Bladder diverticula in children - a clinical, radiologic and endoscopic study.

We have described the clinical, radiologic and endoscopic findings in 84 children with bladder diverticula and 9 children with posterolateral pouch-like protrusions of the bladder wall. Cystoscopically, a new bladder diverticulum is described, resembling a walnutshell. The majority of children had symptoms of urinary tract infection, the walnutshell-like diverticula was frequently associated with haematuria. In 66 or 84 children with bladder diverticula and in 9 children with posterolateral pouches no obstruction of the lower urinary tract was found. Diverticula caused by obstruction were found in 18 cases. Vesicoureteral reflux was present in 34 of 66 children with diverticula without obstruction of the lower urinary tract, in 20 of these there were saccules (diverticula smaller than 2 cm in diameter). Vesicoureteral reflux was found in 8 of 9 children with posterolateral pouches of the bladder wall. Long term follow-up suggests that any protrusion of the bladder wall, regardless of the size of cavity and the shape of the opening, may become a diverticulum associated with further abnormalities of the urinary tract. In 3 patients with postero lateral pouches a transformation from pouches into true diverticula together with the development of vesicoureteral reflux was observed.

Plasma renin activity and plasma aldosterone concentration in infants with various sodium intakes.

Plasma renin activity (PRA) and plasma aldosterone concentration (PA) were measured in 20 healthy infants 2-12 months of age, after taking a commercial modified cow's milk formula with 8.2 mmol/l sodium for at least five days, and after at least five days on a home-made, undiluted acidified cow's milk formula with 12.6 mmol/l sodium. The mean sodium intakes were 1.20 and 1.87 mmol/kg of body weight per day respectively. The arithmetic means for the corresponding PRA were 6.16 and 1.08 ng/ml . h (difference not significant) and the corresponding arithmetic means for PA were 603 and 355 pg/ml, the difference being highly significant (P less than 0.01). It is concluded that one has to consider the sodium intake in the milk formula when studying plasma aldosterone in infancy.

Cystitis cystica: characteristics of the disease in children.

Cystitis cystica was found at cystoscopy in 157 children between the ages of 9 1/2 months and 14 years. Girls were affected much more often than boys, the proportion being 153 to 4. Urinary infection, most commonly caused by E. coli, was almost invariable. Urinary tract anomalies, in particular vesico-ureteric reflux, were frequently present. Histologically, the cysts were composed of submucous aggregations of lymphoid tissue. Cystitis cystica affecting the ureteric orifices may contribute to the occurence of reflux and involvement of the bladder neck may produce some degree of vesical outlet obstruction.

Antireflux ureterocystostomy at the vertex of the bladder.

This is the first report on the technique and the results of an antireflux ureterocystostomy in the vault of the bladder. During the last 3 years, a total of 106 antireflux ureterocystostomies at the vertex of the urinary bladder has been performed. In 93 cases without another preceding antireflux operation, only 2 (2-1%) recurrent refluxes were found, whereas in 13 cases where an antireflux operation had been performed previously, 4 cases of recurrent reflux were seen, making a 30% rate of operative failure in this particular group. In all other cases the end result was excellent; the urine has become negative on culture and the dilatation of the ureter has subsided.