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Biomedical subjects

A M Rickwood

Publications and source records attributed to A M Rickwood.

At least 19 recordsLinked to original sources
PubMed2001

Outcome of patients with prenatally detected duplex system ureterocele; natural history of those managed expectantly.

PURPOSE: We assessed the outcome of patients treated for prenatally detected duplex system ureterocele with particular reference to those treated expectantly. MATERIALS AND METHODS: We reviewed the records of 52 consecutive patients treated between 1984 and 1999 with a median followup of 8 years (range 1 to 16.2). RESULTS: Of the 38 patients who underwent surgical treatment 13 subsequently required unplanned secondary procedures. A total of 14 cases satisfying currently defined criteria, including less than 10% upper renal pole function, an unobstructed lower pole (absent nonrefluxing hydroureteronephrosis), lower pole vesicoureteral reflux not exceeding grade III and unobstructed bladder outflow, were managed expectantly with a median followup of 8 years (range 1.6 to 12.8). In this group of patients prophylactic antibiotics were routinely prescribed until the completion of toilet training or age 5 years in those with persistent reflux on repeat cystography. None has required surgery or had symptoms or urinary infection. In 6 cases followup ultrasonography showed substantial resolution of upper pole hydronephrosis with a collapsed ureterocele. Furthermore, 7 of the 38 patients who underwent surgical treatment early in our series would have been treated expectantly had the current criteria been applied. CONCLUSIONS: In 14 of the 52 patients (approximately 27%) with prenatally detected duplex system ureterocele the natural history of the complaint is essentially benign within the currently available followup.

Animals↗
PubMed1999

The incidence of phimosis in boys.

OBJECTIVE: To establish the incidence of pathological phimosis in boys. PATIENTS AND METHODS: A 2-year review of circumcisions was performed for phimosis among a known population of boys, with the histological findings of the circumcision specimens assessed. RESULTS: Sixty-two boys (all but one aged 5-14 years) had typical pathological (cicatrizing) phimosis and among the 51 circumcision specimens examined histologically, 43 (84%) showed appearances of balanitis xerotica obliterans. During the same period, 30 boys were circumcised for developmental unretractability of the foreskin ('physiological phimosis'). CONCLUSIONS: The incidence of pathological phimosis in boys was 0.4 cases/1000 boys per year, or 0. 6% of boys affected by their 15th birthday, a value lower than previous estimates and exceeded more than eight-fold by the proportion of English boys currently circumcised for 'phimosis'.

Adolescent↗
PubMed1998

Functional results of pyeloplasty in patients with ante-natally diagnosed pelvi-ureteric junction obstruction.

OBJECTIVE: To assess the outcome after pyeloplasty in children with an ante-natal diagnosis of hydronephrosis, shown on post-natal renography to be due to pelvi-ureteric junction (PUJ) obstruction, and in particular to review the outcome of those who had initially been managed expectantly. PATIENTS AND METHODS: Between 1984 and 1995, 321 patients were diagnosed as having PUJ obstruction, after investigating ante-natal hydronephrosis. Of these, 47 had undergone pyeloplasty and also had a normal contralateral kidney; 26 patients had early pyeloplasty because of impaired function and 21 underwent surgery after a period of expectant management. Renal function was assessed renographically before and at least one year after surgery. RESULTS: Relative renal function was stabilized in those patients who underwent early pyeloplasty (mean differential function 28.1% before and 32.7% after surgery). In patients who underwent pyeloplasty after a period of expectant management, the mean relative function decreased from 44.8% initially to 30.5% before surgery; this recovered to 37.5% at the post-operative reassessment, representing a statistically significant loss of function (P < 0.01). CONCLUSION: In patients born with PUJ obstruction and impaired renal function, pyeloplasty failed to significantly improve function. Possibly because of cortical loss. In patients with ante-natal PUJ obstruction managed expectantly there is a small but significant risk of a modest loss of renal function.

