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1.
Pediatr Hematol Oncol ; 36(8): 504-509, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31566047

RESUMO

Non-Hodgkin's lymphomas (NHL) are common malignant tumors in children and adolescents. Among them diffuse large B-cell lymphomas (DLBCL) are relatively rare as compared to non-cleaved small cell lymphoma (mostly Burkitt's-BL) and lymphoblastic lymphoma (LL). While BL has abdominal or cervical site predilection, LL (mostly T-cell) tends to have mediastinal involvement. However, diffuse large B-cell lymphomas may involve abdomen, peripheral lymph nodes, skin, bone, other rare sites. Ureteral NHLs are extremely rare in children; however, many cases have been reported in adults. In adults the histopathology is usually follicular lymphoma. Only one case of unilateral ureter DLBCL has been reported in an adolescent in the past. Here we report a case of bilateral ureteral DLBCL to highlight the unusual presentation of NHLs and that it should be considered in the differential diagnosis of acute renal insufficiency.

2.
J Urol ; 201(4): 802-809, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30248344

RESUMO

PURPOSE: Hinman syndrome is a rare disease with urodynamic findings and a clinical course resembling neuropathic bladder, without a neuropathic etiology. Diffusion tensor imaging is a special technique of magnetic resonance imaging that has recently been used to evaluate the peripheral nerves but has been demonstrated to be applicable for evaluation of the lumbosacral plexus. We examined the lumbosacral plexus using diffusion tensor imaging, which has not previously been reported in patients with Hinman syndrome. MATERIALS AND METHODS: The study included 12 patients who fulfilled criteria for Hinman syndrome, with severe bladder dysfunction on urodynamics, renal scarring on scintigraphy and no pathological findings on magnetic resonance imaging. The 12 subjects serving as controls required pelvic or spinal magnetic resonance imaging for reasons other than spinal abnormalities. Evaluation was performed with a 3.0 Tesla magnetic resonance imaging system and 16-channel body coil. Tractography was done to examine the lumbosacral plexus. Fractional anisotropy and mean diffusivity were computed and compared between groups for the right and left plexuses. RESULTS: Mean fractional anisotropy was 0.24 and 0.35 for the right plexus in patients and controls, respectively, and 0.24 and 0.36 for the left plexus. Mean diffusivity was 1.39 for the right and left plexuses in patients, and 1.28 for the right and left plexuses in controls (p <0.001 for all). CONCLUSIONS: Our study focusing on the lumbosacral plexus as a possible origin of neuropathy revealed abnormal findings in patients with Hinman syndrome resembling nerve injury series. This is the first known study to provide data showing that Hinman syndrome may have a neuropathic etiology.


Assuntos
Imagem de Tensor de Difusão/métodos , Plexo Lombossacral/diagnóstico por imagem , Bexiga Urinaria Neurogênica/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Doenças Raras , Índice de Gravidade de Doença , Síndrome , Doenças da Bexiga Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/fisiopatologia , Bexiga Urinaria Neurogênica/fisiopatologia , Urodinâmica/fisiologia
3.
Turk J Pediatr ; 61(3): 436-439, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31916725

