[Corrective operations in ureterocele in children].
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The authors analyze their experience in the treatment of 59 children aged 3 months--14 years with ureterocele of the single (22 patients) and double ureter (37 patients). Examination and surgical data showed that ureterocele in the operated on children was congenital and became a component of a complicated malformation of the distal ureter. Structural changes varied from minimal to total dysplasia reflected in the degree of the ureteral dilatation. These changes were characteristic for both normal and double ureters and served the base for treatment policy decision. In normal megaureter the authors performed resection of the distal ureter as well as ureterocele, modelling and neoplantation of the proximal segment according to the antireflux technique. Minor dilatation of the pelvic ureter (up to 1.0-1.5 cm dependent on the patient's age) indicated that structural alterations of its wall are confined to the submucosal segment. In view of this, surgical intervention involved only endovesicular electroperforation of ureterocele. The policy in the double ureter ureterocele was based on the same criteria.Keywords:
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No AccessJournal of Urology1 Feb 1994Urinary Levels of the Renal Tubular Enzyme N-Acetyl-β-D-Glucosaminidase in Unilateral Obstructive Uropathy Michael C. Carr, Craig A. Peters, Alan B. Retik, and James Mandell Michael C. CarrMichael C. Carr , Craig A. PetersCraig A. Peters , Alan B. RetikAlan B. Retik , and James MandellJames Mandell View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)34983-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Elevated urinary levels of the renal tubular enzyme, N-acetyl-ß-D-glucosaminidase (NAG), have been shown to be associated with reversible tubular damage and, therefore, may serve as an indicator of tubular damage in the setting of presumed obstruction uropathy. This study compares urinary NAG levels in children with apparent upper tract obstruction with normal children to assess the sensitivity of this assay for the detection of possible renal tubular damage. The study included 40 children 3 weeks to 16 years old with unilateral ureteropelvic junction obstruction (30) or primary obstructive megaureter (10). Urine was obtained from the bladder in all children and from the renal pelvis or ureter in 30 patients at surgery. Pelvic and ureteral urinary NAG levels were consistently higher than bladder levels. In patients with ureteropelvic junction obstruction NAG levels were 7 times higher than normal (76 units per mg., p <0.0001) and 3 times higher than normal in patients with obstructive megaureter (29 units per mg., p <0.001). The mean bladder urinary NAG levels in patients with ureteropelvic junction obstruction (17.6 units per mg. creatinine, standard error of mean 2.01, p <0.001) and megaureters (19.2 units per mg. creatinine, standard error of mean 3.6, p <0.049) were elevated above control patients (10.6 units per mg. creatinine, standard error of mean 1.02). Elevated urinary NAG levels in the renal pelvis, ureter and bladder may be helpful in identifying upper tract obstruction, which if left untreated, might cause progressive renal deterioration. © 1994 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTaha M, Shokeir A, Osman H, Abd El-Aziz A and Farahat S (2007) Obstructed Versus Dilated Nonobstructed Kidneys in Children With Congenital Ureteropelvic Junction Narrowing: Role of Urinary Tubular EnzymesJournal of Urology, VOL. 178, NO. 2, (640-646), Online publication date: 1-Aug-2007.CHEVALIER R (2018) BIOMARKERS OF CONGENITAL OBSTRUCTIVE NEPHROPATHY: PAST, PRESENT AND FUTUREJournal of Urology, VOL. 172, NO. 3, (852-857), Online publication date: 1-Sep-2004.FURNESS P, MAIZELS M, HAN S, COHN R and CHENG E (2018) ELEVATED BLADDER URINE CONCENTRATION OF TRANSFORMING GROWTH FACTOR-beta 1 CORRELATES WITH UPPER URINARY TRACT OBSTRUCTION IN CHILDRENJournal of Urology, VOL. 162, NO. 3 Part 2, (1033-1036), Online publication date: 1-Sep-1999.Fung L and Atala A (2018) CONSTANT ELEVATION IN RENAL PELVIC PRESSURE INDUCES AN INCREASE IN URINARY N-ACETYL-beta-D-GLUCOSAMINIDASE IN A NONOBSTRUCTIVE PORCINE MODELJournal of Urology, VOL. 159, NO. 1, (212-216), Online publication date: 1-Jan-1998.Edelstein R, Bauer S, Kelly M, Darbey M, Peters C, Atala A, Mandell J, Colodny A and Retik A (2018) Long-Term Urological Response of Neonates With Myelodysplasia Treated Proactively With Intermittent Catheterization and Anticholinergic TherapyJournal of Urology, VOL. 154, NO. 4, (1500-1504), Online publication date: 1-Oct-1995. Volume 151Issue 2February 1994Page: 442-445 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.KeywordskidneyglucosaminidaseenzymesMetricsAuthor Information Michael C. Carr Supported by the National Kidney Foundation/American Foundation for Urologic Disease Research Fellowship. More articles by this author Craig A. Peters More articles by this author Alan B. Retik More articles by this author James Mandell More articles by this author Expand All Advertisement PDF downloadLoading ...
