- [Show abstract] [Hide abstract] ABSTRACT: Risk factors for renal scarring in children with lower urinary tract dysfunction (LUTD) were evaluated. The medical records of 120 patients were assessed concerning gender, presence of vesicoureteric reflux (VUR), bladder capacity, detrusor overactivity, residual urine, febrile urinary tract infection (UTI), bacteriuria, constipation, detrusor sphincter incoordination (DSI), high detrusor pressure at maximal cystometric capacity (PMCC), low compliance, and thickness and trabeculation of the bladder wall. Renal scarring was diagnosed by 99mtechnetium-dimercaptosuccinic acid renal scan (DMSA). Renal scarring was detected in 38 patients (31%). VUR, UTI, decreased bladder capacity, urinary residue, and trabeculated and thick bladder wall were associated with scarring at univariate analysis. Multivariate analysis showed VUR (P < 0.0001) as the independent risk factor for renal scarring. Thickness of the bladder wall was a marginal risk factor (P = 0.07). Although UTI was not a risk factor, it was associated with VUR (P = 0.03). In our analysis, VUR was the main risk factor; however, renal scarring was probably due to multifactorial causes, as VUR was associated with UTI.
- [Show abstract] [Hide abstract] ABSTRACT: This study was undertaken to evaluate the use of pubovaginal sling for the treatment of female stress urinary incontinence in patients with intrinsic sphincteric deficiency and patients with urethral hypermobility. Sixty-two patients aging 22 to 73 years-old (mean = 49.6) with a median parity of 4.1 (range 0 - 14) who underwent pubovaginal autologous fascial sling procedures for stress urinary incontinence from August/1999 to August/2002 were prospectively analyzed. Objective pre and postoperative urodynamic evaluation was performed in all cases. The patients were divided into 2 groups: thirty-nine patients (62.9%) with urethral hypermobility (Valsalva leak point pressure equal or superior to 60 cm of H(2)O) and twenty-three patients (37.1%) with intrinsic sphincteric insufficiency (Valsalva leak point pressure below 60 cm of H(2)O). The average follow-up period was 24.8 months, ranging from 3 to 38 months. Three patients (4.8%) had detrusor overactivity before the operation, and 36 patients (58.1%) had voiding dysfunction before surgery. The postoperative objective cure rate was 88.7% for stress urinary incontinence. The study also showed that 32.2% of the patients had voiding dysfunction and 11.3% had detrusor overactivity. The mean hospital stay was 3.1 days (range 2 - 4). No difference in the above parameters was noticed between patients with intrinsic sphincteric deficiency and those with urethral hypermobility. Construction of a pubovaginal sling is an effective technique for the relief of severe stress urinary incontinence, for both patients with urethral hipermobility and with intrinsic sphincteric deficiency, having a cure rate of 88.7%. The high frequency of postoperative voiding urgency was not related to the detrusor overactivity as evaluated by urodynamic studies.
- [Show abstract] [Hide abstract] ABSTRACT: To evaluate the role of dynamic ultrasonography (US) in the diagnosis of bladder dysfunction and to compare dynamic US with urodynamic study, which is considered to be the standard in the diagnosis of bladder dysfunction. Images from 71 pairs of examinations in 63 patients (median age, 7.9 years; range 1.0-17.4 years) were included in the study. After the child consumed adequate fluids in an appropriate environment, natural filling of the bladder occurred, and dynamic US was used to evaluate detrusor activity, determine capacity of the bladder, and estimate residual urine volume. A urodynamic study was performed in every patient within 6 months of dynamic US and under the same treatment conditions. The paired Student t test was used to compare the maximal cystometric capacity values obtained with the two examinations. Analysis of validity was performed with the calculation of sensitivity, specificity, positive and negative predictive values, and their respective 95% confidence limits. The bladder capacity was not significantly different between dynamic US and urodynamic study (P =.12). Analysis of validity for the determination of the presence of clinically substantial residual urine showed 97.7% sensitivity and 100% specificity for dynamic US. The sensitivity and specificity of dynamic US in the detection of involuntary detrusor contraction were 93.0% and 88.9%, respectively. In the analysis of involuntary detrusor contraction with urine leakage, dynamic US showed sensitivity of 100% and specificity of 97.8%. Dynamic US is a sensitive method for the diagnosis of bladder dysfunction.