Cases reported "Vesico-Ureteral Reflux"

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11/220. Multiple pelvoureteric diverticulosis in a 1-month-old infant with a del(10p) chromosomal abnormality presenting with UTI and VUR.

    A 1-month-old girl with a del(10p) chromosomal abnormality presented with a febrile urinary tract infection. Radiographic voiding cystourethrography demonstrated bilateral vesicoureteral reflux and multiple pelvoureteric diverticula ranging in size from 2 to 5 mm. Pandiverticulosis of the urinary tract in a child of this age has not been previously reported.
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keywords = reflux
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12/220. hypothyroidism mimicking chronic renal failure in reflux nephropathy.

    An adolescent with a history of pyelonephritis and renal scarring had antireflux surgery at the age of 2.5 years. His serum creatinine was high at the age of 14 years (133 micromol/l; glomerular filtration rate (GFR) 56 ml/min x 1.73 m(2)), and reflux nephropathy with chronic renal failure was diagnosed. Because of a fall in height velocity, endocrinological investigations were performed six months later which showed hypothyroidism caused by autoimmune thyroiditis. Substitution with thyroxine was started; renal function improved to normal six months later (GFR 108 ml/min x 1.73 m(2)). Metabolic changes of hypothyroidism led to a reduction of GFR in this patient and mimicked chronic renal failure.
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13/220. The so-called megaureter-megacystis syndrome.

    Megaureter-megacystis describes the appearance of the urinary tract in children with massive primary vesicoureteric reflux and it sequellae. The initial symptoms, radiographic findings, diagnostic misconceptions, and treatment for 22 male children are discussed. Incorrect diagnoses, including obstruction, neurogenic bladder dysfunction, and "megacystis," were made in 16 children; treatment was inappropriate in 14. In only eight boys were diagnosis and treatment prompt and correct.
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14/220. Unilateral tibial agenesia with preaxial polysyndactyly and renal disorder in two patients: a new syndrome?

    Left tibial agenesis, polysyndactyly with talipes equinovarus deformity and Grade IV vesicoureteral reflux of the right kidney are described in a 40-day-old male and an unrelated 1-month-old male, is also reported with right tibial agenesis, polysyndactyly with talipes equinovarus deformity and right kidney agenesis and left Grade V vesicoureteral reflux. No other pathology was recorded. Follow up at 1 year and 3 years, respectively, revealed normal motor and mental development. As this combination has been unpublished before, we believe that this a new syndrome.
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keywords = reflux
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15/220. Familial inheritance of crossed fused renal ectopia.

    A family with dominant inheritance of a rare renal malformation is reported. The father and one son had left crossed fused ectopic and dysplastic kidneys and another son had a horseshoe kidney and vesicoureteral reflux. We discuss various potential pathogenetic mechanisms and propose that a defect in the timing of the proper reciprocal induction of the ureteric bud and the metanephric blastema is involved.
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16/220. Renal scars masquerading as complex masses in a patient with vesicoureteral reflux nephropathy.

    Vesicoureteral reflux can lead to chronic pyelonephritis, renal scarring, and renal failure. We present a case of renal scarring masquerading as bilateral, complex renal masses. A 35-year old woman who was diagnosed with vesicoureteral reflux as a child presented for evaluation of recently developed hypertension and an abnormal renal ultrasound. Her serum creatinine level was 2.5 mg/dL and she had subnephrotic-range proteinuria. A renal sonogram showed small, echogenic kidneys and bilateral complex renal masses of 3.8 (right) and 4.4 (left) cm in greatest dimensions. CT scan of the kidneys revealed slightly contrast-enhancing masses with irregular walls. Renal angiogram showed decreased blood supply to the areas coinciding with the masses consistent with renal scarring. There was no increased vascularity. This case demonstrates that renal scarring may masquerade as renal masses. A step-wise, comprehensive approach is necessary to rule out potentially malignant lesions in these patients.
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ranking = 6
keywords = reflux
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17/220. Covering of the terminal ureter with de-serosalized muscle layer of the ileum for antireflux ureteroileostomy: an experimental study in dogs and a preliminary clinical trial.

