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The dilated urinary tract in children. Prospective analysis with correlation of radiological isotope, pressure perfusion and surgical findings
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grade III or IV vesicoureteric reflux into a single system on micturating cystourethrogram (MCU). Results were evaluated by ultrasound 1 to 2 weeks and by MCU 2 months after operation. All 36 ureters were followed. Thirty-one had stopped refluxing and five required repeat injection, one of which continues to reflux (grade 1). No ureteric obstructions were seen. The authors comment that this method is simple and, to date, complication-free. It will alter the management of children with vesicoureteric reflux in the future.-Patricia M. Davidson Urinary Infection and Malformations of Urinary Tract in Infancy. E.
Ring and G. Zobel. Arch Dis Child 63:818-820, (July), 1988. During a 48-month period, 140 infants < 1 year of age with their first urinary tract infection were reviewed for presence of urinary tract abnormalities. This group was compared with 39 infants during the same study period in whom an antenatal diagnosis of urinary tract abnormality had been reached. The study confirms that the incidence of anomalies in early life infections were more common in males with a cut-off at about 4 months of age. Vesicoureteric reflux accounted for 59% of all malformations and obstructive uropathy for 37%. Of the total number of malformations in both groups, about half were detected antenatally and the remainder postnatally when investigated for infections. The majority of antenatally detected malformations were obstructive malformations, whereas 87% of vesicoureteric reflux cases were diagnosed following infection with only 13% having been detected antenatally. The investigators believe that prenatal evaluation of all pregnancies will probably not significantly reduce the number of cases of vesicoureteric reflux detected after urinary infection, but they fail to comment on the antenatal criteria used for the diagnosis of hydronephrosis in their series. Thus, it is possible that some mild hydronephrosis noticed antenatally due to vesicoureteric reflux may not have been reported to their group and investigated. Investigation of both groups appeared to consist of ultrasound cystourethrography and intravenous pyelography in most cases, although in 30 infants only ultrasound was performed. Thus, some anomalies may have been missed in this group. No mention is made of renography.--D.M. Burge
INTERNATIONAL ABSTRACTS
junction obstruction and vesicoureteric junction obstruction. High flow rates are required even in neonates and infants to demonstrate obstruction by Whitaker testing.--Amir Azmy The Role of Percutaneous Nephrostomy in the Management of Obstructing Candidiasis of the Urinary Tract in infants. F.F.
Bartone, R.S. Hurwitz, E.L. Rajas, et al. J Urol 140:338-341, (August), 1988. Five neonates with obstructive urinary tract candidiasis in whom percutaneous nephrostomy had a major role in management are reported. The advantages of percutaneous nephrostomy in this setting include prompt drainage of the obstructed renal pelvis or ureter, direct access to obtain specimens from the renal pelvis to confirm the diagnosis, direct irrigation of fungus bails with amphotericin B, and an access route for fragmentation of fungus balls by guide wire manipulation. In three cases, percutaneous placement of the nephrostomy tube was successful in obtaining and maintaining access to the renal pelvis. In two cases, surgical intervention was required because of problems maintaining placement of the percutaneous catheters. Percutaneous nephrostomy with antegrade amphotericin B irrigation, coupled with systemic antifungal therapy, is the primary treatment. The usefulness of ultrasonography in the early diagnosis of renal candidiasis is also emphasized.---George Halcomb, Jr Renal Dysplasie--A Clinicopathological Review. C.M. Quinn, D.G. Kelly, and S.F. Cahalane. Br J Urol 61:399-401, (May), 1988.
