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Birkemeier K. MR Imaging of the Fetal Genitourinary Tract. Magn Reson Imaging Clin N Am 2024; 32:529-551. [PMID: 38944439 DOI: 10.1016/j.mric.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Fetal MR imaging overcomes many of the technical barriers of ultrasound and is an important diagnostic tool for fetal genitourinary (GU) anomalies. It is suited for evaluation of GU anomalies because of the fluid-sensitive sequences and superior soft tissue contrast. Often GU malformations are part of a multisystem genetic or congenital condition, and imaging the entire fetus with MR adds additional clarity about the extent of disease. It adds confidence to diagnoses of renal agenesis, urinary tract dilation, cystic disease, and tumors. It is particularly useful to delineate anatomy in complex GU malformations. This additional information guides counseling.
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Affiliation(s)
- Krista Birkemeier
- Department of Radiology, McLane Children's Medical Center, Baylor Scott & White Health, Texas A&M School of Medicine, 2401 South 31st Street, MS-01-W256, Temple, TX 76508, USA.
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Marzuillo P, Guarino S, Alfiero S, Annicchiarico Petruzzelli L, Arenella M, Baccelli F, Brugnara M, Corrado C, Delcaro G, Di Sessa A, Gallotta G, Lanari M, Lorenzi M, Malgieri G, Miraglia Del Giudice E, Pecoraro C, Pennesi M, Picassi S, Pierantoni L, Puccio G, Scozzola F, Taroni F, Tosolini C, Venditto L, Pasini A, La Scola C, Montini G. Acute kidney injury in children hospitalised for febrile urinary tract infection. Acta Paediatr 2024; 113:1711-1719. [PMID: 38641985 DOI: 10.1111/apa.17247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
AIM To determine (i) prevalence and the risk factors for acute kidney injury (AKI) in children hospitalised for febrile urinary tract infection (fUTI) and (ii) role of AKI as indicator of an underlying VUR. AKI, in fact, is favoured by a reduced nephron mass, often associated to VUR. METHODS This retrospective Italian multicentre study enrolled children aged 18 years or younger (median age = 0.5 years) discharged with a primary diagnosis of fUTI. AKI was defined using Kidney Disease/Improving Global Outcomes serum creatinine criteria. RESULTS Of 849 children hospitalised for fUTI (44.2% females, median age 0.5 years; IQR = 1.8), 124 (14.6%) developed AKI. AKI prevalence rose to 30% in the presence of underlying congenital anomalies of the kidney and urinary tract (CAKUT). The strongest AKI predictors were presence of CAKUT (OR = 7.5; 95%CI: 3.8-15.2; p = 9.4e-09) and neutrophils levels (OR = 1.13; 95%CI: 1.08-1.2; p = 6.8e-07). At multiple logistic regression analysis, AKI during fUTI episode was a significant indicator of VUR (OR = 3.4; 95%CI: 1.7-6.9; p = 0.001) despite correction for the diagnostic covariates usually used to assess the risk of VUR after the first fUTI episode. Moreover, AKI showed the best positive likelihood ratio, positive predictive value, negative predictive value and specificity for VUR. CONCLUSION AKI occurs in 14.6% of children hospitalised for fUTI and is a significant indicator of VUR.
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Affiliation(s)
- Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Alfiero
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Mattia Arenella
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Baccelli
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Ciro Corrado
- Pediatric Nephrology, "G. Di Cristina" Hospital, Palermo, Italy
| | - Giulia Delcaro
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia Gallotta
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Maya Lorenzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Gabriele Malgieri
- Pediatric Nephrology and Dialysis Unit, A.O.R.N. Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Carmine Pecoraro
- Pediatric Nephrology and Dialysis Unit, A.O.R.N. Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Marco Pennesi
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Sara Picassi
- Pediatria C, Ospedale Donna Bambino, Verona, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giuseppe Puccio
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Francesca Taroni
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Di Milano, Milano, Italy
| | | | - Laura Venditto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Andrea Pasini
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Claudio La Scola
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Di Milano, Milano, Italy
- Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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Moreno Sánchez A, García Atarés Á, Molina Herranz D, Antoñanzas Torres I, Romero Salas Y, Ruiz Del Olmo Izuzquiza JI. Secondary pseudohypoaldosteronism: a 15-year experience and a literature review. Pediatr Nephrol 2024:10.1007/s00467-024-06428-z. [PMID: 38937297 DOI: 10.1007/s00467-024-06428-z] [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: 10/30/2023] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Secondary pseudohypoaldosteronism (S-PHA) is a rare condition resulting from renal tubular resistance to aldosterone in children with urinary tract infection (UTI) and/or nephrourological malformations. It is characterized by nonspecific symptoms but with the potential for life-threatening complications. We aim to evaluate the clinical manifestations, diagnostic approach, and therapeutic interventions in children with S-PHA, along with a review of recent publications. METHODS A retrospective observational descriptive study was conducted on S-PHA cases diagnosed over the last 15 years at a tertiary pediatric nephrology unit. The literature for the last 10 years was reviewed. RESULTS Twelve patients (10 males, 6 days to 6 months) were identified. Weight loss was the main reason for consultation (50%). Ninety-two percent of patients had an underlying nephrourological pathology and 62% concomitant confirmed UTI. Seven out of 12 children were admitted to the PICU. A subsequent extrapontine myelinolysis was observed in one patient as neurological sequelae. Twenty-one articles related to S-PHA have been identified on PubMed and Embase. CONCLUSIONS S-PHA should be considered in infants under 6 months of age with UTI and/or CAKUT. Obstructive anomalies and vesicoureteral reflux can be found, affecting both unilateral and bilateral systems. Early medical and surgical interventions are crucial and require close monitoring to avoid iatrogenic complications.
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Affiliation(s)
- Amelia Moreno Sánchez
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain.
| | - Álvaro García Atarés
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain
| | - David Molina Herranz
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain
| | - Irene Antoñanzas Torres
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain
| | - Yolanda Romero Salas
- Pediatric Nephrology Unit, Department of Pediatrics, Hospital Universitario Miguel Servet, P.º de Isabel La Católica, 1-3, Zaragoza, Spain
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AIUM Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:E20-E32. [PMID: 38224490 DOI: 10.1002/jum.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
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Heling KS, Chaoui R. Ultrasound Diagnosis of Malformations of the Fetal Kidneys and Urinary System. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:232-268. [PMID: 37769695 DOI: 10.1055/a-2132-6573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Malformations of the fetal kidneys and urinary system are common and easily visualized and diagnosed on ultrasound. This article presents the typical sonographic findings of these abnormalities during the various stages of pregnancy. Because malformations of the urogenital tract often have an association with genetic diseases/ciliopathies, these are also discussed. To complete the article, we provide a brief overview of the normal anatomy of the kidneys and urinary system. The normal anatomy and malformations of the genitalia will not be discussed in this article due to their complexity.
