Paediatric isotope-renographic observations in upper urinary tract obstruction

The authors examined the diagnostic value of the isotope renogram (is. r.) in 50 children in whom the final diagnosis was upper urinary tract obstruction. Diagnostically informative is. r.-s were obtained in 42 cases. Positive is. r. was obtained in 20 of the 21 hydronephrosis cases. Based on these results the authors recommend the application of isotope renography both as a screening test and as a completion of urographic and other investigations when anamnestic data and certain symptoms are suggestive of obstructive uropathy.Is. r. performed before the operation of hydronephrosis does not seem to be in itself conclusive in deciding whether renal parenchyma can or cannot be preserved.The isotope renographic follow-up of patients suffering from upper urinary tract obstruction without hydronephrosis is a simple method to obtain continuous information about changes in the function of the kidney and the urine-conveying system.     

Fluconazole treatment in Torulopsis glabrata upper urinary tract infection causing ureteral obstruction.

We report a case of Torulopsis glabrata upper urinary tract infection causing ureteral obstruction. The infection was successfully treated with fluconazole, a new triazole derivative, combined with ureteral catheterization.     

Diuretic radionuclide localization of upper urinary tract obstruction

In 59 children with proved upper urinary tract obstruction diuretic radionuclide ureteral scans provided an accurate assessment of ureteral dilatation sufficient to distinguish ureteropelvic from ureterovesical obstruction. As a result, this test may be used instead of more invasive studies, such as retrograde or antegrade pyelography, to determine the site of obstruction in many cases of hydronephrosis.     

尿路结构异常儿童合并泌尿系感染的病原菌分析

目的探讨尿路结构异常儿童合并泌尿系感染（UTI）致病菌的分布及药物敏感及耐药情况。 方法收集2012年1月至2016年12月中山大学附属第三医院及汕头市中心医院符合UTI住院患儿476例,分为尿路正常组及尿路异常组,比较两组间病原菌构成比及对抗菌药物的敏感和耐药情况。 结果尿路异常者162例（肾积水最为常见,占43.83%）,尿路正常儿童314例。尿路异常儿童合并感染常见于男性（P<0.05）,共检出致病菌166株,革兰氏阴性菌（G^-）为主（71.08%）,大肠埃希菌占首位（40.36%）,肠球菌属居第2位（22.89%）,粪肠球菌在尿路异常组常见（χ²=4.59,P=0.032）。两组间常见病原菌耐药性差异无统计学意义。 结论尿路结构异常男性儿童易发生泌尿系感染,且肠球菌感染的发生率高于尿路结构正常儿童。     

Duplex Doppler ultrasound value in upper urinary tract obstruction

Our prospective study aimed to establish the duplex Doppler ultrasonography (DDU) value in patient's investigative protocol with acute or chronic ureteral obstruction. A. DDU IN ACUTE URETERAL STONE OBSTRUCTION: Between October 1988 and January 2001 we applied DDU evaluation for 177 cases with ureteral lithiasis in which we also studied gray scale echography, resistive index (RI), the difference between affected kidney and contralateral kidney (delta RI) and the characteristics features (amplitude, velocity and frequency) of the ureteral jets (intravesical evaluation in color Doppler mode). a. For 65 cases with RI < 0.70, delta RI < or = 0.06 we didn't find obstruction and 95.4% of the patients had spontaneous passage of the stones. b. For 109 cases with RI > 0.70, delta RI > or = 0.06 the spontaneous passage of the stone was found in 40 cases (36.7%). DDU associated with ureteral jet evaluation increased the predictive value of this method. So, the presence of the ureteral jet on the obstructed side of the upper urinary tract was associated with 63% of spontaneous passage of the stone while the absence of the jet was followed by 5% of spontaneous passage of the stone. The RI was sensitive in 74% and specific in 81% and delta RI was sensitive in 85% and specific in 91%. B. DDU IN CHRONIC URETERAL OBSTRUCTION: Between October 1988 and January 2001 we evaluated the DDU value in chronical ureteral obstruction on 78 cases with operated and/or irradiated genital neoplasm's and retroperitoneal involvement. Our results found RI sensitive in 63% and specific in 70% and delta RI was sensitive in 72% and specific in 78%. After double J stenting (indwelling) RI varied from 0.74 to 0.66 (0.08), with a significative decrease (over 10%) in 61.5% of the cases in which preoperator RI was greater than 0.70. After 1 month we found an increase of RI with 0.02 and after 3 months with 0.05. IN CONCLUSION: We consider DDU a functional imagistic method with an important place in the investigative protocol of the obstructive uropathy.     

