RESUMO
Introducción. El objetivo fue evaluar las características clínicas y la evolución del reflujo vesicoureteral (RVU) según el sexo y grado de RVU.Población y métodos. Se incluyeron pacientes con RVU vistos durante el seguimiento de rutina entre enero de 2014 y enero de 2015. Se registraron las características demográficas, la evolución, los laboratorios y las imágenes.Resultados. Se seleccionó a 220 pacientes, cuya media de edad del diagnóstico era 3,17 ± 3,08 años; en ese momento, los varones eran menores que las niñas (2,00 ± 2,59 vs. 3,81 ± 3,15, p < 0,001). La infección urinaria fue la presentación más frecuente, seguida de hidronefrosis prenatal (HNP). El 22 % de los pacientes tuvo reflujo de grado 1-2; el 51 %, de grado 3; y el 27 %, de grado 4-5. En el reflujo de grado 4-5, las ecografías y gammagrafías con ácido dimercaptosuccínico (DMSA) marcado con 99mTc presentaron más anomalías, y se realizaron más cirugías (p < 0,001). En los varones, fueron más comunes el reflujo de grado 4-5 (43,6 % vs. 18,3 %) y las anomalías ecográficas (77 % vs. 54 %) y en la DMSA (77 % vs. 59 %) (p < 0,05). En las niñas, hubo mayores tasas de infección urinaria, disfunción de las vías urinarias inferiores y resolución espontánea (p < 0,05).Conclusiones. A pesar de la menor edad al momento del diagnóstico, la resolución espontánea fue menor en los varones, y estos presentaron HNP, reflujo grave y anomalías radiológicas más frecuentemente.
Introduction. The aim of the study was to assess the clinical features and outcome parameters of children with vesicoureteral reflux (VUR) based on gender and VUR grade.Population and methods. Patients with VUR who were seen during routine follow-up visits at Ankara University Children's Hospital between January 2014-January 2015 were included in this retrospective study. Patient demographics, clinical course, laboratory investigations, imaging were noted.Results. Two hundred and twenty patients were recruited. Mean age at the time of diagnosis was 3,17 ± 3,08 years. Boys were diagnosed at younger ages as compared to girls (2.00 ± 2,59 vs. 3,81 ± 3.15, p < 0.001). Urinary tract infection (UTI) was the most common presentation. The second presentation form was antenatal hydronephrosis (AHN) which was more common in males (25.6 %, p < 0.001). Twenty-two percent of the patients had grade 1-2, 51 % grade 3 and 27 % grade 4-5 reflux. Patients with grade 4-5 reflux had more abnormal ultrasound (US) and Tech 99m dimercaptosuccinic acid scintigraphy (DMSA) findings and surgery was performed more frequently in this group (p < 0.001). In males, grade 4-5 reflux (43.6 % vs. 18.3 %), abnormal US (77 % vs. 54 %) and DMSA (77 % vs. 59 %) findings were more frequent (p < 0.05). In girls higher rates of UTIs, lower urinary tract dysfunction (LUTD) and spontaneous reflux resolution were seen (p < 0.05).Conclusions: Despite younger age at diagnosis, spontaneous resolution was found lower in boys and they had more frequent AHN, more severe reflux, and radiological abnormalities.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Infecções Urinárias/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Sinais e Sintomas , Turquia/epidemiologia , Sistema Urinário/anormalidades , Infecções Urinárias/cirurgia , Refluxo Vesicoureteral/cirurgia , Estudos Retrospectivos , Dados Estatísticos , HidronefroseRESUMO
OBJECTIVES: The aim of this study was to evaluate and compare the long-term clinical outcomes and quality of life of cats having undergone perineal urethrostomy (PU) or prepubic urethrostomy (PPU). METHODS: This clinical study followed 28 cats (PU, n = 22; PPU, n = 6) that underwent a urethrostomy, with a minimum of 1 year postoperative follow-up. Medical records, pet owner surveys and urologic laboratory tests were used for assessment. Urologic laboratory tests included serum symmetric dimethylarginine (SDMA), serum creatinine, urinalysis, urine specific gravity (USG), urine protein:creatinine (UPC) ratio and urine culture. RESULTS: The main indications for urethrostomy were multiple catheterizations and PU stricture. The overall complication rates of PU and PPU were 31.8% and 83.3%, respectively. Recurrent urinary tract infection (UTI) and urine scald dermatitis were less frequent in PU than in PPU cats (UTI 22.7% vs 66.6%; dermatitis 4.5% vs 83.3%). Bacteriuria was present in 77.2% and 100% of PU and PPU cats, respectively. Owner satisfaction rates were excellent in 81.8% of PU and 33.3% of PPU cases. CONCLUSIONS AND RELEVANCE: A proportion of cats that underwent urethrostomy showed bacteriuria, recurrent UTIs and increased levels of SDMA. PPU is important as a salvage procedure; however, it should be limited to cases in which standard techniques for PU cannot be performed, owing to the potential for recurrent complications and lower owner satisfaction.
