RESUMO
INTRODUCTION: Since 2011 we have been following prospectively myelomeningocele patients treated in utero with particular interest to patients with sphincter weakness/deficiency. We investigated the changes of bladder pattern and upper urinary tract with time in children who underwent in utero repair and had low-pressure incontinence based on urodynamic evaluation (UE). MATERIALS AND METHODS: From the 120 patients in our database, 117 had at least one UE. Of these, 30 were classified as incontinent when leaking at low pressure (<40 cmH20). We reviewed clinical evaluation, urinary tract ultrasound, voiding cystourethrography (VCUG), and other UE parameters at first and last evaluation. RESULTS: We found 30 cases (25.64%). Mean age at initial evaluation was 4.97 months followed by UE done initially at mean age of 5.73 months. Follow-up was 28.4 months. Febrile urinary tract infection has been found in four patients (13.3%), hydronephrosis in four patients, and bladder neck thickening in three (10%). The VCUG showed vesicoureteral reflux in three cases (3/27, 11.1%). A total of 90% of patients had detrusor overactivity with mean maximum detrusor pressure (33.37 cmH20). Only 16.67% of patients showed normal bladder capacity. From the 30 patients, 23 had at least two UE. We noticed a change of bladder pattern as follows: six patients became of high-risk pattern, five normal, and two with underactive bladder pattern. The average interval between the first and last UE was 25.5 months (median: 15 months). CONCLUSION: We concluded that 43.47% of patients with low DLPP have kept the incontinent pattern. If the initial LPP was below 30 cmH20, 70% remained with the incontinet pattern.
Assuntos
Meningomielocele/cirurgia , Micção/fisiologia , Urodinâmica/fisiologia , Pré-Escolar , Feminino , Humanos , Hidronefrose/diagnóstico , Hidronefrose/fisiopatologia , Lactente , Masculino , Meningomielocele/fisiopatologia , Bexiga Inativa/diagnóstico , Bexiga Inativa/fisiopatologia , Incontinência Urinária/diagnóstico , Infecções Urinárias/diagnóstico , Infecções Urinárias/fisiopatologia , Refluxo Vesicoureteral/diagnóstico , Refluxo Vesicoureteral/fisiopatologiaRESUMO
OBJECTIVE: To reliably and quickly diagnose children with posterior urethral valves (PUV), we developed a multi-instance deep learning method to automate image analysis. METHODS: We built a robust pattern classifier to distinguish 86 children with PUV from 71 children with mild unilateral hydronephrosis based on ultrasound images (3504 in sagittal view and 2558 in transverse view) obtained during routine clinical care. RESULTS: The multi-instance deep learning classifier performed better than classifiers built on either single sagittal images or single transverse images. Particularly, the deep learning classifiers built on single images in the sagittal view and single images in the transverse view obtained area under the receiver operating characteristic curve (AUC) values of 0.796 ± 0.064 and 0.815 ± 0.071, respectively. AUC values of the multi-instance deep learning classifiers built on images in the sagittal and transverse views with mean pooling operation were 0.949 ± 0.035 and 0.954 ± 0.033, respectively. The multi-instance deep learning classifiers built on images in both the sagittal and transverse views with a mean pooling operation obtained an AUC of 0.961 ± 0.026 with a classification rate of 0.925 ± 0.060, specificity of 0.986 ± 0.032, and sensitivity of 0.873 ± 0.120, respectively. Discriminative regions of the kidney located using classification activation mapping demonstrated that the deep learning techniques could identify meaningful anatomical features from ultrasound images. CONCLUSION: The multi-instance deep learning method provides an automatic and accurate means to extract informative features from ultrasound images and discriminate infants with PUV from male children with unilateral hydronephrosis.