急性上尿路结石梗阻的影像学分析

目的：探讨超声、腹部平片（ＫＵＢ）、静脉尿路造影（ＩＶＵ）对急性输尿管结石梗阻的诊断价值。方法：回顾性分析３５２例急性输尿管结石梗阻患者的Ｂ超、利尿性Ｂ超、ＫＵＢ、ＩＶＵ的诊断结果。结果：对肾积水的诊断,常规Ｂ超诊断率８３．２％（２９３／３５２）,而５９例可疑病例利尿性Ｂ超的诊断率７９．７％（４７／５９）,利用常规Ｂ超加利尿Ｂ超检查,对梗阻性肾积水的诊断率９６．６％（３４０／３５２）;对输尿管结石     

Salmonella urinary tract infection associated with ureteropelvic junction obstruction

Although rare, urinary tract infections in children by salmonella species have been associated with a high incidence of structural anomalies. We report on a 5-year-old patient with Salmonella enteritidis urinary tract infection associated with ureteropelvic junction obstruction.     

上尿路梗阻并发肾积脓的诊断和治疗(附33例报告)

目的：提高上尿路梗阻并发肾积脓的诊治水平。方法：分析３３例上尿路梗阻并发肾积脓患者的临床特点、诊断和治疗,并结合文献进行讨论。结果：３３例均经手术或穿刺造瘘证实,依临床症状分为急性型和慢性型,其中１５例行肾切除,１０例行肾盂或输尿管切开取石术,８例行肾造瘘术。结论：早期正确的诊断和治疗是避免肾切除的关键。     

伴有上尿路梗阻的腺性膀胱炎的临床特征

目的探讨伴有上尿路梗阻的腺性膀胱炎的临床特征。方法70例伴有上尿路梗阻的腺性膀胱炎与60例无上尿路梗阻的腺性膀胱炎进行比较,观察2组在临床表现和手术疗效方面的差异。结果伴有上尿路梗阻的腺性膀胱炎女性发病率高于男性,发病年龄低于无上尿路梗阻组。临床表现主要为肾区或腹部疼痛,少数患者同时伴有恶心、呕吐、尿频、尿急、尿痛、血尿和发热等,病程一般较短。膀胱镜检查病灶分布特征和尿液细菌培养结果2组之间无差异。伴有上尿路梗阻组没有二次手术病例,无上尿路梗阻组有9．3％患者需进行二次以上的手术。结论伴有上尿路梗阻的腺性膀胱炎通常以上尿路梗阻症状为主要临床表现。治疗时首先应明确和解除输尿管梗阻的原因。对于腺性膀胱炎,应进行积极治疗或密切随访。     

Urinary proteins in children with urinary tract infection

The aim of this study was to test our hypothesis that the urinary excretion of C-reactive protein (CRP), alpha 1-microglobulin (A1M), retinol-binding protein (RBP) and Clara cell protein (CC16) is increased in children with urinary tract infection (UTI) and relates to renal damage as measured by acute dimercaptosuccinic acid (DMSA) scintigraphy. Fifty-two children <2 years of age with UTI were enrolled in the study, 44 of whom were febrile. The control group consisted of 23 patients with non-UTI infection and elevated serum CRP (s-CRP) levels. Thirty-six patients had abnormal DMSA uptake, classified as mild, moderate or severe damage (DMSA class 1, 2, 3, respectively). There was a significant association between DMSA class and the excretion of urinary RBP (u-RBP) and u-CC16. There was also a significant difference in u-CRP levels between children with UTI and control children with non-UTI infections, although u-CRP excretion was not significantly correlated to DMSA class. In conclusion, the urinary excretion of the low-molecular-weight proteins RBP and CC16 showed a strong association with uptake defects on renal DMSA scans. The urinary level of CRP seems to distinguish between children with UTI and other febrile conditions. A combination of these biomarkers may be useful in the clinical assessment of children with UTI.     