The authors studied the clinical, pathological, and radiological features of 15 patients with unilateral renal dysplasia. A constant feature in each case was the presence of the primitive duct surrounded by concentric layers of cellular mesenchyme. Metaplastic cartilage was present in eight of the 15 patients, and seven showed inflammatory changes. Five patients had extrarenal anomalies. The association of infection and urinary tract anomalies in relation to renal dysplasia are discussed.--Amir Azmy Recurrent and Residual Renal Calculi in Children. L MacDonald
Palviureteric Junction Obstruction. The Value of Postmicturition View in sSmTc DTPA Diuretic Renography. I. Gordon, R.M, Mial-
dea-Fernandez and A.M. Peters. Br J Urol 61:409-412, (May), 1988. This is a study to assess the influence of a full bladder on the kidneys' response to a diuretic stimulus. Thirty-one children who had pyeloplasty for pelviureteric junction obstruction had a total of 81 99roTe DTPA diuretic renograms. Following micturition, a single image was acquired as a routine part of the 99roTediuretic scan when the renal pelvis failed to drain after a diuretic stimulus. The value of the postmicturition image in relation to drainage of the renal pelvis is discussed.--Amir Azmy The Dilated Urinary Tract in Children. Prospective Analysis With Correlation of Radiological Isotope, Pressure Perfusion and Surgical Findings. B. Bill, S. Levitt, S. Kogan, et al. Br J Uro161:413-419,
(May), 1988. Twenty-five children with dilated urinary systems were studied to correlate radiological, isotope, pressure perfusion, and surgical findings. Two children with marked bilateral hydronephrosis in the absence of vesicoureteric reflux remained stable, with one showed complete resolution and the other partial resolution. A positive Whitaker test correlated well with the surgical findings and postoperative improvement in renal function in patients with pelviureteric
andA.F. Azmy. Br J Uro161:395-398, (May), 1988. The authors reviewed 113 cases of children with nonmetabolic urinary tract calculi. One hundred were followed for 3 to 17 years (mean, 8.2 years). Seventeen children (15%) developed recurrent calculi after complete clearance (during the initial operation) 13 of these children experienced the recurrence within 5 years. Stone recurrence was closely associated with Proteus urine infection. Five patients required another operation to remove recurrent renal calculi. Small residual fragments in the calyces were left behind in 17 patients; surgical removal was required in three of these cases. Three children had disolution of residual stones using stone solvent, and spontaneous passage of stone occurred in eight patients. Associated urologic abnormalities were present in 33 patients. The authors recommend follow-up for 5 years, as most stone recurrences occurred within this period.--Amir Azmy The Diagnosis of Hypercalcuria in Children. L Voskaki. C. Mengreli, K. Kipourou, et al. Br J Urol 61:385-391, (May), 1988.
The authors describe the calcium loading test based on comparing the 24-hour calcium excretion rate before and after calcium loading under unchanged dietary conditions in 21 children with hypercalcuria and haematuria and/or nephrolithiasis and in 10 controls. The difference in calcium excretion before and after loading clearly distinguished absorptive from renal hypercalcaemia. The authors
grade III or IV vesicoureteric reflux into a single system on micturating cystourethrogram (MCU). Results were evaluated by ultrasound 1 to 2 weeks and by MCU 2 months after operation. All 36 ureters were followed. Thirty-one had stopped refluxing and five required repeat injection, one of which continues to reflux (grade 1). No ureteric obstructions were seen. The authors comment that this method is simple and, to date, complication-free. It will alter the management of children with vesicoureteric reflux in the future.-Patricia M. Davidson Urinary Infection and Malformations of Urinary Tract in Infancy. E.
Ring and G. Zobel. Arch Dis Child 63:818-820, (July), 1988. During a 48-month period, 140 infants < 1 year of age with their first urinary tract infection were reviewed for presence of urinary tract abnormalities. This group was compared with 39 infants during the same study period in whom an antenatal diagnosis of urinary tract abnormality had been reached. The study confirms that the incidence of anomalies in early life infections were more common in males with a cut-off at about 4 months of age. Vesicoureteric reflux accounted for 59% of all malformations and obstructive uropathy for 37%. Of the total number of malformations in both groups, about half were detected antenatally and the remainder postnatally when investigated for infections. The majority of antenatally detected malformations were obstructive malformations, whereas 87% of vesicoureteric reflux cases were diagnosed following infection with only 13% having been detected antenatally. The investigators believe that prenatal evaluation of all pregnancies will probably not significantly reduce the number of cases of vesicoureteric reflux detected after urinary infection, but they fail to comment on the antenatal criteria used for the diagnosis of hydronephrosis in their series. Thus, it is possible that some mild hydronephrosis noticed antenatally due to vesicoureteric reflux may not have been reported to their group and investigated. Investigation of both groups appeared to consist of ultrasound cystourethrography and intravenous pyelography in most cases, although in 30 infants only ultrasound was performed. Thus, some anomalies may have been missed in this group. No mention is made of renography.--D.M. Burge
INTERNATIONAL ABSTRACTS
junction obstruction and vesicoureteric junction obstruction. High flow rates are required even in neonates and infants to demonstrate obstruction by Whitaker testing.--Amir Azmy The Role of Percutaneous Nephrostomy in the Management of Obstructing Candidiasis of the Urinary Tract in infants. F.F.
