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A method was devised to calculate individual kidney function by injecting 99m technetiutn-diethylenetriamine pentaacetic acid, gluconate, or glucoheptonate intravenously and to determine the radioactive uptake by and the contribution of each kidney to total renal function. The accuracy of the method was tested in 13 patients by comparing the results of the differential kidney scan with individual kidney creatinine clearance measurements. The method is applied practically combined with a total twenty-four-hour creatinine clearance test, which allows us to ascribe individual creatinine clearance values to each kidney.

A series of 91 infants and children ranging in age from one day to 15 years and presenting a variety of urologic symptoms was examined by intravenous pyelography and ultrasonic scanning of the kidneys. Ultrasonic examinations were performed without knowledge of the indication for and results of pyelography, in order not to prejudice the interpretation of the results. Pyelography demonstrated hydronephrosis in 20 cases of 181 kidneys examined. The ultrasonic scanning demonstrated hydronephrosis in 19 of these 20 kidneys, the negative result being a case of minimal hydronephrosis. Six kidneys with radiographically dilated pelves were ultrasonically diagnosed as hydronephrosis in three, suspicion of hydronephrosis in one, pelvic dilatation in one and one kidney as normal. In eight kidneys with normal pyelography the ultrasonic scanning suggested hydronephrosis in five and pelvic dilatation in three cases. The criteria used were the demonstration of the dilated renal pelvis and to some extent separation of the calyceal echoes. The results indicate that ultrasonic examination can become a reliable screening procedure in infants and children with urologic symptoms.

has given him an increasingly active role in the treatment of pediatric urological patients. His influence is gradually being felt throughout the hospitals of New York because of his exemplary training program in urology. More recently, Dr. Lattimer has been elected Chairman of the American College of Surgeons Advisory Council on Urology and Chairman of the Committee on Pediatric Urology of the American Academy of Pediatrics. He has pioneered in the use of motion pictures in urological undergraduate teaching and has worked vigorously to point out the advantages of the urological specialty to the more able medical students coming under his influence. During his tour of duty in the army in Europe during World War II, where he achieved the rank of major, and in subsequent tours in South America, Dr. Lattimer has had ample opportunity to examine environmental factors in the world at large as they affect the genitourinary tract. From his department have come papers ranging from the effect of tropical parasites to those of ultrasound as they affect the living organism and man in particular. Among his hobbies are driving a tractor during weekends on his country estate within ten minutes of uptown N ew York and collecting early Americana for loan to children's schools and libraries. Characteristic of him are his insatiable capacity for work, an unfailing good humor, and perhaps most typically of all, the fact that although his middle name is Kingsley, he dropped the nickname of "King" at the time he actually became one. HANS H. ZINSSER, MD

THE MAJORITY of the concern in pediatric urology is centered around infections and anomalies, the former occupying the greater portion of the practicing pediatrician's problem in this field. Therefore, discussion was aimed mainly at pyelonephritis, with queries on other facets of genito-urinary pathology being mentioned. A review of the literature reveals that pyelonephritis is the commonest cause of death in uremia. While it kills twice as many patients as glomerulonephritis, it occupies only about a third of the literature given to these two problems. The statistics of a number of widely accepted authorities reveals that of all the patients admitted to hospitals, 1% have a urinary tract infection and 5% of all patients treated by pediatric services have a urinary tract infection. Pyelonephritis is more common in the female than in the male in the ratio of 9:1. In the female it is more common in the years from 0-12 and from 25-70 years of age. Very few males have pyelonephritis except those with congenital anomalies, and in the older age group those with gonorrheal obstructions and prostatic enlargement. The manifestations of congenital obstructions to urine flow usually present themselves in the ages from 0-6 years. CAUSES OF PYELONEPHRITIS Natural Causes The Short Rrethra of the Female: In females under 8 or 9 years of age, the urethra is about 1 cm long and some females have such a short urethra that it is essentially only a urethral sphincter. In 10 females less than 10 years of age, all 10 had dye in their bladders, after they sat down and stood up 20 times in 6 inches of dyed water. What is not understood is why more females do not get infection, if this is the answer to more frequent infections in females than in males. Overdistention of the Bladder: Marked overdistention of the bladder causes vesicoureteral reflux. This condition is more common in adolescents who do not have enough social experience, i.e. those who would not feel free to excuse themselves from company in order to urinate. Involuntary Residual Urine: In the male patient who has severe paraphimosis and dysuria, an increase in residual urine is often found. Also following circumcision, the skin of the glans penis often exfoliates, leading to urethral meatal ulceration causing dysuria which is followed by a residual urine.

We present our experience in 11 cases of bladder-neck sclerosis in children. The diagnosis was established by mictional ureterocystography. The therapeutic treatment involved opening of the bladder and incision of the back lip of the neck, at the same time performing Young’s Y–V plasty. When the existence of the vesico-ureteral reflux was found, we opted for the antireflux technique.