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Affiliation(s)
- Kai-Sven Heling
- Center for Prenatal Diagnostics, Friedrichstraße, Berlin, Germany
| | - Rabih Chaoui
- Center for Prenatal Diagnostics, Friedrichstraße, Berlin, Germany
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Xie Q, Wang C, Su C, Shi B, Li Y, Huang J, Chen C. Feasibility and Effectiveness of Repeat Laparoscopic Pyeloplasty for Recurrent Ureteropelvic Junction Obstruction in Pediatric Patients. J Endourol 2024; 38:584-589. [PMID: 38545757 DOI: 10.1089/end.2023.0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Objective: To assess the outcomes of redo laparoscopic pyeloplasty (RLP) in pediatric patients with recurrent ureteropelvic junction obstruction (UPJO) in contrast to redo open pyeloplasty (ROP). In addition, evaluate the feasibility and efficacy of RLP as a treatment modality for recurrent UPJO in children. Materials and Methods: The data of 44 patients from March 2012 to March 2022, who underwent redo pyeloplasty, were retrospectively reviewed. In Group RLP, the children underwent RLP, whereas ROP was attempted in Group ROP. Demographics, clinical manifestations, surgical duration, hospitalization duration, complication rates, and treatment success were examined within the respective groups. Moreover, preoperative and postoperative measurements of anterior-posterior diameter of the renal pelvis (APD), preoperative assessment of differential renal function (DRF), and the percentage of improvement in DRF (PI-DRF) were subject to analysis. Results: The study included 28 patients who underwent RLP (Group RLP), and 16 patients who underwent ROP (Group ROP). In all cases, the Anderson-Hynes technique was employed. There was no significant difference between the two groups regarding age, body mass index, gender distribution, affected side, preoperative APD, postoperative APD, and preoperative DRF. In comparison to Group ROP, Group RLP exhibited a shorter hospitalization duration, a longer surgical procedure duration, and a higher percentage improvement in PI-DRF. The median follow-up period for Group RLP was 25 months, whereas it was 25.5 months for Group ROP. Notably, the success rates were similar between the two groups, with a success rate of 89.2% in RLP and 87.5% in ROP (p = 0.634). Conclusion: RLP has a comparable success rate to ROP and is a safe, effective, and feasible procedure for the treatment of failed pyeloplasty in children.
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Affiliation(s)
- Qike Xie
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Congjun Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Cheng Su
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bo Shi
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yong Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junqiang Huang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chao Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Wehbi EJ, Davis-Dao CA, Williamson SH, Herndon CDA, Chamberlin JD, Dudley AG, Cannon S, Lockwood GM, Kern NG, Zee RS, Braga LH, Welch V, Chuang KW, McGrath M, Stephany HA, Khoury AE. The conundrum of high-grade hydronephrosis with non-obstructive drainage on diuretic renography. J Pediatr Urol 2024:S1477-5131(24)00281-X. [PMID: 38906709 DOI: 10.1016/j.jpurol.2024.05.017] [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: 04/12/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Patients with high grade hydronephrosis (HN) and non-obstructive drainage on mercaptoacetyltriglycine (MAG-3) diuretic renography (renal scans) can pose a dilemma for clinicians. Some patients may progress and require pyeloplasty; however, more clarity is needed on outcomes among these patients. OBJECTIVE Our primary objective was to predict which patients with high-grade HN and non-obstructive renal scan, (defined as T ½ time <20 min) would experience resolution of HN. Our secondary objective was to determine predictors for surgical intervention. STUDY DESIGN Patients with prenatally detected HN were prospectively enrolled from 7 centers from 2007 to 2022. Included patients had a renal scan with T ½<20 min and Society for Fetal Urology (SFU) grade 3 or 4 at last ultrasound (RBUS) prior to renal scan. Primary outcome was resolution of HN defined as SFU grade 1 and anterior posterior diameter of the renal pelvis (APD) < 10 mm on follow-up RBUS. Secondary outcome was pyeloplasty, comparing patients undergoing pyeloplasty with patients followed with serial imaging without resolution. Multivariable logistic regression was used for analysis. RESULTS Of the total 2228 patients, 1311 had isolated HN, 338 patients had a renal scan and 129 met inclusion criteria. Median age at renal scan was 3.1 months, 77% were male and median follow-up was 35 months (IQR 20-49). We found that 22% (29/129) resolved, 42% of patients had pyeloplasty (54/129) and 36% had persistent HN that required follow-up (46/129). Univariate predictors of resolution were age≥3 months at time of renal scan (p = 0.05), T ½ time≤5 min (p = 0.09), SFU grade 3 (p = 0.0009), and APD<20 mm (p = 0.005). Upon multivariable analysis, SFU grade 3 (OR = 4.14, 95% CI: 1.30-13.4, p = 0.02) and APD<20 mm (OR = 6.62, 95% CI: 1.41-31.0, p = 0.02) were significant predictors of resolution. In the analysis of decision for pyeloplasty, SFU grade 4 (OR = 2.40, 95% CI: 1.01-5.71, p = 0.04) and T ½ time on subsequent renal scan of ≥20 min (OR = 5.14, 95% CI: 1.54-17.1, p = 0.008) were the significant predictors. CONCLUSIONS Patients with high grade HN and reassuring renal scan can pose a significant challenge to clinical management. Our results help identify a specific candidate for observation with little risk for progression: the patient with SFU grade 3, APD under 20 mm, T ½ of 5 min or less who was 3 months or older at the time of renal scan. However, many patients may progress to surgery or do not fully resolve and require continued follow-up.
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Affiliation(s)
- Elias J Wehbi
- Children's Hospital of Orange County, Division of Pediatric Urology, Orange, CA, USA; University of California, Irvine, Department of Urology, Irvine, CA, USA.
| | - Carol A Davis-Dao
- Children's Hospital of Orange County, Division of Pediatric Urology, Orange, CA, USA; University of California, Irvine, Department of Urology, Irvine, CA, USA
| | - Sarah H Williamson
- Children's Hospital of the King's Daughters, Division of Urology, Norfolk, VA, USA
| | - C D Anthony Herndon
- Children's Hospital of Richmond at Virginia Commonwealth University, Department of Urology, Richmond, VA, USA
| | | | - Anne G Dudley
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Shannon Cannon
- Department of Urology, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Gina M Lockwood
- Department of Urology, The University of Iowa, Iowa City, IA, USA
| | - Nora G Kern
- University of Virginia, Charlottesville, VA, USA
| | - Rebecca S Zee
- Children's Hospital of Richmond at Virginia Commonwealth University, Department of Urology, Richmond, VA, USA
| | - Luis H Braga
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Valre Welch
- Children's Hospital of Richmond at Virginia Commonwealth University, Department of Urology, Richmond, VA, USA
| | - Kai-Wen Chuang
- Children's Hospital of Orange County, Division of Pediatric Urology, Orange, CA, USA; University of California, Irvine, Department of Urology, Irvine, CA, USA
| | - Melissa McGrath
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Heidi A Stephany
- Children's Hospital of Orange County, Division of Pediatric Urology, Orange, CA, USA; University of California, Irvine, Department of Urology, Irvine, CA, USA
| | - Antoine E Khoury
- Children's Hospital of Orange County, Division of Pediatric Urology, Orange, CA, USA; University of California, Irvine, Department of Urology, Irvine, CA, USA
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Wolmer C, Delmas J, Pecorelli S, Dobremez E, Ferdynus C, Harper L. Predicting clinically significant events in children with ureteropelvic junction obstruction. Front Pediatr 2024; 12:1409170. [PMID: 38853782 PMCID: PMC11157035 DOI: 10.3389/fped.2024.1409170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/14/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Ureteropelvic junction obstruction (UPJO) syndrome is one of the most common causes of neonatal hydronephrosis. Management varies from simple monitoring to surgical intervention, with indications differing between institutions. A consensus of 8 societies recently described a new Urinary Tract Dilation (UTD) classification which aims to standardize ultrasound description of hydronephrosis, but which is also supposed to have predictive value in children with hydronephrosis. Our aim was to compare, in a monocentric prospective cohort of children with UPJO, the ability of UTD to predict the occurrence of a clinically significant event within the first year of life, as compared to anteroposterior diameter of the renal pelvis (APD). Study design We used a preexisting cohort of children followed in a prospective study on UPJO. A pediatric radiologist, blinded to the children's outcome, classified the last antenatal ultrasound and postnatal ultrasound according to the UTD-A and UTD-P classification. He also confirmed the APD-A and APD-P measures. We defined a clinically significant event as being: increased pelvic dilation (>5 mm) and/or the presence of a febrile urinary tract infection (fUTI) and/or impaired renal function on initial nuclear scan (<40%). We performed a ROC-AUC curve and Random Forest (RF) analysis to compare the ability of the APD-A, APD-P, UTD-A and UTD-P scores to predict a clinically significant event. Results The cohort included 28 children. Clinically significant events were noted in 20 out of 28 patients: 13 children presented an increase >5 mm in dilation, 6 presented an episode of fUTI and 9 had impaired function of the affected kidney. APD-A was the most effective individual criterion for predicting the occurrence of a significant clinical event (AUC = 0.867). Conclusion In our series, for children with UPJO, the most significant marker was prenatal APD >15 mm to predict an increase in dilation >5 mm.
