiding new formation of renal scars. However, there are generally accepted indications for operative interventions, including bilateral high-grade VUR, especially in young children. Ureteral reimplantation (UCN) is the treatment of choice in cases of high-grade VUR. Alternatively, injection of bulking agents under the refluxing orifice can be performed. It is also generally accepted that UCN with extravesical preparation of the ureter and the bladder should not be done bilaterally in a 1-stage procedure. Postoperative bladder dysfunction may result owing to detrimental neurogenic effects. The authors report on their operative procedure in cases of bilateral high-grade VUR, during which intra/extravesical UCN (mod.Leadbetter-Politano) of the higher-grade refluxive ureter and open subureteral collagen injection (SCIN) of the lower-grade refluxive orifice are combined as 1-stage procedure. Fifty percent of the patients of this study had no VUR on either side after the combined procedure. Fifteen percent showed significant downgrading of VUR on the injected side. These patients underwent a second endoscopic SCIN. Thirty five percent of patients showed no change of VUR on the injected side after the first procedure; these patients underwent reimplantation. Accordingly, 50% of patients with bilateral high-grade VUR required a second operative procedure to achieve full relieve of VUR on both sides. None of the patients showed bladder dysfunction postoperatively. — Thomas A. Angerpointner Coexisting Pelviureteral and Vesicoureteral Junction Obstruction in Children. C. Pesce, L. Musi, P. Campobasso, et al. Eur J Pediatr Surg 13:367–371, (December), 2003. The aim of this study was to adress the reasons for diagnostic failure in children with coexisting pelviureteral and vesicoureteral junction obstruction. A total of 11 children are reported. This anomaly was recognized at presentation in only 5 (45%) of the cases. In the remainder, correct diagnosis was made after initial pyeloplasty, and a significant delay occurred in 3 children. In all 11 patients, treatment consisted of pyeloplasty and subsequent reimplantation. A satisfactory postoperative course with improvement of urinary tract dilatation was noted in all 11 patients, whereas 8 children showed preserved renal function at late follow-up. These data confirm the difficulty in diagnosing pelviuereteral and coexisting vesicoureteral junction obstruction in children. Prompt recognition and relief of urinary tract obstruction is mandatory to prevent deterioration of renal function. — Thomas A. Angerpointner
NERVOUS SYSTEM Late Results Concerning Slit Ventricles and Slit Ventricle Syndrome. P. Linjger, S. Marchland, and G. L. Kaiser Eur J Pediatr Surg 13/Suppl 1: S3–S6, (December), 2003. The aims of this study were first, to investigate the time course of development of slit ventricles (SV) and slit-ventricle syndrome (SV syndrome) in hydrocephalic patients shunted as infants, and second, to assess the difference in incidence of SV and SV syndrome in 2 groups of patients — group A with a conventional valve and group B with an antisiphon device. Twenty-seven infants with hydrocephalus received a ventriculoperitoneal shunt and were followed up prospectively with annual clinic visits and at least 2 CT or MRI scans postoperatively. The
scans were assessed for SV, and ventricular and parenchymal surface and cortical mantle thickness were measured. Revisions for shunt malfunction were recorded. SV were more frequent than SV syndrome and developed within 6.5 months postoperatively in 21% of patients and in 48% after 6 years. No significant differences in incidence of SV or in the surface and cortical mantle thickness were found between the 2 groups. Two patients (40%) with early development of SV had SV syndrome, and the relative risk for shunt revision was significantly higher in patients in whom SV developed early. Forty-eight percent of patients did not need emergency shunt revision during the first 9 years. It is concluded that SV develop over years. The majority of patients with SV remain asymptomatic. No significant difference between the 2 groups was found concerning SV and SVsyndrome. If SV develop early in the postoperative period, complications are more frequent in the long term, so elective value adjustment should be considered. — Thomas A. Angerpointner A Study of Prenatal Ultrasound Scan and Postnatal Magnetic Imaging in the Diagnosis of Central Nervous System Abnormalities. T. R. Patel, C. M. Bannister, and J. Thorne Eur J Pediatr Surg 13/Suppl 1: S18 –S22, (December), 2003. Accurate prenatal diagnosis of central nervous system (CNS) abnormalities is essential in counseling parents, because they are the most common developmental abnormalities causing considerable mortality. Currently, the standard in prenatal imaging is ultrasound scanning (USS). The introduction of fast acquisition magnetic resonance imaging (MRI) has led to increased diagnostic confidence and information available for parents. Frequently, USS initially identifies CNS abnormalities as ventriculomegaly (VM) alone. However, it is known that ventriculomegaly is associated commonly with other CNS pathologies, which may adversely affect the prognosis. Because MRI has superior soft tissue resolution and can be used at any time postnatally, it is expected to identify disorders of myelination that may result from prenatal ventriculomegaly. This study evaluated the role of MRI as a postnatal imaging tool in patients that had prenatal USS diagnosis of isolated ventriculomegaly. The postnatal MRI study group consisted of 9 patients who had initial diagnosis of prenatal isolated ventriculomegaly on USS (cases of spina bifida and Dandi-Walker syndrome were excluded). Both MRI and USS gave the same information in 55.6% of the patients. In the remaining 44.4%, MRI added to the information provided by prenatal USS. An interesting finding was that MRI missed a small fluid-filled cyst and an arachnoid cyst in 2 cases. Fifty-six percent of patients went on to develop other CNS abnormalities prenatally, whereas 33.3% showed prenatal regression of VM with no other pathology. Eleven percent showed postnatal persistence of isolated VM. Because USS has the advantage of being inexpensive and easy to perform, it will remain the primary imaging tool in obstetric care. MRI can provide significant additional information that can affect parent counseling, prenatal intervention, and postnatal management. Postnatally, MRI can give some idea of prognosis by evaluating myelination patterns, which is not possible with USS. — Thomas A. Angerpointner