Showing papers on "Voiding cystourethrogram published in 2006"
Journal Article•
TL;DR: It is of importance that UTI can occur in asymptomatic, jaundiced infants even in the first week of life and urine culture should be considered in the bilirubin work-up of infants older than three days of age with an unknown etiology.
Abstract: The aim of this study was to evaluate the incidence of urinary tract infection (UTI) in newborns with asymptomatic, unexplained indirect hyperbilirubinemia in the first two weeks of life. Jaundiced infants, otherwise clinically well, less than two weeks of ages, with a total bilirubin level above 15 mg/dl were eligible for the study. A bilirubin work-up including glucose-6-phosphate dehydrogenase (G-6 PD) level, as well as urinalysis and a urine culture were performed in all patients. Patients with UTI, defined as more than 10,000 colony-forming units per milliliter of a single pathogen obtained by bladder catheterization, were evaluated for sepsis. Renal function tests and renal ultrasound were performed in cases with UTI. During follow-up, voiding cystourethrogram (VCUG) and dimercaptosuccinic acid scintigraphy (DMSA) were performed as well. A total of 102 patients were enrolled. The bilirubin work-up of patients did not demonstrate any significant underlying disorder. None of the infants had a high direct bilirubin level. UTI was diagnosed in eight (8%) cases [Enterobacter aerogenes (3/8:38%), Enterococcus faecalis (2/8:25%), Klebsiella pneumoniae (2/8:25%) and Escherichia coli (1/8:12%)]. Of those eight patients, only four (50%) had pyuria. Bacteriuria was present in seven (88%) patients. The sepsis screen was negative in all but one case with a high C-reactive protein (CRP) level. None of the patients had a positive blood culture. Renal function tests were within normal levels in all patients. Renal ultrasound showed urinary tract abnormalities in three (38%) patients (hydronephrosis, n=1 and pelviectasis, n=2). VCUG was performed in all patients during the study period and one had unilateral grade 3-4 reflux, while only one patient had a diverticulum of the bladder. DMSA was performed in seven patients and none had renal scars. It is of importance that UTI can occur in asymptomatic, jaundiced infants even in the first week of life. Although it is well known that UTI is a common cause of prolonged jaundice, urine culture should be considered in the bilirubin work-up of infants older than three days of age with an unknown etiology.
74 citations
TL;DR: Using the Society of Fetal Urology (SFU) grading of hydronephrosis based on ultrasonography, a management and treatment algorithm can be constructed and patients who would benefit from early surgical intervention are selected.
67 citations
Journal Article•
TL;DR: Most patients do not require renal replacement therapy in the neonatal period; however, chronic renal insufficiency can occur if the neonate has a significant reduction in nephron number or progressive renal damage from obstruction or infection.
56 citations
TL;DR: Although ultrasounds have become standard in the evaluation of children with UTI, it is worth rethinking their contribution to management, in an era when ultrasounds are performed routinely during pregnancy (and sometimes on multiple occasions), they may be superfluous in the Evaluation of a child withUTI.
Abstract: Urinary tract infection (UTI) is now the most common serious bacterial infection that occurs in infancy and early childhood in the United States.1 The prominence of UTI is a result, in great part, of the dramatic reduction of the previously common manifestations of infection caused by Haemophilus influenzae type b and Streptococcus pneumoniae due to the introduction and near-universal dissemination of effective conjugate vaccines in childhood.
The current standard of care in the management of UTI (especially for young infants and children) includes the performance of imaging procedures.2 Although some controversy has surrounded the selection of imaging procedures, the potential menu of choices includes renal ultrasound, voiding cystourethrogram (VCUG), and renal scintigram. Formerly, the intravenous pyelogram was included among the choices but has been replaced, for most intents and purposes, by renal ultrasound.
