Showing papers on "Voiding cystourethrogram published in 2009"
TL;DR: The body of literature does not support the routine surgical removal of MCDKs, and most authors suggest serial ultrasonography to monitor contralateral growth, routine blood pressure monitoring, and a serum creatinine monitoring algorithm.
Abstract: In children, unilateral multicystic dysplastic kidney (MCDK) is one of the most frequently identified urinary tract abnormalities. A variety of proposed etiologies has been associated with the underlying pathogenesis of MCDK. These include genetic disturbances, teratogens, in utero infections, and urinary outflow tract obstruction. From 5–43% of the time, MCDK has associated genito-urinary anomalies, both structural and functional in nature. A review of the literature reveals that involution rates are reported to be 19–73%, compensatory hypertrophy of the contralateral kidney occurs from 24–81% of the time, and estimated glomerular filtration rates (GFRs) (by the Schwartz formula) range from 86–122 ml/min per 1.73 m2 body surface area. Most authors suggest serial ultrasonography to monitor contralateral growth, routine blood pressure monitoring, and a serum creatinine monitoring algorithm. The risk of hypertension in those with MCDKs does not appear to be greater than that of the general population, and the rates of malignant transformation of MCDK are small, if at all increased, in comparison with those in the general population. If the patient develops a urinary tract infection or has abnormalities of the contralateral kidney, shown on ultrasound, a voiding cystourethrogram is recommended. Finally, the body of literature does not support the routine surgical removal of MCDKs.
144 citations
TL;DR: Although the reflux resolution rates at initial postoperative voiding cystourethrogram approach those of open surgery, there is a significant failure rate at 1 year, which warrants long-term followup.
130 citations
TL;DR: Investigation of vesicoureteral reflux and use of prophylactic antibiotics significantly reduce the risk of febrile urinary tract infection and recommend that patients with a history of prenatal hydronephrosis and postnatally persistent hydr onephrosis be screened with voiding cystourethrography early in life, and be placed on prophyllactic antibiotics until the screening results are known.
75 citations
TL;DR: Most caliceal diverticula remain stable and asymptomatic but approximately 20% may have symptomatic enlargement that may warrant surgical management, and various treatment options are available.
39 citations
TL;DR: A group of siblings of index patients with vesicoureteral reflux who are most likely to be affected are identified, and screening siblings younger than 6 years for reflux and risk factors for renal scarring are identified.
37 citations
TL;DR: In this series urinary tract infection after dextranomer/hyaluronic acid injection was rare and patients with recurrent urinary tract infections and bladder dysfunction preoperatively are at increased risk for urinary tract Infection after treatment.
36 citations
TL;DR: It is proposed that, the patients of AUVs, if not excessively delayed for treatment are otherwise well in terms of general condition as opposed to patients of posterior urethral valves.
Abstract: Background: Anterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. Although they are referred to as valves, these obstructive structures often occur in the form of a diverticulum. The urethra in these cases shows saccular or bulbar dilatation known as anterior urethral diverticulum (AUD). They typically occur where there is a defect in the corpus spongiosum, leaving a thin-walled urethra. This segment of the urethra balloons out during voiding, simulating a mass that is sometimes visible along the ventral wall of the penis. The swelling is fluctuant and urine dribbles from the meatus on compression. The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula. Materials and Methods: We have studied children with congenital anterior urethral valves and diverticula. Six patients of AUVs with diverticula were admitted during the period of 2000-2007 and were prospectively evaluated. The mean age of presentation was 16 months (15 days to 4 years). Straining at micturition and a palpable penile swelling were the most common presenting features. The diagnosis was established by voiding cystourethrogram (VCUG) and supported by ultrasonography (USG). All patients were treated with single-stage open surgical excision except one who died preoperatively due to urosepsis. Initial lay opening of the penoscrotal urethra and delayed repair were done in one patient. Results: The surgical outcome was successful in all but one patient, who died of delayed presentation with severe back pressure changes, urinary ascitis and urosepsis. On long-term follow-up, all patients demonstrated good stream of urine. The renal functions were normal and the patients had no evidence of urinary infections. Conclusion: We propose that, the patients of AUVs, if not excessively delayed for treatment are otherwise well in terms of general condition as opposed to patients of posterior urethral valves. The diagnosis is easily established by VCUG and the severity is revealed by a sonogram. Open surgical excision is the method of choice for patients with a urethral diverticulum; however, cystoscopic fulguration is also feasible in selected patients. The outcome is excellent with minimal morbidity and mortality.
