David B. Joseph

OUTCOME AND COST ANALYSIS OF OPERATIVE VERSUS NONOPERATIVE MANAGEMENT OF NEONATAL MULTICYSTIC DYSPLASTIC KIDNEYS

PURPOSEnWe determine whether nephrectomy or observation is the more appropriate treatment of neonates with multicystic dysplastic kidney in terms of medical care and cost-effectiveness.nnnMATERIALS AND METHODSnWe retrospectively reviewed our 10-year clinical experience with 17 female and 32 male neonates presenting with multicystic dysplastic kidney who were followed with serial renal ultrasound. The literature also was reviewed.nnnRESULTSnNephrectomy was performed in 12 patients (24%) for various reasons, of which family request at concomitant surgery was the most common (7). No kidney was removed due to hypertension or tumor. In the remaining 37 patients followup continues (mean 42 months) with involution developing in 9 multicystic dysplastic kidneys (24%) and 9 patients (24%) lost to followup. The total cost of 1-hour outpatient simple nephrectomy was estimated at

Lower Pole Ureteropelvic Junction Obstruction and Incomplete Renal Duplication

5,000 to

Splenogonadal fusion diagnosed by Doppler ultrasonography.

7,000 and, when performed as a concomitant procedure, it cost

Pediatric urodynamics: basic concepts for the neurosurgeon

2,000 to

Clean, intermittent catheterization of infants with neurogenic bladder.

5,000, the equivalent charges incurred for 17 to 28 serial ultrasound studies performed by a radiologist. Our review of the literature revealed that children with multicystic dysplastic kidney are at minimal risk for hypertension, pain and infection. The most important reason to perform screening renal ultrasound in this condition is to detect earlier stage Wilms tumor (3 to 10-fold the general pediatric population risk of 1/10,000 cases). With a maximum risk of 0.1% for Wilms tumor controversy exists as to whether any screening program is necessary. When screening is instituted, options include monthly parental abdominal palpation versus serial renal ultrasound. Because Wilms tumor has a rapid growth rate, when screening renal ultrasound is instituted, it must be performed no less than every 3 months until age 8 years (total of 32 studies) to screen effectively for early stage tumors.nnnCONCLUSIONSnThe risks associated with multicystic dysplastic kidney are slight. Early nephrectomy is more cost-effective than observation in neonates with multicystic dysplastic kidney only when observation involves screening with ultrasonography every 3 months until age 8 years. Extensive parental counseling should be provided on the slight but definite risks of this condition.

Management of the obstructed urinary tract associated with neurogenic bladder dysfunction.

The rare finding of lower pole ureteropelvic junction obstruction and incomplete renal duplication is discussed in 5 children. The children were divided into 2 groups, with short (less than 0.5 cm.) and long (greater than 4 cm.) lower ureteral segments. Short ureteral segment obstruction was managed by total excision of the narrow ureteral segment and end-to-side pyeloureterostomy. Obstructions associated with long lower ureteral segments were treated by excising the ureteropelvic junction and performing a standard Anderson-Hynes pyeloplasty. A thorough preoperative evaluation is helpful for successful management.

Section on Urology: Report of the Annual Meeting, San Francisco, California, 1995

Splenogonadal fusion usually presents as a left scrotal mass but rarely is the diagnosis suspected preoperatively. Herein, we present the first report of a left splenogonadal fusion which was suspected preoperatively by doppler ultrasonography in a 2 year old boy.

488 UTILITY OF URODYNAMICS IN THE MANAGEMENT OF ASYMPTOMATIC TETHERED CORD IN CHILDREN

A great deal of information about overall bladder and urethral function can be obtained with the utilization of urodynamics. Urodynamics itself does not constitute a single test but more precisely the acquisition of multiple interconnected data combined to give an overall study of the storage and emptying phases of the bladder, function of the urethra, as well as the activity of the pelvic floor musculature. Urodynamic investigation represents one of the few reliable objective tests available to help guide therapy for the neurosurgeon. The authors review the various urodynamic tests most often utilized by pediatric urologists and discuss interpretation pitfalls with respect to interobserver variability. Technical aspects of the study are described along with normal and abnormal findings.