Renal ultrasound is used to assess the gross anatomy of the urinary tract and thereby detect obstructive uropathies. It is a noninvasive test that adequately describes renal size, detects dilatation and duplication of the collecting system, and gross anatomic abnormalities such as a horseshoe kidney.2 Although ultrasounds have become standard in the evaluation of children with UTI, it is worth rethinking their contribution to management. In an era when ultrasounds are performed routinely during pregnancy (and sometimes on multiple occasions), they may be superfluous in the evaluation of a child with UTI.3 Most children with congenital obstruction of the urinary tract are diagnosed in utero. If an ultrasound was performed in the latter part of gestation (beyond 30–32 weeks of gestation) at an experienced institution and found to be normal, repeating it when a young child presents with UTI has a negligible impact on management. In a recent study that evaluated intravenous versus oral treatment of 306 children between the ages of 1 …
Address correspondence to Ellen R. Wald, MD, Department of Pediatrics, Box 4108, University of Wisconsin Children's Hospital, 600 Highland Ave, Madison, WI 53792. E-mail: erwald{at}wisc.edu
46 citations
TL;DR: In addition to grade, bladder volume relative to predicted bladder capacity at the onset of reflux appears to provide additional prognostic information regarding the likelihood of spontaneous resolution of primary vesicoureteral reflux.
41 citations
TL;DR: Children with the Williams-Beuren syndrome are at high risk for presenting with voiding dysfunction and structural abnormalities, and should undergo a minimum evaluation that includes voiding history and urinary tract sonography, while urodynamics, VCUG and additional studies should be performed in symptomatic patients or those whose initial evaluation shows significant abnormalities.
35 citations
TL;DR: Children who underwent voiding cystourethrography with sedation were less likely to void to completion, which may impair the ability to detect vesicoureteral reflux in children accurately.
29 citations
TL;DR: Extravesical ureteral reimplantation is an excellent treatment option for patients with persistent unilateral vesicoureterAL reflux following dextranomer/hyaluronic acid implantation and is less morbid and better tolerated than intravesical reimplantations.
23 citations
TL;DR: The radiographic findings associated with the most common pediatric urologic problems and some less common anomalies are provided.
18 citations
TL;DR: Endoscopic correction of reflux was done in all 9 patients and was successful in 8, as shown on voiding cystourethrogram at 3 months postoperatively, and one patient required a second procedure, which was successful.
17 citations
TL;DR: A retrospective trial was performed to study presentation, evaluation, management, complications and outcome of 186 infants with vesicoureteral reflux (VUR).
Abstract: A retrospective trial was performed to study presentation, evaluation, management, complications and outcome of 186 infants with vesicoureteral reflux (VUR). Medical records of 103 male and 83 female infants with mean age at entry 5.97 months were reviewed. Diagnosis was established using radiographic voiding cystourethrogram. At diagnosis, a renal ultrasound and dimercaptosuccinic acid renal scintigraphy were performed in all children. The follow-up included blood pressure measurements, serial urine cultures, haematological and biochemical tests, radionuclide cystography, renal ultrasounds and renal scintigraphy. The majority of infants with reflux, 176/186, presented with one or more episodes of urinary tract infections. In 113 children, reflux resolved spontaneously, 27 underwent surgical or endoscopic correction and 46 are being followed-up to date. Spontaneous resolution after prophylaxis was more frequent in boys (p < 0.0001), in children with grade I or II (p < 0.0001) and unilateral reflux at diagnosis (p = 0.0215). No significant difference could be established with respect to the presence of scars (p = 0.1680) and the number of breakthrough urinary tract infections (p = 0.1078). The data of the present study indicate that spontaneous resolution rate is high in infants, and therefore, early antireflux
TL;DR: In most clinical situations dextranomer/hyaluronic acid injection at the time of diagnosis is unlikely to be as cost effective as traditional management of vesicoureteral reflux.
TL;DR: In patients with myelodysplasia who have bladder perforation and free urine in the abdominal cavity the peritoneum is chemically inflamed by urine, leading to shunt dysfunction and high intracranial pressure.
