利尿性肾图小儿上尿路扩张的诊断意义

对３３例４４侧上尿路扩张的患儿进行利尿性肾图的检测，其时间活性曲线分成四种类型：Ⅰ型，无梗阻；Ⅱｂ、Ⅲ、Ⅳ型，有明显梗阻存在，其中２１侧接受手术，术中均发现有不同程度的上尿路梗阻性病变；Ⅱａ型，需定期随访，观察病情变化。利尿性肾图对鉴别小儿尿路梗阻是一较为简便、可靠的方法。     

利尿性肾图在小儿肾盂输尿管连接部梗阻致肾积水诊断中的作用

目的探讨以利尿性肾图替代静脉尿路造影对小儿肾盂输尿管连接部梗阻引起的肾积水进行诊断的可能性.方法对1995年8月至2001年10月间的52例同时行静脉尿路造影和利尿性肾图检查并进行了肾盂成形术的病例进行回顾性分析,男47例,女5例,年龄0.2～13岁(平均6.5岁).结果本组52例静脉尿路造影对梗阻部位判断有52例(100%)正确;利尿性肾图检查后,52例患儿梗阻部位的判断也都(100%)正确.静脉尿路造影和利尿性肾图在梗阻部位诊断上差异没有显著性意义(P＞0.05).结论在诊断小儿肾盂输尿管连接部梗阻上,以利尿性肾图来替代静脉尿路造影是可行的.     

神经源性膀胱上尿路损害的危险因素分析

目的 探讨神经源性膀胱(neurogenic bladder,NB)患儿发生上尿路损害的危险因素.方法 以2021年1月至2021年5月重庆医科大学附属儿童医院151例诊断为NB的住院患儿为研究对象,根据是否发生上尿路损害分为上尿路损害组(n=88)和上尿路正常组(n=63),比较两组一般特征(性别、年龄、住院时间、病...     

利尿B超诊断小儿肾盂输尿管连接部梗阻

为了解利尿Ｂ超诊断小儿肾盂输尿管连接部梗阻（ＰＵＪＯ）的意义，对２５例（３４侧）小儿肾积水进行利尿Ｂ超检查，将检查结果与ＩＶＵ、肾盂测压、手术中所见病理改变及正常肾脏检查结果进行比较。结果显示利尿后ＰＵＪＯ患儿肾脏集合系统明显扩大，平均较利尿前扩大１０５％，利尿后９０ｍｉｎ仍不能恢复。同返流、输尿管远端或下尿路梗阻引起的肾积水及正常肾脏检查结果比较有显著性差异（Ｐ＜０．０５）。利尿Ｂ超可作为判断ＰＵＪＯ的方法之一。     

小儿重复肾及合并畸形的超声诊断

目的 分析重复肾及合并畸形的超声声像图特征及其对该病变的诊断价值。方法 对照手术病理证实的32例重复肾及合并畸形的超声声像图特征进行总结。结果 超声图像表现重复肾伴积水26例，占71％，其中输尿管开口异位17例，输尿管囊肿9例。重复肾不伴积水6例，表现为两组集合系统。结论 超声检查对重复肾及合并畸形的诊断有可靠价值。     

^99mTc—DMSA肾静态显像对上尿路感染的诊断

越来越多的临床和实验研究证实，放射性＾９９ｍ锝－二巯基丁二酸（ｔｅｃｈｎｅｔｉｕｍ９９ｍ－ｌａｂｅｌｅｄｄｉｍｅｒｃａｐｔｏｓｕｃｃｉｎｉｃａｃｉｄ，＾９９ｍＴｃ－ＤＭＳＡ）肾静态显像是诊断上尿路感染的可靠影像学方法，其敏感度在９０％左右，特异率高达９５％，以上，它不仅有助于上尿路感染的定位诊断，还能显著病变的性质，范围和严重程度，指导治疗和随访肾脏病变的转归，本文就此作一综述。     

排尿性膀胱尿路造影术在诊断儿童膀胱输尿管反流中的意义

目的 探讨排尿性膀胱尿路X线造影术(MCU)在尿路感染患儿中的检查时机,为早期诊断膀胱输尿管反流提供依据.方法 分析2003年1月-2007年12月我院住院患尿路感染并行排尿期膀胱尿路X线造影术检查的患儿,分析相关的B超,放射性核素肾静态扫描,肾功能(血尿素氮、血肌酐),尿常规,尿微量蛋白(尿IgG、Alb、TRF、RBP、NAG、a1-MG),中段尿培养等检查.结果 [1]进行MCU检查的患儿共392例,年龄1个月-14岁,平均年龄(2.43±3.10)岁.无膀胱输尿管反流者230例;有膀胱输尿管反流者162例;其中原发性膀胱输尿管反流150例,男女比为1.23:1.[2]原发性膀胱输尿管反流阳性、阴性两组患儿间,放射性核素肾静态扫描(DMSA)中表现为急性期放射稀疏、肾疤痕、尿微量蛋白,差异有统计学意义(P<0.05).[3]原发性膀胱输尿管反流患儿年龄分布为<2岁93例(62%),2-7岁39例(26%),>7岁18例(12%).结论 对尿路感染伴随DMSA异常,尿微量蛋白明显增高的患儿应提高警惕,积极行MCU检查,特别是<2岁的男童更应重视.     

