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Biomedical subjects

R L Lebowitz

Publications and source records attributed to R L Lebowitz.

At least 73 records · Page 4Linked to original sources
PubMed1987

Vesicoureteral reflux in asymptomatic siblings of patients with known reflux: radionuclide cystography.

The familial nature of vesicoureteral reflux among siblings of patients with vesicoureteral reflux has been reported to be from 8% to 32%. These included both symptomatic and asymptomatic siblings. The incidence of vesicoureteral reflux in asymptomatic siblings, however, has not been studied extensively. Sixty asymptomatic siblings of patients known to have vesicoureteral reflux were studied with radionuclide voiding cystography. Their ages ranged from 2 months to 15 years (mean, 4.2 years). Vesicoureteral reflux was detected in 27 of 60 (45%) of the siblings. Vesicoureteral reflux was unilateral in 15 and bilateral in 12 of the siblings. Radionuclide cystography is more sensitive than radiographic cystography and results in a very low radiation dose to the patient. The gonadal dose with radionuclide cystography is only 1.0 to 2.0 mrads. Because of these features, radionuclide cystography is a nearly ideal technique for the diagnosis of vesicoureteral reflux in siblings of patients with known vesicoureteral reflux. All siblings (symptomatic or asymptomatic) of patients with known vesicoureteral reflux should have a screening radionuclide cystography.

Child↗
PubMed1986

Traumatic ureteropelvic disruption in the child.

Traumatic disruption of the ureter from the pelvis is a rare injury of the child's urinary tract that probably results from extreme hyperextension of the trunk. The child may be remarkably free from other injuries whereas such trauma is usually lethal in the adult. Hydronephrosis may not occur immediately. Three cases are reported.

Child, Preschool↗
PubMed1986

Complete patent duplication of the urethra.

We reviewed 16 patients with complete patent duplication of the urethra seen between 1945 and 1984. The clinical presentation, radiographic findings and management of each patient are presented. All 16 patients were symptomatic and a double stream was the most common complaint. An operation was necessary in 13 patients. Voiding cystourethrography and retrograde urethrography were necessary to define the anatomy completely and accurately in each patient. The ventral channel, regardless of the position of the meatus, invariably proved to be the more functional urethra.

Child↗
PubMed1986

The detection of vesicoureteral reflux in the child.

Reflux is often an important phenomenon in the urinary tract of a child, and many methods have been advocated to detect it. The single most sensitive, accurate, and efficient way currently available to detect and characterize reflux is direct VCUG under fluoroscopic control with the contrast material instilled through a urethral catheter. Nuclear cystography is the most efficient method for screening for reflux in appropriate situations, for making sure the reflux has disappeared after corrective surgery, and for following reflux that is likely to subside spontaneously.

Child↗
PubMed1986

Percutaneous studies of the upper urinary tract in children, with special emphasis on infants.

Of 101 antegrade pyelography and/or percutaneous nephrostomy procedures performed within a 6-year period, 18 involved patients less than 6 months of age. The procedures in this age group were characterized by ease of performance -without sedation in the neonates and with sedation in the children -and by the use of smaller needles and catheters. The procedures enabled differentiation between obstructed and nonobstructed dilated systems with pressure-flow studies, depiction of the intimate anatomy of complicated urologic abnormalities, temporary drainage, decompression of pyonephrosis, endourologic access, and collection of urine for cultures after ureterosigmoidostomy. The procedures were highly successful and had few complications.

Adolescent↗
PubMed1986

The coexistence of congenital megacalyces and primary megaureter.

Congenital megacalyces is a rare developmental condition of the kidney consisting of hypoplasia of the medullary pyramids and dilatation of the calyces. There is no obstruction. Primary megaureter is a form of obstructive uropathy in which there is an obstructing juxtavesical segment of ureter that is normal in caliber but that is aperistaltic. These conditions were found to occur simultaneously in the same patient six times during the past 10 years. Recognition of this rare coexistence is important so that unnecessary surgery can be avoided.

Abnormalities, Multiple↗
PubMed1985

The elusiveness and importance of bladder diverticula in children.

