Cessation of vesicoureteral reflux for 5 years in infants and children allocated to medical treatment. The International Reflux Study in Children.

A total of 401 children with severe vesicoureteral reflux (97 with grade III and 304 with grade IV) was entered into the European branch of the International Reflux Study in Children. Of these patients 37 with grade III and 43 with grade IV reflux were allocated to medical treatment as a sideline group because the reflux grade III or IV had improved to grade II or I, or it had disappeared during the preceding 2 to 6 months (median 4). Of the remaining 321 patients with persistent grade III or IV reflux 158 were randomly allocated to medical treatment of whom 3 switched to surgery. We report on 235 children treated medically (155 random medical and 80 sideline), of whom 88% had a complete 5-year followup with x-ray and/or isotope voiding cystourethrography at 6, 18, 30 and 54 months. Seven children dropped out of the study after a followup of 6 months or less, including 6 with persistent vesicoureteral reflux. Cessation of vesicoureteral reflux was observed significantly more often in children with unilateral (40 of 74, 54%) than with bilateral (18 of 154, 12%) reflux (p < 0.001). No significant difference between grades III and IV was noted. Vesicoureteral reflux ceased in 25 of 153 children (16%) from the random medical group and in 32 of 75 children (43%) in the sideline group. Of 194 children with vesicoureteral reflux detected for the first time at entry reflux resolved in 55 (28%). In only 2 of 34 children (6%) in whom vesicoureteral reflux was detected more than 1 year before entry did reflux resolve after 5 years. Among the children in whom vesicoureteral reflux either disappeared, diminished or remained unchanged the proportion with urinary tract infection recurrences was almost the same.

[Intrathoracic kidney in childhood with special reference to secondary renal transport in Bochdalek's hernia]. / Die intrathorakale Niere im Kindesalter (mit besonderer Berücksichtigung der sekundären Nierenverlagerung bei Bochdalekscher Zwerchfellhernie).

Three cases of thoracic renal ectopia are described. Remarkable is the case of an "acquired" congenital right diaphragmatic hernia (Bochdalek's herniation) with previously normally positioned kidneys. Classification is as follows: 1. real thoracic ectopia with normally developed closed diaphragm, 2. eventration of the diaphragm (relaxatio diaphragmatica), 3. diaphragmatic hernia: a) congenital diaphragmatic defects, b) acquired herniation (Bochdalek's). 4. traumatic rupture of the diaphragm with renal ectopia.

[Gonadal dosis in intravenous urography and voiding cystourethrography of children (athor's transl)]. / Gonadenexposition bei kindlichen Urogrammen und Miktionscystourethrogrammen.

Measurements of gonadal doses of 92 children during intravenous urography and voiding cystourethrography are reported. The high deviation of doses in the testes is discussed. The application of a lead protector for the testes is demanded to decrease exposure by a factor 15 in the central beam and a factor 1.3-2 in scattered radiation. By choice of spot film radiography instead of large radiography the ovarian dose is reduced to a factor 7-40. The gonadal dose is clearly lower if 70 mm technique instead of large film technique is used. A correlation between area ionisation product and gonadal dose could not be found; therefore the genetic radiation dose cannot be calculated by data recorded as required by law.