Ureteropelvic junction obstruction in children.
The spectrum of problems inherent in the diagnosis and treatment of ureteropelvic junction obstruction is outlined on the basis of the review of a series of 195 children.
Adolescent↗
Biomedical subjects
A B Retik
Publications and source records attributed to A B Retik.
Pathophysiology and recoverability of function and structure in obstructed kidneys.
This article focuses on the effect of obstruction on renal structure and function and the assessment of the degree of recovery following relief of the obstruction.
Child↗
The unstable bladder in childhood.
A comprehensive study of children with voiding dysfunction, which included careful documentation of voiding habits, thorough radiologic investigation, and urodynamic evaluation was undertaken. Proposed etiologic factors, indications for therapy, and results of treatment are discussed.
Adolescent↗
Obstructing polyps of the posterior urethra in boys: embryology and management.
Solitary fibrous polyps are in uncommon but important cause of obstructive uropathy, infection and hematuria in boys. The clinical presentation and management in 5 boys are discussed and the literature is reviewed. Emphasis is placed on the pitfalls in diagnosis and recent endoscopic techniques of treatment.
Child↗
Hypospadias: a familial study.
The families of 177 boys with varying degrees of hypospadias were evaluated prospectively to determine the occurrence of hypospadias and other congenital anomalies within this population. A significant number of male subjects in each family member category were affected, with first degree relatives (brothers and fathers) having a 14 and 9 per cent incidence, respectively. Siblings were at a greater risk for having this anomaly when the proband had a more severe degree of hypospadias and when the abnormality also was present in other relatives. A multifactorial mode of inheritance is suggested as the basis for transmission of this congenital defect.
Abnormalities, Multiple↗
The bladder in boys with posterior urethral valves: a urodynamic assessment.
Urodynamic evaluation was performed on 8 of 62 boys (13 per cent) with persistent voiding difficulties after fulguration of posterior urethral valves. All had varying degrees of incontinence when evaluated. The striated muscle component of the external urethral sphincter was intact in each child. Five different types of bladder function were noted in the 8 children. Three boys had had a prior Y-V plasty of the bladder neck to improve upper and lower urinary tract emptying, which may have contributed to the subsequent incontinence. One additional boy had significant bladder neck obstruction requiring a unilateral bladder neck incision to improve voiding. Appropriate treatment plans were instituted based on the urodynamic findings of the bladder, bladder neck and external sphincter areas, and 6 of the 8 children are now completely continent.
Child↗
Empiric recurrence risk factors in urinary tract malformations: hypospadias.
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Congenital Abnormalities↗
Megaureters in children.
The results of surgery for megaureter are reviewed in 40 children. Special attention is focused on the etiologic causes of these dilated ureters in relation to the surgical results. Thirty of 31 children with obstructive or refluxing megaureters and normal bladders had satisfactory results. Less satisfactory results occurred in children with abnormal bladder dynamics. No child in this series required upper ureteral tapering. A discussion of the causes and further management of the surgical failures is presented.
Child↗
Renal abscess in children.
Ten children with renal abscesses treated during the last 25 years are reviewed following our recent experience with 3 children, each of whom presented with an abscess. The diagnosis was not readily apparent before hospitalization, despite characteristic features of the disease. Excretory urography with nephrotomography proved to be the most valuable diagnostic study. Angiography was useful in differentiating the abscess from other intrarenal processes. Staphylococcus aureus was the most common infecting organism. Upper urinary tract anomalies were noted most frequently with gram-negative infections. Treatment consisted of drainage of the abscess in 8 children. Nephrectomy was required in 2 girls, each of whom had multiple extensive gram-negative carbuncles. The pathogenesis and therapy of a renal abscess are discussed.
Abscess↗
The non-obstructive ectopic ureterocele.
We have seen 5 children with a non-obstructive ectopic ureterocele associated with an undilated upper pole collecting system. Thus the telltale signs of renal duplication found with obstruction of the upper pole were absent. Cystoscopy confirmed the diagnosis when retrograde injection of the ureterocele outlined a narrow ureter and small dysplastic kidney. Because reflux usually was present in the ipsilateral lower pole ureter (86 per cent) surgical treatment consisted of excision of the ureterocele and common sheath ureteral reimplantation. Removal of the small non-functioning upper renal segment was not necessary in most instances. The embryology of this anomaly is discussed.
