Lower Urinary Tract Abnormalities Research Articles

Lower Urinary Tract Abnormalities in Children with Multicystic Dysplastic Kidney

Lower Urinary Tract Abnormalities in Children with Multicystic Dysplastic Kidney

Lower urinary tract abnormalities in children with multicystic dysplastic kidney.

To determine the nature and frequency of associated structural abnormalities of the lower urinary tract in children with multicystic dysplastic kidney. The authors reviewed imaging findings from studies in 59 children with unilateral multicystic dysplastic kidney. All patients had undergone renal ultrasonography (US), renal scintigraphy, and voiding cystourethrography. The diagnosis was based on characteristic imaging findings (echogenic, cystic kidney at US that did not function at scintigraphy). Nineteen (32%) patients had one or more abnormalities of the lower urinary tract. Vesicoureteral reflux was most common (15 patients). Reflux occurred into the contralateral ureter in 12 patients and the ipsilateral atretic ureter in five (two had bilateral reflux). Four patients had ectopic ureters: Three cases were ipsilateral and inserted into the prostatic urethra (two cases, both with reflux) or into the seminal vesicle (one case); one case was contralateral and inserted into the bladder neck. Four patients had an ipsilateral obstructed single-system ureterocele. Four patients had bladder diverticula. Other abnormalities included hypospadias, opacification of a small utricle (not in the patient with hypospadias), ejaculatory duct reflux, internal urachal sinus, and lipomeningocele with a neurogenic bladder. Abnormalities of the lower urinary tract are common in children with unilateral multicystic dysplastic kidney. Voiding cystourethrography should be performed routinely in this population.

Relationship Between Lower Urinary Tract Abnormalities and Disease-Related Parameters in Multiple Sclerosis

Multiple sclerosis affects the lower urinary tract in many patients. The relationship between lower urinary tract abnormalities and disease-related parameters of multiple sclerosis is not well described. We screened urologically and neurologically 212 patients according to a standard protocol. Micturition complaints were noted in 52 percent of the patients and urodynamic abnormalities were found in 64 percent. A statistical correlation was found between detrusor hyperactivity and detrusor hypoactivity with disease-related parameters, that is disease duration, disability status, myelin basic protein concentration in the cerebrospinal fluid and neurophysiological investigations. No relationship was found between detrusor hypersensibility or detrusor hyposensibility and the aforementioned disease-related parameters. In 1 patient upper urinary tract abnormalities were noted in combination with urodynamic abnormalities. We conclude that lower urinary tract abnormalities can be found in every patient with multiple sclerosis unrelated to the state of the disease. Severe upper urinary tract abnormalities are rare.

Relationship Between Lower Urinary Tract Abnormalities and Disease-Related Parameters in Multiple Sclerosis

Relationship Between Lower Urinary Tract Abnormalities and Disease-Related Parameters in Multiple Sclerosis

Stress-overflow urinary incontinence after radical hysterectomy and radiation therapy for cervical cancer

A 40-year-old woman was evaluated for urinary incontinence, loss of bladder sensation and residual urine 12 months after radical abdominal hysterectomy and external pelvic radiation therapy for stage IIb cervical cancer. The patient had no history of abnormal lower urinary tract function before treatment. The urodynamic follow-up study at 12 months showed 80 ml of residual urine, low bladder compliance (detrusor pressure of 77 cmH2O at 200 ml filling) and an incompetent urethral closure mechanism. Cystoscopy showed a pale bladder mucosa with telangiectasia. Two years later the urodynamic findings were almost unchanged, and pudendal nerve terminal motor latency measured according to Snooks and Swash showed prolonged motor latency to the external urethral sphincter. Thus, this patient had combined stress overflow incontinence with pudendal neuropathy and fibrosis of the bladder wall.

Transplanting patients with abnormal lower urinary tracts.