Assuntos
Aprendizado Profundo , Hidronefrose/diagnóstico , Interpretação de Imagem Assistida por Computador/métodos , Anormalidades Urogenitais/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Estudos de Casos e Controles , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Humanos , Lactente , Recém-Nascido , Rim/anormalidades , Rim/diagnóstico por imagem , Masculino , Curva ROC , Reprodutibilidade dos Testes , Ultrassonografia/métodos , Uretra/anormalidades , Uretra/diagnóstico por imagemRESUMO
OBJECTIVE: The objective of this video is to illustrate feasibility of the ureteral ligation for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys. MATERIALS AND METHODS: In this video, one case is presented to demonstrate this novel technique. A nine-year-old boy presented with progressive lower urinary tract symptoms. Radiological workup depicted a duplex kidney on the left side with the absence of function on the upper pole and hydroureteronephrosis with a massive ureterocele. Laparoscopic ureteral transection, drainage, and ligation of both extremities of the enlarged ureter (upper pole ureter) were performed. RESULTS: Immediately after ureteral ligation, ultrasonic evidence of ureterocele decompression and improved hydroureteronephrosis was observed. This patient remained asymptomatic without postoperative complications after 3 years. De novo reflux was not observed. CONCLUSION: Ureteral ligation, as demonstrated in the video, is a good approach for the treatment of massive ureteroceles associated with non-functioning upper kidney moieties in duplex kidneys. Compared with the current standard techniques (incision/puncture), ureteral ligation has the clear advantage of not causing 'de novo reflux' or unsuccessful de-obstruction, and is not as surgically demanding as other reconstructive/ablative techniques. The disadvantage is the need of regular clinical and ultrasonographic follow-up.
Assuntos
Hidronefrose/cirurgia , Rim/anormalidades , Laparoscopia/métodos , Procedimentos de Cirurgia Plástica/métodos , Ureter/cirurgia , Ureterocele/cirurgia , Criança , Humanos , Hidronefrose/diagnóstico , Hidronefrose/etiologia , Rim/cirurgia , Ligadura/métodos , Masculino , Ureterocele/complicaçõesAssuntos
Cardiopatias Congênitas/complicações , Hidrocolpos/complicações , Hidronefrose/etiologia , Hímen/anormalidades , Polidactilia/complicações , Doenças Uterinas/complicações , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/cirurgia , Anormalidades Congênitas , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Hidrocolpos/diagnóstico , Hidrocolpos/cirurgia , Hidronefrose/diagnóstico , Hímen/diagnóstico por imagem , Hímen/cirurgia , Recém-Nascido , Imageamento por Ressonância Magnética , Polidactilia/diagnóstico , Polidactilia/cirurgia , Doenças Uterinas/diagnóstico , Doenças Uterinas/cirurgiaRESUMO
La policitemia primaria es producida por una mutación adquirida o heredada en las células progenitoras de los glóbulos rojos, mientras que la poliglobulia secundaria está relacionada con un aumento de la eritropoyetina sérica como respuesta a la hipoxia tisular o a la producción autónoma tumoral. Hace más de medio siglo que se conoce que la hidronefrosis puede actuar como una rara causa de eritrocitosis debido al aumento de producción de eritropoyetina por un riñón que censa una disminución de oxígeno, mecanismo también observado en la estenosis de la arteria renal y en los quistes renales. Se describe a continuación el caso de un paciente de 38 años con poliglobulia atendido en el Hospital Italiano de San Justo (Argentina), que presenta como hallazgo una hidronefrosis unilateral severa y cuya resolución quirúrgica a través de una nefrectomía revierte el cuadro hematológico de base. (AU)
Primary polycythemia is produced by an acquired or inherited mutation in progenitor cells of red blood cells, while secondary polyglobulia is related to an increase in serum erythropoietin in response to tissue hypoxia or autonomous tumor production. Since the middle of the twentieth century, the hydronephrosis is known to be a rare etiology of secondary polycythemia, with increased erythropoietin production caused by diminished oxygen sensing by the kidney, also seen in renal artery stenosis and kidney cysts. We describe a case of a 38 year old patient with polycythemia studied in the "Hospital Italiano de San Justo" (Argentina) that presented an incidental severe unilateral hydronephrosis, and nephrectomy was carried out as a final resolution of the hematological disorder. (AU)
Assuntos
Humanos , Animais , Masculino , Adulto , Pessoa de Meia-Idade , Policitemia/diagnóstico , Pielonefrite/diagnóstico , Infecções Urinárias/complicações , Eritropoetina/sangue , Hidronefrose/diagnóstico , Nefrectomia/tendências , Policitemia/complicações , Policitemia/etiologia , Pielonefrite/sangue , Obstrução da Artéria Renal/patologia , Dor Lombar , Hipóxia-Isquemia Encefálica/patologia , Eritrócitos/fisiologia , Doenças Renais Císticas/patologia , Disuria , Febre , Hidronefrose/cirurgia , Hidronefrose/complicações , Anemia , Nefrectomia/métodosRESUMO
A 28-year-old pregnant woman at 19 weeks gestation presented with dysuria as well as lower abdominal and left flank pain. Imaging revealed left-sided hydronephrosis and a mass invading the posterior bladder wall. Management included placement of a left nephrostomy tube and transurethral resection of ~25% of the mass. Microscopy showed an ectopic decidual reaction within the muscularis propria. The patient improved symptomatically and continued prenatal care. Complete resolution of her ureteral obstruction was demonstrated during the postpartum period. Ectopic decidual reactions involving the urinary bladder are extremely rare, and ureteral obstruction secondary to this phenomenon has not yet been reported.
