Posterior Urethral Valves (PUV): Experience of Follow up Over 7 years

2020 ◽  
Vol 15 (2) ◽  
pp. 40-43
Author(s):  
Sudip Das Gupta ◽  
Nitai Pada Biswas ◽  
Sanjib Kumar Roy ◽  
Ma Kashem ◽  
Akm Anwarul Islam ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Posterior Urethral Valves ◽  
University Hospital ◽  
Voiding Cystourethrogram ◽  
Laboratory Findings ◽  
Urethral Valves ◽  
Long Run ◽  
Tract Infections ◽  
Medical University

Objectives: Posterior urethral vale is one of the major common congenital obstructive urethral lesions in male children. Endoscopic fulguration with observation is the treatment of choice for posterior urethral valves (PUV). This prospective study was carried out to assess the outcome of endoscopic fulguration of posterior urethral valves based upon the clinical, radiological and laboratory findings. Methods : The study started in Bangabandhu Sheikh Mujib Medical University Hospital in October 2004 on 50 male children with posterior urethral valves who were treated with endoscopic fulguration and came for routine follow up. Diagnosis was established by voiding cystourethrogram (VCUG) and confirmed by urethrocystoscopic findings.. The patients came for follow up after valve ablation at three months interval up to 1 year, and at six months interval for seven years. Results: Mean age of the patients was 2 years ranging from 1 to 12 years old. At diagnosis mean serum creatinine level ± SD was 90.4±44.8 μmol /litre and it decreased to 58.3±11.4μmol/litre at the end of 7 years follow up. Hydronephrotic changes decreased from decreased from 84% to 2%. Proteinuria decreased from 38% to 4%.Urinary tract infections decreased from 58% to 8% at the end of last follow up. Conclusion: In this study patients improved dramatically following fulguration of posterior urethral valves. But these patients need regular follow up because some of these patients may develop ESRD in the long run. Bangladesh Journal of Urology, Vol. 15, No. 2, July 2012 p.40-43

scholarly journals Management of Posterior Urethral Valves: An Outcome Analysis of Endoscopic Valve Fulguration

2019 ◽  
Vol 31 (2) ◽  
pp. 68-72
Author(s):  
Shah Md Ahsan Shahid ◽  
Nawshad Ali ◽  
Sayed Sirajul Islam ◽  
Shantona Rani Pal ◽  
Khondokar Seheli Nasrin Lina
Keyword(s):  
Urinary Tract ◽  
Renal Dysplasia ◽  
Posterior Urethral Valves ◽  
Definitive Treatment ◽  
Uneventful Recovery ◽  
Outcome Analysis ◽  
Early Presentation ◽  
Urethral Valves ◽  
Urethral Valve

Posterior urethral valves (PUV) constitute the most common infra-vesical urinary obstruction in boys. PUV are often accompanied by severe consequences to the lower and upper urinary tract (LUT, UUT). They also represent a major urological cause for pediatric renal transplantations. Surgical options for primary management invariably aim at abolition of valves. However, temporary urinary diversion may sometimes be a viable alternative, especially in critically ill patients or preterm infants. It was a retrospective, descriptive study which was conducted at the Department of Pediatric Surgery, Rajshahi Medical College from January 2018 to December 2018. All stable patients with the diagnosis of posterior urethral valves were included in the study. Endoscopic valve fulguration was performed in all diagnosed patients using bugbee electrode and an adequate sized cystoscope. The procedure was performed under general anesthesia and the urinary bladder was drained with a suitable size Foley's or silicon catheter for 14days. Patients were discharged from the hospital 48-72 hours after the procedure on oral antibiotics and were advised to come to the outpatient department for follow up visits for a period of 6 months. A total of 84 patients were included in the study. All were males with a mean age of 6.5years ranging from 6 months to 12 years. Sixty five patients were without any diversion while 19 had vesicostomy or ureterostomy already done in our department or somewhere else. Stricture urethra was seen in 5 patients, incontinence of urine was seen in 7 patients, nocturnal enuresis in 15 patients and recurrent urinary tract infection in 19 patients. Chronic renal failure was seen in 4 patients while 16 patients lost the follow up.18 patients had an uneventful recovery. Urethral valve ablation is the definitive treatment of posterior urethral valves. Endoscopic urethral valve fulguration is safe, effective and definitive way of management for posterior urethral valves. Early treatment improves the quality of life and prevents the ongoing renal damage. Early presentation in fetal and neonatal life has worst prognosis due to associated renal dysplasia. TAJ 2018; 31(2): 68-72

Frequency of urinary tract infection in children with antenatal diagnosis of urinary tract dilatation

