Vesicoureteral reflux in asymptomatic siblings of patients with known reflux: radionuclide cystography.

The familial nature of vesicoureteral reflux among siblings of patients with vesicoureteral reflux has been reported to be from 8% to 32%. These included both symptomatic and asymptomatic siblings. The incidence of vesicoureteral reflux in asymptomatic siblings, however, has not been studied extensively. Sixty asymptomatic siblings of patients known to have vesicoureteral reflux were studied with radionuclide voiding cystography. Their ages ranged from 2 months to 15 years (mean, 4.2 years). Vesicoureteral reflux was detected in 27 of 60 (45%) of the siblings. Vesicoureteral reflux was unilateral in 15 and bilateral in 12 of the siblings. Radionuclide cystography is more sensitive than radiographic cystography and results in a very low radiation dose to the patient. The gonadal dose with radionuclide cystography is only 1.0 to 2.0 mrads. Because of these features, radionuclide cystography is a nearly ideal technique for the diagnosis of vesicoureteral reflux in siblings of patients with known vesicoureteral reflux. All siblings (symptomatic or asymptomatic) of patients with known vesicoureteral reflux should have a screening radionuclide cystography.

Nonutility of cineurograms in children with congenital heart disease.

Cineurography is often performed after cineangiocardiography to look for occult congenital urinary tract disease. The accuracy of cineurography was investigated in 171 patients by comparing cineurograms with renal sonograms. One hundred fifteen cineurograms (67%) showed both kidneys well enough to allow assessment of renal structure and function and the results were confirmed in 112 by ultrasonography; 3 cineurograms yielded false-positive results. Limited or no information was obtained from cineurograms of 56 patients (33%) because of nonvisualization or poor visualization of 1 or both kidneys. Of the 11 patients (6%) with urinary tract disease, only 3 were correctly assessed by cineurography. Ultrasonography discovered all 11 renal abnormalities and produced only 1 false-positive result. These data indicate that cineurography is a poor screening test and should be abandoned. When uroradiologic screening is necessary for high-risk patients, sonography is recommended.

The detection of vesicoureteral reflux in the child.

Reflux is often an important phenomenon in the urinary tract of a child, and many methods have been advocated to detect it. The single most sensitive, accurate, and efficient way currently available to detect and characterize reflux is direct VCUG under fluoroscopic control with the contrast material instilled through a urethral catheter. Nuclear cystography is the most efficient method for screening for reflux in appropriate situations, for making sure the reflux has disappeared after corrective surgery, and for following reflux that is likely to subside spontaneously.

Ether cystitis.

Two children are reported in whom chemical cystitis developed when ether was used to dissolve a Foley catheter balloon that would not deflate. The irritative effects of ether and preventive measures are discussed.

Lesions of Cowper's ducts and glands in infants and children.

Lesions of Cowper's duct and gland are more common than previously reported. They may be asymptomatic or may cause micturition difficulties or urinary retention. They may be congenital or acquired (usually inflammatory). Radiographic findings are either a rounded filling defect arising from the floor of the bulbous urethra or reflux into a dilated duct which parallels the bulbomembranous urethra. Panendoscopic fulguration is a simple and effective method of treatment for symptomatic patients with retention cysts. Asymptomatic patients do not need any therapy. A dilated duct should not be confused with partial urethral duplication, a urethral diverticulum, or an ectopic ureter since such an error may lead to an unnecessary operation.

Neonatal hydronephrosis caused by vesical diverticula.

Bladder diverticula are uncommon in infants and are an uncommon cause of hydronephrosis in newborns but can cause significant problems. A thorough diagnostic approach must include both excretion urography and cystourethrography. Early appropriate surgical intervention will result in preservation of renal function.

Pitfalls in pediatric urinary sonography.

Our review of pediatric urinary tract ultrasonograms over a period of two and one-half years resulted in a catalog of pitfalls. Cases included normal scans mistaken for abnormal and vice versa. These erroneous diagnoses stemmed from the inappropriate selection of the primary imaging test, improper timing of the ultrasonogram, errors of commission or omission in performance of the scans, and improper interpretation of the findings. For ease of reference, the pitfalls are grouped under bladder, ureters, and kidney with emphasis on the first two which are common sources of error.