Assuntos
Coristoma/diagnóstico , Decídua , Hidronefrose/diagnóstico , Hidronefrose/etiologia , Complicações na Gravidez/diagnóstico , Doenças da Bexiga Urinária/diagnóstico , Adulto , Coristoma/etiologia , Coristoma/terapia , Feminino , Humanos , Hidronefrose/terapia , Imageamento por Ressonância Magnética , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/terapia , Doenças da Bexiga Urinária/etiologia , Doenças da Bexiga Urinária/terapiaRESUMO
To our knowledge, there are nine previous reports of patients with congenital scrotal agenesis (CSA), seven of which were bilateral, and unilateral in two, also named as hemiscrotal agenesis (HSA). Here, we report a male infant with the previously undescribed co-occurrence of HSA with cutis marmorata telangiectatica congenita (CMTC), and hydronephrosis due to vesicoureteral reflux, all of them on the left side. CMTC is a segmental vascular malformation usually attributed to mosaicism of a postzygotic mutation, whereas the mechanisms in the CSA involve a failure on the labioscrotal fold (LSF) development due to a localized 5α-reductase deficiency and/or androgen insensitivity. Since the skin with HSA was affected also by CMTC and by the fact that it exhibited lack of response to the topical testosterone treatment, all this suggests to us an androgen insensitivity mosaicism in our patient restricted to the left LSF, because skin with intact androgen receptors normally shows some type of response. Since CSA and/or HSA have been also seen in patients with PHACES, popitleal pterygium syndrome, or as part of a recently proposed familial entity with CSA (or agenesis of labia majora as its female counterpart), developmental delay, visual impairment, and moderate hearing loss, further reports could confirm this manifest genetic heterogeneity, highly evocative of somatic mosaicism in our patient.
Assuntos
Hidronefrose/diagnóstico , Escroto/anormalidades , Dermatopatias Vasculares/diagnóstico , Telangiectasia/congênito , Humanos , Recém-Nascido , Livedo Reticular , Masculino , Fenótipo , Síndrome , Telangiectasia/diagnósticoRESUMO
OBJECTIVE: To evaluate renal pelvis diameters in human fetuses, to establish normative patterns of their growth and size during the second gestational trimester. METHODS: We studied 140 kidneys (70 fetuses; 38 male, 32 female) ranging in age from 12-25 weeks' postconception. The renal pelvis was dissected and the transverse and longitudinal diameters were measured. The renal length, width, and thickness were assessed. To compare the quantitative data in both sexes, Student's t-test was used (P <.05). RESULTS: The mean transverse diameter in male fetuses was 3.61 mm in the right side and 3.58 mm in the left. In female fetuses, it was 3.51 mm in the right side and 3.43 mm in the left. There was no statistical significant difference between the sides either in males (P <.81) or in females (P <.33). There was no significant difference in the mean transverse diameter between male and female fetuses (P <.9). The mean longitudinal diameter in male fetuses was 4.28 mm in the right side and 4.31 mm in the left. In female fetuses, it was 4.17 mm in the right side and 4.33 mm in the left. There was no significant statistical difference between the sides in either males (P <.82) or females (P <.33). There was no significant difference in the mean longitudinal diameter between male and female fetuses (P <.9). CONCLUSIONS: Transverse and longitudinal diameters are useful as parameters for assessment of the renal pelvis in human fetuses.
