Urological anomalies in anorectal malformations in the Netherlands: Effects of screening all patients on long-term outcome

Introduction: Urological anomalies are frequently seen in patients with anorectal malformations (ARM) and can result in upper urinary tract deterioration. Whether the current method of screening is valid, adequate and needed for all patients is not clear. We, therefore, evaluated the urological screening methods in our ARM patients for changes in urological treatment, outcome and follow-up. Methods: The medical records of 331 children born with an ARM in the period 1983-2003 were retrospectively studied. Documentation of diagnosis, screening method, urological anomalies, treatment, complications, follow-up and outcome were measured. Results: The overall incidence of urological anomalies was 52%. The incidence of urological anomalies and urological follow-up time decreased with diminishing complexity of the ARM. Hydronephrosis, vesico-urethral reflux, lower urinary tract dysfunction and urinary incontinence were encountered most. Treatment invasiveness increased with the increase of complexity of an ARM. Lower urinary tract dysfunction needing urological care occurred in 43% in combination with lumbosacral or spinal cord anomalies and in 8% with no abnormalities in the lumbosacral-/spinal region. Conclusions: Urological anomalies in patients with complex ARM are more severe than in patients with less complex ARM. Ultrasonography of the urinary tract should be performed in all patients. Voiding cysto-urethrography can be reserved for patients with dilated upper urinary tracts, urinary tract infections or lumbosacral and spinal abnormalities. All patients with complex ARM need urodynamic investigations. When using these indications, the screening for urological anomalies in ARM patients can be optimized with long-term follow-up in selected patients

Therapy of vesico-ureteral reflux in children

The operation after Lich-Gregoir is a technically simple and successful method for the treatment of primary vesicoureteral reflux. The operation is performed extravesically without opening of the bladder and without splinting the ureter. The stay in the hospital is short

An Analysis of Post Surgical Outcome in Primary Vesico Ureteric Reflux Patients

7 INTRODUCTION: Vesico ureteral reflux is a dynamic event – the retrograde flow of bladder urine into the upper urinary tracts. It’s a feature of disordered anatomy and function at the uretero vesical junction. Although this reflux nephropathy may disappear during growth, it is of clinical concern because of the morbidity from ascending urinary infection and associated nephropathy that can lead to hypertension and renal function insufficiency. To reduce the morbidity and mortality associated with vesico ureteric reflux, there are many studies available all over the world with relation to the pre-op work up, medical and surgical management, post operative follow up and outcome. AIMS AND OBJECTIVES: 1. To analyse the post surgical outcome in primary vesicoureteral reflux patients with the clinical and imaging parameters in the follow up. 2. To analyse the primary vesico ureteral reflux treated surgically with those treated by chemoprophylaxis alone. MATERIALS AND METHODS: This a prospective study conducted in the department of pediatric surgery, Institute of Child health over a period of 2½ years. This study was performed between August 2009 and January 2012 for primary vesico ureteral reflux. Apart from the clinical examination, baseline investigation, blood parameters, ultrasonogram – voiding cystourethrogram intravenous urogram and DMSA scan were taken. Patients were followed up for and more year post operatively for resolution of reflux and urinary tract infection. Patients treated surgically were compared with those treated with chemoprophylaxis alone in terms of recurrent urinary tract infections and resolution of reflux as demonstrated by voiding cystourethrogram. SELECTION CRITERIA: Inclusion Criteria: All patients with primary vesico ureter reflux (i.e due to intrinsic defect within the ureterovesical junction) irrespective of grade or laterality. Exclusion Criteria: All patients with secondary vesico ureteral reflux as a result of another pathology like associated bladder outlet obstruction (posterior urethral valve) and neurogenic bladder dysfunction are excluded from the study. CONCLUSION: 1. Majority of cases presented at an age of <3 years and all were symptomatic with history of recurrent UTIs. 2. Male female ratio was 1:0.6, predominately males in our study. 3. Bilateral cases were 62.9% as compared to 37.1% unilateral cases. 4. Grade III, IV, V reflux constituted 83.9% of total renal units. 5. Type of surgery was predominantly Cohen’s Reimplant with success rate of 95.6%. 6. In ultrasonogram, an increase in diameter of the ureter and/or renal pelvis was observed as a sign of reflux. 7. Micturiting cystourethrogram is an investigation tool for grading the reflux pre operatively and for the detection of post operative resolution. 8. Surgery is the preferred option for persistent Gr.III & IV and all Gr.V reflux. 9. Many patients who eventually required surgical management had already suffered kidney damage. So, early referral for surgical intervention would reduce the number and extent of renal damage due to reflux

Chromosome 18q-Syndrome and 1p terminal duplication in a patient with bilateral vesicoureteral reflux: case report and literature revision

Background: Vesico-ureteral reflux (VUR) is a dynamic event in which a retrograde flow of urine is present into the upper tracts. VUR may occur isolated or in association with other congenital abnormalities or as part of syndromic entities. We present a patient with a bilateral primary VUR, syndromic disease caused by a large deletion of 18q (18q21.3-qter) and terminal duplication of 1p (1p36.32-p36.33). Case report: The patient was 8 years old female with a disease including moderate growth retardation, psychomotor retardation, facial dysmorphism, single umbilical artery, umbilical hernia, urachal remnant, bilateral congenital clubfeet and renal-urinary disease. Chromosomal analysis and Array-CGH revealed two heterozygous chromosomal rearrangements: 1p terminal duplication and de novo 18q terminal deletion. She referred to our clinic to evaluation of bilateral hydronephrosis and right renal cortex thinning. Voiding cystourethrography demonstrated bilateral grade IV VUR and dimercaptosuccinic acid renal scintigraphy confirmed right renal cortex thinning and showed a cortical uptake of 75% of the left kidney and 25% of the right kidney. The patient underwent ureterovesical reimplantation after failure of 3 endoscopic submeatal Deflux injections with VUR resolution. Conclusions: This is the first report involving a patient with 18q-syndrome and contemporary presence of 1p chromosomal terminal duplication. The coexistence of two chromosomal rearrangements complicates the clinical picture and creates a chimeric disorder (marked by characteristics of both chromosomal anomalies). Kidney problems, primarily VUR is reported in 15% of patients affected by 18-q syndrome and no cases is reported in the literature regarding a correlation between VUR and 1p36 chromosomal duplication