RESUMO

Tekin A, Yagmur I, Ergün O, Ayik MF, Atay Y, Ulman I, Avanoglu A. Excision of the atrial Wilms` tumor thrombus without sternotomy, atriotomy and cardiovascular By-pass. Turk J Pediatr 2019; 61: 436-439. The treatment of atrial-extention Wilms` tumor thrombus is surgical excision after chemotherapy. Atriotomy with cardiovascular by-pass is the one of the most common method for this procedure. Herein, we aimed to present a case of Wilms` tumor with a tumor thrombus extending into the right atrium totally excised with retrohepatic cavatomy. A 3.5 year-old girl was admitted with the symptom of dysuria. The examinations revealed a mass consistent with Wilms` tumor in the middle and lower poles of the left kidney. Doppler ultrasound and Echocardiographic examinations showed a tumor thrombus extending into the right atrium and some pulmonary nodules which were interpreted to be metastasis. Wilms` tumor was histopathologically diagnosed by an open biopsy. After three courses of chemotherapy imaging studies revealed that the atrial axtention of the tumor thrombus persisted. The tumor thrombus was found to be fibrotic on the magnetic resonance imaging scan of the patient. Therefore, nephroureterectomy along with the excision of the tumor thrombus from the inferior vena cava was done with intraoperative continuous trans-esophageal echocardiography (TEE). The suprarenal and retrohepatic vena cava were exposed by dissecting and ligating all short hepatic veins and completely mobilizing the right lobe of the liver. The thrombus was dissected out via Vertical cavatomy at the retrohepatic level. TEE confirmed complete removal of the thrombus from the atrium; Vena cava was then repaired. There was no need for a blood transfusion, or cardiovascular by-pass (CPB) during the operation. Total exposure of the retrohepatic and subdiaphragmatic vena cava using transplantation techniques is an effective method for the excision of a tumor thrombus without sternotomy, atriotomy and CPB, avoiding possible intra- and postoperative complications in selected cases of Wilms` tumor with intraatrial thrombus extension. The case emphasises the importance of multidisciplinary communication and collaboration.

4.
Int. braz. j. urol ; 44(6): 1194-1199, Nov.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-975658

RESUMO

ABSTRACT Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent.

5.
Int Braz J Urol ; 44(6): 1194-1199, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30325612

RESUMO

INTRODUCTION: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. PATIENTS AND METHODS: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. RESULTS: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. CONCLUSION: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent.


Assuntos
Resinas Acrílicas/administração & dosagem , Materiais Biocompatíveis/administração & dosagem , Dextranos/administração & dosagem , Ácido Hialurônico/administração & dosagem , Polímeros/administração & dosagem , Refluxo Vesicoureteral/terapia , Criança , Pré-Escolar , Seguimentos , Humanos , Resultado do Tratamento , Ureteroscopia
6.
J Clin Res Pediatr Endocrinol ; 10(3): 216-222, 2018 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-29595517

RESUMO

Objective: Disorders of sex development (DSD) is a nomenclature intended to defeat the discomfort of families and patients and has found worldwide usage. The aim of this study was to address the perception and usage of terminology among the parents of DSD patients in a tertiary center in western Turkey. Methods: The records of the DSD council (multidisciplinary team where each patient with DSD is discussed) between years 2008-2015 were reviewed retrospectively. Data including details of the management process, patient characteristics and follow-up details were noted. Then inquiries reflecting parental perception about terminology were implemented during clinical visits. Results: In total, 121 patients were evaluated in monthly meetings of the DSD council and 79 inquiries were completed. Fifty-one percent of the families admitted knowing the terms DSD, ambiguous genitalia, "dubious genitals" and intersex. However, only 2% preferred using DSD, 6% intersex and 14% ambiguous genitalia. Fifty-two percent of the parents used a disease name in Latin (mostly hypospadias) addressing the disorder. The offspring of 69% of the parents who were familiar with the name "dubious genitals" were diagnosed in the neonatal period. The preferred terminology used by parents was strongly associated with the terminology used most commonly in the medical speciality their child most often attended. Conclusion: Each country has its own social norms. We suggest therefore that local committees including medical professionals, patients and families should be employed to develop proper terminology.


Assuntos
Transtornos do Desenvolvimento Sexual , Conhecimentos, Atitudes e Prática em Saúde , Pais , Terminologia como Assunto , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Turquia
7.
J Clin Res Pediatr Endocrinol ; 9(2): 179-181, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28094762

RESUMO

Persistent Müllerian duct syndrome is the result of either anti-Müllerian hormone (AMH) deficiency or AMH receptor resistance. A long tubular structure was palpated during the physical examination of a 13-month-old male patient who had presented with bilateral undescended testes. At physical examination, the testes were not palpable. The patient's karyotype was XY, SRY (+), and his AMH level was 22 ng/mol. Structures suggestive of ovaries, a uterus, and fallopian tubes were observed during the laparoscopic examination of the ectopic testis. AMHR2 gene sequence analysis performed with a preliminary diagnosis of AMH receptor resistance revealed a previously unreported homozygous c.24G>A (p.W8X) mutation. The patient was assessed as a case of AMH receptor resistance. Orchiopexy was performed.


