1/18. Covering of the terminal ureter with de-serosalized muscle layer of the ileum for antireflux ureteroileostomy: an experimental study in dogs and a preliminary clinical trial.We demonstrated a new operative technique for antireflux ureteroileostomy in dogs. The severed ureter was reimplanted into the isolated ileum. Ten terminal ureters were covered with a 2 x 2 cm2 section of de-serosalized ileal wall after direct ureteroileostomy, and another six terminal ureters were covered with a 2 x 2 cm2 section of non-de-serosalized full-thickness ileal wall. Thirteen ureters were directly anastomosed to the ileum without any additional procedures. The bladder was augmented by the detubularized ileum with the ureter. Postoperative evaluations on ureteral stenosis and reflux were performed monthly for 3 months. The ureters covered with the de-serosalized ileal wall prevented ureteral reflux even when the intravesical pressure climbed as high as 100 cm H2O. Although two of these ten ureters demonstrated strictures at the precise site of direct ureteroileostomy, the sections of the ureters covered with the de-serosalized ileal wall were opened and did not collapse. In the resected specimens, the terminal ureters were found in the intramural part of the ileum. The ureters covered with the full-thickness of ileal wall did not prevent reflux. Our method of covering the terminal ureter with the de-serosalized ileal wall worked well as an antireflux mechanism, and the intramural ureter did not cause ureteral stricture. After this animal experiment, we introduced this antireflux mechanism clinically.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/18. Prototype of a reflux-preventing ureteral stent and its clinical use.We have experimentally produced a ureteral stent which prevents vesicorenal reflux. This stent has a thin silicon sleeve at its distal end (intravesical portion). In a model experiment the sleeve demonstrated an excellent capability to prevent reflux. The sleeve allowed flow of fluid with minimal pressure rise. A patient with bilateral ureteral obstruction was managed with endoscopic insertion of a sleeved stent in the right ureter and a usual pigtail stent in left ureter. During cystography vesicorenal reflux was not observed on the right side while reflux occurred on the left side. Excretory urography forty days after stent placement demonstrated recovery of renal function and maintenance of drainage in both renal units. Thus, the drainage characteristic of this stent appears to be approximately the same as that of usual stent.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/18. Urinothorax associated with VURD syndrome.VURD syndrome is a congenital genitourinary anomaly combining posterior urethral V alves, U nilateral vesicoureteral R eflux and renal D ysplasia. We report on a case of VURD syndrome presenting with acute renal failure and respiratory distress syndrome due to urinothorax. Urinothorax is a rarely reported complication of obstructive uropathy, but has not been linked to VURD syndrome. The diagnosis of urinothorax was confirmed by demonstration of a pleural fluid to serum creatinine ratio greater than one. Without tube thoracotomy drainage, urinothorax resolved rapidly after urinary catheterization and the renal recovery was also excellent after primary valve ablation. We discuss the diagnosis and management of urinothorax and the possible protective effect of urinoma, urinothorax, and unilateral vesicoureteral reflux on the renal function. We consider that urinothorax and urinoma may be deemed to be the extension of the clinical spectrum of VRUD syndrome. Excellent renal prognosis in our case also favors the protective effect provided by the buffer of pressure from unilateral vesicoureteral reflux, urinoma and urinothorax.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/18. Intravesical bladder stimulation in myelodysplasia.Intravesical transurethral bladder stimulation has been used as a diagnostic and rehabilitative technique in children with a neurogenic bladder for 3 years. The program has expanded from 10 to 42 patients undergoing a significant number of therapy sessions. The technique presently is done on an outpatient basis. The child is catheterized for 90 minutes and undergoes electrotherapy for 60 minutes, ideally 3 to 5 days per week. An individual series consists of 15 to 30 daily sessions. Presently, 62 patients have been evaluated and 42 have had a least 1 complete series. This ongoing program has provided more data to classify better patients who can expect success with the program. Of the patients who presented initially with detrusor contractions and areflexia 80 and 33 per cent, respectively, can expect to void to completion or have full sensation so as to perform timely clean intermittent catheterization. A total of 21 patients underwent at least 3 series, and 38 per cent void with low pressure and total continence.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/18. An unusual encapsulated collection of urine (urinoma) in an infant with vesicoureteral reflux.We describe an unusual case of encapsulated collection of urine (urinoma) in a 7-month-old female infant. The clinical diagnosis was urinary tract infection. The retrograde cysto-urethrogram revealed grade III vesicoureteral reflux, which we believe was the cause of the urinoma. The investigation was completed with isotope and ultrasound studies. High pressure reflux was the cause of the urine extravasation in the perirenal space.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/18. pseudotumor cerebri associated with obstructive nephropathy.We report two infants with pseudotumor cerebri associated with renal disease. The pathogenesis of increased intracranial pressure in this clinical setting is unclear, but may be mediated by one or more of the conditions commonly associated with pseudotumor cerebri, including sinus thrombosis, increased intravascular fluid volume, anemia, and endocrine disturbances resulting in abnormal calcium and phosphorus metabolism. The onset of pseudotumor cerebri also may be related to changes in vasopressin levels that affect brain water permeability.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/18. High pressure pyelocalyceal reflux. Case presentation.In the absence of vesicoureteral reflux or urinary tract obstruction, conservative management is advocated for children with recurrent urinary tract infection. Conventional radiographic studies and static nuclear imaging techniques, however, may fail to reveal a subclinical but significant structural or functional abnormality. Recurrent breakthrough infections during appropriate medical treatment and high pressure pyelocalyceal reflux may justify a more aggressive therapeutic approach. We propose that a pressure perfusion study with fluoroscopy and continuous pressure monitoring be performed preoperatively to help select those children in whom surgery is an acceptable alternative.- - - - - - - - - - ranking = 7keywords = pressure (Clic here for more details about this article) |
8/18. Early vesico-ureteral reflux following conus medullaris injury: case report.The authors describe severe vesico-ureteral reflux and simultaneous renal insufficiency which occurred after a spinal cord injury to the conus medullaris. They point out the misleading character of these injuries when there are only minimal neurological signs in the trunk and limbs. The main clinical consequence may be an isolated neuropathic bladder which, if not detected, delays treatment. Additionally, they underline the role of mixed bladder and sphincter lesions in the development of renal insufficiency; also the role of increased intravesical pressure during filling and emptying with bilateral vesico-ureteral reflux.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/18. Augmentation ileocystoplasty in neuropathic bladder.Augmentation cystoplasty is a viable treatment modality in patients with neuropathic bladder. Indications include incontinence despite pharmacologic manipulation, persistent hydroureteronephrosis, vesicoureteral reflux, and propantheline bromide intolerance. Eight patients have had augmentation cystoplasties, with all obtaining normal bladder capacity, intravesical pressure, and voiding frequency. Reflux and hydronephrosis have been eliminated or significantly reduced in those patients who had experienced those problems prior to augmentation. Four cases are presented.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/18. Observations on vesico-ureteric reflux and intrarenal reflux: a review and survey of material.Objectives of this study were to evaluate some of the factors influencing vesico-ureteric reflux and intrarenal reflux. Reflux occurs in about one-third to a half of Caucasian children with urinary tract infection and although not greatly influenced by examination technique or sex it is affected by age, diuretics and race. Intrarenal reflux occurs in about 10% of cases with total reflux and does not appear to cause scars on its own. autopsy studies can provide valuable information on papillary morphology and reaction to pressure, but information is of doubtful reliability in the first months of life and in fixed specimens. The literature pertaining to vesico-ureteral reflux, intrarenal reflux and related research projects is briefly reviewed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
| | Next -> |