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- Müller, Lennart, 1959, et al.
(author)
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Ultrasound assessment of detrusor thickness in children and young adults with myelomeningocele
- 2006
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In: J Urol. - 0022-5347. ; 175:2
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Journal article (peer-reviewed)abstract
- PURPOSE: We determine by ultrasonography the range of dT in carefully treated and followed children with myelomeningocele, and evaluate the role of such measurements for the understanding of bladder abnormalities in these patients. MATERIALS AND METHODS: We studied 66 children and young adults with MMC (34 males and 32 females, median age 8.1 years, range 1.1 to 20.1). Detrusor thickness was measured with a previously established ultrasonographic technique and the results were compared to those in normal children. The variation in detrusor thickness with degree of bladder dysfunction as well as with bladder wall trabeculation, kidney function and anticholinergic treatment was studied. RESULTS: The detrusor of the ventral wall was slightly thinner in children with MMC compared to normal. No significant variation in dT was found for different degrees of bladder dysfunction, bladder wall trabeculation, kidney function or anticholinergic treatment. Boys had thicker detrusor of the ventral wall than girls. CONCLUSIONS: Children with MMC, followed closely and treated according to international standards, do not acquire detrusor thickening as measured by ultrasonography. The detrusor thickness did not correlate with the degree of bladder dysfunction or renal function, or with anticholinergic treatment. Bladder wall trabeculation at VCU was not associated with bladder wall thickening on ultrasonography. We postulate that in a closely monitored and actively treated population of patients with MMC muscular hypertrophy and the development of connective tissue in the bladder wall is kept to a minimum.
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| 2. |
- Müller, Lennart, 1959, et al.
(author)
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Ultrasonography as predictor of permanent renal damage in infants with urinary tract infection.
- 2009
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In: Acta paediatrica (Oslo, Norway : 1992). - : Wiley. - 1651-2227 .- 0803-5253. ; 98:7, s. 1156-61
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Journal article (peer-reviewed)abstract
- AIM: To evaluate the ability of ultrasound (US) in infants (<1 year) with acute urinary tract infection (UTI), to identify those with permanent renal damage (PRD) at scintigraphy 1 year later. METHODS: US, dimercaptosuccinic acid scintigraphy and voiding cystourethrography were performed in 191 infants. RESULTS: US was abnormal in 46 infants (24%). PRD was found in 46 infants (24%); 19 of these had abnormal US (sensitivity 41%). In 145 infants without PRD, 27 had abnormal US (specificity 81%). Dilating reflux or verified obstruction occurred in 21 (11%) infants, of whom 18 (86%) had PRD while 28 of 170 (16%) without such diagnoses had PRD. Of 16 infants with dilating reflux, 9 (sensitivity 56%) had abnormal US and 14 (88%) PRD. Dilatation at US was seen in 27 children; 7 of these had dilating reflux and 5 verified obstruction. CONCLUSION: US performed in association with acute UTI had limited ability to identify children with PRD at (99m)Tc-dimercaptosuccinic acid (DMSA) 1 year later, although abnormal renal size was a strong indicator of renal damage. The ability of US to identify children with dilating reflux was also limited. However, once detected at US, dilatation of the urinary tract was associated with dilating reflux or obstruction in half of the cases. Our study confirms that dilating reflux and obstruction are strong indicators of PRD but only half of those who developed PRD had such diagnoses.
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| 3. |
- Müller, Lennart, 1959
(author)
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Ultrasonography of the urinary tract in children, with special emphasis on the urinary bladder
- 2006
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Doctoral thesis (other academic/artistic)abstract
- Ultrasonography (US) is routinely used in children with urinary tract disorders. However, the bladder is usually evaluated with invasive methods, e.g. voiding cystourethrography (VCU) and cystometry. The first aim of this thesis was to develop and evaluate a non-invasive US method for assessment of the detrusor, the anatomical bladder wall structure most likely to be affected by disorders hampering bladder function. The most important issue in evaluating children with urinary tract infection (UTI) is to identify individuals who are at risk of permanent renal damage (PRD). The role of US in this respect is debated. The second aim of this thesis was to evaluate US for identification of infants at risk of PRD after symptomatic UTI. I. A transabdominal US technique was developed, assessing the thickness of the low echogenic detrusor layer of the urinary bladder wall at anatomically defined locations. The method proved reliable, with an intra- and interobserver variability of 0.2 mm. II. Detrusor thickness (DT) was measured in 150 healthy children, aged 0-13 years. DT decreased with increasing bladder fullness and increased with age. Boys had slightly thicker detrusors than girls. The upper limit of normal for DT was 1.5-2 mm, depending on age and bladder fullness.III. DT was measured in 66 children with neurogenic bladder disturbance (myelomeningocele). The DT was thinner than in normal children, and there was no correlation between DT and bladder- or renal function, treatment with anticholinergics or trabeculation of the bladder at VCU. It appears that treatment with intermittent catheterisation and anticholinergics are effective in preventing bladder wall thickening. IV. US, DMSA scintigraphy and VCU were performed in 191 infants with symptomatic, first time UTI. One year later children with abnormal scintigraphy had a follow-up scintigraphy. US had a low sensitivity (43%) in predicting permanent renal damage (PRD) and in detecting dilating reflux (56%) as a risk factor for PRD. Dilating reflux, obstruction and anomaly were confirmed as important risk factors for PRD, but was found in only half of the children who developed PRD, and this probably contributed to the low ability of US to predict PRD.
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