An Unusual Case of Syringohydromyelia Presenting with Neurogenic Bladder

We report the case of a 4-year-old boy who first presented with acute pyelonephritis at the age of 6 months. Diagnostic workup revealed high-grade bilateral vesicourethral reflux (VUR). At the age of 18 months, a bulking agent was used to treat bilateral VUR. Since the VUR persisted, an open bilateral Lich-Gregoir procedure was done at the age of 3 years. Immediately after surgery, he developed acute urinary retention with hydronephrosis that resolved with the placement of dwelling urinary catheter. After removal of the catheter urinary retention relapsed so placement of suprapubic urinary catheter was indicated since he did not have sensory loss. He was started with tamsulosin (α − 1-blocker) and prophylactic antibiotics. Urodynamics were performed and suggested bladder outlet obstruction. On the basis of previous urethroscopy and the absence of neurological sequelae, the differential diagnosis of Hinman syndrome was made. After removal of the suprapubic catheter, clean intermittent catheterization was started and α-blocker continued. However, magnetic resonance imaging of the brain and the spinal cord revealed syringohydromyelia extending from thoracic spine (Th5) to conus medullaris with 6 to 7 mm in diameter. Electromyoneurogram was normal. After a follow-up of 3 years, the hydronephrosis has resolved. The patient is on clean intermittent catherization and has no urinary tract infections. [...] Georg Thieme Verlag KG Stuttgart &middo...
Source: European Journal of Pediatric Surgery Reports - Category: Surgery Authors: Tags: Case Report Source Type: research

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This study aimed to assess predictors for grade 3 –5 vesicoureteral reflux (VUR) in infants ≤ 2 months of age admitted for first urinary tract infection (UTI).MethodsRetrospective cohort study of 195 infants ≤ 2 months admitted to a pediatric ward for first UTI between 2006 and 2017. Clinical, laboratory, and imaging data were collected from electronic medical charts. We examined associations between grade 3–5 VUR and different patient characteristics.ResultsTwenty infants (10%) were diagnosed with grade 3 –5 VUR; all had fever. Infants with grade 3–5 VUR had higher blo...
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
A 28 year-old female presented to the emergency room with symptoms of left pyelonephritis. She was admitted and was found on imaging study to have left hydronephrosis and duplicated bladder. A left nephrostomy tube was placed, and urology was consulted for management of her infections in context of her anatomy. During her evaluation, the patient reported three to four urinary tract infections or episodes of left pyelonephritis per year, as well as recurrent left flank pain and mixed urinary incontinence for several years.
Source: Urology - Category: Urology & Nephrology Authors: Source Type: research
This report describes a 15-year-old male adolescent who developed sudden visual disturbance resulting from hypertensive retinopathy. The cause of hypertension was bilateral obstructive uropathy caused by enlarged paraureteral bladder diverticula. After the non-functioning right kidney and ureter and the bilateral diverticula were removed, the left ureter was reimplanted in the bladder. Pathologic findings showed chronic pyelonephritis and partial loss of the bladder musculature in the diverticular wall. This observation indicates that dilated CBD can cause latent UTI, ureteral obstruction, hydronephrosis, and secondary hyp...
Source: Journal of Korean Medical Science - Category: Biomedical Science Tags: J Korean Med Sci Source Type: research
We present a new preclinical model to study treatment, resolution and sequelae of severe ascending pyelonephritis. Urinary tract infection (UTI), primarily caused by uropathogenic Escherichia coli (UPEC), is a common disease in children. Severe pyelonephritis is the primary cause of acquired renal scarring in childhood, which may eventually lead to hypertension and chronic kidney disease in a small but important fraction of patients. Preclinical modeling of UTI utilizes almost exclusively females, which (in most mouse strains) exhibit inherent resistance to severe ascending kidney infection; consequently, no existing precl...
Source: DMM Disease Models and Mechanisms - Category: Biomedical Science Authors: Tags: RESOURCE ARTICLE Source Type: research
Authors: Arora N, Saha A, Kaur M Abstract Tuberculous pyelonephritis is rare in children; three case reports are presented. Case 1 was an 11-year-old girl with a previous history of pulmonary tuberculosis who presented with flank pain and fever for 10 days. An ultrasound suggested focal pyelonephritis, and a contrast-enhanced computed tomography (CECT) scan demonstrated acute focal pyelonephritis and a perinephric collection. Mycobacterium tuberculosis was cultured in the urine. She responded well to anti-tuberculous treatment (ATT). Case 2 was a 13-year-old boy who presented with fever, haematuria, burning mi...
Source: Paediatrics and international child health - Category: Pediatrics Tags: Paediatr Int Child Health Source Type: research
​BY Dhimitri A. Nikolla, DOAn 82-year-old man with a history of dementia, multiple urinary tract infections, insulin-dependent diabetes mellitus, and an admission a month earlier for Fournier gangrene presented to the emergency department with reports of confusion and hypotension from his nursing home. His vital signs were normal, but he was disoriented with a mildly tender abdomen. His genital examination revealed a suprapubic catheter without evidence of soft tissue infection. A CT with contrast of the abdomen and pelvis revealed the images shown.​What is the diagnosis? What is the treatment?The CT images demonstrate...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Conclusions PHA‐1 may be precipitated by UTI or urinary tract anomalies in early infancy. Urine analysis should be performed in infants with hyponatraemia. Diagnosis of PHA‐1 facilitates appropriate renal investigations to reduce long‐term morbidity.
Source: Journal of Paediatrics and Child Health - Category: Pediatrics Authors: Tags: Original Article Source Type: research
AbstractNeutrophil gelatinase-associated lipocalin (NGAL) is best known as a non-invasive early marker of acute kidney injury (AKI). However, recent published reports have described additional utility of both plasma NGAL (pNGAL) and urine NGAL (uNGAL) in various pathologic conditions within the pediatric urinary tract, including urinary tract infection, vesicoureteral reflux (VUR), renal scarring, and obstructive uropathy. These two forms of NGAL have different applications related to their mechanisms of upregulation: pNGAL can serve as a marker of systemic inflammatory conditions, whereas uNGAL is specific for insults to ...
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
Authors: Choi da M, Heo TH, Yim HE, Yoo KH Abstract PURPOSE: To evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline. METHODS: We retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, la...
Source: Korean Journal of Pediatrics - Category: Pediatrics Tags: Korean J Pediatr Source Type: research
We present a case of a 62‐year‐old diabetic woman with acute pyelonephritis and spondylitis caused by Salmonella typhi. She was admitted to Tokyo Medical Dental University Hospital, Tokyo, Japan, because of unconsciousness and was diagnosed with sepsis by retrograde pyelonephritis as a result of Salmonella typhi. Antibiotics treatment was immediately started; however, she subsequently developed lumbar spondylitis, and long‐term conservative treatment with antibiotics and a fixing device were required. This is the first report of a diabetic patient who developed retrograde urinary tract infection with Salmonella typhi...
Source: Journal of Diabetes Investigation - Category: Endocrinology Authors: Tags: Case Report Source Type: research
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