Stacy T Tanaka, John W Brock
Pediatric urologic conditions, including urinary infections.
Med Clin North Am. 2011 Jan;95(1):1-13. doi: 10.1016/j.mcna.2010.08.018.
Abstract/Text
Genitourinary complaints are common in children, and the busy primary care provider must determine initial treatment and assess need for specialty referral. Many complaints are self-limited, but some represent disorders that can threaten organ function. In this article, an initial approach in the primary care office and a guide to specialty referral for pediatric urologic conditions of the urinary tract, male genitalia, and female genitalia are suggested.
Copyright © 2011 Elsevier Inc. All rights reserved.
G G Mackie, F D Stephens
Duplex kidneys: a correlation of renal dysplasia with position of the ureteral orifice.
J Urol. 1975 Aug;114(2):274-80.
Abstract/Text
A study was made of 51 duplex kidneys, ureters and bladders to assess the types of abnormalities seen in duplex kidneys. The abnormalities affected ectopic and orthotopic segments equally. The occurrence of renal abnormality was closely correlated to the abnormal locations of the segment's ureteral orifice. When the orifice was displaced either cranially (orifice positions B, C and D) or caudally (orifices G and H) the orthotopic and ectopic segments, respectively, showed more severe hypoplasia and dysplasia. Faulty embryogenesis is proposed to explain these findings and the importance of endoscopic positioning of the ureteral orifice is emphasized in determining whether heminephrectomy will be necessary.
Katherine C Hubert, Jeffrey S Palmer
Current diagnosis and management of fetal genitourinary abnormalities.
Urol Clin North Am. 2007 Feb;34(1):89-101. doi: 10.1016/j.ucl.2006.10.002.
Abstract/Text
Prenatal assessment with ultrasonography provides excellent imaging of fluid-filled structures (eg, hydronephrosis, renal cysts, and dilated bladder) and renal parenchyma. This information allows for the generation of a differential diagnosis, identification of associated anomalies, and assessment of the prenatal and postnatal risks of a given anomaly. This enhances parental education and prenatal and postnatal planning. This article discusses the current methods of diagnosis and management of fetal genitourinary anomalies, and also the postnatal evaluation and treatment of these conditions.
Seyedmehdi Payabvash, Abdol-Mohammad Kajbafzadeh, Parisa Saeedi, Zhina Sadeghi, Azadeh Elmi, Mehrzad Mehdizadeh
Application of magnetic resonance urography in diagnosis of congenital urogenital anomalies in children.
Pediatr Surg Int. 2008 Sep;24(9):979-86. doi: 10.1007/s00383-008-2196-7. Epub 2008 Jul 31.
Abstract/Text
Magnetic resonance urography (MRU) has become a useful adjuvant in evaluating urogenital anomalies. In present study, we evaluated the ability of MRU in diagnosis of different congenital urogenital anomalies when the results of conventional imaging modalities were inconclusive. A total of 90 children were included in this series. The children were evaluated with T2-weighted and contrast-enhanced T1-weighted MRU sequences. The results were compared with findings obtained with ultrasonography, intravenous urography, renal nuclide scan, and voiding cystourethrography. MRU was requested in these children because conventional imaging modalities were equivocal or a co-existing urogenital anomaly was suspected. Only those cases that underwent surgery were included in this study and the surgical findings were set as the reference standard in statistical evaluation. The records of 61 boys with mean (range) age of 2.3 years (2 months-12 years) and 29 girls with mean (range) age of 3.3 years (3 months-12 years) were reviewed. The final diagnosis was ureteropelvic junction obstruction (n = 25), vesicoureteral junction obstruction (n = 16), ureterocele (n = 19), ectopic kidney (n = 11), posterior urethral valve (n = 17), and polycystic kidney (n = 2). The overall sensitivity of MRU, intravenous urography, renal nuclide scan, ultrasonography, and voiding cystourethrography in diagnosis of the aforementioned anomalies were 86, 63, 50, 44, and 41%, respectively. MRU was much more sensitive than other imaging modalities in diagnosis of end-ureteral dilation (100%) and ureterocele (89%). MRU provides a reliable noninvasive technique for imaging of the congenital anomalies in the urinary tract of children with T2-weighted MRU sequences providing unenhanced static-water images of the urinary tract as well as depicting adjacent soft-tissue lesions, and T1-weighted MRU technique imitating conventional intravenous urography. Both MRU sequences can be combined for a comprehensive examination of the urinary tract.
