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Coyle D, Nidaw E, Getachew H, Payne SR, Subramaniam R. Paediatric Urology in
Sub‐Saharan
Africa: Challenges and Opportunities. BJU Int 2022; 130:277-284. [DOI: 10.1111/bju.15852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Coyle
- The Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Ephrem Nidaw
- Department of Surgery Addis Ababa University School of Medicine Addis Ababa Ethiopia
| | - Hanna Getachew
- Department of Surgery Addis Ababa University School of Medicine Addis Ababa Ethiopia
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Temporary vesicostomy in pediatrics: What are the potential predictors of functional and morphological improvement of the upper urinary tract? J Pediatr Urol 2021; 17:834.e1-834.e9. [PMID: 34602355 DOI: 10.1016/j.jpurol.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/14/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Vesicostomy is a simple, well-tolerated, and reversible procedure with few complications that safeguards upper urinary tract (UUT), decreases VUR grade, decreases UTI, and preserves renal function and should be considered in patients with PUV who have undergone prior valve ablation and bladder function not improved, and in myelodysplastic children that do not respond to catheter drainage [1-4]. OBJECTIVE We evaluated the temporary vesicostomy as a safeguard of the UUT in children with bladder outlet obstruction, bladder dysfunction, and high-grade VUR with sepsis and assessed the possible predictors of the UUT's morphological and functional improvement since these have been rarely explored in previous reviews. STUDY DESIGN We evaluated the outcome and complications of temporary vesicostomy who were operated on 69 children at our center from 2014 to 2019. RESULT There were 63 (91.3%) boys and 6 (8.7%) girls who underwent vesicostomy at a mean age of 15.38 ± 2.74 months old. Twenty-nine cases (42%) were diagnosed as primary VUR, 23 (33.3%) had posterior urethral valve (PUV), and 5 (7.2%) had voiding dysfunction, while 12 (17.4%) were neurogenic bladder. Twenty-five (36.2%) patients were diagnosed prenatally and the remainder (44, 63.8%) postnatally. All patients were evaluated at least one year postoperatively. UTI was diagnosed in all cases before vesicostomy; 47 (68.1%) had a single episode of UTI and 22 (31.9%) had recurrent episodes of UTI. Mean serum creatinine was 1.75 ± 0.13 (0.7-4.8) mg/dl. Serum creatinine and the rate of UTI significantly improved (p-value <0.01). Seven (10.1%) cases were complicated with prolapse, 8 (11.6%) with stenosis, and 10 (14.5%) with peristomal dermatitis, all of them were males. DISCUSSION About 75.4% of cases developed morphological improvement, while 24.6% of cases not improved (p-value = 0.0001). Improvement or stability of glomerular filtration rate (GFR) was seen in 84.1%, while 15.9% deteriorated GFR (p-value = 0.0001). This deterioration is associated with prenatal renal dysplasia. Age less than one year, abdominal swelling, severe HUN, grade V VUR and recurrent UTI before vesicostomy all independently affect functional improvement after vesicostomy. CONCLUSION Vesicostomy is a simple, reversible, and well-tolerated surgery with few complications that is indicated in children with bladder outlet obstruction, bladder dysfunction, and high-grade VUR to protect UUT, improve renal function, decrease VUR, hydronephrosis, and febrile UTI. Age less than one year, abdominal swelling, severe HUN, grade V VUR and recurrent UTI before vesicostomy all were predictors that independently affect morphological and functional outcomes after vesicostomy.
