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- Clementson Kockum, Christina, et al.
(författare)
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Pediatric urinary tract reconstruction using intestine
- 1999
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 33:1, s. 53-56
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse the outcome of urinary tract reconstruction in children. MATERIAL AND METHODS: Fifteen children with bladder exstrophy or neurogenic bladder, 4-18 years old, were followed in accordance with a predetermined program for bladder augmentation (13 pat) or continent urinary reservoir (2 pat). The follow-up time was 1.7-6.3 years, median 3.7 years. RESULTS: All were dry, though one case had occasional leaks. Three bladder neck reconstructions, two artificial sphincters, one sling plasty and one fistula closure with subsequent bladder neck injection were required. Bladder volumes were adequate for age at low pressures. Reflux resolved in 12/13 ureters. A boy with preoperative renal insufficiency was transplanted. Total renal function remained otherwise stable despite acidosis in one case and some glomerular impairment in all. Progressive parenchymal lesions were seen in combination with abundant mucus, infections and calculi only. Growth and bowel function was unaffected. Bone mineral density showed overall increase; some low values were not consistent between investigations. CONCLUSIONS: Urinary tract reconstruction in children results in continence and regression of reflux. Growth, bone mineralization and renal function are unimpaired during the first years, but irrigation of the bladder is essential to minimize the risk of urinary tract infection. However, glomerular function might be affected and the possible risk of metabolic complications in later life can only be determined by continuous close monitoring over an extended period of time. ABBREVIATIONS: Voiding cystourethrogram (VCUG), dimercapto-succinic acid (DMSA), Chrome51-Ethylenediaminetetraacetic acid (Cr-EDTA), single photon absorption (SPA), bone mineral content (BMC), bone mineral density (BMD), dual photon x-ray absorption (DEXA), glomerular filtration rate (GFR), urinary tract infection (UTI), immunoglobulin G (IgG), clean intermittent catheterization (CIC) and subureteral teflon injection (STING).
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| 2. |
- Wallin, Lena, et al.
(författare)
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Follow-up of acute pyelonephritis in children by Tc-99m DMSA scintigraphy - Quantitative and qualitative assessment
- 2001
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Ingår i: Clinical Nuclear Medicine. - 0363-9762. ; 26:5, s. 423-432
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The author's goal was to create a system to identify children at risk for development of progressive renal damage, Methods: Thirty-four children were examined with Tc-99m DMSA scintigraphy in the acute stage of an initial episode of pyelonephritis, after 6 months, and again after 1 year, The scintigraphic findings were correlated with clinical and laboratory data, Results: All children had parenchymal defects in the acute stage: 93% of the kidneys and 85% bilaterally, After 6 months, the defects had diminished or disappeared in 66% of the kidneys, New defects appeared in 22%, At 1 year, no further improvement was seen in the kidneys, with an improved or unchanged pattern at 6 months, New defects appeared in 34%, Mean kidney activity uptake expressed as the percentage of administered dose (KU/AD), was low in the acute stage, increased at 6 months, with no further significant increase at 1 year, Eighty-three percent of children with urine cultures growing greater than or equal to 10(4) bacteria/ml at follow-up had decreased KU/AD values, whereas all children with urine cultures growing < 10(4) bacteria/ml had increased KU/AD values. Conclusions: Quantitative assessment increases the sensitivity of Tc-99m DMSA scintigraphy. Follow-up with this method makes it possible to identify the children with decreasing renal tubular function who may be at risk for progressive renal damage, Moderate bacteria of 104 bacteria/ml urine is associated with deterioration of renal tubular function.
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