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Affiliation(s)
- Clara Wolmer
- Department of Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France
| | - Jean Delmas
- Department of Pediatric Radiology, Hopital Pellegrin-Enfants, CHU Bordeaux, France
| | - Silvia Pecorelli
- Department of Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France
| | - Eric Dobremez
- Department of Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France
| | - Cyril Ferdynus
- Methodological Support Unit, Félix Guyon University Hospital Center, Saint-Denis, France
| | - Luke Harper
- Department of Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France
- INSERM, Clinical Investigation Center-CIC-1401, Bordeaux, France
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Elsayed Y, Soylu H. Point-of-care abdominal ultrasound in pediatric and neonatal intensive care units. Eur J Pediatr 2024; 183:2059-2069. [PMID: 38459132 DOI: 10.1007/s00431-024-05443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 03/10/2024]
Abstract
A spectrum of critical abdominal pathological conditions that might occur in neonates and children warrants real-time point-of-care abdominal ultrasound (abdominal POCUS) assessment. Abdominal radiographs have limited value with low sensitivity and specificity in many cases and have no value in assessing abdominal organ perfusion and microcirculation (Rehan et al. in Clin Pediatr (Phila) 38(11):637-643, 1999). The advantages of abdominal POCUS include that it is non-invasive, easily available, can provide information in real-time, and can guide therapeutic intervention (such as paracentesis and urinary bladder catheterization), making it a crucial tool for use in pediatric and neonatal abdominal emergencies (Martínez Biarge et al. in J Perinat Med 32(2):190-194, 2004) and (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021). Conclusion: Abdominal POCUS is a dynamic assessment with many ultrasound markers of gut injury by two dimensions (2-D) and color Doppler (CD) compared to the abdominal X-ray; the current evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency situations. However, it should still be considered an adjunct rather than replacing abdominal X-rays due to its limitations and operator constraints (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021). What is Known: • Ultrasound is an important modality for the assessment of abdominal pathologies. What is New: • The evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency abdominal situations in the neonatal and pediatric intensive care units.
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Affiliation(s)
- Yasser Elsayed
- Section of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
- Women's Hospital, 820 Sherbrook Street, Winnipeg, MB, R2016, R3A0L8, Canada.
| | - Hanifi Soylu
- Section of Neonatology, Department of Pediatrics, Selcuk University, Konya, Turkey
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Rivetti G, Marzuillo P, Guarino S, Di Sessa A, La Manna A, Caldamone AA, Papparella A, Noviello C. Primary non-refluxing megaureter: Natural history, follow-up and treatment. Eur J Pediatr 2024; 183:2029-2036. [PMID: 38441661 PMCID: PMC11035438 DOI: 10.1007/s00431-024-05494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 04/23/2024]
Abstract
Primary non-refluxing megaureter (PMU) is a congenital dilation of the ureter which is not related to vesicoureteral reflux, duplicated collecting systems, ureterocele, ectopic ureter, or posterior urethral valves and accounts for 5 to 10% of all prenatal hydronephrosis (HN) cases. The etiology is a dysfunction or stenosis of the distal ureter. Most often PMU remains asymptomatic with spontaneous resolution allowing for non-operative management. Nevertheless, in selective cases such as the development of febrile urinary tract infections, worsening of the ureteral dilatation, or reduction in relative renal function, surgery should be considered. CONCLUSION Ureteral replantation with excision of the dysfunctional ureteral segment and often ureteral tapering is the gold-standard procedure for PMU, although endoscopic treatment has been shown to have a fair success rate in many studies. In this review, we discuss the natural history, follow-up, and treatment of PMU. WHAT IS KNOWN • PMU is the result of an atonic or stenotic segment of the distal ureter, resulting in congenital dilation of the ureter, and is frequently diagnosed on routine antenatal ultrasound. WHAT IS NEW • Most often, PMU remains asymptomatic and clinically stable, allowing for non-operative management. • Nevertheless, since symptoms can appear even after years of observation, long-term ultrasound follow-up is recommended, even up to young adulthood, if hydroureteronephrosis persists. • Ureteral replantation is the gold standard in case surgery is needed. In selected cases, however, HPBD could be a reasonable alternative.
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Affiliation(s)
- Giulio Rivetti
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Angela La Manna
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Anthony A Caldamone
- Division of Urology, Warren Alpert School of Medicine at Brown University/Hasbro Children's Hospital, Providence, RI, USA
| | - Alfonso Papparella
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Carmine Noviello
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
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11
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Kim HW, Hwang J, Pai KS, Suh YA. Urinary tract dilation classification system for predicting surgical management and urinary tract infection in neonates and young infants: a systematic review and meta-analysis. Pediatr Radiol 2024; 54:795-804. [PMID: 38282063 DOI: 10.1007/s00247-024-05854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND The urinary tract dilation classification system has recently been developed to ensure a unified approach to describe urinary tract dilation in neonates and young infants. However, the predictive value of this system for surgical intervention or urinary tract infection (UTI) has not yet been evaluated in a meta-analysis. OBJECTIVE This systematic review and meta-analysis aimed to evaluate the utility of a postnatal urinary tract dilation classification system for predicting surgical management or a UTI occurrence. MATERIALS AND METHODS As the urinary tract dilation classification system was introduced in 2014, we searched Embase and PubMed databases for studies published between January 2014 and December 2022. Original articles that reported surgical interventions or UTI episodes according to postnatal urinary tract dilation grades were included. The pooled odds ratio (OR) was calculated, using either the fixed-effects or random-effects model, given the lower urinary tract dilation grades as the base category. The quality of the included studies was evaluated using the Newcastle-Ottawa scale. RESULTS Of the 285 articles reviewed, eight (comprising 2,165 children) were included in the analysis. The studies were of medium-to-high quality. Pooled analysis demonstrated that urinary tract dilation P3 (combined OR, 21.41; 95% confidence interval [CI], 15.72-29.17) and urinary tract dilation P2-P3 (combined OR, 65.17; 95% CI, 33.08-128.38) were associated with surgical intervention. The urinary tract dilation P3 (combined OR, 2.11; 95% CI, 1.56-2.85) and urinary tract dilation P2-P3 (combined OR, 3.36; 95% CI, 2.43-4.63) were associated with UTI episodes. CONCLUSION The postnatal urinary tract dilation classification system is useful for predicting the need for surgical management and UTI episodes in infants with hydronephrosis.
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Affiliation(s)
- Hae Won Kim
- Department of Healthcare, Kakao Brain Co., Seongnam, Republic of Korea
| | - Jisun Hwang
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, 164 World Cup-Ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea.
| | - Ki Soo Pai
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yoong-A Suh
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
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12
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Miguel OX, Kaczmarek E, Lee I, Ducharme R, Dingwall-Harvey ALJ, Rennicks White R, Bonin B, Aviv RI, Hawken S, Armour CM, Dick K, Walker MC. Deep learning prediction of renal anomalies for prenatal ultrasound diagnosis. Sci Rep 2024; 14:9013. [PMID: 38641713 PMCID: PMC11031588 DOI: 10.1038/s41598-024-59248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/08/2024] [Indexed: 04/21/2024] Open
Abstract
Deep learning algorithms have demonstrated remarkable potential in clinical diagnostics, particularly in the field of medical imaging. In this study, we investigated the application of deep learning models in early detection of fetal kidney anomalies. To provide an enhanced interpretation of those models' predictions, we proposed an adapted two-class representation and developed a multi-class model interpretation approach for problems with more than two labels and variable hierarchical grouping of labels. Additionally, we employed the explainable AI (XAI) visualization tools Grad-CAM and HiResCAM, to gain insights into model predictions and identify reasons for misclassifications. The study dataset consisted of 969 ultrasound images from unique patients; 646 control images and 323 cases of kidney anomalies, including 259 cases of unilateral urinary tract dilation and 64 cases of unilateral multicystic dysplastic kidney. The best performing model achieved a cross-validated area under the ROC curve of 91.28% ± 0.52%, with an overall accuracy of 84.03% ± 0.76%, sensitivity of 77.39% ± 1.99%, and specificity of 87.35% ± 1.28%. Our findings emphasize the potential of deep learning models in predicting kidney anomalies from limited prenatal ultrasound imagery. The proposed adaptations in model representation and interpretation represent a novel solution to multi-class prediction problems.
