Publication year: 2012 Source: European Urology Supplements, Available online 7 February 2012 Hashim Hashim, Christopher R.J. Woodhouse Ureteropelvic junction obstruction (UPJO) is the most common cause of postnatal hydronephrosis. However, hydronephrosis now is usually diagnosed antenatally and affects approximately 1 in 1500 live births. Ultrasonographic scanning is the imaging modality of choice to diagnose hydronephrosis but is unable to differentiate between obstructed and nonobstructed kidneys. Mercaptoacetyltriglycine (MAG3) scanning is essential to distinguish an obstructed renal pelvis from a renal pelvis that is dilated but otherwise normal. Occasionally, vesicoureteric reflux may give a similar picture. Reflux can usually be ruled out with a well-performed MAG3 scan, but if not, micturating cystourethrography should be performed.There is no consensus on how to manage patients with UPJO and when to treat them conservatively or surgically. Some indications for surgery include <40% differential function of the hydronephrotic kidney on MAG3 scanning, a >20-mm anterior-posterior diameter of the renal pelvis on ultrasonographic scan, pain, and infection.Pyeloplasty is the gold-standard treatment if surgery is indicated. This procedure can be open, laparoscopic, or robot-assisted. Endopyelotomy and ureterocalicostomy have also been performed in children with some success.There is also no consensus on how to follow up patients who have had surgery. Some guidelines recommend 2–3-yr follow-up with ultrasonographic and MAG3 scanning, and if stable, the patient then should be discharged. Follow-up of patients who have conservative treatment must be more rigorous to avoid deterioration of the kidneys.There is increasing interest in using different diagnostic modalities, including urinary markers and magnetic resonance urography, in the diagnosis of UPJO and in correlating the findings with the best treatment option.
Publication year: 2012 Source: European Urology Supplements, Available online 4 February 2012 Evi Comploj, Armin Pycha Among males born at full term or prematurely, 1–30% are affected by cryptorchidism. Approximately 70% of cryptorchid testes will spontaneously descend by 3 mo.The cause of cryptorchidism is multifactorial. A prerequisite for testicular descent is a normal hypothalamic-pituitary-gonadal axis. In addition, an undisturbed interaction with the anatomic structures is required, as well as the appropriate hormonal milieu and environmental conditions. Hereditary factors also play a major role.The Kaplan classification distinguishes between palpable testes (80%) and nonpalpable testes (20%). The nonpalpable group includes intra-abdominal, inguinal, and absent (vanishing) testes, whereas palpable testes can be between the internal and external inguinal ring, high scrotal, or in a superficial pouch between the oblique and the Scarpa fascia in the so-called Denis Browne pouch.Therapy for undescended testis (UDT) is usually carried out when a child is between 6 and 12 mo; individuals with high UDT especially benefit from an early orchidopexy. The lower the pretreatment position, the more chance there is of spontaneous descent as well as better results of surgical intervention.Although the management of a palpable testis is standardized, there are no guidelines for the management of boys with a nonpalpable testis. It seems that both preoperative and postoperative hormonal treatment may have a beneficial effect on fertility later in life. Because of the increased risk of testicular malignancy, lifelong follow-up is mandatory.
Publication year: 2012 Source: European Urology Supplements, Available online 4 February 2012 Guy A. Bogaert, Koen Slabbaert In the past 30 yr, the therapeutic approach to children with vesicoureteral reflux (VUR) has undergone a dynamic evolution from mainly surgery, as soon as VUR was detected, toward a conservative approach with antibiotic prophylaxis (stimulated and supported by results from the International Reflux Study in Children), to an endoscopic approach, and to the currently used active surveillance approach without prophylaxis. During those 30 yr, the diagnostic approach has not changed as much, although there is always an attempt to make the diagnosis of VUR while avoiding the “classic” voiding cystourethrogram (VCUG), which is one of the most stressing exams for a child and his or her family.Initially, radiographic grading of VUR was the only method of measuring the severity of VUR and of calculating the chance of spontaneous resolution. However, several other factors such as age, sex, presence of bladder and/or bowel dysfunction, presence of associated anatomic abnormalities, and laterality have been shown to have an influence on the spontaneous resolution rate.Based on the results of recent randomized studies (PRIVENT, Randomized Intervention for Children with Vesicoureteral Reflux [RIVUR], Swedish reflux study) and the updated VUR guidelines from the American Urological Association and the European Association of Urology–European Society for Pediatric Urology, this review will give an overview of the important clinical features of VUR, the diagnostic methods, the computer models and nomograms to detect which children with VUR should be treated, and the options their respective chances of success for treating patients. It will become clear that the treatment selection and decision for treating VUR in a child is an individualized process.
