Urinary tract dilatation in constipated children

Chronic constipation as a causative factor for development of varicocele in men: a prospective ultrasonographic study

OBJECTIVE

The purpose of this study was to determine the role of chronic constipation in the etiopathogenesis of varicocele in men.

METHODS

In this prospective study, group 1 included 25 male patients who had symptoms of chronic constipation for a mean duration +/- SD of 17.0 +/- 20.3 months (range, 3-96 months), and group 2 included 26 male subjects without any symptoms associated with constipation. All subjects were evaluated by both physical examination and scrotal ultrasonography. For the plexus pampiniformis (PP) veins, a mean diameter exceeding 2 mm and reflux for more than 1 second were accepted as suggestive findings for varicocele, as described previously.

RESULTS

Left varicocele was detected in 13 (52%) of the 25 patients in group 1 and in 5 (19%) of the 26 subjects in group 2 (P = .02). The mean diameters of the left PP veins were 2.58 +/- 0.97 mm (range, 1.2-4.3 mm) in group 1 and 1.71 +/- 0.53 mm (range, 1.0-3.0 mm) in group 2 (P < .001). A significant difference was detected between the two groups for varicocele prevalence and the mean diameter of the left PP veins.

CONCLUSIONS

Chronic constipation is a significant causative factor for the development of left varicocele, which may be attributable to the accompanying distention of the sigmoid colon and distal part of the descending colon, with resultant compression of the left testicular vein in the retroperitoneum. Therefore, we propose routine ultrasonographic examinations for the possible development of varicocele in men with chronic constipation.

Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation

OBJECTIVE

To analyse experience in treating young children (4-5 years old) with urodynamically confirmed voiding dysfunction, using a noninvasive training programme.

PATIENTS AND METHODS

Between January 1996 and October 1997, 20 children (all < 5 years old, mean age 4.45 years, 18 girls and two boys, mean ages 4.44 and 4.5 years, respectively) with voiding dysfunction were treated. Three children showed filling phase dysfunction alone (bladder instability), six emptying phase dysfunction alone (dysfunctional voiding) and 11 showed both filling and emptying phase dysfunction. Sixteen children had incontinence problems (three diurnal, two nocturnal and 11 diurnal and nocturnal). Eight children had a history of recurrent urinary tract infections and 12 girls had vaginal irritation. Four children were referred for perineal pain caused by spasms of the pelvic floor. Eight children had encopresis based on chronic obstipation. Therapy consisted of keeping a voiding and drinking chart, instructions on proper toilet posture, daily rules for application at home, and if possible relaxation biofeedback of the pelvic-floor muscles. Therapy was considered successful if incontinence and other urological symptoms resolved. The treatment of encopresis is also discussed.

RESULTS

Of the 20 children, 13 had a good result; they all became dry during the day and night, and encopresis resolved. Six children had moderate success; in one, nocturnal incontinence persisted, and in two diurnal and nocturnal incontinence continued. In two children encopresis persisted and in one the faecal incontinence ameliorated. In one child the therapy was prematurely interrupted because of lack of motivation.

CONCLUSION

This experience suggests that a noninvasive training programme is applicable in very young children with symptoms of dysfunctional elimination of urine and faeces.

The intravenous urogram in the detection and evaluation of renal damage following urinary tract infection

Intravenous urography (IVU) still provides the most comprehensive structural assessment of the urinary tract. In particular, the radiological renal appearances approximate closely to the morphology of the renal scarring of reflux nephropathy or chronic atrophic pyelonephritis. It also provides reproducible renal measurements for follow-up assessment of renal growth and scarring. It is now less often used for first-line investigation of the acute urinary tract infection (UTI) because the swelling accompanying acute renal involvement is less easily recognised than the areas of defective function demonstrated on 99mtechnetium-dimercaptosuccinic acid (DMSA) studies. Also IVU contributes a higher radiation dose when calculated for full IVU (dependent on the number of films exposed) and there is a slight risk of side effects from injected contrast media, reduced by using non-ionic compounds. Because of its value in confirming such a serious diagnosis as renal scarring, suspected on ultrasonography or DMSA scintigraphy, modification of the technique of IVU with adequate preparation and the use of a reduced number of films, or single films localised to the renal areas, should be considered. Expertise in the interpretation of IVU must also be maintained because of the ancillary information regarding bowel and bladder function, the spine and evidence of stones, pertinent to the management of children with UTI and renal scarring. IVU and DMSA study remain complementary investigations.

Constipation and reversible urinary tract abnormalities

Urinary tract anomalies were prospectively investigated with ultrasound in 29 children with functional constipation. These children were compared before and after treatment with 451 age matched healthy controls without constipation. The bladder residue and upper renal tract dilatation after micturition were significantly increased in the group with constipation and improved after treatment.