Neonatal urinary ascites secondary to urinary bladder rupture

We describe the clinical presentation, radiology and clinical management of four neonates with spontaneous urinary bladder rupture and secondary urinary ascites seen in 1984 and two recent cases seen in 2007. All neonates had normal genitourinary systems on antenatal serial ultrasound scans. The management of these cases ranged from conservative management (n = 3) to surgical repair of bladder (n = 1). We present a review of the current literature covering management strategies and the possible role of ischemia in the pathogenesis of neonatal bladder rupture which continues to be a clinically challenging entity to diagnose and manage.     

Imaging the urinary tract in children with urinary tract infection

Aim: To evaluate whether ultrasonography (US) alone is sufficient in imaging the urinary tract in 1185 children with urinary tract infection (UTI). Methods: The reports on US and voiding cystourethrography (VCUG) were reviewed. Results: Initial US was normal in 861/1185 patients (73%). VCUG revealed abnormal findings in 285/861 (33%), of which grade III–V vesicoureteral reflux (VUR) comprised 97 cases (11%). During follow‐up, VUR had resolved in 88/97 (91%) patients: in 50/57 (88%) patients without active treatment for VUR, in 27/29 (93%) with endoscopic and in 11/11 (100%) with open surgery for VUR. During follow‐up, 11/97 patients (11%) had developed new renal scarring detectable in US, but no renal impairment occurred. Except for VUR, VCUG showed nonobstructive urethral valves in two infant boys with normal initial US. Thus, in 861 children with normal initial US, 40 patients with grade III–V VUR and two patients with significant nonreflux pathology may have benefited from surgical treatment, giving the total number of possibly missed pathological finding in 42/861 (4.9%) cases if VCUG had not been performed. Conclusion: We suggest that children with UTI could be examined using US alone and to use VCUG only after additional indications.     

Radiological evaluation of the urinary tract in children with urinary infection

Objective: This article in to study the association of structural abnormalities of the urinary tract in children with urinary tract infection (UTI) using ultrasound examination.Methods : 262 children with culture proven urinary tract infection were studied. Antibiotics were given as per sensitivity pattern. All children had an ultrasound of the abdomen done within 3 weeks. A micturating cystourethrogram (MCU) was done in those with abnormalities of the lower urinary tract detected on ultrasound, as well as in those who had recurrence of infection, after a normal ultrasound. IVU and renal isotope scans were done in selected cases.Result : All children were followed up until one year after the study period. Fifty-four patients had an underlying urinary tract anomaly; 42 were picked up by ultrasound and 12 by MCU. 22.9% of males and 15.9% of females had anomaly of the urinary tract. Children less than 2 years had the highest incidence of anomalies.Conclusion : Pelviureteric junction obstruction with hydronephrosis, vesicoureteric reflux and non-refluxing megaureter are the major anomalies picked up. 20% of children with urinary tract infections have an underlying structural abnormality of the urinary tract, three-fourth of which are picked up on ultrasound. An ultrasound abdomen is recommended in all children after the first UTI. In addition, an MCU is also indicated in all boys below 2 years with UTI, since one-third of anomalies will be missed if only ultrasound is done.     

Management of daytime urinary incontinence and lower urinary tract symptoms in children

Lower urinary tract symptoms, particularly urgency, frequency and incontinence are common in school-aged children but are often overlooked. They may cause considerable physical, social and psychological difficulties to children and their families, and usually are manifestations of underlying non-neurogenic voiding disorders. The differential diagnoses include overactive bladder syndrome, dysfunctional voiding and vaginal reflux as well as less common conditions like giggle incontinence, voiding postponement, pollakiuria and diabetes insipidus. In this paper, we discuss an evidence-based approach to the management of conditions causing daytime urinary incontinence and lower urinary tract symptoms in children from a general paediatrician's perspective.     

Recurrent urinary tract infection

This study is a review of 85 children with urinary tract infection in university hospitals and clinics. It shows importance of early diagnosis and investigations regardless of age and sex.     

Relationship of urinary anion gap to urinary ammonium excretion in the neonate

The present study was undertaken to define the relationship of urinary anion gap (UAG = sodium plus potassium minus chloride) to urine ammonium concentration in preterm and full-term neonates with spontaneous and NH4Cl-induced metabolic acidosis. Studies were performed in 10 premature infants (mean birth weight: 1,618 g, gestational age: 30.8 weeks) weekly for 6 consecutive weeks, in 11 full-term neonates (mean birth weight: 3,085 g, gestational age: 38.6 weeks) on the 7th day of life and in 25 older control infants (mean age: 6.5 months, body weight: 6,802 g) before and after NH4Cl-loading test. Blood acid-base parameters, plasma electrolyte concentrations, urine pH, ammonium, titratable acidity, bicarbonate, net acid and electrolyte concentrations were measured, UAG calculated. It was demonstrated that the significant reduction in plasma total CO2 content induced by NH4Cl administration and the subsequent elevation in urinary ammonium concentration was associated with some decrease of UAG in each group. In premature infants there was no relationship between urinary ammonium excretion and UAG during the first 2 weeks of life while from the 3rd week onward a significant negative correlation could be demonstrated. In one-week-old full-term neonates UAG also tended to decline with increasing ammonium concentrations; this relationship, however, proved to be insignificant. In the older control infants urinary ammonium excretion was found to correlate negatively to UAG. It is concluded that due to marked dynamic changes in unmeasured ionic composition of neonatal urine UAG is not a valuable index of urinary ammonium excretion in newborn infants during the first weeks of life.     

