Acute effect of sacral neuromodulation on video-urodynamic parameters of neurogenic lower urinary tract dysfunction in a patient with vesicoureteral reflux: a case report.

Neurogenic lower urinary tract dysfunction (NLUTD) is a common urological disease that causes long-term complications and severely reduces patient's quality of life. Sacral neuromodulation has proven to be an effective treatment for NLUTD. However, most previous studies have focused mainly on the efficacy and safety of sacral neuromodulation in the treatment of NLUTD and less on the changes in urodynamic parameters in patients before and after sacral neuromodulation. This study aimed to evaluate the effect of short-term sacral neuromodulation on the results of video-urodynamic parameters in a 63-year-old woman with NLUTD with vesicoureteral reflux. The patient was admitted to the Department of Urology of Beijing Hospital in January 2021 and examined using video-urodynamics. In the same month, the patient underwent the first stage of sacral neuromodulation, with an experience period of 2 weeks. After the experience period ended, video-urodynamics was performed again in February 2021. By comparing the two video-urodynamic results, the effect of short-term sacral neuromodulation on the anatomy and physiology of the lower urinary tract was determined. After 2 weeks of sacral neuromodulation treatment, video-urodynamic parameter analysis showed that while the urine storage period of the patient significantly improved, the voiding period was not significantly changed. This was specifically reflected in the improvement of bladder compliance, safe capacity of the bladder, and significant reduction in vesicoureteral reflux. The improvement of the safe capacity of the bladder effectively helped the patient to control the number of intermittent catheterizations within an acceptable range, which greatly improved her quality of life. Therefore, the patient underwent permanent sacral neuromodulation implantation in February 2021. This study suggests that short-term sacral neuromodulation can significantly improve lower urinary tract function and reduce vesicoureteral reflux in patients with NLUTD with vesicoureteral reflux. In short, we believe that sacral neuromodulation may be a good choice for patients with NLUTD.

High-grade vesicoureteral reflux in infants: Our experience with endoscopic subureteric injections.

BACKGROUND: Vesicoureteral reflux (VUR) is the most common urological anomaly in pediatric patients. Management options for VUR vary from continuous antibiotic prophylaxis (CAP) to surgery via either endoscopic subureteric injection of a bulking agent or open anti-reflux surgery. In this study, we assess the efficacy of subureteric injections of Dextranomer/Hyaluronic acid Copolymer (Deflux) in managing primary VUR in infant patients with high-grade VUR. METHODS: From 2010 to 2015, children less than 1-year-old with primary high-grade VUR were observed prospectively following the administration of endoscopic subureteric injections of Dextranomer/Hyaluronic Acid Copolymer (Deflux). The diagnosis of VUR was based on MCUG, and all patients underwent a holistic clinical, laboratory, and radiological assessment before and after the intervention. Complete success was defined as the resolution of VUR on follow up 1 year post-operatively. RESULTS: A total of 30 infants (50 renal units) with high-grade VUR (grades IV and V) were included in the study. The mean age at surgery was 6.3 ± 2.5 months. Most of the patients presented with a urinary tract infection (90%). Complete symptomatic relief was achieved in 27 patients (90%) at the first post-operative follow-up. Forty-four renal units received one injection, while six required a second injection as they did not meet our treatment success criteria. No patients required a third injection or referral for open surgery. CONCLUSION: Endoscopic injection of Dextranomer/Hyaluronic acid Copolymer (Deflux) at the vesicoureteral junction is an effective minimally invasive intervention to treat high grades VUR (IV-V) infants.

Can a four-session biofeedback regimen be used effectively for treating children with dysfunctional voiding?

