Incidence of urinary tract infection after cystography / Incidência de infecção urinária após cistografia

ABSTRACT Objective: Cystography an invasive procedure with potential complications such as urinary infection (UI). There are few studies about the incidence of complications associated with this procedure. The purpose of this study is to evaluate the incidence of post-cystography urinary infection (UI.). Methods: Retrospective study with a review of clinical records of patients under 15 years of age, followed in this hospital, who underwent cystography (radiologic or indirect radionuclide) between 2009 and 2018. Post-cystography UI was defined when it occurred until seven days after the procedure. Descriptive and nonparametric statistics were applied to assess possible predictive factors related with post-cystography UI. Results: In the study period, 531 cystograms were undertaken (55% indirect radionuclide and 45% radiologic). The mean age at the procedure was 11.5 months; 62% were boys. Every patient had a previous negative urine culture; 50% were under antibiotic prophylaxis at the time of the procedure. The most common indication for the procedure was the post-natal study of congenital hydronephrosis/other nephrological malformation (53%), followed by the study of febrile UI (31%). Vesicoureteral reflux (VUR) was diagnosed in 40% of procedures. Post-cystography UI occurred in 23 cases (incidence of 4.3%). The most frequent microorganism was E. coli (52%). The presence of VUR was significantly associated with the occurrence of post-cystography IU. Conclusions: The incidence of post-cystography UI was low in our sample. The presence of VUR was significantly associated with the occurrence of post-cystography UI. The authors highlight the importance of an adequate catheterization technique and the need for clinical surveillance after the procedure.

RESUMO Objetivo: A cistografia é um exame invasivo que apresenta potencial iatrogenia, nomeadamente infecção urinária (IU). Os estudos sobre a incidência de complicações associadas a esse exame são escassos. O objetivo deste trabalho foi avaliar a incidência de IU após realização de cistografia. Métodos: Estudo retrospetivo por consulta dos prontuários clínicos dos doentes com idade inferior a 15 anos, seguidos em consulta nesse hospital, que realizaram cistografia (radiológica ou isotópica) entre 2009 e 2018. Admitiu-se relação de causalidade quando o diagnóstico de IU ocorreu até sete dias após a realização do exame. Foi realizada análise estatística descritiva e utilizados testes não paramétricos para avaliar possíveis fatores preditores da ocorrência de IU após cistografia. Resultados: Realizaram-se 531 cistografias (55% isotópicas e 45% radiológicas). A mediana de idade foi de 11,5 meses; 62% eram do sexo masculino. Todos os doentes efetuaram urocultura prévia (negativa); 50% recebiam profilaxia antibiótica (ATB) à data do exame. A indicação mais frequente foi o estudo pós-natal de hidronefrose (HN) congênita/outra malformação nefrourológica (53%), seguida do estudo da IU febril (31%). Documentou-se refluxo vesicoureteral (RVU) em 40% dos exames. Ocorreu IU após cistografia em 23 casos (incidência de 4,3%). O microrganismo mais frequente foi a E. coli (52%). Verificou-se associação entre a presença de RVU e a ocorrência de IU. Conclusões: A incidência de IU pós-cistografia foi relativamente baixa na amostra deste estudo. Observou-se associação entre a ocorrência de IU após cistografia e a presença de RVU. Sublinha-se a importância de uma técnica adequada de cateterização vesical e da vigilância clínica após o exame.

Is computed tomography cystography indicated in children with pelvic fractures? / 中华创伤杂志(英文版)

PURPOSE@#Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images.@*METHODS@#A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chi-square test and two-sided Fisher's exact test. A p value of less than 0.05 was considered statistically significant.@*RESULTS@#A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).@*CONCLUSION@#The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

One wire tubeless ureteral reimplant: preliminary experience and step-by-step technique / One wire tubeless ureteral reimplantation: experiência preliminar e técnica passo-a-passo

BACKGROUND AND OBJECTIVES: Ureteral Reimplant is commonly used in pediatric and gyne-cologic surgery. Most techniques demand an experienced surgeon and lasts 2-3 hours. There is no consensus about the preferred technique until today. We report a simple modification of the Taguchi to reduce duration and make it more suitable for laparoscopic approach. METHOD: Three patients underwent distal ureteral reimplant, based on our modified Taguchi minimally invasive approach technique. Cystography and ultrasonography were performed on the 30th, 90th and 180th postoperative days to monitor kidneys; a one-year follow-up for recurrence or clinical symptoms was also performed. RESULTS: Operative time for ureteral reimplant using our technique was 15-25 minutes. The results of the performed exams on postoperative days showed normal kidneys without hydro-nephrosis. At the one-year follow-up no signs of recurrence or clinical symptoms were present. CONCLUSION: Our modifications allowed a faster and easier management of distal ureteral reimplant, with excellent perioperative and post-operative outcomes. To our knowledge this is the first detailed description of this technique through minimally invasive approach. However, further studies and a longer follow up will be necessaries to confirm the long-term outcomes and clinical benefits of our technical proposal.