Child↗
PubMed1998

Urological consequences of incomplete cord lesions in patients with myelomeningocele.

OBJECTIVES: To determine the urological consequences of incomplete cord lesions in patients with myelomeningocele and a neuropathic bladder. PATIENTS AND METHODS: From a total of 407 patients with myelomeningocele and a neuropathic bladder, 31 (8%) were identified as having a combination of sacral sensory or motor sparing and positive conus reflexes. Their case-notes were reviewed with reference to spinal neurology, patterns of micturition, including the degree of spontaneous continence, findings on imaging and urodynamic studies, and forms and outcomes of any treatment given. RESULTS: The anatomical distribution of the lesions was thoracic (two), thoracolumbar (three), lumbar (six), lumbosacral (four) and sacral (11). The mean age at presentation was 9.5 years (range 3.5-19.5) and the mean follow-up 4.5 years (range 0.5-10.5). At presentation, 14 patients had urinary incontinent episodes both day and night, 10 by day only, seven by night only, and the upper urinary tracts were dilated in eight (26%). Nineteen were ambulant unaided and 10 with aid of crutches or calipers, whilst two were wheelchair-bound. Only one patient had faecal incontinence. A urodynamic examination in 18 patients showed competent sphincteric mechanism and detrusor hyper-reflexia in all, and detrusor sphincter dyssynergia in 11. The methods of treatment included oxybutynin and/or clean intermittent catheterization alone or in combination. Thirty patients are currently reliably dry by day and 26 also by night. Five patients have undergone surgical treatment for vesico-ureteric reflux, three a Mitrofanoff procedure and two augmentation cystoplasty. CONCLUSION: Although patients with congenital incomplete cord lesions and positive conus reflexes may gain some measure or urinary continence spontaneously, they are at serious risk of developing upper urinary tract complications. The treatment of urinary continence is simple and effective because there is a competent sphincter mechanism. These patients require life-long supervision even if they require no treatment for urinary incontinence.

Adolescent↗
PubMed1997

The natural history of pelvi-ureteric junction obstruction in children presenting clinically with the complaint.

OBJECTIVE: To determine the natural history of untreated pelvi-ureteric junction (PUJ) obstruction in children presenting clinically with the complaint. PATIENTS AND METHODS: The study comprised 42 children with anatomical PUJ obstruction (three with bilateral lesions) who were managed expectantly in the first instance, who had no immediately troublesome symptoms and differential function in the affected kidney(s) of > 40%. They were followed by serial ultrasonography and dynamic diuresis renography. Pyeloplasty was advised for those with persistent symptoms or where differential renal function fell below 40%. RESULTS: Only 15 children had presented with clearly relevant symptoms (loin pain or febrile urinary infection). Thirty-four kidneys showed obstructive renographic curves initially and 38 had moderate or severe hydronephrosis. During the follow-up (range 14-120 months, mean 56) patients remained asymptomatic except for four of the nine presenting with loin pain. Renographic curves were apt to change, with 'obstruction' increasing or decreasing with time, in the latter instance usually with lessening or resolution of hydronephrosis. Eleven patients underwent pyeloplasty, five for symptoms and six because of deteriorating renal function. Renal function did not decline in any patient with mild hydronephrosis and/or a non-obstructive renographic curve at presentation, but did so disproportionately in those with severe hydronephrosis or a Type IV renographic curve. CONCLUSIONS: Patients effectively asymptomatic at presentation are likely to remain so. Expectant management is appropriate for patients with mild hydronephrosis and/or non-obstructive renographic curves at the outset. Conversely, pyeloplasty may be advisable for those with severe hydronephrosis or Type IV renographic curves. Otherwise, for most the natural history of the complaint remains to be determined.

Adolescent↗
PubMed1995

'Congenital' hydronephrosis: limitations of diagnosis by fetal ultrasonography.

