466 INTERNATIONAL ABSTRACTS

toms, while those presenting later had infective symptoms. Ninety- three percent had unilateral or bilateral dilatation of the upper urinary tract at diagnosis, and 72% had ureteric reflux. Unilateral reflux occurred twice as often on the left side as on the right. Catheter drainage with supportive measures led to early fulgeration of the valves endoscopically. Surface diversion was undertaken to treat children in special circumstances. Six kidneys were removed. A tendency for spontaneous cessation of reflux was noted, and anti- reflux surgery late in the series was only performed for recurrent episodes of urinary tract infection. With a similar tendency for improvement in dilated nonrefluxing ureters (provided the valve has been effectively treated), a conservative approach is advocated here also. Depression of renal function, which was present in the majority of children, particularly when diagnosed under the age of three months, returned to normal in nearly two thirds of patients. The GFR (done on 25 at diagnosis) was found useful in prediction of outcome. When under 50% of expected GFR for age, recovery was unlikely and chronic renal failure almost inevitable. Less severe renal failure did not usually impair childhood growth until the pubertal spurt when progressive failure ensued. It is concluded that treatment of the valves and little, if any, subsequent surgery is indicated in these children.--R.J. Fitzgerald

Cutaneous Vesicostomy Experience in Infants and Children. H. Norman Noe and G.R. Jerkins. J Urol 134:301-303, (August), 1985.

Cutaneous vesicostomy has proved to be a useful form of tempo- rary diversion in children. Experience with 35 patients who under- went diversion for either lower tract dysfunction or obstruction is reported. In only one child did vesicostomy appear to be of question- able value in adequately draining the upper urinary tracts. Renal functional improvement or stabilization was observed in the remain- ing 34 children. Complications occurred in 14 patients, with urinary tract infections of a clinically serious nature being observed in six. This experience tends to confirm vesicostomy to be an effective, simple, and easily reversible means to treat selected conditions in infants and children. Complications are encountered but they have been managed effectively.--George Holcomb, Jr

Evaluation of Obstructive Uropathy in Children. ~ T c - D T P A Re- nography Studies under Conditions of Maximal Diuresis. R.N. Sukhai, P.P.M. Kooy, E.D. Wolff, et al. Br J Urol 57:124-129, (April), 1985.

Renographic studies under standardized conditions of maximal diuresis provoked by hypotonic saline infusion and frusemide were used in 17 patients with dilatation of the upper urinary tract in order to distinguish between obstructed and nonobstructed urinary tracts. Of the six patients who were obstructed on clinical and x-ray evidence only, three showed an obstructed pattern on the reno- graphic curves after maximal diuresis. After operation, these three patients showed improvement in both renographic curve and func- tional images of the renal parenchyma. A new method of identifying the parenchymal area is described.--R.J. Fitzgerald

Development of New Renal Scars: A Collaborative Study. J.M. Smellie, P.G. Ransley, LC.S. Normand, et al. Br Med J 290:1957- 1960, (June), 1985.

This important study, by collating patient information from 23 hospitals, set out to answer the questions when and under what circumstances, do new renal scars develop? To be included in the study a child must have bad a previous IV urogram (IVU), and in a subsequent urogram, in the opinion of three independent observers, have developed a new renal s ea r~e f ined as a ealyceal deformity

with thinning of the overlying parenchyma. Children with urinary obstruction, stones, or congenital abnormalities of the kidney were excluded. The timing of the new scars was taken as the date of the last IVU performed before the scar was detected. Ureteric reflux was recorded in three grades: (I) minimal, not reaching the kidney; (II) reaching to the kidney but without dilatation; and (III) up to the kidney with dilatation of the ureter or renal pelvis. New renal scars were seen in 87 kidneys from 74 children (8 boys and 66 girls). Seventy-four initially normal kidneys developed scars and further scars appeared in 13 already scarred kidneys. Every child had had a urinary infection. In all except one case, this shortly preceded the last IVU, which did not show the new scar. Thirty six had not previously been diagnosed as having a urinary infection, and delay in the recognition and treatment of infection was common. Fifty-six children had had repeated symptomatic infections. New scars were detected at all ages from under 1 year to 10 years of age, and only after the age of 7 years did the frequency with which new scars developed decline. Vesico-ureteric reflux was seen in 67 children (72 kidneys) but in six it was in the contralateral ureter. In only one child did a technically satisfactory cystogram, carried out immediately after the presentation, fail to show reflux. In children with reflux, the probability of scarring at presentation is, in those who have had two or more symptomatic infections, twice that of those after one or none. Scarring was more extensive in children with severe degrees of reflux. Recurrent infection can be prevented by continuous prophy- lactic chemotherapy but fresh scars developed in children who received only short intermittent courses of treatment for recurrent infection. Scars appeared after both effective chemotherapy and successful ureteric reimplantation. Some of these appear to be due to progression of previous inflammatory damage. It is suggested that scanning with Tc99mDMSA (Dimereapto-sulphonic acid) is more accurate in delineating these early lesions. The authors conclude that when children with obstruction are excluded, reflux and infection are the major factors contributing to the development of new sears, which continue to appear up to the age of 10 years. This detailed, careful study contradicts many previously widely held views and should make doctors treating reflux reconsider their regimens. - James Dickson

A Comparison of Diuresis Renography, the Whitaker Test and Renal Pelvic Morphology in Idiopathic Hydronephrosis. E.W. Lup- ton, D. Richards, H.J. Testa, et al. Br J Urol 57:119-123, (April), 1985.

In 36 patients (ages not stated) with radiologically demonstrated idiopathic hydronephrosis, diuresis renography, the Whitaker test and, where possible, renal pelvic morphologic features (histology) are compared. The agreement between the results of the tests showing obstruction was as follows: diuresis renography/Whitaker test 67%; diuresis renography/renal pelvic morphology 74%; Whi- taker test/renal pelvic morphology 58%. Both diuresis renography and the Whitaker test are indicated in some cases of idiopathic hydronephrosis.--R.J. Fitzgerald

Infundibulopelvic Stenosis in Children. J. Lacaya, G. Enriquex, R. Delgado, et al. Am J Roentgenol 142:471~,79, (March), 1984.

Of 11,500 children undergoing excretory urography over a 17- year period, three were found to have infundibulopelvic stenosis, a rare renal anomaly characterized by ealiceal dilatation, infundibulo- pelvic stenosis, and hypoplasia or stenosis of the renal pelvis. The authors describe three patients, ages 2, 2, and 7 years and review the nine other reported cases in children. The 12 patients include 7 girls and 5 boys ranging in age from 3 months to 15 years. Symptoms at presentation included infection (8), polydipsia and polyuria (2), hematuria due to trauma (1), and one child had no symptoms. Renal