PubMed · 4372764
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W E Bradley, F B Scott, G W Timm. 1974. Sphincter electromyography.. https://pubmed.ncbi.nlm.nih.gov/4372764/
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Laser resection (LR) of posterior urethral valves during infancy as early as possible after diagnosis appears to represent a safe and reliable method. In contrast to other procedures, LR allows valve ablation with thin cystoscopes and carries little risk, even in premature and newborn infants. Its application in seven children in the course of 2 years principally confirmed its suitability for use: it could be applied in all cases without any problems and led to extensive resection of the valve tissue and removal of the obstruction in all patients. The encouraging clinical findings were confirmed by control cystoscopies and micturating cystourethrograms. Complications arising from the method were not observed.
A case is reported in which complete disruption of the bulbous urethra resulted in a straddled-type injury, which was managed by endoscopic realignment with a thin trocar needle. The endoscopic urethroplasty consisted of: (i) direct observation of the proximal end of the obliterated urethra by an antegrade flexible cystoscope; (ii) adjustment of the direction of trocar penetration under fluoroscopy and direct vision; (iii) confirmation of the exact trocar position and penetration by antegrade flexible cystoscope; and (iv) placement of the guidewire following the trocar penetration as guidance for urethrotomy. A Foley catheter was left in place for 6 weeks. To date, no further endoscopic revision has been required. Although long-term follow up and more experience are required, this technique is reported because it appears to be safe, reproducible, simple and minimally invasive.
OBJECTIVE: To determine the sensitivity of the direct radionuclide cystogram (DRC) in detecting vesico-ureteric reflux compared with the micturating cysto-urethrogram (MCU) in the same initial setting, in infants younger than one year. PATIENTS AND METHODS: The results from the dual cystograms of 62 refluxing infants < 1 year old (mean 0.58) were compared. Results from same-day renal scintigraphy with dimercaptosuccinic acid (DMSA) in 60 of the 62 infants were also compared with the reflux grades. RESULTS: Reflux was detected in 105 units, 96 detected on the DRC and 47 on the MCU, representing a sensitivity of 91% and 45%, respectively. The DRC missed half of grade 1, 20% of grade 2 and 6% of grade 3 reflux. Reflux at low bladder filling rates (DRC) represented 40% of all reflux units, and a half (52%) of scarred renal units detected by DMSA scintigraphy. CONCLUSIONS: In young infants the MCU may fail to detect significant reflux and the DRC may fail to detect the lesser grades. The combination of both cystograms in the initial investigation of reflux provides more comprehensive information.