OBJECTIVE: To determine whether children presenting clinically with pelvi-ureteric junction obstruction had fetal hydronephrosis. PATIENTS AND METHODS: Forty-three children, born during or after 1985, presented clinically with pelvi-ureteric junction obstruction. Records of the maternal pregnancies were reviewed with reference to the findings of any fetal ultrasonography. RESULTS: In 25 patients fetal ultrasonography was performed at or beyond 30 weeks' gestation (mean 33.2). None had significant fetal hydronephrosis. CONCLUSION: Hydronephrosis due to pelvi-ureteric obstruction is not necessarily congenital and patients presenting clinically may differ inherently from those detected fetally.

Female↗
PubMed1995

Congenital testicular maldescent: significance of the complete hernial sac.

OBJECTIVE: To test the hypothesis that testicular maldescent is rarely congenital in the absence of a complete hernial sac. PATIENTS AND METHODS: The study comprised 110 boys undergoing orchidopexy. Operative findings (complete hernial sac versus no hernial sac) were compared with recorded testicular descent at birth. RESULTS: Among 70 testes recorded as maldescended neonatally there was no example without a complete hernial sac at orchidopexy. Among 60 recorded as descended neonatally, 43 had no sac at orchidopexy. CONCLUSIONS: The findings are consistent with the hypothesis, though not with the proposition, that the presence of a complete hernial sac at orchidopexy constitutes proof of congenital testicular maldescent.

Age Factors↗
PubMed1994

Prenatally diagnosed pelviureteric junction obstruction: a benign condition?

Renal function in neonates with antenatally diagnosed pelviureteric obstruction is usually well preserved and rarely deteriorates in the short term. To assess if function is maintained in the medium term, and, where not, if any factors are predictive of deterioration, the authors reviewed their cases (1985 to 1992) of antenatally diagnosed unilateral pelviureteric obstruction with renographic confirmation (type II and IIIb curves). Initial renographic assessment was performed at 1 to 3 months. Among the 160 cases, initial differential function exceeded 40% in 140 (87.5%), and these were managed expectantly with renographic follow-up, usually at 24, 48, and 72 months of age. The 20 patients with reduced differential function underwent early intervention (pyeloplasty, or trial of nephrostomy drainage in those with very poor function). Follow-up in those managed expectantly showed good differential function in 135 (96.5%), despite persistence of renographic obstruction in two thirds of the cases, more than half of which have had renographic follow-up beyond 4 years. Differential function decreased to below 40% in five patients (3.5%); this was not related to the type of renographic curve or severity of the hydronephrosis. The natural history of antenatally diagnosed pelviureteric obstruction continues to appear benign, and it may differ from that in older children who present clinically.

Child, Preschool↗
PubMed1994

Infection stones in children: a twenty-seven-year review.

OBJECTIVE: The objective of this study was to determine the relationship between urinary tract infection and pediatric urolithiasis and to characterize the pediatric infection stone former. METHODS: Two hundred seventy consecutive pediatric stone formers presenting over a twenty-seven-year period were studied. Of these, 161 children (60%) had infection-related stones. Account was taken of stone composition, anatomic location, associated anatomic lesions, and the rate of stone recurrence over a median follow-up of three years. RESULTS: The mean age of children with infection stones was 4.9 years, with two-thirds being under six years of age. Proteus mirabilis accounted for 82 percent of pure urine cultures. Seventy percent of stones were renal and 30 percent were ureteral or intravesical. One-third of patients had anatomic lesions (pelviureteric obstruction, primary obstructed megaureter, and others) contributing to stone formation. Recurrent stones occurred in 14 percent of cases. CONCLUSIONS: This study reaffirms the predominance of urinary tract infection secondary to P. mirabilis as the leading cause of pediatric urolithiasis in the United Kingdom. The significant recurrence rate suggests the importance of prophylactic antibiotics, surgical correction of congenital anomalies, and long-term follow-up of this patient population.

