Thirty‐six children aged between two months and 15 years presented with pelvi‐ureterlc junction obstruction between the years 1975 and 1980. This paper discusses the results of surgery, the use of the Cummlngs catheter and emphasises the radiographic assessment and follow‐up of these patients.
Direct radionuclide cystography in 100 patients has been shown to be a useful investigation in the diagnosis and management of reflux and a valuable complement to radiographic methods; it may well have a place in the detection of reflux in the infected patient. The advantages include low radiation exposure, an accurate measurement of residual urine volumes, simplicity of technique and the use of materials and equipment that have in recent years become increasingly available for routing investigation.
Summary— We have followed up 83% of a series of 166 patients with vesicoureteric reflux who were treated surgically more than 10 years ago. We found an incidence of hypertension of 12.8%. The need for careful follow‐up of the blood pressure of patients with reflux nephropathy is stressed.
Vesicoureteric reflux is now considered to be due essentially to congenital malformation of the vesicoureteric junction. It is also considered to be a major cause of renal failure in early adult life. The condition is associated with recurrent urinary tract infection and in some instances with renal scarring. When reflux is detected clinically, in the investigation of patients with recurrent urinary tract infection, renal scarring is often already present. The reflux tends to disappear in later childhood. A family study has been made based on 186 index patients with established primary reflux, with special attention to a history of genitourinary symptoms in the sibs and parents of these patients. There were 39 sibs under the age of 4 years. For these the parents were offered investigation by micturating cystogram. The parents of 20 accepted. Reflux was shown in 3, and in 2 of these there was already renal scarring. The proportion of all infants and young children who have reflux is not accurately known, but the few published surveys of screening of normal infants and young children by micturating cystogram suggest that the prevalence is of the order of 1%. The prevalence in sibs is, then, about 10 times higher. There was a main group of 214 sibs over the age of 4 years. For these the parents were offered investigation by intravenous pyelogram only for those sibs who had a history of recurrent urinary tract infection. If renal scarring was found then a micturating cystogram was done. Of 110 sisters, 12 were `symptomatic9, renal scarring was found in 5 of these (1 was on haemodialysis), and reflux was still present in 3. Of 104 brothers 7 were `symptomatic9, renal scarring was found in 2 and reflux was present in both. For comparison, the published reports of several surveys of schoolgirls indicate that about 2 in 100 have recurrent urinary tract infection, and in about a quarter of these (0·5%) reflux was present and in about one-eighth (0·25%) renal scarring was present. The prevalence in sibs is, then, 10 to 20 times higher. Similarly in the parents: of 183 mothers 7 (1 was on haemodialysis) and of 181 fathers 2 had renal scarring. The family findings are consistent with multifactorial inheritance, as with other common malformations. Routine investigation, in infancy, of younger sibs of patients with vesicoureteric reflux would identify patients in whom the reflux was recognised very early. These would be valuable for the study of the natural history and management of the disorder, and the degree to which it was possible to prevent the development of renal scarring.
Sixteen infants with severe ureteric anomalies were admitted to the Paediatric Unit over the years 1980–81. The two principal aims of treatment were firstly, initial resuscitation and the treatment of severe sepsis, thereby mostly avoiding early operative urinary diversion, and secondly to proceed to corrective surgery when the infant was sufficiently recovered. Initial management included resuscitation, intravenous antibiotics, parenteral nutrition, and where necessary bladder drainage by urethral catheter. Peritoneal dialysis was not required. The diagnosis was established by urography and ultrasound. Surgical urinary diversion was performed on only two of the cases, and results from early corrective surgery have been satisfactory.
Ceftriaxone, a new broad spectrum cephalosporin with a long biological half-life has been used on a single intravenous daily dosage regimen over a five day period to treat complicated urinary tract infection. Bacteriological analysis of urine up to six weeks after such treatment, indicated that ceftriaxone was successful in 13 out of 15 cases treated compared with two out of 15 cases treated with cefuroxime given three times daily over the five day treatment period.
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