- Email: [email protected]
Urinary tract infection and reflux nephropathy in childhood
774
cystrography was performed in 7 patients, but demonstrated the ureterocele in only 2. Cystoscopy was diagnostic in all patients. Early in this series simple unroofing was performed in 4 patients, and in each instance free vesicoureteral reflux ensued. Nephroureterectomy was performed as the primary procedure in 2 children because the kidney was afunctional and severely infected. The preferred technique is total excision of the ureterocele and reimplantation of the ureter into the bladder by an antireflux technique. Postoperative IVPs showed lessening of hydroureteronephrosis in 9 of the 10 children in whom excision and reimplantation had been accomplished as the primary method of treatment.--George Holcomb The Role of Adjunctive Drug Therapy for Intermittent Catheterization and Self-Catheterization in Children With Veaical Dysfunction. N. Hilwa and A. D. Per/mutter. J Urol
119:551-554 (April), 1978 Thirty-nine children with vesical dysfunction were managed with clean intermittent catheterization on an average of four times daily. Of the 24 girls, 5 achieved continence day and night without drug therapy. Of the 16 patients who were placed on drug therapy, 15 became dry. One girl had improved, but she was wet in less than 2 hr and had previously had a sphincterotomy. There were two failures. Only 2 of the 13 boys were dry without drug therapy, but 8 of 9 became continent on medication. There was one failure because of a previous sphincterotomy. Intermittent catheterization in childhood is a preferred alternative to urinary diversion in cases of neurogenic bladder dysfunction.--George Holcomb The Development of Bowel and Bladder Contol From Birth to
18 Years of Age. R. H. Largo, M. Gianciaruso, and A. Prader. Schweiz Med Wochenschr 108:155-160, 1978 The development of bowel and bladder control in the first years of life and the frequency and length of enuresis and/or encopresis from 6 to 18 yr of age have been evaluated by a longitudinal study in 351 Ziirich children. Bowel control is usually established at the age of 3 yr, with control of the bladder by 5 yr of age. This maturation process cannot be accelerated by toilet training. One-quarter of all boys and one-tenth of all girls had either enuresis or encopresis or both, but usually it resolved at puberty. With the exception of primary diurnal enuresis, encopresis and the other types of enuresis were more frequent in boys than in girls. A secondary encopresis or enuresis can be observed for the first time as early as the age of 10-13 yr. Primary diurnal enuresis is unusual in boys. On the other hand, the primary type of encopresis is a rare event in both sexes. In the authors' opinion enuresis or/and encopresis are specific age-dependent developmental phenomena prior to puberty. They depend on either genetic or exogenic psyehosocial causes. The natural history and varieties of nonorganic enuresis and encopresis, as mentioned in the study, are of special interest for every physician interested in the problems of incontinence.--G. Kaiser
ABSTRACTS Urinary Tract Infection and Reflux Nephropathy in Childhood.
J. P. Guignard. Schweiz Med Wochenschr 107:I671-1675, 1977 Recurrent urinary tract infection (UTI) occurs in 1.2% of girls and 0.07% of boys. Because of possible serious consequences, every UTI requires a thorough investigation, including complete x-ray studies. The prognosis is usually very good if there is no underlying urinary tract malformation. In 20%-25% of patients UTI is associated with urologic abnormalities (i.e., obstruction or vesicoureteral reflux). Even after early and successful surgical correction of these malformations prognosis in these patients is not always favorable because of continuing pyelonephritis and progressive scarring of the kidneys. From 30% to 50% of patients with UTI show vesicoureteral reflux. About 20% of these children develop chronic pyelonephritis. In the etiology of this nephropathy, reflux and especially intrarenal reflux associated with UTI plays a crucial role. The importance of reflux alone without concomitant UTI is still unclear. The author recommends short-term treatment for uncomplicated UTI and prophylactic chemotherapy for uncomplicated recurrent UTI with or without vesicoureteral reflux. Progressive reflux and development of chronic pyelonephritis while on chemotherapy require surgical intervention. If there is a major urologic malformation, surgery is always indicated. A careful follow-up for several years is mandatory in every child with UTI.--B. Kehrer Congenital Posterior Urethral Perineal Fistula. P. E. Rice, T.
