[show abstract][hide abstract] ABSTRACT: The paper reports examination, treatment and follow-up data on 8 children aged 4-13 suffering from total enuresis, who failed previous conservative or operative treatment. Upon examination enuresis was attributed to trauma or malformations of the neck of the urinary bladder (NUB) or urethra (in 2 and 6 patients, respectively). Out of the latter, NUB congenital defect was in 4, total epispadia in 1, spina bifida in 1 patient. Urodynamic studies showed the absence of detrusor-sphincter dyssynergia and confirmed organic nature of NUB lesion. Six children underwent NUB electromyography which recorded no uniform, preformed complexes with adequate voltage. All the children were operated on: NUB reconstruction according to Davis, bilateral uretero-cystostomy according to Coen. An immediate postoperative response was seen in 7 children who were able to retain urine for 40 min-2.5 hours. Long-term response (6 months-3 years) was achieved in 7 children who recovered normal uresis. Total enuresis persisted in 1 patient with spina bifida. 2.5-3 years after the treatment the bladder capacity increased in spite of its resection by 1/3.
[show abstract][hide abstract] ABSTRACT: The present study is a review of the results of Cohen's operation performed on 43 ureters in 32 children. Treatment results were assessed through the comparison of cystographic and 131I-hippuran renographic findings obtained before and after surgery. Urodynamic recovery in the affected ureter was demonstrated in all children. One year after surgery, there was no improvement in the activity of the resected kidney in 37% of patients. In the remaining patients, secretion improved by 10-13% in the affected kidney. Seventeen children returned for follow-up examination 2 years after surgery. The activity of the affected kidney and the contralateral one improved in 13 of 17 patients. There was no upper urinary retention due to ureteral stricture in any of the children. The rate of recurrent vesico-ureteral reflux (VUR) was 5.3%. Augmentation or persistence of purification deficiency in the affected kidney, detected in 12 patients at first postoperative follow-up, was qualified as a result of aggravated chronic pyelonephritis rather than that of surgical complications related to methodologic specifics. This assumption was verified by the results of the next follow-up examination 2 years after surgery. Therefore, Cohen's method can be recommended for large-scale application in the treatment of VUR in children and is expected to essentially reduce the rate of relapses and improve the standards of surgical care of children with this grave disease.
[show abstract][hide abstract] ABSTRACT: Ninety-six children, aged 4 to 14, with congenital obstructive uropathies were subjected to 131I-hippuran renography, followed by mathematical processing of renographic curves, the measurement of blood mean molecular levels, and blood and urinary immunochemical tests before, and 1 month as well as 1 year after surgery. Intraoperative renal biopsy was taken from 20 patients with unilateral hydronephrosis. Latent chronic renal failure (CRF) was identified where a deficiency of total renal clearance of 131I-hippuran (20 to 56%) was combined with a rise in blood mean molecules from 0.3 to 0.41 conventional units at 254 nm. Latent CRF was detected in 40 of 64 children with unilateral uropathy and in all 32 patients with bilateral uropathy. In patients with unilateral hydronephrosis, the presence of CRF was unrelated to the morphological pattern of pyelonephritis in the affected kidney. Children with latent CRF showed high levels of urinary IgG and albumin and blood mean molecules. One year after the operation, renal function improved in patients whose contralateral kidney had no secretory deficiency. One year after surgery, renal reabsorption mechanisms tended to recover in CRF-free patients only. The clinical pattern of latent CRF and its elimination following surgery were unrelated to roentgenologic markedness of hydronephrosis and VUR, but were dependent on the recovery of compensatory mechanisms in the contralateral kidney. By the end of the first postoperative year, latent CRF was diagnosed in 31% of children with unilateral hydronephrosis (as compared to the preoperative 68%), 43% (vs. the preoperative 60%) of children with unilateral VUR, and in 44% (vs. the preoperative 50%) of patients with unilateral neuromuscular ureteral dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)
[show abstract][hide abstract] ABSTRACT: Operative intervention on the urinary bladder in children entails postoperative reactive cystitis. Biopsies of urinary bladder mucosa were studied morphologically. Basing on these morphological findings and clinical evidence, three leading variants of the mucosa changes were distinguished: focal squamous cell metaplasia; excess of the lymphoid tissue and lymphangiectasia; hemangiectasia. These morphological changes aggravate the course of postoperative cystitis. UHF-therapy and magnetic-laser radiation beginning postoperative day 4 and 7, respectively, reduce inflammation developing in postoperative cystitis. This indicates effectiveness of the above combined therapy which can be also used for prevention of acute inflammation episodes in postoperative period.
[show abstract][hide abstract] ABSTRACT: Chronic cystitis was diagnosed in 36% of children with neuromuscular ureteral dysplasia, in 69% of those with vesicoureteral reflux, in 42% of girls with urolithiasis. Recurrent inflammation was registered in 96, 11% of patients with fibrinous cystitis and catarrhal cystitis, respectively, and in 62% of girls with bullous cystitis. Histological examination of 130 biopsies of bladder mucosa from girls with frequent recurrences of chronic cystitis provided a clear morphological picture of each endoscopic cystitis form. In bullous cystitis there are 2 congenital variants of mucosal structure: overdevelopment of lymphoid tissue as massive lymphoid follicules and lymphangioectatic form. Catarrhal cystitis is characterized by vascular angiomatosis. All the patients with fibrinous cystitis had squamous cell epithelial metaplasia. Morphological findings evidence that fibrinous cystitis is the most severe and unfavorable form of cystitis, bullous cystitis is less severe while catarrhal cystitis is favorable.