JUSTIFICATIVA E OBJETIVOS: O reimplante ureteral é comumente utilizado em cirurgia pediátrica e ginecológica. A maioria das técnicas exigem um cirurgião experiente e dura 2-3 horas. Não há consenso sobre a técnica preferida até hoje. Relatamos uma modificação simples do Taguchi para reduzir sua duração e torná-lo mais adequado para a abordagem laparoscópica. MÉTODO: Três pacientes foram submetidos a reimplante ureteral distal, com base na técnica de abordagem minimamente invasiva de Taguchi modificada. Cistografia e ultra-sonografia foram realizadas no 30º, 90º e 180º dias de pós-operatório para monitorização dos rins; um acompanhamento de um ano para recorrência ou sintomas clínicos também foi realizado. RESULTADOS: O tempo operatório para o reimplante ureteral utilizando a nossa técnica foi de 15-25 minutos. Os resultados dos exames realizados nos dias pós-operatórios mostraram rins normais sem hidronefrose. No seguimento de um ano não houve sinais de recorrência ou sintomas clínicos. CONCLUSÃO: Nossas modificações permitiram um manejo mais rápido e fácil do reimplante ureteral distal, com excelentes resultados peri- e pós-operatórios. Tanto quanto sabemos, esta é a primeira descrição detalhada desta técnica através de abordagem minimamente invasiva. No entanto, estudos adicionais e um acompanhamento mais longo serão necessários para confirmar os resultados a longo prazo e os benefícios clínicos da técnica proposta.

"Gunshot injury to the pelvis".The bullet voided through the urethra

Gunshot injuries (GSIs) are considered as an emergency and life threatening. The gunshots injuries to the urinary tract are uncommon. The high-velocity of bullet can cause both a penetrating injury to the target organs as well as blast injury to nearby structures, in addition to thermal injuries. In most of the cases, laparotomy is required to remove the bullet and to repair the injuries. The phenomenon of spontaneous migration of retained bullet to different parts of body has been described in the medical literature. Here, we present a patient who sustained penetrating GSI to the pelvis, without organ injuries, including the bladder. The bullet initially was retained within peri-vesical fat and the bladder wall while the mucosa remained intact, then it migrated into the bladder and came out through the urethra during voiding on the sixth day after injury

Reflujo vesico ureteral y uropatías obstructivas congénitas / VUR and congenital obstructive uropathy

REFLUJO VESICOURETERAL Las malformaciones congénitas de la vía urinaria se dividen en obstructivas y no obstructivas. De las no obstructivas, el reflujo vésico ureteral es el más frecuente e importante, tanto por la frecuencia como por sus consecuencias. EPIDEMIOLOGÍA: Es una enfermedad presente hasta en el 0,5 por ciento a 1 por ciento de los recién nacidos, que puede ir a la resolución espontánea. No todos se hacen sintomáticos y es el resposable del 30 por ciento de las ITU febriles (70 por ciento en ITU febriles del sexo masculino), del 90% de las cicatrices renales y el 90 por ciento de la HTA de la edad pediátrica. 16 al 20 por ciento de los pacientes portadores de RVU llegan a la IRC terminal.(AU)

REFLUX VESICOURETERAL: Congenital malformations of the urinary tract are divided into obstructive and non-obstructive. Of the non-obstructive, ureteral vesicoureth reflux is the most frequent and important, both because of the frequency and its consequences. EPIDEMIOLOGY: It is a disease present in up to 0.5 percent to 1 percent of newborns, which can go to spontaneous resolution. Not all are symptomatic and are responsible for 30 percent of febrile UTIs (70 percent in febrile UTIs of males), 90pertcent of renal scars and 90 percent of AHT of the pediatric age. 16 to 20 percent of patients with VUR reach the terminal CKD. (AU)