33 citations
TL;DR: The magnitude of fetal renal pelvic dilatation is not reliably predictive of reflux and this measure alone cannot be used to direct postnatal cystography, however, postnatal calicectasis appears to be an important predictor of vesicoureteral reflux in children with fetal renal Pelvic Dilatation.
27 citations
Journal Article•
TL;DR: It is concluded that severe VUR is frequently associated with early kidney damage, perhaps with prenatal onset, and the overall relative risk of kidney damage shown by DMSA scan and urography was statistically higher in children with vesico-ureteral reflux of various degrees than in controls.
Abstract: To review the most relevant clinical studies that evaluate kidney damage in children with primary vesico-ureteral reflux (VUR), we reviewed and compared randomized controlled trials and clinical trials from scientific literature. In these studies, vesico-ureteral reflux was diagnosed by voiding cystourethrogram and kidney damage was assessed by either DMSA scan or urography. Relative risk with 95% confidence intervals was calculated using Review Manager Software (The Cochrane Collaboration, 2000). The overall relative risk of kidney damage shown by DMSA scan and urography was statistically higher in children with vesico-ureteral reflux of various degrees than in controls (3.7 times and 2.8 times, respectively). However, in high-grade VUR, the relative risk of congenital kidney damage was 5.6 times that of controls. We conclude that severe VUR is frequently associated with early kidney damage, perhaps with prenatal onset. Progression of kidney damage may depend on the severity of VUR and untreated urinary tract infections. Prevention of congenital kidney damage from severe VUR is possible when there is early intervention, even during fetal growth.
24 citations
TL;DR: Pediatric patients with recurrent urinary tract infections and voiding dysfunction should always be evaluated for congenital bladder diverticulum and Diverticulectomy, with ureteral reimplantation for high-grade reflux, provides good results without recurrence.
Abstract: The purpose of the study is to present the authors’ clinical and surgical experience with congenital bladder diverticula in nine pediatric patients at a developing world tertiary care center. Records of nine patients diagnosed and treated as congenital bladder diverticula from 2000 to 2007 were retrospectively reviewed for age, sex, chief complaints, associated anomalies, investigative work-up, operative notes, and postoperative follow-up. All were males. Age at presentation ranged from six months to eight years (mean three years). All were diagnosed postnatally by ultrasound and/or voiding cystourethrography (VCUG) and confirmed on urethrocystoscopy. Open surgical excision of diverticulum was done in all the patients. Ureteral reimplantation was simultaneously done only in three patients with VCUG-documented high-grade vesicoureteral reflux (VUR). With an average follow-up of four years, gradual resolution of symptoms was seen in seven of nine patients whose postoperative follow up records were available. There was no diverticulum recurrence at the defined mean follow-up. Pediatric patients with recurrent urinary tract infections and voiding dysfunction should always be evaluated for congenital bladder diverticulum. Although investigations such as intravenous urography (IVU), urodynamic studies, nuclear renal scanning, and, sometimes, CT scan and MRI, form an important part of preoperative diagnostic work-up and postoperative follow up, USG and VCUG may be enough when availability and cost are the constraints. Diverticulectomy, with ureteral reimplantation for high-grade reflux, provides good results without recurrence.
22 citations
TL;DR: The incidence of febrile urinary tract infection following ureteroneocystostomy in a contemporary, single institution series may be lower than previously reported.
Journal Article•
TL;DR: The results indicate that none of the urodynamic factors was significantly associated with recurrence of urinary tact infection in girls.
Abstract: BACKGROUND To determine urodynamic, behavioral and functional abnormalities predisposing to recurrent urinary tract infection in 5- to 17-year-old girls. METHODS A prospective case-control study was carried out. A total of 148 girls met inclusion criteria. They received a careful evaluation including complete history, voiding-drinking diary, bowel questionnaire, physical investigation, sonography, voiding cystourethrogram and urodynamic investigation. RESULTS In a multivariate model, independent risk factors for recurrent urinary tract infection included age 20 mL (OR=1.1; 95% CI, 1.0-1.1). CONCLUSIONS Independent risk factors for recurrent urinary tract infection were age
TL;DR: Linkage analysis in a large cohort of vesicoureteral reflux families ruled out UPK3, UPK2, UpK1B, KAL, PAR1 and PAR2 as candidate genes for reflux and identified genes that cause this disease.