Publication year: 2012 Source: Annales Françaises d’Anesthésie et de Réanimation, Available online 31 January 2012 Hui Wang, Zhipeng Xu, Chunsheng Feng, Yun Wang, Xingyuan Jia, … Background and purposeIt has not been clearly described for mechanisms of postoperative cognitive dysfunction (POCD), but not yet for narcotic in connection with POCD. Acetylcholine plays important roles in learning and memory especially in elderly people. It is not very clear that cholinergic changes in the hippocampus are in relation to spatial memory impairment. The effects of isoflurane, a commonly used inhalation anaesthetic, as well as acetylcholine on learning and memory in the brain tissue of aged rats were observed in present study. We investigated the inhalation anaesthesia drug’s effect on cholinergic system to examine whether the regional and progressive cholinergic changes may lead to POCD.MethodsSeventeen-month-old rats were randomly assigned to either an isoflurane anaesthesia group (n = 17) or propofol anaesthesia group (n = 17). In isoflurane anaesthesia experiment group, isoflurane (1.4 to 1.7% for 2 hours) was delivered via a ventilator to make freely moving microdialysis model. In propofol group, propofol was administered by continuous infusion via a tail vein catheter to make freely moving microdialysis model. They were all mechanically ventilated. Morris Water Maze test was used to assess the learning and memory abilities of all the two groups’ rats twice a day for 5 days. Microdialysis was performed on the freely moving rats to determine the levels of acetylcholine in the brain tissues immediately after each Water Maze test.ResultsThe isoflurane anaesthesia treatment increased the escape latency contrast to propofol anaesthesia group. The isoflurane anaesthesia’s rats were then divided into isoflurane-induced severe learning/memory impairment group (n = 6, mean escape latency is 1.96 times more than that of in propofol anaesthesia group) and the isoflurane-induced mild learning/memory impairment group (n = 11, mean escape latency is equal or less than 1.96 times of that in propofol anaesthesia group). The results demonstrated that those rats that were categorized in the isoflurane-induced severe learning/memory impairment group had decreased levels of acetylcholine in the brain tissue as compared to those rats categorized in the mild learning/memory impairment group and in propofol anaesthesia group.ConclusionThe results indicated that isoflurane may impair learning and memory in aged rats.
Publication year: 2012 Source: Microbes and Infection, Available online 28 January 2012 Vijayan Kamalakannan, Sreenivas Kirthika, Kalyanaraman Hari Priya, Subash Babu, Rangarajan Badri Narayanan RecombinantWolbachiaheat shock protein 60 (rWmhsp60) induces gene expression of pro-inflammatory cytokines IL-1β, IL-6 and TNF-α in human monocytic cell line THP-1. In addition, it inhibits the phagocytic activity and does not alter the nitric oxide production by differentiated THP-1 macrophages, which corroborates with no significant change in inducible nitric oxide synthase gene expression in rWmhsp60 treated THP-1 monocytes. Further, 24 h stimulation of peripheral blood mononuclear cells from normal individuals by rWmhsp60 reveals that monocytes enter the late apoptotic stage, while lymphocytes do not show apoptosis. Thus these findings suggest that rWmhsp60 may contribute to inflammation mediated monocyte dysfunction in filarial pathogenesis.
Publication year: 2012 Source: European Urology Supplements, Available online 28 January 2012 Tom P.V.M. de Jong, Aart J. Klijn, Marianne A.W. Vijverberg Up to 10% of school-age children suffer from recurrent urinary tract infections (UTIs) and/or urinary incontinence. Lower urinary tract problems are, together with asthma, the most important chronic disease of the pediatric age group. Diagnosis must discriminate among those children with functional voiding problems, those with neuropathic bladders, and those with anatomic anomalies who may need surgery. In boys with overactive bladder (OAB) and incontinence, urethral obstruction must be evaluated as the possible cause. Functional incontinence with lower urinary tract symptoms (LUTS) is very common in girls and can be accompanied by UTI. In girls with dysfunctional voiding or underactive bladder, other anomalies need to be excluded because, for many of these girls, LUTS can be a chronic condition that requires lifelong attention to voiding behavior.