Interet de l'association echographie mode B - cystographie radiologique retrograde dans l'exploration des infections urinaires de l'enfant

Objectif: Determiner l'interet d'associer systematiquement a l'echographie mode B une cystographie radiologique retrograde lors de l'exploration d'une infection urinaire chez l'enfant. Materiel et methode: ce travail est une etude retrospective realisee dans le service de chirurgie pediatrique du CHU de Treichville. II a porte sur l'analyse de 25 dossiers d'enfant ayant presente une infection urinaire et hospitalises sur une periode de 3 ans allant d'avril 2000 a avril 2003. Chaque enfant a beneficie d'une echographie mode B et d'une cystographie radiologique retrograde. Ces examens ont ete realises dans le service de radiologie du CHU de Treichville. Resultats : Les aspects objectives par la cystographie etaient ceux des valves de l'uretre posterieur dans 19 cas (76pour cent des cas); de lithiase vesicale dans 4 cas (16 pour cent des cas) et de reflux vesico-ureteral primitif dans 2 cas (8pour cent des cas). L'echographie etait anormale dans tous les cas de valves de l'uretre posterieur et de lithiase vesicale- Elle etait normale dans un cas de reflux vesico-ureteral soit une sensibilite de 96pour cent. Sur les 2 cas de reflux vesico-ureteral primitif observes; l'atteinte etait bilaterale dans 1 cas avec 2 unites ureterales refluant de grade II et unilaterale dans l'autre cas avec une unite ureterale refluant de grade III. Sur les 3 unites ureterales refluant observees; l'echographie etait normale dans les 2 cas de grade II et anormale dans le cas de grade III. Sur 16 uropathies observees entre 0 et 3 ans; l'echographie etait anormale dans 15 cas et anormale dans 1 cas. L'analyse statistique des resultats de l'imagerie dans cette tranche d'age a permis de valider le caractere significatif du gain obtenu par l'association echographie mode B-cystographie radiologique retrograde en tenue de diagnostic positif des uropathies observees; quand elle est comparee a l'echographie mode B seule (P = 0;002). Conclusion : la cystographie radiologique retrograde doit etre systematiquement associer a l'echographie mode B lors de l'exploration d'une infection urinaire haute chez l'enfant jusqu'a l'age de 3 ans

A comparison between voiding patterns of healthy infants and those with recurrent UTI

OBJECTIVE: The purpose of this study was to compare voiding patterns of healthy infants and those with recurrent UTI aged 1-24 months.METHODS: This was an analytical, cross sectional study of healthy infants and those with recurrent UTI, aged 1-24 months from March 1999 to March 2000 seen at University of Santo Tomas Hospital. The study included 100 subjects; Group I (50 subjects) healthy infants (neurologically intact with other anomalies ruled out by ultrasound and voiding cystourethrogram) Group 2 (50 subjects) are those with recurrent UTI. During the 24-hour period, all micturitions were recorded in terms of voiding frequency, volume and character of voiding. The observation was completed with three determination of residual urine volume using ultrasound by a single sonologist who did not know the diagnosis of each case. Voiding patterns in terms of mean voiding frequency, mean volume per voiding, mean functional bladder capacity and character of voiding were determined. Mean residual urine volume was also determined in milliliters. The two groups were compared using T test with a p value of 0.05 percent at 95 percent confidence interval.RESULTS: The mean voiding frequency was 17.03 (SD +/- 7.5) in-group 1 and 13.5 (SD +/- 4.9) in-group 2 (p value of 0.009) The mean volume per voiding was 33.88 (SD +/- 15.2) on group 1 and 40.12 (SD +/- 37.4) in Group 2 (p value of 0.27). The mean bladder capacity was 44.02 (SD +/- 29.5) in group 1 and 66.48 (SD +/- 29.4) in group 2 (p value 0.00). In group 1 subjects, twenty eight percent showed interrupted voiding pattern compared to none in group 2 (p value 0.00). The mean residual urine volume for group 1 was 7.97 (SD +/- 7.5) and 6.06 (SD +/- 6.6) in group 2 (p value 0.183).CONCLUSION: The voiding patterns of pediatric patients with recurrent UTI were significantly characterized by increased frequency, decreased functional bladder capacity, and interrupted voiding. Mean volume per voiding was also decreased in those with recurrent UTI but not to a significant degree. Determination of residual urine in those with recurrent UTI was not significantly different from healthy infants.