Assuntos
Doenças do Gato/cirurgia , Complicações Pós-Operatórias/veterinária , Infecções Urinárias/veterinária , Procedimentos Cirúrgicos Urológicos/veterinária , Animais , Brasil , Gatos , Feminino , Masculino , Qualidade de Vida , Uretra/cirurgia , Infecções Urinárias/cirurgia , Procedimentos Cirúrgicos Urológicos/classificaçãoRESUMO
AIMS: Involuntary Detrusor Contraction (IDC) may alter therapeutic plans; therefore, urodynamic demonstration (UD) is pivotal. We explore if same session repetitions enhance its demonstration and minimize false-negative results. METHODS: Two hundred fifty two women (mean age 47 ± 5.7) had 4 full repetitions of UD with the last round filled with 4°C fluid (Ice-water test). IDC was diagnosed if with at least 3 cm H2O after artifacts were ruled out. RESULTS: 44.4% of the cases showed IDC in the first round of the exam but it could be demonstrated in 88.5% of the women if 4 rounds are taken into account. Only 2 cases showed IDC exclusively in the first round. Nine cases (3.5%) showed IDC in the first round and only on Ice-test, while all other IDC-detected cases revealed it in scattered patterns along the repetitions. Likewise, IDC detection on the second, third and fourth rounds varied widely and unpredictably, many failing to show a consistent pattern of presentation after its detection. IDC wave amplitude did not show any correlation to the detection. CONCLUSIONS: Urodynamic repetition is a necessary procedure where IDC is important to demonstrate, as its false-negative rate is high and its unpredictable pattern of detection may be improved by repetition.
Assuntos
Contração Muscular/fisiologia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária/patologia , Incontinência Urinária por Estresse/diagnóstico , Transtornos Urinários/diagnóstico , Transtornos Urinários/fisiopatologia , Adulto , Idoso , Artefatos , Reações Falso-Negativas , Feminino , Humanos , Pessoa de Meia-Idade , Hipertonia Muscular/fisiopatologia , Músculo Liso/patologia , Prolapso de Órgão Pélvico/cirurgia , Estudos Prospectivos , Recidiva , Reprodutibilidade dos Testes , Temperatura , Infecções Urinárias/cirurgia , UrodinâmicaRESUMO
INTRODUCTION AND OBJECTIVE: Ureteral duplication is the most common urologic abnormality. The upper pole ureter can sometimes be associated with a ureterocele. In rare cases the ureteral insertion is extravesical and can result in significant hydroureteronephrosis. Patients can present with urinary tract infection, abdominal mass or urinary obstruction. Traditional procedures include ureteral reimplantation, ureteroureterostomy or heminephroureterectomy. These reconstructive procedures are technically challenging in small infants, especially when the hydroureteronephrosis is severe. In some cases a distal cutaneous ureterostomy is performed for immediate drainage followed by definitive surgery when the child is older. We describe our initial experience with a novel cystoscopic technique which provides drainage of the upper pole ureter and avoids the need for an incision or stoma. MATERIALS AND METHODS: A 3 month-old boy presented with urinary tract infections and failure to thrive. Ultrasound revealed severe upper pole hydroureteronephrosis. Voiding cystourethrography did not reveal vesicoureteral reflux or the presence of a ureterocele. The patient underwent cytoscopy. The ectopic ureteral orifice was not identified. A transurethral, transvesical needle puncture and confirmatory ureteropyelography was used to access the dilated upper pole ureter. Guidewire passage, followed catheter dilation then allowed creation of a new ureteral orifice using a holmium laser. RESULTS: The patient tolerated the procedure well. He was discharged after overnight observation. The hydronephrosis improved, urinary tract infections have not recurred and the patient rapidly improved feeding and weight gain. CONCLUSION: Trans-Urethral Neo-Orifice creation is a minimally invasive option for initial decompression for patients with obstructive ureteral ectopia.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Ureter/anormalidades , Ureter/cirurgia , Humanos , Lactente , Masculino , Resultado do Tratamento , Infecções Urinárias/cirurgiaRESUMO
Introduction: Natural orifice transluminal endoscopic surgery (NOTES) and Laparoendoscopic Single Site Surgery (LESS) are emerging technologies, which allows to performed surgical procedures avoiding any surgical scars. However there are some problems due to the lack of equipment available for these procedures. The aim of these study is to present our initial experience with the transvaginal nephrectomy NOTES and LESS using standard laparoscopic instruments. Material and Methods: Two female patients (23 and 26 years old) with diagnosis of recurrent urinary tract infection and renal atrophy. A laparoscopic simple nephrectomy with transvaginal NOTES assistance was performed, using one access port for the camera and two abdominal work ports of 10 and 3mm. In a third patient (15 years old) a transumbilical LESS nephrectomy was preformed with the use of standard laparoscopic instruments. Results: Average operative time was 110 min (40-200), with an estimated blood loss of 200 cc. There were no perioperative complications and all patients were discharged 36 hours after surgery. Conclusion: Laparoscopic simple nephrectomy with transvaginal NOTES assistance and LESS are technically feasible with the use of standard laparoscopic instruments. Special access trocars and instruments development for this procedure will allow to performed a pure technique without the use of abdominal incisions.