OBJECTIVE: To compare the outcomes of the open-ended six to ten sessions of biofeedback against a novel regime of four sessions of biofeedback to treat children with dysfunctional voiding. MATERIALS AND METHODS: Patients from two centers using different methods were retrospectively analyzed. Group 1 comprised 20 patients treated with four sessions of biofeedback. Group 2 comprised 20 patients treated with six to ten sessions of biofeedback. Each group was evaluated with subjective and objective parameters pre-treatment, immediately post-treatment and 6 months post-treatment. RESULTS: All patients in Group 1 were treated with four sessions of biofeedback and in Group 2 the mean number of sessions was 7.35±1.30 (range 6-10). Normalized voiding flow curves after treatment were determined in 18 patients in Group 1 (90%) and 19 patients in Group 2 (95%) (p=0.553). There were seven patients (35%) in Group 1 and eight patients (40%) in Group 2 with reflux. When units were compared, there were 11 units (4 bilateral) in Group 1 and 13 units (5 bilateral) in Group 2 with reflux (p=0.747). At 6 months post-treatment, in Group 1, seven had resolved (63.6%), three had improved (27.2%) and one persisted (9.01%). In Group 2, ten had resolved (76.9%) and three had improved (23.1%) (p=0.553). CONCLUSIONS: Biofeedback therapy is one of the most widely used techniques in dysfunctional voiding in children. The regime of use has not been well defined, and the results of this study showed that a regime of four sessions of biofeedback therapy may be as safe and effective as the previously defined open-ended six to ten sessions.

Combination of calcium hydroxyapatite and autologous blood for endoscopic treatment of vesicoureteral reflux in children.

OBJECTIVE: To report the results of endoscopic correction of vesicoureteral reflux (VUR) with concomitant injection of pure calcium hydroxyapatite (CaHA) and autologous blood. PATIENTS AND METHODS: Records of patients who underwent endoscopic correction of VUR using concomitant injection of CaHA and autologous blood from 2008 through 2010 were retrospectively reviewed. Data regarding patients' demographics, preoperative VUR grades, febrile urinary tract infections, complications of procedure, postoperative VUR grades and cure rates were collected. Voiding cystourethrography was performed 3 months postoperatively. RESULTS: Total number of 23 children (9 girls and 14 boys) with 40 refluxing ureters were included. The mean age of children was 1.9 ± 0.97 (SD) years. Reflux grades were II to IV in 14, 11 and 15 renal refluxing units (RRUs), respectively. The mean follow-up period was 44 months. VUR was successfully treated in 87.5% of RRUs after three injections. Significant statistical difference was found between VUR grades before and after the first, second and third injections (p < 0.001, p = 0.001 and p = 0.011, respectively). Moreover, there was a significant difference between primary reflux grade and treatment success (p = 0.031). Febrile UTI was resolved in 85% of patients (17 of 20 patients with febrile UTI) after endoscopic treatment which shows significant improvement (p < 0.001). The procedure was uneventful in all patients, and no obstruction was reported during the follow-up period. CONCLUSION: Concomitant injection of pure CaHA without any additives (hyaluronic acid, etc.) and autologous blood can be an effective, repeatable and cost-benefit approach for the management of children suffering VUR with a success rate of 87.5% after three injections.

Long-term ultrasound appearance of concomitant autologous blood and dextranomer/hyaluronic acid copolymer implants: is it associated with successful correction of vesicoureteral reflux?

OBJECTIVE: To find the association between mound appearance on ultrasound imaging and successful correction of vesicoureteral reflux (VUR). METHODS: We retrospectively reviewed the ultrasound and voiding cystourethrogram (VCUG) results of patients who underwent dextranomer/hyaluronic acid injection via the hydrodistention injection technique (HIT) or HIT with concomitant autologous blood injection (HABIT) for 5 years postoperatively. VUR resolution at postoperative VCUG was considered as a success. Retained volumes of implants were measured and compared between HABIT and HIT and successful and failed treatments. Presence of mound on ultrasound imaging was also evaluated as a predictor of VUR resolution on VCUG. RESULTS: Measured mound volume was significantly higher in treatments that were successful than in those that were failures (P <.05). During 5-year follow-up, measured mound volumes in the HABIT group were significantly higher than in the HIT group (P <.05). Sensitivity, specificity, positive predictive value, and negative predictive value of mound visualization on the first-month sonography to predict success were 97.7%, 21.5%, 89.6%, and 60%, respectively. These results were dramatically changed for the 50 patients with further VCUG after 1 year of follow-up, with 95.7% sensitivity, 37.0% specificity, 54.0% positive predictive value, and 90.9% negative predictive value. CONCLUSION: Reduction or absence of the mound after implantation is more frequent among failed treatments in which visualization of the mound on postoperative sonography can predict VUR resolution. Autologous blood injection concomitant with dextranomer/hyaluronic acid implantation results in better immediate and long-term mound preservation, which could possibly be the reason for the higher success rate in HABIT group.