Obstructive uropathy
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Upper urinary tract
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(Background and Methods) we performed renal ultrasonographic screening on 3799 healthy 3-month-old infants, who showed up for the routine health check up in Nobeoka City, for congenital malformations of the urinary tract.(Results) Urinary tract disorders were suspected in 139 (3.7%). Almost all ultrasonographic abnormalities of these were dissociation of CEC (Central Echo Complex). Thirty-three (24.4%) of the 135, which was 0.9% of the original 3799, were diagnosed as having significant congenital anomalies in urinary tract, such as vesicoureteral reflux (VUR) in 17, hydronephrosis in 10, unilateral renal agenesis in 2, unilateral small kidney in 2 and each case of horseshoe kidney, simple ureterocele, ectopic ureterocele, megaureter and mild dilated ureter. Minor or mild renal pelvis enlargement without the dilatation of calyx was found in 78 cases. Fiftythree of the 78 were followed more than 3 months, and complete or partial reduction of the pelvic enlargement was noted in 39 (74%), while enlarged pelvis remained unchanged in 14. There was no progressive hydronephrosis among these patients during the follow-up. Urinary tract infections were found in 6 cases (5 in VUR and 1 in ectopic ureterocele). Eleven ureters in 9 children of VUR (44%) were cured spontaneously (follow-up period: 3 months-6 months and 2 years). Surgical correction was required in 6 cases, antireflux surgery for VUR in 4, heminephroureterectomy for ectopic ureterocele in 1 and endoscopic incision of ureterocele for simple ureterocele in 1.(Conclusion) Our result indicate that infant ultrasonographic screening is a useful and valuable method of detecting urinary tract malformations.
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Objective:To explore the value of MRU in the congenital urinary tract malformation of children. Methods:20 cases of children with congenital urinary tract malformation were retrospectively analysed.MRU using TSE was performed and the results were compared with that of IVP and operation.Results:The stenosis of the pyelo-uretal junction was in 9 cases,the stenosis of the low end of ureter with megaureter was in 7 cases.Atresia of ureter,ureterocele,neruogenic bladder and posterior urethral valve with bilateral vesicoureteral reflux were in 1 case respectively.The natunal images of MRU and MIP images could show the location and degree of obstruction.The diagnostic rate was 90% combined with routine MRI scans.Conclusion:MRU is a non-invasive technique and plays an important role in the diagnosis of congenital urinary tract malformation of children. [
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Objective To investigate the diagnostic value of multi-slice spiral CT urography (MSCTU) in congenital anomalies of kidney and urinary tract. Methods Imaging data of 75 patients with congenital anomalies of kidney and urinary tract confirmed pathologucally or clinically were retrospectively analyzed. MSCTU features were studied. Results The congenital anomalies of kidney and urinary tract were definitely diagnosed with MSCTU in all 75 patients,including ureteropelvic junction obstruction (UPJO) in 34,renal and ureter duplication in 14,horseshoe kidney in 7,ectopic kidney in 6,polycystic kidney in 6,megaureter in 3 and UPJO complicated with other anomalies in 5 patients. Conclusion MSCTU is an excellent method to detect congenital anomalies of kidney and urinary tract.
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Pyelogram
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Multicystic dysplastic kidney
Ectopic kidney
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The authors analyze their experience in the treatment of 59 children aged 3 months--14 years with ureterocele of the single (22 patients) and double ureter (37 patients). Examination and surgical data showed that ureterocele in the operated on children was congenital and became a component of a complicated malformation of the distal ureter. Structural changes varied from minimal to total dysplasia reflected in the degree of the ureteral dilatation. These changes were characteristic for both normal and double ureters and served the base for treatment policy decision. In normal megaureter the authors performed resection of the distal ureter as well as ureterocele, modelling and neoplantation of the proximal segment according to the antireflux technique. Minor dilatation of the pelvic ureter (up to 1.0-1.5 cm dependent on the patient's age) indicated that structural alterations of its wall are confined to the submucosal segment. In view of this, surgical intervention involved only endovesicular electroperforation of ureterocele. The policy in the double ureter ureterocele was based on the same criteria.