Ming-Dar Lee, Chun-Chen Lin, Brian Pin-Hsuan Chang, Pei-Yi Lin, Jeng-Daw Tsai
Pseudoureterocele.
Pediatr Neonatol. 2018 Feb;59(1):104-105. doi: 10.1016/j.pedneo.2017.09.002. Epub 2017 Sep 6.
Abstract/Text
金子一成：小児の尿路感染症up-to-date. 小児感染免疫。2021. 33巻（1）：58-65.
Ottavio Adorisio, Antonio Elia, Luca Landi, Maria Taverna, Valeria Malvasio, Alfredo D Danti
Effectiveness of primary endoscopic incision in treatment of ectopic ureterocele associated with duplex system.
Urology. 2011 Jan;77(1):191-4. doi: 10.1016/j.urology.2010.02.061. Epub 2010 Dec 18.
Abstract/Text
OBJECTIVES: To report our experience with the endoscopic treatment of ectopic ureterocele to demonstrate its long-term effectiveness. Endoscopic treatment is often recommended as the initial and definitive treatment in patients with ureterocele.
METHODS: A total of 46 children with ectopic ureterocele in a duplex system underwent primary endoscopic incision from January 1998 to January 2006. The mean follow-up was 3.8 years. Of the 46 children, 35 had been diagnosed prenatally and 11 had been diagnosed after birth because of a urinary tract infection. Low-dose antibiotic prophylaxis was administered to all children and was maintained until voiding cystourethrography showed no reflux. The pre- and postoperative evaluation included clinical assessment, ultrasound evaluation, diethylenetriaminepentacetic acid renography, and cyclic voiding cystourethrography.
RESULTS: Ureterocele decompression was achieved in 43 patients (93%). Three patients required additional surgery for persistent ureterocele (1 underwent ureteroureterostomy and 2 ureteropyelostomy). None of our patients showed deterioration of renal function after the procedures. Vesicoureteral reflux was seen in the lower moiety of the ipsilateral kidney in 14 patients (30%). Of the 14 patients with vesicoureteral reflux, 10 had spontaneous resolution. The remaining 4 underwent endoscopic correction. Five patients (10%) developed de novo vesicoureteral reflux in the ipsilateral ureterocele moiety. Of these 5 patients, 3 were treated with endoscopic injection and 2 had spontaneous resolution after 6 months of follow-up.
CONCLUSIONS: Our data have shown that primary endoscopic puncture of a ureterocele is a simple, long-term, effective, and safe procedure, avoiding complete reconstruction in most patients.
Copyright © 2011 Elsevier Inc. All rights reserved.
Paolo Caione, Simona Gerocarni Nappo, Giuseppe Collura, Ennio Matarazzo, Maida Bada, Laura Del Prete, Michele Innocenzi, Ermelinda Mele, Nicola Capozza
Minimally Invasive Laser Treatment of Ureterocele.
Front Pediatr. 2019;7:106. doi: 10.3389/fped.2019.00106. Epub 2019 Apr 8.
