Association between rectal diameter and response to treatment with parasacral transcutaneous electrical nerve stimulation and behavioral changes in children and adolescents with bladder and bowel dysfunction

ABSTRACT Purpose: Parasacral Transcutaneous Electrical Stimulation (TENS) is one of the treatments for children with Bladder and Bowel Dysfunction (BBD). Some studies showed that children with increased Rectal Diameter (RD) have more Functional Constipation (FC). However, RD prediction in maintenance of BBD after treatment was never evaluated. Our aim is to evaluate the association between RD and response to treatment in children and adolescents with BBD. Materials and Methods: This study evaluated patients from 5-17 years old with BBD. Dysfunctional Voiding Scoring System (DVSS), Rome IV criteria, and the Constipation Score were used. RD was measured using abdominal ultrasound before treatment according to the technique established by Klijn et al. and was considered enlarged when >3cm. No laxatives were used during treatment. Descriptive analysis and binary regression were performed and the area under the ROC curve was calculated. Results: Forty children were included (mean age 8.4±2.8 years, 52.5% male). Before treatment, RD was enlarged in 15 children (37.5%) (mean diameter 3.84±0.6cm), with FC persisting post-treatment in 11/15(73.3%). Those patients also required more laxatives following treatment and had more severe FC. Binary regression showed pretreatment RD to be an independent predictor of the persistence of FC post-treatment (OR=9.56; 95%CI:2.05-44.60). In ROC curve analysis, the sensitivity was 100% (95%CI: 0.49-1.0) and specificity 77.14% (95%CI:0.60-0.90) for rectal diameter >3 cm. The likelihood ratio was 4.38 (95%CI:2.40-8.0) for the persistence of BBD following treatment. Conclusion: RD appears to be relevant in the evaluation of children with BBD, not only as a diagnostic tool but also as a predictor of treatment outcome.

Total corpora mobilization for penile reconstruction

ABSTRACT Purpose: Total corpora mobilization (TCM) is a novel technique that is used for penile reconstruction in cases of micropenis and penile amputation. Its principle is based on Kelly's procedure for bladder exstrophy (1). In contrast to the Kelly procedure, TCM is performed entirely through the perineum with the patient in the lithotomy position. Materials and Methods: TCM was performed on three patients. The first was a boy who suffered trauma from a dog bite at an age of eight months. At 23 years old he underwent TCM. The second patient had genital self-amputation induced by psychiatric disorder. After treatment, at 27 years old, he desired surgery for penile reconstruction. The third patient had partial androgen insensitivity syndrome (PAIS) with a micropenis and at 23 years old had TCM procedure. The patients were placed in the lithotomy position with a perineal incision in the midline. A subperiosteal incision was made and the corpora cavernosa were detached from the pubic arch and the ischial rami. The periosteum and the neurovascular bundles were preserved. Subsequently the corpora cavernosa was mobilized upward and the periosteum that was left attached to them was sutured to the pubis. Results: At twenty-four, nine, and six months, respectively, in the follow-up process, all patients expressed satisfaction with the final cosmetic appearance, penile length, and erectile function. Conclusion: TCM may prove to be an alternative for patients with a functional disturbance because of small penile length, though a higher number of cases and a more extended follow-up are needed to draw a more definitive conclusion.

Corporoplasty: A simplified technique for clitoroplasty

ABSTRACT Introduction Clitoroplasty constitutes an important step in feminizing surgery for congenital adrenal hyperplasia (CAH) ( 1 ). In this video we present a technique that aims to preserve clitoral sensitivity and engorgement while minimizing the risk of neurovascular lesion. Materials and methods We present a video of a three-year-old girl with history of CAH classical form, PRADER-III, who underwent clitoroplasty. After an initial endoscopic evaluation of the urogenital sinus, the clitoris was degloved and a rectangular incision was made on the ventral corpora cavernosa 15mm above the corpora bifurcation and 0.5 mm below the coronal sulcus. The cavernous tissue was partially resected. The upper and lower borders of the rectangular gap were closed by a 5-0 PDS running suture similar to the Mikulicz technique. Next, the edge of the glans was deepithelialized to reduce its size. For improved clitoral positioning, the clitoris was sutured to the pubic fat. From that point onward the procedure followed that of a standard vaginoplasty using the en-bloc technique ( 2 - 4 ). Thus far we have performed this technique in 33 patients, with 31 of them being girls with CAH and 2 being women with clitoral hypertrophy. Conclusion Corporoplasty is a simplified technique for clitoroplasty, with the advantage being that is faster and safer than the technique that involves the dissection of the neurovascular bundle. In addition, corporoplasty has the possible benefit of preserving the cavernosal blood flow that permits the engorgement of the clitoris during sexual arousal.

Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment

ABSTRACT Introduction: Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Myelomeningocele (MMC) represents the most frequent and most severe cause of NB in children. Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children. Materials and Methods: Five Pediatric Urologists joined a group of experts and reviewed all important issues on "Spina Bifida, Neurogenic Bladder in Children" and elaborated a draft of the document. All the members of the group focused on the same system of classification of the levels of evidence (GRADE system) in order to assess the literature and the recommendations. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document. Results and Discussion: The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Clean intermittent catheterization (CIC) should be implemented during the first days of life, and antimuscarinic drugs should be indicated upon results of urodynamic studies. When the patient becomes refractory to first-line therapy, receptor-selective pharmacotherapy is available nowadays, which leads to a reduction in reconstructive procedures, such as augmentation cystoplasty.

Evaluation of autonomic function in children and adolescents with overactive bladder

ABSTRACT Aims: To evaluate autonomic activity in children/adolescents with isolated overactive bladder. Materials and Methods: Descriptive, analytical, non-interventional, cross-sectional study conducted between February 2017 and January 2018 with individuals aged between 5 and 17 years old, with overactive bladder (OAB group) or asymptomatic (control). Neurological or anatomical abnormalities, diabetes mellitus and kidney failure constituted exclusion criteria. The DVSS and the Rome III questionnaire were applied, and heart rate variability (HRV) was assessed. The chi-square test, Student's t-test, ANOVA and the Mann Whitney U test were used in the statistical analysis. Results: 41 patients with OAB and 20 controls were included. In the OAB group, there were more girls (p=0.23), more overweight/obese and constipated patients. The DVSS score was higher in the OAB group. HRV showed a higher heart rate variability at the frequency domain and LF/HF variation in the control group (p=0.02 and p=0.05 respectively). In the intergroup evaluation, LF (Hz) was predominant in the control group at the post-voiding evaluation moment (p=0.03). Conclusion: The control group demonstrated a physiological heart rate variation during the voiding process, with a predominance of sympathetic activity during urinary storage.

Parasacral transcutaneous electrical nerve stimulation in children with overactive bladder: comparison between sessions administered two and three times weekly

ABSTRACT Purpose: This study compares the results achieved following parasacral TENS administered using two different weekly schedules. Materials and Methods: Children of at least four years of age with a diagnosis of pure overactive bladder were included in this randomized clinical trial and treated with parasacral TENS (2 versus 3 sessions per week). All the participants also underwent standard urotherapy. Results: Sixteen children were included in the twice-weekly group and eighteen in the three times weekly group. There were no statistically significant differences between the two groups with respect to sex; however, there was a difference in age. There were no significant differences regarding complete resolution of urinary symptoms, with 8 children (50%) in the twice-weekly group and 11 children (61%) in the three times weekly group having their symptoms completely resolved (p=0.73). There was a significant difference in the DVSS score in both groups following TENS treatment compared to baseline (p=0.0001 for both groups), but not between groups. Evaluation of the bladder diary showed no difference between the groups before or after treatment. Conclusion: For children with overactive bladder who are unable to undergo parasacral TENS treatment three times weekly, the method can be administered successfully at twice-weekly sessions.

A new double graft technique in urethroplasty for complex urethral stenosis: preliminary findings

ABSTRACT The management of complex urethral stenosis may involve different surgical techniques. As retraction of the graft may account for surgical failure, this risk increases in patients with more extensive stenosis requiring a graft of greater diameter. Although double grafts have already been used to maximize success in these cases, we propose a modified technique for urethroplasty with longitudinal urethral incision. The hypothesis was that this technique would increase the lumen by using only a urethral incision on the dorsal surface. Two patients presenting with recurrent urethral stenosis underwent urethroplasty using a double graft of oral mucosa that preserves the integrity of the spongy tissue and allows ventral inlay graft fixation using a midline relaxing incision in the portion of the urethra with stenosis. In both cases, the urethrocystoscopy and uroflowmetry performed after surgery showed a pervious and complacent urethra. After four and six months of follow-up, the postoperative outcomes were satisfactory for both patients. Further studies involving larger numbers of patients and long-term follow-up are required to evaluate the effectiveness of this method.