Assuntos
Criptorquidismo/cirurgia , Transtorno 46,XY do Desenvolvimento Sexual/diagnóstico , Orquidopexia/métodos , Testículo/anormalidades , Criptorquidismo/diagnóstico , Criptorquidismo/genética , Transtorno 46,XY do Desenvolvimento Sexual/genética , Transtorno 46,XY do Desenvolvimento Sexual/cirurgia , Humanos , Lactente , Masculino , Mutação , Receptores de Peptídeos/genética , Receptores de Fatores de Crescimento Transformadores beta/genética , Testículo/cirurgia
8.
J Pediatr Urol ; 12(6): 395.e1-395.e6, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27480468

RESUMO

INTRODUCTION: Various graft and flap techniques have been proposed for urethral reconstruction in proximal hypospadias repair. The Bracka repair involving the transfer of inner prepuce like a Wolfe graft mostly results in satisfactory results besides a high fistula rate. AIM: The aim was to decrease the high fistula rate with Bracka repair; we wanted to use the advantages of vascularized skin in the Bracka method. The aim of this study was to evaluate our results with this modification. STUDY DESIGN: Our modification involves using a flap instead of a graft. In the first stage, chordee was corrected by transection of the urethral plate and dorsal midline plication when necessary. Instead of a graft as suggested by Bracka, inner preputial skin with ample blood supply was transferred and stitched to the denuded ventral penile surface. In the second stage after 6 months, this flap was tubularized in the Thiersch-Duplay fashion. Hospital records of patients who had undergone two stage modified Bracka repair between June 2007 and July 2012 were reviewed, including complaints, complications, and need for interventions. RESULTS: Thirty-eight patients had undergone this operation. Four patients were lost to follow-up. The main complaint was obstructed urinary flow. Voiding symptoms were first attributed to urethral stenosis, but were, however, found to be due to diverticulum and vortex of the urine in the dilated urethra. Twenty-one patients (61%) had voiding problems and 10 patients (29%) had urinary tract infections. Fistula was observed in 23 and diverticula were observed in 24 patients. Of these, 16 patients had both fistula and diverticula. Only two patients (5%) were free of complications and totally satisfied with the operation, and 23 of the 34 patients had complications requiring intervention (Figure). DISCUSSION: Inner preputial flaps used in proximal hypospadias repairs are prone to diverticula formation. They become redundant in time requiring reoperation, thus decreasing the success rate. Careful fixation of the flap to the corpora and allowing time for additional attachment of the urethral plate substitution through fibrotic activity could not overcome this complication. CONCLUSION: Our modification of the Bracka technique using a flap for the plate resulted in a high rate of complications (in particular diverticulum formation) and was therefore abandoned. We recommend careful use of flaps in hypospadias surgery and long-term follow-up studies to evaluate actual functional and cosmetic results.


Assuntos
Divertículo/epidemiologia , Hipospadia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos , Doenças Uretrais/epidemiologia , Adolescente , Criança , Pré-Escolar , Humanos , Hipospadia/patologia , Incidência , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
9.
Urology ; 84(3): 689-93, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25168553

RESUMO

OBJECTIVE: To evaluate an outcome of endoscopic correction of vesicoureteral reflux (VUR) using Vantris (Promedon, Cordoba, Argentina) in terms of its effectiveness and morbidity in a multicenter study. MATERIALS AND METHODS: From 2009 to 2013, 611 patients (210 boys and 401 girls) with a mean age of 3.56 years (range, 1 month-18 years) were treated at 7 centers worldwide endoscopically with Vantris injection. VUR was unilateral in 413 and bilateral in 198 patients comprising 809 renal refluxing units (RRUs). Of these, primary VUR was present in 674 RRUs (83.3%) and 135 (16.7%) were complex cases. Reflux was grades I-V in 24 (2.96%), 123 (15.2%), 451 (55.8%), 158 (19.5%), and 53 (6.6%) RRUs respectively. The follow-up continued from 6 to 54 months. RESULTS: Reflux resolved in 759 RRUs (93.8%) after first Vantris injection, in 26 (3.1%) after second, and in 6 (0.7%) after third injection, respectively. VUR improved to grade I after 1 or 2 injections in 5 ureters (0.6%), which needed no further treatment. Thirteen ureters (1.6%) failed endoscopic correction and required ureteral reimplantation. Vesicoureteral junction obstruction requiring ureteral reimplantation developed in 6 ureters (0.7%) and in 4 (0.5%) required stent insertion. Twenty-three patients (3.8%) suffered afebrile urinary tract infection. Seven (1.2%) developed febrile urinary tract infection. None of the studied patients demonstrated VUR recurrence on voiding cystourethrography. CONCLUSION: The results of this multicenter survey confirm that endoscopic subureteral Vantris injection is a simple, safe, and effective outpatient procedure for treating all grades of VUR.