磁共振尿路造影在上尿路梗阻诊断中的应用

目的　评估磁共振尿路造影技术在诊断上尿路梗阻性疾患中的价值。　方法　采用磁共振尿路造影术（ Ｍ Ｒ Ｕ） 诊断上尿路梗阻患者３５ 例。　结果　所有病例均清晰显示梗阻部位及尿路积水情况。　结论　 Ｍ Ｒ Ｕ 是一种无创性、无需造影剂的诊断上尿路梗阻的方法。     

磁共振水成像对上尿路梗阻的诊断价值

目的:评价磁共振水成像(MRU)对泌尿系梗阻性疾病的临床诊断价值。方法:采用快速自旋回波重T2加权序列和脂肪抑制技术,对56例经B超和IVP怀疑上尿路梗阻患者,进行泌尿系冠状位扫描,将图像按最大强度投影法重建出MRU图像。结果:其中32例MRU均能清晰显示尿路梗阻的部位和肾盂积水,解剖结构清楚,可对梗阻作出定性诊断,并经手术和病理证实为尿路梗阻者。其中尿路结石16例,尿路先天性梗阻4例,输尿管炎性狭窄2例,移植肾输尿管狭窄2例,其他8例。余26例排除上尿路梗阻。结论:MRU是无创伤的检查方法,不接触射线,不需碘对比剂,诊断尿路梗阻性疾病定位、定性准确,尤其适用于因严重梗阻IVP显影不良的病例。     

磁共振尿路造影在上尿路梗阻诊断中的

目的 评估磁共振尿路造影技术在诊断上尿路梗阻性疾患中的价值。方法 采用磁共振尿中造影术（ＭＲＵ）诊断上尿路梗阻患者３５例。结果 所有病例均清晰显示梗阻部位及尿路积水情况。结论 ＭＲＵ是一种无创性、无需造影剂的诊断上尿路梗阻的方法。     

经皮肾穿刺造瘘在上尿路梗阻性疾病的应用

目的:探讨经皮肾穿刺造瘘在上尿路梗阻性疾病(UUTO)的应用价值.方法:对42例UUTO患者,先行经皮肾穿刺造瘘引流,待肾功能改善、机体状况好转或经引流及造影确定诊断之后,12例行经皮肾取石碎石术,11例行开放肾、输尿管切开取石术,4例行开放肾切除术,4例行肾盂输尿管成型(3例加行取石)术,3例经造瘘管注射硬化剂治疗,3例行输尿管肾盏吻合术,3例行输尿管狭窄段切除端端吻合术,1例行输尿管松解术,1例行输尿管皮肤造瘘术.结果:38例患者一次穿刺成功.全部病例均及时解除了上尿路梗阻,肾功能得到改善,或为进一步诊治创造了条件.在保肾治疗的35例,31例治愈出院;4例肾功能改善,维持在轻度氮质血症水平;4例肾切除患者和3例注射硬化剂治疗患者均治愈出院.结论:经皮肾穿刺造瘘安全、有效,在UUTO的诊治中具有重要的应用价值.     

Management of children with unobstructed urinary tract infection

There are two major considerations when taking care of children with urinary tract infection (UTI): firstly to prevent renal damage and secondly to relieve symptoms. A distinction should always be made between these two aims, since they often concern separate populations that may need different treatment and follow-up strategies. Acute pyelonephritis is a common disorder of infancy and early childhood which is easily overlooked. In all infants and children in whom the cause of fever is not apparent and in all those failing to thrive, urine should be examined by dip slide culture and by an estimation of leucocyte content. With adequate care the immediate and long-term prognosis of acute pyelonephritis is excellent. Thus prevention of kidney damage is mainly a matter of putting existing knowledge into practice. Uncomplicated recurrent lower UTI involves a low risk of renal damage. Short courses of antibiotic treatment easily eradicate most such infections but have no effect on the mechanisms underlying the susceptibility to recurrence. Singledose therapy should be considered in such instances. Long-term antibiotic prophylaxis is mainly indicated in children with a high risk of renal scarring. Treatment is not recommended for children with asymptomatic bacteriuria.     