Usefulness of concomitant autologous blood and dextranomer/hyaluronic acid copolymer injection to correct vesicoureteral reflux.

PURPOSE: We present the long-term results of a new modification of endoscopic treatment of vesicoureteral reflux involving concomitant injection of autologous blood following the standard hydrodistention injection technique to prevent bulking agent leakage immediately after the procedure. MATERIALS AND METHODS: A total of 341 children underwent endoscopic implantation of dextranomer/hyaluronic acid for vesicoureteral reflux. A subset of 171 patients underwent hydrodistention autologous blood injection, while 170 underwent classic hydrodistention injection. Frequency of symptomatic urinary tract infection after endoscopic treatment was recorded. Success was defined as absence of vesicoureteral reflux on postoperative voiding cystourethrography. RESULTS: A total of 523 ureters in 214 girls and 127 boys were treated. In patients undergoing hydrodistention autologous blood injection mean age was 39.48 months, mean maximal reflux grade was 3.02 and success rate was 93.6% after the first injection (98.0% in patients with grade II, 92.1% with grade III, 93.3% with grade IV and 85.7% with grade V reflux). In patients who underwent classic hydrodistention injection mean age was 36.12 months, mean maximal reflux grade 3.05 and success rate was 81.8% after the first injection (91.5% in patients with grade II, 89.4% with grade III, 74.4% with grade IV and 44.4% with grade V reflux). The success rate was significantly higher (p = 0.001) in patients undergoing hydrodistention autologous blood injection vs classic hydrodistention injection. Of the patients 1.7% in the hydrodistention autologous blood injection group and 2.9% in the classic hydrodistention injection group reported symptomatic urinary tract infection during followup. CONCLUSIONS: Immediate injection of autologous blood following dextranomer/hyaluronic acid injection to create a blood clot and barricade against bulking agent leakage is more effective than pure dextranomer/hyaluronic acid implantation. This novel modification stabilizes the subureteral implant mount and may affect the antireflux outcome.

Endoscopic Deflux injection for pediatric transplant reflux: a feasible alternative to open ureteral reimplant.

OBJECTIVE: Pediatric renal transplantation is frequently performed using a freely refluxing vesicoureteral anastomosis. The resulting vesicoureteral reflux (VUR) may increase the morbidity of urinary tract infections (UTIs) that commonly occur in this setting, yet open surgical correction of the refluxing anastomosis can prove difficult. We report our experience using endoscopic injection of dextranomer/hyaluronic acid (Deflux) to correct transplant VUR. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients treated with endoscopic injection of Deflux (Q-Med, Uppsala, Sweden) for VUR into their renal allograft. Indications for inclusion in the study were renal allograft transplantation for primary end-stage renal disease, radiographically proven VUR into the allograft, normal voiding history, and at least one documented febrile UTI. Preoperative and postoperative images, including voiding cystourethrogram and allograft ultrasound, were compared. Location of the transplant orifice and volume of Deflux were recorded. Clinical outcomes, including documented UTI and changes in serum creatinine following treatment, were also assessed. RESULTS: Eight patients were identified who were treated for transplant VUR, with a total of nine transplant ureters injected. Mean patient age at time of injection was 11.6 years (range: 7-19 years). Post-injection voiding cystourethrograms and allograft ultrasound were available for all patients. Following treatment, four ureters demonstrated resolution of VUR and one ureter demonstrated improvement to grade 1 VUR. The remaining four ureters demonstrated no change in VUR grade. No patients showed any change in their serum creatinine, and no episodes of transplant pyelonephritis have occurred during the follow-up period. Mean post-injection follow-up has been 17.3 months (range 9-26 months). CONCLUSION: Initial results demonstrate that endoscopic treatment with Deflux is feasible and may provide a less invasive alternative for treatment of transplant VUR. Further investigation with a larger group of patients and longer follow-up is needed.

