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1.
Ann Ital Chir ; 86: 443-9, 2015.
Article in English | MEDLINE | ID: mdl-26567456

ABSTRACT

INTRODUCTION: An aberrant or accessory crossing renal vessel (CV) leading to the lower pole of the kidney is the most common extrinsic cause of uretero pelvic obstruction(UPJ) obstruction in a child and young adolescent.There is still controversy regarding there functional significance in obstruction Preoperative identification of such vessels may influence surgical management. OBJECTIVE: First aim is to determine the value of magnetic resonance (MR) urography in detecting crossing vessels in children with UPJ obstruction,comparing the data with postoperative findings and the second one is to evaluate morphologic and functional parameters in these hydronephrotic kidneys. MATERIALS AND METHODS: Between June 2009 and December 2012 we retrospectively reviewed MR urography records of one hundred and nine children with unilateral hydronephrosis at the University Children's Hospital. 68 (62.4%) were male and 41 (37.6%) were female,median age was 6.5 ± 5.7. Of the total number of patients, 30 (27%) underwent pyeloplasty, while 79 (72.5%) did not. The age at surgery ranged from 0.3 to 18 years (median 6.6 years). The indication for surgery was based on standard criteria (obstructed renal transit time with or without altered renal function of vDRF < 40%), and did not depend on the presence or absence of a crossing vessel.Consensus reviewes of the MR urography studies were compared with surgical findings. RESULTS: A crossing vessel (CV) was found upon surgery in 9 (33%) of 30 kidneys.On MRU, there was no crossing vessel in 21 kidneys, confirmed at surgery in 18. A crossing vessel was detected with MRU in 9 kidneys and confirmed at surgery in 6. Thus, the sensitivity of MRU was 66.7%, the specificity was 85.7%, the positive predictive value was 66.7%, the negative predictive value was 85.7% and the accuracy was 80%. There was no statistically significant difference in the detection of crossing vessels between MR urography and surgery (p = 0.004 and p < 0.01 respectively). Overall, MRU and surgery showed good agreement (κ = 0.524). CONCLUSION: Based on our results we suggest that MR urography is a reliable and safe diagnostic tool to determine crossing vessels in selected children with UPJ obstruction. Thus, MRU can substitute for other imaging modalities and provide detailed information about the morphology and function of the affected kidney KEY WORDS: Children, Crossing renal vessels, Hydronephrosis, Ureteropelvic function obstruction.


Subject(s)
Diagnostic Techniques, Urological , Hydronephrosis/diagnostic imaging , Kidney Pelvis/diagnostic imaging , Kidney/blood supply , Magnetic Resonance Imaging , Ureteral Obstruction/diagnostic imaging , Vascular Malformations/diagnostic imaging , Adolescent , Child , Child, Preschool , Female , Humans , Hydronephrosis/etiology , Hydronephrosis/surgery , Infant , Kidney Pelvis/blood supply , Kidney Pelvis/surgery , Male , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Ureteral Obstruction/etiology , Ureteral Obstruction/surgery , Vascular Malformations/complications
2.
J Urol ; 170(4 Pt 2): 1686-90; discussion 1690, 2003 Oct.
Article in English | MEDLINE | ID: mdl-14501692

ABSTRACT

PURPOSE: We present 2 techniques of enhancement and sculpturing of a small and/or deformed glans. MATERIALS AND METHODS: The small glans in primary or re-do hypospadias repair was enhanced by longitudinal double-faced island flaps incorporated onto the ventral side of the glans between the glans wings. The deformed glans, of small or normal size (with normal urethra or well functioning neourethra), was enlarged and sculptured by injection of hydrogel. Between May 1997 and March 2002, 27 patients underwent glans enhancement and sculpturing. Small deformed glans occurred after failed hypospadias repair in 10 patients, penile trauma in 3, hemangioma sclerozation in 2, primary hypospadias in 8 and normally developed penile body in 4. A double-faced island flap was performed in 14 patients, glans was enhanced by hydrogel injection in 9 and both procedures were performed in 4. RESULTS: Mean followup was 34 months for the double-faced flap technique 17 months for hydrogel injection. Satisfactory enlargement and esthetic appearance were achieved in 13 of the 14 patients who underwent the double-faced flap technique and 1 required surgical correction. Of the 9 patients who underwent either single or multistage hydrogel injection 8 had good results and 1 required partial removal of hydrogel after hypercorrection. The combination of these 2 techniques provided satisfactory results in all 4 cases. CONCLUSIONS: Enlargement and sculpturing of a small deformed glans are challenging and difficult. A double-faced island flap and/or injection of hydrogel resolves this problem satisfactorily.


Subject(s)
Hypospadias/surgery , Penile Diseases/surgery , Penis/abnormalities , Postoperative Complications/surgery , Surgical Flaps , Adolescent , Child , Child, Preschool , Esthetics , Follow-Up Studies , Humans , Hydrogel, Polyethylene Glycol Dimethacrylate/administration & dosage , Infant , Injections , Male , Penis/injuries , Penis/surgery , Reoperation , Suture Techniques
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