Bartone, R.S. Hurwitz, E.L. Rajas, et al. J Urol 140:338-341, (August), 1988. Five neonates with obstructive urinary tract candidiasis in whom percutaneous nephrostomy had a major role in management are reported. The advantages of percutaneous nephrostomy in this setting include prompt drainage of the obstructed renal pelvis or ureter, direct access to obtain specimens from the renal pelvis to confirm the diagnosis, direct irrigation of fungus bails with amphotericin B, and an access route for fragmentation of fungus balls by guide wire manipulation. In three cases, percutaneous placement of the nephrostomy tube was successful in obtaining and maintaining access to the renal pelvis. In two cases, surgical intervention was required because of problems maintaining placement of the percutaneous catheters. Percutaneous nephrostomy with antegrade amphotericin B irrigation, coupled with systemic antifungal therapy, is the primary treatment. The usefulness of ultrasonography in the early diagnosis of renal candidiasis is also emphasized.---George Halcomb, Jr Renal Dysplasie--A Clinicopathological Review. C.M. Quinn, D.G. Kelly, and S.F. Cahalane. Br J Urol 61:399-401, (May), 1988.
The authors studied the clinical, pathological, and radiological features of 15 patients with unilateral renal dysplasia. A constant feature in each case was the presence of the primitive duct surrounded by concentric layers of cellular mesenchyme. Metaplastic cartilage was present in eight of the 15 patients, and seven showed inflammatory changes. Five patients had extrarenal anomalies. The association of infection and urinary tract anomalies in relation to renal dysplasia are discussed.--Amir Azmy Recurrent and Residual Renal Calculi in Children. L MacDonald
Palviureteric Junction Obstruction. The Value of Postmicturition View in sSmTc DTPA Diuretic Renography. I. Gordon, R.M, Mial-
dea-Fernandez and A.M. Peters. Br J Urol 61:409-412, (May), 1988. This is a study to assess the influence of a full bladder on the kidneys' response to a diuretic stimulus. Thirty-one children who had pyeloplasty for pelviureteric junction obstruction had a total of 81 99roTe DTPA diuretic renograms. Following micturition, a single image was acquired as a routine part of the 99roTediuretic scan when the renal pelvis failed to drain after a diuretic stimulus. The value of the postmicturition image in relation to drainage of the renal pelvis is discussed.--Amir Azmy The Dilated Urinary Tract in Children. Prospective Analysis With Correlation of Radiological Isotope, Pressure Perfusion and Surgical Findings. B. Bill, S. Levitt, S. Kogan, et al. Br J Uro161:413-419,
(May), 1988. Twenty-five children with dilated urinary systems were studied to correlate radiological, isotope, pressure perfusion, and surgical findings. Two children with marked bilateral hydronephrosis in the absence of vesicoureteric reflux remained stable, with one showed complete resolution and the other partial resolution. A positive Whitaker test correlated well with the surgical findings and postoperative improvement in renal function in patients with pelviureteric
andA.F. Azmy. Br J Uro161:395-398, (May), 1988. The authors reviewed 113 cases of children with nonmetabolic urinary tract calculi. One hundred were followed for 3 to 17 years (mean, 8.2 years). Seventeen children (15%) developed recurrent calculi after complete clearance (during the initial operation) 13 of these children experienced the recurrence within 5 years. Stone recurrence was closely associated with Proteus urine infection. Five patients required another operation to remove recurrent renal calculi. Small residual fragments in the calyces were left behind in 17 patients; surgical removal was required in three of these cases. Three children had disolution of residual stones using stone solvent, and spontaneous passage of stone occurred in eight patients. Associated urologic abnormalities were present in 33 patients. The authors recommend follow-up for 5 years, as most stone recurrences occurred within this period.--Amir Azmy The Diagnosis of Hypercalcuria in Children. L Voskaki. C. Mengreli, K. Kipourou, et al. Br J Urol 61:385-391, (May), 1988.
The authors describe the calcium loading test based on comparing the 24-hour calcium excretion rate before and after calcium loading under unchanged dietary conditions in 21 children with hypercalcuria and haematuria and/or nephrolithiasis and in 10 controls. The difference in calcium excretion before and after loading clearly distinguished absorptive from renal hypercalcaemia. The authors