It may be said without fear of contradiction that the urologic study of pediatric cases has not received the consideration that is due so important a subject. This is practically an undeveloped province of medicine, and, as evidence of this statement, attention may be called to the scant references, both in pediatric and in genitourinary literature. In this country, Beer, 1 Hyman, 2 Hinman, 3 Stevens, 4 Thomas and Tanner, 5 and Helmholz and I 6 have made a study of the subject—not a large showing. Hence, it appears to me that this province for clinical study has been decidedly neglected, though the problems and possibilities undoubtedly are many and of great variety. But to achieve gratifying results, the closest cooperation between the pediatrician, general practitioner and genito-urinary surgeon is necessary. This alliance effected, I am ready to admit, without being unduly enthusiastic, that pediatric urology will be the open

The development of children's urology was hampered by two totally different factors. The first, purely mechanical, was overcome by the fabrication of proper instruments, and the second and more important factor, the psychologic, was overcome by the realization of physicians that children do have urologic complaints for which proper diagnosis can be made and treatment given. Dr. Meredith Campbell's textbook "Pediatric Urology"1 helped make many realize the psychologic importance of urologic disease in children. The average physician is quite used to the patient with disease of the urinary tract who directs his complaints toward that field and is able to cooperate in simple examinations. The average urologist is also accustomed to a patient who has large veins and an adequate urethra and who can urinate at will. The child, on the other hand, frequently has small veins, urethral inadequacy, and inability to urinate at will. His symptoms may not be

Summary A further radiographic method forthe determination of voiding efficiency was tested. The findings suggested that to increase the sensitivity of any standardized cystogram the addition of floating Lipiodol may provide: (1) a more delicate evaluation of borderline vesical detrusor function in the pediatric patient who cannot void on command, as determined by the presence or absence of floating Lipiodol within the urinary tract after 24 hours; (2) superiority over the conventional aqueous contrast medium for the radiographic determination of residual urine; (3) a diagnostic aid in the determination of the segment of the urinary tract which retains urine; and (4) the elimination of repeated traumatic catheterizations, especially in children. This additional cystographic technique has proved most valuable in the field of pediatric urology.

From the genuine white towers of the hospital on the banks of the East River of Manhattan comes a revelation of the proceedings of the "Conferences in Pediatric Urology." Almost immediately one is prepared for the pearls of wisdom which result from many years of experience with complex problems in pediatric urology. Instead, we are asked to observe the end product of well designed and cut jewels which sparkle with brilliance. While the style of the cut is made clear, the steps in the process are left rough and uncut in the literary projection. Perhaps these authors expect too much of their audience; however, it would seem that a general urologist and even a budding pediatric urologist could find it difficult to follow the sequence by which the rough diamond is cut, faceted, and highly graded. No substantial scientific precepts are utilized to buttress a particular approach in technique and

During the past two decades, significant advances have been made in pediatric urology. While many difficulties have been resolved, the problem of a satisfactory and optimum anesthetic management still remains a challenge to some. Thus, published reports on uropediatric anesthesia are meager, limited to a few pediatric centers, and controversial in many respects. 1 In an attempt to clarify this problem, an analysis was made of the pertinent literature and the clinical experiences in the anesthetic management for pediatric urology. A survey of the progress in anesthesia is of paramount importance to the urologist interested in pediatrics. It reveals several fundamental facts inadequately stressed and not fully appreciated clinically. To begin with, there is no ideal anesthetic agent and/or technique per se. All have their advantages, disadvantages, limitations, contraindications, and complications. Accordingly, for safe and optimum anesthesia, the anesthetic management for each operative procedure must be individualized. Secondly, there is

In 300 pages 16 knowledgeable contributors cover in reasonable depth 13 important problems in the comparatively new and rapidly developing field of pediatric urology. The editors, Johnston of Liverpool and Scholtmeijer of Amsterdam, are to be commended on their selection of the topics to be studied as well as for their choice of authors of the individual chapters. Ten of the essayists are from the United Kingdom, five from the continent, and a single contributor comes from the United States. This makeup should broaden the horizon of most American readers who on occasion are unaware of significant work in the field of pediatric urology going on in parts of the world other than our own. Appropriate space is allocated to the various topics so that they can be covered in greater depth and detail than in the usual sketchy textbook account or the journal article. Indeed, some can be characterized

Children are not simply little adults, as the author points out in his introduction. Certain complex urosurgical procedures are mainly applicable to and suitable for the young child because of physiologic and morphologic differences and potential for progressive maturation. An atlas entirely directed to genitourinary surgery of children has long been needed. Like many monographs, the current text approaches this need, but falls short of the goal. The author obviously has enjoyed a rich experience in pediatric urology; the strengths of this work include clear, systematically described procedures, and excellent art work. Fine points of technique, and potential pitfalls, are discussed with adequate explanation to add justification and understanding. Some subjects are not covered; other subjects might have been covered more extensively. The section of hypospadias omits a number of techniques popular in the United States. The section on epispadias repair makes no reference to any of several methods of