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2.
J Pediatr Urol ; 6(3): 204-11, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20347395

RESUMEN

Although prenatal diagnosis has been a prominent feature of Paediatric Urology for more than two decades the published literature has been largely characterized by studies reporting short to medium-term follow up. This deficiency is now being addressed by the growing availability of published and unpublished long-term outcome data for a range of prenatally detected anomalies. This review analyses the evidence on long-term outcomes which is provided by studies with mean or median follow- up exceeding 5 years, with particular emphasis on the small number of studies reporting follow -up at 10 years and beyond. The natural history and outcome of conservatively managed uropathies is considered in conjunction with an appraisal of evidence- based indications for surgical intervention. This review evaluates the relative benefits and drawbacks of prenatal diagnosis for children and their parents and also considers the impact of prenatal diagnosis on the delivery of Paediatric Urological services and specialist training.


Asunto(s)
Enfermedades Fetales/diagnóstico , Evaluación de Resultado en la Atención de Salud , Diagnóstico Prenatal/métodos , Enfermedades Urológicas/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Embarazo , Factores de Tiempo , Enfermedades Urológicas/embriología
3.
Semin Fetal Neonatal Med ; 13(3): 189-95, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18037084

RESUMEN

The long-term outcomes of prenatally detected uropathies are poorly documented. Limited data on fetal intervention show a possible reduction in early mortality from pulmonary hypoplasia, but no beneficial effect on long-term prognosis for renal function. Prenatally detected vesicoureteric reflux (VUR) is characterised by males with high-grade primary reflux, who are at long-term risk of renal impairment. Prenatal diagnosis and surgical intervention have contributed to a reduction in long-term morbidity in children with pelviureteric junction (PUJ) obstruction. By the same token, many children have almost certainly undergone unnecessary early pyeloplasty for an obstruction that would have resolved spontaneously. Multicystic dysplastic kidney (MCDK) carries a low (1%) risk of hypertension in childhood. The limited evidence on the long-term outcome of mild dilatation (pelvicaliectasis) indicates this is a largely innocent finding, which carries no increased risk of morbidity.


Asunto(s)
Enfermedades Fetales/diagnóstico , Diagnóstico Prenatal , Sistema Urinario/anomalías , Animales , Dilatación Patológica , Humanos , Cálices Renales/patología , Pelvis Renal/patología , Riñón Displástico Multiquístico/diagnóstico , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Uretra/anomalías , Reflujo Vesicoureteral/diagnóstico
6.
BJU Int ; 93(4): 609-16, 2004 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15008741

RESUMEN

OBJECTIVES: To study the outcome of composite cystoplasty using cultured urothelial cells combined with de-epithelialized colon or uterus in a porcine surgical model, using appropriate controls, and to characterize the neo-epithelium created by composite cystoplasty. MATERIALS AND METHODS: Urothelial cells were isolated and propagated in vitro from open bladder biopsies taken from nine female minipigs. Cohesive sheets of confluent urothelial cells were transferred to polyglactin carrier meshes and sutured to de-epithelialized autologous colon in four animals and de-epithelialized autologous uterus in five. These composite segments were then used for augmentation cystoplasty. Conventional colocystoplasty, de-epithelialized colocystoplasty and sham operations were carried out in six control animals. After killing the animals at approximately 90 days the bladders were removed for examination and immunohistochemical analysis, using a panel of antibodies against cytokeratins and urothelial differentiation-associated antigens. RESULTS: Macroscopically, the bladders augmented with composite segments derived from uterine muscle had no evidence of shrinkage or contracture. Histological analysis showed that in four of five composite uterocystoplasties, the neo-urothelium was stratified and had a transitional morphology, although in some areas coverage was incomplete. Immunohistochemical analysis showed evidence of squamous differentiation in both native and augmented segments. All composite and de-epithelialized colonic segments showed significant contraction with poor urothelial coverage, reflecting the unsuitability of the thin-walled porcine colon for de-epithelialization. CONCLUSIONS: The functional and macroscopic outcome of bladder augmentation with a composite derived from cultured urothelium and de-epithelialized smooth muscle of uterine origin endorses the feasibility of composite cystoplasty.


Asunto(s)
Vejiga Urinaria/cirugía , Derivación Urinaria/métodos , Urotelio , Animales , Células Cultivadas , Femenino , Inmunohistoquímica , Modelos Anatómicos , Fenotipo , Porcinos , Porcinos Enanos , Ingeniería de Tejidos , Vejiga Urinaria/citología
7.
Proc Inst Mech Eng H ; 217(4): 311-6, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12885202

RESUMEN

Surgical reconstruction of the urinary bladder is performed on patients of all ages for a diverse range of conditions, including congenital abnormalities, bladder dysfunction, trauma and cancer. The most common material utilized to augment or replace the bladder during these procedures is a segment of the patient's own intestine. However, this procedure ('enterocytoplasty') is associated with significant clinical complications that arise due to the exposure of the epithelial lining of the intestine to urine. A number of alternative approaches are being actively developed to find a practical and functional substitute for native bladder tissue. These range from 'composite enterocystoplasty', where the de-epithelialized intestine wall is lined with bladder epithelial cells that have been propagated in vitro, to augmenting the urinary system with natural or synthetic biomaterials that may incorporate in vitro-propagated cells. However, if tissue-engineered products are to have therapeutic application in bladder reconstruction, a number of issues remain to be addressed; these issues are discussed briefly below.