Pediatric urinary tract infection

Urinary tract infections (UTI) are one of the most common and serious infections among pediatric patients in the emergency department. Detection of UTI requires a systematic approach to urine testing and an understanding of the limitations to common screening tests. Proper culturing techniques are essential to the diagnosis. Accurate diagnosis and prompt treatment can reduce morbidity associated with UTIs.     

Hospital-acquired urinary tract infection

From 16,534 admissions, 60 patients, 4 days to 15 years of age, with one or more hospital-acquired urinary tract infections were identified during a 5-year period by a prospective surveillance system. The patient charts were subsequently reviewed to characterize the population at risk for such infections and to describe the course and consequences of these infections. Infections in individual patients ranged from one to greater than 50. The hospital-acquired urinary tract infection rate for the study period was 14.2 infections per 1,000 admissions. In the patients in whom all urinary tract infections were well documented, the following characteristics were defined: (1) 92% (97 of 105) of the infections occurred in catheterized patients; (2) almost half (49 of 105) of the infections occurred in patients exposed to only intermittent catheterization; (3) 28% (29 of 105) of the infections were asymptomatic; (4) fever was the most frequent finding in the symptomatic patients and occurred in 66% (60 of 105); (5) pyuria was found in only 51% (35 of 69) of the urinalyses performed at diagnosis; (6) 85% (89 of 105) of the infections were single-organism infections; (7) 82% (101 of 123) of the causative organisms were Escherichia coli, Pseudomonas sp, coagulase-negative staphylococci, Enterococcus spp, Klebsiella spp, or Enterobacter sp. The urinary tract infections in the 60 patients were not complicated by bacteremia, and no direct relationship between the infections and the minimal mortality in our patients could be established.     

Etiological profile of urinary tract infections and antimicrobial susceptibility of urinary pathogens

A review on the etiological profile of urinary tract infections in childhood and the sensitivity pattern of urinary pathogens in Spain is presented. Escherichia coli continues to be the main etiological agent of urinary tract infection in childhood. Consequently, its sensitivity pattern will usually determine the choice of empirical therapy. The predominance of E. coli is reduced in certain circumstances, in which the presence of other microorganisms is increased. However, the clinical information available at diagnosis does not allow accurate identification of the etiology; only staining and microscopic urine examination can help in treatment selection. In Spain, E. coli presents a high percentage of resistance to ampicillin and cotrimoxazole, whereas second- and third-generation cephalosporins, fosfomycin, aminoglycosides and amoxicillin-clavulanate maintain high sensitivity. In some areas, amoxicillin-clavulanate and first-generation cephalosporins show high levels of resistance, which can limit their empirical use.     

Vincristine-induced urinary bladder paralysis

The authors describe the development of bladder paralysis in a child with acute lymphoblastic leukemia undergoing maintenance chemotherapy. Immediately before the adverse clinical event, the child had received vincristine intravenously and triple therapy with hydrocortisone, cytosine arabinoside, and methotrexate intrathecally and had begun a 5-day pulse of prednisolone. The authors conclude that the ensuing reversible bladder paralysis was related to the vincristine. The clinical event resolved, and vincristine was deleted from the child's subsequent therapy until full recovery was achieved. The authors advise recognition of this problem and discontinuation of the vincristine if transient bladder paralysis develops until symptoms completely disappear.     

窒息新生儿尿内皮素、尿微量蛋白的变化观察

目的　 探讨尿内皮素 (ET)、尿微量蛋白 (a1 M、TRF、Alb)在新生儿窒息肾脏损害中的意义。 方法 　窒息组在生后第 3天、第 7天采用放射免疫法测定尿ET ,同时测定其尿微量蛋白水平。对照组健康新生儿同期进行上述检测。 结果 　发现窒息组第 3天尿ET含量明显高于对照组 (P <0 0 1)。且重度窒息组 >轻度窒息组 >对照组。第 7天重度窒息组尿ET平均水平虽高于对照组、轻度窒息组 ,但统计显示无明显差异 (P >0 0 5 )。尿微量蛋白 (a1 M、TRF、Alb)变化与尿ET呈正相关 (P <0 0 1)。 结论 　尿ET与尿微量蛋白含量测定可以作为新生儿肾功能损伤的早期指标。新生儿窒息尿ET的增高与肾损害有密切关系     

The artificial urinary sphincter

Urinary incontinence has many etiologies and a similarly varied and wide-ranging spectrum of therapeutic alternatives. The AMS artificial sphincter represents one of these options that has a distinct, albeit limited, place in certain patients. The authors outline the mechanical details of these devices and present their own clinical experience in a large pediatric population.     

Pediatric urinary tract infections

Pediatric urinary tract infections are common. These infections have been recognized as a source of acute morbidity and long-term medical consequences in adulthood. There are various risk factors and clinical presentations in children with urinary tract infections. The main objectives in management include prompt diagnosis, appropriate antimicrobial therapy, identification of anatomic anomalies, and, in select patients, long-term follow-up.