Ureteropelvic junction obstruction in children.
The spectrum of problems inherent in the diagnosis and treatment of ureteropelvic junction obstruction is outlined on the basis of the review of a series of 195 children.
Adolescent↗
Biomedical subjects
R L Lebowitz
Publications and source records attributed to R L Lebowitz.
Rectourethral fistula on the urethrogram.
Radiologic demonstration of a rectourethral fistula is of importance in the evaluation of the male neonate with imperforate anus. After pull-through operation a remnant of the fistula may remain as a small unimportant sinus tract or may cause problems.
Adult↗
Barium enema as an adjunct to the urogram when the left kidney is not seen.
The barium enema is a useful adjunct to urography when the left kidney is not seen. When the anatomic splenic flexure of the colon is in normal position, a non-visualized kidney is present in the renal fossa.
Barium Sulfate↗
Neonatal hydronephrosis caused by vesical diverticula.
Bladder diverticula are uncommon in infants and are an uncommon cause of hydronephrosis in newborns but can cause significant problems. A thorough diagnostic approach must include both excretion urography and cystourethrography. Early appropriate surgical intervention will result in preservation of renal function.
Diverticulum↗
Thymus size and its relationship to the respiratory distress syndrome.
Thymic size can be affected by both exogenous and endogenous glucocorticoids. The risk of respiratory distress syndrome is reduced after maternal steroid administration. To find whether fetal lung maturity correlates with size of the thymus, the cardiothymic:thoracic ratio was measured in 167 newborn infants with and without RDS. Mean CT/T was significantly greater (0.40 vs 0.35; P less than 0.001) in those babies with RDS. This relation was independent of gestational age, although an increase in CT/T with advancing gestational age was shown. Prepartum maternal steroid administration did not result in significant involution of the cardiothymic shadow when compared with control infants with and without RDS. The CT/T may be of use in predicting which premature babies are more likely to develop RDS.
Female↗
Obstructing polyps of the posterior urethra in boys: embryology and management.
Solitary fibrous polyps are in uncommon but important cause of obstructive uropathy, infection and hematuria in boys. The clinical presentation and management in 5 boys are discussed and the literature is reviewed. Emphasis is placed on the pitfalls in diagnosis and recent endoscopic techniques of treatment.
Child↗
The so-called megaureter-megacystis syndrome.
Megaureter-megacystis describes the appearance of the urinary tract in children with massive primary vesicoureteric reflux and it sequellae. The initial symptoms, radiographic findings, diagnostic misconceptions, and treatment for 22 male children are discussed. Incorrect diagnoses, including obstruction, neurogenic bladder dysfunction, and "megacystis," were made in 16 children; treatment was inappropriate in 14. In only eight boys were diagnosis and treatment prompt and correct.
Child↗
Diverticula of the bladder in children.
Diverticula of the bladder in infants and children are common and occur when vesical mucosa protrudes through a congenital defect in the muscle wall. Most are primary. Diverticula secondary to obstruction or neurogenic dysfunction are not as common as was once thought. The majority of diverticula are asymptomatic but they can cause vesico-ureteral reflux, obstruction or residual urine. Diverticula also occur after bladder surgery and in association with some syndromes. Voiding cystourethrography is the most reliable method for detection.
Abnormalities, Multiple↗
Lesions of Cowper's ducts and glands in infants and children.
Lesions of Cowper's duct and gland are more common than previously reported. They may be asymptomatic or may cause micturition difficulties or urinary retention. They may be congenital or acquired (usually inflammatory). Radiographic findings are either a rounded filling defect arising from the floor of the bulbous urethra or reflux into a dilated duct which parallels the bulbomembranous urethra. Panendoscopic fulguration is a simple and effective method of treatment for symptomatic patients with retention cysts. Asymptomatic patients do not need any therapy. A dilated duct should not be confused with partial urethral duplication, a urethral diverticulum, or an ectopic ureter since such an error may lead to an unnecessary operation.
Bulbourethral Glands↗
Ether cystitis.
Two children are reported in whom chemical cystitis developed when ether was used to dissolve a Foley catheter balloon that would not deflate. The irritative effects of ether and preventive measures are discussed.
Child↗
Urography in children: when should it be done? 1. Infection.
Radiologic evaluation of urinary tract infection in children should include both excretory urography and voiding cystourethrography. Excretory urography is done to search for anomalies predisposing to infection and for signs of previous episodes of pyelonephritis or reflux and to serve as a baseline for future studies. Voiding cystourethrography is done to search for abnormalities in the natural barriers that protect the renal medulla from infection. If reflux is found to be present and sequential reflux studies are done, they should be performed by the radionuclide method to observe changes in degree or cessation.
Child↗
Urography in children: when should it be done? 2. Conditions other than infection.
Conditions that are often associated with an increased incidence of renal anomalies include imperforate anus, congenital vertebral abnormalities, and Fanconi anemia; excretory urography should be done if such a condition is present. Urography is also useful to provide baseline data in conditions associated with later development of urinary problems, such as myelodysplasia, prune-belly syndrome, and exstrophy of the bladder. In addition, urography serves as a periodic check for complications of treatment (hydronephrosis, obstruction) in patients with urinary diversion. Certain signs, eg, dribbling, hematuria after mild trauma, unexplained pneumothorax or pneumomediastinum in a neonate, and neonatal abdominal mass, call for immediate urography. In many conditions that were formerly thought to be associated with major urinary abnormalities, urography is not called for. Such is the case in hypospadias, deformities of the external ear alone, and undescended testes. Dehydration is the only absolute contraindication to urography.
Child↗
Renal malposition associated with omphalocele.
Nine patients with omphalocele had abnormally positioned kidneys; in 8, the kidneys were more cephalad than normal, immediately subdiaphragmatic in position. In one patient the kidneys were more caudal than normal. This renal malposition should be recognized in order to avoid unnecessary imaging procedures in patients with omphalocele.
Adult↗
Pseudostricture of the urethra: urinal artefact on urethrography.
Explore the source record for details and available documents.
Child↗
Urography in the child who wets.
Most children who wet have no underlying structural abnormality and will not benefit from urography. However, several conditions may mimic simple enuresis, and in children with clinical clues that suggest these diagnoses, urography can be confirmatory. The urogram should be conducted so as to exclude an anatomic cause for wetting. This is likely in females in the presence of a duplex collecting system, a nonfunctioning kidney, marked vaginal reflux, or a widened interpublic distance. In the urogram of a child of either sex, a spinal anomaly should be sought.
Child↗
Hydronephrosis from retroperitoneal fibrosis after anterior spine fusion. A case report.
Explore the source record for details and available documents.
Adult↗
Strictures of the ileal loop.
Intrinsic ileal loop strictures in children are much more common than previously reported. They occur late and are usually clinically silent. Their etilogy is inflammatory rather than ischemic and a local immunosuppressive effect of urine also may play a role. Periodic urography, continued indefinitely, is the only certain method of early detection.
Child↗
Hypothyroidism in cystinosis.
It has recently been shown that hypothyroidism complicates cystinosis. The radiographic bone changes of hypothyroidism (retarded skeletal age) cannot be detected while the patient has overt rickets, since the secondary ossification centers are not ossified. When the rickets is treated and the secondary ossification centers fail to appear (the skeletal age remains retarded), then the diagnosis of hypothyroidism should be suspected. After treatment with thyroid hormone is begun and a growth spurt occurs, rickets that has been controlled may reactivate. The previous doses of vitamin D will no longer be adequate because of the patient's growth spurt.
Child↗