Introduction: Intermittent pelviureteric junction obstruction, and its consequence,intermittent hydronephrosis is a difficult condition to identify. The renal collecting system is not dilated between the episodes of abdominal pain attacks and a prompt investigation is hard to carry out during the time of painful crisis. Therefore, most of the patients are initially misdiagnosed. Aim: The aim of the study was to assess the occurrence and the clinical characteristics of this phenomenon in children operated in the Department of Urological Surgery, Heim Pál Children Hospital, Budapest, Hungary. Patients and methods: Medical records of children operated for hydronephrosis between 2008 and 2012 were reviewed. The occurrence rate and clinical features of intermittent hydronephrosis were analyzed. Results: 76 children were operated for pelviureteric junction obstruction, of which 10 met the criteria of intermittent hydronephrosis. The average interval between the onset of symptoms and the final diagnosis was 2 years and 4 months. In 7 patients pyeloplasty, and in 3 patients nephrectomy were performed. Conclusions: Intermittent hydronephrosis represents a well-defined proportion among cases operated for hydronephrosis. The delay in diagnosis led to the loss of the kidney in one third of the patients, and this finding urges for the awareness of health professionals for this phenomenon. In case of recurrent abdominal pain of unknown etiology one must suspect a urological origin, even if a previous abdominal ultrasound showed normal kidneys. Orv. Hetil., 2013, 154, 940–946.
A total of 1386 operations for undescended testis was made in 1250 boys. In 774 of them an apparently intact testis and epididymis were found. In 612, such epididymal developmental abnormalities were detected which exclude or do not make possible the passage of sperms from these organs to the deferent duct. It is believed to be plausible that the large number of cases with infertility is due, also in individuals with a unilateral cryptorchidism, to the abnormal fusion of the epididymis in both testes.
Bevezetes: Az intermittalo pyeloureteralis obstrukcio es kovetkezmenye, az intermittalo hydronephrosis korismezese nem egyszerű, mivel panaszmentes időszakban veseuregi tagulat nincs, es a rohamszerű hasi-vesetaji fajdalmak idejen azonnali kivizsgalasra legtobbszor nincs mod. A betegek tobbseget sokaig teves diagnozissal kezelik, ez a keslekedes a vese elvesztesehez vezethet. Celkitűzes: A Fővarosi Heim Pal Gyermekkorhaz Urologiai Sebeszeti Osztalyan a korkep gyakorisaganak es klinikai jellemzőinek elemzese. Betegek es modszer: A szerzők attekintettek 2008 es 2012 kozott pyeloureteralis obstrukcio miatt operalt betegekben a korkep előfordulasat, a korlefolyas jellegzetessegeit. Eredmenyek: 76 gyermeket operaltak pyeloureteralis obstrukcio, kozuluk 10 gyermeket (het fiu, harom leany) intermittalo hydronephrosis miatt. A panaszok kezdetetől a diagnozis felallitasaig atlagosan ket ev negy honap telt el. A 10 gyermek kozul het gyermekben szervmegtarto műtet, haromnal nephrectomia tortent. Kovetkeztetesek: Az intermittalo hydronephrosis nem elhanyagolhato aranyban fordul elő a hydronephrosis miatt operalt gyermekekben. A korismezes keslekedese betegeink mintegy egyharmadaban a vese elvesztesevel jart, ezert is kell felhivni a gyermekkori hasi fajdalmak kivizsgalasaval foglalkozo szakemberek figyelmet e korkepre. Visszaterő, ismeretlen eredetű hasi fajdalmak eseten akkor is gyanakodni kell veseeredetre, ha a korabbi ultrahang ep hugyszerveket mutatott. Orv. Hetil., 2013, 154, 940–946.
