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Urinary Tract Infection

The UCSF pediatric urology team has a major interest in studying children with urinary tract infection. We maintain an ongoing prospective database containing information from children treated for urinary tract infection. The database is sponsored by the Pediatric Clinical Research Center; associated studies have analyzed the outcomes of children with urinary tract infection and have identified risk factors. Abnormalities or scarring on renal scans (99mTc-DMSA) predict a higher risk of recurrent urinary tract infection and a decreased change of vesico-ureteral reflux resolution. Results from these studies have been published and are presently in use in our clinical practice.

 

DMSA scan (renal scan)

Severe vesico-ureteral reflux and scarring documented by DMSA renal scan.


 


Hypospadias and Genital Reconstruction

We have extensive operative experience in the management of hypospadias and genital reconstruction. Our basic anatomical studies have lead to nerve sparring surgical reconstructive procedures for the correction of penile curvature. These are described in numerous publications that cover all aspects of hypospadias and genital reconstruction. Please visit the Center for the Study & Treatment of Hypospadias's website for more information.

Urinary Tract Reconstruction: Incontinence, Myelomeningocele (Spina Bifida) and Pediatric Tumors

The UCSF pediatric urology team maintains a large surgical practice in pediatric urologic reconstruction involving the treatment of patients with voiding dysfunction, posterior urethral values, reflux of urine and urologic tumors. We direct the urologic care of a large population of patients with myelomeningocele (Spina Bifida). Our group has authored numerous publications about reconstructive urology. We have completed a study, sponsored by the Pediatric Clinical Research Center, on the long-term consequences of bladder augmentation achieved by placing intestinal tissue in the urinary tract. Our results show that children with intestinal augmentations do not suffer growth retardation or severe metabolic abnormalities.

The Anatomy and Embryology of Posterior Urethral Valves

Posterior urethral valves (PUV) are a common cause of lower urinary tract obstruction in male infants and the most common congenital cause of bilateral renal obstruction. Their incidence is estimated at 1 in 5000-8000 male births, but may in fact be more common due to fetal demise. We histologically analyzed the anatomy of posterior urethral valves. Findings revealed an oblique membrane causing obstruction at the level of the posterior urethra, emanating from the distal verumontanum and attaching further distally to the roof of the urethra. Three dimensional reconstruction revealed two lumens separated by this membrane. Conceptually it may be easiest to think of this as two lumens, one dorsally and one ventrally. The ventral lumen begins at the glanular urethra and, moving proximally towards the bladder, becomes narrower posteriorly to a point of obliteration at the level of the verumontanum. The dorsal lumen, starting at the bladder and moving distally, becomes narrower anteriorly to a point of obliteration distal to the verumontanum at the anterior urethral wall We hypothesize that the severity of the membrane or persistence of the urogenital membrane is variable, consistent with the differential presentation of posterior urethral valves. The ventral and dorsal non-intersecting lumens are separated by the membrane which in some cases may be totally obstructing, such as in those infants with severe renal sequelae, or only mildly obstructing as in cases with normal renal function. Passing of an imaginary microscopic catheter into the ventral lumen would end blindly at the level of the verumontanum. In reality when a feeding tube or catheter is passed the oblique membrane or Congenital Obstructive Posterior Membrane is ruptured breaking into the ventral lumen and changing the membrane into the appearance of the a classic value. Neonatal patients that have been diagnosed with PUV and require extensive urethral catheterization secondary to sepsis or pulmonary issues prior to the PUV resection may have little “value” left at the time of surgery secondary to perforation and atrophy from prolonged catheterization.

 
 

Posterior Urethral Valves Histology

3-D Representation of Posterior Urethral Valves

 

Supplementary cost data to paper, The Use of Internal Double-J Stents, External Trans-anastamotic Stents During Pediatric Pyeloplasty: A Decisiono Tree Cost Effectiveness Analysis. Published in the Journal of Urology, 2011. J. Yiee and L. Baskin.

 




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