Child↗
Urachal anomalies and related umbilical disorders.
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Cysts↗
Urodynamic evaluation of boy with myelodysplasia and incontinence.
Twenty-two boys with myelodysplasia and incontinence were evaluated urodynamically. Three types of bladder function were noted, but each could not be correlated with any particular neuroligic level. The integrity of the external sphincter innervation was determined by electomyographic monitoring of periurethral striated muscle. Bladder sphincter dyssynergia was found in one of the boys with voluntary control, five with involuntary bladder contractions, and five with adynamic bladders who voided by Credé's method. A radiologically narrow external sphincter on voiding cystography could only be correlated with the bioelectric activity in children with dyssynergia. A narrow sphincter was also noted in three children with synergy and four with complete lower motor neuron lesions. Marked fibrosis was found to be the cause of narrowing of external sphincter area in these boys. Thus, urodynamic evaluation helped define the etiology of outlet obstruction when it was present in the boy with myelodysplasia. A classification of bladder sphincter function is proposed.
Adolescent↗
A new approach to electromyography of the external urethral sphincter.
Detailed electromyographic investigation of the external urethral sphincter was done as part of a urodynamic evaluation of 119 patients. The sphincter was located by inserting electrodes alongside the urethra. The electromyogram was viewed on an oscilloscope and recorded on paper. Normal and abnormal sphincter electromyograms were defined and the role of sphincter electromyography in urodynamic studies was discussed. It was observed that electromyographic activity does not always correlate with urethral resistance but must be interpreted in conjunction with other urodynamic parameters, such as urethral pressures, urinary flow rates and voiding cystourethrography. In addition, sphincter electromyography provides valuable information to define the various neural pathways involved in micturition and continence.
Electromyography↗
Changing concepts in the urodynamic evaluation of children.
Urodynamic evaluation was performed in 46 children with myelodysplasia, spinal cord injury, enuresis, postoperative incontinece, sacral agenesis and recurrent urinary tract infection. The basic study consisted of voiding cystourethrography followed by the simultaneous recording of intra-abdominal and intravesical pressure with external urethral sphincter electromyography. Urethral pressure profile, urinary flow rate and anal sphincter electromyography were performed selectively. There was no correlation between the clinical neurological level and the cystometric pattern in patients with spinal cord lesions. Bladder-external sphincter dyssynergia was associated with a high post-void residual urine in children with hypertonic bladders, while in children with hypotonic bladders dyssynergia did not affect the post-void residual. Since, urinary symptoms bore little relationship to urodynamic findings in our study we recommend complete evaluation of children who have persistent disturbances of micturition.
Adolescent↗
Changing concepts in the urodynamic evaluation of children.
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Adolescent↗
Paraurethral cysts in female neonate.
Paraurethral cysts in the female neonate are uncommon lesions. All reported cases have either ruptured spontaneously or responded to simple marsupialization. However, complete urologic evaluation is mandatory because they simulate ectopic ureteroceles in appearance. Herein is reported our experience with 5 patients. The etiology, embryogenesis, natural history, differential diagnosis, and treatment are discussed.
Cysts↗
Infection of the urinary tract after anti-reflux surgery.
Two hundred twenty-three children who underwent anti-reflux surgery were evaluated. Pyelonephritic scarring was more apt to occur with greater degrees of reflux. Postoperative infection was principally confined to the bladder and occurred primarily in females. The beneficial effect of anti-reflux surgery is discussed.
Adolescent↗
Renal growth and urinary infection following antireflux surgery in infants and children.
The 223 children who underwent antireflux surgery for primary reflux were evaluated. Preoperative phylonephritic scarring was more commonly present with greater degrees of reflux. Antireflux surgery was successful in all cases. Postoperative infection occurred in 21 per cent with almost all episodes being clinical cystitis. Postoperatively, a statistically significant increase in renal growth was noted, which was thought to be related to the extent of preoperative nephron loss.
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