Introducción: La cirugía endoscópica transluminal a través de orificios naturales (NOTES) y la cirugía laparoendoscópica a través de sitio único (LESS) son tecnologías emergentes, que permiten realizar procedimientos quirúrgicos minimizando el uso de incisiones abdominales. Sin embargo, existen limitaciones respecto al equipamiento disponible para simular la cirugía tradicional. Nuestro objetivo es presentar nuestra experiencia con la técnica de nefrectomía laparoscópica NOTES y LESS con el uso de instrumentos laparoscópicos estándar. Materiales y Métodos: Dos pacientes de sexo femenino de 23 y 26 años, ambas con diagnóstico de infecciones urinarias recurrentes y atrofia renal secundaria. Se les realizó una nefrectomía simple con asistencia de NOTES, utilizando un puerto de trabajo transvaginal para la cámara y dos puertos adicionales de 10 (umbilical) y 3 mm en el abdomen. Un tercer paciente de sexo masculino de 15 a±os de edad, fue operado a través de la técnica LESS por vía transumbilical con el uso de cistoscopio flexible e instrumentos laparoscópicos estándar. Resultados: La media del tiempo operatorio fue de 110 min (40-200), la pérdida sanguínea promedio fue de 133 cc (0-200). No se reportan complicaciones, siendo todos los pacientes dados de alta antes de 36 horas. Conclusión: La nefrectomía laparoscópica con asistencia de NOTES y LESS es técnicamente posible con el uso de instrumentos laparoscópicos estándar. El desarrollo y acceso a trócares y pinzas especiales, permitirá realizar una técnica pura sin el uso de incisiones abdominales.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Infecções Urinárias/cirurgia , Laparoscopia/métodos , Nefrectomia/instrumentação , Nefrectomia/métodos , Endoscopia , Laparoscópios , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Recidiva , Fatores de Tempo , Resultado do Tratamento , Umbigo , VaginaRESUMO
La infección urinaria es una de las afecciones más importantes dentro de la urología pediátrica debido a su elevada frecuencia, dificultad diagnóstica, gran tendencia a recurrencias y posibilidad de generar insuficiencia renal. La relación varón/mujer aumenta con la edad y es mayor después de los 4 años 10:1. El 5-15 por ciento de los niños en edad escolar con una infección urinaria presentan anomalías renales que requieren intervención quirúrgica. Se revisaron 50 historias clínicas de niños hospitalizados con el diagnósticos de infección urinaria en el Hospital Tipo II, Padre Justo de Rubio, Estado Táchira, para el periodo 1998-2002. Se realizó un estudio retrospectivo incluyendo niños que presentaron clínica presuntiva de infección urinaria, con uroanálisis patológico y urocultivo positivo; para determinar a que porcentaje de niños se les cumplió el protocolo de estudio de infección urinaria encontrando: solo el 26 por ciento de los pacientes fueron estudiados, donde el sexo más afectado correspondio al femenino (53.84 por ciento), representado por el grupo etáreo de los preescolares., se les realizó Ultrasonografía renal y uretrocistografía miccional revelando anormalidades en el 15.4 por ciento y en el 54 por ciento respectivamente. El 15 por ciento ameritó urografía de eliminación y un 8 por ciento gammagrafía renal. Y solo el 46 por ciento ameritó tratamiento quirúrgico.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Protocolos Clínicos , Disuria/diagnóstico , Febre/diagnóstico , Infecções Urinárias/cirurgia , Infecções Urinárias/diagnóstico , Infecções Urinárias/patologia , Técnicas de Diagnóstico Urológico/instrumentação , Ultrassonografia , Nefropatias/etiologia , Doenças Urológicas/etiologia , Pediatria , Urografia/métodosRESUMO
Se reportaron los primeros pacientes operados en el Instituto Hondureño del Seguro Social, en la Unidad Materno Infantil con diagnóstico de Megaureter obstructivo primario. La técnica operatoria utilizada fue la Plicatura Ureteral propuesta en 1977 por el Dr. Zygmunto Kalinski, más reimplantación ureteral tipo cohen. La evolución postoperatoria de los cuatro pacientes ha sido excelente tanto clínica com radiológicamente