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Affiliation(s)
- Olivier X Miguel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Emily Kaczmarek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Inok Lee
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Alysha L J Dingwall-Harvey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Ruth Rennicks White
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H-8L6, Canada
| | - Brigitte Bonin
- Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H-8L6, Canada
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada
| | - Richard I Aviv
- Department of Radiology and Medical Imaging, University of Ottawa, Ottawa, Canada
- Department of Radiology and Medical Imaging, The Ottawa Hospital, Ottawa, Canada
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- ICES, Toronto, Canada
| | - Christine M Armour
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
- Prenatal Screening Ontario, Better Outcomes Registry and Network, Ottawa, Canada
| | - Kevin Dick
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Mark C Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- Department of Pediatrics, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics and Gynecology, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H-8L6, Canada.
- International and Global Health Office, University of Ottawa, Ottawa, Canada.
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada.
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada.
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13
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Hamdani G, Yaniv N, Shoham S, Borovitz Y, Levi S, Landau D, Dagan A. Isolated Hydronephrosis and Urinary Tract Infection by Two Years of Age: A Population-Based Study. J Pediatr 2024; 271:114055. [PMID: 38614256 DOI: 10.1016/j.jpeds.2024.114055] [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: 01/01/2024] [Revised: 03/12/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE To evaluate the risk for urinary tract infection (UTI) in infants with isolated hydronephrosis (IH). STUDY DESIGN A retrospective, population-based study including all infants insured by Clalit Health Services and followed from birth to age 2 years in 3 regions of central Israel. Infants were divided into 3 groups based on electronic medical record diagnoses by age 6 months: (1) control: no urological diagnosis; (2) IH; and (3) complicated urological diagnosis (CUD): any additional nephrological/urological diagnosis with/without HN. The primary outcome was a diagnosis of UTI in the first 2 years of life. RESULTS The cohort included 340 619 infants (52% male): 333 920 controls, 4369 with IH, and 2331 with CUD. Infants with IH were associated with a greater risk for UTI than control patients (17% vs 4%, P < .001). UTI risk for a male infant with IH was greater than for a female infant in the control group (12.6% vs 6.5%, P < .001). In a multivariable logistic regression analysis, both IH (OR 7.04; 95% CI 6.46-7.66) and CUD (OR 14.9; 95% CI 13.6-16.4) were independently associated with UTI. CONCLUSION Infants with IH are at a greater risk for UTI in the first 2 years of life, supporting the recommendation for a high index of suspicion for UTI in this population.
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Affiliation(s)
- Gilad Hamdani
- Nephrology Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
| | - Noga Yaniv
- Research Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Shoval Shoham
- Research Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yael Borovitz
- Nephrology Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Shelly Levi
- Nephrology Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Daniel Landau
- Nephrology Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Dagan
- Nephrology Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Damasio MB, Donati F, Bruno C, Darge K, Mentzel HJ, Ključevšek D, Napolitano M, Ozcan HN, Riccabona M, Smets AM, Sofia C, Stafrace S, Petit P, Ording Müller LS. Update on imaging recommendations in paediatric uroradiology: the European Society of Paediatric Radiology workgroup session on voiding cystourethrography. Pediatr Radiol 2024; 54:606-619. [PMID: 38467874 DOI: 10.1007/s00247-024-05883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/13/2024]
Abstract
Voiding cystourethrography (VCUG) is a fluoroscopic technique that allows the assessment of the urinary tract, including the urethra, bladder, and-if vesicoureteral reflux (VUR) is present-the ureters and the pelvicalyceal systems. The technique also allows for the assessment of bladder filling and emptying, providing information on anatomical and functional aspects. VCUG is, together with contrast-enhanced voiding urosonography (VUS), still the gold standard test to diagnose VUR and it is one of the most performed fluoroscopic examinations in pediatric radiology departments. VCUG is also considered a follow-up examination after urinary tract surgery, and one of the most sensitive techniques for studying anatomy of the lower genitourinary tract in suspected anatomical malformations. The international reflux study in 1985 published the first reflux-protocol and graded VUR into five classes; over the following years, other papers have been published on this topic. In 2008, the European Society of Paediatric Radiology (ESPR) Uroradiology Task Force published the first proposed VCUG Guidelines with internal scientific society agreement. The purpose of our work is to create a detailed overview of VCUG indications, procedural recommendations, and to provide a structured final report, with the aim of updating the 2008 VCUG paper proposed by the European Society of Paediatric Radiology (ESPR). We have also compared VCUG with contrast-enhanced VUS as an emergent alternative. As a result of this work, the ESPR Urogenital Task Force strongly recommends the use of contrast-enhanced VUS as a non-radiating imaging technique whenever indicated and possible.
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Affiliation(s)
- Maria Beatrice Damasio
- Pediatric Radiology Department, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy.
| | - Francesco Donati
- Pediatric Surgery Department, University of Genova, Genoa, Italy
| | - Costanza Bruno
- Radiology Department, AOUI Verona (Azienda Ospedaliera Universitaria Integrata), Verona, Italy
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Department of Radiology, Universitätsklinikum Jena, Jena, Germany
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Marcello Napolitano
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Milan, Italy
| | - H Nursun Ozcan
- Department of Radiology/Division of Pediatric Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | | | - Anne M Smets
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Samuel Stafrace
- McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
| | - Philippe Petit
- Department of Pediatric Radiology, Hopital Timone Enfants, Aix Marseille-Université, Marseille, France
| | - Lil-Sofie Ording Müller
- Division of Radiology and Nuclear Medicine, Department of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
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15
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Quiring ME, Son Y, Thaker R, Davidson N, Wu E, Fink BA, Thomas B, Gentry NB, Yossef A, DeMario VK, Earnshaw L, Weldekidan B, Dean G. Vesicoureteral reflux severity is not associated with unplanned urinary catheterization or length of hospital stay after ureteroneocystostomy. J Pediatr Urol 2024; 20:183-190. [PMID: 37770341 DOI: 10.1016/j.jpurol.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Vesicoureteral reflux (VUR) is a common urologic condition affecting approximately 1% of all children. Surgical success often depends on the grade of VUR, as patients with grades 4 or 5 have been have a greater risk for postoperative complications. Unplanned urinary catheter placement (UCP) postoperatively and prolonged length of hospital stay (LOS) are indicative of unexpected complications. The association between VUR severity and such metrics remain unclear. OBJECTIVE The study's objective is to determine if the severity of VUR is associated with higher rates of UCP or prolonged LOS after ureteroneocystostomy (UNC). STUDY DESIGN The 2020 National Surgical Quality Improvement Program Pediatric database was analyzed for patients with VUR. A total of 1742 patients were initially evaluated with 1373 meeting exclusion criteria. The patients were divided into 3 groups of varying voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC) severity: VCUG Grade 1 or RNC Grade 1 (Group A), VCUG Grade 2 or 3 or RNC Grade 2 (Group B), and VCUG Grade 4 or 5 or RNC Grade 3 (Group C). Basic statistical analysis was performed, and logistic regression was performed with both UCP and LOS as dependent variables. RESULTS Among the 1373 patients, 2.9% were included in Group A, 32.5% were in Group B, and 64.6% were in Group C. Significant differences were found among the groups for mean age, gender, inpatient status, rate of congenital malformation, ureteral stents, and ASA classification. Regarding surgical treatment, differences were also found comparing mean operative time, LOS, laterality and type of procedure, urine culture results, rates of UTI, surgical site infections, postoperative returns to the emergency department, and unplanned procedures and catheterization. Multivariate analysis demonstrated no significant association between the rate of UCP and VUR severity, while postoperative UTI and unplanned procedure were both independent factors associated with UCP postoperatively. Additionally, postoperative UTI, ASA classification, mean operation time, ureteral stent placement, unplanned procedure, and UCP were independent factors found to contribute to LOS. CONCLUSION Greater VUR severity does not appear to increase the need for catheterization or prolong hospital stay, while the development of a UTI postoperatively or having an additional unplanned procedure are associated with an increased likelihood of both. The postoperative course after UNC also appears to be influenced more so by other factors such as the operative approach and whether complications arise.
