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1.
Pan Afr Med J ; 33: 170, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31565131

RESUMO

Congenital mega-urethra is a rare malformation causing micturition disturbance sometimes associated with upper urinary tract impairment. Despite the frequent association with other urinary and non-urinary abnormalities in children, stone-related complication has been reported only once in the literature. We report a case of congenital mega urethra complicated by stasis and stone formation in a 3 year old child successfully treated in the Department of Paediatric Surgery at the Mother-Child Hospital in Nouakchott. This study highlights the epidemiological clinical and therapeutic features of this association between congenital mega-urethra and urinary stones.


Assuntos
Uretra/anormalidades , Cálculos Urinários/diagnóstico , Pré-Escolar , Humanos , Masculino , Resultado do Tratamento , Uretra/cirurgia , Cálculos Urinários/patologia , Cálculos Urinários/cirurgia
3.
J Med Case Rep ; 13(1): 46, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30813946

RESUMO

BACKGROUND: Congenital prepubic sinus is a rare anomaly found in the midline of the lower abdomen. Congenital prepubic sinus is usually asymptomatic in neonates, and a diagnosis is often achieved later in life after spontaneous extrusion of purulent material from the pre-existing hole in the pubic region. We present a case of congenital prepubic sinus presenting with purulent discharge after circumcision. A 4-year-old Caucasian boy presented to our urology out-patient clinic with purulent discharge from the distal part of the dorsum of his penis. He had a history of circumcision performed at a different center, 6 months ago. His parents stated that although various antibiotics were used, the purulent discharge continued for 6 months and the child had no complaints before circumcision. His condition was reported as superficial dorsal venous thrombosis, known as penile Mondor disease, in magnetic resonance imaging that was performed in the previous hospital. A physical examination revealed a small pinhole lesion at the distal part of his penis and a rigid cylindrical tube extending to the proximal side of his penis. We performed fistulography by injecting contrast material through a small angiocatheter and confirmed the diagnosis of prepubic sinus. Surgical exploration was performed and a long sinus, apparently ending as a fibrous tract at the anterior surface of his pubic symphysis, was found and resected. CONCLUSIONS: Before congenital prepubic sinus surgery, it is critically important to rule out penile Mondor disease and the possibility of a circumcision complication (especially infective complications) mimicking congenital prepubic sinus.


Assuntos
Circuncisão Masculina , Fístula Cutânea/patologia , Pênis/patologia , Sínfise Pubiana/patologia , Uretra/patologia , Pré-Escolar , Circuncisão Masculina/efeitos adversos , Fístula Cutânea/congênito , Fístula Cutânea/cirurgia , Humanos , Masculino , Pênis/anormalidades , Pênis/cirurgia , Sínfise Pubiana/cirurgia , Resultado do Tratamento , Uretra/anormalidades , Uretra/cirurgia
4.
Pediatrics ; 143(3)2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30709926

RESUMO

OBJECTIVES: Posterior urethral valves predispose children to renal replacement therapy (RRT) and bladder dysfunction. Researchers of single-institutional series were unable to refine risk stratification because of rarity of the disease. We aimed to identify clinical variables associated with the risk of RRT and clean intermittent catheterization (CIC) in a large multicenter cohort study. METHODS: Children with posterior urethral valves born between 1995 and 2005 who were treated before 90 days of life at 5 children's hospitals were retrospectively reviewed. Outcomes included RRT and recommendation for CIC. Predictors and outcomes were assessed by using survival analysis. RESULTS: A total of 274 patients were managed for a median of 6.3 years, and 42 progressed to RRT. On survival analysis, 16% progressed to RRT by 10 years of age. RRT varied by the serum nadir creatinine level in the first year of life (SNC1) (log-rank P < .001). After stratifying by the SNC1, the estimated risk of progressing to RRT by 10 years of age was 0%, 2%, 27%, and 100% for an SNC1 of <0.4, an SNC1 of 0.4 to 0.69, an SNC1 of 0.7 to 0.99, and an SNC1 of ≥1.0 mg/dL, respectively. CIC was recommended in 60 patients, which translated on survival analysis to a risk of 26% by 10 years of age. CONCLUSIONS: Risk of RRT and CIC recommendation increased with age. The SNC1 strongly predicted need for RRT. These results allow for both improved family counseling and the potential for more appropriate screening and intervention strategies for those identified in higher-risk groups.