Since 1977, 23 patients with bladder or bladder outlet dysfunction leading to renal failure have received 28 kidney transplants in our institution. Three patients were provided with an ileal conduit, but the remainder were transplanted using their own bladder following urodynamic assessment and bladder reconstruction. Graft and patient survival were good when compared to a group of patients with normal lower urinary tracts, actuarial graft survival at 5 years being 70% for both groups and patient survival being 82% and 90%, respectively. Patients who develop renal failure from detrusor/sphincter dysfunction can be transplanted successfully once the cause of the renal failure has been identified and corrected.

Transplanting patients with abnormal lower urinary tracts

Transplanting patients with abnormal lower urinary tracts

KIDNEY TRANSPLANTATION IN PATIENTS WITH AN ABNORMAL LOWER URINARY TRACT

Several factors influence the decision about which type of urinary drainage is best for any given patient. In a patient who has undergone cystectomy, supravesical drainage is required. However, many patients with upper tract urinary diversion have bladders that can be rehabilitated to provide adequate urinary storage. In most patients who have not had a cystectomy, the bladder can be augmented with bowel to achieve a suitable capacity. The urethral resistance component of continence can be achieved using bladder neck reconstruction, periurethral injection, or artificial urinary sphincter. Intermittent catheterization may be required following lower tract reconstruction. When reconstruction is possible, the native bladder is usually the best option for kidney transplant drainage. In general, one should provide an effective, low-pressure means of urine drainage that the patient can manage. With improvements in surgical technique and with better immunosuppressive regimens, kidney transplantation can be performed safely in patients with abnormal lower urinary tracts. Using appropriate bladder rehabilitation or supravesical diversion can preserve and even improve a patient's life style.

99mTc-DMSA imaging with tomography in renal transplant recipients with abnormal lower urinary tracts.

This study examined whether renal parenchymal imaging using 99mTc DMSA scintigraphy with tomography is a sensitive measure of renal scarring in renal transplant recipients with an abnormal lower urinary tract and whether such scars correlate with impairment of renal function. Three groups of patients were compared: group 1, patients with an abnormal lower urinary tract and deteriorating renal function (n = 9); group 2, abnormal lower urinary tract and stable renal function (n = 5); and group 3, normal lower urinary tract and deteriorating renal function (n = 8). Eight of the nine patients in group 1 had multiple scars visible on 99mTc DMSA scans and this correlated with histology when a renal biopsy was performed; the only patient without scars had a transplant glomerulopathy. The presence of scars was associated with either raised intravesical pressures or recurrent urinary tract infections (UTIs). Only one patient in each of groups 2 and 3 had visible scars and both these patients had a history of recurrent UTIs. Patients in group 3 with deteriorating renal function due to chronic rejection documented by biopsy did not have cortical scars visible with 99mTc DMSA tomography. 99mTc DMSA scanning with tomography is a useful investigation in the management of renal transplant patients with declining renal function; multiple scars may indicate abnormal lower urinary tract function and are not seen in chronic rejection.

Renal transplantation into abnormal lower urinary tract

Because doubts remain about the safety and efficacy of renal transplantation for patients with primary urological abnormalities, we have studied the outcome of transplantation in a large group of such patients. Between 1977 and 1989, 69 renal transplants were completed in 62 patients with abnormal lower urinary tracts (29 primary vesicoureteric reflux, 13 posterior urethral valves or bladder outflow obstruction, 6 vesicoureteric tuberculosis, 5 neuropathic bladders, and 9 miscellaneous causes). Graft survival in this urological group was similar to that in 150 allograft recipients (157 grafts) with end-stage renal failure of a non-urological cause. No aetiological subgroup had poorer graft survival than the others, although patients with recurrent urinary-tract infections and a history of outflow obstruction tended to have worse graft function. 9 patients (10 transplants) had renal transplantation into a urinary diversion (8 ileal conduits, 1 rectal bladder). These patients had graft survival and renal function comparable with those of the whole urological group. We found no effect of immunosuppressive treatment (cyclosporin or azathioprine), type of kidney donor (living or cadaveric), or donor or recipient age on graft survival time or renal function. Thus, renal transplantation in patients with abnormal lower urinary tracts is safe and effective; patients with ileal conduits do well and have few substantial difficulties. Preoperative assessment of bladder emptying and urodynamics are important in these patients.