TL;DR: With the diagnosis of isolated female epispadias, one‐stage reconstruction of the urethra, bladder neck and labia minora and clitoris was performed.
Abstract: Isolated female epispadias without exstrophy is an extremely rare syndrome. The symptoms of female epispadias are primary urinary incontinence and abnormal anatomical features. A 12-year-old girl presented with primary urinary incontinence. On physical examination, bifid clitoris and labia minora were seen. The vagina and hymen were normal. Voiding cystourethrogram showed no reflux. With the diagnosis of isolated female epispadias, one-stage reconstruction of the urethra, bladder neck and labia minora and clitoris was performed.
TL;DR: The present analysis suggests that children with AHN should undergo an ultrasound within the first month of life and further course of action should be decided on the basis of the individual case.
Abstract: Hydronephrosis is the most common genitourinary anomaly as detected on obstetric ultrasonography and the incidence of associated vesicoureteral reflux is around 10-12%. There is inconsistency in the literature regarding which child should under go a voiding cystourethrogram (VCUG) in cases of antenatal hydronephrosis (AHN). Besides, there is a scarcity of prospective studies to demonstrate the risk of varying degree of AHN, associated reflux and their long-term impact on the kidneys. The present analysis suggests that children with AHN should undergo an ultrasound within the first month of life and further course of action should be decided on the basis of the individual case. Children with persistent moderate to severe AHN should undergo a VCUG and a functional study.
TL;DR: The presence of a DxHA mound on initial postoperative ultrasound does not predict resolution of VUR, and a larger prospective study is needed to evaluate additional parameters.
TL;DR: Severity of lower ureteral dilatation is the most significant factor influencing the failure of endoscopic subureteral injection of Deflux Ⓡ .
Abstract: Ⓡ ) has become an established alternative to long-term antibiotic prophylaxis and open ureteral reimplantation for the management of vesicoureteral reflux (VUR) in children. We retrospectively evaluated the risk factors for treatment failure after endoscopic correction of VUR. Materials and Methods: Between 2005 and 2007, 23 boys and 26 girls (total of 69 ureters) with VUR underwent endoscopic subureteral injection of Deflux Ⓡ primarily. VUR was unilateral in 29 patients and bilateral in 20 patients. Of the 69 ureters, VUR was grade II to V in 13, 28, 20, and 8, respectively. Follow-up urinalysis and ultrasonography were performed 1 and 3 months after the procedure, and a voiding cystourethrogram was performed at 6 or 9 months postoperatively. Results: Treatment failure was defined as persistent VUR of grade II or over grade II. Endoscopic correction failed in 22 of 69 refluxing ureters. Age, sex, laterality, number of preoperative urinary tract infections, time from diagnosis to operation, presence of renal scarring, and injection volume did not influence outcome. However, preoperative presence of voiding symptoms, high-grade reflux and hydronephrosis, and having a horseshoe or golf-hole shaped ureteral orifice had a negative influence on the treatment result by univariate analysis. Severe dilatation of the lower ureter was the only statistically significant factor by multivariate analysis. Conclusions: Severity of lower ureteral dilatation is the most significant factor influencing the failure of endoscopic subureteral injection of Deflux Ⓡ .
TL;DR: BVG DRC is a sensitive and an accurate test that gives additional information on the reflux phenomenon with respect to bladder filling and is better than conventional DRC for grading of VUR.
Abstract: Aim : Evaluation of vesicoureteric reflux (VUR) in children by bladder volume graded direct radionuclide cystogram (BVG DRC). This technique allows detection of VUR at different bladder volume grades. Materials and Methods : In this prospective study, 33 patients (66 renal units) with suspected vesicoureteric reflux were subjected to a voiding cystourethrogram (VCUG) and BVG DRC. The patients were assessed further with radioisotope renal scans for renal cortical scars. Results : Twenty-two patients and 36 renal units were found to have VUR in either of the reflux studies. A VCUG was able to detect 20 units (55.50%) and a BVG DRC was able to detect 35 units (97.2%). A VCUG had a test accuracy of 77.8% and a BVG DRC had a test accuracy of 98.6%. There was a positive correlation between bladder volume grades and scarring on a DMSA scan. Conclusions : Like a conventional DRC, BVG DRC is a sensitive and an accurate test. It gives additional information on the reflux phenomenon with respect to bladder filling. The bladder volume graded technique is better than conventional DRC for grading of VUR.
