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PubMed2000

Outcome of augmentation sigmoidocystoplasty in children with neurogenic bladder.

PURPOSE: The role of augmentation cystoplasty in the neuropathic bladder has been well determined since clean intermittent self-catheterization (CISC) has been accepted as a treatment modality in voiding dysfunction. We present our clinical experience with sigmoid augmentation cystoplasty in children with neurogenic bladder disorder. MATERIAL AND METHODS: From 1991 to 1997 sigmoid augmentation cystoplasty with modified clam technique was performed in 18 cases with neuropathic bladder pathologies. In 4 cases, ureteroneocystostomy was performed, 2 of whom were bilateral. Age range of these patients was 5-17 years (mean 10.3 years) and follow-up period was from 16 to 70 months (mean 41 months). RESULTS: Pyuria was detected in 10 cases and 2 of them were symptomatic. Clinical acidosis was detected in only 1 case. Fifteen cases (83%) were continent by using CISC with 4-6 hourly and detrusor pressure lower than 30 cm water at maximal bladder capacity. CONCLUSION: In children with neurogenic bladder pathologies refractory to conservative management, augmentation cystoplasty with CISC is an effective treatment modality in protecting the upper urinary tract and preventing incontinence.

Adolescent↗
PubMed1986

Mortality in relation to urinary characteristics in the very aged.

The value of urinary characteristics observed in a health survey of people aged 85 years or more was studied in a 5-year follow-up. Of the 561 aged people participating in the initial survey, 167 (30%) were alive after 5 years. Hematuria, pyuria, and albuminuria were associated with high mortality; urinary acidity was associated with low mortality. Positive bacterial staining, glucosuria, and specific gravity of urine were not related to the survival rate. Contrary to earlier observations, bacteriuria found in the urinary bacterial culture did not have any prognostic significance in respect of survival during the follow-up period. Judging from the results, the medical treatment of asymptomatic bacteriuria, with the aim of reducing the mortality of the very aged, appears to be unwarranted.

Aged↗
PubMed1984

Hypercalciuria in clinical pediatrics. A review.

Idiopathic hypercalciuria is a cause of a variety of urinary tract complaints in clinical pediatrics. These include gross or microscopic hematuria, enuresis, urinary frequency or urgency, dysuria, sterile pyuria, and proteinuria in addition to renal calculi. A random urine calcium-creatinine concentration ratio can be used to initially screen for hypercalciuria. Patients with indeterminate results should have the test repeated, while those with abnormal values should receive a complete metabolic workup to determine the cause of hypercalciuria. Identifiable causes of hypercalciuria should be treated specifically, and thiazide diuretics are the preferred treatment for uncomplicated renal calculi. Pharmacotherapy in children with idiopathic hypercalciuria and symptomatology other than renal stones is controversial and should be limited to patients with severe clinical manifestations.

Adolescent↗
PubMed1980

Acute abdominal pain in children.

During a twelve-month period, 416 children with acute abdominal pain required emergency admission to Southampton General Hospital; 46% had operations. Appendicitis was the commonest organic cause of acute abdominal pain identified (31%). Constipation (9%) can present as acute abdominal pain simulating appendicitis. All children should have a urine sample examined microscopically and the finding of significant pyuria is suggestive, but not diagnostic, of a urinary tract infection (7%). Mesenteric adenitis, which can only be diagnosed with certainty at laparotomy, was less common (4%). Despite careful clinical assessment and follow up, 45% of children in this series remained undiagnosed. Sedation but not analgesia may assist in the diagnosis of the acute abdomen in children.

Abdomen, Acute↗
PubMed1999

The validity of the uriscreen test for early detection of urinary tract infection in children.