Assuntos
Acrilatos/química , Resinas Acrílicas/química , Álcoois/química , Endoscopia/métodos , Refluxo Vesicoureteral/terapia , Adolescente , Materiais Biocompatíveis/química , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Fatores de Tempo , Ureteroscopia/métodos , Uretra/patologia , Bexiga Urinária/patologia
10.
J Clin Res Pediatr Endocrinol ; 5(4): 229-35, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24379031

RESUMO

OBJECTIVE: Disorders of sex development (DSD) are a group of congenital medical conditions that affect life as a whole. In this study, we aimed to reflect the experience of a multidisciplinary team in the clinical/psychiatric follow-up of a group of children and adolescents with DSD. METHODS: The study group consisted of 51 patients diagnosed with DSD. The Kiddie-Schedule for Affective Disorders and Schizophrenia, Wechsler Intelligence Scale for Children-Revised, Draw a Person Test and Children's Apperception Test, and the Clinical Global Impression Scale (CGIS) were used for psychiatric evaluations. RESULTS: The mean age of the patients was 7.8 years (median: 7.8; min: 1.0; max: 18.0). Genetic evaluation showed 46,XX configuration in 15 patients (29.4%) and 46,XY in 35 (68.6%). One patient (2.0%) was diagnosed to have a sex chromosome disorder. Forty patients (78.4%) had no problems with their given gender identity and gender role. Thirty-four (66.7%) patients had normal intellectual capacity. Twenty-eight (54.9%) patients did not have any psychiatric problem. Depression, anxiety disorders, attention deficit/hyperactivity disorder, and adjustment disorders were the common diagnoses. The mean score of symptom severity on CGIS-severity-baseline was 6.15±0.68 and after one year, it was 1.46±0.51 (Z=-3.236 p=0.001). The mean score of CGI-Improvement was 1.23±0.44. CONCLUSION: It is important to identify and treat the psychiatric disorders encountered in patients with DSD. A psychiatrist needs to be included in the professional team following these patients. Examination and observation results need to be shared by holding periodic team meetings to establish a wholesome point of view for every unique child.


Assuntos
Transtornos do Desenvolvimento Sexual/diagnóstico , Transtornos do Desenvolvimento Sexual/psicologia , Equipe de Assistência ao Paciente , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Pré-Escolar , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos do Desenvolvimento Sexual/genética , Feminino , Seguimentos , Humanos , Lactente , Cariotipagem , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/genética , Transtornos Mentais/psicologia , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Escalas de Wechsler
11.
J Pediatr Urol ; 9(3): 344-7, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22687342

RESUMO

OBJECTIVE: To evaluate the clinical course of multicystic dysplastic kidney (MCDK) and to reveal any criteria indicating spontaneous involution. MATERIAL METHODS: Hospital records of patients with MCDK followed in two different institutions in 1994-2009 were reviewed and data were analyzed regarding involution. RESULTS: Records of 96 patients were reviewed, of whom 46 were diagnosed antenatally and followed for more than 1 year. Fourteen patients had undergone nephrectomy. There was one case of hypertension which resided with nephrectomy. There was no malignancy. Involution rate was 53.6% (15/28) for right-sided and only 16.7% (3/18) for left-sided kidneys. The initial size of the kidney was found to be another predictive parameter for involution. Initial sizes of 43 (15 involuted and 28 non-involuted) kidneys were documented. Mean standard deviation score for involuting and non-involuting kidneys was -3.19 and 3.12, respectively. The chance of involution for a large kidney on the left was zero; however, involution risk for a small right-sided kidney was 67%. CONCLUSION: Reviewing a 15-year period of our patient records conveyed data supporting current literature mainly encouraging non-operative management of MCDK. Further studies are required; however, our two objective indicators, the initial size and side of dysplastic kidney, may contribute to the management.


