Eric A Jones | PubMed Health

PubMed2006

Renal ultrasound studies after endoscopic injection of dextranomer/hyaluronic acid copolymer for vesicoureteral reflux.

OBJECTIVES: To examine the outcomes of renal ultrasound studies after subureteral injection of dextranomer/hyaluronic acid copolymer and provide recommendations for postoperative management of vesicoureteral reflux (VUR). METHODS: Pediatric patients aged 15 years or younger with uncomplicated primary VUR were recruited for endoscopic treatment with dextranomer/hyaluronic acid gel. After undergoing the procedure, patients were instructed to continue prophylactic antibiotic treatment until a follow-up voiding cystourethrogram was obtained 2 weeks or more after treatment. VUR resolution was defined as grade 0. Repeat endoscopic injection was offered to patients with persistent VUR. Postoperative renal ultrasound scans were obtained on the same day as the voiding cystourethrogram. RESULTS: Of 120 patients treated, 6 were lost to follow-up and 14 had not yet undergone the posttreatment evaluation. The 100 remaining patients (efficacy population) had a mean age of 4.2 years (range 0.5 to 15), and the median reflux grade was 2 (range 1 to 5). The overall VUR resolution rate for the patients was 87% after endoscopic injection. Of 100 patients, 88 achieved complete resolution after a single injection and 19 required a repeat injection. Of the 100 patients who underwent postoperative ultrasound examination, none demonstrated renal ultrasound changes consistent with significant ureteral obstruction or renal parenchymal changes. CONCLUSIONS: Renal ultrasound studies after endoscopic treatment with dextranomer/hyaluronic acid gel are unnecessary after determination of reflux resolution by voiding cystourethrography.

Child, Preschool↗

PubMed2006

Primer: diagnosis and management of uncomplicated daytime wetting in children.

Functional daytime wetting is a common source of pediatric urologic complaints. Evaluation typically begins in the office setting. In contrast to the adult population, where an inability to maintain voiding control is virtually always considered pathologic, the evaluation of urinary incontinence in children must occur within the context of the child's developmental age. Functional incontinence refers to cases of urinary incontinence in which no structural or neurologic abnormality can be identified. The underlying etiologic mechanisms are heterogeneous, and include disorders of both the storage and voiding phases of the bladder cycle. Optimal treatment of functional daytime wetting depends on an accurate determination of the underlying etiology. Therapeutic options include behavior modification, medication, and aggressive treatment of comorbid conditions such as urinary infection and constipation.

Child↗

PubMed2002

Megalourethra and urethral diverticula.

Megalourethra and urethral diverticula encompass a diverse group of congenital and acquired urethral defects. The appropriate management of these anomalies relies on a keen appreciation of phallic anatomy and an understanding of urethral embryology. A thorough history and physical examination--including a careful evaluation of the urinary tract--is necessary to identify associated congenital anomalies. Finally, satisfactory surgical management demands meticulous attention to surgical technique.

Diverticulum↗