Calyx to parenchyma ratio in pelvi-ureteric junction obstruction.

OBJECTIVE: To review the ultrasonography of patients who had undergone pyeloplasty for pelvi-ureteric junction (PUJ) obstruction, and document the changes in calyceal distension and parenchymal thickness after pyeloplasty, to attempt to establish an additional prognostic indicator. PATIENTS AND METHODS: Fifty-eight patients who underwent pyeloplasty for PUJ obstruction were assessed retrospectively. Pre- and postoperative ultrasonograms were analysed for both pyelocaliectasis, graded according to the Society for Fetal Urology criteria, and the ratio of the depth of calyces to the thickness of the parenchyma (C/P ratio). Patients underwent nuclear medicine renography before and 3 months after pyeloplasty. The results were analysed using the paired t-test, Kruskal-Wallis test, Spearman's correlation coefficient by rank test and the Mann-Whitney U-test. RESULTS: There was no significant difference in hydronephrosis grade before and after surgery (P < 0.05) but there was a significant difference in the C/P ratios (P < 0.01). There was no correlation between C/P ratios and the results of diuresis renography. CONCLUSION: Hydronephrosis as measured by an estimate of pelvic volume is an insensitive marker of improvement after pyeloplasty. Reduced calyceal distension correlates well with other favourable prognostic indicators. Therefore, the C/P ratio may be an additional indicator of the appropriateness of surgical intervention, and should be the subject of further study.

The clinical and radiological findings in boys with endoscopically severe congenital posterior urethral obstruction.

OBJECTIVE: To assess the clinical and radiological spectrum in boys with endoscopically severe posterior urethral obstruction, as there is a broad clinical spectrum which does not always correlate with the cystoscopic findings. PATIENTS AND METHODS: Between December 1990 and July 2000, 39 boys (newborn to 12 years old) underwent cystoscopy to investigate a urethral anomaly and were found to have a severe obstructing posterior urethral membrane. Their voiding cystograms, video-recorded cystoscopy and presenting signs were reviewed. RESULTS: Of the 39 boys assessed, a voiding cystogram and presenting signs were available in 36. Of these 36 boys, three cystograms were initially reported as normal, eight showed posterior urethral dilatation as the only feature, and the remainder had more severe bladder and upper tract changes. Fourteen were diagnosed after identifying antenatal hydronephrosis, four presented with voiding dysfunction, one with haematuria and 17 were found after investigation of a urinary tract infection. CONCLUSIONS: This study shows that a congenital posterior urethral membrane that has only a small posterior defect endoscopically can have a wide clinical and radiological spectrum. The difference in outcome may be caused by variations in the response of the bladder to the obstruction, resulting in a different effect on the upper tracts.

Congenital posterior urethral membrane: variable morphological expression.

PURPOSE: We assessed the variable morphological expression of posterior urethral membrane by reviewing video recorded cystoscopy. MATERIALS AND METHODS: Between December 1990 and July 2000, 86 males newborn to 15 years old undergoing cystoscopy for urethral anomalies were identified with a posterior urethral membrane. Recorded cystoscopy was reviewed and membrane degree was graded as minimal, moderate or severe. RESULTS: Of the 86 boys with a membranous lesion in the posterior urethra the condition was considered severe in 40, moderate in 21 and minimal in 21. Four patients on whom data were too inadequately recorded to be properly classified were excluded from study. CONCLUSIONS: This study demonstrates that congenital posterior urethral membrane represents a spectrum of lesions and may vary in the degree of obstruction.

Rectal mucosal biopsy compared with laparoscopic seromuscular biopsy in the diagnosis of intestinal neuronal dysplasia in children with slow-transit constipation.

BACKGROUND/PURPOSE: Intestinal neuronal dysplasia (IND) as a cause for severe chronic constipation remains controversial. The aim of this study is to examine the correlation between a deficiency of substance P (SP) immunoreactive nerve fibers in the colon and enzyme histochemistry of rectal biopsies in children with slow-transit constipation. METHODS: Fifty children with intractable constipation have been assessed by rectal biopsies examined with histochemical staining for lactate dehydrogenase, and 32 children among those 50 have been studied by laparoscopic seromuscular biopsy of the colon labelled with antibodies to SP using immunofluorescence methods. RESULTS: Four children have evidence of IND. Fifteen children, including all 4 IND cases, showed a deficiency of SP immunoreactivity. There is a significant correlation between giant ganglia and SP deficiency (P <.01). CONCLUSION: This study is attempting to propose that a deficiency of SP immunoreactivity in colonic circular muscle nerves may be used as a histologic marker for slow-transit constipation and that IND may be a small subset of patients with SP deficiency.