A randomized controlled trial of the effectiveness of osteopathy-based manual physical therapy in treating pediatric dysfunctional voiding.

OBJECTIVE: Pediatric dysfunctional voiding (DV) presents physical and emotional challenges as well as risk of progression to renal disease. Manual physical therapy and osteopathic treatment have been successfully used to treat DV in adult women; a pediatric trial of manual physical therapy based on an osteopathic approach (MPT-OA) has not been reported. The aim of this study was to determine whether MPT-OA added to standard treatment (ST) improves DV more effectively than ST alone. METHODS: Twenty-one children (aged 4-11 years) with DV were randomly assigned to receive MPT-OA plus standard treatment (treatment group) or standard treatment alone (control group). Pre-treatment and post-treatment evaluations of DV symptoms, MPT-OA evaluations and inter-rater reliability of DV symptom resolution were completed. RESULTS: The treatment group exhibited greater improvement in DV symptoms than did the control group (Z=-2.63, p=0.008, Mann-Whitney U-test). Improved or resolution of vesicoureteral reflux and elimination of post-void urine residuals were more prominent in the treatment group. CONCLUSIONS: Results suggest that MPT-OA treatment can improve short-term outcomes in children with DV, beyond improvements observed with standard treatments, and is well liked by children and parents. Based on these results, a multi-center randomized clinical trial of MPT-OA in children with vesicoureteral reflux and/or post-void urinary retention is warranted.

Results of biofeedback treatment on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux.

OBJECTIVES: It is well known that a relationship exists between vesicoureteral reflux (VUR) and dysfunctional voiding, and the spontaneous resolution rate in older children is lower than the rate in younger children. In this study, we analyzed our experience with biofeedback treatment in older children with confirmed voiding dysfunction and VUR and investigated the effect of this treatment on the reflux resolution rates in these children. METHODS: A total of 78 children, 5 to 14 years old (mean age 9), with voiding dysfunction and VUR detected by voiding cystourethrography were treated with biofeedback therapy. Voiding cystourethrography was performed 6 months after completion of the biofeedback program to determine the reflux status. The treatment results were also documented as subjective and objective improvements. RESULTS: The reflux in 98 units (20 bilateral) was grade 1 in 26, grade 2 in 32, grade 3 in 28, and grade 4 in 12. At 6 months of follow-up, VUR had resolved on voiding cystourethrography in 62 units (63%), the grade had improved in 28 units (29%), and the reflux had remained unchanged in 8 units (8%). Among the older children treated with biofeedback, we also observed improvements in nocturnal enuresis (82%), daytime wetting (70%), constipation (78%), frequency (76%), infrequency (64%), urgency (71%), staccato voiding (81%), flattened voiding (81%), bladder overactivity (82%), detrusor sphincter dyssynergia (77%), spinning top urethra (67%), and urinary tract infection (80%). CONCLUSIONS: Biofeedback therapy is applicable in older children with dysfunctional voiding and VUR and yields greater resolution rates than the historical resolution rates.