The cloacal malformation: radiologic findings and imaging recommendations.

The imaging studies and records of 65 patients with the cloacal malformation seen from 1969 to 1989 were reviewed. The malformations were described according to cloacal configuration (urethral, vaginal), type of urinary-cloacal communication (urethral, vesical), and level of rectal communication (vaginal, cloacal, vesical, other). Lower urinary tract abnormalities were frequent (reflux, ureteral ectopia, bladder diverticula, bladder duplication, urachal remnants, urethral duplication), as were genital abnormalities (uterine duplication, vaginal duplication, uterine atresia, vaginal atresia), abnormalities of the bony pelvis (partial sacral agenesis, pubic diastasis), and renal abnormalities (agenesis, obstruction, horseshoe kidney). Contrast material studies of the cloaca and the distal limb of the colostomy with fluoroscopy in various projections were essential for diagnosis. Voiding cystourethrography was important for detecting vesicoureteric reflux. Sonography was of limited value for evaluation of the malformation but was valuable for imaging the kidneys. MR imaging revealed that spinal cord abnormalities cannot be predicted based on the appearance of the lumbosacral spine and are more common than previously thought.

Pre‐transplant bladder rehabilitation in patients with abnormal lower urinary tracts

Pre‐transplant bladder rehabilitation in patients with abnormal lower urinary tracts

Diagnostic study of urinary frequency in children

A urologic study of 28 patients (11 males and 17 females, 4 to 14 years old) revealed that 23 patients (83%) had organic disease, 20 of whom had lower urinary tract abnormalities. Of 22 patients who were assessed psychologically, 14 had difficulty in adaptation, 20 had special birth order problems, and in 14 onset of symptoms occurred before school age. After five years of follow-up, 18 of 20 patients who were re-evaluated had no recurrent urinary frequency symptoms.

Use of Bowel in Undiversion

Urinary undiversion is becoming an uncommon procedure because fewer patients are being diverted. The lessons learned from undiversion, however, have made possible early primary reconstructions in patients who would previously have been candidates for diversion. Intermittent clean catheterization and the use of bowel to augment or form a compliant storage vessel for urine have permitted reconstruction in patients with abnormal bladder and urethral function. Thus patients with neurogenic bladder or with severe lower urinary tract abnormalities can look forward to healthy kidneys and urinary continence without the use of appliances. Certainly there are yet many lessons to be learned, but the potential is just starting to be appreciated.

Supravesical Urinary Diversion in Renal Transplantation

Urinary diversion may be used in patients without a bladder or with irreversible, lower urinary tract abnormalities who might not otherwise be suitable candidates for renal transplantation. Three cases have been described to illustrate three different methods of supravesical urinary diversion that have been employed in association with renal transplantation.

The Management of Renal Transplant Recipients with Abnormal Lower Urinary Tract — Reconstruction Versus Diversion

The Management of Renal Transplant Recipients with Abnormal Lower Urinary Tract — Reconstruction Versus Diversion

Experimentelle und histologische Untersuchungen über Hautgewöhnung

Urological conditions of infancy and childhood account for the largest single disease group requiring either surgical or medical intervention. This makes early detection and classification of abnormalities mandatory. This study presents an analysis of the results of ultrasonic screening in 1000 patients. Ultrasonic examination was readily instituted even in children with uncharacteristic symptoms for the early detection of abnormalities. Most cases of kidney and upper urinary tract abnormalities were diagnosable by ultrasound examination alone, whereby the characteristic pathoanatomical pattern of the lesion was seen. Lower urinary tract abnormalities were also detected with high accuracy. However, in most patients radiographic investigations were necessary for further classification. Sonography was also of great value in the initial investigation of acute renal failure; in patients with non-specific clinical and laboratory findings ultrasonography often presented the key to the diagnosis. Ultrasound also proved extremely useful in the follow up of patients with kidney and urinary tract disease. Based on the ultrasonic examination of 1000 patients it is shown that sonography is a most helpful and reliable method for the diagnosis or exclusion of kidney and/or urinary tract disease in paediatric patients of any age.