2019 ◽  
Vol 105 (3) ◽  
pp. 260-263 ◽  
Author(s):  
Marco Pennesi ◽  
Stefano Amoroso ◽  
Giulia Bassanese ◽  
Stefano Pintaldi ◽  
Giulia Giacomini ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antibiotic Prophylaxis ◽  
Risk Group ◽  
Voiding Cystourethrogram ◽  
Urinary Tract Dilatation ◽  
Increased Risk ◽  
Tract Infections ◽  
Collecting System ◽  
Urinary Collecting System

BackgroundNeonates with congenital urinary tract dilatation (UTD) may have an increased risk of urinary tract infections (UTI). At present, the management of these patients is controversial and the utility of continuous antibiotic prophylaxis (CAP) remains uncertain as the literature presents contradicting evidence. The aim of this observational study was to assess UTI occurrence in children with prenatal diagnosis of urinary collecting system dilatation without antibiotic prophylaxis.MethodsBetween June 2012 and August 2016, we evaluated the incidence of UTI and the clinical and ultrasonography evolution in 407 children with a prenatally diagnosed UTD. All subjects underwent two prenatal ultrasounds scans (USs) at 20 weeks and 30 weeks of gestation and within 1 month of birth. Patients with a confirmed diagnosis of UTD underwent US follow-up at 6, 12 and 24 months of life. According to the UTD classification system stratify risk, after birth UTD were classified into three groups: UTD-P1 (low risk group), UTD-P2 (intermediate risk group), and UTD-P3 (high risk group). Voiding cystourethrogram was performed in all patients who presented a UTI and in those with UTD-P3. No patient underwent CAP.ResultsPostnatal US confirmed UTD in 278 out of 428 patients with the following rates: UTD-P1 (126), UTD-P2 (95) and UTD-P3 (57). During postnatal follow-up, 6.83% patients presented a UTI (19 out of 278). Eleven out of 19 had vesicoureteral reflux (VUR), and other four were diagnosed with obstructive uropathy and underwent surgical correction. Five patients presented a UTI reinfection.ConclusionThe occurrence of UTI in patients with urinary collecting system dilatation was low. The recent literature reports an increased selection of multirestistant germs in patients with VUR exposed to CAP. This study constitutes a strong hint that routine continuous antibiotic prophylaxis could be avoided in patients with UTD.

scholarly journals Utility of urethral ratio in voiding cystourethrogram to identify milder variants of posterior urethral valves

2018 ◽  
Vol 5 (5) ◽  
pp. 1847
Author(s):  
Arun M. Ainippully ◽  
Anoop P. V. ◽  
Arun V. ◽  
Prathap S.
Keyword(s):  
Urinary Tract ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Posterior Urethral Valves ◽  
P Value ◽  
Voiding Cystourethrogram ◽  
Paediatric Surgery ◽  
Urethral Valves ◽  
Significant Difference ◽  
Urethral Valve

Background: Majority of patients with posterior urethral valves are diagnosed antenatally. Few patients present later in childhood with milder variants of the disease where the radiological findings are not very apparent. In this study, we aim to evaluate the role of urethral ratio beyond which here is higher probability of finding a mild variant of urethral valve thereby identifying patients who need to undergo a cystoscopic evaluation.  Methods: This study was conducted in the Department of Paediatric Surgery between 2016 and 2017. 48 male patients who presented with either urinary tract infection or other lower urinary tract symptoms were included in the study. The candidates were examined and evaluated with an ultrasound followed by a voiding cystourethrogram (VCUG). The Urethral ratio was calculated. All patients then underwent a cystoscopy to rule out the presence of valve. We analyzed the data in Stata IC 15 statistical software and R statistical computing environment. Results: Of the 48 children recruited to the study, the median age of those with posterior urethral valve on cystoscopy was 8(IQ 3-18) and those without valves was 9(IQ 6.5-21) months. There was a statistically significant difference in the quality of urinary stream, straining on micturition, presence or absence of palpable bladder between the two groups (p value <0.05). The mean urethral ratio in the first group with PUV was 2.25(CI 2.02 to 2.48) and that in the second group with no urethral valve was 1.48(CI 1.32 to 1.65). with cut-off point of Urethral ratio at 2 the specificity and positive predictive value for the presence of PUV reached 100%.Conclusions: The present study indicates the calculation of urethral ratio on VCUG is an objective method for assessment of milder variants of PUV. In the present study, a Urethral ratio greater than 2 had a positive predictive value of 100% and would mandate a cystoscopic evaluation.

scholarly journals Congenital Bladder Diverticulum in a Neonate Simulating Posterior Urethral Valves

2018 ◽  
Vol 7 (4) ◽  
pp. 49
Author(s):  
Tapasya Pandita ◽  
Nitin James Peters ◽  
Ram Samujh
Keyword(s):  
Urinary Tract ◽  
Urinary Retention ◽  
Urinary Tract Infections ◽  
Posterior Urethral Valves ◽  
High Index ◽  
Bladder Diverticulum ◽  
Urethral Valves ◽  
Primary Bladder ◽  
Tract Infections ◽  
High Index Of Suspicion

Primary bladder diverticulae are rare anomalies of the bladder. They usually present with recurrent urinary tract infections and dysuria. We present a case of retrovesical diverticulum, which presented with urinary retention behaved like a case of posterior urethral valves. A high index of suspicion and a well performed micutrating cystourethrogram helps in clinching the diagnosis. Excision of these diverticulae with or without ureteric reimplant is curative in most cases.