Assuntos
Cateterismo Uretral Intermitente/métodos , Terapia de Substituição Renal/métodos , Uretra/anormalidades , Uretra/diagnóstico por imagem , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Cateterismo Uretral Intermitente/efeitos adversos , Masculino , Terapia de Substituição Renal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
5.
J Pediatr Surg ; 54(7): 1467-1470, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30115449

RESUMO

BACKGROUND: Congenital Prepubic Sinus (CPS) is an uncommon urogenital anomaly characterized by a blind tract between the skin over the pubis to anterior of the urinary bladder, Urethra or umbilicus. We report four such cases to emphasize varied clinical presentation and embryological conundrum. METHODS: Following Ethical Review Committee (ERC) approval, medical records of pediatric patients (<16 years) presenting with CPS (identified through operating room records and Hospital Information Management System (HIMS) between 1994 and 2018 were reviewed for demographics, clinical presentation, investigations including histopathology, management and outcome. RESULTS: Four cases of CPS, 3 females and 1 male, age range 9 months to 13 years were managed over 25-years. Clinical presentation includes a discharging sinus and recurrent episodes of cellulitis and abscess formation in pubic area and labia majora. Urological investigations were mostly normal. Insertion of lacrimal probe or plastic sheath of intravenous cannula through the sinus opening was useful to determine the course of sinus and aid its excision. Histology of excised sinus highlights the possible embryological origin. CONCLUSIONS: CPS is a rare anomaly with varied clinical presentation. It seems CPS is an aborted urethral duplication (Stephen Type 3) or a Cloacal remnant. Complete excision of the tract in the reported cases was curative. TYPE OF STUDY: Case series. LEVEL OF EVIDENCE: IV.


Assuntos
Cloaca/anormalidades , Umbigo/anormalidades , Uretra/anormalidades , Bexiga Urinária/anormalidades , Abscesso/etiologia , Adolescente , Celulite (Flegmão)/etiologia , Pré-Escolar , Cloaca/cirurgia , Feminino , Humanos , Lactente , Masculino , Umbigo/cirurgia , Uretra/cirurgia , Bexiga Urinária/cirurgia
6.
Trop Doct ; 49(1): 65-67, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30394855

RESUMO

This case series of 51 patients (age range = 11-17 years; 30-month follow-up) describes a new modified approach to treatment of distal and mid-penile hypospadias that has fewer complications. The meatal locations were sub-coronal (51%), coronal (45%) and mid-penile (4%). Forty patients had chordee. Urethra with the corpus spongiosum was dissected off the corpus cavernosum up to the peno-scrotal junction. The distal 5 mm stenotic and avascular part of the urethral tube was excised. The elastic urethra was then stretched and sutured to form a neo-meatus. The urethra was anchored to the Buck's fascia at the glandular, sub-coronal and mid-penile levels. Meatal regression in one patient (2%), subcutaneous hematomas in two patients (4%) and wound dehiscence in two patients (4%) were the complications in the immediate postoperative period. None developed fistula, meatal stenosis or residual chordee in the 30-month follow-up.


Assuntos
Hipospadia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Uretra/cirurgia , Adolescente , Criança , Seguimentos , Humanos , Masculino , Pênis/anormalidades , Pênis/cirurgia , Complicações Pós-Operatórias , Uretra/anormalidades
7.
Eur J Pediatr Surg ; 29(1): 85-89, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30267391