Assuntos
Doenças Fetais/diagnóstico , Feto/anatomia & histologia , Hidronefrose/diagnóstico , Pelve Renal/anatomia & histologia , Feminino , Idade Gestacional , Humanos , Pelve Renal/embriologia , Masculino , Tamanho do ÓrgãoRESUMO
Las anomalías del árbol vascular son comunes. Los aneurismas aislados de las arterias ilíacas son de observación bastante rara. Representan un porcentaje escaso de las distintas estadísticas y a menudo se resalta su aislamiento, precisamente para recordar su rareza. Reportamos un caso masculino, de 74 años de edad, que asistió a consulta por presentar síntomas urinarios. Se le realizó un ultrasonido de abdomen, observándose hidronefrosis renal bilateral moderada, además masas complejas una en cada fosa ilíaca. Se le indicó Tomografía Axial Computarizada de abdomen, donde se confirmó la hidronefrosis renal bilateral y aneurismas de ambas arterias ilíacas. Se completó el estudio con un Angiotac, y se demostró que ambas ilíacas estaban tortuosas y dilatadas (Dolicomegarterias).
Vascular tree anomalies are common. Iliac arteries isolated aneurisms are very unusual. They represent an scarce percent of the different statistics and their isolation is frequently highlighted, precisely to recollect their rareness.We report the case of a male, 74-years-old patient, assisting the consultation with urinary symptoms. An abdominal ultrasound was made, showing moderated bilateral renal hydronephrosis and also complex masses in each iliac fosse. An abdomen computed axial tomography was indicated, confirming the bilateral renal hydronephrosis and aneurisms in both iliac arteries. The study was completed with an Angiotac and it was demonstrated that both iliac arteries were tortuous and dilated ( Mega-dolicho arteries ).
Assuntos
Humanos , Feminino , Idoso , Aneurisma Ilíaco/diagnóstico , Aneurisma Ilíaco/etiologia , Aneurisma Ilíaco , Aorta Abdominal/anormalidades , Aorta Abdominal , Hidronefrose/diagnósticoRESUMO
A síndrome megabexiga microcólon hipoperistaltismo intestinal (SMMHI) é uma doença rara, de provável herança genética, com prognóstico reservado, já no primeiro ano de vida. Relata-se um caso de SMMHI em criança do sexo feminino, atualmente com 16 anos de idade, com o objetivo de ressaltar o prognóstico favorável, não esperado, com sobrevida até a adolescência, de uma síndrome rara. Chama-se a atenção para a possibilidade de estabelecer o diagnóstico no período perinatal e para a importância de realizar o estudo urodinâmico.
Assuntos
Humanos , Feminino , Adolescente , Cistostomia , Doenças da Bexiga Urinária/complicações , Doenças da Bexiga Urinária/patologia , Hidronefrose/complicações , Hidronefrose/diagnóstico , Sistema Urinário/patologiaRESUMO
OBJECTIVE: To assess the role of transforming growth factor-beta1 (TGF-beta1) in congenital ureteropelvic junction obstruction at diagnosis and during postoperative follow-up. MATERIALS AND METHODS: We conducted a case-control study including 19 patients with a mean age of 6.7 years and 19 matched controls. All patients presented negative voiding cystourethrography, obstructive diuretic renogram and underwent dismembered pyeloplasty. Urinary TGF-beta1 and other markers were measured pre-, intra- and postoperatively. RESULTS: The mean bladder urine TGF-beta1 concentration in obstructed patients prior to pyeloplasty was higher than in controls (92.5 pg/mL +/- 16.8 vs. 35.8 pg/mL +/- 16.2; p = 0.0001). The mean renal pelvic urine TGF-beta1 concentration in the hydronephrotic kidney was higher than in the preoperative bladder urine sample (122.3 pg/mL +/- 43.9 vs. 92.5 pg/mL +/- 16.8; p = 0.036). Postoperative mean TGF-beta1 concentration was significantly lower than preoperative TGF-beta1 (48.7 pg/mL +/- 13.1 vs. 92.5 pg/mL +/- 16.8; p = 0.0001). CONCLUSION: TGF-beta1 is a cytokine leading to renal fibrosis. The measurement of urinary TGF-beta1 could become a useful tool for the diagnosis of obstructive hydronephrosis and the evaluation of the parenchyma function status, pre and postoperatively.