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Assefa HG, Getachew H, Tadesse A, Kiflu W, Temesgen F, Dejene B, Mammo TN. Outcome of PUV Patients Following Ablation in a Tertiary Teaching Hospital in Addis Ababa, Ethiopia. Res Rep Urol 2021; 13:639-645. [PMID: 34513741 PMCID: PMC8420799 DOI: 10.2147/rru.s322822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Posterior urethral valve (PUV) is the most common cause of congenital lower urinary tract obstruction in boys. It is considered that early diagnosis and intervention have good outcomes in terms of renal function, though the varying extent of embryological insult requires these boys to remain in extended follow-up and care. Objective To assess the renal outcome of patients following PUV ablation. Methods This was a descriptive retrospective study. Data were collected from the operation logbooks of patients from 2015 to 2019 that had been admitted to the Tikur Anbessa Specialized Hospital pediatric surgery unit with a working diagnosis of PUV and had ablation done primarily or following diversion. Data were collected from January to April 2020 and analyzed using SPSS 25. P value≤0.05 was considered significant. Results Seventy patients were analyzed and followed for 3 years for the development of postoperative chronic kidney disease (CKD) after PUV ablation. Postoperative CKD was found in 52.9% of patients and end-stage renal disease in 2.9%. Risk factors associated with postoperative CKD were the presence of preoperative and postoperative proteinuria, postoperative hypertension, and elevated nadir serum creatinine. Results also showed that a delay between the development of vesicostomy and ablation had a significant correlation with renal outcome. Elevated nadir serum creatinine, postoperative proteinuria, and delay between the development of vesicostomy and ablation were found to be independent risk factors of development of CKD. Conclusion There was a high rate of CKD development in patients who had had ablation for PUV, which was comparable to other studies. Three variables were found to be independent risk factors for the progression of CKD, unlike other findings seen in low- and middle-income countries.
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Affiliation(s)
- Hiwote G Assefa
- Department of Surgery, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Hanna Getachew
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Amezene Tadesse
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Woubedel Kiflu
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Fisseha Temesgen
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Belachew Dejene
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
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Sharifiaghdas F, Mirzaei M, Nikravesh N. Can transient resting of the bladder with vesicostomy reduce the need for a major surgery in some patients? J Pediatr Urol 2019; 15:379.e1-379.e8. [PMID: 31060966 DOI: 10.1016/j.jpurol.2019.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/26/2019] [Accepted: 03/29/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neuropathic bladder, voiding dysfunction, and posterior urethral valves may cause a great challenge in children. Preserving the kidney function is the main aim in all of these patients which can be achieved by cutaneous vesicostomy. OBJECTIVE The objective of this study is to evaluate the long-term outcomes of patients who have undergone cutaneous vesicostomy in an 11-year period at the study center. STUDY DESIGN In this retrospective study, the authors evaluated the long-term treatment results and complications of cutaneous vesicostomy on children with bilateral severe hydronephrosis, bilateral vesicoureteral reflux (VUR), and urosepsis who were operated at our center from 2007 to 2018. RESULTS There were 64 (80%) boys and 16 (20%) girls. Their mean of age was 15.27 months old when they underwent vesicostomy. Twenty-three (28.75%) of them had neurogenic bladder and 17 (21.25%) of them had intact neuronal pathway defined as dysfunctional voiding. Twenty-five (31.25%) boys had posterior urethral valves. Fifteen (18.75%) of them were younger than six months old with primary bilateral high-grade VUR and urosepsis. Mean of follow-up time was 65.34 ± 37.82 months (11.5 months-10.5 years). Cure rate was 95% in urinary tract infection, 80.7% in secondary VUR, and 40% in primary VUR. Creatinine level was significantly reduced after vesicostomy and during follow-up (P < 0.001). Complications after vesicostomy were stoma stenosis (11.25%), mucosal prolapse (7.5%), dermatitis (3.75%), and febrile urinary tract infection (5%). In primary VUR after vesicostomy, 60% of the patients did not require an intervention to correct the reflux (Table). DISCUSSION A number of 29 of 66 patients with closed vesicostomy needed another surgery: three modified Gil-Vernet antireflux surgeries, one ureteral reimplantation, two endoscopic Deflux injections, 13 valve ablations, six ileocystoplasties, and four Botox injections. The 37 (56.06%) remaining patients did not require any other surgery after closure of vesicostomy. CONCLUSION Vesicostomy should be considered in children with neuropathic bladder or bladder outlet obstruction in case first-line therapies fail. This simple and reversible procedure can reduce febrile urinary tract infections, protect the upper urinary tract, and reduce the need for a major surgery without decreasing the bladder capacity.