Disfunção vésico-intestinal em mães e filhos: um estudo transversal de base populacional / Bladder and bowel dysfunction in mothers and children: a population-based cross-sectional study

ABSTRACT BACKGROUND: Recently it was shown an association between lower urinary tract symptoms in mothers and their children. However, the role of functional constipation in this binomial is unclear. OBJECTIVE: To evaluate bladder and bowel dysfunction between mothers and children. METHODS: A population-based cross-sectional study. Mothers and their children responded a self-administrated questionnaire composed by Rome IV criteria, International Consultation on Incontinence Questionnaire - Overactive Bladder, Dysfunctional Voiding Scoring System and demographic questions. RESULTS: A total of 441 mother-child pairs was obtained. Children's mean age was 9.1±2.7 years, with 249 (56.5%) female. Mothers' mean age was 35.7±6.1 years. Isolated constipation was present at 35 (7.9%) children and 74 (16.8%) mothers. Isolated lower urinary tract symptoms were present in 139 (31.5%) children and 92 (20.9%) mothers and bladder bowel dysfunction occurred in 51 (11.6%) children and 78 (17.7%) mothers. There wasn't any association between isolated lower urinary tract symptoms in children and isolated lower urinary tract symptoms in mothers (P=0.31). In univariate analysis there were an association between bladder bowel dysfunction in children and bladder bowel dysfunction in mothers (OR=4.8 IC 95% 2.6-9.6, P<0.001) and isolated constipation in children and isolated constipation in mothers (OR=3.0 IC 95% 1.4-6.4, P=0.003). In multivariate analysis mothers with bladder bowel dysfunction was the only independent factor associated with bladder bowel dysfunction in children (OR=5.4 IC 95% 2.5-11.6, P<0.001). CONCLUSION: Mothers with bladder bowel dysfunction are more likely to have a child with bladder bowel dysfunction. Association between these two dysfunctions plays an important role in this familiar presentation.

RESUMO CONTEXTO: Recentemente foi demonstrada associação entre sintomas do trato urinário inferior entre mães e filhos. No entanto, o papel da constipação funcional neste binômio não é claro. OBJETIVO: Avaliar a disfunção vésico-intestinal entre mães e filhos. MÉTODOS: Estudo transversal de base populacional. As mães e os filhos responderam a um questionário de autorresposta, composto pelos critérios de Roma IV, International Consultation on Incontinence Questionnaire - Overactive Bladder, Dysfunctional Voiding Scoring System e perguntas sociodemográficas. RESULTADOS: Foram estudados 441 pares mãe-filho. A idade média dos filhos foi de 9,1±2,7 anos, sendo 249 (56,5%) do sexo feminino. A idade média das mães foi de 35,7±6,1 anos. A constipação sem sintomas do trato urinário inferior estava presente em 35 (7,9%) crianças e 74 (16,8%) mães. Sintomas do trato urinário inferior isolados estavam presentes em 139 (31,5%) crianças e 92 (20,9%) mães e a disfunção vésico-intestinal ocorreu em 51 (11,6%) crianças e 78 (17,7%) mães. Não houve associação entre sintomas isolados do trato urinário inferior em crianças e sintomas isolados do trato urinário inferior em mães (P=0,31). Na análise univariada, houve associação entre disfunção vésico-intestinal em crianças e disfunção vésico-intestinal em mães (OR=4,8 IC 95% 2,6-9,6; P<0,001) e constipação isolada em crianças e constipação isolada em mães (OR=3,0 IC 95 % 1,4-6,4; P=0,003). Na análise multivariada, mães com disfunção vésico-intestinal foi o único fator de associação independente para disfunção vésico-intestinal em crianças (OR=5,4 IC 95% 2,5-11,6; P<0,001). CONCLUSÃO: Mães com disfunção vésico-intestinal têm maior probabilidade de ter filhos com disfunção vésico-intestinal. A associação entre constipação e sintomas do trato urinário inferior desempenha um papel importante nesta apresentação familiar.