Journal Article•
TL;DR: majority of this cohort of patients with varying degrees of reflux nephropathy were managed conservatively with regular monitoring and low-dose prophylactic antibiotic therapy, and clinical and laboratory evidence of renal failure was not observed during the follow up period.
Abstract: Fifty-six children (35 boys and 21 girls) below the age of 12 years with primary Vesicoureteric reflux (VUR) detected by voiding cystourethrogram after an initial episode of documented urinary tract infection (UTI), were studied prospectively for a period of 6-12 years (Mean 8 years) with reference to scarring, grade of reflux, break-through infections, adverse effects to prophylactic drugs and clinical and laboratory evidence of renal failure. The mean age at presentation was 1.95 years. Grade I-V reflux occurred in 7.1%, 28.6%, 48.2%, 12.5%, 3.6% respectively. Thirty-one (55.3%) had detectable renal scars on dimercaptosuccinic acid (DMSA) scan. All of them were treated with low dose prophylactic antibiotics until the age of 5 years. None had any major adverse effects to the prophylactic antibiotics. Ten (17.9%) had breakthrough UTI while on prophylaxis and 3 (5.4%) had UTI after discontinuing prophylaxis at 5 years of age. Two patients underwent ureteric reimplantation. Clinical and laboratory evidence of renal failure was not observed during the follow up period. Systolic blood pressure of all patients was below the 90th percentile for age. One had significant proteinuria. Majority of this cohort of patients with varying degrees of reflux nephropathy were managed conservatively with regular monitoring and low-dose prophylactic antibiotic therapy.
TL;DR: Commentary on the paper by Leroy et al suggests the lower the specificity, the smaller the expected proportion of children without reflux who have a negative result, and thereby avoid an unnecessary imaging investigation.
Abstract: Commentary on the paper by Leroy et al (see page241)
Many children are investigated for vesicoureteric reflux (VUR) following a urinary tract infection (UTI), but the imaging technique of a voiding cystourethrogram (VCUG) is unpleasant for the child and not without risk. A clinical scoring system capable of confidently predicting VUR would therefore be an attractive alternative approach.
The original study by Oostenbrink and colleagues1 seemed to suggest that a score derived from the combination of clinical factors (age, sex, and positive family history), ultrasound findings and C reactive protein (CRP) result could predict the presence of VUR with high sensitivity, albeit with rather low specificity. A diagnostic test with 100% sensitivity can be useful in ruling out a condition when it is negative, even when it has low specificity (that is, cannot be relied upon when positive). This has been referred to as a “SnNout” (when a test has a high S e n sitivity, a N egative result rules out the diagnosis).2 However, the lower the specificity, the smaller would be the expected proportion of children without reflux who have a negative result, and thereby avoid an unnecessary imaging investigation. A negative result, excluding VUR, was seen in 17% of children without VUR in Oosterbrink’s series.
Leroy and colleagues3 are to be commended on repeating the work of Oostenbrink. When a group of patients is used to develop a diagnostic test, the performance of that test tends to be overestimated. This is particularly …
Journal Article•
TL;DR: Balloon dilatation is a safe, effective and feasible therapy for lower urinary tract obstruction in children.