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Affiliation(s)
- F Sharifiaghdas
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Mirzaei
- Department of Urology, Kerman University of Medical Sciences, Kerman, Iran.
| | - N Nikravesh
- Urology and Nephrology Research Center, Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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[CLINICAL OUTCOMES OF CUTANEOUS VESICOSTOMY IN PEDIATRIC UROLOGICAL DISEASES]. Nihon Hinyokika Gakkai Zasshi 2019; 110:230-233. [PMID: 33087683 DOI: 10.5980/jpnjurol.110.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Introduction & objective) We aimed to evaluate the validity and complications of cutaneous vesicostomy retrospectively. (Material & methods) We reviewed the charts of 28 patients (9 male, 19 female) who underwent cutaneous vesicostomy between 2003 and 2017 at our center. The validity of the cutaneous vesicostomy was evaluated by estimating the incidence of febrile urinary tract infection (UTI) before and after the operation using the person years method. To estimate the occurrence of complications, the rates of adverse events and reoperation were summed. (Results) The preoperative and postoperative incidence rate of febrile UTI decreased from 0.058 times/person-years to 0.012 times/person-years, and this decrease was statistically significant (p<0.001). Six (21.4%) patients developed mucosal prolapse of the bladder, which was the most common complication. Most of the patients had refractory constipation. Three patients with mucosal prolapse and 2 with stenosis required repeat vesicostomy by the Lapides technique, after which there was no relapse. (Conclusions) Cutaneous vesicostomy could significantly reduce the incidence rate of febrile UTI. Severe constipation was considered as a risk factor for prolapse.
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Deshpande AV. Current strategies to predict and manage sequelae of posterior urethral valves in children. Pediatr Nephrol 2018; 33:1651-1661. [PMID: 29159472 DOI: 10.1007/s00467-017-3815-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
Posterior urethral valves (PUV) constitute a significant urological cause of chronic kidney disease (CKD) in children. The condition is characterised by the unique pathophysiology of the evolution of bladder dysfunction after relief of obstruction, which contributes to CKD. Improvements in prenatal diagnosis followed by selective foetal intervention have not yet produced improvement in long-term renal outcomes, although better patient selection may alter this in the future. Proactive management with surveillance, pharmacotherapy, timed voiding, double voiding, and/or assisted bladder-emptying, is being increasingly offered to those with severe bladder dysfunction and has the potential of reducing the burden of renal disease. Clinicians are currently able to counsel regarding the prognosis using serum creatinine and other emerging markers. However, much of this work remains to be validated. Satisfactory graft survival rates are now reported with aggressive management of bladder dysfunction in children who are candidates for renal transplantation. Knowledge gaps exist in identifying early markers of renal injury, risk stratification, and in understanding patient and carer perspectives in PUV.
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Affiliation(s)
- Aniruddh V Deshpande
- Department of Paediatric Urology and Surgery, John Hunter Children's Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia. .,Priority Research Centre GrowupWell, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
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Follow-up of 50 children after posterior urethral valve management in Al-Azhar University Hospitals. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000529796.57938.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Pellegrino M, Visconti D, Catania VD, D'Oria L, Manzoni C, Grella MG, Caruso A, Masini L, Noia G. Prenatal detection of megacystis: not always an adverse prognostic factor. Experience in 25 consecutive cases in a tertiary referral center, with complete neonatal outcome and follow-up. J Pediatr Urol 2017; 13:486.e1-486.e10. [PMID: 28495235 DOI: 10.1016/j.jpurol.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/13/2017] [Accepted: 04/10/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Megacystis is a condition of abnormal enlarged fetal bladder for gestational age, which is usually associated with urological malformations that may constitute a life-threatening condition for the baby. OBJECTIVE The purpose of this study was to assess the prognostic and etiological criteria of fetal megacystis and to describe the neonatal outcome in a large series collected in a single tertiary center. STUDY DESIGN A retrospective observational study was conducted between 2008 and 2012. We reviewed all consecutive cases of fetal megacystis diagnosed during routine ultrasound (US) screening. The following data were collected and analyzed: maternal age, gestational age at diagnosis, prenatal ultrasonographic details of the urinary system, extra-urinary ultrasonographic anomalies, fetal karyotype, pregnancy outcome, postnatal