Falso residuo postmiccional diagnosticado por videourodinamia / False postvoid residual volume diagnosed by videourodynamics

Presentamos un caso de un paciente varón joven diagnosticado de reflujo vésico ureteral bilateral. En el estudio urodinámico se objetiva una posible disinergia vesico-esfinteriana no neurógena, con gran residuo postmiccional. Tras tratamiento con biofeedback se soluciona la disinergia, persistiendo el gran residuo. El estudio con videourodinamia permitió diagnosticar la presencia de un falso residuo postmiccional causado por el vaciamiento ureteral del reflujo bilateral masivo

We present a case report of a young male patient, with a bilateral vesico renal reflux. The urodynamic study findings suggested the possibility of a non-neurogenic bladder-external spincter dissinergya producing a valuable residual volume. After biofeedback treatment, the dissinergia disappeaed, but residual volume persisted. The videourodynamic assessment allowed us the accurate diagnosis of a false residual volume, produced by the voiding of the refluxed urine from the ureters into the bladder

[Comparison of effectiveness of endoscopic injection of autologous blood and conservative therapy in the treatment of bilateral primary vesicoureteral reflux]. / Porównanie skutecznosci endoskopowego ostrzykniecia krwia autologiczna ujsc moczowodowych z leczeniem zachowawczym obustronnych pierwotnych odplywów pecherzowo-moczowodowych.

Vesicoureteral reflux (VUR) is one of the most frequent diseases which leads to pyelonephritis and furthermore, renal damage. The treatment of VUR (surgical or endoscopic) remains a controversial topic. Autologous blood injection--autohemotherapy (AHT) is used in the endoscopic treatment of VUR. The aim of the research was the comparison of efficacy of AHT and conservative therapy in children with bilateral VUR grade III. 125 children were treated endoscopically. The results of the AHT were compared with the results of conservative treatment in 121 children with the same kind of disease. Complete disappearance of VUR after AHT was observed in 61.6% of children and in 59.5% after two years of medical treatment. These results were not significantly different (p > 0.73) in contrast to the results reached after one year of conservative therapy (p < 0.01). After the conservative treatment in 33.5% of kidneys reflux nephropathy (NR) was observed. In the group treated by AHT NR developed in 25.2% of kidneys. The frequency of NR was significantly higher in children after conservative treatment (p < 0.001). 29.8% of children after conservative therapy and 8% of children after AHT were operated. The results of research proved that usefulness of intravesical autohemotherapy in the treatment of VUR. The method was safe with a low quantity of complications. The efficacy of AHT in the elimination of bilateral high grade VUR was comparable to this reached after two years of conservative treatment.

Biofeedback therapy expedites the resolution of reflux in older children.

PURPOSE: In older children the spontaneous resolution rate of low grade vesicoureteral reflux is low and currently its management is controversial in regard to surgery versus prophylaxis versus observation alone. Bladder dysfunction in children with neurogenic bladders and to a less declarative degree in neurologically intact children has a role in the etiology or persistence of reflux. We determine the impact of biofeedback therapy on neurologically intact children with vesicoureteral reflux and detrusor-sphincter dyssynergia. MATERIALS AND METHODS: Vesicoureteral reflux was detected by voiding cystourethrography in children evaluated for urinary tract infections. Children with breakthrough infections or dysfunctional voiding based on history underwent uroflowmetry with concomitant patch electromyography of the external sphincter. Dyssynergia was defined as increased or steady electromyography activity during micturition. Biofeedback was initially performed weekly and the interval increased as indicated. The goals were to eliminate dyssynergia and reduce or eliminate post-void residual urine. Voiding cystourethrography was performed 1 year later to determine the status of the reflux. Ureteral reimplantation was performed during the period of biofeedback when indicated. RESULTS: From February 1997 to March 2001, 25 children 6 to 10 years old (mean age 9) with vesicoureteral reflux and detrusor-sphincter dyssynergia were treated with biofeedback therapy. There were 31 units (5 bilateral) with reflux, which was grade I in 10, II in 15, III in 5 and IV in 1. Children underwent an average of 7 sessions of biofeedback (range 2 to 20). On followup voiding cystourethrography, vesicoureteral reflux resolved in 17 units (55%), grade improved in 5 (16%) and reflux remained unchanged in 9 (29%). All cured vesicoureteral reflux was grade I (8 cases) or II (9). Four children (5 renal units) underwent reimplantation. In cured children there were no breakthrough infections during or since therapy and post-void residual urine decreased from an average of 40% before to 10% after therapy. Symptoms of urgency, daytime wetting and hoarding of urine improved or were eliminated in all children with resolved vesicoureteral reflux. CONCLUSIONS: Treating external detrusor-sphincter dyssynergia in older children with low grade vesicoureteral reflux, with biofeedback results in 1-year resolution rates that are considerably greater than historical resolution rates. External detrusor-sphincter dyssynergia should be screened for in children when surgery or discontinuation of chemoprophylaxis is considered so that biofeedback can be started.