Diuresis renography and morphology in upper urinary tract obstruction.

The results of a combined study of 25 patients with idiopathic hydronephrosis are presented. Diuresis renography was performed pre-operatively and surgically removed specimens of the renal pelvis and ureter were examined by light and electron microscopy. There was good correlation between the results of these 2 methods of assessment which have defined 2 broad categories of patients with renal pelvic dilatation. These findings are discussed with particular reference to the clinical value of diuresis renography.     

Laparoscopic management of ureteropelvic junction obstruction in patients with upper urinary tract anomalies

PURPOSE: We report our experience with the laparoscopic management of ureteropelvic junction obstruction in patients with upper urinary tract abnormalities. MATERIALS AND METHODS: Between July 1994 and May 2002, 7 men and 4 women with upper urinary tract anatomical abnormalities were referred to our institution for management of symptomatic ureteropelvic junction obstruction. Anomalies included horseshoe kidneys in 5 cases, pelvic kidneys in 3, a pancake kidney in 1, a malrotated kidney in 1 and a duplicated collecting system in 1. Three patients had associated renal stones that were extracted during reconstruction. Mean patient age was 37.4 years (range 25 to 60). One patient had undergone a previously unsuccessful endopyelotomy and 2 had a history of abdominal surgery. RESULTS: Mean operative time was 195 minutes (range 85 to 403) and mean estimated blood loss was 122 cc (range 20 to 300). No patient in this series required transfusion. Average length of hospital stay was 3.2 days (range 2 to 5). Renal function failed to improve after surgery in 1 patient with poor renal function and severe hydronephrosis. The remaining 10 patients (91%) had durable clinical and/or radiographic success during a followup of 32.6 and 21.3 months, respectively. There were no major complications. CONCLUSIONS: Laparoscopic pyeloplasty is an effective treatment alternative for ureteropelvic junction obstruction associated with renal or urinary tract anomalies.     

Idiopathic hypercalciuria associated with urinary tract infection in children

The aim of this study was to evaluate the association between idiopathic hypercalciuria (IH) and urinary tract infection (UTI) in children. This prospective clinical study included 75 patients with UTI (without urinary tract malformations and lithiasis) and a control group of 30 healthy children. Of the total number of patients with UTI, 21% (n = 16/75) had IH, but only 7% (n = 2/30) with IH were reported in the control group (p < 0.05). Recurrent UTI affected 33% (n = 25/75) of patients , and in 67% (n = 50/75) of patients, UTI was diagnosed for the first time. In the group of patients with recurrent UTI, 44% (n = 11/25) had IH, but only 10% (n = 5/50) were reported in the group of patients with first-time UTI (p < 0.05). The results of multifactorial logistic regression analysis showed that clinical and laboratory parameters (recurrent UTI, dysuria, and microscopic hematuria) may predict the diagnosis of IH in 80% of patients and absence of IH in 87% of cases. In our opinion, IH is a major contributing factor to UTI, especially to recurrent UTI in children.     

MRU诊断上尿路梗阻性疾病的价值

目的 探讨磁共振尿路造影（MRU）诊断上尿路梗阻性疾病的意义。方法 59例上尿路梗阻性疾病患者接受检查，MRU为冠状位快速自旋回波T2加权像。结果 所有病例MRU尿路梗阻部位及扩张状况均显示良好，其中54例经手术或病理确诊，仅2例术前MRU误诊。结论 MRU作为一种非侵袭性、无辐射损伤和不需造影剂的新技术，对上尿路梗阻性疾病的定位及定性诊断具有特殊价值，是一种可供选择的有临床实用价值的尿路成像方法。