diagnosis, and medical/surgical follow-up. RESULTS Of the 25 fetuses included in this study, 76% were males. The mean gestational age (GA) at diagnosis was 23.1 ± 7.5 weeks (range 12-34), among them only four (16%) were diagnosed during the first trimester. Associated urological malformations were detected in 92% (n = 23) of the cases, while other malformations were detected in 36% (n = 9). Oligohydramnios or anyhydramnios were observed in 52% (n = 13) of the cases. Twelve (48%) fetuses were considered as having poor prognosis for renal function. Vesicocentesis with or without vesico-amniotic infusion were performed in 28% (n = 7) of the cases. Pregnancy outcome was surprisingly good, with only one case of prenatal death and survival rate of 96% (n = 24) of liveborn babies. Posterior urethral valve (PUV) (n = 9, 36%) was the most common etiology of the fetal megacystis, followed by persistent urogenital sinus (n = 2, 8%), Prune belly syndrome (n = 2, 8%) and bilateral vescico-ureteral reflux (VUR) (n = 2, 8%). Surgical or endoscopic procedures were performed in 75% (n = 18) of the cases. Six (24%) newborns presented with moderate/severe respiratory distress that requested invasive assisted ventilation. Three cases (n = 3, 12%) of perinatal death were observed due to severe impaired renal function. After a median follow-up of 29 months renal function was good in 79% (n = 19) of the cases. CONCLUSIONS Fetal megacystis may underline a wide range of associated pathologies with the highest prevalence of urinary malformation. Optimal counseling of the involved parents requires a multidisciplinary approach to allow the best management during the pregnancy and the perinatal period. Despite the high risk of renal failure, lung hypoplasia, and severe associated anomalies, the outcome of fetuses with megacystis could be improved thanks to an appropriate perinatal diagnosis and neonatal management.
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Affiliation(s)
- Marcella Pellegrino
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy.
| | - Daniela Visconti
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Vincenzo Davide Catania
- Department of Pediatric Surgery, Pediatric Urology, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Luisa D'Oria
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Carlo Manzoni
- Department of Pediatric Surgery, Pediatric Urology, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Maria Giovanna Grella
- Department of Pediatric Surgery, Pediatric Urology, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Alessandro Caruso
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Lucia Masini
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
| | - Giuseppe Noia
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Catholic University of Sacred Heart, Policlinico A. Gemelli Hospital, Rome, Italy
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Hosseini SMV, Zarenezhad M, Kamali M, Gholamzadeh S, Sabet B, Alipour F. Comparison of early neonatal valve ablation with vesicostomy in patient with posterior urethral valve. Afr J Paediatr Surg 2015; 12:270-2. [PMID: 26712294 PMCID: PMC4955479 DOI: 10.4103/0189-6725.172571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To compare the results of final renal function by two methods of treatment in patients diagnosed as posterior urethral valve (PUV) (valve ablation vs. vesicostomy). MATERIALS AND METHODS Fifty-four boys diagnosed with PUV participated in this study. They were divided into top two groups. Thirty-one of the total were treated with primary valve fulguration (Group 1) and 23 were treated with vesicostomy (Group 2). One-year-creatinine level and glomerular filtration rate (GFR) were measured. Also, they were taken ultrasonography detecting hydronephrosis. Data analysed in IBM SPSS21 with t-test and Chi-square test. Presented with 95% of confidence intervals. RESULTS Fifty-four boys diagnosed with PUV participated in this study. The mean age of patients in Group 1 was 3.8 ± 1.48 days and Group 2 was 4.7 ± 1.85 days. One-year Cr level was 1.57 ± 1.45 in Group 1 and 1.57 ± 1.45 in Group 2 which was not statistically significant (P < 0.8). Also 1-year GFR level was 31.1 ± 4.4 in Group 1 and 33 ± 4.7% in Group 2 (P < 0.10/23) in Group 2 (43.47%) had severe hydronephrosis and 14/31 (45.16%) in Group 1 had severe hydronephrosis. Graded ultrasound results were not significantly different (P = 0.24). CONCLUSION The results showed no significant difference. Vesicostomy might be a more favourable method due to less complication and follow-up in early neonatal life. Hence, the condition of the patients and decision of the surgeon are effective parameters in choosing an optimal method in patients diagnosed with PUV.
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Affiliation(s)
| | - Mohammad Zarenezhad
- Iranian Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Re: Role of vesicostomy in the management of posterior urethral valve in sub-Sahara Africa. J Pediatr Urol 2014;10:62-6. J Pediatr Urol 2014; 10:790. [PMID: 24993420 DOI: 10.1016/j.jpurol.2014.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/24/2022]
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