REFLUJO VESICO-URETERAL

Arch Esp Urol. 2006 Nov;59(9):924. [Vesico-ureteral reflux] [Article in Spanish] Palacios A, de Castro R, Reis A. Servicio de Urología, Hospital Pediátrico Maria Pía, Porto, Portugal. [email protected] PMID: 17190222 [PubMed - indexed for MEDLINE

Treatment of vesico-ureteral reflux in infants and children using endoscopic approaches

Abstract Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. Endoscopic treatment of VUR dates back to 1981 when Matouschek first described injection of the ureteral orifice in an attempt to correct VUR. In addition, also Politano and colleagues and McDonald described successful correction of reflux using endoscopic techniques. After these reports subureteral Teflon injection (STING) came to be appreciated as a viable new way to less invasively correct one of the most common pediatric urologic problems. The technique is technically easy to perform and is usually performed as an outpatient procedure. It is performed in general anesthesia in children and may require repeat injections, particularly in patients with high-grade reflux. As for endoscopic technique, a main problem existed. The success in children with high grade reflux was less than reported for open or laparoscopic reimplant techniques. However, in the past 10 years, newer products have become available that are changing the indications for endoscopic correction. In these review, we analyzed the papers published in the literature on this topic to give to the readers an updated overview about the results of endoscopic treatment of VUR after 30-years of his first description

Is a low sacral ratio associated with primary vesicoureteral reflux in children?

Introduction: The association of sacral anomalies with fecal incontinence and lower urinary tract dysfunction is known. The sacral ratio is proposed as a tool for evaluation of sacral development. The aim of this cross-sectional study was to evaluate the prevalence and severity of vesicoureteral reflux in children with a low sacral ratio. Materials and Methods: Six hundred and sixty nine children who were referred to a radiology clinic for a standard (fluoroscopic) VCUG to detect vesicoureteral reflux and other anomalies of the lower urinary tract after an episode of urinary tract infection were included in the study and their sacral ratios were measured. Results: All children were younger than 14 years of age (mean 3.44±3.20). Of 669 children, 593 (88.6%) had normal sacral ratios out of whom 423 (71.3%) did not have VUR and 170 (28.7%) had VUR. Seventy-six (11.3%) children out of 669 cases had low sacral ratios; 49 (64.5%) of them had no VUR and 27 (35.5%) had VUR. There was no significant difference in the prevalence of VUR between children with and without a low sacral ratio (p value=0.217). Also, there was no significant difference or trend between a low sacral ratio and the severity of reflux (Chi2 for trend). Conclusions: Although sacral anomalies may be related to some cases of VUR by producing lower urinary tract dysfunction, the sacral ratio is not associated with VUR

A clinical study of canine urolithiasis

The purpose of this study on some clinical aspects of Canine Urolithiasis was to provide essential background data for future investigations on this disease intended to be undertaken in the Royal (Dick) School of Veterinary Studies. Knowledge of the incidence of the disease in the clinic population, the incidence of the different chemical types of uroliths, and the incidence of other aspects of this disorder as it occurs in this area was therefore required, since only when these facts are available can efficient planning of future investigations into the more important aspects of this anomaly be effeeted. Dy necessity, therefore, the present investigation has in part, taken the form of a survey of these aspects in a number of clinical cases of the disease - the results of this survey are embodied in the first part of this thesis.Although Urolithiasis has been known to be a serious condition in dogs for many years, the suspected aetiologic factors associated with urolithogenesis have been little studied and consequently the position of their individual contributions to the overall disease- complex remains obscure. In an endeavour to clarify the position of some of these causative factors, their correlation with the different chemical types of uroliths and occasionally the inter- relationships between one factor and another, were studied and the results of this have been recorded inter alia in part two.The remaining section of this thesis deals with the analysis of uroliths obtained from the patients studied. It is immediately apparent in a condition of this kind where we are probably dealing with, not one disease, not a series of similar diseases, but a number of seemingly unrelated diseases which may have little in common apart from the resultant calculus formation, that in order to differentiate between the possible conditions involved, an accurate method of analysis of the uroliths was required. It being assumed that the different chemical types of urolith form as a result of different disorders. In this study, a combiiation of quantitative micro -- chemical and X-ray diffraction crystallographic analysis was selected to fulfil these requirements

Autologous adipocyte graft in endoscopic treatment of vesico-renal reflux in children: a preliminary study

No bulking agent is ideal for endoscopically treating vesico-renal reflux in children. Many teams have tried to find a safe and efficient material, ideally an autologous material. We describe here a protocol for the use of autologous viable fat in the treatment of primary vesico-renal reflux in children aged from 3 to 15 years. Fat harvesting was done from the medial side of the thigh by manual aspiration. Samples were centrifuged to purify the graft from blood and lipid. Lastly fat was injected beneath the pathologic ureter by a conventional endoscopic technique. A voiding cystourethrography (VCUG) closed the procedure. Follow-up included renal ultrasonography the day after surgery, and one and three months later. A VCUG was performed systematically at three months and, in cases of acute pyelonephritis, during the survey