RESUMEN
BACKGROUND: Idiopathic bulbar urethritis (IBU) is characterized by hematuria ± dysuria without infection. Symptoms result from inflammation of the bulbar urethra, distal to external sphincter. IBU is difficult to manage and there is no recommended therapy. OBJECTIVE: To determine whether instillation of triamcinolone acetonide is a useful treatment of IBU and its associated complications. SETTING AND PARTICIPANTS: Data were prospectively collected, for 22 months, on 14 consecutive patients presenting with terminal hematuria or blood spotting ± dysuria to a pediatric urology unit. Median age was 12 years (range: 10-15). Mean symptom duration was 13 months (range: 8-24). Normal baseline laboratory blood tests, urine cultures, and ultrasound assessments were seen in all; therefore, none were excluded on the basis of a known pathology. Follow-up telephone interviews, to assess symptom persistence and side effects, were performed at 6 weeks postintervention. The mean follow-up period was 15 months (range: 4-20). INTERVENTION: Visual confirmation of IBU was obtained cystoscopically and 40 mg of triamcinolone was instilled to the inflamed area under direct vision using an open-ended ureteral catheter. OUTCOME MEASUREMENTS: Symptoms resolution was the primary outcome. Repeat cystoscopic assessment ± triamcinolone instillation was recorded, as was the occurrence of complications. RESULTS AND LIMITATIONS: Seven patients (50%) required at least one further treatment. Overall complete or partial resolution was reported in 12/14 patients (85.7%). No side effects were reported. CONCLUSIONS: This small prospective series demonstrates that intraurethral instillation of triamcinolone seems to be a promising treatment option to alleviate inflammatory symptoms in majority of cases of idiopathic urethritis. Patient Summary: Fourteen boys with inflammation of the urethra, with no identifiable cause, were treated by topically triamcinolone, directly to the inflamed area. We demonstrate an 85.7% complete/partial resolution of symptoms with no side effects seen.
Asunto(s)
Antiinflamatorios/administración & dosificación , Triamcinolona Acetonida/administración & dosificación , Uretritis/tratamiento farmacológico , Adolescente , Niño , Humanos , Masculino , Proyectos Piloto , Estudios Prospectivos , Resultado del Tratamiento , Uretritis/patología , Cateterismo UrinarioRESUMEN
OBJECTIVE: ⢠To document the outcome of ureterocalicostomy in children. PATIENTS AND METHODS: ⢠The outcomes of 13 children who had undergone ureterocalicostomy consecutively under the care of two paediatric urologists between 1997 and 2009 were evaluated retrospectively. ⢠Ureterocalicostomy was performed as the primary procedure in four children with horseshoe kidney and four children presenting with gross pelvi-ureteric junction (PUJ) obstruction. ⢠In the remaining five children, it was performed as a secondary procedure for recurrent PUJ obstruction after previous pyeloplasty. ⢠An open approach was employed in 12 patients, whereas, in one patient, it was performed by a laparoscopically-assisted technique. RESULTS: ⢠Mean age at operation was 9.3 years and the mean (range) duration of follow-up was 2.6 (0.3-7.0) years. Twelve children (92%) experienced a good functional outcome following ureterocalicostomy, as defined by reduced dilatation and improved drainage on postoperative ultrasonography and/or isotope imaging. ⢠However one child (8%) developed symptomatic anastomotic obstruction 5 months after primary ureterocalicostomy for obstruction in a horseshoe kidney. Surgical revision was successful, with good drainage, preservation of differential function and relief of symptoms on further follow-up to 3 years. CONCLUSIONS: ⢠Ureterocalicostomy provides a versatile and reliable means of relieving obstruction for a variety of indications, including horseshoe kidney, recurrent PUJ obstruction and gross PUJ obstruction with unfavourable anatomy. ⢠Approximation of ureteric and caliceal urothelium and excision of renal parenchyma in the proximity to the anastomosis are the key steps for securing a satisfactory outcome.