[Vesicoureteric reflux and functional voiding dysfunction in children]. / Reflux vésico urétéral et troubles mictionnels fonctionnels chez l'enfant.

PURPOSE: To analyze the efficacy of the different treatments of vesicoureteric reflux (VUR) associated with reflex bladder sphincter dyssynergia (RBSD). PATIENTS AND METHODS: The medical records of 33 children (28 girls) aged 4 to 12 years presenting reflex bladder sphincter dyssynergia and vesicoureteric reflux have been reviewed. The most common clinical symptom was urinary tract infection. Voiding dysfunction included: dysuria, urinary leak, enuresia, urgency, constipation. In most cases, vesicoureteric reflux was low grade (grade 1, n=9; grade 2, n=18; grade 3, n=6) and bilateral (n=18). Three types of treatments have been utilized: reimplantation, reeducation, medical treatment (diet, antibio-prophylaxis, anti-cholinergics). RESULTS: Eleven children (2 with a solitary kidney) underwent early reimplantation which was effective on vesicoureteric reflux but 6 of them had post-operative voiding dysfunction and 5 had a new episode of urinary infection. Six had reeducation first then they underwent reimplantation. Sixteen children had an exclusive medical treatment (13 with reeducation). In 9 children vesicoureteric reflux disappeared (one child still complains of voiding dysfunction). In 7, voiding dysfunction improved but vesicoureteric reflux is still present. CONCLUSION: The management of vesicoureteric reflux associated with reflex bladder sphincter dyssynergia is complex. Surgery should certainly not be the initial treatment. However, it can remain useful if one wishes to get complete resolution of reflux.

[Studies on the behavior of some immunologic parameters after local, endoscopic autohemotherapy in children treated for vesicoureteral reflux]. / Badania nad zachowaniem sie okreslonych parametrów immunologicznych po miejscowej, endoskopowej autohemoterapii u dzieci leczonych z powodu odplywu pecherzowo-moczowodowego.

Evaluation of the effect of autologous blood injection into muscular layer on the immune system in children who were treated endoscopically for vesicoureteral reflux. There were 29 children examined after before and endoscopic autohemoinjection. The examination included determination of basic immunoglobulin levels in serum (IgA, IgG, IgM). Also the human lymphocyte subpopulations were determined. Initial and final values were compared, average values and standard deviations for respective age groups were determined. Autologous blood used for injections in endoscopic treatment of vesicoureteral reflux stimulates immune system, especially in young children.

[Analysis of the failure of endoscopic treatment of vesico-renal reflux in children using injections of teflon and collagen and the preliminary results of injections of Macroplastic]. / Analyse des échecs du traitement endoscopique du reflux vésico-rénal chez l'enfant par injections de téflon ou de collagène et résultats préliminaires des injections de Macroplastique.

