No description available.

No description available.

M.Med. (Paediatrics), Faculty of Health Sciences, University of the Witwatersrand, 2008 / Background: Posterior urethral valves (PUV) result in a spectrum of obstruction, and up to thirty percent of patients progress to renal failure. Objective: Descriptive study of patients with PUV, and to compare growth and renal function in the primary valve ablation versus vesicostomy group. Methods: Retrospective record review of patients with PUV at Chris Hani Baragwanath Hospital from January 1985 to December 2005. Results: A total of 128 boys were identified. The mean (range) age was 12.9 months (0 to 139.4). The mean duration of follow-up was 42 months, with 65% lost to follow- up. UTI and voiding problems were the most common modes of presentation. Young age at presentation and renal dysfunction after surgery were poor prognostic features. Hydronephrosis was present in 89.5%. Renal failure was present in 37% of patients at last visit. Primary valve ablation was performed in 44.2% and vesicostomy in 55.8%. No statistical difference in renal outcome or somatic growth was observed between the surgical groups. Conclusion: PUV is a common condition with significant morbidity. The renal outcome in black South African boys is similar to reports from developed countries. The type of initial surgical management did not impact on renal outcome or somatic growth.

No description available.

No description available.

Thesis (M.D.)--Columbia College, 1805. / Microform version available in the Readex Early American Imprints series.

Thesis (M.Sc. (Physiology))--Mahidol University, 1983.

No description available.

Este estudo teve como objetivo avaliar a conduta do enfermeiro frente ao traumatismo de uretra ocasionado pela inserção do cateter uretral. Este estudo teve aprovação do Comitê de Ética em pesquisa da Escola de Enfermagem de Ribeirão Preto - Parecer 466/12 e foi realizado em um Hospital Universitário em duas etapas: na primeira etapa, descritiva, foi efetuada consulta ao sistema eletrônico do hospital que trata de notificações sobre eventos adversos dos pacientes. Nessa etapa foi utilizado instrumento de perguntas objetivas elaborado pelo próprio pesquisador. Na segunda, quase-experimental pós teste, foram coletados os dados relacionados a autoconfiança de enfermeiros, que participaram de cenário simulado de baixa fidelidade. Nessa etapa para obtenção dos dados foi aplicado um questionário de caracterização dos sujeitos e instrumento já validado, de autoconfiança na Assistência de Enfermagem à Retenção Urinária (EAAERU), a qual encontra-se dividida em cinco fatores: 1) \"Intervenções realizadas durante o cateterismo urinário e/ou em situações iatrogênicas\", 2) \"Intervenções prévias ao cateterismo urinário\", 3) \"Intervenções realizadas após o cateterismo urinário\"; 4) \"Comunicação, consentimento e preparo dos materiais para realização do cateterismo urinário\", e 5) \"Avaliação objetiva da RU\" (retenção urinária). Os dados da primeira etapa foram analisados por estatística descritiva e os dados da segunda etapa foram codificados e digitados duplamente em planilhas do aplicativo Excel®, exportados e analisados no programa SPSS (Statistical Package for Social Science) ®, versão 22.0, como a escala original. Os resultados demonstram que na primeira fase do estudo entre as 5300 notificações do serviço, apenas 27 (1,96%) estavam relacionadas a problemas urinários. Entre essas, cinco diretamente ao cateterismo urinário. Na segunda fase do estudo, a amostra foi composta por 53 enfermeiros, entre os quais a maior parte era do sexo feminino, com idade média de 36 anos, menos de dez anos de formação. Entre eles a maioria cursava ou já haviam cursado pós-graduação. Segundo os entrevistados todos 53 (100,0%) já realizaram o cateterismo urinário e 46 (86,8%) já vivenciaram dificuldades no procedimento. A maioria já avaliou trauma uretral ocasionado pela passagem do cateter. A conduta tomada nessa circunstância foi comunicar o fato e solicitar avaliação de outro profissional (médico e/ou outro enfermeiro). Após atividade simulada de trauma uretral, na avaliação da autoconfiança, a EAAERU demonstrou boa confiabilidade na sua aplicação (? 0,966). Os menores escores encontrados na autoconfiança dos profissionais estiveram relacionados aos fatores 1) \"Intervenções realizadas durante o cateterismo urinário e/ou em situações iatrogênicas\" e 5) \"Avaliação objetiva da RU\". Observou-se ainda associação positiva entre a autoconfiança e a frequência de realização do cateterismo urinário. Conclui-se que os traumas de uretra são comuns na prática clínica, porém pouco notificados. Com relação à autoconfiança na introdução do cateterismo urinário em que ocorrem situações de trauma de uretra há dificuldade na tomada de decisão e na avaliação objetiva da RU. Uma vez que o cateterismo é de competência do enfermeiro, são necessários programas e instrumentos que capacitem os profissionais para tais situações / This study aimed to evaluate the conduct of the nurse to the urethral trauma caused by the insertion of urethral catheter. This study was approved by the Ethics Committee in research of the College of Nursing in Ribeirão Preto - Opinion 466/12 and was performed in University Hospital in two stages: in the first stage, descriptive, a question was made on the hospital\'s electronic system, which deals with notifications about adverse events of patients. In this stage, it was used an instrument of objective questions elaborated by the researcher herself. In the second stage, quasi-experimental posttest study, the data related to self-confidence of nurses who participated in simulated low-fidelity scenario was collected. In this stage, to obtain the data, it was applied a characterization questionnaire of subjects and already validated instrument of Self-Confidence Scale of Nursing Care in Urinary Retention (EAAERU), which is divided in five factors: 1) \"Interventions performed during urinary catheterization and/or in iatrogenic situations\", 2) \"Prior interventions to performing urinary catheterization\", 3) \"Interventions performed for urinary catheters\"; 4) \"Communication, consent and preparation of materials for performing urinary catheterization\", and 5) \"Objective evaluation of the urinary retention\". The first stage\'s data were analyzed by descriptive statistic and the second stage\'s data were codified and double typed in spreadsheets in the Excel® app, exported and analyzed in the SPSS program (Statistical Package for Social Science)®, version 22.0, like the original scale. The results demonstrate that in the first stage of the study, among the 5300 notifications of service, only 27 (1,96%) were related to urinary problems. Among these, five directly related to urinary catheterization. In the second stage of the study, the sample was made by 53 nurses, among which most were women, with an average age of 36 years, less than ten years of formation. Among them, most were attending or had already attended postgraduate. According to the interviewers, all 53 (100,0%) had performed urinary catheterization and 46 (86,8%) had gone through trouble during the process. Most of them had evaluated urethral trauma caused by the introduction of the catheter. The conduct taken in this circumstance was to communicate the fact and request the evaluation of another professional (Doctor and/or another nurse). After simulated activity of the urethral trauma, in the self-confidence evaluation, EAAERU showed good reliability on its application (?=0,966). The lowest scores found in the professionals\' self-confidence were related to the factors 1) \"Interventions performed during urinary catheterization and/or in iatrogenic situations\" and 5) \"Objective evaluation of the urinary retention\". It was also observed positive association between the self-confidence and the performance of urethral catheterization. It is concluded that urethral traumas are common on clinical practice, however little notified. With regard to self-confidence to the introduction of urethral catheterization in which occur urethral trauma situations, there is difficulty in decision making and objective evaluation of the urinary retention. Once the catheterization is the nurse\'s responsibility, programs and tools are necessary to enable professionals in such situations