Assuntos
Estreitamento Uretral/cirurgia , Estreitamento Uretral/epidemiologia , Infecções Urinárias/cirurgia , Infecções Urinárias/etiologiaAssuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Infecções Urinárias/cirurgia , Infecções Urinárias/classificação , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle , Infecções Urinárias/terapia , Gravidez , Antibioticoprofilaxia , PediatriaRESUMO
Urinary tract infections may have different clinical presentations that may range from asymptomatic bacteriuria to purulent collections and severe sepsis. We report 6 diabetic patients, 3 presenting with a renal carbuncle and 3 with an emphysematous pyelonephritis. All required medical and surgical treatment and had a good evolution. Two carbuncles were caused by beta-hemolitic type B streptococcus. This is the second notification of this agent as causative of renal abscesses, probably reaching the kidney through hematogenous dissemination from cutaneous foci
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções Urinárias/diagnóstico , Pielonefrite/complicações , Infecções Urinárias/cirurgia , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia , Urina/microbiologia , Ultrassonografia , Diabetes Mellitus/complicações , Antraz/complicações , Nefrectomia , Enfisema Subcutâneo/complicações , Hepatite Alcoólica/complicaçõesRESUMO
A nine-year-old boy sustained a penetrating injury to the perineum. He later presented with urinary tract infections and a history of passing splinters in the urine. Investigation revealed a foreign body in the urinary bladder, and at suprapubic cystotomy splinters of wood and fragments of cloth were removed.
Assuntos
Migração de Corpo Estranho/complicações , Bexiga Urinária , Infecções Urinárias/etiologia , Criança , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Infecções Urinárias/cirurgiaRESUMO
Se presenta una revisión de una serie de 147 niños de la actividad privada que son atendidos en primera consulta urológica por infección urinaria, en los que se efectuó evaluación radiológica. Se analizan los hallazgos urológicos de significación terapéutica en los diferentes grupos. El estudio Rx aportó hallazgos determinantes en la terapéutica o pronóstico en uno de cada 5 niñitas y uno de cada 3 varones. Sólo 7,5% de los pacientes requirieron tratamiento quirúrgico. Se determinó el grupo de niños en que los hallazgos Rx y la indicación quirúrgica es de más alta incidencia
Assuntos
Lactente , Pré-Escolar , Humanos , Masculino , Feminino , Infecções Urinárias , Infecções Urinárias , Infecções Urinárias/cirurgia , Infecções Urinárias/terapiaRESUMO
The course of 54 patients (35 boys and 19 girls) with end-stage renal disease resulting from obstructive uropathy was reviewed. The mean age at the initial sign of obstructive uropathy was 3.5 years. Twenty-two patients (41%) manifested evidence of obstructive uropathy during the first year of life. The mean age at the time of onset of ESRD (dialysis) was 12.2 years and was similar in boys and girls. The mean time interval between the first sign of obstructive uropathy and the initiation of dialysis was nine years. Fourteen patients operated upon at less than one year of age developed ESRD one to 20 years (mean ten years) following their initial surgery. Progression to ESRD occurred despite appropriate surgical management, including corrective as well as diversionary urologic procedures. However, because the patients were selectively referred for care of ESRD, no assessment of the incidence of ESRD caused by obstructive uropathy was possible. The data indicate that prolonged follow-up periods are necessary to assess the ultimate outcome of renal function in young patients with obstructive uropathy. Despite early intervention and intact renal function for many years during childhood, progression to ESRD may occur.