Non-invasive localized deep microwave hyperthermia was applied as an alternative treatment to surgery in 29 patients with contraindications for prostatectomy. Patients were treated twice weekly, on Mondays and Thursdays, for 1 hour, without sedation on an outpatient basis. All patients tolerated treatment well without secondary effects. The results indicate that localized deep microwave hyperthermia applied by this method is safe and effective in the treatment of benign prostatic hyperplasia.
Experience is described of 41 infants and children with duplex-system ureteroceles, 25 presenting clinically and 16 by prenatal ultrasonography. Bladder outflow obstruction was rare but lower polar vesicoureteric reflux (VUR), usually of lesser grades, was common. Upper polar function, as assessed by 99mTc-DMSA, was negligible in children with truly ectopic ureteroceles but well preserved in those where the lesion lay wholly intravesically. Lower polar function was good, even in the presence of secondary obstruction, except in 2 infants with major VUR. Twenty-three patients were treated by upper polar nephrectomy plus aspiration of the ureterocele; 2 subsequently required ureterocele excision. Histology of excised specimens indicated that a more conservative approach would not have been rewarded. Where upper polar function was good, conservation was maintained in 3 cases by pyelopyelostomy and in 5 more by excision of the ureterocele plus bipolar ureteric reimplantation. Other operative strategies were employed in 2 cases. Finally, a defined group of 8 children was managed expectantly without untoward results. It was concluded that the variable anatomy and function associated with duplex-system ureteroceles require a flexibile approach to treatment, including, possibly, no treatment at all.
Simple renal cysts are rare in children although numbers detected have increased of late owing to ultrasonography. Where the lesion is asymptomatic and the diagnosis is not in doubt, an expectant approach is appropriate, but other circumstances may call for active intervention. We describe their treatment by sclerotherapy. Between the years 1986 and 1990, 2880 renal ultrasound scans were performed on children referred to the Department of Urology. Sixteen renal cysts were identified in 16 patients, an incidence of 0.55%. In two cases symptoms were considered to be related to the cysts and in two further cases ultrasonography could not exclude other lesions. This female child presented at 4 years of age with episodic left hypochondrial pain. Intravenous urography (IVU) suggested a space-occupying lesion within the left upper renal pole, which ultrasonography confirmed as a simple, 4 cm × 4 cm cyst (Fig. 1a).
Among 108 consecutive patients with myelomeningocele aged 5-12 years initiaily treated by a selective policy, seven (6-5%) achieved spontaneous urinary continence, five with normal micturition and two with urgency. AlU had positive conus reflexes and incomplete cord lesions which, with one exception, comprised motor as weli as sensory sacral sparing.Neuropathic bladder, with urinary incontinence and the risk of renal complications, is a major problem for patients with myelomeningocele and especially for those with smaller lesions whose handicaps otherwise tend to be slight. Reports Among the 11 patients reviewed clinically, four had gross urinary and faecal incontinence. Five had an entirely normal pattern of micturition by day although one had primary nocturnal enuresis. Two children were fully continent but had marked urgency of micturition.Neurological examination ofthe seven children with spontaneous daytime urinary continence showed a primary neurological level (that to which motor and sensory functions were entirely normal) ranging from L3 to S2. All had positive conus reflexes and an incomplete cord lesion which, except for one girl with urgent micturition, comprised motor as well as sensory sparing in the second to fourth sacral segments. None had suffered symptomatic urinary infections; recent ultrasound examinations or intravenous urography had shown normal upper renal tracts. Bowel habit was normal in all cases.The incidence of spontaneous urinary continence in relation to the anatomical level of the cord lesion was thoracolumbar 0/8, lumbar 3/44 (7%), lumbosacral 3/39 (8%), and sacral 1/16 (6%). DiscussionThe incidence ofspontaneous urinary continence in the present series, 6-5%, is far less than that previously claimed of children treated by nonselective' 2 or selective3 policies and lesser still when considering those with entirely normal daytime micturition.Normal urinary control would be expected only of patients with positive conus reflexes and incomplete cord lesions with both motor and sensory sacral sparing, as were the findings in the present series. Incomplete cord lesions are quite common with sacral and lumbosacral myelomeningoceles but unusual with lumbar and exceptional with thoracolumbar lesions. As a rule there is only sensory sacral sparing and when this is accompanied by positive conus reflexes a precarious form of urinary control may be achieved but one which is undoubtedly abnormal.5 Urgent micturition is associated with detrusor hyperreflexia and detrusorsphincter dyssynergia; residual urine is common and upper renal tract complications may develop. A few patients with a combination of detrusor areflexia and moderate urethral resistance manage to stay more or less dry by regular voiding by abdominal straining or compression. Possibly previous reports included as having normal urinary control some patients precariously continent by these abnormal means, others where the casenotes were inaccurate 640 on 12 May 2018 by guest. Protected by copyright.
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