This study of 785 cases of vesicorenal reflux in 494 children treated endoscopically over a 7-year period was designed to evaluate the results obtained with three products used successively: Teflon, collagen and Macroplastic. Following Teflon injection, despite a 90% short-term success rate, recurrent reflux was subsequently observed in 16.71% of the ureters reviewed. The failure rate was 52.63% after collagen injection and 11.77% after Macroplastic. After one or two injections, complete resolution of reflux was obtained in 48% of children treated with collagen, versus 85.72% with Teflon and 93.33% with Macroplastic. In one half of cases, failure was related to the quality of the product and its modifications after injection. The marked resorption of collagen accounts for the poor results despite the large doses injected. Apart from one case of partial resorption of Teflon paste, the failures with this product were due to lateralisation or secondary elimination of the product from the injection site due to its fluidity. Macroplastic, due to its higher viscosity and absence of retraction, currently provides the best results with doses of less than 0.20 ml in children.

[The conservative treatment of children with vesico-ureteral reflux]. / Konservativnoe lechenie detei s puzyrno-mochetochnikovym refliuksom.

The article deals with the results of examination and nonoperative treatment of 120 children with vesicoureteral reflux (VUR). Their ages ranged from 3 to 13 years. The authors used a complex of methods for the examination of the functional condition of the kidneys, upper urinary tract (excretory urography, renoscintigraphy, electroureterography, clearance tests), lower urinary tract (cystography, cystoscopy, cystotonometry, urethroprofilometry, electromyography of the detrusor and its obturator apparatus), bacterio- and immunological studies (determination of the microbial number, bacteria covered with antibodies, immunoglobulins G, A, and M). The results of the study were analysed in 3 groups in which VUR was linked with normoreflexia (33.3%, group 1), hyperreflexia (48.6%, group 2), and hyporeflexia (18.1%, group 3). There was an obvious growth of cystitis incidence in patients with bladder dysfunction. The data of computed scintigraphy showed partial renal dysfunction in patients with unilateral VUR not only on the side of the affection but also in the contralateral intact kidney. It is assumed that there is a clear relation between the degree of renal dysfunction, the ureteral motor activity, and bladder dysfunction. The treatment included: (1) pharmacotherapy of neurogenous bladder dysfunction with belladonna preparations (in hyperreflex) and aceclidine (in hyporeflex urinary bladder) in optimization of the organism's bioenergetic processes; (2) percutaneous bladder electrostimulation; (3) combination of the listed methods together with cerucal. The results of treatment and the indications (absolute and relative) for nonoperative treatment of VUR in children are discussed.

[A method for the electrical impulse profilometry of the vesicoureteral segment]. / Sposob élektroimpul'snoi profilometrii puzyrno-mochetochnikovogo segmenta.

The proposed technique of electric stimulation (electric pulse profilometry) of vesicoureteral segment provides further possibilities in diagnosis, for children with reflux in particular. It enables one to identify the severity of pathological changes, the degree of immaturity of the aforementioned system and to assess the efficacy and potential of the method in children. The advisability of the technique, that could be monitored by various objective parameters derived from the comparison of the background and stimulation effect, was confirmed by the findings in 9 children with refluxed megaloureter.

[A case of solitary pelvic kidney with vesicoureteral reflux and neurogenic bladder dysfunction].

A case of solitary pelvic kidney with neurogenic bladder dysfunction with vesicoureteral reflux is presented. The patient was a 15-year-old boy with sacral vertebral dysplasia and hare-lip, and he has been complaining of recurrent fever episodes and urinary incontinence since 11 years old. Renal anomaly was confirmed by DIP, CT and angiography, and grade IV vesicoureteral reflux was demonstrated by voiding cystourethrography. On cystometrography, low compliance bladder which had a 70 ml capacity on first desire to void and 90 ml capacity on maximum desire to void was observed. Electromyography of anal sphincter performed with uroflowmetry revealed no relaxation of external sphincter during voiding. To preserve renal function, antireflux surgery was performed by Cohen's method, and a successful result, that is cessation of reflux and no ureteral obstruction, was achieved. After operation, periodic transcutaneous electrical stimulation were applied to the pudendal nerve, as a result bladder capacity increased to 150 ml and dysuria with incontinence improved.