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Affiliation(s)
- Mark E Quiring
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA.
| | - Young Son
- Jefferson Health New Jersey, Department of Urology, 18 E Laurel Rd, Stratford, NJ 08084, USA.
| | - Ranel Thaker
- Lake Erie College of Osteopathic Medicine, 1858 W Grandview Blvd, Erie, PA 16509, USA.
| | - Noah Davidson
- Lake Erie College of Osteopathic Medicine, 1858 W Grandview Blvd, Erie, PA 16509, USA.
| | - Edward Wu
- Alabama College of Osteopathic Medicine, 445 Health Sciences Blvd, Dothan, AL 36303, USA.
| | - Benjamin A Fink
- Jefferson Health New Jersey, Department of Urology, 18 E Laurel Rd, Stratford, NJ 08084, USA; Rowan University, School of Osteopathic Medicine, 113 E Laurel Rd, Stratford, NJ 08084, USA.
| | - Brian Thomas
- Rowan University, School of Osteopathic Medicine, 113 E Laurel Rd, Stratford, NJ 08084, USA.
| | - Nathaniel B Gentry
- New York Institute of Technology College of Osteopathic Medicine, 2405 Aggie Rd, Jonesboro, AR 72401, USA.
| | - Angie Yossef
- Pacific Northwest University of Health Sciences College of Osteopathic Medicine, 200 University Parkway, Yakima, WA 98901, USA.
| | - Virgil K DeMario
- University of the Incarnate Word, School of Osteopathic Medicine, 7615 Kennedy Hill Dr, San Antonio, TX 78235, USA.
| | - Lance Earnshaw
- Jefferson Health New Jersey, Department of Urology, 18 E Laurel Rd, Stratford, NJ 08084, USA.
| | - Blen Weldekidan
- Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, USA.
| | - Gregory Dean
- Temple University, Department of Urology, 3401 N Broad St, Philadelphia, PA 19140, USA.
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16
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Scott Wang HH, Li M, Cahill D, Panagides J, Logvinenko T, Chow J, Nelson C. A machine learning algorithm predicting risk of dilating VUR among infants with hydronephrosis using UTD classification. J Pediatr Urol 2024; 20:271-278. [PMID: 37993352 DOI: 10.1016/j.jpurol.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/17/2023] [Accepted: 11/04/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUNDS Urinary Tract Dilation (UTD) classification has been designed to be a more objective grading system to evaluate antenatal and post-natal UTD. Due to unclear association between UTD classifications to specific anomalies such as vesico-ureteral reflux (VUR), management recommendations tend to be subjective. OBJECTIVE We sought to develop a model to reliably predict VUR from early post-natal ultrasound. STUDY DESIGN Radiology records from single institution were reviewed to identify infants aged 0-90 days undergoing early ultrasound for antenatal UTD. Medical records were reviewed to confirm diagnosis of VUR. Primary outcome defined as dilating (≥Gr3) VUR. Exclusion criteria include major congenital urologic anomalies (bilateral renal agenesis, horseshoe kidney, cross fused ectopia, exstrophy) as well as patients without VCUG. Data were split into training/testing sets by 4:1 ratio. Machine learning (ML) algorithm hyperparameters were tuned by the validation set. RESULTS In total, 280 patients (540 renal units) were included in the study (73 % male). Median (IQR) age at ultrasound was 27 (18-38) days. 66 renal units were found to have ≥ grade 3 VUR. The final model included gender, ureteral dilation, parenchymal appearance, parenchymal thickness, central calyceal dilation. The model predicted VUR with AUC at 0.81(0.73-0.88) on out-of-sample testing data. Model is shown in the figure. DISCUSSION We developed a ML model that can predict dilating VUR among patients with hydronephrosis in early ultrasound. The study is limited by the retrospective and single institutional nature of data source. This is one of the first studies demonstrating high performance for future diagnosis prediction in early hydronephrosis cohort. CONCLUSIONS By predicting dilating VUR, our predictive model using machine learning algorithm provides promising performance to facilitate individualized management of children with prenatal hydronephrosis, and identify those most likely to benefit from VCUG. This would allow more selective use of this test, increasing the yield while also minimizing overutilization.
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Affiliation(s)
| | - Michael Li
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Dylan Cahill
- School of Medicine, Harvard University, Boston, MA, USA
| | | | - Tanya Logvinenko
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Jeanne Chow
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Caleb Nelson
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
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17
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Walker EYX, Winyard P, Marlais M. Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families. Pediatr Nephrol 2024; 39:1065-1075. [PMID: 37656310 PMCID: PMC10899401 DOI: 10.1007/s00467-023-06137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
Congenital anomalies of the kidney and urinary tract are collectively one of the most commonly diagnosed antenatal conditions. Clinicians have several tools available to diagnose anomalies, including imaging, biomarkers, family history and genetic studies. In certain cases, antenatal interventions such as vesico-amniotic shunting may be considered to improve postnatal outcomes.Congenital kidney anomalies detected antenatally can vary in clinical significance from almost no impact postnatally to significant morbidity and perinatal mortality. Prognosis broadly depends on kidney size, structure and amount of amniotic fluid, alongside genetics and family history, and progression on subsequent scans. It is important to counsel parents appropriately using a parent-focused and personalised approach. The use of a multidisciplinary team should always be considered.
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Affiliation(s)
- Emma Y X Walker
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Paul Winyard
- UCL Great Ormond Street Institute for Child Health, London, UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute for Child Health, London, UK.
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18
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Shi T, Lao W, Ouyang K, Chen Y, Zhang Y, Luo J, Chen S. Laparoscopic pyeloplasty for newborns with severe hydronephrosis. Front Pediatr 2024; 12:1343211. [PMID: 38560400 PMCID: PMC10979644 DOI: 10.3389/fped.2024.1343211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Aim We aimed to investigate the short-term efficacy and safety of laparoscopic pyeloplasty for treating newborns with severe hydronephrosis due to ureteropelvic junction obstruction (UPJO). Methods A retrospective analysis was performed on 16 newborn patients with severe neonatal hydronephrosis who underwent laparoscopic pyeloplasty at our hospital from January 2021 to November 2022. All patients were regularly followed up. Laparoscopic pyeloplasty with double J stent placement was performed after the presence of severe hydronephrosis was confirmed. Results Among the 16 pediatric patients (13 males, 3 females), the left side was affected in 13 cases and the right side in 3. The average age at surgery was 9.50 (8.50-12.00) days, with an average weight of 3.30 ± 0.95 kg. Laparoscopic pyeloplasty was performed in all cases without the need for open conversion. The mean surgery duration was 292.06 ± 73.60 min, with minimal blood loss (2.50, 2.00-5.00 ml). Postoperative hospital stays averaged 13.44 ± 4.70 days. No anastomotic leakage occurred, and follow-ups at 1, 3, 6, and 12 months showed no stent displacement, except for one case where the stent was removed at 1 month, and the others at 3 months. There were no cases of worsened hydronephrosis, except for one with renal atrophy at the 6-month follow-up. Changes in renal pelvis anteroposterior diameter exhibited a time effect (F = 49.281, P < 0.001), with significant differences at 1, 3, 6, and 12 months postoperatively compared to preoperative values (P < 0.05). Notably, differences were observed between 6 and 3 months, as well as between 12 and 3 months postoperatively (P < 0.05). Similarly, renal parenchymal thickness changes showed a time effect Pediatric urology, Guangdong Women and Children Hospital, Guangzhou, China (F = 49.281, P < 0.001), with significant differences at 1, 3, 6, and 12 months postoperatively compared to preoperative values (P < 0.05). Significant differences were also noted between 6 and 1 month, as well as between 12 and 1 month postoperatively (P < 0.05). There was one case of urinary tract infection after surgery, and no case of recurrence was observed. Conclusion Severe neonatal hydronephrosis must be treated promptly. Laparoscopic pyeloplasty is a safe and feasible treatment with minimal complications for newborn patients with severe hydronephrosis due to UPJO.