Urinary Tract Infections in Children with Posterior Urethral Valves After Kidney Transplantation

1992 ◽  
Vol 148 (6) ◽  
pp. 1874-1876 ◽  
Author(s):  
Manuel Mochon ◽  
Bruce A. Kaiser ◽  
Stephen Dunn ◽  
Joann Palmer ◽  
Martin S. Polinsky ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Posterior Urethral Valves ◽  
Urethral Valves ◽  
Tract Infections

URINARY INFECTION AT DEPARTMENT OF UROLOGY OF HUE UNIVERSITY OF MEDICINE AND PHARMACY HOSPITAL

2018 ◽  
pp. 100-108
Author(s):  
Dinh Khanh Le ◽  
Dinh Dam Le ◽  
Khoa Hung Nguyen ◽  
Xuan My Nguyen ◽  
Minh Nhat Vo ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Clinical Manifestations ◽  
University Hospital ◽  
E Coli ◽  
Positive Urine ◽  
Tract Infections

Objectives: To investigate clinical characteristics, bacterial characteristics, drug resistance status in patients with urinary tract infections treated at Department of Urology, Hue University Hospital. Materials and Method: The study was conducted in 474 patients with urological disease treated at Department of Urology, Hue Universiry Hospital from July 2017 to April 2018. Urine culture was done in the patients with urine > 25 Leu/ul who have symptoms of urinary tract disease or infection symptoms. Patients with positive urine cultures were analyzed for clinical and bacterial characteristics. Results: 187/474 (39.5%) patients had symptoms associated with urinary tract infections. 85/474 (17.9%) patients were diagnosed with urinary tract infection. The positive urine culture rate was 45.5%. Symptoms of UTI were varied, and no prominent symptoms. E. coli accounts for the highest proportion (46.67%), followed by, Staphycoccus aureus (10.67%), Pseudomonas aeruginsa (8,0%), Streptococcus faecali and Proteus (2.67%). ESBL - producing E. coli was 69.23%, ESBL producing Enterobacter spp was 33.33%. Gram-negative bacteria are susceptible to meropenem, imipenem, amikacin while gram positive are vancomycin-sensitive. Conclusions: Clinical manifestations of urinary tract infections varied and its typical symptoms are unclear. E.coli is a common bacterium (46.67%). Isolated bacteria have a high rate of resistance to some common antibiotics especially the third generation cephalosporins and quinolones. Most bacteria are resistant to multiple antibiotics at the same time. Gram (+) bacteria are susceptible to vancomycin, and gram (-) bacteria are susceptible to cefoxitin, amikacin, and carbapenem. Key words: urinary tract infection

scholarly journals Microbiome recovery in adult females with uncomplicated urinary tract infections in a randomised phase 2A trial of the novel antibiotic gepotidacin (GSK140944)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrea Nuzzo ◽  
Stephanie Van Horn ◽  
Christopher Traini ◽  
Caroline R. Perry ◽  
Etienne F. Dumont ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Human Microbiome ◽  
Time Points ◽  
Pharyngeal Cavity ◽  
Adult Females ◽  
Microbiome Diversity ◽  
Antibiotic Drug ◽  
Tract Infections

Abstract Background With increasing concerns about the impact of frequent antibiotic usage on the human microbiome, it is important to characterize the potential for such effects in early antibiotic drug development clinical trials. In a randomised Phase 2a clinical trial study that evaluated the pharmacokinetics of repeated oral doses of gepotidacin, a first-in-chemical-class triazaacenaphthylene antibiotic with a distinct mechanism of action, in adult females with uncomplicated urinary tract infections for gepotidacin (GSK2140944) we evaluated the potential changes in microbiome composition across multiple time points and body-sites (ClinicalTrials.gov: NCT03568942). Results Samples of gastrointestinal tract (GIT), pharyngeal cavity and vaginal microbiota were collected with consent from 22 patients at three time points relative to the gepotidacin dosing regimen; Day 1 (pre-dose), Day 5 (end of dosing) and Follow-up (Day 28 ± 3 days). Microbiota composition was determined by DNA sequencing of 16S rRNA gene variable region 4 amplicons. By Day 5, significant changes were observed in the microbiome diversity relative to pre-dose across the tested body-sites. However, by the Follow-up visit, microbiome diversity changes were reverted to compositions comparable to Day 1. The greatest range of microbiome changes by body-site were GIT followed by the pharyngeal cavity then vagina. In Follow-up visit samples we found no statistically significant occurrences of pathogenic taxa. Conclusion Our findings suggest that gepotidacin alteration of the human microbiome after 5 days of dosing is temporary and rebound to pre-dosing states is evident within the first month post-treatment. We recommend that future antibiotic drug trials include similar exploratory investigations into the duration and context of microbiome modification and recovery. Trial registration NCT03568942. Registered 26 June 2018.