RESUMO

INTRODUCTION: Delayed presentation of posterior urethral valves (PUVs) is a rare condition. Presentation and diagnosis of the patients with late PUVs are challenging. Voiding cystourethrogram (VCUG) is mainly practiced. In this study, we aimed to evaluate the children with late-presented PUVs, and the reliability of VCUG in this group. MATERIALS AND METHODS: Between January 2003 and December 2017 records of patients who were diagnosed with late-presented PUVs were analyzed. Delayed presentation of PUV was defined as patients who were diagnosed and treated after infancy. Cases were examined in terms of age at diagnosis, presenting symptoms, urinalysis, urinary ultrasound, urodynamic studies, VCUG, and dimercaptosuccinic acid scintigraphy findings. Postoperative follow-up conditions were also assessed. RESULTS: Seventeen boys were diagnosed with late-presented PUVs (mean age was 7.35 years). The most common symptoms at presentation were frequency (58.8%), day and nighttime incontinence (47%), and febrile urinary infection (41%). PUV was noted by VCUG in 10 patients alone. The classical sign of dilated posterior urethra was detected in 9 patients. The 10th patient had posterior urethral irregularity. Urethra could not be evaluated due to unsuccessful voiding in one patient. Six patients had normally appearing urethra on VCUG. Reflux was detected in nine (52.9%) patients. CONCLUSION: Late-presented PUVs may be missed on VCUG. Whether a PUV might be present is crucial in boys with a history of recurrent urinary infection, persistent reflux, and repetitive daytime incontinence. Based on our results, we conclude that cystoscopic examination should be preferred for those cases to diagnose PUVs regardless of VCUG results.


Assuntos
Cistografia/métodos , Uretra/anormalidades , Uretra/diagnóstico por imagem , Adolescente , Humanos , Masculino , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Uretra/cirurgia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Infecções Urinárias/etiologia , Micção , Transtornos Urinários/etiologia
8.
J Pediatr Surg ; 54(2): 313-317, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30528203

RESUMO

AIM: The most common cause of congenital bladder outlet obstruction (BOO) is posterior urethral valves (PUV). Initial treatment requires decompression, but transurethral incision (TUI) or primary diversion is all described. There is no randomized control trial to guide management. This study aims to describe management, circumcision, and UTI rate in a national cohort of PUV boys. METHODS: Boys diagnosed with BOO were recruited (via BAPS CASS) over 1 year with ethics committee approval (ref: 12/SC/0416). Data were collected via questionnaire, presented as number (%), analyzed by Mann-Whitney/chi-square/Fisher Exact tests, and p < 0.05 was taken as significant. RESULTS: BOO presented in 121 boys during 2014-2015, and 113 were PUV. Catheter placement in 87/121(72%) was more likely to happen in antenatal vs. postnatal vs. late(>1 y) presentations, p < 0.0001. Polyuria occurred in 23/45(51%), 12/48(25%), 0/28(0%), respectively, p < 0.0001. Initial surgical treatment was TUI in 108/121(89%) and vesicostomy in 2. Two ureterostomies were secondary procedures. Circumcision was performed in 52/121(43%) in antenatal presentation vs. postnatal vs. late 27/45(60%), 20/48(42%), 2/28(7%), respectively, p = 0.01. 69 UTIs occurred in 49 patients. Circumcision was associated with an 86% reduced risk of UTI, p < 0.0001. There was a 66% reduction in UTI risk associated with TUI alone, p < 0.01. There was 1 death due to pulmonary hypoplasia and renal failure, and 2 experienced end-stage renal failure (ESRF). CONCLUSION: Standard treatment for BOO and PUV in the current UK cohort is urethral catheterization followed by TUI. Supravesical diversion is a rescue therapy. UTIs are common and reduced by circumcision, with 43% being circumcised. Initial mortality rate was 1%, and 1.6% present in ESRF. LEVEL OF EVIDENCE: Prognostic study - Level I - Prospective National Cohort Study.


Assuntos
Circuncisão Masculina , Uretra/anormalidades , Obstrução do Colo da Bexiga Urinária/complicações , Obstrução do Colo da Bexiga Urinária/cirurgia , Cateterismo Urinário , Cistostomia , Terapias Fetais , Humanos , Lactente , Recém-Nascido , Masculino , Poliúria/etiologia , Diagnóstico Pré-Natal , Estudos Prospectivos , Taxa de Sobrevida , Uretra/cirurgia , Obstrução do Colo da Bexiga Urinária/congênito , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
9.
J Pediatr Surg ; 54(2): 318-321, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30528204