Assuntos
Hidronefrose/diagnóstico , Fator de Crescimento Transformador beta1/urina , Obstrução Ureteral/diagnóstico , Biomarcadores/urina , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Humanos , Hidronefrose/urina , Pelve Renal , Masculino , Período Perioperatório , Sensibilidade e Especificidade , Resultado do Tratamento , Obstrução Ureteral/congênito , Obstrução Ureteral/cirurgia , Obstrução Ureteral/urina , Bexiga Urinária/metabolismo , Refluxo Vesicoureteral/diagnósticoRESUMO
OBJECTIVE: To assess the role of transforming growth factor-β1 (TGF-β1) in congenital ureteropelvic junction obstruction at diagnosis and during postoperative follow-up. MATERIAL AND METHODS: We conducted a case-control study including 19 patients with a mean age of 6.7 years and 19 matched controls. All patients presented negative voiding cystourethrography, obstructive diuretic renogram and underwent dismembered pyeloplasty. Urinary TGF-β1 and other markers were measured pre-, intra- and postoperatively. RESULTS: The mean bladder urine TGF-β1 concentration in obstructed patients prior to pyeloplasty was higher than in controls (92.5 pg/mL ± 16.8 vs. 35.8 pg/mL ± 16.2; p = 0.0001). The mean renal pelvic urine TGF-β1 concentration in the hydronephrotic kidney was higher than in the preoperative bladder urine sample (122.3 pg/mL ± 43.9 vs. 92.5 pg/mL ± 16.8; p = 0.036). Postoperative mean TGF-β1 concentration was significantly lower than preoperative TGF-β1 (48.7 pg/mL ± 13.1 vs. 92.5 pg/mL ± 16.8; p = 0.0001). CONCLUSION: TGF-β1 is a cytokine leading to renal fibrosis. The measurement of urinary TGF-β1 could become a useful tool for the diagnosis of obstructive hydronephrosis and the evaluation of the parenchyma function status, pre and postoperatively.
Assuntos
Criança , Feminino , Humanos , Masculino , Hidronefrose/diagnóstico , Fator de Crescimento Transformador beta1/urina , Obstrução Ureteral/diagnóstico , Biomarcadores/urina , Estudos de Casos e Controles , Seguimentos , Hidronefrose/urina , Pelve Renal , Período Perioperatório , Sensibilidade e Especificidade , Resultado do Tratamento , Obstrução Ureteral/congênito , Obstrução Ureteral/cirurgia , Obstrução Ureteral/urina , Bexiga Urinária/metabolismo , Refluxo Vesicoureteral/diagnósticoRESUMO
Se presenta un caso clínico y los hallazgos imagenológicos de una pioureterohidronefrosis en una paciente de 4 años de edad, sin antecedentes patológicos, con historia de 5 días de evolución con dolor abdominal, fiebre de 38,2ºC, dolor en hipocondrio y flanco izquierdo con ocupación del fondo de saco lateral izquierdo al tacto rectal.
A case of a 4 year old girl with no pathologic background, with pyoureterohydronephrosis is presented. The history was 5 days of abdominal pain and fever (38,2 Cº), and an occupation of the left recess in the rectal digital examination.Imagenologic studies demonstrate pyoureterohydronephrosis.
Assuntos
Humanos , Feminino , Pré-Escolar , Doenças Uretrais/complicações , Hidronefrose/diagnóstico , Hidronefrose , Doenças Uretrais/cirurgia , Nefrostomia PercutâneaRESUMO
Ultrasound and nuclear medicine appear to be the modalities of choice when dealing with the imaging study of the urinary system in infants. In children, a CT sean does not have the impact it has had on adults, since pediatric patients present with different pathologies and also because of the peculiar physiological conditions of childhood. The Uro-resonance has emerged as a powerful and useful diagnostic tool, bringing together in a single study anatomical images and functional information as well without the use of ionizing radiation. We review the technical aspeets, anatomical and physiological concepts of the study, while providing examples of current applications in the infant.
El estudio por imágenes del sistema urinario del niño ha estado a cargo del ultrasonido y la medicina nuclear. En el niño, la tomografía computada no tiene el impacto que ha tenido en adultos, por tratarse de patologías diferentes y por las condiciones fisiológicas propias de la edad pediátrica. La Uro-resonancia se proyecta como una herramienta útil, reuniendo en un solo estudio imágenes anatómicas e información funcional, en ausencia de radiación ionizante. Se revisan aspectos de la técnica, conceptos anatómicos y fisiológicos del estudio, adicionando ejemplos de aplicaciones en el niño.
