RESUMO
Objective: The ectopic ureter frequently drains an ectopic dysplastic or hypoplastic kidney. The present study aims at defining the role of MRU in establishing the diagnosis of this anomaly
Patients and Methods: Between February 1996 and March 2000, 11 girls presented or were referred to our department for management of urinary incontinence. Their age at presentation ranged from 4-9 years [mean 6.5 years]. Radiological work up included abdominal ultrasound [US], excretory urogram [IVU], voiding cystourethrography [VCUG], [99 m] technetium-dimercaptosuccinic acid [[99m] Tc-DMSA] renal scan, enhanced spiral computed tomography [CT] and magnetic resonance urography [MRU]
Results: Ultrasound showed evidence of a solitary kidney with failure to visualize a contralateral kidney in 7/11 patients. In the remaining 4 patients [36.4%], US revealed a pelvic kidney in two and a pelvic cystic mass in another two patients. IVU revealed only one functioning renal unit in all cases. None of the patients showed vesicoureteral reflux on VCUG. On [99 m] Tc-DMSA, a single kidney was seen in 9/11 patients and ectopic pelvic kidneys with normal contralateral kidneys in 2/11 patients. The 7 patients, in whom US and [99m] Tc-DMSA scan had failed to localize the kidney, underwent CT scanning which visualized a pelvic hypoplastic kidney with a normal contralateral kidney in 2/7 patients. The remaining 5 patients underwent MRU that disclosed a normal kidney with a contralateral lumbar hypoplastic kidney in one and a pelvic ectopic kidney in four. The patients were managed by nephrectomy [n=9] and ureteroneocystostomy [n=2]
Conclusions: A single system ectopic ureter should be suspected in all girls with continuous urinary dribbling after the age of successful toilet training. With the inclusion of MRU into radiological workup, dysplastic or hypoplastic kidneys can be accurately localized. MRU is indicated for the diagnosis and for therapeutic planning in such cases
RESUMO
Objective: To evaluate staged Fowler - Stephens orchiopexy for the high intra-abdominal testis
Patients and Methods: The study included 78 patients with laparoscopicallydiagnosed high intra-abdominal testes. Their age ranged from 2 -16 years. All cases underwent staged Fowler - Stephens orchiopexy. The first stage was done during diagnostic laparoscopy by clipping the internal spermatic artery and vein 2-3 cm superior to the intra-abdominal testis. Six months later the second stage of the procedure in the form of open [67cases] or laparoscopic orchiopexy [11 cases] was performed. Only 65 patients were available for follow up at 6 and 18 months following the second stage. At each follow-up visit, the testicular position, size and viability were assessed by Technetium 99 [Tc99m] testicular scintigraphy
Results: Out of 78 cases, 10 had bilateral high intra-abdominal testes. Second stage open orchiopexy was done in 67 cases while the remaining 11 cases were subjected to laporoscopic orchiopexy. No operative or postoperative complications were detected apart from a prolonged ileus after the second stage in 6 patients. On follow up, 49 testes were scrotal and of good size while 6 testes were scrotal and atrophic. In the remaining 10 cases the testes were at the neck of the scrotum and of good size. Tc99m testicular scintigraphy was done in 65 cases. A good perfusion was detected in the majority of them [59 cases] while no radiotracer accumulation was detected in the remaining 6 cases
Conclusion: Laparoscopic clipping of the gonadal vessels is safe in patients with high abdominal testes. The staged approach with preservation of the testicular collateral vascular supply providesan adequate viability of the high abdominal testis with a high success rate. Tc99m testicular scintigraphy allows a proper assessment of the testicular viability as compared to measurement of the testicular size only