Evaluation of PSA requests in men under 40 years of age / Avaliação das solicitações de PSA em homens com menos de 40 anos de idade

ABSTRACT Objectives: To evaluate the frequency of PSA requests in men under age 40 years; and to observe the possible influence of medical specialty of the requesting physician. Material and method: This is an observational, cross-sectional study using the database of a national clinical laboratory on PSA requests from October 1, 1997 until December 31, 2016. Descriptive statistics were used. The work was approved by the Ethics Committee of our institution. Results: 2,514,375 PSA requests were evaluated, 158,399 (6.3%) in men younger than 40 years old. These percentages did not vary significantly when observed over time (1998-2016). The prevalence of requests for patients under 40 years of age, was 18.2% among general practitioners; 16.5% among cardiologists, 8.4% among geriatricians and 6.8% among urologists. Conclusion: There is a very high frequency of PSA requests in men with low probability of benefiting from the test. It is necessary to invest in the dissemination of best practices related to prostate cancer screening, especially among clinicians and cardiologists.

RESUMEN Objetivos: Evaluar la cantidad de solicitudes del antígeno prostático específico (PSA) para hombres menores de 40 años, así como observar la posible influencia de la especialidad del médico solicitante. Material y método: Estudio observacional, de corte transversal, que utilizó la base de datos de un gran laboratorio clínico brasileño con las solicitudes de PSA desde el 1 de octubre de 1997 hasta el 31 de Diciembre de 2016. Se analizaron los datos mediante estadística descriptiva. El estudio fue aprobado por el comité ético de nuestra institución. Resultados: Se evaluaron 2.514.375 solicitudes de PSA, 158.399 (6.3%) en hombres menores de 40 años. Los porcentajes no variaron significantemente con el tiempo (1998-2016). La prevalência de solicitudes para pacientes menores de 40 años, fue de 18,2% entre los clínicos, 16,5% entre cardiólogos, 8,4% geriatras y 6,8% entre los urólogos. Conclusión: Hay una cantidad muy grande de solicitudes de PSA en hombres con baja probabilidad de sacar provecho de la realización del test. Es necesario invertir en la divulgación de mejores prácticas de tamizaje del cáncer de próstata, especialmente entre los clínicos y cardiólogos.

RESUMO Objetivos: Avaliar a frequência das solicitações de antígeno prostático específico (PSA) para homens com menos de 40 anos, bem como observar a possível influência da especialidade do médico solicitante. Material e método: Estudo observacional, de corte transversal, que utilizou o banco de dados de um laboratório clínico brasileiro de grande porte com as solicitações de PSA no período de 1º de outubro de 1997 a 31 de dezembro de 2016. Os dados foram analisados por estatística descritiva. O trabalho foi aprovado pelo Comitê de Ética de nossa instituição. Resultados: Foram avaliadas 2.514.375 solicitações de PSA, 158.399 (6,3%) em homens com menos de 40 anos. Esses percentuais não variaram significativamente quando observados no tempo (1998-2016). Entre as solicitações com identificação da especialidade do médico para pacientes com menos de 40 anos de idade, 18,2% foram de clínicos, 16,5% de cardiologistas, 8,4% de geriatras e 6,8% de urologistas. Conclusão: Há uma frequência muito elevada de solicitações de PSA em homens com baixa probabilidade de se beneficiarem com a realização do exame. Faz-se necessário investimento na divulgação das melhores práticas em relação ao rastreamento do câncer de próstata, especialmente entre os clínicos e cardiologistas.

Association between stress and lower urinary tract symptoms in children and adolescents

ABSTRACT Introduction: Lower urinary tract dysfunction (LUTD) is a common clinical condition. Emotional and behavioral issues are increasing among children and adolescents, with stress indicating difficulties in personal and social functioning. This study evaluated whether urinary tract symptoms (LUTS) is associated with stress. Materials and Methods: A cross-sectional, analytical study with 6-14-year-old patients with LUTS and no anatomical/neurogenic urinary tract abnormalities was conducted using the Dysfunctional Voiding Scoring System, a psychological assessment and the Child Stress Scale. The overall stress score was analyzed in relation to the psychological assessment data. Answers to the seven specific DVSS urinary questions were compared with those for the four Child Stress Scale domains. Univariate and multivariate analyses were performed. The chi-square test and Pearson's correlation were used to determine associations. Significance was defined as p <0.05. Results: Most children were male (56%). Mean age was 9.0±2.25 years. Stress was detected in 20 out of 98 patients (20.4%; 95% CI: 13-30%). Of these, 90% were born from unplanned pregnancies and 67% were upset about their disorder. All the Child Stress Scale domains were significantly associated with urinary dysfunction, with dysuria being significantly associated with all four domains. In the multivariate analysis, dysuria was the only symptom that remained associated with stress. Associations with stress strengthened as the frequency of dysuria increased: physical reactions (p <0.01), emotional reactions (p <0.05), psychological reactions with a depressive component (p <0.01) and psychophysiological reactions (p <0.05). Conclusion: Stress levels are higher in children and adolescents with LUTS who have more severe symptoms. Dysuria was the symptom most associated with stress, both in the physical reactions domain, in the psychological reactions domains with or without a depressive component and in the psychophysiological reactions domain.