M. Holder, and K. 14. Ashcraft. J Urol 119:416-417 (March), 1978 This infant represents the fourth reported patient with a congenital posterior urethral perineal fistula. All 4 patients were male subjects who had fistulous openings extending from the verumontanum or its immediate surrounding area to the perineum, without anal or scrotal involvement. The fistula was excised by using a perineal approach for this 13-day-old infant. Follow-up revealed a normal voiding cystourethrogram 1 me postoperatively, and he voided normally.--George Holcomb Diagnosis and Management of Testes in the Superficial Inguinal Pouch. E. C. Ashby. Lancet 1:468--470 (March),
1978 Undescended testes may be classified as "arrested" (intraabdominal, intracanalicular, emergent inguinal, high scrotal), "deviated" (obstructed, tethered at inguinal or rarer sites), or "retraetile" only. There is widespread acceptance of operation in the first 5 yr for testes that are "arrested" or deviated or testes in the superficial inguinal pouch that cannot be pushed into the scrotum (deviated/obstructed). However, a testis lateral to the external ring that can be coaxed into the scrotum but that does not stay there has traditionally been regarded as retractile. The author contends that this testis is abnormal in its descent and should be retermed a "deviated/tethered" testis. The author reviews his series of 86 boys and 111 orchidopexies and draws a comparison between
cystrography was performed in 7 patients, but demonstrated the ureterocele in only 2. Cystoscopy was diagnostic in all patients. Early in this series simple unroofing was performed in 4 patients, and in each instance free vesicoureteral reflux ensued. Nephroureterectomy was performed as the primary procedure in 2 children because the kidney was afunctional and severely infected. The preferred technique is total excision of the ureterocele and reimplantation of the ureter into the bladder by an antireflux technique. Postoperative IVPs showed lessening of hydroureteronephrosis in 9 of the 10 children in whom excision and reimplantation had been accomplished as the primary method of treatment.--George Holcomb The Role of Adjunctive Drug Therapy for Intermittent Catheterization and Self-Catheterization in Children With Veaical Dysfunction. N. Hilwa and A. D. Per/mutter. J Urol
119:551-554 (April), 1978 Thirty-nine children with vesical dysfunction were managed with clean intermittent catheterization on an average of four times daily. Of the 24 girls, 5 achieved continence day and night without drug therapy. Of the 16 patients who were placed on drug therapy, 15 became dry. One girl had improved, but she was wet in less than 2 hr and had previously had a sphincterotomy. There were two failures. Only 2 of the 13 boys were dry without drug therapy, but 8 of 9 became continent on medication. There was one failure because of a previous sphincterotomy. Intermittent catheterization in childhood is a preferred alternative to urinary diversion in cases of neurogenic bladder dysfunction.--George Holcomb The Development of Bowel and Bladder Contol From Birth to
18 Years of Age. R. H. Largo, M. Gianciaruso, and A. Prader. Schweiz Med Wochenschr 108:155-160, 1978 The development of bowel and bladder control in the first years of life and the frequency and length of enuresis and/or encopresis from 6 to 18 yr of age have been evaluated by a longitudinal study in 351 Ziirich children. Bowel control is usually established at the age of 3 yr, with control of the bladder by 5 yr of age. This maturation process cannot be accelerated by toilet training. One-quarter of all boys and one-tenth of all girls had either enuresis or encopresis or both, but usually it resolved at puberty. With the exception of primary diurnal enuresis, encopresis and the other types of enuresis were more frequent in boys than in girls. A secondary encopresis or enuresis can be observed for the first time as early as the age of 10-13 yr. Primary diurnal enuresis is unusual in boys. On the other hand, the primary type of encopresis is a rare event in both sexes. In the authors' opinion enuresis or/and encopresis are specific age-dependent developmental phenomena prior to puberty. They depend on either genetic or exogenic psyehosocial causes. The natural history and varieties of nonorganic enuresis and encopresis, as mentioned in the study, are of special interest for every physician interested in the problems of incontinence.--G. Kaiser
ABSTRACTS Urinary Tract Infection and Reflux Nephropathy in Childhood.
J. P. Guignard. Schweiz Med Wochenschr 107:I671-1675, 1977 Recurrent urinary tract infection (UTI) occurs in 1.2% of girls and 0.07% of boys. Because of possible serious consequences, every UTI requires a thorough investigation, including complete x-ray studies. The prognosis is usually very good if there is no underlying urinary tract malformation. In 20%-25% of patients UTI is associated with urologic abnormalities (i.e., obstruction or vesicoureteral reflux). Even after early and successful surgical correction of these malformations prognosis in these patients is not always favorable because of continuing pyelonephritis and progressive scarring of the kidneys. From 30% to 50% of patients with UTI show vesicoureteral reflux. About 20% of these children develop chronic pyelonephritis. In the etiology of this nephropathy, reflux and especially intrarenal reflux associated with UTI plays a crucial role. The importance of reflux alone without concomitant UTI is still unclear. The author recommends short-term treatment for uncomplicated UTI and prophylactic chemotherapy for uncomplicated recurrent UTI with or without vesicoureteral reflux. Progressive reflux and development of chronic pyelonephritis while on chemotherapy require surgical intervention. If there is a major urologic malformation, surgery is always indicated. A careful follow-up for several years is mandatory in every child with UTI.--B. Kehrer Congenital Posterior Urethral Perineal Fistula. P. E. Rice, T.
M. Holder, and K. 14. Ashcraft. J Urol 119:416-417 (March), 1978 This infant represents the fourth reported patient with a congenital posterior urethral perineal fistula. All 4 patients were male subjects who had fistulous openings extending from the verumontanum or its immediate surrounding area to the perineum, without anal or scrotal involvement. The fistula was excised by using a perineal approach for this 13-day-old infant. Follow-up revealed a normal voiding cystourethrogram 1 me postoperatively, and he voided normally.--George Holcomb Diagnosis and Management of Testes in the Superficial Inguinal Pouch. E. C. Ashby. Lancet 1:468--470 (March),
1978 Undescended testes may be classified as "arrested" (intraabdominal, intracanalicular, emergent inguinal, high scrotal), "deviated" (obstructed, tethered at inguinal or rarer sites), or "retraetile" only. There is widespread acceptance of operation in the first 5 yr for testes that are "arrested" or deviated or testes in the superficial inguinal pouch that cannot be pushed into the scrotum (deviated/obstructed). However, a testis lateral to the external ring that can be coaxed into the scrotum but that does not stay there has traditionally been regarded as retractile. The author contends that this testis is abnormal in its descent and should be retermed a "deviated/tethered" testis. The author reviews his series of 86 boys and 111 orchidopexies and draws a comparison between