Assuntos
Humanos , Criança , Doenças Urológicas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Rim/fisiopatologia , Urografia/métodos , Diuréticos , Doenças Urológicas/fisiopatologia , Fatores de Tempo , Furosemida , Gadolínio , Hidronefrose/diagnóstico , Meios de Contraste , Radioisótopos , Sistema Urinário/fisiopatologia , Taxa de Filtração GlomerularRESUMO
Con la introducción del ultrasonido materno-fetal en el seguimiento sistemático del embarazo normal se detectan anomalías congénitas en el 1 por ciento de los fetos, el 20 por ciento de las cuales corresponden al tracto urinario. Se realizó el estudio de recién nacidos y lactantes con hidronefrosis prenatal, cuyos ultrasonidos materno-fetales demostraron la presencia de un doble sistema excretor. Para este propósito todos los recién nacidos y lactantes con hidronefrosis detectada prenatalmente, y doble sistema excretor diagnosticado antes o después del nacimiento, fueron seguidos mediante ultrasonografía renal evolutiva, uretrocistografía miccional, gammagrafía estática o dinámica y, en algunos casos, mediante urograma excretor. Hallamos doble sistema excretor en 7 de los 182 pacientes (3,8 por ciento) con anormalidades del tracto urinario diagnosticadas antes del nacimiento. El diagnóstico fue prenatal solo en uno de los fetos (31 semanas de embarazo). La dilatación hidronefrótica fue ligera en dos fetos y grave en cinco. La hidronefrosis obedeció a diferentes causas. Se realizó nefrectomía polar superior en los casos de ectopia ureteral y de uréter superior obstruido, reimplantación en un ureterocele, y en otro se comprobó la ruptura espontánea mediante endoscopia. Los restantes pacientes se trataron sintomáticamente. La hidronefrosis detectada antes del nacimiento mediante ultrasonografía materno-fetal puede estar asociada a un doble sistema excretor. La dilatación hidronefrótica asociada a un doble sistema puede deberse a diferentes causas, y es necesario estudiar cuidadosa y sistemáticamente a estos niños y tratarlos adecuadamente, porque cada uno puede necesitar una conducta diferente.
With the introduction of the maternofetal ultrasound in the systematic follow-up of normal pregnancy, congenital anomalies are detected in 1 percent of the fetuses, 20 percent of which correspond to the urinary tract. The newborns and infants with prenatal hydronephrosis were studied. The maternofetal ultrasound showed a double excretory system. To this end, all the newborns and infants with prenatally detected hydronephrosis and double excretory system diagnosed before or after birth were followed up by evolutive renal ultrasonography, micturition urethrocystography, static or dynamic scintigraphy and, in some cases, by excretory urogram. Double excretory system was found in 7 of the 182 patients (3.8 percent) with abnormalities of the urinary tract diagnosed before birth. Diagnosis was prenatal in just one of the fetuses (31 weeks of pregnancy). Hydronephrotic dilatation was mild in two fetuses and severe in five. Hydronephrosis had different causes. Upper polar nephrectomy was performed in those cases of ureteral ectopy and obstructed upper ureter, reimplantation in one ureterocele, whereas in another it was confirmed the spontaneous rupture by endoscopy. The rest of the patients were symptomatically treated. The hydronephrosis detected before birth by maternofetal ultrasonography may be associated with a double excretory system. Hydronephrotic dilatation associated with a double excretory system may have different causes, and it is necessary to study carefully and systematically these children and to treat them adequately, since each of them may need a different conduct.
Assuntos
Humanos , Gravidez , Recém-Nascido , Lactente , Hidronefrose/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Ultrassonografia Pré-Natal/métodos , Ureterocele/diagnósticoRESUMO
O objetivo do estudo foi avaliar a aplicabilidade do estudo dos jatos ureterais como método diagnóstico na identificação das hidronefroses obstrutivas e não obstrutivas na população pediátrica.Foram estudadas 48 crianças com Hidronefrose Unilateral.Freqüência Relativa dos Jatos (FRJ) foi definida como o número de jatos ureterais no lado afetado dividido pela soma dos jatos ureterais observados bilateralmente.Observou-se que FRJ < 0,25 é o melhor valor que distingue as hidronefroses e o faz corretamente em 91,2 por cento dos casos, com uma Sensibilidade de 86,4 por cento e Especificidade de of 96.15 por cento. FRJ < 25 por cento mostrou ser indicador de obstrução nas hidronefroses unilaterais da infância e pode ser utilizado na diferenciação das hidronefroses obstrutivas e não obstrutivas na população pediátrica.
