Upper Urinary Tract In Children Research Articles

Extracorporeal Shock Wave Lithotripsy in Paediatric Patients

24 children with urolithiasis of the upper urinary tract were treated by extracorporeal shock wave lithotripsy (ESWL). In all patients sufficient stone disintegration could be achieved by an average of 950 shock waves. Percutaneous nephrostomy was required for "Steinstrasse" ureteral obstruction in 2 cases. At discharge from hospital 16 children were considered stone-free. Follow-up showed 90% of the children to be stone-free without recurrence (mean 20 months). The necessary precautions considered, ESWL is the method of choice for treatment of urolithiasis of the upper urinary tract in children. The long term effects of ESWL on the juvenile kidney have yet to be observed.

Diagnostic Imaging in Pediatric Renal Inflammatory Disease

THE TERM inflammatory disease encompasses a broad spectrum of conditions in pediatrics. These include diffuse pyelonephritis, focal pyelonephritis, renal abscess, pyonephrosis, and pararenal retroperitoneal abscesses due to infection of the urinary tract. Uncomplicated pyelonephritis does not require imaging for diagnosis if the clinical presentation and laboratory data are characteristic. However, the signs and symptoms of infection of the upper urinary tract in children may present a diagnostic challenge. During the neonatal period, infections of the urinary tract are more common among boys and nonspecific symptoms predominate. These include poor feeding, slow gain in weight, vomiting, diarrhea, irritability, and jaundice. Fever or hypothermia also is often present. Bacteremia occurs in approximately 35% of newborns with infection of the urinary tract.1In infants aged 1 month to 2 years, nonspecific manifestations still predominate, but sepsis and severe illness are less frequent than in the neonate. Among ambulatory children younger than

Diuretic renography in evaluating dilated upper urinary tract in children

The diuretic renogram provides a previously unavailable noninvasive method for assessing and following urinary tract dilation of diverse cause, and defining true obstruction in children. Technetium-99m-DTPA (diethylenetriaminepentaacetic acid) is injected intravenously and a posteriorly placed gamma scintillation camera used to image the kidneys, ureters, and bladder. Furosemide is subsequently injected to stimulate a diuresis, and the washout pattern of isotope is monitored (time-activity histogram). Nonobstructive, obstructive, and poor renal function patterns were seen. Forty patients with varying degrees of hydroureteronephrosis were evaluated. Tracings were performed serially and compared with the clinical course in time, as well as with pressure flow studies and operative findings. All patients with a nonobstructed diuretic renogram did well, except for 1 boy in whom ureteropelvic obstruction developed later. Difficulty in evaluating the obstructive renogram pattern occurred only in some children with severe (grade V) hydronephrosis. Further standardization of the diuretic renogram with regard to time of diuretic injection, state of patient hydration, and regions of imaging may improve diagnostic accuracy.

Diagnostic Imaging in Pediatric Renal Inflammatory Disease

THE TERM inflammatory disease encompasses a broad spectrum of conditions in pediatrics. These include diffuse pyelonephritis, focal pyelonephritis, renal abscess, pyonephrosis, and pararenal retroperitoneal abscesses due to infection of the urinary tract. Uncomplicated pyelonephritis does not require imaging for diagnosis if the clinical presentation and laboratory data are characteristic. However, the signs and symptoms of infection of the upper urinary tract in children may present a diagnostic challenge. During the neonatal period, infections of the urinary tract are more common among boys and nonspecific symptoms predominate. These include poor feeding, slow gain in weight, vomiting, diarrhea, irritability, and jaundice. Fever or hypothermia also is often present. Bacteremia occurs in approximately 35% of newborns with infection of the urinary tract.1In infants aged 1 month to 2 years, nonspecific manifestations still predominate, but sepsis and severe illness are less frequent than in the neonate. Among ambulatory children younger than

Anatomical basis of the surgical approach to the kidney in children.

The authors studied the different surgical approaches to the upper urinary tract in children. These approaches are the posterolateral lumbar, posterior and anterolateral lumbar routes. Special emphasis should be given to the anterolateral extraperitoneal approach. This approach in children gives excellent exposure of the kidney and causes minimum disruption of the normal anatomy, thereby yielding very satisfactory functional and cosmetic results.

Hyaluronicase in intramuscular excretory urography.

Intramuscular excretory urography (1, 7) is one of the simpler and easier methods of studying the upper urinary tract in children. With the discovery of hyaluronidase (6, 8), the “spreading factor,” extravascular administration of solutions has been facilitated (5). Several articles have appeared concerning the use of hyaluronidase in subcutaneous excretory urography (2, 3, 10). Since the technic of intramuscular is less difficult than that of subcutaneous urography (9, 11), the effect of hyaluronidase on the rate of absorption of Diodrast and Neo-Iopax administered intramuscularly was tested clinically. Technic Into one buttock we injected either Diodrast 35 per cent or Neo-Iopax 50 per cent2 in amounts varying from 6 to 10 c.c, plus 1 c.c. of 2 per cent procaine solution. Into the other buttock we injected the same mixture, to which had been added hyaluronidase in quantities from 150 to 750 TRU (turbidity reducing units). Thus each patient acted as his own control. Nine patients were tested in this mann...