    We demonstrated a new operative technique for antireflux ureteroileostomy in dogs. The severed ureter was reimplanted into the isolated ileum. Ten terminal ureters were covered with a 2 x 2 cm2 section of de-serosalized ileal wall after direct ureteroileostomy, and another six terminal ureters were covered with a 2 x 2 cm2 section of non-de-serosalized full-thickness ileal wall. Thirteen ureters were directly anastomosed to the ileum without any additional procedures. The bladder was augmented by the detubularized ileum with the ureter. Postoperative evaluations on ureteral stenosis and reflux were performed monthly for 3 months. The ureters covered with the de-serosalized ileal wall prevented ureteral reflux even when the intravesical pressure climbed as high as 100 cm H2O. Although two of these ten ureters demonstrated strictures at the precise site of direct ureteroileostomy, the sections of the ureters covered with the de-serosalized ileal wall were opened and did not collapse. In the resected specimens, the terminal ureters were found in the intramural part of the ileum. The ureters covered with the full-thickness of ileal wall did not prevent reflux. Our method of covering the terminal ureter with the de-serosalized ileal wall worked well as an antireflux mechanism, and the intramural ureter did not cause ureteral stricture. After this animal experiment, we introduced this antireflux mechanism clinically.
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ranking = 10
keywords = reflux
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18/220. The silent neurogenic bladder.

    Children with occult or silent neurogenic bladders may present with urinary reflux and severe upper urinary tract deterioration. Commonly, the neuro-deficit eludes detection. Reimplantation of these ureteral units will likely result in failure.
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ranking = 1
keywords = reflux
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19/220. Outcome of the distal ureteric stump after (hemi)nephrectomy and subtotal ureterectomy for reflux or obstruction.

    OBJECTIVE: To assess the outcome of the distal ureteric stump (DUS) after (hemi)nephrectomy with subtotal ureterectomy. patients AND methods: The records of 89 patients (median age 2.7 years, range 0.25-12) who underwent nephrectomy (24) or heminephrectomy (65) with subtotal ureterectomy between 1982 and 1996 were reviewed retrospectively for symptoms caused by the DUS. The mean follow-up was 9.8 years. nephrectomy was undertaken for a poorly functioning dysplastic (in nine), scarred (in 10) or hydronephrotic (in five) kidney, and heminephrectomy for a poorly functioning upper moiety associated with ectopic ureterocele (in 26) or stenotic hydroureter (in 15), or for a poorly functioning lower moiety associated with reflux (in 24). There were 38 refluxing and 51 non-refluxing ureteric stumps. Two additional patients primarily operated elsewhere were referred with DUS symptoms. RESULTS: Only one patient had a symptomatic DUS, with recurrent haematuria and bacteriuria. The two patients referred from elsewhere presented with febrile UTIs. The first had been left with a long refluxing stump opening ectopically into the urethra, and the second with a long stump which was converted from nonrefluxing to a refluxing stump when he developed dysfunctional voiding. Surgical excision of the distal stump was curative in each case. CONCLUSIONS: The risk of a symptomatic DUS in patients who undergo subtotal ureterectomy in conjunction with (hemi)nephrectomy is very low, with no difference between refluxing and nonrefluxing stumps. Long ureteric stumps and dysfunctional voiding may cause symptoms. Because of the low morbidity associated with a short ureteric stump, we recommend subtotal ureterectomy in children who undergo (hemi)nephrectomy for reflux, vesico-ureteric obstruction or ectopic ureterocele associated with a poorly functioning kidney or kidney moiety.
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ranking = 13
keywords = reflux
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20/220. Megacystis secondary to myenteric plexus pathology. Presentation of two cases.

    Herein, 2 cases of megacystis secondary to myenteric plexus pathology are reported. Unlike the entity of visceral myopathy, there was ganglion cell loss both in the bladder and in the colon of these 2 cases. Moreover, they did not present any gastrointestinal symptoms. Megacystis was the common pathology in these patients, whereas 1 of them suffered from unilateral vesicoureteral reflux. We could not find any similar report dealing with this phenomenon up to this time in the literature.
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ranking = 1
keywords = reflux
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