N. O. Ericsson

Renal Function in Infantile Obstructive Uropathy

From clinical observations and studies of the renal function in six male infants and children with obstructive uropathy, the following conclusions may be summarized:

Micturition Studies in Infants and Children: Technique

A method for simultaneous and continuous registration of bladder pressure and urine flow is presented. It has been tested in infants and children of various ages. The sources of error and the reliability of the method are analysed. The pressure is measured via a suprapubic bladder puncture. The urine flow is converted into gas flow, which is registered by a pneumotachograph. The method is accurate enough for it to be used even in infants.

Separate renal function studies in predominantly unilateral hydronephrosis.

Preliminary investigation of acidification and concentration power of each kidney in two patients with predominantly unilateral hydronephrosis due to congenital ureteropelvic obstruction, the following conclusions may be drawn.

Micturition Studies in Infants and Children: Urodynamics in Boys with Disorders of the Lower Urinary Tract

Urodynamics were studied in one group of boys with definite infravesical obstruction and in another group with various other disorders of the lower urinary tract. They were compared with a group of normal cases and a control group without infravesical obstruction. In the group with a priori definite infravesical obstruction, opening pressure, maximum voiding pressure and peak-flow pressure relatively often fell outside the 2 standard deviations of the control group. As regards other pressure variables, there was a high degree of overlap between normal and abnormal micturition. In individual patients combinations of normal pressure/decreased flow were observed. Bladder pressure measurement alone provides only a limited basis for evaluation. Boys with lesions of the lower urinary tract use abdominal straining to a much greater extent than normal boys, but apparently with little improvement in bladder emptying. Maximum flow in all patients with a priori definite infravesical obstruction fell outside the lowe...

Essential hematuria in children--prognostic aspects.

Hematuria is a condit,ion calling for immediate investigation to ascertain the underlying etiologic factor. In many instances, however, the cause of bleeding cannot be determined despite intensive examinations. These unexplained hematiirias constitute a separat,e group and are generally defined as “essential hematuria”. This designation doex not imply a definite disease but probably represents a sort of melting-pot including hematurias of multiple pathogeneses. Silva de Assis [12] defines essential hematuria as renal hematuria, unior bilateral, intermittent or continuous and more or less intense, without any evidence of histologic or functional alterations of the kidneys. The lack of detectable changes has led to different etiological hypotheses and a wide variety of nomenclature. The synonyms which have been proposed, such as local renal hemophilia, constitutional renal hemophilia, angioneurotic renal hematuria, renal epistaxis, hematuria of small foci, hematuric renal nephralgia, represent attempts to define a condition with an obscure etiology. Failure to recognize the true causative factor is mainly due to the present-day diagnostic inadequacy. Only histologic studies might give clues to diagnosis. In most instances, however, hematuria is not severe enough to warrant nephrectomy. But, even after removal of

Urodynamic Studies in Boys with Disorders of the Lower Urinary Tract: I. Urethral Strictures. A Pre- and Postoperative Study

Sixteen boys with urethral strictures underwent urodynamic investigation pre- and postoperatively. The intravesical pressure preoperatively showed wide variations during micturition and was increased in only half of the patients. The urinary flow pre-operatively displayed a uniform picture with a decreased maximum flow in all the patients, plateau-formation and slow initiation of the flow curve. The maximum exit velocity of the urinary stream was decreased and the urethral energy losses were very high. After treatment, the out-flow situation was generally improved, but restored to normal only in some cases. Patients with short strictures showed the highest degree of urethral obstruction, but they also seemed to have the best prognosis, some of them even reaching supernormal flows. Flow measurement alone is recommended in the long-term follow-u, which is necessary in these patients. After-contraction was not present in any of the patients pre-operatively, blt occurred in about half of them postoperatively. This and some other findings may indicate the existence of functional changes in the bladder neck in patients with urethral stricture. On case with partial detrusor muscle insufficiency is reported.

The Lower Urinary Tract in Neonates with Myelomeningocele: Neurologic and Radiologic Correlative Study

A group of 27 infants with myelomeningoceles was investigated in the newborn period by neurologic examination and by micturating cystourethrography. An abnormal configuration of the bladder, trabeculation of the bladder wall, narrowing of the urethra at the external sphincter and alteration in the shape of the bladder neck were common findings. The incidences of trabeculation and a wide bladder neck were significantly related to neurologic lesions at a low thoracic and high lumbar level. Possible pathogenetic mechanisms presented in the literature are reviewed and the hypothesis is advanced that the alterations ate related to interruption of sympathetic innervation of the bladder.

Micturition Studies in Infants and Children: Influence of an Indwelling Urethral Catheter and of Rectal Pressure Recording

The influence on micturition of a 5 F urethral catheter was studied with simultaneous measurement of intravesical pressure and urinary flow in 17 boys aged 1 month-14 years. No significant effect could be shown as regards intravesical pressure. A decrease in maximum flow, particularly in infants, was found. in certain cases, particularly those with infravesical obstruction, the degree of obstruction was less with a catheter in the urethra. Suprapubic puncture is recommended as the most suitable technique for measuring intravesical pressure in infants and children. the effect of rectal pressure measurement on detrusor function was studied in 25 children aged 7 months 14 years, with simultaneous recording of intravesical pressure, urinary flow and rectal pressure. Ano-vesical inhibition induced by rectal pressure measurement could not be shown. Measurement of rectal pressure is a suitable method for detecting intra-abdominal pressure changes, provided the children accept the rectal balloon. Impedance pneumo...

Unilateral neurological defect in myelomeningocele with normal bladder function. Report on two cases.

Various clinical reviews concerning myelomeningocele give the incidence of normal urinary control as between 3 % (4) and 33 %, the latter figure originating from a somewhat selected series (3). With the cele in lumbosacral region the continence figures are generally low. The criteria of continence and particularly of normal bladder function vary. Sometimes the reports are based entirely on the history; sometimes bladder function is studied in a more detailed and objective manner. Only in recent years have conditions for the development of entirely intact bladder function begun to arise greater interest. Knowledge of these should constitute the basis of any clinical attempt to achieve continence. We shall here describe 2 cases of myelomeningocele which developed normal bladder function. These 2 cases were among the last 50 consecutive patients with myelomeningocele in the lower thoracic or the lumbosacral areas who were referred for urological evaluation. This group was examined by a team of a neurologist, a radiologist and a urologist.

Factors promoting urinary and anal continence in children with myelomeningocele.

In a previous study (5 ) 2 cases of myelomeningocele with normal bladder function were described. In these patients the clinical picture was characterised by unilateral disturbance of neurological function. They were included in a recent series of 50 cases investigated neurologically, radiologically and urologically. The degree of severity and the type of incontinence or partial continence varied. In the literature diverging opinions are found concerning the relationship between remaining bladder function and the neurological findings. In this study an attempt has been made, using ordinary clinical methods, to determine the conditions for acquisition of partial bladder and anal continence. The aim has been to select suitable cases which might respond to bladder training, either partially or completely and thus permitting the social rehabilitation of the patient. The literature on this subject is scanty.