Prolonged dense nephrograms in battered children. Suspect rhabdomyolysis and myoglobinuria.

Prolonged, dense nephrograms were seen on intravenous urography in 5 cases of child abuse presenting with possible renal injury. Each child had oliguria, elevated muscle enzymes, and pigmented urine positive for blood, but without red cells on microscopic examination. These findings are suggestive of myoglobinuria. The abnormalities resolved with appropriate fluid and electrolyte management. This complication of child abuse, not previously emphasized, may be suggested by the urographic findings. Possible factors contributing to the dense nephrograms are presented.

Ureteropelvic junction obstruction in children.

The spectrum of problems inherent in the diagnosis and treatment of ureteropelvic junction obstruction is outlined on the basis of the review of a series of 195 children.

Exstrophy of the bladder.

Exstrophy of the bladder is the most common of a spectrum of related anomalies. The pelvic skeletal changes in all of these disorders vary in degree but are similar in type. The kidneys are urinary collecting systems are usually normal in patients with untreated exstrophy, and the "hurley" appearance of the lower ureters should be regarded as a physiologically normal variant.

Neonatal hydronephrosis: 146 cases.

Recognition and precise etiologic diagnosis of neonatal hydronephrosis is worthwhile since, although often severe, it is usually treatable with at least partial success. This relatively favorable prognosis, despite dilatation that may be marked, suggests a greater regenerative capacity at this age, or may be due to the relative infrequency or short duration of the infection.

Renal parenchymal infections in children.

The excretion urogram-nephrotomogram is the most important imaging study in the diagnosis of renal parenchymal infection in children. If renal parenchymal infections are discovered before significant necrosis has occurred, vigorous treatment with appropriate parenteral antibiotics may result in resolution without the need for surgical drainage.

Pediatric uroradiology.

Pediatric uroradiology is the art and science of obtaining images of the child's urinary tract, not only to obtain maximum information, but also to minimize the invasive nature, hazards, and costs of the examinations. This article discusses which examinations should be used in which situations and when; and, if more than one is needed, the order in which the examinations should be performed and why.

Life-threatening anoxic spells caused by tracheal compression after repair of esophageal atresia: correction by surgery.

Three infants who developed anoxic spells 2, 5, and 20 mo following repair of esophageal atresia developed apneic spells during or within a few minutes of feeding. These episodes began with stridor and cyanosis; when severe, they progressed to apnea and loss of consciousness. Mouth-to-mouth resuscitation was often necessary. Investigations failed to detect esophageal obstruction and/or a recurrent tracheoesophageal fistula. No neurologic or cardiac abnormalities were found. The cause was compression of a 1- to 3-cm segment of trachea anteriorly by a vascular structure and posteriorly by a dilated esophagus that emptied slowly because of poor motility. Endoscopy confirmed the x-ray findings. The aortic arch and innominate artery were suspended to the sternum anteriorly, which relieved the apneic spells in all patients.

Urography in children: when should it be done? 1. Infection.

Radiologic evaluation of urinary tract infection in children should include both excretory urography and voiding cystourethrography. Excretory urography is done to search for anomalies predisposing to infection and for signs of previous episodes of pyelonephritis or reflux and to serve as a baseline for future studies. Voiding cystourethrography is done to search for abnormalities in the natural barriers that protect the renal medulla from infection. If reflux is found to be present and sequential reflux studies are done, they should be performed by the radionuclide method to observe changes in degree or cessation.

Urography in children: when should it be done? 2. Conditions other than infection.

Conditions that are often associated with an increased incidence of renal anomalies include imperforate anus, congenital vertebral abnormalities, and Fanconi anemia; excretory urography should be done if such a condition is present. Urography is also useful to provide baseline data in conditions associated with later development of urinary problems, such as myelodysplasia, prune-belly syndrome, and exstrophy of the bladder. In addition, urography serves as a periodic check for complications of treatment (hydronephrosis, obstruction) in patients with urinary diversion. Certain signs, eg, dribbling, hematuria after mild trauma, unexplained pneumothorax or pneumomediastinum in a neonate, and neonatal abdominal mass, call for immediate urography. In many conditions that were formerly thought to be associated with major urinary abnormalities, urography is not called for. Such is the case in hypospadias, deformities of the external ear alone, and undescended testes. Dehydration is the only absolute contraindication to urography.