RESUMO

AIM: Posterior urethral valves (PUVs) are the most common cause of congenital bladder outlet obstruction (BOO) in boys and end-stage renal failure (ESRF) in childhood. In the 1980s, 1 in 4000 boys had PUV. Presentation was 1/3 antenatal/neonatally, 1/3 postnatal, 1/3 late (>1 year). This study aimed to describe the current proportions in a contemporary cohort. METHODS: A national audit (BAPS CASS) of referrals in the UK and Ireland of boys diagnosed with suspected or confirmed PUV in a year was conducted. National registration data provided the male birth-rate. Data were presented as number (%), analysed by Mann-Whitney U-test and Chi-square test, with P < 0.05 taken as significant. The study was approved by a national ethics committee (NRES Committee South Central Oxford A (12/SC/0416)). RESULTS: Data were collected from 1st October 2014 to 30th September 2015 from 25/26 centres on 121 cases of suspected bladder outlet obstruction (BOO), of which 113 (93%) were because of PUV. The male birth rate during the period was 432,806/year. The calculated incidence of BOO was 1/3580 and for PUV was 1/3800 per-annum. The proportion of PUV presenting according to age was: antenatally (n = 40, 35%), infancy (n = 47, 42%), and late (n = 26, 23%). Plasma creatinine was higher in antenatally-diagnosed BOO vs. postnatal, 54 (39.5-109.5) µmol/l vs. 34(21-47) µmol/l, P = 0.0005. Hydronephrosis and ureteric dilatation were significantly greater in antenatally diagnosed BOO vs. postnatal vs. late. Renal dysplasia (cortical thinning, poor corticomedullary differentiation, or renal cysts) was significantly more likely in antenatally diagnosed BOO. CONCLUSION: Neither the incidence (~1/4000) nor the proportion antenatally diagnosed (~1/3) of boys with PUV appears to have changed in the past 30 years. Those boys who were antenatally diagnosed have significantly higher postnatal plasma creatinine, more hydroureteronephrosis, and renal dysplasia than those diagnosed in infancy or later. It may be hypothesized that this is the reason they are detected antenatally. LEVEL OF EVIDENCE: Prognosis study - Level I - prospective national cohort study.


Assuntos
Uretra/anormalidades , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/epidemiologia , Creatinina/sangue , Humanos , Hidronefrose/etiologia , Incidência , Lactente , Recém-Nascido , Irlanda/epidemiologia , Rim/anormalidades , Rim/diagnóstico por imagem , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Masculino , Estudos Prospectivos , Ultrassonografia Pré-Natal , Reino Unido/epidemiologia , Uretra/diagnóstico por imagem , Obstrução do Colo da Bexiga Urinária/complicações , Obstrução do Colo da Bexiga Urinária/congênito
10.
J Pediatr (Rio J) ; 95(3): 328-333, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29534877

RESUMO

OBJECTIVE: Posterior urethral valve is the most common lower urinary tract obstruction in male children. A high percentage of patients with posterior urethral valve evolve to end-stage renal disease. Previous studies showed that cytokines, chemokines, and components of the renin-angiotensin system contribute to the renal damage in obstructive uropathies. The authors recently found that urine samples from fetuses with posterior urethral valve have increased levels of inflammatory molecules. The aim of this study was to measure renin-angiotensin system molecules and to investigate their correlation with previously detected inflammatory markers in the same urine samples of fetuses with posterior urethral valve. METHODS: Urine samples from 24 fetuses with posterior urethral valve were collected and compared to those from 22 healthy male newborns at the same gestational age (controls). Renin-angiotensin system components levels were measured by enzyme-linked immunosorbent assay. RESULTS: Fetuses with posterior urethral valve presented increased urinary levels of angiotensin (Ang) I, Ang-(1-7) and angiotensin-converting enzyme 2 in comparison with controls. ACE levels were significantly reduced and Ang II levels were similar in fetuses with posterior urethral valve in comparison with controls. CONCLUSIONS: Increased urinary levels of angiotensin-converting enzyme 2 and of Ang-(1-7) in fetuses with posterior urethral valve could represent a regulatory response to the intense inflammatory process triggered by posterior urethral valve.


Assuntos
Angiotensina II/urina , Angiotensina I/urina , Feto/anormalidades , Fragmentos de Peptídeos/urina , Peptidil Dipeptidase A/urina , Uretra/anormalidades , Doenças Uretrais/urina , Biomarcadores/urina , Estudos de Casos e Controles , Feminino , Humanos , Técnicas de Imunoadsorção , Recém-Nascido , Masculino , Gravidez , Uretra/embriologia , Doenças Uretrais/diagnóstico , Doenças Uretrais/embriologia
12.
Radiol Technol ; 90(2): 149-167, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30420572

RESUMO

Retrograde urethrograms and voiding cystourethrograms provide clinicians with important information to determine treatment options and surgical interventions for patients with urethral abnormalities. This article discusses the elements with which radiologic technologists should be familiar, including urethra anatomy, the pathology of urethral abnormalities, imaging techniques, and special considerations for preoperative and postoperative patients.


