Paediatric excretory urography at the Port-of-Spain General Hospital, 1985-1987 - abstract

In developing countries where ultrasonography and nuclear medicine scanning are not widely available, the intravenous pyelogram (IVP) is the principal method of visualizing the urinary tract. As a result, there exists a real potential for over requesting this relatively expensive study which is unpleasant and not without risk, especially in children. To assess the appropriate use of paediatric IVPs at the Port-of-Spain General Hospital, a retrospective study was done of all IVPs (n=373) performed on children at this institution during the 3-year period, 1985-1987. Radiological abnormalities were reported in 29 percent of cases. The most common abnormal findings were consistent with infection (29 percent) and hydronephrosis (26 percent). The most common indications for radiological study were urinary tract infection (23 percent) and haematuria (17 percent). Problems in making the diagnosis of a urinary tract infection in children were identified as the improper collection and handling of the urine specimen. Based on this survey, almost one-third of children who have IVPs at this institution do not have any indication for doing this potentially dangerous and certainly expensive procedure (AU)

The dangers in the use of intravascular contrast media during radiological investigations

The complications and dangers encountered when contrast media are injected into the vascular system are discussed. Suggestions are given in an effort to reduce the incidence of these complications, thereby making these radiological investigations safer for the patient (AU)

Retroperitoneal lipoblastoma: report of a case and review of the literature

We present the first case of retroperitoneal lipoblastoma at the University Hospital of the West Indies. This is one of the few reported cases in the general literature (AU)

Cysto-urethrography in the University Hospital of the West Indies

Cysto-urethrography was performed on 100 patients with complicated urethral stricture and the findings were correlated at operation. In this series, the indications for cysto-urethrography were impassable strictures, strictures requiring frequent dilatations, or the presence of septic complications including peri-urethral fistulae. The technique of cysto-urethrography was performed initially by the use of metal cannulae and later by the use of a foley type, self-retaining catheter. Water soluble contrast media were used and an attempt was made to obtain both ascending and descending cysto-urethrograms in each case. The value of the descending examination is stressed. Analysis of the 100 cases revealed strictures in 97, and fistulae without strictures in 3 cases. Most of the strictures were solitary and occurred in the bulbous urethra. Fistulae originated in the urethra in 30; other complications are listed. By comparison with other series it appears that in many countries, traumatic stricture is becoming more common than inflammatory stricture; this is not the case in developing countries like Jamaica. In the present series most of the strictures were inflammatory in origin. The high incidence of complications, especially fistulae, is thought to result from the initial treatment of stricture by repeated bouginage with secondary infection. (AU)

Bladder neck stenosis: the value of descending cysto-urethrography in the demonstration of this complication of inflammatory stricture

Attention is drawn to fibrotic stenosis of the bladder neck as a complication of inflammatory urethral stricture and ten cases with this complication in a series of 210 cases of urethral stricture are described. Descending cysto-urethrography is essential for the diagnosis and shows a narrow bladder neck instead of the normal funnel shape during the nicturition of the contrast medium. In addition, there is usually gross reflux of contrast medium into the prostatic glands and severe bladder diverticulosis. Ascending cysto-urethrography may show a "jet" effect as the contrast medium enters the bladder. Cases of stricture with bladder neck stenosis have a higher incidence of other complications than those which do not show bladder neck stenosis which suggests that the development of the stenosis may be related to the severity of the stricture. The stenosis is due to fibrosis secondary to chronic infection of the bladder neck tissues. The source of the infection is presumed to be due to the reflux of infected urine into the prostatic glands and this is always marked in cases with bladder neck stenosis. Treatment should consists of urethroplasty and resection of the bladder neck. (AU)