Multi-institutional experience with PIC cystography--incidence of occult vesicoureteral reflux in children with febrile urinary tract infections.

Objectives: It has been reported that all children with febrile urinary tract infections (FUTIs) and normal voiding cystourethrogram (VCUG) findings show occult reflux (vesicoureteral reflux [VUR]) when examined by cystography performed with positioning of the instillation of contrast at the ureteral orifice (PIC cystography). In this study, we evaluated the reproducibility of this finding using a prospective multi-institutional collaborative examination to determine whether PIC-VUR is as common in such cases as previously shown.

Methods: From March 2002 to October 2003, four institutions performed PIC cystography consecutively and prospectively in pediatric cases of FUTI (greater than 101 degrees F) who had not shown VUR by conventional VCUG.

Results of 265 consecutive proximal hypospadias repairs using the Thiersch-Duplay principle.

Purpose: We review the evolution of the concept of tubularization of the urethral plate and our results in the repair of proximal hypospadias.

Materials And Methods: A total of 281 children born with proximal hypospadias underwent Thiersch-Duplay urethroplasty with or without a midline incision of the urethral plate between 1989 and 1998. Followup data were available in 265 children.

Prevention of renal fibrosis by spironolactone in mice with complete unilateral ureteral obstruction.

Purpose: Recent data suggest that aldosterone directly mediates cardiac fibrosis and hypertensive nephrosclerosis. We conducted experiments to determine whether administration of spironolactone, a mineralocorticoid receptor antagonist, reduced renal fibrosis in an experimental model of obstructive uropathy.

Materials And Methods: Complete unilateral ureteral obstruction (UUO) was created surgically in 8 to 10-week-old male C57BL/6 mice by placing sutures around the right ureter.

Infectious response to E. coli: molecular and genetic pathways.

Urinary tract infections are most commonly caused by type 1-piliated Escherichia coli (UPEC) and result in urothelial apoptosis, local cytokine release and neutrophil infiltration. A human urothelial cell line was incubated with various E. coli isolates and was then characterized by flow cytometry.

Efficacy and safety of the Healthtronics LithoTron lithotripter.

Purpose: To evaluate our experience with the LithoTron lithotripter (Healthtronics, Atlanta, GA), a dry portable system that utilizes a spark-gap electrode as an energy source.

Patients And Methods: We prospectively evaluated the first 312 treatments performed on 199 men and 99 women with an average age of 43.5 years (range 4 months-80 years), over a 25-month period between May 1999 and June 2001.

Chylous ascites following surgical treatment for wilms tumor.

Purpose: Postoperative chylous ascites is a rare complication of retroperitoneal surgery that has considerable morbidity. We review the pathogenesis and management of chylous ascites following surgical treatment of Wilms tumor.

Materials And Methods: We identified 9 children with chylous ascites after surgical treatment of Wilms tumor.

Single layered small intestinal submucosa in the repair of severe chordee and complicated hypospadias.

Purpose: Severe ventral chordee often accompanies proximal hypospadias. We describe our experience with single layered small intestinal submucosa (SIS), a commercially available, acellular, collagen based biomaterial, in the repair of severe chordee as part of a multistage approach to the repair of proximal hypospadias.

Materials And Methods: Between 2001 and 2002, 9 boys with proximal hypospadias (penoscrotal to perineal) and severe ventral chordee (greater than 40 degrees) underwent SIS grafting to correct the curvature.

Modified cecal flap neoappendix for the Malone antegrade continence enema procedure: a novel technique.

Purpose: We report our experience with the creation of a tubularized cecal flap to construct a neoappendix. This flap effectively serves as an alternative means of creating a conduit for antegrade continence enemas in patients who have either an absent or an unusable appendix.

Materials And Methods: We reviewed our results from our initial 4 patients in whom we used this technique.

The role of gadolinium enhanced magnetic resonance imaging for children with suspected acute pyelonephritis.

Purpose: The diagnosis of pyelonephritis is primarily clinical. However, the history and physical findings can be confusing in children, leading to adjunctive nuclear renal cortical scintigraphic studies (99mtechnetium dimercapto-succinic acid [DMSA]) to confirm the diagnosis. Nonetheless, ambiguity occurs when differentiating between acute pyelonephritis and chronic scarring.

Percutaneous hepatolithotomy: the Northwestern University experience.

Obstruction of intrahepatic ducts by calculi can lead to abdominal pain, cholestasis, abscesses, and cholangitis. Patients with stones recalcitrant to extraction using endoscopic retrograde cholangiopancreatography (ERCP) have traditionally been referred to a general surgeon for open stone extraction or hepatic lobectomy despite its great potential morbidity. Borrowing techniques, instrumentation, and experience in performing percutaneous nephrolithotomy, we describe our experience with percutaneous hepatolithotomy (PHL), a minimally invasive, safe, and effective alternative to open surgery for recalcitrant biliary stones.

Extracorporeal shock wave lithotripsy of pancreatic duct stones using the Healthtronics LithoTron lithotriptor and the Dornier HM3 lithotripsy machine.

Purpose: Pancreatic duct stones, which are most often a result of alcohol induced chronic pancreatitis, can lead to chronic abdominal pain, pseudocysts, and exocrine and endocrine failure of the pancreas. Others have reported success using extracorporeal shock wave lithotripsy (ESWL) (Dornier Medical Systems, Inc., Marietta, Georgia) for pancreatic stones.