Abstract: Objective To evaluate the clinical effect of balloon dilatation in the treatment of lower urinary tract obstruction in children. Methods Twenty-six boys suffering from lower urinary tract obstruction underwent the balloon dilatation operation. These patients included 23 cases of posterior urethral valves, 2 cases of anterior urethral valves and 1 case of traumatic urinary tract stricture. Their ages ranged from 18 days to 7 years. All the patients were diagnosed by voiding cystourethrogram (VCG). Some of the boys suffered from bilateral hydronephrosis and dilated ureters. Before operation, the patients with urine retention or abnormal renal function should drain urine and correct the disorder of fluid and electrolyte. Balloon dilatation was done after their conditions were improved. During operation, ketamine anaesthesia was used, and 30% diatrizoate meglumine was used as dilatation drug. The balloon catheters which had the length of 4 cm and the diameters of 5, 8,10 mm respectively were used for dilating the urethra. After operation, a Foley's catheter was routinely indwelled. Results During procedure, compression phenomena disappeared in the course of operation. All the patients urinated normally after catheter was removed at 1 week post operatively. 6 cases received ureteral reimplantation to prevent vesicoureteral reflux after 1 to 3 months. 25 patients were followed up from 1 to 13 years and all patients had normal micturition and the bilateral hydronephrosis were improved. Conclusion Balloon dilatation is a safe, effective and feasible therapy for lower urinary tract obstruction in children.
TL;DR: A neonate presenting with an abdominal wall urinoma caused by rupture of an anterior urethral diverticulum is reported, which is an uncommon cause of congenital urethrals obstruction and urinary extravasation compared with a posterior urethra with smooth voiding.
Abstract: An anterior urethral valve with diverticulum is an uncommon cause of congenital urethral obstruction and urinary extravasation compared with a posterior urethral valve. We report a neonate presenting with an abdominal wall urinoma caused by rupture of an anterior urethral diverticulum. Urine drainage via urethral catheter was effective to resolve the abdominal urinoma. Voiding cystourethrogram performed 6 months after an endoscopic incision of the distal margin of the diverticulum revealed a normal urethra with smooth voiding. To our knowledge, no similar case has been reported previously.
TL;DR: After the first febrile urinary tract infection in young children with normal prenatal ultrasonographic findings, an ultrasonogram performed at the time of acute illness is of limited value for the clinical decision about further treatment.
Abstract: Purpose: The primary purpose for imaging the urinary tract of children with urinary tract infection is to detect congenital anomalies that may predispose the children to persistent or recurrent infection and also to prevent progressive renal deterioration. We evaluated the efficacy of imaging studies after a first febrile urinary tract infection in young children with normal prenatal ultrasonographic findings. Materials and Methods: We retrospectively reviewed 52 young children who were treated due to their first febrile urinary tract infection between 2001 and 2003. In all cases, urine specimens were collected via suprapubic aspiration. An the ultrasonogram and dimercaptosuccinic acid(DMSA) renal scans were obtained within 48 and 72 hours after hospitalization. Contrast voiding cystourethrograms were obtained within 1 to 4 week later after controlling the urinary tract infection. Results: On the ultrasonographic studies, 43 children(90%) were normal and 9 children(10%) were abnormal, and all of these abnormalities were upper tract dilatation that was not due to obstructive uropathy. DMSA renal scans revealed acute pyelonephritis in 34 children(65%) and normal findings in 18(35%). Voiding cystourethrogram revealed reflux in 15 children(31%). 4 children had Grade II reflux, 1 child had III reflux and 9 children had grade IV reflux. Conclusions: After the first febrile urinary tract infection in young children with normal prenatal ultrasonographic findings, an ultrasonogram performed at the time of acute illness is of limited value for the clinical decision about further treatment. A DMSA renal scan is useful for identifying pyelonephritis and renal scar, but its effect on the outcomes is unclear. Voiding cystourethrogram is most useful imaging study for identifying the reflux that needs antimicrobial prophylaxis for reducing reinfections and to prevent renal scarring.
TL;DR: Perirenal urinomas may be the first symptom in patients with posterior urethral valves and drainage via double-J stenting offers a promising alternative to percutaneous puncture.