Assuntos
Fluoroscopia , Uretra/anormalidades , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Adulto , Meios de Contraste , Humanos , Masculino , Segurança do Paciente , Exposição à Radiação/prevenção & controle , Proteção Radiológica , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Sistema Urinário/anatomia & histologia
13.
Medicine (Baltimore) ; 97(46): e13249, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30431606

RESUMO

RATIONALE: Periurethral abscess is a life-threatening disease, and the occurrence of a urethral defect with periurethral abscess is a rare finding. In this case, the patient had a lengthy urethral defect from the bulbous urethra to the membranous urethra accompanied by periurethral abscess that developed within a short time. Herein, we report a case of a pedicle-sparing tunica vaginalis flap utilized in urethral reconstruction which degenerated due to fibrotic changes and soft tissue defects in the urethral bed. PATIENT CONCERNS: The patient was a 36-year-old man with fever and lower urinary tract symptoms who had been treated with antibiotics and anti-inflammatory drugs for urinary tract infections 3 days before admission. Purulent necrosis was formed by the urethral abscess, and a long-length urethral defect was formed in the bulbous urethra. DIAGNOSIS: Based on the initial computed tomography and laboratory findings, empirical antibiotics were administered to treat a lower urinary tract infection. On the 7th day of hospitalization, ultrasonography was performed due to the sudden swelling of the scrotum, and the patient was diagnosed with a periurethral abscess that was 10 × 3 cm in size. INTERVENTION: Initial urinary diversion, wide debridement, and a large amount of abscess drainage were performed. Necrosis of the urethral ventral part caused a urethral defect that was 5 cm in size. After treatment with antibiotics, long-term disinfection and intermittent debridement were conducted and urethral reconstruction was performed using a tunica vaginalis flap with preserved vascular structure. OUTCOMES: No complications occurred until 6 months after urethral reconstruction. LESSONS: Urethral reconstruction using a tunica vaginalis flap is a good method for selected patients. Pedicle-sparing tunica vaginalis is an advantageous material for resolving urethral defects, especially when the surrounding circulation conditions are poor.


Assuntos
Abscesso/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Uretra/anormalidades , Doenças Uretrais/cirurgia , Abscesso/complicações , Adulto , Humanos , Masculino , Uretra/cirurgia , Doenças Uretrais/complicações
14.
BMJ Case Rep ; 20182018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30317193

RESUMO

Posterior urethral valves (PUV) are an important cause of paediatric obstructive uropathy. PUV are usually diagnosed by prenatal ultrasonography (US) revealing hydronephrosis and bladder distention. We describe a 17-day-old male infant with abdominal distention who had no hydronephrosis on prenatal US. Laboratory investigations showed serum creatinine of 12 mg/dL, hyperkalaemia and metabolic acidosis. Abdominal US showed large amount of ascites, normal-sized kidneys without hydronephrosis and incompletely distended bladder. Paracentesis revealed clear, yellow ascitic fluid with creatinine level of 27 mg/dL compatible with urinary ascites. Voiding cystourethrogram (VCUG) demonstrated PUV with a dilated posterior urethra, grade 5 right vesicoureteral reflux and a ruptured kidney fornix with peritoneal extravasation of contrast. Foley decompression resulted in normalisation of creatinine within 72 hours. Transurethral resection of PUV was performed, and a repeat VCUG showed recovery of forniceal rupture. This case illustrates an unusual presentation of a potentially life-threatening but treatable cause of urinary tract obstruction.


Assuntos
Ascite/diagnóstico , Uretra/anormalidades , Obstrução Uretral/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Ascite/complicações , Diagnóstico Diferencial , Humanos , Recém-Nascido , Masculino , Tomografia Computadorizada por Raios X , Uretra/diagnóstico por imagem , Uretra/cirurgia , Obstrução Uretral/complicações , Refluxo Vesicoureteral/complicações
15.
BMJ Case Rep ; 20182018 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-30249735

RESUMO

Posterior urethral valve and foreign body are among the important causes of male urethral obstruction. Although one is congenital and the other is acquired, both entities are rare in children with only a few reported cases. Because of myriad of symptoms associated with both conditions, a conclusive diagnosis requires both physical examination and radiological imaging. We report a first of its kind association of posterior urethral valve with foreign body in the posterior urethra in a 6-year-old male child which was eventually managed by endoscopic intervention.


