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Obstructive uropathy
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Voiding cystourethrography (VCUG) Demonstrates nearly all bladder, neck, and urethral obstructions and vesicoureteral refluxIt is commonly performed in children to investigate congenital abnormalitiesIn adults, it may be used in suspected cases of urethral strictures
Hypnosis and guided imagery
Published in Hilary McClafferty, Mind–Body Medicine in Clinical Practice, 2018
One hour of instruction in self-hypnosis was shown to be highly effective for procedural pain and stress in a randomized controlled trial of 44 children undergoing voiding cystourethrography (VCUG) for dysfunctional voiding. In the prospective randomized study, 44 children aged 4–15 years (n = 21 hypnosis group) were assigned to a 1-hour training session in self-hypnotic visual imagery by a trained therapist the day before the scheduled procedure. They were instructed to practice at home several times before the procedure. The therapist was present during the procedure to conduct similar exercises with the child. Results indicated significant benefits to the hypnosis group. Parents reported the procedure to be significantly less traumatic for their child as compared to prior VCUG, observational assessments by staff reported significantly less distress than controls, medical staff also reported significantly less difficulty in completing the procedure in the hypnosis group, and procedure time was shortened by 14 minutes for hypnosis versus control group (Butler et al. 2005).
Multicystic dysplastic kidney
Published in Prem Puri, Newborn Surgery, 2017
David F. M. Thomas, Azad S. Najmaldin
Opinion is divided on whether it is necessary to perform this invasive investigation routinely if the urinary tract appears otherwise normal on ultrasound. The findings of several studies have endorsed the safety of omitting a routine voiding cystourethrography (VCUG) in such cases.9,10 When VUR is present it is usually low grade and self-limiting. Children with MCDK who have not undergone a routine VCUG do not appear to be at any higher risk of urinary tract infection (UTI) or renal damage. However, if a routine VCUG is not performed, it is important that parents and general practitioners are aware that the occurrence of a documented or suspected UTI or an unexplained febrile illness should prompt further investigation to look for possible VUR.
Determining the effectiveness of the immature granulocyte percentage and systemic immune-inflammation index in predicting acute pyelonephritis
Published in Postgraduate Medicine, 2023
Deniz Karakaya, Tülin Güngör, Evrim Kargın Cakıcı, Fatma Yazılıtaş, Evra Celikkaya, Mehmet Bulbul
The patients’ demographic data (age and gender), clinical features, IG percentage, CRP values, and platelet (PLT), neutrophil, lymphocyte, and WBC counts were recorded. In addition, patients were evaluated for the presence of underlying urological anomalies using imaging methods (i.e. ultrasonography and voiding cystourethrography). ANC, lymphocyte count, and platelet levels in the peripheral blood were used to calculate the NLR, platelet-to-lymphocyte ratio (PLR), and SII. The NLR and PLR were defined as the total neutrophil and platelet counts divided by the total lymphocyte count. The SII was calculated using the following formula: SII = (Platelet x Neutrophil)/Lymphocyte. Tests obtained with automated hematological analyzers from the complete blood count (CBC) included WBC count, neutrophil count, lymphocyte count, IG percentage .The IG percentage was analyzed using an automated hematology analyzer. The IG percentage shows the proportion of cells with a relatively high RNA/DNA ratio relative to the neutrophils. This group primarily consists of promyelocytes, myelocytes, and metamyelocytes [14]. A particularly attractive aspect of the IG test is its ease of use, as its values are obtained automatically using a routine hematology analyzer without the need for any additional evaluation devices or associated costs.
A late complication developing 12 years after a transobturator tape procedure: vulvar abscess with vaginocutaneous fistula
Published in Journal of Obstetrics and Gynaecology, 2018
Moon Kyoung Cho, Min Youp Choi, Chul Hong Kim
A 59-year-old woman presented as a new patient to our hospital with a vulvar abscess ∼12 years after the placement of a transobturator tape for SUI. The patient had undergone an outside-in TOT procedure using monofilament polypropylene mesh. However, we were unable to identify the name of the product. The patient did not experience any complications after the surgery, and her medical history was unremarkable. She presented to our gynaecology clinic with a 1-month history of a painful right inguinal mass. Pelvic examination did not reveal any abnormality in the vagina or cervix, but a 10-cm tender mass was identified on the mons pubis and right labia majora. We initiated antibiotic treatment with a third-generation cephalosporin and metronidazole. The size of the abscess decreased, and the patient’s symptoms disappeared within a few days. Approximately 2 months after treatment, the patient returned with the same symptoms. The results of blood and urogenital cultures were unremarkable. However, the patient’s symptoms had worsened and were accompanied by fever and chills. Pelvic MRI revealed a 6.0 × 3.3 cm abscess on the right vulva that communicated with the vaginal wall. However, no definite fistula tract on retrograde urethrography (RUG) and voiding cystourethrography (VCUG) was observed. A planned operation was performed for abscess excision. We identified a very small opening of the fistula tract on the vaginal wall under anaesthesia. The opening was ∼2–3 mm in diameter. We confirmed the presence of a vaginocutaneous fistula during the operation (Figure 1). The suburethral tape was removed, the fistula tract was excised and primary repair was performed on both the cutaneous and vaginal sides. The postoperative period was uneventful under antibiotic therapy, and the patient was healthy and continent throughout the first postoperative year.
Revascularized Pyelo-Uretero-Cystoplasty in Patients with Chronic Bladder Outlet Obstruction Due to Ectopic Ureterocele: A Safe Surgical Technique with Superior Continence Outcomes
Published in Journal of Investigative Surgery, 2022
Asal Hojjat, Shabnam Sabetkish, Abdol-Mohammad Kajbafzadeh
We considered augmentation in patients who were totally incontinent despite anticholinergics medication (Oxybutynin, 0.2 mg/kg/day) and CIC. Urodynamic investigations with a suprapubic line revealed bladder overactivity with a dyssynergic voiding outline at the time of admission before the intervention. Our assumption was that intrauterine outlet obstruction from an ectopic obstructive ureterocele and post-natal continuation of bladder outlet obstruction may cause permanent bladder molecular/cellular and neural changes following incomplete ablation of the ureterocele. Similar pathology to that is in boys with a history of PUV bladder dysfunction, which can remain after valve ablation and not managing the bladder neck obstruction. Urinary retention and several episodes of UTI which did not resolve after initial endoscopic incision were the presenting symptoms in all patients. The CIC was not always feasible due to passing the catheter through the ureterocele. From these thirteen cases affected by an ectopic ureterocele, fourteen entities of duplex systems and nonfunctioning refluxing upper pole moieties necessitated upper pole partial nephrectomy along with augmentation pyelo-uretero-cystoplasty (eight) and ureterocele unroofing. In non-randomized control group in five patients (three female and two male) non-revascularization pyelo-uretero-cystoplasty was performed. Four and one patients had left and right side duplex system in control group, respectively. The rest of eight patients who underwent RPUC along with ureterocele unroofing technique had four left side, three right sides, and a bilateral duplex system. All ectopic ureterocele were released in the bladder neck down into the urethra. Dimercapto-succinic acid (DMSA) renal scan confirmed a nonfunctioning upper pole segment in all duplex systems. Voiding cystourethrography (VCUG), measurement of serum creatinine, and ultrasonography were also performed for all patients.