Diverticula of the bladder are due to congenital areas of weakness in its wall. Their relationship to ureteral reflux makes them important to discover, yet due to their dynamic nature they can be elusive on uroradiologic studies and at cystoscopy. Fluoroscopically monitored voiding cystourethrography is the most efficient method of detection but even this examination has false negatives.

Adolescent↗
PubMed1985

International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children.

The classification of grading of vesicoureteric reflux (VUR) agreed to by the participants in the International Reflux Study in Children is described. It combines two earlier classifications and is based upon the extent of filling and dilatation by VUR of the ureter, the renal pelvis and the calyces. A standardised technique of voiding cystography is also described to ensure comparability of results.

Child↗
PubMed1985

Relationship between hair/eye color and primary vesicoureteral reflux in children.

The relationship between hair/eye color and primary vesicoureteral reflux was analyzed in more than 900 children. Children with blonde hair/blue eyes did not show an increased prevalence of reflux nor did any other hair/eye combination. With the possible exception of rufous coloring, the color of the hair and eyes are poor predictors of the competence of the ureteral orifice.

Child↗
PubMed1985

Pediatric uroradiology.

Pediatric uroradiology is the art and science of obtaining images of the child's urinary tract, not only to obtain maximum information, but also to minimize the invasive nature, hazards, and costs of the examinations. This article discusses which examinations should be used in which situations and when; and, if more than one is needed, the order in which the examinations should be performed and why.

Child↗
PubMed1985

Artificial urinary sphincters in children: radiographic evaluation.

Use of the artificial urinary sphincter to treat incontinence in children has increased over the past decade. The hydraulic fluid used in this device is radiopaque, and the radiologist is directly involved in its evaluation. Despite advances in design and surgical technique, mechanical failures and other complications occur. Our experience with 34 artificial sphincters implanted in 31 children during 1973-1983 is reviewed, giving a method of radiographic evaluation, diagnostic errors to avoid, examples of sphincter malfunction, and common complications.

Adolescent↗
PubMed1985

Intermittent hydronephrosis: a unique feature of ureteropelvic junction obstruction caused by a crossing renal vessel.

Obstruction at the ureteropelvic junction (UPJ) is usually intrinsic. Recently, however, 13 (11%) of approximately 120 children with UPJ obstruction were found to have extrinsic obstruction caused by a lower-pole renal vessel. In each case, the obstruction was confirmed at the time of surgery. Most of these patients had intermittent pain. Excretory urograms did not show obstruction between episodes of pain, but when a urogram was obtained during an episode, marked obstruction was noted. Contrast agent trapped in a segment of proximal ureter suggests the presence of an extrinsic obstruction. Properly timed renal imaging, therefore, can identify the urinary tract as the source of the symptoms.

Adolescent↗
PubMed1985

Voiding cystourethrography: the initial radiologic study in children with urinary tract infection.

The order in which children with urinary tract infection should undergo voiding cystourethrography (VCUG), excretory urography (EU), and/or renal ultrasonography (US) is not standardized. To determine a logical sequence of study, we performed VCUG and then either US or EU on 389 consecutive children with urinary tract infections. Thirty-seven percent (133/358) of the children were found to have reflux; of these, 22.5% (30/133) had an abnormal excretory urogram. No correlation was found between either the age of the child and the degree of reflux or the age of the child and the percentage of children with abnormal excretory urograms. Since normal EU or US results do not exclude significant reflux, VCUG is recommended as the preferred initial screening examination in children with urinary tract infection.

Child↗
PubMed1984

Predictive value of urodynamic evaluation in newborns with myelodysplasia.

We examined 36 infants with myelodysplasia, using excretory urography, voiding cystourethrography, and urodynamic assessment in the newborn period and periodically thereafter to determine those at risk for decompensation of the urinary tract. Urodynamic evaluation showed 18 with dyssynergia of the detrusor and external sphincter, nine with synergic activity of the sphincter, and nine with no activity of the sphincter. Thirteen (72%) of the group with dyssynergia had or later were found to have hydroureteronephrosis, while this was the case in only two (22%) with synergy and one (11%) with absent activity. The conditions of these 16 patients improved after decompression by cutaneous vesicostomy or intermittent catheterization. Infants with dyssynergia of the detrusor-external sphincter are at high risk for deterioration of the urinary tract; they should be followed up closely, and intermittent catheterization should be started early.

Child, Preschool↗