Abstract/Text
Introduction: Ureterocelemay cause severe pyelo-ureteral obstruction with afebrile urinary tract infections in infants and children. Early decompressive treatment is advocated to reduce the risk of related renal and urinary tract damage. Endoscopic techniques of incision have been offered utilizing diathermic electrode. We adopted laser energy to release the obstruction of the ureterocele and reduce the need of further surgery. Our technique is described and results are presented, compared with a group of matched patients treated by diathermic energy. Materials and methods: Decompression was performed by endoscopic multiple punctures at the basis of the ureterocele. Holmium YAG Laser was utilized with 0.5-0.8 joule energy, through 8-9.8F cystoscope under general anesthesia. The control group received ureterocele incision by diathermic energy through pediatric resettoscope. Foley indwelling catheter was removed after 18-24 h. Renal ultrasound was performed at 1, 3, 6, and 12 months follow-up. Voiding cysto-urethrogram and radionuclide renal scan were done at 6-18 months in selected cases. Statistical analysis was utilized for data evaluation. Results: From January 2012 to December 2017, 64 endoscopic procedures were performed: 49 were ectopic and 15 orthotopicureteroceles. Fifty-three were in duplex systems, mostly ectopic. Mean age at endoscopy was 6.3 months (1-168). Immediate decompression of the ureterocele was obtained, but in five cases (8%) a second endoscopic puncture was necessary at 6-18 months follow-up for recurrent dilatation. Urinary tract infections and de novo refluxes occurred in 23.4 and 29.7% in the study group, compared to 38.5 and 61.5% in the 26 controls (p < 0.05). Further surgery was required in 12 patients (18%) at 1-5 years follow-up (10 in ectopic ureteroceles with duplex systems): seven ureteral reimplantation for reflux, five laparoscopic hemy-nephro-ureterectomy. Orthotopic ureteroceceles had better outcome. Secondary surgery was necessary in 13 patients (50.0%) of control group (p < 0.05). Conclusions: Early endoscopic decompression should be considered first line treatment of obstructing ureterocele in infants and children. Multiple punctures at the basis of the ureterocele, performed by low laser energy, is resulted a really minimally invasive treatment, providing immediate decompression of the upper urinary tract, and reducing the risk of further aggressive surgery.
R Pearce, R Subramaniam
Partial nephroureterectomy in a duplex system in children: the need for additional bladder procedures.
Pediatr Surg Int. 2011 Dec;27(12):1323-6. doi: 10.1007/s00383-011-2968-3. Epub 2011 Aug 30.
Abstract/Text
INTRODUCTION AND OBJECTIVES: Heminephroureterectomy (HN) is our treatment of choice in a duplex system with non-functioning moiety. We examined the need for endoscopic incision (EI)/bladder reconstructive surgery (BRS) and whether ureteroceles and/or vesicoureteric reflux (VUR) influenced management options.
METHODS: Retrospective study of patients undergoing HN by a single surgeon (2003-2008). Patients were classified according to the presence (Group 1) or absence (Group 2) of ureterocele. The groups were subdivided with coexisting dilating VUR (a) or not (b). Statistical analysis included Fisher's exact test.
RESULTS: Thirty-one children were identified. Seventeen (54.8%) had ureterocele (Group 1) and 14 patients had no ureterocele (Group 2). Group 1 had eight with VUR (1a) and nine without (1b). Group 2 had seven with VUR (2a) and seven without (2b). Significantly more patients with ureterocele required EI/BRS (p = 0.006). Five (29%) in Group 1 required BRS versus none in Group 2 (p = 0.04). Six (75%) in Group 1a underwent EI/BRS versus three (33%) in Group 1b (p = 0.15). Significantly more in Group 1a required EI prior to HN versus Group 1b (p = 0.04). Similar numbers of patients required BRS in Groups 1a and 1b (p = 0.61).
CONCLUSIONS: In the absence of ureterocele, there is minimal likelihood of requiring surgery apart from HN, independent of VUR. Presence of ureterocele is an indicator for additional procedure within the bladder. There is a higher incidence of EI when ureterocele co-exists with dilating VUR.
Wein: Campbell-Walsh Urology, 12th. Ed.