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Affiliation(s)
| | - Weihua Lao
- Pediatric Urology, Guangdong Women and Children Hospital, Guangzhou, China
| | | | - Yueqing Chen
- Pediatric Urology, Guangdong Women and Children Hospital, Guangzhou, China
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19
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Santos AI, Ferreira RT. Nuclear medicine and pediatric nephro-urology: a long-lasting successful partnership. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:3-22. [PMID: 38445832 DOI: 10.23736/s1824-4785.24.03557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Congenital anomalies of the kidney and urinary tract, as well as urinary infections, are very frequent in children. After the clinical and laboratory evaluation, the first imaging procedure to be done is a renal and bladder ultrasound, but afterwards, a main contribution comes from nuclear medicine. Through minimally invasive and sedation-free procedures, nuclear medicine allows the evaluation of the functional anatomy of the urinary tract, and the quantification of renal function and drainage. If pediatric dosage cards provided by scientific societies are used, radiation exposure can also be low. In the pediatric conditions previously mentioned, nuclear medicine is used both for initial diagnosis and follow-up, mostly in cases of suspicion of ureteropelvic or ureterovesical junction syndromes, as well as vesicoureteral reflux or renal scars of febrile infectious episodes. Pediatric nephro-urology constitutes a significant workload of pediatric nuclear medicine departments. The following paragraphs are a revision of the renal radiopharmaceuticals, as well as the nuclear nephro-urology procedures - dynamic and static renal scintigraphy, and direct and indirect radionuclide cystography. A summary of the techniques, main indications, interpretation criteria and pitfalls will be provided. Some future directions for the field are also pointed out, among which the most relevant is the need for nuclear medicine professionals to use standardized protocols and integrate multidisciplinary teams with other pediatric and adult health professionals that manage these life-long pediatric pathologies, which are recognized as an important cause of adult chronic kidney disease.
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Affiliation(s)
- Ana I Santos
- Service of Nuclear Medicine, Hospital Garcia de Orta, Almada, Portugal -
- Nova Medical School, NOVA University, Lisbon, Portugal -
| | - Rita T Ferreira
- Service of Nuclear Medicine, Hospital Garcia de Orta, Almada, Portugal
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Rius-Gordillo N, Ferré N, González JD, Ibars Z, Parada-Ricart E, Escribano J. Role of dexamethasone in controlling the proinflammatory cytokine cascade in the first episode of paediatric acute pyelonephritis. Acta Paediatr 2024; 113:564-572. [PMID: 37965887 DOI: 10.1111/apa.17034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
AIM Febrile urinary tract infection is a common bacterial infection in childhood. The kidney damage after acute pyelonephritis (APN) could be related to the stimulation of the proinflammatory response. We aimed to investigate the role of inflammatory cytokines and the effect of dexamethasone after a first episode of APN. METHODS Subanalysis of the DEXCAR RCT in which children with confirmed APN (1 month-14 years) were randomly assigned to receive a 3 days course of either intravenous dexamethasone or placebo. Urinary cytokine levels at diagnosis and after 72 h of treatment were measured. RESULTS Ninety-two patients were recruited. Younger patients, males and those with abnormalities in the ultrasound study or vesicoureteral reflux showed higher values of urinary cytokines. Patients with severe APN had higher Tumour Necrosis Factor (TNF)α levels (81.0 ± 75.8 vs. 33.6 ± 48.5 pg/mg creatinine, p = 0.015). Both intervention groups showed similar basal clinical characteristics, including urinary cytokine levels. Treatment reduced urinary cytokine levels irrespective of dexamethasone administration. Neither the intervention group nor the urinary cytokine levels modulated the development of kidney scars. CONCLUSION Basal urinary cytokines were associated with age, abnormal ultrasound and vesicoureteral reflux. Patients with severe APN had higher TNFa urinary levels. Administration of dexamethasone in children with APN does not improve the control of the proinflammatory cytokine cascade.
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Affiliation(s)
- Neus Rius-Gordillo
- Paediatrics Unit, Hospital Universitari Sant Joan de Reus, Reus, Spain
- Paediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Natàlia Ferré
- Paediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Juan David González
- Paediatrics Unit, Hospital General Universitario Santa Lucia, Cartagena, Spain
| | - Zaira Ibars
- Paediatrics Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Ester Parada-Ricart
- Paediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
- Paediatrics Unit, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Joaquín Escribano
- Paediatrics Unit, Hospital Universitari Sant Joan de Reus, Reus, Spain
- Paediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
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Vincent K, Rutledge A, Laney Z, Newman JC, Selewski DT, Steflik HJ. Recurrent neonatal acute kidney injury: incidence, predictors, and outcomes in the neonatal intensive care unit. J Perinatol 2024; 44:428-433. [PMID: 37932405 DOI: 10.1038/s41372-023-01800-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Determine recurrent neonatal acute kidney injury (rAKI) incidence, risk factors, and associated outcomes. STUDY DESIGN Single-center retrospective cohort of neonates admitted to the NICU 1/1/20-6/30/21. Comparisons were made between those with no AKI, single AKI episode (sAKI), and rAKI. Multivariable linear and logistic regression models were used to assess associations between rAKI and length of mechanical ventilation (LMV), length of hospitalization stay (LOS), mortality, and hypertension (HTN) at discharge. RESULTS The incidence of AKI in the cohort of 869 infants was 19%: 705 (81%) no AKI, 100 (12%) sAKI, 64 (7%) rAKI. Both sAKI and rAKI were independently associated with longer LMV and LOS. sAKI was independently associated with almost 4x higher odds of mortality than rAKI. CONCLUSION In this single center cohort of neonates, sAKI independently predicts mortality, however rAKI is independently associated with increased LMV and LOS suggesting rAKI is clinically important and warrants further study.
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Affiliation(s)
- Katherine Vincent
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
| | - Austin Rutledge
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Zegilor Laney
- Department of Pediatrics, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Jill C Newman
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Heidi J Steflik
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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22
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González-Bertolín I, Barbas Bernardos G, Zarauza Santoveña A, García Suarez L, López López R, Plata Gallardo M, De Miguel Cáceres C, Calvo C. NUM-score: A clinical-analytical model for personalised imaging after urinary tract infections. Acta Paediatr 2024. [PMID: 38429950 DOI: 10.1111/apa.17191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024]
Abstract
AIM To identify predictive variables and construct a predictive model along with a decision algorithm to identify nephrourological malformations (NUM) in children with febrile urinary tract infections (fUTI), enhancing the efficiency of imaging diagnostics. METHODS We performed a retrospective study of patients aged <16 years with fUTI at the Emergency Department with subsequent microbiological confirmation between 2014 and 2020. The follow-up period was at least 2 years. Patients were categorised into two groups: 'NUM' with previously known nephrourological anomalies or those diagnosed during the follow-up and 'Non-NUM' group. RESULTS Out of 836 eligible patients, 26.8% had underlying NUMs. The study identified six key risk factors: recurrent UTIs, non-Escherichia coli infection, moderate acute kidney injury, procalcitonin levels >2 μg/L, age <3 months at the first UTI and fUTIs beyond 24 months. These risk factors were used to develop a predictive model with an 80.7% accuracy rate and elaborate a NUM-score classifying patients into low, moderate and high-risk groups, with a 10%, 35% and 93% prevalence of NUM. We propose an algorithm for approaching imaging tests following a fUTI. CONCLUSION Our predictive score may help physicians decide about imaging tests. However, prospective validation of the model will be necessary before its application in daily clinical practice.
