Role of imaging tools in diagnosis of Vesicoureteral reflux in children

Vesicoureteral reflux [VUR] is a relatively common and important entity in children. VUR can expose patient to risk of pyelonephritis, permanent renal damage or scar. VUR itself has no deleterious effect on kidney parenchyma until the development of infection or increased intravesical pressure. The diagnosis of VUR could lead to appropriate therapy and prevention of long term complications. There are several diagnostic procedures for diagnosis of VUR, Conventional Voiding Cystourethrography [VCUG] and Direct Radionuclide Cystography [DRC] are most popular of them. Although DRC has advantages such as higher sensitivity and lower radiation, conventional VCUG remain as a helpful diagnostic tool both for excellent anatomical image and quantitave subjective grading system. Most physicians suggest performing VCUG for male patient in first assessment and DRC for later studies. In females, some advice to follow same as male children but most clinicians tends to apply DRC at start of assessment. There are some limitations for two mentioned test despite such advantages. Insertion of urinary catheter had some potential hazards for patient and distress for parents and child. Two special studies microwave radiometry and indirect radionuclide cystography is newer tools that could diagnose VUR without catheterization. These two tests are not standardized yet and remained to be less popular. Another limitation is exposure even low dose to radiation. MR VCUG and Cystosonography are two new procedures that had lowest if any radiation exposure, However these two tests also need further investigation and subjective standardization

Prevalence of nocturnal enuresis in school aged children. The role of personal and parents related socio-economic and educational factors

Nocturnal enuresis is a common psychosocial concern for both parents and children. In the present study we have determined the prevalence of nocturnal enuresis in Urmia, Iran children and associated personal and familial factors with this problem. A cross sectional epidemiological study for detection of nocturnal enuresis prevalence rate and evaluation of associated familial and personal factors in elementary school children [7-11 years old] from Urmia were investigated. The subjects were selected by cluster sampling method. Chi square test and logistic regression were used in univariate and multivariate respectively. Of the 1600 questionnaires distributed, 918 [57%] were completed and included in the final analysis. The rest, which were not filled by parents and also those out of our study age range were excluded. Gender of the subjects was almost equally distributed [48.6% males and 51.4% females]. Prevalence of nocturnal enuresis was 18.7% [n=172] and prevalence of daytime incontinence was 5.5% [n=51]. There was no significant gender difference between these two groups. Enuretics had crowded families, positive family history, low educational level of parents, jobless father, working mother, single parent, poor school performance, positive history of urinary tract infection [UTI]. Our results with enuresis prevalence and associated factors were comparable to other epidemiological studies from various countries. We found that Iranian families do not pay sufficient attention to their enuretic children

Outcome of immediate use of the permanent peritoneal dialysis catheter in children with acute and chronic renal failure

Peritoneal dialysis remains the only available option for patients which need immediate dialysis and it could be a bridge between end-stage renal failure [ESRD] and transplantation. There is a paucity of published experience of children with immediate use of permanent Tenckhoff Catheter for peritoneal dialysis from developing countries. In this study we report our experience on immediate use of permanent peritoneal access and continued peritoneal dialysis for a prolonged time. Fifty six patients were studied including 30 males and 26 females within the age range of 1 month to 14 years with mean age of 6.5 years in Urmia, Northwest Iran. No operative morbidity was seen. During a total of 499.5 continuous ambulatory peritoneal dialysis months, 16 patients had 28 episodes of peritonitis, which means a overall result of one episode per 17.8 months. There were 3 patients [5.35%] with catheter site leakage, 12 [21.4%] catheter obstructions [which led to omentectomy], 4 [7.2%] exit site infections [2 patients in the early postoperative period and 2 patients in during follow up]. Death due to catheter related complications occurred in 1 per 56 patients and due to non-catheter related causes in 10 per 56 patients. Present results indicate that catheter-related complications were not higher than those previously reported and peritoneal dialysis could be initiated immediately after catheter implantation and could be a safe bridge between end-stage renal failure [ESRD] and transplantation

Technetium Tc 99m dimercaptosuccinic acid renal scintigraphy in diagnosis of urinary tract infection in children with negative culture

The aim of this study was to evaluate the accuracy of Technetium Tc 99m dimercaptosuccinic acid [99mTc-DMSA] renal scintigraphy in the diagnosis of urinary tract infection [UTI] in children with suspected infection but with a negative urine culture. The records of all children with suspected or definite diagnosis of UTI presented during a 2-year period were reviewed in this study. Abnormal findings on renal scintigraphy, voiding cystourethrography [VCUG], and ultrasonography were evaluated and compared between the patients with the definite diagnosis of UTI and those with suspected UTI and negative urine cultures. Of 210 patients, 86 had a definite diagnosis of UTI [group 1] and 124 had suspected UTI without a positive culture [group 2]. Abnormal findings on DMSA scans were seen in 76 patients [88.4%] in group 1 and 84 [67.7%] in group 2. Vesicoureteral reflux was detected by VCUG in 50% and 32.3% of the patients in groups 1 and 2, respectively. In group 2, vesicoureteral reflux was seen in 40.5% of the patients with abnormal DMSA scan. Ultrasonography findings were abnormal in 51.3% and 39.8% of the patients with abnormal DMSA scan findings in groups 1 and 2, respectively. According to our findings, in children with a negative urine culture and abnormal urinalysis, 99mTc-DMSA renal scintigraphy is helpful in diagnosing UTI and vesicoureteral reflux; we recommend VCUG when DMSA scan supports UTI despite a negative urine culture and a normal ultrasongraphy