Assuntos
Rim Displásico Multicístico/patologia , Rim Displásico Multicístico/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Rim Displásico Multicístico/cirurgia , Nefrectomia , Estudos Retrospectivos , Sensibilidade e Especificidade
12.
J Pediatr Surg ; 45(1): 262-4, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20105617

RESUMO

A 17-year-old girl with the diagnosis of right renal hydatid disease was treated by retroperitoneoscopic technique. No complications occurred at peroperative and postoperative periods. There were no clinical symptoms and radiologic pathologic causes to show recurrence at postoperative second year. This is the first case that is reported via retroperitoneoscopic laparoscopic approach at the treatment of renal hydatidosis in children. We prefer retroperitoneoscopic approach to avoid intraperitoneal contamination. Retroperitoneoscopic laparoscopic treatment can be an alternative treatment technique at renal hydatidosis therapy because of its advantages to conventional surgery, Although further reports of its long-term outcomes and additional experiences are necessary.


Assuntos
Equinococose/cirurgia , Nefropatias/cirurgia , Laparoscopia/métodos , Adolescente , Feminino , Humanos , Estudos Longitudinais , Espaço Retroperitoneal , Resultado do Tratamento
13.
J Urol ; 179(4): 1564-7, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18295262

RESUMO

PURPOSE: The objective of this study was to determine the clinical, demographic, urodynamic and prognostic characteristics related to vesicoureteral reflux among patients with idiopathic lower urinary tract dysfunction. MATERIALS AND METHODS: We retrospectively reviewed the records of 348 children with idiopathic detrusor overactivity or dysfunctional voiding who had been examined for vesicoureteral reflux between 1995 and 2005 at a university hospital. Demographic, clinical and urodynamic parameters were compared between groups according to the presence, grade, laterality and resolution of vesicoureteral reflux. RESULTS: Among the 348 patients 8 infants were excluded from statistical analysis and are discussed separately. Among the 340 remaining patients 1 year and older vesicoureteral reflux was documented in 155 (46%), of whom 32% had bilateral reflux. Of the overall cases 60% were grade III or higher. Mean age in the refluxing group (6.5 +/- 2.8 years) was significantly lower than in the nonrefluxing group (7.6 +/- 2.5 years, p <0.001). Continent children presented with a significantly higher rate of vesicoureteral reflux compared to incontinent children (74% vs 42%, p <0.001). Among the patients who had urinary tract infection the presence of reflux increased the rate of renal cortical abnormalities (45% vs 17%, p <0.001). However, among patients who were free of urinary tract infection the presence of reflux was not associated with cortical abnormalities (25% vs 24%, p >0.05). Median maximum filling pressure was higher in the refluxing group compared to the nonrefluxing group (40.0 vs 34.0 cm H(2)O, p <0.001). Detrusor overactivity and dysfunctional voiding showed similar rates for development of vesicoureteral reflux. Reflux was resolved with medical treatment in 40% of the patients. The resolution rate was significantly higher in children with nondilating reflux and initial lower median cystometric bladder capacity. CONCLUSIONS: Vesicoureteral reflux is associated with daytime incontinence, urinary tract infection, younger age and renal cortical abnormalities among patients with idiopathic lower urinary tract dysfunction. Increased intravesical pressures seem to be the primary factor for inducing reflux in idiopathic lower urinary tract dysfunction. Initial bladder capacity predicts the resolution of reflux.