排尿性尿路超声造影对儿童原发性膀胱输尿管反流的诊断价值

目的 探讨排尿性尿路超声造影(contrast-enhanced voiding urosonography,CeVUS)对儿童原发性膀胱输尿管反流(vesicoureteral reflux,VUR)的诊断价值.方法 回顾性分析上海儿童医学中心2018年12月至2020年6月116例[232个肾盂-输尿管单位(pye...     

MSCTU在小儿先天性上尿路畸形的诊断价值

对于泌尿系统疾病的影像学诊断CT一直占有非常重要的地位,传统诊断方法B型超声、X线、排泄性静脉尿路造影及逆行尿路造影等对小儿复杂泌尿系畸形的解剖形态、泌尿系功能及病因学诊断上存在很大局限性,其发现泌尿系统病变往往需要CT检查以获得确定性诊断,为手术方案的制定提供帮助.     

CT尿路造影对小儿泌尿外科疾病诊断的意义

CT尿路造影(CTU)是近年来泌尿系影像诊断领域中继静脉尿路造影(IVU)及超声之后又兴起的一项新的检查技术,它具有较高的分辨率,对术前患肾形态、肾实质厚度、肾功能、肾积水程度、输尿管是否扩张、判定梗阻部位、性质及是否合并其他畸形等方面都能做出正确评估,我院从1997年3月～2001年1月对IVU检查患肾不显影、IVU及超声均不能做出明确诊断的部分病例采用CTU方法,取得较满意的效果.现报道如下.     

Optimal Diagnostic Testing for Urinary Tract Infection in Young Children

Urinary tract infection (UTI) is a major concern in young febrile children. Current recommendations favor use of urine obtained by bladder catheterization or aspiration, but opinion varies as to the best ancillary tests to predict a positive culture and guide initial management. The utility of dipstick leukocyte esterase, blood, and nitrite; unspun urine leukocyte count; gram stain of cytocentrifuged urine; and standard spun sediment examination was evaluated in 142 febrile, < 5-year-old children seen in the Emergency Department, 25 of whom had culture-proven UTI. Using sensitivity and negative predictive values as criteria for performance, unspun urine leukocyte count and gram stain of cytocentrifuged urine used in parallel was the best approach but still failed to detect some UTI. Analysis of the nature of the specimens evaluated provided explanation of differences from previous observations. Adoption of this modified approach to prediction of urinary tract infection appears to improve prediction but has operational implications and creates potential problems for the laboratory.This study was presented at the Fall Society for Pediatric Pathology Meeting, in Dallas, Texas, USA, September 2002.     

Protective Temporary Vesicostomy for Upper Urinary Tract Problems in Children: A Five-Year Experience

Objective

Temporary vesicostomy is a urinary diversion procedure for patients with upper urinary tract (UUT) dilatation, secondary to bladder outlet obstruction or dysfunction. The aim of this study was to evaluate our experience in children undergoing such diversion, analyzing its efficacy to prevent urinary tract infection (UTI), improve or resolve hydronephrosis, stabilize or improve kidney function and restore the health of UUT.

Methods

In this retrospective study, patients who had vesicostomy by Blocksom technique due to bladder outlet obstruction or dysfunction were evaluated in Mofid Children’s Hospital (in Tehran) from March 2007 to March 2012. The reason for applying this procedure was failure in clinical treatment. Data regarding gender, age, diagnosis, time of any surgical intervention, associated anomalies, primary/secondary complications and mortality were collected using a questionnaire, and evaluated by giving a grade that ranged from 0 (worst) to 10 (best) based on Lickert’s scale.

Findings

From a total number of 53 patients, (88.7% male and 11.3% female) with a mean age of 225 days, 66% had posterior urethral valve and 16 (30%) neurogenic bladder. UTI was present in all cases, hydronephrosis in 52 (98.1%), and vesico-ureteral reflux only in 45 (84.9%) patients. Valve ablation was performed in 17 cases, and clean intermittent catheterization in14 patients which were unsuccessful. We performed vesicostomy in all patients. Mortality rate was 7.5%. Vesicostomy was closed in 35 patients. Cure rate was 85% in UTI, 82.7% in hydronephrosis, 80% in VUR, and 86.5% in kidney function.

Conclusion

Vesicostomy is a simple procedure that protects upper urinary tract, decreases hydronephrosis, and improves kidney function. The procedure is well tolerated and reversible, with less complication and should be considered in children in whom conservative and medical treatment has failed.     

Nephrogenic Metaplasia of Urinary Tract in Children

Nephrogenic metaplasia of the urinary tract, originally thought to be a benign tumor with possible malignant potential, is commonly called nephrogenic adenoma. It predominantly affects male adults and is rarely seen in children. In this report 18 pediatric cases are reviewed and some clinical and pathologic parameters are compared with the condition in adults. Male to female ratio is reversed (3. 7:1 in adults and 1:3.5 in children). Recurrences are more common and are more frequently multiple in the pediatric age group. Although no malignant transformation has been reported, prolonged follow-up is recommended since the natural history of this lesion is still uncertain.     

Urinary Tract Infection in Children with Type I Diabetes

ABSTRACT. The prevalence and incidence of bacteriuria in 304 girls and 337 boys with type I diabetes was studied by screening for bacteriuria at their regular outpatient controls. In 90 girls and 108 boys a urine specimen was sampled every third month during a year. The prevalence of bacteriuria was 3/304 in girls and 0/337 in boys. During the one year follow-up one of the 90 girls had pyelonephritis and two cystitis while none of the boys had bacteriuria. It is concluded that the rate of urinary tract infection in young diabetic persons does not differ from that present in healthy young people.