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Affiliation(s)
| | | | | | - Leire García Suarez
- Pediatric Nephrology Department, La Paz University Hospital, Madrid, Spain
- Pediatric Nephrology Department, Fuerteventura Virgen de la Peña General Hospital, Fuerteventura, Spain
| | | | - Marta Plata Gallardo
- Pediatric Emergency Department, La Paz University Hospital, Madrid, Spain
- Pediatric Emergency Department, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina De Miguel Cáceres
- Pediatric Emergency Department, La Paz University Hospital, Madrid, Spain
- Pediatric Emergency Department, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Cristina Calvo
- Pediatrics and Infectious Disease Department, La Paz University Hospital, IdiPaz Foundation, Translational Research Network in Pediatric Infectious Diseases (RITIP), CIBERINFEC, ISCIII, Madrid, Spain
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23
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Chang JW, Kuo FC, Lin TC, Chin TW, Yang LY, Chen HH, Fan YH, Yang HH, Liu CS, Tsai HL. Long-term complications and outcomes of augmentation cystoplasty in children with neurogenic bladder. Sci Rep 2024; 14:4214. [PMID: 38378755 PMCID: PMC10879155 DOI: 10.1038/s41598-024-54431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/13/2024] [Indexed: 02/22/2024] Open
Abstract
Augmentation cystoplasty (AC) is an effective surgical procedure for patients with neurogenic bladder whenever conservative treatments have failed. The present study aimed to determine the risks of metabolic complications, malignancy, long-term outcomes and histopathologic changes of native bladder and the augmented intestine after AC in children with neurogenic bladder. Pediatric patients < 18 years who underwent AC between 2000 and 2020 were enrolled. Early postoperative complications, long-term outcomes and histopathologic changes in mucosal biopsies of native bladder and the augmented intestine after AC were reviewed. Twenty-two patients with a mean age of 7.6 ± 4.4 years were included. The ileum was used in 19 patients and the sigmoid colon in 3 patients. The length of hospital stay was 14.8 ± 6.8 days. Post-operatively, the urinary continence rate improved from 22.7 to 81.8% (p < 0.001). Hydronephrosis resolved in 17 of 19 patients. Vesicoureteral reflux resolved in 16 (64.0%) of the refluxing ureter units and was downgraded in 7 (28.0%). Grades of hydronephrosis and reflux significantly improved following AC (p < 0.001). The estimated glomerular filtration rate also significantly increased (p = 0.012). Formation of urinary tract stones was the most frequent late complication (in 8 patients, 36.4%). Life-threatening spontaneous bladder perforation occurred in 1 patient. After a mean follow-up of 13.4 ± 5.9 years, there were no cases of mortality, new-onset symptomatic metabolic acidosis, or changes in serum electrolytes. Of the 17 patients who were followed for > 10 years, no cases of malignancy or metaplastic changes were identified in the native bladder or augmented bowel epithelium. AC is a safe and effective procedure with low surgical and metabolic complication rates. In addition, AC provides a satisfactory continence rate and long-term protection of renal function, increases functional capacity, and regresses reflux and hydronephrosis. Individualized surveillance is recommended for the early identification of urolithiasis and metabolic disturbances.
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Affiliation(s)
- Jei-Wen Chang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fang-Cheng Kuo
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan
| | - Tzu-Ching Lin
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tai-Wai Chin
- Department of Pediatric Surgery, Changhua Christian Children Hospital, Changhua, Taiwan
| | - Ling-Yu Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Hung Chen
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hua Fan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Hsin Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan
| | - Chin-Su Liu
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan
| | - Hsin-Lin Tsai
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Bei-Tou District, Taipei, Taiwan.
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Sartorius V, Giuseppi A, Iacobelli S, Leroy-Terquem E, Vinit N, Heidet L, Blanc T, Stirnemann J, Kermorvant-Duchemin E, Lapillonne A. Post-obstructive diuresis after posterior urethral valve treatment in neonates: a retrospective cohort study. Pediatr Nephrol 2024; 39:505-511. [PMID: 37656311 DOI: 10.1007/s00467-023-06100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND The management of posterior urethral valve (PUV) in neonates requires close monitoring in the intensive care unit because of the risk of post-obstructive diuresis (POD). Our aim was to describe the incidence and factors associated with POD in newborns treated for PUV. METHODS Retrospective analysis of the medical records of all neonates who underwent surgical intervention for PUV in our neonatal intensive care unit between January 2014 and April 2021. RESULTS Of the 40 patients included, 15 (37.5%) had POD defined by urine output > 6 ml.kg-1.h-1 during the first 24 h following urinary tract obstruction relief. At prenatal ultrasound examinations, oligohydramnios was more common in the group with POD than in the group without (53.3% vs. 8%, p = 0.002). Preterm birth was more frequent in neonates with POD (66.7% vs. 8%; p < 0.001). Median serum creatinine (212 [137-246] vs. 95 [77-125] µmol.l-1; p < 0.001) and urea (8.5 [5.2-12.2] vs. 4.1 [3.5-4.7] mmol.l-1; p < 0.001) concentrations on the day of obstruction relief were significantly higher in the group with POD than in the group without. After adjustment for prematurity, logistic regression models confirmed correlation between the occurrence of POD and the severity of the consequences of urethral obstruction (i.e., oligohydramnios and serum creatinine levels; ß = 2.90 [0.88; 5.36], p = 0.013 and ß = 0.014 [0.003; 0.031], p = 0.034, respectively). CONCLUSIONS In neonates, POD is common after the relief of PUV-related obstruction. Our findings may help to identify patients at highest risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Victor Sartorius
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France.
- Université Paris Cité, Paris, France.
| | - Agnès Giuseppi
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Silvia Iacobelli
- Department of Neonatal and Pediatric Intensive Care, CHU La Réunion, Saint-Pierre, France
| | - Elise Leroy-Terquem
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Nicolas Vinit
- Université Paris Cité, Paris, France
- Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Laurence Heidet
- Université Paris Cité, Paris, France
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Diseases (MARHEA), AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Thomas Blanc
- Université Paris Cité, Paris, France
- Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Julien Stirnemann
- Université Paris Cité, Paris, France
- Department of Obstetrics and Fetal Medicine, AP-HP Hôpital Necker Enfants-Malades, Paris, France
| | - Elsa Kermorvant-Duchemin
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandre Lapillonne
- Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France
- Université Paris Cité, Paris, France
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25
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Mahmoud TA, Morsy EEDS, Morsy HAEA, Abouzeid AM, Elmoghazy HM. Predictors of surgical intervention for antenatally detected ureteropelvic junction obstruction (UPJO): A prospective multivariate analysis. Urologia 2024; 91:220-225. [PMID: 37232448 DOI: 10.1177/03915603231173009] [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: 05/27/2023]
Abstract
OBJECTIVE We aimed to identify clinical and radiological predictors of the need for surgical intervention in infants with antenatally detected UPJO. MATERIAL AND METHODS We prospectively followed infants born with antenatally diagnosed ureteropelvic junction obstruction (UPJO) presented at our outpatient clinics for evidence of obstructive injury with a standard protocol with ultrasonography and renal scintigraphy. Indications for surgery included progression of hydronephrosis on serial examinations, initial differential renal function (DFR) ⩽35% or >5% loss in sequential studies, and febrile urinary tract infection (UTI). Univariate and multivariate analyses were utilized to define the predictors for surgical intervention, while the appropriate cut-off value of the initial Anteroposterior diameter (APD) was determined using the receiver operator curve analysis. RESULTS Univariate analysis revealed a significant association between surgery, the initial APD, cortical thickness, Society for Fetal Urology grade, UTD risk group, initial DRF, and febrile UTI (p-value < 0.05). No significant association between surgery and sex or side of the affected kidney (p-value 0.91 and 0.38, respectively). On multivariate analysis, the initial APD, initial DRF, obstructed renographic curve, and febrile UTI (p-value < 0.05) were the only independent predictors for surgical intervention. An initial APD of 23 mm can predict surgical requirement, with a specificity of 95% and sensitivity of 70%. CONCLUSION For antenatally diagnosed UPJO, the APD value (at the age of 1 week), DFR value (at the age of 6-8 weeks), and febrile UTI during follow-up are significant and independent predictors of the need for surgical intervention. APD, when used with a cut-off value of 23 mm, is associated with high specificity and sensitivity for predicting surgical need.
