Voiding cystourethrography (VCUG) has been considered as the gold standard technique for the diagnosis of vesicoureteral reflux (VUR). But, it requires fluoroscopic guidance which expose children to radiation. Voiding urosonography (VUS) is technically analogous to VCUG and has the major advantage of zero radiation exposure. This study aims to determine the efficacy of contrast enhanced-VUS (ce-VUS) with respect to VCUG in diagnosing VUR.This study involves 30 children over a period of 3 years. All patients underwent a VCUG followed by the ce-VUS on the same day. All VUS studies were done by the same sonologist in the sonography department. The images were recorded and reviewed by the same sonologist before reporting.The median age of the patients was 51.53 months. There were 21 males and 9 females. On VCUG, 16 patients had no reflux, and 14 patients had reflux. On ce-VUS, 14 patients had no VUR, and 16 patients had VUR. Of the total 58 kidney-ureter units (KUUs), VUR was detected in 17 KUUs on VCUG and in 21 KUUs on ce-VUS. Thus, ce-VUS detected 4 refluxing units that were not seen on VCUG. In right KUUs, ce-VUS detected VUR in 3 units where no reflux was found in VCUG. In the 28 left KUUs, 25 units on ce-VUS showed concordance with the grade of VUR as detected by VCUG; 3 were discordant. Two units on ce-VUS showed a VUR one grade higher than the corresponding grade on VCUG and in one unit it was one grade lower. Thus, in total, ce-VUS picked up 4 cases which were missed by VCUG.ce-VUS is a good imaging modality when compared to voiding cystourethrography to assess pediatric vesicoureteral reflux, in view of its superior diagnostic performance, feasibility and radiation safety for children.
Introduction: The modified Asopa's procedure for repair of hypospadias is well established and suited for patient characteristics for which Snodgrass urethroplasty cannot be done. We describe our experience with this procedure in 30 patients managed with this procedure highlighting the factors affecting outcome in this repair. Materials and Methods: Data of 30 patients (age range 2.5-15 years) who underwent hypospadias repair in a tertiary care teaching institution from 2012 to 2015 with modified Asopa procedure (Hodgson XX technique) utilizing Transverse Preputial Island Flap by a single surgeon were reviewed and retrospectively analyzed according to age of patients, site of meatus, presence or absence or chordee, glans configuration and complications - fistula, glans dehiscence, meatal stenosis. These complications were further analyzed with respect to the various patient characteristics and GMS (Glans, Meatus and Shaft) score. Results: The mean age of presentation was 5.5 years and mean follow-up period was 22 months. The mean total GMS score was 8.5; range being 11 to 5. In total, only six patients had complications (20%). The patients with low GMS score (7 or less) had no complications. The complication rate was more in proximal hypospadias repair (n= 5/24) when compared with distal hypospadias (n=1/6). There were more complications in patients with chordee (n=4/6) and those with conical glans (n=4/6). Conclusion: Location of the meatus, presence/absence of chordee and glans configuration affect outcome in patients undergoing modified Asopa's procedure for hypospadias repair. Keywords: hypospadias; Asopa's procedure; Child; Complications; Outcome .
Introduction: Pediatric urolithiasis is a morbid condition that is often associated with underlying metabolic disorders. It is essential to diagnose and manage the underlying metabolic disorder along with management of urolithiasis to prevent stone recurrence and decrease the morbidity. Materials and Methods : This retrospective observational study was conducted in 50 patients below 15 years of age with urolithiasis. Urine collection was done for 24 hours in toilet-trained children and spot samples were taken from younger children. The urinary parameters that were evaluated included calcium, oxalate, citrate, uric acid, and total urine volume. The serum levels of calcium, phosphorus, creatinine, uric acid, electrolytes, parathormone, and albumin were also measured. Stone analysis was done whenever possible. Results: There were 32 males and 18 females. Sixty-two percent of the patients had a low calcium intake and 70% of the children had a history of low water intake and had a low urine volume over 24 hours. Half of the children had serum metabolic abnormalities, including hypocalcaemia (n=19,38%), hypocalcaemia with hyperphosphatemia (n=2, 4%), hypercalcemia (n=2, 4%), and hyperuricemia (n=2,4%). Urinary abnormalities were detected in 42% of the children (n=21). These abnormalities included hypocitraturia in 11 patients (50%), hypercalciuria in 7 patients (30%), hyperoxaluria in 1 patient (6%), and hyperuricosuria in 2 patients (12%). Stone analysis was done in 18 patients. Fifteen patients (30%) had calcium oxalate stones, two patients (4%) had uric acid stones, and one patient had a mixed stone. Conclusions: It is important to maintain an optimal blood calcium level and increase fluid intake to prevent stone formation in children. Keywords : Urolithiasis; Pediatric; Metabolic Disorders.
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)