Adolescent↗
PubMed1994

Combined bladder neck suspension and augmentation cystoplasty for neuropathic incontinence in female patients.

OBJECTIVE: To perform bladder neck suspension simultaneously with augmentation cystoplasty in female patients where sphincteric incompetence was not the sole cause of impaired functional bladder capacity. PATIENTS AND METHODS: During an 8-year-period, 26 female patients (mean age 14, range 5-39) were treated with a Marshall-Marchetti plus cystoplasty (Liverpool) or a colposuspension plus clam cystoplasty (Sheffield). All had marked sphincteric incompetence compounded by detrusor hyper-reflexia and/or non-compliance. The patients were followed up for a mean period of 30 months (range 8-80). RESULTS: There were no major complications. At follow-up 23 (88%) were dry by day on a regime of intermittent self-catheterization. Nine patients were taking adjuvant medication, usually for prevention of nocturnal enuresis. CONCLUSION: The results compare tolerably with those of all alternative procedures, including the more elaborate reconstructions (e.g. Kropp procedure) and the expensive artificial urinary sphincter.

Adolescent↗
PubMed1993

Experience with duplex system anomalies detected by prenatal ultrasonography.

We reviewed 39 neonates with prenatally diagnosed duplex system anomalies. Principal diagnoses were ureterocele in 15 patients, ureteral ectopia in 15, lower polar vesicoureteral reflux in 6, lower pole ureteropelvic junction stasis in 2 and yo-yo reflux in an incompletely duplicated system in 1. Several patients had other ipsilateral and contralateral urinary anomalies. Ten patients (26%) had relevant physical signs and only 1 became symptomatic, with urosepsis, neonatally. At initial assessment, before any accounted urinary tract infection, renal polar function as judged by radionuclide examinations almost always was severely impaired in the presence of major ureteral ectopia or severe reflux. By contrast, function was usually well preserved when there was obstruction, or lesser degrees of ectopia or reflux. A total of 19 patients underwent surgery (14 electively and 5 after episodes of urosepsis), while 20 have been managed nonoperatively for 12 to 84 months (mean 34) during which time the appearances and function of the upper renal tracts have remained stable. We conclude that the natural history of these anomalies is often benign and that a policy of routine surgical intervention, developed when most cases presented symptomatically, may not be appropriate in patients who present antenatally.

Female↗
PubMed1993

Bacterial factors in the formation of renal scars. An experimental study on the role of Escherichia coli P-fimbriation and hydrophobicity.

A model capable of comparing the effects of bacterial virulence factors on renal scarring in vivo has been developed using the female piglet. By creating, at open surgery, unilateral vesicoureteric reflux (VUR) and quantifying scarring both by uptake of an isotope bound to functioning renal parenchyma and by planimetry of the surface area scarred, the effects of 2 organisms, a P-fimbriate Escherichia coli and an E. coli K1 have been compared. The P-fimbriate E. coli was shown to express P-fimbriae in freshly voided urine, was more hydrophobic and produced smaller scars. This indicates that neither the hydrophobicity nor P-fimbriation of the organism causing urinary tract infection (UTI) is of prime importance for the development of renal scars and is evidence against the "big bang" theory for the development of renal scars. Studies on the association of UTI with VUR showed that infection with both E. coli under study led to VUR on the side contralateral to the side undergoing surgery. It seems likely that a non-specific effect of UTI, such as bladder oedema, is responsible for this acquired VUR. An effect of the 2 bacteria under study on the lower urinary tract was observed in that infection with the P-fimbriate E. coli allowed the retention of an intravesical wax plug, whereas infection with E. coli K1 did not. Epidemiological data have shown that the majority of upper urinary tract infections in children are associated with UTI by P-fimbriate organisms. Such an association may be explained in part by an effect of P-fimbriate bacteria on lower urinary tract function rather than an effect on the upper urinary tract.

Animals↗