Upper tract dilatation

Vesicoureteric Reflux with Upper Tract Dilatation 246... 

The main dilemma in the investigation of upper urinary tract dilatation is to distinguish between dilatation with obstruction, dilatation with no obstruction and dilatation associated with vesicoureteric reflux (VUR). At times the obstructive cause is obvious, e.g., duplex kidney with upper moiety dilatation due to a ureterocele or upper tract dilatation... 

After birth it is essential to resuscitate the child when necessary, make urine drainage free, and destroy the valves. Follow-up in all patients should include yearly imaging using sonography to assess upper tract dilatation, drainage, and residual bladder volume. Renal functional imaging is also necessary. 

Riccabona M (2004) Pediatric MRU-Its potential and its role in the diagnostic work-up of upper urinary tract dilatation in infants and children. World J Urol 22 79-87... 

There are no contraindications to IRC however, caution should be exercised in excluding VUR when there is dilatation with poor drainage of the upper tracts. Also in the presence of a pelvic kidney or a low ectopic kidney, the full bladder may obscure the kidney. 

In all children with a horseshoe kidney, VUR should be excluded. The upper urinary tract dilatation may be secondary to VUR (Fig. 4.2d). More than 100 renal malignancies have been reported in patients with horseshoe kidney (Buntley 1976). The risk of developing a Wilms tumor increases sevenfold in patients with a horseshoe kidney (Mesrobi an etal. 1985). 

Herbetko J, Hyde 1 (1990) Urinary tract dilatation in constipated children. Br J Radiol 63 855-857 Higashi TS, Takizawa K, Suzuki S et al (1990) Mullerian duct cyst US and CT spectrum. Urol Radiol 12 39-44 Hilton S, Kaplan GW (1995) Imaging of common problems in urology. Urol Clin N Am 22 1-20 Ho DS, Jerkins GR, Williams M et al (1995) UPJ obstruction in upper and lower moiety of duplex renal systems. Urology 45 503-506... 

Upper Urinary Tract Dilatation in Newborns and Infants... 

Other etiologies for urinary tract dilatation include duplex kidneys complicated by a dilatation of the upper or the lower pole (Abuhamad et al. 1996 Vergani et al. 1999). Such anomalies can be associated with an ectopic extravesical ureter (Fig. 13.12) or an ectopic ureterocele (Fig. 13.13), which can be demonstrated in utero. 

Functional obstruction is the central problem in nonneurogenic bladder-sphincter dysfunction. Bladder distortion, VUR, upper urinary tract dilatation, UTI and reflux nephropathy are potential consequences. 

Altogether, it should be underlined that a slightly modified VCU technique allows the diagnosis of unstable bladder (overactive bladder) to be made in centers without urodynamic facilities with similar accuracy. Therefore, modified VCU is recommended in all children for the evaluation of symptoms of persistent and severe nonneurogenic bladder-sphincter dysfunction, in particular with (febrile) UTI and breakthrough infections and in all neonates and infants for the evaluation of upper urinary tract dilatation and extended ultrasound signs indicative of VUR. 

Indeed, due to the rapid advances in imaging modalities and technology, as well as new therapeutic procedures, an update was needed on several important areas of pediatric urology such as vesicoureteric reflux, urinary tract infection and upper urinary tract dilatation. 

Dedicated chapters are devoted to specific problems of the newborn and infant, such as imaging and interpretation of upper urinary tract dilatation, postnatal imaging of fetal uropathies, associated urinary problems with imperforate anus, epispadias... 

As such they increase eardiae output, dilate bronehioles, and usually produee eonstric-tion of blood vessels, hi medicine, they are eommonly prescribed in eardiae emergencies including shock and anaphylaxis, in some cases for weight loss, and in cold remedies, where they shrink swollen membranes in the upper respiratory tract. 

ACUTE HEALTH RISKS irritation of eyes, nose and throat irritation of mucous membranes of upper respiratory tract coughing burning in the throat and chest tightness of the chest shortness of breath sleeplessness restlessness dyspnea cyanosis pulmonary edema drowsiness loss of consciousness congestion in the throat and bronchi arterial dilation fall in blood pressure headache, dizziness methemoglobinemia death. 

ACUTE HEALTH RISKS irritation of eyes and upper respiratory tract severe eye and skin bums severe gastrointestinal irritation bloody diarrhea liver damage skin eruptions oli-gurua circulatory collapse photophobia with myosis dilation of pupils retinal hemorrhage congestion of blood vessels coma convulsions death. 

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