OBJECTIVE: To determine the validity of the Uriscreen, a rapid diagnostic test based on the detection of urine catalase for the early detection of urinary tract infection (UTI) in children, compared with standard urinalysis and dipstick tests. STUDY DESIGN. Cross-sectional study. STUDY POPULATION: Children 1 month to 17 years of age who presented to the emergency department of a pediatric tertiary care center between March and November of 1996 with symptoms suggestive of UTI. METHODS: Urine specimens obtained from a random sample of 121 patients were evaluated simultaneously for possible UTI by Uriscreen (catalase test), urinalysis (microscopic pyuria), dipstick (leukocyte esterase and nitrite), and quantitative urine culture. All specimens were collected by one of three sterile techniques (midstream void technique, bladder catheterization, or suprapubic aspiration), as appropriate for age, and tested immediately. Using the quantitative urine culture as the gold standard (reference test), the sensitivity, specificity, and positive and negative predictive values of all the screening tests were determined and compared. Age, sex, temperature, presenting symptoms, and method of urine collection were recorded for each participant. RESULTS: Of the 121 patients, 35 (28.9%) had positive culture results: 30 girls (85.7%) and 5 boys (14.3%). Compared with urinalysis and dipstick tests, Uriscreen had the highest sensitivity (100% vs 88.6% and 97.1%, respectively) and the highest negative predictive value (100% vs 95% and 98.6%, respectively), but the poorest specificity (68.6% vs 88.4% and 82.5%, respectively) and positive predictive value (56.4% vs 75.6% and 69.4%, respectively). CONCLUSIONS: The clinical use of Uriscreen for the presumptive diagnosis of UTI in children is limited and not significantly superior to urinalysis or the dipstick test. However, because of its 100% sensitivity and negative predictive value and its ease of use, rapidity, and low cost, it is recommended highly for ruling out the diagnosis of UTI. In laboratories, a negative Uriscreen result may prevent the need for performing expensive urine cultures.

Bacteriuria↗
PubMed1996

[A boy highly suspected of hypersensitivity pneumonitis characterized by generalized mucosal lesions].

The case is a boy who developed progressive dyspnea and had since been followed over a long period time as a case of unknown fever without respiratory symptoms. He showed mucosal symptoms such as intraoral aphtha, eosinophilic pyuria and diarrhea and was clinically diagnosed as hypersensitivity pneumonitis. The affected child showed high levels of circulating immune complex, a decline in DLco on the respiratory function test and a decrease in CD 4/8 in bronchoalveolar lavage lymphocytes; furthermore, an antibody specific to Aureobasidium pullulans was positive in the precipitated antibody test. As for the immune function of the affected child during the follow-up, hypergammaglobulinemia and various immune abnormalities were observed. We thought the clinical feature of the affected child to be of pathophysiological value in dealing with unknown fever in childhood, so we reported our findings in this paper.

Alveolitis, Extrinsic Allergic↗
PubMed1985

Management of acute dysuria. A decision-analysis model of alternative strategies.

A decision-analysis model was developed to estimate the effects and costs of alternative initial management strategies for women presenting with dysuria and pyuria. We compared days of morbidity and direct medical costs associated with single-dose and multiple-dose regimens of amoxicillin and trimethoprim-sulfamethoxazole and examined the cost-effectiveness of doing an initial urine culture. We used varying assumptions for prevalence of etiologic agents, treatment efficacy, frequency of side effects, and duration of symptoms. Single-dose regimens were preferable to multiple-dose regimens of either drug, and trimethoprim-sulfamethoxazole was preferable to amoxicillin. Single-dose trimethoprim-sulfamethoxazole therapy resulted in the fewest expected symptom-days (2.7) and the lowest expected cost (+54). The advantage of single-dose strategies in minimizing expected symptom-days resulted largely from the threefold to fourfold increase in the incidence of side effects reported with multiple-dose therapy. Obtaining an initial urine culture in all patients reduced expected symptom-days by about 10% but increased expected cost by about 40%.

Adult↗
PubMed1975

Controlled trial comparing co-trimoxazole and methenamine hippurate in the prevention of recurrent urinary tract infections.

To study the effects of continous low doses of antibacterial agents after eradication of bacteriuria in patients with recurrent urinary tract infection, 31 patients with documented recurrent urinary tract infection were allocated alternately to treatment with either co-trimoxazole (400 mg of suphamethoxazole and 80 mg of trimethoprim each night) or methenamine hippurate (1 g each night). The majority of patients (79%) had underlying radiological abnormalities of the renal tract, but normal renal function (the mean serum creatinine level was 1.05 mg per 100 ml). During the study the incidence of bacteriuria and pyuria was significantly lower in the co-trimoxazole-treated group. Patients receiving co-trimoxazole also had fewer acute clinical episodes of urinary tract infection than patients receiving methenamine hippurate. There were no significant side effects from either drug. Two patients with frequent recurrences of infection developed renal calculi. No change in creatinine clearance or maximum urinary concentrating ability was observed over a follow-up period of four to 30 months (mean 10.4 months). Co-trimoxazole is an effective agent in the prophylaxis of urinary tract infection in this highly susceptible group of patients, and in the doses used was superior to methenamine hippurate.

