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Edição 28

Urinary loss is the third most frightening event for a child, coming in close behind fear of their parents’ death and the fear of going blind. Thus there is a strong reason for doctors to pay special attention to these children when they are referred for investigation. Standard investigation by imaging for patients with daytime or nighttime urinary loss (enuresis) consists of an ultrasound examination of the urinary tract and, when requested, urethrocystography.

Ultrasound Examination of the Urinary Tract

This ultrasound examination is more detailed than a routine urinary tract examination and should be carried out when the patient’s bladder is at maximum capacity. The thickness of the bladder wall is measured, and both the bladder’s maximum capacity and the post-mictional residue evaluated (the latter should not be greater than 10% of the initial volume). The examination also covers the thorough evaluation of the kidneys, especially in girls with a history of constant urinary loss, due to the diagnosis of Complete Pyelo-Urethral Duplicity with Ectopic Urethra. An interesting fact is that this diagnosis is usually made a late stage, around 5 to 8 years of age, and these girls often have to wear sanitary napkins because of the urinary loss.

Urethrocystography

This examination is carried out by the insertion of a urethral catheter so that the bladder can be filled with contrast and saline.  The aim is to evaluate the bladder and urethra’s morphology, determine whether vesico-urethral reflux (the return of urine from the bladder to the kidneys) is present, and whether there is post-mictional residue.

Special attention must be given to the morphology of the female urethra, which should be long, tubular and of regular diameter.  When the urethra presents itself as dilated and with a “waisted” morphology, associated, or not, with reduced bladder capacity and a discrete irregularity in the shape of the bladder (to which the thickening of the bladder wall is secondary), a Dysfunction of the Lower Urinary Tract should be diagnosed, and confirmed by Urodynamics.

Doctors should also be attentive to the morphology of the urethra in patients who are subjected to urethrocystography for an infection of the urinary tract, which could be secondary to detrusor-sphincter dyssynergia. Dr. Dolores Bustelo, in charge of Paediatric Radiology at CETAC, believes that the preservation of renal function is fundamental for everyone. She said, “We should be prepared to carry out the right diagnosis because 30 to 50% of children with bladder dysfunction present vesico-urethral reflux and, of those that do, almost 50% have permanent renal scarring.” When the paediatrician or nephro-paediatrician receives a urethrocystography report relating a “waisted” urethra, he will look at an episode of urinary infection or loss in a different light.  These children will probably undergo urodynamics and medicinal treatment will not be directed only at the urinary infection, but also at the bladder disfunction, and accompanied by mictional re-education.

CETAC

At CETAC, Urethrocystography is carried out using cutting-edge Digital X-Ray imaging equipment, the only one of its make and model in operation in the country.  This equipment allows the examination to be performed in a shorter time than before, which helps to put the patient at ease.  Furthermore, the images obtained with this equipment are high definition and of extraordinary quality, which permits a swift and accurate diagnosis.

Imagine the impact on a child’s life of  not being able to sleep over at a friend’s house because he “wets the bed”, or the problems that constantly “wet knickers” can cause a girl.  The social and psychological weight of these events can mark a child for life. We all have a great responsibility to the future of these children.

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For More Information: Batel Clinic
Rua Padre Ildefonso, 105     Phone: 41-3270-3270