Asunto(s)
Ingeniería de Tejidos/métodos , Trasplante de Tejidos/métodos , Trasplantes , Enfermedades de la Vejiga Urinaria/cirugía , Incontinencia Urinaria/cirugía , Órganos Bioartificiales , Humanos , Intestinos/trasplante , Procedimientos de Cirugía Plástica/métodos , Ingeniería de Tejidos/instrumentación , Trasplante de Tejidos/instrumentación , Enfermedades de la Vejiga Urinaria/complicaciones , Incontinencia Urinaria/etiología , Reservorios Urinarios Continentes , Urotelio/trasplante
9.
J Urol ; 167(2 Pt 1): 666-9, 2002 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-11792949

RESUMEN

PURPOSE: We document the inheritance pattern of multicystic dysplastic kidney in 3 affected families and screen first-degree relatives of a cohort of children with prenatally detected multicystic dysplastic kidney for renal anomalies. The study also afforded an opportunity to document the natural history of prenatally detected multicystic dysplastic kidney. MATERIALS AND METHODS: We identified 3 families during clinical treatment of children with prenatally detected multicystic dysplastic kidneys. Other members of these families were evaluated with renal ultrasonography. For the family screening study index cases were identified from a fetal uropathy database. A total of 94 first-degree relatives (52 parents, 35 full siblings and 7 half siblings) of 29 children with prenatally detected multicystic dysplastic kidneys were studied with urinary tract ultrasonography, blood pressure measurement, urinalysis and plasma biochemistry. RESULTS: Two families had affected sibling pairs, 1 of which also had a half sibling with vesicoureteral reflux. The third family included 3 individuals with multicystic dysplastic kidney and 1 with renal agenesis thought to have resulted from involution of multicystic dysplastic kidney. This family is consistent with autosomal dominant inheritance with variable expressivity and reduced penetrance. In the screening study ultrasonography did not demonstrate significant renal anomalies in any of the 94 first-degree relatives of the multicystic dysplastic kidney index cases. Followup assessment of prenatally detected multicystic dysplastic kidneys in index cases demonstrated total involution in 52% at a median age of 6.5 years with no multicystic dysplastic kidney related morbidity. CONCLUSIONS: Multicystic dysplastic kidney can be familial but is most commonly a sporadic anomaly. Formal screening of relatives is not recommended. Followup data on a cohort of children with prenatally detected multicystic dysplastic kidney add further support to conservative management.


Asunto(s)
Riñón Displástico Multiquístico/genética , Femenino , Humanos , Lactante , Masculino , Riñón Displástico Multiquístico/diagnóstico por imagen , Embarazo , Ultrasonografía Prenatal
10.
Prenat Diagn ; 21(11): 1004-11, 2001 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-11746155

RESUMEN

The prenatal detection of urinary tract anomalies is changing paediatric practice but in many areas the impact on clinical outcome remains difficult to quantify. However it is already apparent that termination of pregnancy has reduced the numbers of infants with lethal pulmonary hypoplasia and renal dysplasia who would previously have been liveborn but destined to succumb as neonates. Similarly, referrals of major non lethal abnormalities such as bladder exstrophy are declining as parents increasingly opt for termination. Fetuses at greatest risk of early onset postnatal renal failure can now be identified with considerable accuracy on prenatal ultrasound. Termination, prompted by quality of life considerations, could result in reduced numbers of infants and young children requiring end stage renal failure treatment in the first few years of life. Pre natal detection of anomalies such as PUJ obstruction and reflux undoubtedly provides an opportunity to avert functional deterioration and minimise urinary infection. But the proportion of children who genuinely benefit has proved difficult to assess. The prenatal detection of mild dilatation is of doubtful benefit in all but a minority of cases. Clinically significant underlying pathology is rare yet this common prenatal finding often generates disproportionate parental anxiety.


Asunto(s)
Enfermedades Fetales/diagnóstico por imagen , Ultrasonografía Prenatal , Sistema Urinario/anomalías , Enfermedades Urológicas/diagnóstico por imagen , Enfermedades Fetales/etiología , Enfermedades Fetales/patología , Enfermedades Fetales/terapia , Humanos , Tamizaje Masivo/métodos , Pronóstico , Resultado del Tratamiento , Sistema Urinario/diagnóstico por imagen , Enfermedades Urológicas/congénito , Enfermedades Urológicas/patología , Enfermedades Urológicas/terapia
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