Abstract: BACKGROUND Flank swelling and pseudotumors of the kidney are unusual manifestations of obstructive uropathies in small children. Our case illustrates typical problems and briefly reviews management options. CASE REPORT A 5-week-old boy presented with a large, palpable urinoma due to posterior urethral valves. Sonography and voiding cystourethrogram led to the diagnosis and immediate suprapubic transcutaneous urinary diversion was performed. However, the urinoma did not resolve. Thus, in addition to suprapubic urinary diversion, indirect drainage - instead of percutaneous puncture - was performed by retrograde insertion of a double-J catheter. Urethral valves were resected 4 weeks later and follow-up demonstrated an uneventful further development with normal renal function as assessed by regular ultrasound studies, a repeat cystourethrogram and a renal scan. CONCLUSION Perirenal urinomas may be the first symptom in patients with posterior urethral valves. Drainage via double-J stenting offers a promising alternative to percutaneous puncture. A renoprotective "pop-off" mechanism by which intrarenal pressure may be relieved is discussed.
TL;DR: Bladder diverticulum should be a differential diagnosis in children, especially male, presenting with urinary retention, fever and an abdominal mass that was initially diagnosed as a mesenteric cyst on ultrasonography.
Abstract: An 11-month-old infant presented with acute urinary retention. He had presented 3 months earlier with complaints of an enlarging abdominal mass that was initially diagnosed as a mesenteric cyst on ultrasonography. Voiding cystourethrogram revealed a large bladder diverticulum. Bladder diverticulum should be a differential diagnosis in children, especially male, presenting with urinary retention, fever and an abdominal mass.
Journal Article•
TL;DR: It is indicated that symptomatic primary VUR is more common and has better prognosis in girls and recurrence of UTI is not re-lated to the grade of VUR.
Abstract: Background: Experience with vesicoureteral reflux (VUR) differs in
differ-ent centers and there are plenty of controversies. The aim of
this study was to evaluate the outcome of primary VUR complications and
the rate of recurrence of UTI. Methods: The medical charts of all
infants and children with primary VUR who were followed up by two
nephrologists were reviewed. During 19 years (1985-2004), 330 patients
(271 females, 59 males) with 496 refluxing ureters were followed up as
primary VUR. Results: The patients' age at diagnosis was 4 days to 16
years (mean: 4.1 years) and the mean duration of follow-up was 4.5
years. Urinary tract infec-tion (UTI) was the presenting symptom in 95%
and fever was recorded in 35% of cases. Frequencies of different grades
of VUR at initial investigation were 10%, 35%, 30%, 13% and 12% for
grades I to V, respectively. Recurrence of UTI in VUR of grades I to V
were 22.2%, 18.1%, 20%, 23.4% and 17.9%, re-spectively. Follow-up
voiding cystourethrogram revealed resolution of VUR in 55%, improvement
in 27.5%, no change in 12%, and deterioration in 5.5%. Complications
such as chronic renal failure and hypertension were observed in 13 and
13 patients, respectively. Renal scarring was present in 52% of boys
and 29% of girls. Conclusion: The present study indicates that
symptomatic primary VUR is more common and has better prognosis in
girls. Recurrence of UTI is not re-lated to the grade of VUR.
TL;DR: The aim of this study was to reevaluate the necessity of DMSA scans as a screening test in infants without reflux or with low grade reflux, and the incidence of renal defects was significantly correlated with VUR grade.
Abstract: Objective:99mTc-dimercaptosuccinic acid(DMSA) scan is considered to be the most sensitive examination for detection of renal scars. However, because of its high radiation exposure to the kidney and its limited usefulness for patients with low grade vesicoureteral reflux(VUR), some authors have suggested that DMSA scans should be reserved primarily for children with VUR grade 3 and above. The aim of this study was to reevaluate the necessity of DMSA scans as a screening test in infants without reflux or with low grade reflux. Methods:In this retrospective study, 189 infants(mean age:6.2 months) diagnosed as UTI were enrolled. Voiding cystourethrogram(VCUG), DMSA scan and renal ultrasonography were performed within 1 month of UTI. VUR grade was classified into three subgroups; low grade(grade 1-2), moderate grade(grade 3), and high grade(grade 4-5), respectively. Results:Renal defects were present in 67 of 189 infants, and 82 of the 378 renal units. The incidence of renal defects was significantly correlated with VUR grade(P
TL;DR: Standard urethrographic imaging and endoscopic management is appropriate for the majority of symptomatic Cowper's syringoceles.