Onabotulinumtoxin type A improves lower urinary tract symptoms and quality of life in patients with human T cell lymphotropic virus type 1 associated overactive bladder

ABSTRACT Aim: To evaluate the efficacy of the onabotulinum toxin type A in the treatment of HTLV-1 associated overactive bladder and its impact on quality of life (QoL). Methods: Case series with 10 patients with overactive bladder refractory to conservative treatment with anticholinergic or physical therapy. They received 200Ui of onabotulinumtoxin type A intravesically and were evaluated by overactive bladder symptoms score (OABSS) and King's Health Questionnaire. Results: The mean (SD) of the age was 52 + 14.5 years and 60% were female. All of them had confirmed detrusor overactivity on urodynamic study. Seven patients had HAM/TSP. The median and range of the OABSS was 13 (12-15) before therapy and decreased to 1.0 (0-12) on day 30 and to 03 (0-14) on day 90 (p < 0.0001). There was a significant improvement in 8 of the 9 domains of the King's Health Questionnaire after the intervention. Hematuria, urinary retention and urinary infection were the complications observed in 3 out of 10 patients. The mean time to request retreatment was 465 days. Conclusion: Onabotulinum toxin type A intravesically reduced the OABSS with last long effect and improved the quality of life of HTLV-1 infected patients with severe overactive bladder.

Urodynamic outcome of parasacral transcutaneous electrical neural stimulation for overactive bladder in children

ABSTRACTObjective:To evaluate the urodynamic changes immediately after the first session (acute effect) and after the last session of parasacral TENS in children with idiopathic OAB.Materials and methods:We performed urodynamic evaluation immediately before and after the first session of parasacral TENS and immediately after the last session (7 weeks later). Only children with idiopathic isolated OAB were included. Patients with dysfunctional voiding were not included.Results:18 children (4 boys and 14 girls, mean age of 8.7) were included in the first analysis (urodynamic study before and immediately after the first session) and 12 agreed to undergo the third urodynamic study. Urodynamic before and immediately after the first session: There was no change in the urodynamic parameters, namely low MCC, low bladder compliance, presence of IDC, the average number of IDC, or in the maximum detrusor pressure after the first exam. Urodynamic after the last session: The bladder capacity improved in most patients with low capacity (58% vs. 8%). Detrusor overactivity was observed in 11 (92%) before treatment and 8 (76%) after. There was not a significant reduction in the average number of inhibited contractions after TENS (p=0.560) or in the detrusor pressure during the inhibited contraction (p=0.205).Conclusion:There was no change in the urodynamic parameters immediately after the first session of stimulation. After the last session, the only urodynamic finding that showed improvement was bladder capacity.

Urinary Symptoms and Urodynamics Findings in Patients with Friedreich's Ataxia

Purpose To assess the prevalence of LUTS, urinary tract and urodynamics changes in patients with Friedreich's Ataxia (FA), the most common form of hereditary ataxia. Materials and Methods This study evaluated 258 patients with genetically confirmed diagnoses of FA. Of the patients, 158 responded to a questionnaire which assessed their urinary symptoms. Patients with clinical changes underwent renal function examinations, ultrasound, and urodynamic studies (UDS). Results The sample analyzed showed that 82% of the patients complained of LUTS, although only 22% related the symptoms with quality of life impairment. Twenty eight (18%) of them agreed to undergo urodynamic evaluation. Urgency was the most common symptom. The exam was normal in 4 (14%) and detrusor underactivity was the most common finding. 14% (4 patients) presented with dilatation of the upper urinary tract at ultrasound scans. None of them had creatinine alterations. Conclusions LUTS was found in a large percentage of patients with FA, but only a few related it to their quality of life impairment. Although creatinine levels was normal in this sample, some patients may show upper urinary tract abnormalities, with deserves close observation and proper care. .

The buccal mucosa fenestrated graft for Bracka first stage urethroplasty: experimental study in rabbits

To histologically evaluate, in an experimental study in rabbits, the integration process of the buccal mucosa fenestrated graft applied in the corpora cavernosa for Bracka first stage urethroplasty.

