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Biomedical subjects

R P Lyon

Publications and source records attributed to R P Lyon.

16 recordsLinked to original sources
PubMed1992

Normal growth with renal insufficiency owing to posterior urethral valves: value of long-term diversion. A twenty-year follow-up.

Twenty-five patients with posterior urethral valves have been monitored for 10-29 years (mean 18 years). Eight underwent diversion because of impaired renal function (creatinine greater than 0.8 mg/dl) accompanied by unimproved upper tract form and function after valve ablation. In the nondiverted group, 6 patients (35%) progressed to renal failure; in the diverted group 5 patients (63%) did so (p = 0.30). Of 13 patients whose lowest serum creatinine in the first year after valve ablation was greater than 0.8 mg/dl, 9 (69%) went on to renal failure (p = 0.02); in the remaining 12 patients, only 2 (17%) did so (p = 0.008). The mean age for renal failure was 13 years for both groups. The Tanner scale rating (mean percent height) for all patients at 10 years was 61% for the diverted group and 35% for those without diversion (p = 0.004). When the patients treated after the age of 1 year (n = 7) were excluded from the calculation, the rating remained different (54% diversion, 26% no diversion; p = 0.012). We conclude that the boy born with urethral valves and serious upper tract damage is at risk for renal failure, especially during the teen years. An undefined relationship appears to exist between urinary obstruction and growth. In our study, the boys who underwent diversion continued to grow along a normal Tanner height curve.

Adolescent↗
PubMed1979

Treatment of vesicoureteral reflux: point system based on 20 years of experience.

During the last 20 years 500 girls with recurrent urinary tract infection and documented reflux were seen in private practice. All patients received medical treatment for 3 to 48 months (an average of 15 months) after which the 250 who were not cured underwent a corrective operation. The primary reason for an antireflux operation is to protect the kidney from the damaging effect of a combination of high pressure and infection. Thus, the criteria for operation included persistent infection, renal changes typical of previous pyelonephritis, major reflux and abdominal or flank pain. The surgical cure rate after careful long-term followup approaches 98%. The medical cure rate at the end of 2 years reached 88%. This experience has enabled the establishment of a rigorous point system, providing common denominators regarding indications for operation. It emphasizes the desirability of attempting a medical cure for at least 1 year after urethral dilatation, except when major orifice defects and major reflux exist. This system should help to increase communication and coordination of efforts among the pediatrician, radiologist and urologist.

Child↗
PubMed1977

Ureterovesicoplasty: selection of patients, incidence and avoidance of complications. A review of 3,527 cases.

The procedure of ureteral reimplantation has certainly come of age. The incidence of complications can be kept low by careful selection of patients for operation along clear and definite guide lines, by close attention to detail in the surgical procedures and by rigorous followup care. When surgical intervention is deemed advisable the expected cure rate should be more than 94%. While complications do occur resultant damage to the upper urinary tracts should be minimized by its prompt recognition and by institution of appropriate therapy.

California↗
PubMed1975

Intermittent catheterization rather than urinary diversion in children with meningomyelocele.

Fifteen girls more than 4 years old and with neuromuscular defects of meningomyelocele are maintaining adequate urinary continence through the use of intraurethral catheterization done by themselves or their parents. Urinary diversion has been necessary in only 1 child. The indwelling catheter has allowed heavily trabeculated bladders to become smooth enough for an antirflux operation to be successful, although the period of followup is only 2 years. Upper tract deterioration has not been observed and urine has been maintained sterile without the help of medication 50 per cent of the time when catheterizations have been done on a routine 3-hour schedule. For this method to be sucessful and replace conduit deversion, parents, child, nurse and physician must be a well-knit team. With the hope that a reliable artificial urinary sphincter will eventually provide contience for some children, one is further justified in pursuing urinary continence by use of the catheter, instead of resorting early to permanent conduit conversion.

Child↗
PubMed1973

Renal arrest.

Explore the source record for details and available documents.

Adolescent↗
PubMed1972

Renal arrest.

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Anti-Bacterial Agents↗