Adult↗
PubMed1992

Pattern of renal dysfunction in analgesic nephropathy--comparison with glomerulonephritis.

Comprehensive renal function tests were performed in 84 patients with analgesic nephropathy, 33 glomerulonephritis patients matched for creatinine clearance, and 30 control subjects. A system of 1-day renal function tests including urine microscopy, creatinine clearance, phenolsulphonphthalein excretion, urine concentration and acidification, and electrolyte excretion, was used. Patients with analgesic nephropathy were found to have significant sterile pyuria and haematuria, even those with mild renal insufficiency, significantly reduced concentrating ability and a distal acidifying defect, and a tendency to impaired sodium conservation. These function defects are consistent with the primary lesion of renal papillary necrosis in analgesic nephropathy; the detection of these defects have implications in patient management.

Adult↗
PubMed1992

[Usefulness of dipstick test for determining leukocytes and bacteria in urine].

The value of a simple dipstick test (BMtestLN, Boehringer Mannheim-Shionogi) for determination of leukocytes and bacteria in urine was examined. This test consisted of detection of esterase, an enzyme present in leukocytes and the nitrate reduced by bacteria. A total of 666 clinical urine specimens were tested with both tests. The evaluation of leukocytes in urine was compared with microscopic examination, and the identification and measurement of strains was performed using a semiquantitative plate culture method as a reference. The leukocyte esterase test had a sensitivity of 85.3%, a specificity of 67.3%, positive predictive value of 54.7% and negative predictive value of 90.8%. The range of the sensitivity value of nitrate test was 25.7% for the detection of bacteriuria (bacteria greater than or equal to 10(4) CFU/ml). This test had a specificity of 99.6%, positive predictive value of 94.8% and negative value of 82.9%. We concluded that this dipstick test is not useful for determination of the slight change of pyuria, but sensitive for the determination of acute and untreated urinary tract infections.

Bacteriuria↗
PubMed1979

The clinical spectrum of Reiter's syndrome and similar postenteric arthropathies.

Certain infections of the genitourinary and gastrointestinal tracts, such as nongonococcal urethritis, dysentery and yersiniosis, precipitate characteristic arthritic syndromes in genetically susceptible individuals. Eye and skin lesions in the form of conjunctivitis, iritis, keratodermia blenorrhagica and erythema nodosum occurring in association with particular distributions of arthritis make recognizable clinical entities. Reiter's syndrome may be diagnosed with certainty from the presence of tender heels, low back pain, a predominance of knee and foot arthritis and pyuria, when the more obvious clinical markers of the syndrome are absent; a flagrant case represents one of the easiest clinical diagnoses in medicine. Diagnosis is important for a good prognosis, optimal treatment and sometimes prophylactic measures. Sacroiliitis often progressing to spinal ankylosis is a prominant feature in the B27-positive patient. Erythema nodosum occurs in B27-negative subjects as a response to yersiniosis and ulcerative colitis.

Arthritis↗
PubMed1985

Use of clinical findings in the diagnosis of urinary tract infection in women.

To develop a decision rule for predicting urinary culture results in patients suspected of having urinary tract infection, we used discriminant analysis to identify the optimum combination of clinical findings. Thirty variables identified in a pilot study were recorded from 248 patients in a second study. Five findings were independent predictors of positive urinary culture: history of urinary tract infection, back pain, microscopic pyuria, hematuria, and bacteriuria. An additive decision rule that assigned one point for each of the five variables was tested in a third group of 258 patients. These scores stratified patients into subsets with increasing likelihood of positive culture. Higher scores identified patients who can confidently be treated without documentation of bacteriuria. If the rule applies successfully to other populations, cost savings could result from identification of patients who do not require quantitative urinary culture to demonstrate significant bacteriuria.

Adolescent↗
PubMed1987

A multicenter comparative trial of three-day norfloxacin vs ten-day sulfamethoxazole and trimethoprim for the treatment of uncomplicated urinary tract infections.

Two-hundred nine patients with symptoms of acute urinary tract infection and pyuria were randomized to 400 mg of administered norfloxacin twice daily for three days, or 800 mg of sulfamethoxazole and 160 mg of trimethoprim administered twice daily for ten days. Therapeutic outcome was assessed five to nine days and four to six weeks after treatment. The cure rates were 71/74 (96%) with norfloxacin and 81/81 (100%) with sulfamethoxazole and trimethoprim five to nine days after treatment. Only seven patients had a recurrence at the second follow-up visit; four in the norfloxacin group and three in the sulfamethoxazole and trimethoprim group. No isolates were resistant to norfloxacin, but three Escherichia coli were resistant to sulfamethoxazole and trimethoprim. Fifteen patients in each group reported a side effect during treatment. Two patients in the norfloxacin group and four patients in the sulfamethoxazole and trimethoprim group discontinued therapy due to an adverse effect. In this multicenter study, a three-day course of norfloxacin was as effective and safe as a ten-day regimen of sulfamethoxazole and trimethoprim in the treatment of acute uncomplicated urinary tract infections.