Urinary Tract Infection

1979 ◽  
Vol 1 (5) ◽  
pp. 133-136
Author(s):  
Richard H. Rapkin
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urine Culture ◽  
Underlying Disease ◽  
Chief Complaint ◽  
Voiding Cystourethrogram ◽  
Intravenous Pyelogram ◽  
Rapid Generation

The identification of urinary tract infection (UTI) is important in order to reduce its morbidity, to prevent its sequelae, and to identify underlying disease. This article will discuss methods of diagnosis and management of UTI, screening for UTI, and the importance of further evaluation and follow-up of children with UTIs. Much of what we know about UTI is controversial and rapid generation of new knowledge may make current recommendations passé. CASE V.M., a 4-year-old girl, was brought to the physician's office with the chief complaint of frequency of urination. Nine months before she had been seen because of frequency and dysuria and two consecutive midstream urine cultures grew &gt;100,000 colonies/ml of a Gramneative rod. Sulfisoxazole was begun and a urine culture was sterile 48 hours after therapy was begun. The dysuria and frequency disappeared; therapy was continued for ten days and a urine culture four days later was sterile. One week later a voiding cystourethrogram (VCU) and an intravenous pyelogram (IVP) were performed and were interpreted as normal. Repeat urine cultures at one, two, three, and six months after the episode were sterile. Two days before the child was seen, she had become irritable and wet the bed during sleep (she had been successfully trained at 27 months of age), and she began to void frequently during the next 24 hours.

scholarly journals Infeções do Trato Urinário numa Coorte de Transplantados Renais

2014 ◽  
Vol 27 (3) ◽  
pp. 364 ◽  
Author(s):  
Ana Bispo ◽  
Milene Fernandes ◽  
Cristina Toscano ◽  
Teresa Marques ◽  
Domingos Machado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Hospital Admissions ◽  
Female Gender ◽  
Tract Infections

<strong>Introduction:</strong> Urinary tract infection is the most common infectious complication following renal transplantation and its frequency is insufficiently studied in Portugal. The aim of this study was to characterize the incidence of urinary tract infections and recurrent urinary tract infections in renal transplant recipients.<br /><strong>Material and Methods:</strong> This was a retrospective cohort observational study, obtained from clinical files of all patients who received a renal transplant at the Hospital of Santa Cruz, from January 2004 to December 2005, with a mean follow-up period of five years or until date of graft loss, death or loss of follow-up. After a descriptive analysis of the population, we used bivariate tests to identify risk factors for urinary tract infections.<br /><strong>Results:</strong> A total of 127 patients were included, with a 593 patients.year follow-up. We detected 53 patients (41.7%) presenting with at least one episode of urinary tract infection; 21 patients (16.5%) had recurrent urinary tract infection. Female gender was the only risk factor associated with the occurrence of urinary tract infections (p &lt; 0.001, OR = 7.08, RR = 2.95) and recurrent urinary tract infections (p &lt; 0.001, OR = 4.66, RR = 2.83). Escherichia coli (51.6%), Klebsiella pneumoniae (15.5%) and Enterobacter spp (9.9%) were the<br />most frequently identified pathogens. Patients did not reveal an increased mortality or allograft loss. However, urinary tract infections were the most important cause of hospital admissions.<br /><strong>Discussion:</strong> Female gender was the only risk factor for urinary tract infections in this population. Escherichia coli was the most frequent agent isolated.<br /><strong>Conclusion:</strong> Despite preventive measures, urinary tract infections remain an important cause of morbidity and hospital admissions.<br /><strong>Keywords:</strong> Urinary Tract Infections; Postoperative Complications; Risk Factors; Kidney Transplantation; Portugal.

scholarly journals Urinothorax Caused by Xanthogranulomatous Pyelonephritis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Waiel Abusnina ◽  
Hazim Bukamur ◽  
Zeynep Koc ◽  
Fauzi Najar ◽  
Nancy Munn ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Obstructive Uropathy ◽  
Xanthogranulomatous Pyelonephritis ◽  
Robot Assisted ◽  
Rare Form ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Tract Infections

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy.

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