China
Africa
Explore chapters and articles related to this topic
Principles of paediatric surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
UTIs in children may be due to a urinary tract abnormality which may carry a risk of developing renal scarring from ascending infection. Infection and obstruction are particularly hazardous. Older children complain of dysuria and frequency, whereas infants present with vomiting, fever and poor feeding. Urine specimens from children are easily contaminated during collection and results must be interpreted with care. A proven infection is investigated by an ultrasound scan. Micturating cystography and radioisotope renography are helpful in excluding vesicoureteric reflux and renal scarring. Treatment aims to relieve symptoms, correct causes and preventing renal scarring. Vesicoureteric reflux may resolve spontaneously, some may need antibiotic prophylaxis or in a very small number of cases an endoscopic treatment or a re-implantation of the ureter.
Imaging techniques in the evaluation of neurogenic bladder dysfunction
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Nuclear medicine studies are performed by injecting radiopharmaceutical compounds that will concentrate in targeted tissues or organs. Gamma cameras measure uptake of radiation emitted from these isotopes and organspecific physiology can be inferred from a time-dependent projection of these emissions. The most common urologic application for nuclear medicine is radioisotope renography for evaluating renal function and/or obstruction.
Ureteric stricture rates and management after robot-assisted radical cystectomy: a single-centre observational study
Published in Scandinavian Journal of Urology, 2018
Abolfazl Hosseini, Linda Dey, Oscar Laurin, Cristofer Adding, Jonas Hoijer, Jan Ebbing, Justin W. Collins
Between December 2003 and December 2015, 371 patients with urinary bladder cancer underwent RARC with totally ICUD at the Karolinska Institute (Stockholm, Sweden). The operation comprised three stages: cystectomy, pelvic lymph-node dissection and urinary diversion, which was performed according to the Karolinska technique [4]. The Karolinska operative technique for ICUD has been described previously [17]. The operative technique emphasizes the importance of shortening the ureters before forming the Wallace plate. The aim is to improve vascularity at the distal ends of the ureters. Completing the anastomosis intracorporeally also results in less dissection and stretching of the ureters compared with an extracorporeal approach [8]. The time of removal of the stents is routinely 6–8 days after the operation, depending on time of discharge. Three surgeons (PW, AH, CA) who had experience with both open and robotic cystectomy performed these operations. Of the 371 patients, 131 (35%) received a neobladder after cystectomy and 240 (65%) had an ileal conduit as a urinary diversion. Furthermore, 129 patients (34%) received cisplatin-based neoadjuvant and 81 patients (21%) had BCG instillation before the surgery (Table 1). All patients received a ureteric–ileal anastomosis using the Wallace plate technique [18]. All anastomoses utilized a running suture technique. Monofilament suture was used earlier in the series in 81 patients (22%) and a barbed suture (Quill™) was used in the remaining 290 patients (78%). The standardized follow-up after cystectomy in the authors’ institution includes telephone contact by a specialized contact nurse, control of serum creatinine every 3 weeks for the first 2 months after the cystectomy and radioisotope renography performed 6–8 weeks after the surgery, to pick up early stricture formation. In addition, a computed tomography (CT) scan of the abdomen and thorax is taken at 6 and 12 months in the first year, with yearly CT scans thereafter. BUIA stricture was diagnosed when the patients showed clinical evidence of obstruction on radiological examination procedures during the routine postoperative follow-up. Of the 24 patients identified with BUIA stricture, 22 patients underwent an endoscopic approach as a first optional treatment. The remaining two patients declined intervention. In patients who failed first line treatment with endoscopic balloon dilatation, the stricture was repaired by either open surgery or a robot-assisted technique. Outcome data on ureteric stricture rates were analysed retrospectively from the institution’s prospectively compiled database.