Journal Archives - Volume 1
Editorial: Perhaps nowhere in paediatric urology are the refinements of instrumentation more apparent than in endoscopic management of lower urinary problems, especially in the neonates. At least for posterior urethral valves (PUV) it seems to stem from a constant search for a better treatment. The postnatal clinical picture being varied, as is seen in many syndromes, the evolution of procedures for the treatment of PUV has kept pace with the gradual recognition of this syndromic character.
Abstract: Congenital anomalies are defined as structural or anatomical abnormalities present at birth. They can be divided into malformation (an embryologic defect). Deformation (abnormal intrauterine mechanical constraint), disruption after normal development) and dysplasia (abnormal organization of tissue). In addition, they can be single or multiple and minor or major. Major anomalies are present in 2–5% of neonates and account for as 20–30% of perinatal deaths. To date, over 109 different malformation have been detected by prenatal Sonography. Since, the estimated incidence of congenital urologic abnormalities in the general population is 1–2%, a relatively high incidence of genitourinary abnormalities are noted in the fetus. In four series the incidence of genitourinary abnormalities ranged from 15–38%. In the series that reported a low 15% incidence of genitourinary abnormalities they excluded 21 fetuses with polyhydramnios and six with oligohydramnios. The purpose of antenatal diagnosis is to detect lesions that are incompatible with extrauterine life and to either counsel the parents regarding termination of the pregnancy or to intervene antenatally with the aim of preventing postnatal morbidity or mortality. Antenatal diagnosis permits the fetus to be delivered under controlled circumstances, allows for early transfer for definitive therapy and most importantly permits the parents to assimilate the information over a period of time.
Abstract: Posterior urethral valves are the most common cause of lower urinary tract obstruction in male infants. Regardless of recent controversy regarding their exact nature the fact remains that the entire urinary tract from the level of obstruction upwards is affected by these lesions to varying degrees as demonstrated by Hendren in this classic paper. The prognosis of patients presenting for treatment has improved dramatically with the mortality rate dropping from 25% in the 1960s to zero in the 1980s. However, patients with the most severe form of the disease often die immediately after birth and do not present for treatment. In addition, up to 26% of patients treated in the neonatal period develop end-stage renal failure and there is an intermediate group that does not require transplantation but also does not have enough renal function to permit growth and development.
Abstract: Whereas, bladder Exstrophy was once considered to be a state, which could not be reconstructed, the surgical management of bladder Exstrophy has evolved through the years to now yield consistent surgical success. Management issues, including surgical tips and strategies for handling complications, are addressed. The staged approach to bladder Exstrophy reconstruction, when properly applied, usually results in a continent, voiding patient with pleasing external genitalia and preserved renal function.
Abstract: Exstrophy of the cloaca is one of the most major congenital malformations compatible with survival. It is a multisystem anomaly involving the gastrointestinal, nervous, musculoskeletal and genitourinary tracts and should be managed using a multidisciplinary approach. Improvements in management have led to survival of most infants and the focus has shifted to improving quality of life. Staged reconstruction is the preferred method of management of the genitourinary malformation, with initial bladder closure and later attempts at achieving continence. In patients who do not achieve adequate bladder capacity for bladder neck reconstruction, bladder augmentation and continence via a cathertizable stoma are available options. Long-term follow-up is essential to prevent long-term complications, maintain function and psychological well being, and to assist these children to integrate into society and become productive adults.
Abstarct: Vesicoureteral reflux is a common condition with potentially serous sequeleae. Primary reflux will usually resolve spontaneously, however, these patients have to be followed carefully and treated with antibiotic prophylaxis. For patients with persistent reflux, open surgical reimplantation is still the treatment of choice although endoscopic techniques are being evaluated.
Abstract: Radionuclide studies have traditionally been pivotal in the evaluation of nephrourologic disorders in children. The need to study individual functional aspects of kidneys has been instrumental in the appreciation of capability of nuclear medicine techniques. With the introduction of selective radipharmaceuticals, better imaging devices and powerful computers, the use of nuclear medicine procedures in the diagnosis and follow-up of Nephro-urologic problems in the recent past has grown phenomenally. Radionuclide studies along with ultrasound evaluation of genitourinary morphology have significantly reduced the need for intravenous urography in pediatric practice. Nuclear medicine procedure is relatively non-invasive requiring only an intravenous injection. They require neither fasting nor bowel preparation. They can be performed on an outpatient's basis without the need for anesthesia. They have no systemic pharmacological effects neither allergic reactions, with minimal absorbed radiation does.
Abstract: Tremendous advances in songraphy have taken place in the last few decades. Duplex imaging and later the addition of color (color duplex imaging) have enabled the radiologists to explore different facets of a clinical problem not feasible with black and white, 2-D imaging available earlier. This has opened up entirely new fields of investigation never even dreamed of only a couple of decades earlier e.g., assessment of renal perfusion; evaluation of renal artery stenosis, tumor vascularity and post biopsy complications assessment, etc.
Abstract: Chronic renal failure (CRF) is a severe, irreversible loss of renal function which eventually results in end stage renal disease (ESRD). Glomerulonephritis is the main cause of CRF responsible for more than a third of all cases. Reflux nephropathy, congenital renal anomalies, obstructive uropathy and hereditary nephropathies account for the remainder. During neonatal period and infancy important causes include obstructive uropathy, renal cortical necrosis, infantile polycentric kidney disease and renal hypoplasia.
Management of intersex disorders is a challenge as it is critical to make a diagnosis of these conditions and assign an appropriate sex of rearing to the new born as expeditiously as possible to avoid great mental and psychological stress to the parents. An etiological diagnosis is important as it is expected to provide information on the somatic growth of genitalia, potential metabolic derangements, developments, development of virilization or female type of breast at adolescence and probability of malignant tumours at a later date.