A urethral defect was surgically created in 16 male rabbits of the New Zealand breed through the excision of the penile urethra. The urethral defect was corrected by applying buccal mucosa fenestrated graft through two cruciform incisions in the distal portions of its longitudinal axis. The animals were sacrificed at 2, 4, 8 and 12 weeks post surgery and their genitals were subjected to clinical and histological assessment.

The buccal mucosa fenestrated graft showed complete uptake in all groups, with keratinization squamous metaplasia and mucosal proliferation of the fenestrated areas. The fenestrated graft area represented an increase in length of 25% in length in relation to the original standard graft.

The fenestrated buccal mucosa graft presented total integration to the adjacent epithelia with re-epithelization of the incision areas of the graft (fenestrations) and no significant inflammatory or scarring reactions when compared to other mucosa transplanted areas; therefore its application is viable in cases of extensive urethral defect whenever the donating area might be insufficient. .

Finasteride for recurrent priapism in children and adolescents: a report on 5 cases

PURPOSE: Recurrent priapism is prevalent in children. Different medications have been used to avoid new episodes, however, there is no consensus regarding the best option. The use of finasteride to treat priapism in adults has already been tested. The aim of the present study was to test the hypothesis that a low dose of finasteride would be effective in preventing recurrent priapism in children. MATERIALS AND METHODS: Since 2007, five children and adolescents with recurrent episodes of priapism have been treated with finasteride in our department, and the medical records of these patients were reviewed for this study. In four cases, the dose used was 1 mg a day, while the remaining patient used 1 mg twice a day. RESULTS: Prior to initiating finasteride treatment, one patient reported having had 6 episodes of acute priapism, while the remaining patients had more than 10 episodes. One of the patients reported having stuttering priapism almost daily. With a mean follow-up of 20 months, four patients had no episodes and only one patient complained of sporadic and shorter duration episodes. CONCLUSIONS: These initial results suggest that a low daily dose of finasteride appears to represent an effective and safe form of treatment for recurrent priapism in children and adolescents with SCD. However, in order to confirm these initial findings, studies with a large population and a control group are essential.

Ultrasound evaluation of renal scarring in children with vesicouretral reflux / Avaliação ultra-sonográfica das cicatrizes renais em crianças com refluxo vesico-ureteral

Introdução: Um dos objetivos do tratamento do refluxo vesicoureteral (RVU) é evitar o aparecimento de cicatrizes renais. O exame de escolha para avaliação do parênquima renal é a cintilografia com DMSA (99mTc ácido dimercaptossuccínico). Por outro lado, a ultra-sonografia, devido a sua praticidade, ausência de morbidade e baixo custo, tem-se tornado um exame rotineiro no acompanhamento dos pacientes portadores de patologias urológicas. O objetivo deste estudo foi avaliar a acurácia da ultra-sonografia na detecção de cicatrizes renais nos pacientes portadores de RVU. Material e métodos: Foram avaliados retrospectivamente 88 pacientes tratados em nossa instituição que realizaram ultra-som e DMSA durante a avaliação urológica. Todos os exames ultra-sonográficos foram revisados por um único radiologista com experiência em patologias renais. As cicatrizes renais foram classificadas como focais ou generalizadas. Os achados ao ultra-som foram comparados à cintilografia, e foram determinados os seguintes parâmetros: valor preditivo positivo, valor preditivo negativo, sensibilidade e especificidade do método. Resultados: Dos 41 pacientes que apresentavam sinais sugestivos de cicatriz renal ao ultra-som, houve confirmação deste achado em 36. Por outro lado, dentre os 47 pacientes que apresentavam ultra-som normal, houve o achado de 14 cicatrizes renais. O valor preditivo positivo, valor preditivo negativo, sensibilidade e especificidade da ultra-sonografia foram de 87,5 porcento, 61 porcento, 66 porcento e 84 porcento, respectivamente. A estratificação dos pacientes demonstrou que quando as cicatrizes são focais a correlação é de apenas 32 porcento, enquanto que é de 96,5 porcento, quando a lesão é generalizada. Conclusão: O exame ultra-sonográfico renal, quando realizado por operador experiente e em equipamento de alta resolução, apresenta boa acurácia, na detecção de cicatrizes generalizadas do rim, no entanto tem um papel limitado na detecção de cicatrizes focais.