Abstract: We report a case of acute urinary retention in a 13-month-old boy, secondary to a perforate Cowper's syringocele. Diagnosis was established with voiding cystourethrogram, transperineal ultrasound and urethroscopy; definitive management involved endoscopic unroofing of the syringocele and resolution of the patient's obstructive signs and symptoms followed. Although novel diagnostic and therapeutic options have been reported, standard urethrographic imaging and endoscopic management is appropriate for the majority of symptomatic Cowper's syringoceles.
1 Jan 2006
TL;DR: Boys with posterior urethral valves will present later in life with a urinary tract infection or voiding dysfunction, usually in the first week of life.
Abstract: Posterior urethral valves are an uncommon but important cause of prenatally detected hydronephrosis. It often affects both kidneys and may be associated with renal dysplasia and insufficiency. Immediate postnatal evaluation and intervention should be undertaken. A renal ultrasound and voiding cystourethrogram are obtained on the first day of life, and a catheter is placed until intervention is undertaken, usually in the first week of life. Occasionally, boys with posterior urethral valves will present later in life with a urinary tract infection or voiding dysfunction.
1 Sep 2006
TL;DR: Using color Doppler ultrasound and endoscopy with a pediatric cystoscope to diagnose urethral diverticular cancer previously undetected by a voiding cystourethrogram in a 43-year-old woman, a radical excision was carried out including the anterior 1/2 of the vagina while sparing the bladder.
Abstract: We describe our experience using color Doppler ultrasound and endoscopy with a pediatric cystoscope to diagnose urethral diverticular cancer previously undetected by a voiding cystourethrogram in a 43-year-old woman. We then carried out a radical excision of the urethral and periurethral tissues including the anterior 1/2 of the vagina while sparing the bladder. The patient has been followed-up for 7 years with no evidence of cancer recurrence.
1 Jan 2006
TL;DR: Children with vesicoureteral reflux usually present with a urinary tract infection (UTI), although some cases are diagnosed during the evaluation of prenatally detected hydronephrosis.
Abstract: Children with vesicoureteral reflux usually present with a urinary tract infection (UTI), although some cases are diagnosed during the evaluation of prenatally detected hydronephrosis. Approximately 25% of children with a UTI will be found to have reflux. Ultrasound is normal in 75% of children with reflux, and so children with a significant UTI are evaluated with a voiding cystourethrogram (VCUG). Reflux is graded based on the appearance of the VCUG:
TL;DR: Routine screening of siblings of children with vesicoureteral reflux with a voiding cystourethrogram is widely advocated, but not all urologists, or indeed parents, support the use of this invasive procedure in asymptomatic children.
Abstract: BACKGROUND Siblings of children with vesicoureteral reflux (VUR) have an increased incidence of VUR compared with the general population. Younger siblings are at greatest risk. If untreated, VUR can lead to urinary tract infection (UTI), hypertension, renal scarring, and reflux nephropathy. Routine screening of siblings with a voiding cystourethrogram (VCUG) is widely advocated; however, not all urologists, or indeed parents, support the use of this invasive procedure in asymptomatic children. Ultrasound is a less invasive alternative, but its efficacy as a VUR screening tool is largely unknown.
TL;DR: Renal ultrasound studies after endoscopic treatment with dextranomer/hyaluronic acid gel are unnecessary after determination of reflux resolution by voiding cystourethrography.
TL;DR: Positioned instillation of contrast cystogram performed immediately after injection of dextranomer/hyaluronic acid was not useful in predicting which patients would have persistent reflux postoperatively and patients are best served with the extant protocol of conventional cystography 3 to 4 months postoperative.