Acute Disease↗
PubMed1987

[Practical approach in an isolated abnormality of urinalysis].

The three major abnormalities found in urinalysis (proteinuria, hematuria and pyuria) usually lead on to invasive investigations. It emerges that the general practitioner is able, with only a few simple non-invasive diagnostic methods, to establish a wide range of differential diagnoses with precise etiology and prognosis.

Diagnosis, Differential↗
PubMedDate not supplied

Detection of leukocyte esterase in urine: a new screening test for nongonococcal urethritis compared with two microscopic methods.

First-catch urine samples of 130 men attending a clinic for genitourinary medicine were screened with the leukocyte esterase dipstick test. Conventional microscopy of centrifuged sediment and inverted microscopy of unspun urine samples were performed 2-4 hr later. The leukocyte esterase test had sensitivities of 100% and 96.6% and specificities of 55% and 52.8%, respectively, when compared with the two microscopic methods. The apparently low predictive value of the positive leukocyte esterase test was probably linked to its ability to detect lysed cells and the limitations of the microscopic methods, which were used as the absolute indicator of nongonococcal urethritis. Of the 42 patients with microscopic pyuria, 45.2% had positive cultures for Chlamydia trachomatis, and the leukocyte esterase test was positive in every case. Twenty-one per cent of the C. trachomatis-positive patients were asymptomatic, and 42% had fewer than five polymorphonuclear leukocytes per high-power field (X1000) of the gram-stained urethral smear. The leukocyte esterase test appears to be a simple, practical, and sensitive test that is useful in screening for nongonococcal urethritis, especially asymptomatic nongonococcal urethritis.

Esterases↗
PubMedDate not supplied

[Bacteria and leukocyte count in the urine in the diagnosis of urinary tract infections].

The count of bacteria in fresh, unstained, uncentrifuged urine specimens, using a phase-contrast microscope, magnification X400, and a hemocytometer chamber, is a simple method to exclude urinary tract infection. The specificity of this method is 94%, while the sensibility is 66%. We exclude an urinary infection when the count is less than 5 bacteria/0.1 ml. If we add to bacteria the evaluation of pyuria, the sensibility of this method does not change. On the contrary what we observe is an increase of the false positives. Bacteria more easily identified in urine specimens are E. Coli and Klebsiellae; the bacterioscopy has confirmed respectively 82% and 100% of positive urinecultures. The corresponding values for Protei and Streptococci are 23% and 20% respectively. This method is very simple also for teaching; it requires only a few minutes and is inexpensive. Its most useful utilization is the exclusion of urinary tract infection when the concentration of bacteria in the urine is less than 5 bacteria/0.1 ml.

Adolescent↗
PubMed1972

Renal disease due to analgesics. I. Recognition of the problem of analgesic nephropathy.

The incidence of renal impairment secondary to the abuse of analgesic compounds now accounts for a significant proportion of patients requiring renal replacement therapy. The clinical features of 100 cases of analgesic nephropathy are described; essentially these consist of otherwise unexplained renal impairment, urinary tract symptoms, radiological changes and sterile pyuria, often associated with dyspepsia, anemia and psychiatric disturbances. The classical pathological changes consist of interstitial nephritis and progressive reduction in renal size, secondary to repeated episodes of papillary necrosis. Cessation of analgesic abuse usually arrests the deterioration in renal function, and indeed some recovery of function may occur.

Analgesics↗
PubMed1977

[Vaginal reflux during miction-cystourethrography in girls (author's transl)].

The cases of 57 girls with reflux of radioopaque iodin solution into the vagina during mictioncystourethrography are reported. In 52.6% (30 cases) no signs of anomalies of the urinary tract or of pyelonephritis were found. For this group of 30 girls pyuria (leucocyturia) was typical (in 86.6%). In contrast, a urinarty-tract infection was found only in a few cases (16.6%). The authors discuss the clinical importance of vaginal reflux and its role in the pathogenesis of urinary-tract infections.

Adolescent↗