Roger Baker

Comparative results of urological evaluation of children with initial and recurrent urinary tract infection.

Complete urologic evaluation was done on male and female children having initial or recurrent urinary tract infection. Of 200 girls having recurrent urinary tract infection 43 per cent showed ureterovesical reflux on the cystogram. Of 39 boys with recurrent urinary tract infection 41 per cent had reflux. Thus, the incidence of reflux is comparable in male versus female patients. Of 47 girls studied after only 1 episode of urinary tract infection 36 per cent had reflux and of 20 boys studied after initial infection 45 per cent had reflux. The data indicate that initial or recurrent urinary tract infection in boys or girls is of equal significance. All other factors being equal, failure to evaluate a patient urologically after 1 or more episodes of urinary tract infection solely because of the sex of the child could mean that a potentially severe urinary tract abnormality can be undetected and untreated.

Complications associated with surgical repair of urethrovaginal fistula

We present 4 patients seen in the last five years with urethrovaginal fistulas involving the mid or proximal urethra. Our experience in the transvaginal repair of these fistulas has been disappointing. The best chance for the development of a functioning continent urethra is by suprapubic bladder flap technique or bladder tube replacement with suprapubic urinary diversion. We suggest that no urethral catheter be placed. Complications following surgical repair have been fistula recurrence, urethral shortening and retraction, persistent reflux, bladder calculi, and bladder cancer.

Renal Biopsy in Children: Analysis of 61 Cases of Open Wedge Biopsy and Comparison with Percutaneous Biopsy

Abstract Open wedge renal biopsy was done In 61 children with undiagnosed renal disease. Light and electron microscopic Interpretations were compatible with each other In 66 per cent of the cases. However, In approximately a third of the cases there was a disparity In diagnosis of one microscopic examination versus the other. Regardless, the greatest yield for establishment of diagnosis is obtained by using light and electron microscopy. No deaths were related to renal biopsy. Minor complications occurred in 9 per cent of the cases, none of which required reoperation. Comparison of open wedge with percutaneous renal biopsy reveals that the mortality rate is probably less with the wedge technique. The incidence of complications is approximately the same for both procedures. Percutaneous biopsies resulted in a 10 per cent failure rate to produce any renal tissue or the tissue obtained was inadequate for examination. Thus, diagnosis is not established and treatment is not instituted in 1 of 10 children who is still subject to the morbidity and complications of the needle procedure. However, open wedge biopsy always results in an adequate amount of renal tissue for these diagnostic studies. It can be used for children of all ages compared to percutaneous needle biopsy, which becomes increasingly more of a problem from various parameters with decreasing age of the child, even when performed successfully.