Comparison of different substances for subureteric injection in the management of vesicoureteric reflux in children.

INTRODUCTION: Endoscopic techniques are becoming increasingly accepted for treatment of vesicoureteric reflux as alternatives to open surgical reimplantation. However, there is some debate about the ideal injectable material. Since we have accumulated experience with several substances, an opportunity existed to compare them. MATERIALS AND METHODS: From 1991 to 2003, 101 children with vesicoureteric reflux were treated by endoscopic subureteric injection either once (74) or twice (27) by either of two pediatric urologists. There were a total of 165 ureteral injections, 83 with polytetrafluoroethylene (Teflon), 73 with polydimethylsiloxane (Macroplastique), and 9 with collagen. Each child was evaluated pre-operatively and 3 months post-operatively with a nuclear cystogram and renal ultrasonography. RESULTS: The polytetrafluoroethylene and polydimethylsiloxane groups were not significantly different with respect to sex, age, indication for surgery, severity of reflux or prior surgeries. The collagen group overall did very poorly with only 3 of 9 refluxing ureters cured. The other two substances had much more success with 61% of ureters in the polytetrafluoroethylene group cured on first injection and 75% with polydimethylsiloxane, plus another 19% and 11% cured on second attempt, respectively (total 80% and 86%). CONCLUSIONS: Subureteric injections of polytetrafluoroethylene and polydimethylsiloxane are very effective at curing vesicoureteric reflux in children with little morbidity. When comparing individual cases, ureters, and all grades of reflux, polytetrafluoroethylene and polydimethylsiloxane have similar success rates. Collagen injections were less successful, and patients with neurogenic bladders had poor results.

MCDK not excluded by virtue of function on renal scan.

INTRODUCTION: The conservative management of multicystic dysplastic kidneys (MCDK) has been very successful, largely due to advances in diagnostic imaging. Classically, MCDK is described as a non-functioning cystic renal mass. However, we noticed that the increasing sensitivity of renal scans is able to demonstrate function in MCDK that previously would not have been detected. METHODS: We describe eight cases of MCDK with elements of function on renal scan, and their follow up. RESULTS AND CONCLUSIONS: One half (4/8) of these children underwent nephrectomy, and histology was consistent with MCDK. The remaining 4/8 were successfully followed to radiographic involution, without any complications. Therefore, we believe that minimal function on nuclear scintigraphy does not preclude the diagnosis of MCDK, and is yet another adjustment in our understanding of this entity.

Evaluation of a non-invasive method to determine bladder volume in children.

Although urethral catheterization is the "gold standard" for accurate bladder urine volume measurement in all patients, the discomfort associated with its use makes it less than ideal in pediatric urologic practice. Portable ultrasound scanners have been demonstrated to be an acceptable alternative in adults in several studies, but little data exists on their use in children. A portable ultrasound scanner that automatically calculates the bladder urine volume was used for 40 separate determinations and correlated with bladder urine volume measured by urethral catheterization (coefficient of correlation = 0.759). The scanner is reasonably accurate, well-tolerated and a useful alternative to urethral catheterization for measuring bladder urine volume.