Assuntos
Corpos Estranhos/diagnóstico , Uretra/anormalidades , Obstrução Uretral/etiologia , Criança , Corpos Estranhos/complicações , Humanos , Masculino
16.
Urologe A ; 57(8): 969-986, 2018 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30073372

RESUMO

Dilatations of the urinary tract are discovered in increasing numbers in intrauterine or postnatal sonographic screening examinations. Only few urinary tract anomalies (e. g. urethral valves) require immediate therapy; however, ureteropelvic stenosis and primary megaureter in particular require a prognostic classification between relevant obstructions needing correction and dilations which do not affect renal function. Ultrasound, diuresis scintigraphy and magnetic resonance imaging (MRI) remain the main pillars of advanced diagnostics despite an increasing number of biomarkers. The prevention of progressive renal parenchymal damage is the main focus of diagnostic and therapeutic strategies, while avoiding unnecessary or unnecessarily stressful interventions.


Assuntos
Ureter/anormalidades , Uretra/anormalidades , Sistema Urinário/anormalidades , Dilatação , Humanos , Rim , Imagem por Ressonância Magnética , Cintilografia , Ureter/diagnóstico por imagem , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/etiologia , Estreitamento Uretral/diagnóstico por imagem , Estreitamento Uretral/etiologia , Sistema Urinário/diagnóstico por imagem , Doenças Urológicas/diagnóstico
17.
J Pediatr Surg ; 53(11): 2256-2260, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30037657

RESUMO

PURPOSE: To determine whether there is a difference in the outcome of renal transplantation (RT) in patients with posterior urethral valves (PUV) and children with non-uropathy related end stage renal disease. METHODS: Data were acquired retrospectively. We analyzed possible factors that influence the function of renal allografts and graft survival. Between 1995 and 2016 there were 149 RT. Out of them, there were 27 boys with PUV, who received 29 kidneys. Thirty patients, who received a total of 31 renal grafts due to a non-uropathic (NU) diagnosis, served as control group. Mean follow-up was 7.4 to 10.2 years. RESULTS: There was no difference in estimated graft survival between patients with PUV and NU patients. Graft failure occurred in 23.1% of PUV patients and 34.5% patients of the NU group. There was no statistically significant disparity in graft function between the two groups. Age at transplantation and donor age were the only factors that had a significant impact on renal function. There was a higher incidence of UTI in the PUV group (96%) than in the NU group (67%). Vesicostomy was the favourable intervention in regards of graft function. CONCLUSIONS: RT in PUV patients is successful with the same outcome as in NU patients. Bladder dysfunction may not have a major impact on graft function and graft survival. It seems that the type of pre-transplant surgical procedures may influence outcome. Therefore, these interventions -if necessary- should be limited to a minimum. TYPE OF STUDY: Retrospective Comparative Study LEVEL OF EVIDENCE: Level III.


Assuntos
Transplante de Rim , Uretra , Criança , Pré-Escolar , Humanos , Transplante de Rim/efeitos adversos , Transplante de Rim/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Uretra/anormalidades , Uretra/cirurgia , Doenças Urológicas/cirurgia
18.
J Med Case Rep ; 12(1): 210, 2018 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-30012211

