Urinary tract infection in girls. I. A computerized analysis of urethral stenosis

Recent trends of genitourinary endoscopy in children

Downsizing and refinement of the pediatric endoscope in video-monitoring systems have facilitated genitourinary endoscopy even in small children without any traumatic instrumentation. Indications for endoscopy in children with hematuria or tractable urinary tract infection have been tailored for the rareness of genitourinary malignancy or secondary vesicoureteral reflux (VUR) as a result of infravesical obstruction. Most mechanical outlet obstructions can be relieved endoscopically irrespective of sex and age. Endoscopic decompression by puncture or incision of both intravesical and ectopic ureteroceles can be an initial treatment similar to open surgery for an affected upper moiety. Endoscopy is necessary following urodynamic study to exclude minor infravesical obstruction only in children with unexplained dysfunctional voiding. Genitourinary endoscopy is helpful for structural abnormalities before and at the time of repairing congenital urogenital anomalies. Endoscopic injection therapy of VUR has been established as a less invasive surgical treatment. Pediatric endoscopy will play a greater role in the armamentarium for most pediatric urological diseases through the analysis of visual data and discussion on the indications for endoscopy throughout the world.

The wide bladder neck and posterior urethra in childhood

Involvement of anomalies of the bladder and urethra in recurrent urinary tract infections and micturition disorders in children are examined in the light of published evidence and of the authors' own observations. The data of 300 children followed up for a wide bladder neck and posterior urethra at the Nephrology Clinic of Heim Pál Children's Hospital, Budapest, are reviewed. The dilatation in question is regarded as functional, attributable to a congenital neurogenic or myogenic defect. For the management and prevention of the recurrent ascending infections long-term urinary disinfection and meticulous toilet of the external meatus are recommended. The symptoms are expected to subside spontaneously at the age of menarche. The importance of a close nephrologic follow-up is emphasized.

Effect of hormonal deprivation on the bladder defense mechanism

The mucopolysaccharide (MPS) layer of the bladder has been implicated as a bacterial anti-adherence factor in previous experimentation. Production of MPS is known to be related to hormones in other systems of the body and probably to the urinary system. Due to the known rising incidence of urinary tract infection in most menopausal females, an experimental model using oophorectomized rabbits was designed. Oophorectomized and control rabbits were observed for their ability to clear their bladder of experimentally induced Escherichia coli 04 infections. There was a 2-fold increase in the mean number of days for clearance of bacteria among oophorectomized rabbits versus control rabbits. Twice as many rabbits cleared their infection within 1 week in the control population versus the oophorectomized population. To further examine the relationship of oophorectomy to urinary tract infection, a group of 1030 female canines in an animal veterinary practice was studied. It was found that the incidence of infection was higher in the spayed population than in the non-spayed group. The non-spayed group seem to have an age dependent history of urinary infection whereas ovariohysterectomy appeared to abolish this relationship to age.

Cystourethritis

We believe this review lists the major factors and mechanisms considered responsible for producing cystourethritis. Knowledge of these factors and mechanisms is essential before effective investigation of this disease can be undertaken. We suggest a rational scheme for investigation of these patients. We believe successful treatment depends on establishing the probable cause in each individual patient. In view of the multifactorial etiology of the disease, attempts to find a single effective medical or surgical therapy will be doomed to failure.