TL;DR: Understanding of the possible stressors associated with this imaging study in combination with developmentally appropriate use of distraction, relaxation, medical play, and pre-procedure preparation can potentially reduce the negative emotional impact for many children without the risks and concerns associated with sedation.
TL;DR: In this article, the authors describe the management and intermediate-term outcomes for adult women with VUR, including pyelonephritis and pre-existing risk factors for VUR.
TL;DR: In patients with posterior urethral valves vesicoureteral reflux is often associated with poorly functioning kidneys, and patients with bilateral reflux have decreased overall kidney function.
TL;DR: Laroscopic ureteric reimplantation with CO(2) pneumovesicum is technically feasible with a high success rate (92%) and the role of this new technique in the treatment of VUR remains to be determined.
TL;DR: It is shown that successful endoscopic correction of vesicoureteral reflux is accompanied by a low incidence of new renal scarring and febrile urinary tract infection and patients who initially have corrected reflux but who have a febrian urinary tract infections at long-term followup require prompt revaluation to rule out recurrent reflux.
TL;DR: In this paper, the authors tested the hypothesis that early valve ablation can decrease the incidence of bladder dysfunction in full-term males with prenatally diagnosed hydronephrosis and proved postnatally to have posterior urethral valve.
TL;DR: Hypertension is often noticed in infants with MCDK, and uninephrectomy leads to normalization, however, prospective studies are needed to exclude a spontaneous improvement of hypertension.
Abstract: Multicystic dysplastic kidney (MCDK) is one of the most common renal abnormalities in children. The aim of our study was to evaluate the clinical course and outcome of patients with MCDK. Ninety pediatric patients with unilateral MCDK followed by the Pediatric Nephrology Department of Bakirkoy Maternity and Children’s Hospital between 1990 and 2007 were included in this retrospective study. The dimercaptosuccinic acid radionuclide scan revealed no function in MCDK in all of our patients. Voiding cystourethrogram was performed in all patients. Twenty patients (22.2%) had abnormalities in the contralateral kidney. Nephrectomy was performed in 41 patients (45.5%). Twelve patients had undergone routine nephrectomy before 1996. Since then, patients have been followed up conservatively, and nephrectomy has been performed only when indicated. Indication of nephrectomy was arterial hypertension in 16 patients (23.1%), recurrent urinary tract infection (UTI) in 11 (15.9%), and severe abdominal pain in two (2.8%). Hypertension was noted within the first year of life in all patients except two. MCDK completely involuted in 39.3% within 48 months. There was no malignant transformation, proteinuria, or renal failure. In conclusion, hypertension is often noticed in infants with MCDK. Uninephrectomy leads to normalization. However, prospective studies are needed to exclude a spontaneous improvement of hypertension.
TL;DR: It is demonstrated that up to 27% of patients treated endoscopically may have a febrile urinary tract infection after an initial negative postoperative voiding cystourethrogram/radionuclide cystogram at 2 to 5 months and up to 92% of those will demonstrate delayed vesicoureteral reflux recurrence.
TL;DR: Mound calcifications have now been reported after endoscopic therapy for vesicoureteral reflux with autologous chondrocytes as well as dextranomer/hyaluronic acid copolymer, and that these calcified mounds may mimic ureterovesical junction stones.
TL;DR: Selective use of voiding cystourethrography is recommended to evaluate children awaiting renal transplantation and it is continued to support performing this test in children with renal failure due to urological causes and those with a history of urinary tract infection, hydronephrosis or voiding dysfunction.
TL;DR: Nomogram tables containing estimates of annual reflux resolution rate are constructed as a function of age at presentation, gender, grade, laterality, mode of clinical presentation and ureteral anatomy to predict the probability of annual resolution for individual cases of reflux.