How and when the B.1.1.7 variant originated is unclear as it is not phylogenetically related to other COVID-19 viruses circulating at the time B.1.1.7 was found in the United Kingdom. Within a few weeks, it replaced all
SIMPLE exclusion or treatment of obstructive pathology in the urinary tract may no longer be considered the sole purpose of urological management of patients with recurrent infection or chronic pyelonephritis. The increasing number of reports of the association of vesico-ureteric reflux with atrophic chronic pyelonephritis might indicate that the diagnosis and eradication of possible primary septic foci in the lower urinary or genital tracts should be more vigorously pursued in order to reduce the incidence of ascending renal infection.The present paper reports the results of a urological survey of a consecutive series of patients who presented with urinary tract infection and in whom no evidence of organic obstruction or neurogenic disturbance could be demonstrated. As far as possible the analysis of the findings was approached without preconceived direction or bias so that any emergent pattern which could be significant in the natural history of chronic pyelonephritis would not be obscured.Materials and Methods.-The series comprised 200 female and seven male patients whose ages ranged from 3 weeks to 72 years with a representative scatter through the individual decades as shown in Figure I . The few male patients either presented as pzdiatric problems or were found to have radiological evidence of non-obstructive chronic pyelonephritis. A much larger group of male patients with prostatitis was not considered for analysis.Ascending cinecystography usually preceded the endoscopy and was undertaken in the Urological Diagnostic Theatre so that the examination of the patient was generally accomplished in a single visit. Ascending urethrography was carried out when urethral diverticulum formation was suspected either at urethroscopy or on palpation of the urethra and when urethritis proved intractable. Retrograde pyelograms were taken in any patient in whom excretory pyelograins were not considered to be diagnostic.Cysto-urethroscopy was carried out by the same urologist in each case.
RESULTSThe results of the survey were broadly grouped into three categories according to the I . Normal renal outlines and pelvicalyceal systems. 2. Mild changes of renal cortical scarring or calyceal clubbing or distortion, indicative of 3. Moderate or gross changes of chronic pyelonephritis. pyelographic findings as follows :chronic pyelonephritis. Symptoms.-Sixteen patients (8 per cent.) presented without symptoms referable to the urinary tract whilst sixty-eight patients (33 per cent.) presented with hzcmaturia alone or with other urinary
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