Assuntos
Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária/fisiopatologia , Transtornos Urinários/fisiopatologia , Refluxo Vesicoureteral/fisiopatologia , Criança , Pré-Escolar , Humanos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Urodinâmica
14.
J Clin Ultrasound ; 35(7): 357-62, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17523192

RESUMO

PURPOSE: To determine whether sonographic examination of subureteral implants after endoscopic dextranomer/hyaluronic acid (DHA) injection would help to evaluate the efficacy of this method in the treatment of vesicoureteral reflux. MATERIALS AND METHODS: Thirty-six patients (49 ureters) who underwent endoscopic subureteral DHA injection were evaluated using voiding cystourethrography (VCUG) and bladder sonography for a mean duration of 2.1 years (range, 3 months to 6.5 years) after treatment. Patient records-including the results of VCUG, renal sonography, Dimercapto succinic acid (DMSA) scintigraphy, and periodic urinary analysis-were also reviewed to determine the outcome of treatment. RESULTS: Reflux was corrected in 43/49 (88%) ureters (complete cure in 38, downgrading of reflux in 5). No change was noted in 6 (12%) ureters on VCUG. The reflux was found to be corrected in 19/22 (86%) ureters, with the implants clearly identifiable on sonography. However, reflux was documented in only 3/27 (11%) ureters, around which no implant was seen on sonography. CONCLUSION: The identification of the implant in the subureteral region by bladder sonography correlated with resolution of reflux in the early postinjection period. On the other hand, the majority of the implants disappeared on sonography in the long term despite correction of reflux. Therefore, we believe that the use of bladder sonography is not useful in the evaluation of patients in long-term follow-up.


Assuntos
Dextranos/uso terapêutico , Ácido Hialurônico/uso terapêutico , Próteses e Implantes , Bexiga Urinária/diagnóstico por imagem , Refluxo Vesicoureteral/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Injeções , Masculino , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler
15.
Urol Int ; 75(2): 129-32, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16123566

RESUMO

INTRODUCTION: It is recommended that the bladder be filled at least twice to perform a standard urodynamic study. However, the procedure is time-consuming and distressing for both the patient and the professional. The impact of the number of fillings on urodynamic parameters in children with normal urodynamic results and those with detrusor instability is presented in this study. PATIENTS AND METHODS: Urodynamic data from 70 children with detrusor instability and 42 with normal urodynamic parameters who had undergone 3 consecutive fillings in a single session during a 2-year period were reviewed retrospectively. The variable parameters that were compared between the 2 groups were the mean bladder capacity ratio, maximum filling pressure and the number of contractions during the filling phase. RESULTS: In the normal group, no difference was found in bladder capacities between the 3 fillings, but there was a significant decrease in the maximum bladder filling pressures in the subsequent fillings. In children with detrusor instability, the number of contractions in the 1st filling was significantly higher than those in the subsequent fillings. Also in this group, a significant difference in the mean bladder capacities between fillings was noted as well as a decrease in the maximum bladder filling pressures in contrast to normal bladders. CONCLUSION: In patients with suspected detrusor instability the bladder should be filled at least twice for a reliable urodynamic assessment. Two normal fillings without contractions, with normal capacity and normal maximum bladder filling pressure are highly suggestive of a normal 3rd filling.


Assuntos
Contração Muscular , Doenças da Bexiga Urinária/diagnóstico , Bexiga Urinária/fisiopatologia , Urodinâmica/fisiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Músculo Liso/fisiopatologia , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores de Tempo , Micção/fisiologia , Urologia/métodos
17.
Turk J Pediatr ; 44(3): 240-3, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12405437

RESUMO

A prospective study was established to identify the incidence of vesicoureteral reflux in the asymptomatic siblings of patients with reflux in our region. Of 32 patients with reflux, 37 siblings were screened with urine analysis, urine culture and contrast voiding cystourethrograms, and six (16.2%) were found to have reflux. Renal scan revealed scarring in five. We concluded that siblings of children with vesicoureteral reflux are at high risk, and must be screened so that renal damage and associated morbidity secondary to reflux might be minimized.


Assuntos
Refluxo Vesicoureteral/genética , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Distribuição por Sexo , Turquia/epidemiologia , Refluxo Vesicoureteral/epidemiologia
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