Blackwell B. Evans

Ureteropelvic junction obstruction: the effect of pyeloplasty on renal function.

We studied preoperatively and postoperatively 41 children who underwent pyeloplasty for correction of unilateral ureteropelvic junction obstruction. Conventional radiological studies and quantitative radioiodine hippurate renal scans were obtained to assess the effect of pyeloplasty on the appearance of the kidney and its function. Analysis of the data suggests that the degree of improvement in renal function is related primarily to the age at which the surgical correction is accomplished and whether infection has occurred preoperatively.

Correction of Intrinsic Penile Chordee with a Ventral Penile Graft of Fascia Lata

Chordee is an abnormal curvature of the penis detected on erection. Congenital or primary curvature of the penis without hypospadias is, however, rare. There are two kinds of primary curvatures; those associated with a normal corpus spongiosum and those with a hypoplastic spongiosum. Secondary curvatures associated with Peyronies disease or periurethral fibrosis associated with urethral stricture are more common in adults. Four nonhuman primates had successful correction of artificially induced chordee with a graft of fascia lata.

Cerebrospinal Fluid Pseudocyst After Urinary Diversion

The development of an abdominal mass after urinary diversion in a patient with a ventriculoperitoneal shunt should alert the physician to the possibility of a cerebrospinal fluid pseudocyst. Two pediatric cases of cerebrospinal fluid pseudocysts are presented to illustrate this complication. The etiology, diagnosis and management of the pseudocyst are discussed and the literature is reviewed.

Management of Severe Hydroureteronephrosis in Infants and Young Children

Loop cutaneous ureterostomy and cutaneous pyelostomy are safe and effective means of temporary diversion with few complications. Reconstructive operation is delayed until the upper urinary tract has shown maximum improvement in form and function and the patients tolerance for elective operation has improved. Results of reconstruction may be less than optimal and serious complications may arise. However the staged approach has been shown to be safe and effective. Experience with 29 patients has led to a reassessment of the approach to patients with posterior urethral values and a stronger inclination to primary valve resection, thus avoiding many of the reconstructive procedures ultimately associated with temporary diversion. Patients with posterior urethral valves who have hydronephrotic upper urinary tracts, normal or near normal serum chemistry studies and are free of infection may receive initial valve ablation. All patients with massive hydroureteronephrosis require long-term followup to ensure preservation of renal function regardless of the approach used.

131I hippuran quantitative scintillation camera studies in the evaluation and management of vesicoureteral reflux.

A study was made of 136 patients with vesicoureteral reflux with the conventional radiologic modalities of voiding cystourethrography and IVP. In addition, a 30-minute quantitative scintillation camera study was used. Comparison of these studies indicates that most periodic re-evaluations with IVP can be eliminated in favor of the scintillation study with its markedly reduced radiation dosage and lack of allergic type reactions. Unfortunately, as the quantitative scintillation camera study has been performed in these patients, it has been impossible to diagnose the presence of vesicoureteral reflux. Therefore, voiding cystourethrography or direct radionuclide cystography must be repeated at some time to determine if conservative management has been successful. The benefit of the routine use of the quantitative scintillation camera study in the early postoperative period seems to be strongly supported even by the small group of patients studied.

The Renal Quantitative Scintillation Camera Study for Determination of Renal Function

The renal quantitative scintillation camera study assesses glomerular filtration rate and effective renal plasma flow based upon renal uptake of 99mtechnetium-iron ascorbate and 131iodine-hippuran, respectively. The method was compared to inulin, para-aminohippuric acid and creatinine clearance studies in 7 normal subjects and 9 patients with various degrees of reduced renal function. The reproducibility of the technique was determined in 15 randomly selected pediatric patients. The values of glomerular filtration rate and effective renal plasma flow were not significantly different from those of inulin and para-aminohippuric acid studies. The reproducibility of the technique was comparable to that of inulin and para-aminohippuric acid studies. Patient acceptance of the technique is excellent and the cost is minimal. Renal morphology and excretory dynamics also are demonstrated. The technique is advocated as a clinical measure of renal function.

Thyroid uptake of 1311 following hippuran renal scintillation camera studies in children blackwell

The thyroid uptake of radioactive iodine after scintillation camera studies using 131I-labeled hippuran was studied and the radiation dose calculated in 30 euthyroid children with normal renal function. Fifteen children received Lugols solution which reduced the thyroid uptake and radiation dose significantly.

Renal Quantitative Scintillation Camera Studies in the Management of Myelodysplasia

The renal quantitative scintillation gamma camera study has been used in the evaluation and management of 95 children with myelodysplasia. This study has been helpful in assessing renal function. The precise information, reproducibility of results, high correlation with excretory urography and a minimal amount of irradiation exposure to the patient make this procedure an ideal technique to evaluate and follow a population that needs continuous monitoring of individual as well as total renal function.