The aim of this study was to evaluate the Ureteral Jets(UJ) in the bladder as a diagnostic tool to distinguish obstructive from non-obstructive dilatations of the upper tract in pediatric population.We evaluated 48 patients who presented with unilateral hydronephrosis suspicious of pyeloureteral junction obstruction. Relative Jet Frequency (RJF) was defined as the UJ frequency of hydronephrotic side divided by total UJ frequency. RJF< 0.25 was the best threshold and it correctly discriminates obstruction in 91.2 per cent of the childrens with a sensitivity of 86.4 per cent and specificity of 96.15. In this study RJF < 25 per cent was found to be a good indicator of obstruction in children with unilateral hydronephrosis. CDUS evaluation of UJ can be used to differentiate obstructed from non-obstructed hydronephrosis in the pediatric population.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Técnicas de Diagnóstico Urológico , Hidronefrose/diagnóstico , Obstrução Ureteral , Sensibilidade e Especificidade , Ultrassonografia Doppler em CoresRESUMO
Relata-se o caso de um paciente com ureter retrocava, diagnosticado inicialmente em exame de urografia excretora e confirmado com tomografia computadorizada do abdome. A tomografia computadorizada torna-se necessária não apenas para confirmar a posição do ureter em relação à veiacava inferior, como também para excluir outras doenças que cursam com hidronefrose, pois hidronefrose é o principal achado do ureter retrocava sintomático.
The authors report a case of a patient with retrocaval ureter found out in an excretory urography and confirmed with abdominal computerized tomography. The computerized tomography is necessary to confirm the position of the ureter and to exclude other diseaseswhich are associated with hydronefrosis, the main imaging finding,when there is a symptomatic retrocaval ureter.
Assuntos
Humanos , Masculino , Adulto , Doenças Ureterais/diagnóstico , Tomografia Computadorizada por Raios X , Urografia , Veia Cava Inferior/patologia , Diagnóstico Diferencial , Espaço Retroperitoneal/patologia , Fibrose Retroperitoneal/diagnóstico , Hidronefrose/diagnóstico , Obstrução Ureteral/diagnósticoRESUMO
Eggshell calcification of kidney in case of ureteropelvic junction obstruction (UPJO) is an uncommon finding with only a few cases reported in literature. We report a thirty-year-old symptomatic man with curvilinear calcification in hydronephrotic right kidney. Thorough investigations to rule out genitourinary tuberculosis and hydatid disease of kidney were performed prior to the definitive management by laparoscopic approach.
Assuntos
Humanos , Masculino , Adulto , Calcinose/etiologia , Nefropatias/complicações , Obstrução Ureteral/complicações , Calcinose/diagnóstico , Calcinose/cirurgia , Hidronefrose/complicações , Hidronefrose/diagnóstico , Hidronefrose/cirurgia , Nefropatias/diagnóstico , Nefropatias/cirurgia , Laparoscopia , Nefrectomia , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/cirurgiaRESUMO
OBJECTIVE: To characterize and determine whether patients with recurrent abdominal symptoms and associated ureteropelvic junction obstruction (UPJO) (Dietl's crisis) are effectively treated by pyeloplasty and to determine criteria for evaluating UPJO in childhood abdominal pain. MATERIALS AND METHODS: A retrospective chart review from 1998 to 2001 was performed to identify patients with Dietl's crisis and associated UPJO. Chart review included presenting symptoms, location of lesion, condition of the affected renal unit, referral method, and surgery success. RESULTS: Eight patients (7 male and 1 female) were identified with Dietl's crisis. All eight were initially misdiagnosed and spent at least a year with significant pain symptoms before being properly diagnosed. Only one patient had associated urologic complaints. Renal scan split functions of the affected renal unit ranged from 34% to 51%. One nephrectomy and seven pyeloplasties were performed and resolution of all patients' abdominal symptoms, including pain, resolved. CONCLUSIONS: Children with Dietl's crisis often suffer a delay in diagnosis; the clinical entity appears to be under-diagnosed. Renal parenchyma is typically preserved, and there is a paucity of associated urologic complaints. Once properly diagnosed, patients are well served by a pyeloplasty. Children with periumbilical pain and vomiting, particularly males, would benefit from ultrasound imaging.