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No AccessJournal of UrologyPediatric Urology1 Nov 1997LAPAROSCOPIC HEMINEPHROURETERECTOMY IN PEDIATRIC PATIENTS Gunter Janetschek, Jorg Seibold, Christian Radmayr, and Georg Bartsch Gunter JanetschekGunter Janetschek , Jorg SeiboldJorg Seibold , Christian RadmayrChristian Radmayr , and Georg BartschGeorg Bartsch View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64180-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: An increasing number of operative procedures in pediatric urology can be performed by laparoscopy. We report our experience with laparoscopic heminephroureterectomy, which is a typical operation in pediatric patients. Materials and Methods: Laparoscopic heminephroureterectomy was performed in 14 consecutive children. In 12 cases 7 upper renal poles were removed for ectopic refluxing megaureter and obstructive ureterocele in 5 and 2, respectively. In 5 children lower poles were destroyed by reflux nephropathy. In 2 children laparoscopic upper pole heminephroureterectomy for obstructive ureterocele was combined with a Pfannenstiel incision for reimplantation of the refluxing lower pole ureter. Results: All operations were completed as planned. Operative time was 180 to 330 minutes (mean 222) in group 1 and 345 to 510 (mean 427) in group 2. Blood loss was minimal (10 to 30 ml.) and there were no intraoperative or postoperative complications. Mean postoperative hospital stay in groups 1 and 2 was 4.4 and 7.5 days, respectively. Conclusions: Laparoscopic heminephroureterectomy in children is feasible and associated with minimal blood loss, low morbidity and a low complication rate. The disadvantage is the long operative time. This technically demanding procedure should be performed only at specialized centers. References 1 : Laparoscopic nephrectomy: initial report of pelviscopic organ ablation in the pig. J. Endourol.1990; 4: 247. Google Scholar 2 : Expanding horizons in pediatric laparoscopy. J. Urol.1993; 4: 261A. part 2, abstract 190. Google Scholar 3 : Laparoscopic surgery in pediatric patients. In: Laparoscopic Surgery in Urology.. Edited by . New York: Thieme1996: 106. chapt. 10. Google Scholar 4 : Laparoscopic renal surgery in children. J. Urol.1994; 151: 735. Link, Google Scholar 5 : Laparoscopic nephroureterectomy in the child: initial case report. J. Urol.1994; 151: 740. Link, Google Scholar 6 : Laparoscopic nephroureterectomy in infants. J. Endourol.1993; 4: 236. abstract V-144. Google Scholar 7 : Transperitoneal nephrectomy for benign disease of the kidney: a comparison of laparoscopic and open surgical techniques. Urology1994; 43: 607. Google Scholar 8 : Diagnosis of bilateral abdominal cryptorchism by laparoscopy. Endoscopy1976; 8: 33. Google Scholar 9 : Laparoendoscopic surgical management of the abdominal/transinguinal undescended testicle. J. Endourol.1992; 6: 159. Crossref, Google Scholar 10 : Laparoscopic repair of pediatric hydroceles. J. Endourol.1994; 8: 415. Google Scholar 11 : Laparoendoscopic upper pole partial nephrectomy with ureterectomy. J. Urol.1993; 150: 940. Link, Google Scholar From the Department of Urology, University of Innsbruck, Innsbruck, Austria.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byFuchs J, Luithle T, Warmann S, Haber P, Blumenstock G and Szavay P (2009) Laparoscopic Surgery on Upper Urinary Tract in Children Younger Than 1 Year: Technical Aspects and Functional OutcomeJournal of Urology, VOL. 182, NO. 4, (1561-1568), Online publication date: 1-Oct-2009.Piaggio L, Franc-Guimond J, Figueroa T, Barthold J and González R (2018) Comparison of Laparoscopic and Open Partial Nephrectomy for Duplication Anomalies in ChildrenJournal of Urology, VOL. 175, NO. 6, (2269-2273), Online publication date: 1-Jun-2006.Wallis M, Khoury A, Lorenzo A, Pippi-Salle J, Bägli D and Farhat W (2018) Outcome Analysis of Retroperitoneal Laparoscopic Heminephrectomy in ChildrenJournal of Urology, VOL. 175, NO. 6, (2277-2282), Online publication date: 1-Jun-2006.LEE R, RETIK A, BORER J, DIAMOND D and PETERS C (2018) PEDIATRIC RETROPERITONEAL LAPAROSCOPIC PARTIAL NEPHRECTOMY: COMPARISON WITH AN AGE MATCHED COHORT OF OPEN SURGERYJournal of Urology, VOL. 174, NO. 2, (708-712), Online publication date: 1-Aug-2005.PEDRAZA R, PALMER L, MOSS V and FRANCO I (2018) BILATERAL ROBOTIC ASSISTED LAPAROSCOPIC HEMINEPHROURETERECTOMYJournal of Urology, VOL. 171, NO. 6 Part 1, (2394-2395), Online publication date: 1-Jun-2004.SIMON S, FERRIGNI R, NOVICKI D, LAMM D, SWANSON S and ANDREWS P (2018) Mayo Clinic Scottsdale Experience With Laparoscopic Nephron Sparing Surgery for Renal TumorsJournal of Urology, VOL. 169, NO. 6, (2059-2062), Online publication date: 1-Jun-2003.ROBINSON B, SNOW B, CARTWRIGHT P, de VRIES C, HAMILTON B and ANDERSON J (2018) Comparison of Laparoscopic Versus Open Partial Nephrectomy in a Pediatric SeriesJournal of Urology, VOL. 169, NO. 2, (638-640), Online publication date: 1-Feb-2003.COOPER C, PASSERINI-GLAZEL G, HUTCHESON J, IAFRATE M, CAMUFFO C, MILANI C and SNYDER H (2018) LONG-TERM FOLLOWUP OF ENDOSCOPIC INCISION OF URETEROCELES: INTRAVESICAL VERSUS EXTRAVESICALJournal of Urology, VOL. 164, NO. 3 Part 2, (1097-1100), Online publication date: 1-Sep-2000.YAO D and POPPAS D (2018) A CLINICAL SERIES OF LAPAROSCOPIC NEPHRECTOMY, NEPHROURETERECTOMY AND HEMINEPHROURETERECTOMY IN THE PEDIATRIC POPULATIONJournal of Urology, VOL. 163, NO. 5, (1531-1535), Online publication date: 1-May-2000.HAMILTON B, GATTI J, CARTWRIGHT P and SNOW B (2018) COMPARISON OF LAPAROSCOPIC VERSUS OPEN NEPHRECTOMY IN THE PEDIATRIC POPULATIONJournal of Urology, VOL. 163, NO. 3, (937-939), Online publication date: 1-Mar-2000.HOZNEK A, SALOMON L, ANTIPHON P, RADIER C, HAFIANI M, CHOPIN D and ABBOU C (2018) PARTIAL NEPHRECTOMY WITH RETROPERITONEAL LAPAROSCOPYJournal of Urology, VOL. 162, NO. 6, (1922-1926), Online publication date: 1-Dec-1999.EL-GHONEIMI A, VALLA J, STEYAERT H and AIGRAIN Y (2018) LAPAROSCOPIC RENAL SURGERY VIA A RETROPERITONEAL APPROACH IN CHILDRENJournal of Urology, VOL. 160, NO. 3 Part 2, (1138-1141), Online publication date: 1-Sep-1998.JANETSCHEK G, DAFFNER P, PESCHEL R and BARTSCH G (2018) LAPAROSCOPIC NEPHRON SPARING SURGERY FOR SMALL RENAL CELL CARCINOMAJournal of Urology, VOL. 159, NO. 4, (1152-1155), Online publication date: 1-Apr-1998. Volume 158Issue 5November 1997Page: 1928-1930 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Gunter Janetschek More articles by this author Jorg Seibold More articles by this author Christian Radmayr More articles by this author Georg Bartsch More articles by this author Expand All Advertisement PDF downloadLoading ...
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Correction of primary non-reflux megaureter (153 ureters) was made in 136 patients aged 3 months to 14 years. Bilateral disease was in 17 patients. Non-reflux non-obstructive megaureter was in 113 cases, obstructive in 40 cases including association with ureterocele in 23 cases. Resection of distal ureter with its neoimplantation into the urinary bladder according to the antireflux technique was made in 146 patients, endovesical electroperforation and resection of ureterocele were made in 5 and 2 patients, respectively. Good results were obtained in 88.3% (135 ureters), satisfactory in 2.6% (4 ureters), unsatisfactory in 9.1% (14 ureters). After effective correction of megaureter, the treatment should be focused on adequate therapy of pyelonephritis present in 90% examinees, on improvement of urodynamics and stabilization of sclerotic process in renal parenchyma. The patients need long-term follow-up and more effective treatment.
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