Posterior urethral valves cause bladder outflow obstruction and damage to the developing fetal kidney. Posterior urethral valves affect 1 in 8000 new-born males. A third of these children develop end stage renal failure by adolescence, despite valve ablation in the early post-natal period, implying that majority of the damage to the kidneys occurs in utero. How does this damage occur, and should we intervene in utero? The answers to these questions require further research, and are the basis to this thesis. This thesis focused on the effect bladder outflow obstruction has on morphology and apoptosis in the fetal kidney in a fetal lamb model. It also looked at the effect of bladder outflow obstruction on fetal stress hormone levels. Bladder outflow obstruction was created surgically in fetal lambs at day 70 of gestation, and fetal kidneys were analysed at day 2, 5, 10, 20 and 30 after creation of obstruction. Controls undergoing sham surgery were used for comparison. Four aspects were investigated: - effects of bladder outflow obstruction on renal histology effects of bladder outflow obstruction on expression of pro-apoptosis gene Bax and anti-apoptosis gene Bcl-X - effects of bladder outflow obstruction on renal regional apoptosis effects of bladder outflow obstruction on serum fetal ACTH and cortisol levels. Bladder outflow obstruction resulted in sequential morphological change in the fetal kidney over time. By 2 days post-obstruction, cystic change was noted. In addition, patchy attenuation of the nephrogenic blastema was evident by 5 days post-obstruction, with more confluent blastemal attenuation as well as generalized renal architectural disorganization by 10 days post-obstruction. By 20 and 30 days post-obstruction, cystic renal dysplasia had developed. Bladder outflow obstruction resulted in an increase in the ratio of renal expression of pro-apoptosis gene Bax to anti-apoptosis gene Bcl-X. Regional apoptosis counts showed increased tubular apoptosis compared to controls at 2 days post-obstruction, and increased blastemal apoptosis compared to controls at 5 days post-obstruction. By 10 days post-obstruction, blastemal apoptosis counts were reduced compared to controls. There were no significant differences in fetal serum ACTH and cortisol levels between fetal lambs with bladder outflow obstruction and controls. In conclusion, the results of this thesis outline the spectrum of morphological change in the fetal kidney over 30 days of bladder outflow obstruction. They show that detectable changes in morphology occur within two days of bladder outflow obstruction. Likewise, detectable changes in gene expression occur within 2 days of bladder outflow obstruction. The increased ratio of expression of Bax to Bcl-X suggests a swing towards increased apoptosis in response to bladder outflow obstruction. Further research is required to ascertain if these changes are reversible. However, the early onset of these changes as shown in this thesis suggests that any fetal intervention to protect the fetal kidney from the effects of bladder outflow obstruction may need to be instituted very early in gestation