RESUMO

BACKGROUND: Survival of neonates with intrauterine renal insufficiency and oligo- or anhydramnios correlates with the severity of secondary pulmonary hypoplasia. Early prenatal diagnosis together with repetitive amnioinfusions and modern intensive care treatment have improved the prognosis of these neonates. Extracorporeal membrane oxygenation is an established treatment option, mainly applied to neonates with pulmonary hypoplasia caused by congenital diaphragmatic hernia. However, a few case reports of extracorporeal membrane oxygenation in neonates with lower urinary tract obstruction have been published. CASE PRESENTATION: We describe a case of a Caucasian male infant with prenatally diagnosed lower urinary tract obstruction and secondary pulmonary hypoplasia who was delivered spontaneously at 36 + 2 weeks of gestation. Venovenous extracorporeal membrane oxygenation was initiated on the first day of life for severe respiratory failure and consecutive hypoxemia despite treatment with inhaled nitric oxide and high-frequency oscillation. The patient was supported by extracorporeal membrane oxygenation for 10 days and extubated 6 weeks later. Hemofiltration was required on the second day of life because of renal insufficiency and was later replaced by peritoneal dialysis. The child was discharged after 4 months with nasal high-flow mild oxygen therapy and peritoneal dialysis. CONCLUSION: Neonatal extracorporeal membrane oxygenation support is a possible treatment option for neonates with lower urinary tract obstruction and pulmonary hypoplasia.


Assuntos
Anormalidades Múltiplas/terapia , Duodeno/anormalidades , Oxigenação por Membrana Extracorpórea , Doenças Fetais/diagnóstico , Recém-Nascido , Pneumopatias/terapia , Pulmão/anormalidades , Oligo-Hidrâmnio/terapia , Insuficiência Respiratória/terapia , Bexiga Urinária/anormalidades , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/etiologia , Feminino , Doenças Fetais/terapia , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/terapia , Pneumopatias/congênito , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Masculino , Oligo-Hidrâmnio/diagnóstico , Oligo-Hidrâmnio/etiologia , Gravidez , Diagnóstico Pré-Natal/métodos , Prognóstico , Insuficiência Renal/congênito , Insuficiência Renal/diagnóstico , Insuficiência Renal/terapia , Insuficiência Respiratória/congênito , Anormalidades do Sistema Respiratório/diagnóstico , Anormalidades do Sistema Respiratório/terapia , Uretra/anormalidades , Uretra/diagnóstico por imagem
20.
Medicine (Baltimore) ; 97(23): e11033, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29879071

RESUMO

We investigated long-term functional changes in the kidney and bladder of patients with posterior urethral valve (PUV) who underwent fetal intervention or postnatal surgery.We retrospectively reviewed the medical records of 28 consecutive patients treated for PUV at our institution. Detailed data on medical and surgical histories, particularly on pre- and postnatal treatment modality, including fetal vesicoamniotic shunt, endoscopic valve ablation, and vesicostomy, were collected and analyzed. Long-term renal function was evaluated based on serum levels of creatinine (sCr), estimated glomerular filtration rate (eGFR), and renal scans. Voiding function was evaluated in urodynamic tests.Vesicoamniotic shunting was performed in 12 (42.8%) patients. Although the mean initial sCr was significantly higher in patients in whom a fetal shunt was placed than in others (2.04 vs 1.17 mg/L, P = .038), the sCr at long-term follow-up was not significantly different between them (0.64 vs 0.40 mg/L, P = .186). The mean maximum detrusor pressure was significantly lower in patients with a fetal shunt than in others (37.7 vs 73.0 cm H2O, P = .019). Postnatal vesicostomy was performed in 14 patients, and primary valve ablation was performed in 13 patients. The mean initial sCr was higher in patients in the vesicostomy group than in the primary valve ablation group (2.08 vs 0.86 mg/L, P = .014). However, no significant differences were found in sCr (0.9 vs 0.3 mg/L, P = .252) or GFR (59.1 vs 68.5 mL/min/1.73 m, P = .338) at long-term follow-up. Bladder capacity was greater and residual urine volume was less in the vesicostomy group than in the primary valve ablation group, but without statistical significance.Vesicostomy is more beneficial in the recovery of renal function and is not inferior in terms of bladder function, even in patients with severe PUV disorder. It is a reliable surgical option that can spare renal function and guarantee adequate bladder function in the long term.


Assuntos
Rim/fisiopatologia , Uretra/anormalidades , Estreitamento Uretral/complicações , Bexiga Urinária/fisiopatologia , Creatinina/sangue , Cistostomia/métodos , Terapias Fetais/métodos , Idade Gestacional , Taxa de Filtração Glomerular/fisiologia , Humanos , Testes de Função Renal/métodos , Masculino , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Uretra/patologia , Uretra/cirurgia , Obstrução Uretral/epidemiologia , Obstrução Uretral/etiologia , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/cirurgia
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