Abstract: Transurethral sphincterotomy is a commonly performed operation in spinal cord injury patients. Sixty-three patients who have had transurethral sphincterotomy were evaluated at our spinal cord injury unit for the risk and possible predictors of long-term outcome associated with this procedure. In addition to history and physical examination, all patients had urine culture, blood urea and creatinine, intravenous pyelogram and/or KUB with renal ultrasound, 4 channel videourodynamics, voiding cystourethrogram, and cystocopy when indicated. Their mean age was 53 years, and their level of injury was cervical 32, thoracic 25, and lumbar 6. The mean time since injury was 27 years (3-50), and the mean follow-up since their last sphincterotomy was 11 years (2-30). The mean number of sphincterotomies was 1.74 (1-4). Urine culture revealed bacteruria (asymptomatic) in 48 and sterile urine in 15 patients. Renal function was normal in 61 patients and abnormal in 2 patients. Videourodynamics revealed detrusor hyperreflexia in 60, detrusor areflexia in 3, abnormal detrusor compliance in 9, and detrusor sphincter dyssynergia in 34 patients. The mean Leak point pressure was 36.4 cm H2O (5-100), and the mean maximum detrusor pressure was 54.7 cm H2O (12-100). Nineteen (30%) patients had significant upper tract complications including; renal calculi, atrophic kidney, vesicoureteral reflux, and renal scarring with impaired renal function. Fifty percent of upper tract complications developed more than 2 years after sphincterotomy. Thirty patients had lower tract complications including; recurrent symptomatic urinary tract infection, bladder stones, urethral diverticulum, urethral stricture, bladder neck stenosis, and recurrent epididymitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract: Acute focal bacterial pyelonephritis is a renal inflammatory disease that has similarities to both pyelonephritis and renal abscess. The diagnosis is based on clinical symptoms of pyelonephritis and renal abnormalities detected on radiologic imaging studies (ultrasonography and computed tomographic scanning). Ultrasonographic examination demonstrates mass lesions in the renal cortex that resolve after appropriate antibiotic therapy. Computed tomographic studies reveal localized, wedge-shaped or circular, poorly enhancing, hypodense areas and/or swelling of the superior pole of the kidney. A voiding cystourethrogram should be done to rule out reflux as an underlying cause. Magnetic resonance imaging is not required for diagnosis or follow-up evaluation. Escherichia coli is the most common etiologic agent. All reported cases have responded to conservative therapy with extended courses of oral bactericidal antibiotics. Resolution is typically complete in one to three months. A follow-up evaluation with ultrasonography is required to document resolution.

Abstract: The purpose of this study was to determine if the frequency of vesicoureteric reflux on voiding cystourethrography in children with a history of urinary tract infection varies according to the specialty of the physician requesting the examination.The study included 309 children (192 girls, 117 boys) with a history of urinary tract infection who had their first voiding cystourethrogram. The median age at first voiding cystourethrogram in boys was 12 months; in girls, it was 48 months. The reports of these examinations were retrospectively reviewed, and the presence of vesicoureteric reflux was recorded. The age and sex distribution of children referred for voiding cystourethrography by pediatric urologists and nephrologists (subspecialists) was compared with the age and sex distribution of children referred by pediatricians, family practitioners, and adult urologists (other clinicians). The rate of detection of vesicoureteric reflux was calculated according to age and sex. Ages studied were younger than 1 ...

Abstract: Prenatal sonographic diagnosis of ureteroceles usually involves clearly duplicated urinary collecting systems associated with ectopic ureters draining the upper renal moieties. We present an unusual case in which an initial sonographic examination was consistent with bilateral orthotopic ureteroceles in association with bilateral single renal systems. The possibility of single systems raised perinatal considerations unique to this anomaly. Repeat prenatal sonography was suggestive of duplex systems and subsequently confirmed as such by neonatal ultrasound and voiding cystourethrogram. At the age of 1 month, the infant underwent bilateral ipsilateral ureteroureterostomy with conservation of the bilateral dilated upper renal moieties. We discuss the possible pathophysiology underlying the different conflicting sonographic findings and address current management of such lesions.

Abstract: Stress incontinence affects primarily women, and a common cause is intrinsic sphincter deficiency (ISD). Traditionally, patients with ISD are treated surgically with implantation of an artificial sphincter or with a pubovaginal sling procedure. Although these procedures are effective, an alternate nonsurgical treatment option is Contigen Bard Collagen Implant. Ensuring optimal results with Contigen Implant requires proper diagnosis and patient selection. Contigen Implant is indicated for the treatment of urinary incontinence from ISD. Candidates are usually females with at least one previous failed suspension and with an open bladder neck at rest. Patients with a hypermobile urethra, high leak point pressures, or significant detrusor problems are poor candidates for Contigen. Those who are considered for Contigen should undergo a diagnostic evaluation to confirm the presence of incontinence, identify contributing factors, and identify the need for further diagnostic evaluation. The basic evaluation can be performed by any physician. It consists of a thorough history, physical examination, and urinalysis. It may also include a patient diary of voiding activity and a pad test to quantify the degree of incontinence. Those patients in whom incontinence is confirmed with a basic evaluation should undergo urodynamic evaluation by an experienced urologist. The object is to identify the specific cause of incontinence, detect functional, neurological, or anatomic lesions, and help select the most appropriate therapy. The urodynamic evaluation consists of cystometry, uroflowmetry, cystogram with voiding cystourethrogram, determination of leak point pressure and post-void residual, and videourodynamic studies if indicated. Optimal outcomes with Contigen Implant will be realized through proper patient selection, and this requires a thorough patient evaluation.

Abstract: Urethral polyps are uncommon but may result in infravesical obstruction. A case diagnosed by voiding cystourethrogram and sonography is presented.

Abstract: The case of an 11-year-old boy with an anterior urethral valve is reported. A weak urinary stream and urinary dribbling were his main symptoms. Clinical evaluation consisted of renal ultrasonography, an intravenous urogram, a voiding cystourethrogram, and panendoscopy. Transurethral excision of the valve achieved a satisfactory result.

Abstract: Urethral polyps are uncommon but may result in infravesical obstruction. A case diagnosed by voiding cystourethrogram and sonography is presented.

Abstract: Two girls, each with a single ectopic urerer inserted into the proximal urethra, are reported. Abdominal ultrasonography showed that the involved kidneys were small and hydronephrotic. The associated ureters were dilated and opened into the proximal urethra. Diagnosis was confirmed by voiding cystourethrogram.

Abstract: The case of an ll-year-old boy wilh an anterior urethral valve is reported. A weak urinary stream and urinary dribbling were his main symp- toms. Clinical evaluation consisted of renal ultrasonography, an intravenous urogrant, a voiding cystourethrogram , and pmlendoscopy. Transurethral exci- sion of the valve achieved a satisfac- tory result.