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Introduction: Intermittent pelviureteric junction obstruction, and its consequence,intermittent hydronephrosis is a difficult condition to identify. The renal collecting system is not dilated between the episodes of abdominal pain attacks and a prompt investigation is hard to carry out during the time of painful crisis. Therefore, most of the patients are initially misdiagnosed. Aim: The aim of the study was to assess the occurrence and the clinical characteristics of this phenomenon in children operated in the Department of Urological Surgery, Heim Pal Children Hospital, Budapest, Hungary. Patients and methods: Medical records of children operated for hydronephrosis between 2008 and 2012 were reviewed. The occurrence rate and clinical features of intermittent hydronephrosis were analyzed. Results: 76 children were operated for pelviureteric junction obstruction, of which 10 met the criteria of intermittent hydronephrosis. The average interval between the onset of symptoms and the final diagnosis was 2 years and 4 months. In 7 patients pyeloplasty, and in 3 patients nephrectomy were performed. Conclusions: Intermittent hydronephrosis represents a well-defined proportion among cases operated for hydronephrosis. The delay in diagnosis led to the loss of the kidney in one third of the patients, and this finding urges for the awareness of health professionals for this phenomenon. In case of recurrent abdominal pain of unknown etiology one must suspect a urological origin, even if a previous abdominal ultrasound showed normal kidneys. Orv. Hetil., 2013, 154, 940–946.
Context: Insulin-like 3 and its receptor, leucine-rich repeat-containing G protein-coupled receptor 8 (LGR8), are essential for the first phase of testicular descent. Homozygous loss of either of the two genes in mice leads to cryptorchidism. Although mutations in both homologous human genes are not a common cause of cryptorchidism. To date, only one missense mutation at codon 222 (T222P) of the LGR8 gene has been proposed as a causative mutation for cryptorchidism. This conclusion was based on both functional in vitro studies and the lack of mutation in a large group of controls. The geographical origin of the mutation carriers suggested a founder effect in the Mediterranean area. Objectives: We sought to define the frequency of the T222P mutation in four different countries to assess whether the screening for this mutation could be of use as a diagnostic genetic test. Materials and Methods: A total of 822 subjects (359 with a history of cryptorchidism and 463 controls) from Italy, Spain, Hungary, and Egypt were genotyped for the T222P mutation by direct sequencing. Results: The phenotypical expression of the mutation also included normal testicular descent. The mutation frequency was not significantly different in cryptorchid patients vs. noncryptorchid controls (3.6 vs. 1.7%, respectively). No significant geographical differences were observed in mutation frequencies. The haplotype analysis allowed us to predict three distinct haplotypes, i.e. three possible mutation events. Conclusions: Our results suggest that the T222P mutation cannot be considered either causative or a susceptibility factor for cryptorchidism. A true causative mutation in the LGR8 gene still remains to be identified.
There are recurrences and postoperative hydrocele of varicocele after any kind of surgical treatment. Laparoscopic clipping and dissection of internal spermatic vessels was performed without any complication in 73 children to treat varicocele in our department between 1995 and 1998. We have used a new method to detect etiological factors at laparoscopic surgery. The well-known Linton and Trendelenburg test was adapted to detect incidental collateral veins in 73 patients. Using these test, collateral veins were detected in 16 boys. The testicular artery identified in most of the cases as a pulsatile vessel. The operating time was 10-25 minutes. Laparoscopic varicocelectomy is a safe, effective treatment causing minimal discomfort and allowing patients an early to return to activity. These results suggest this technique a viable alternative to open ligation in paediatric urological practice.
The authors summarise the short history of the laparoscopy, and main steps of its use in international and Hungarian practice of urological surgery. They evaluate the possibility of laparoscopy in paediatric urological practice. Finally, they present their experience with this minimally invasive technique from 1995. Between October 1995 and September 1998, 83 laparoscopic procedures were performed. In 59 patients the vena testicularis were ligated by laparoscopy and in 22 patients 24 non palpable testes were diagnosed and operated. In 9 of the cases laparoscopic orchidopexy was performed. The authors demonstrate their operative technique. All laparoscopic interventions were tolerated well by children and they were treated without any complication. Postoperative pain medication were given for 5 children. The operative time for varix ligation ranged from 15 and 20 minutes, and for laparoscopic orchidopexy from 30 and 40 minutes. The recurrence rate of varicocele was found to be 1.5%, and postoperative hydrocele developed in one patient (1.5%).