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Nulens K, Lorenzo AJ, Dos Santos J, Ellul K, Rickard M. Fetal urinary tract dilation: What to tell the parents. Prenat Diagn 2024; 44:148-157. [PMID: 38117007 DOI: 10.1002/pd.6497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/04/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
Urinary tract dilation (UTD), which refers to the abnormal dilation of the urinary collection system, is the most common finding on prenatal ultrasound and presents with varying severity, presentation, etiology, and prognosis. Prenatal classification and risk stratification aim to prevent postnatal complications, such as urinary tract infections and further kidney dysfunction. Parents expecting a child with UTD should be counseled by a multidisciplinary team consisting of maternal-fetal medicine specialists, and pediatric urology and nephrology providers. This review summarizes the key points in the diagnostic evaluation and management during the prenatal and initial postnatal period, focusing on the information that should be provided to future parents. We address frequently asked parental questions and concerns that our multidisciplinary clinical practice faces.
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Affiliation(s)
- Katrien Nulens
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Katie Ellul
- Ontario Fetal Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Selvi I, Dönmez Mİ, Değirmenci E, Zoroğlu H, Ziylan O, Oktar T. Voiding Cystourethrogram Before Pyeloplasty: To Do or Not To Do? Urology 2024; 184:182-188. [PMID: 37866651 DOI: 10.1016/j.urology.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To assess the incidence of concomitant vesicoureteral reflux (VUR) in unilateral cases of ureteropelvic junction obstruction (UPJO) and to identify factors that predict VUR. METHODS Files of 381 pediatric patients who underwent unilateral pyeloplasty between 2000 and 2017 were retrospectively reviewed. A total of 270 patients with available data and ≥5 years of follow-up were eligible for this study. Demographic parameters, preoperative hydronephrosis grade, renal pelvis anteroposterior diameter (APD), renal parenchymal thickness (PT), split renal functions on MAG-3 scan and VUR status were noted. The patients were divided into two groups: those with concomitant VUR (group I, n: 24, 8.9%) and those without VUR (group II, n: 246, 91.1%). RESULTS Among 270 patients (205 boys, 75.9%) with a median age of 4 months (2-98), 197 (72.9%) had antenatal hydronephrosis. Median follow-up was 11 years (5-22). Among 24 patients with concurrent VUR, 6 (25%) had grade II VUR, whereas grade III-V VUR was detected in 18 (75%). Of these, 12 (50%) had ipsilateral VUR, 3 (12.5%) had contralateral, and 9 (37.5%) had bilateral VUR. In a median 137-month follow-up, spontaneous VUR resolution was observed in 6 (25%) patients, whereas 15 (62.5%) patients underwent endoscopic subureteral injection and 3 (12.5%) patients ureteroneocystostomy, respectively. Preoperative APD [35.5, (Inter Quantile Range) IQR (27.6-36.0) vs 26.5 IQR (25.0-35.0), P = .004] were significantly higher in group I, whereas group I had significantly lower PT [3.7, IQR (3.4-6.4) vs 5.8 IQR (4.4-6.1), P = .026]. Predictive factors for concomitant VUR were presentation with febrile UTI (odds ratio (OR): 2.769, P = .048), PT <3.95 mm (OR: 1.367, P = .043), and APD >28.8 mm (OR: 1.035, P = .001). CONCLUSION Our results indicated that concomitant VUR and UPJO might be detected in 1 out of every 11 patients undergoing pyeloplasty, while some type of surgical intervention for VUR was required in 75% of these patients. Thus, voiding cystourethrogram prior to pyeloplasty may be limited in those presenting with febrile urinary tract infection, having higher APD and lower PT on preoperative urinary ultrasonography.
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Affiliation(s)
- Ismail Selvi
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - M İrfan Dönmez
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey.
| | - Enes Değirmenci
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Hatice Zoroğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Orhan Ziylan
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Tayfun Oktar
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey; Koç University, School of Medicine, Department of Urology, Istanbul, Turkey
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Walsh CA, Lees N. Prevalence of anomalies on the routine mid-trimester ultrasound: 3172 consecutive cases by a single maternal-fetal medicine specialist. Australas J Ultrasound Med 2024; 27:12-18. [PMID: 38434547 PMCID: PMC10902829 DOI: 10.1002/ajum.12369] [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: 03/05/2024] Open
Abstract
Introduction/Purpose The routine mid-trimester fetal anatomy ultrasound (FAS) is offered to every pregnant woman and remains critical in the detection of structural fetal anomalies. Our study aimed to determine the prevalence of abnormalities on routine FAS performed by a single operator, who is an experienced sub-specialist in maternal-fetal medicine. Methods A retrospective analysis of all routine FAS performed a tertiary private obstetric ultrasound practice in metropolitan Sydney over a 7-year period, August 2015-July 2022. An advanced ultrasound protocol including detailed cardiac views was used in every case. Second opinion scans for suspected abnormalities were excluded. Fetal anomalies were classified into major and minor, based on the likely need for neonatal intervention. Results Among 14,908 obstetric ultrasound examinations, routine FAS were performed on 3172 fetuses by a single operator. More than 99% of women had screened low-risk for fetal aneuploidy. Structural anomalies were identified in 5% (157/3172) of fetuses; the prevalence of major anomalies was 1% (30/3172). Almost 60% of total anomalies were either cardiac or renal. No differences were identified in anomaly rates for singletons compared with twins (5.0% vs. 4.2%; P = 0.75). The prevalence of placenta previa and vasa previa was 10% and 0.1%, respectively. Discussion The prevalence of fetal anomalies on routine FAS by a single operator using a standardised protocol was higher in our practice (5%) than in previously published studies. Although most anomalies were minor, the rate of major abnormality was 1%. Conclusion The routine mid-trimester FAS remains an integral component of prenatal ultrasound screening.
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Affiliation(s)
| | - Nicole Lees
- Shore for WomenSt LeonardsNew South WalesAustralia
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Khalil A, Sotiriadis A, D'Antonio F, Da Silva Costa F, Odibo A, Prefumo F, Papageorghiou AT, Salomon LJ. ISUOG Practice Guidelines: performance of third-trimester obstetric ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:131-147. [PMID: 38166001 DOI: 10.1002/uog.27538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 01/04/2024]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Faculty of Medicine, Thessaloniki, Greece
| | - F D'Antonio
- Centre for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - F Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital, and School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - A Odibo
- Obstetrics and Gynecology Department, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - F Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK; Nuffield Department for Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - L J Salomon
- URP FETUS 7328 and LUMIERE platform, Maternité, Obstétrique, Médecine, Chirurgie et Imagerie Foetales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
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Montini G, Tessitore A, Console K, Ronfani L, Barbi E, Pennesi M. Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. Pediatrics 2024; 153:e2023062598. [PMID: 38146260 DOI: 10.1542/peds.2023-062598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Febrile urinary tract infection (fUTI) in well-appearing children is conventionally treated with a standard 10-day course of oral antibiotic. The objective of this study is to determine the noninferiority (5% threshold) of a 5-day amoxicillin-clavulanate course compared with a 10-day regimen to treat fUTIs. METHODS This is a multicenter, investigator-initiated, parallel-group, randomized, controlled trial. We randomly assigned children aged 3 months to 5 years with a noncomplicated fUTI to receive amoxicillin-clavulanate 50 + 7.12 mg/kg/day orally in 3 divided doses for 5 or 10 days. The primary end point was the recurrence of a urinary tract infection within 30 days after the completion of therapy. Secondary end points were the difference in prevalence of clinical recovery, adverse drug-related events, and resistance to amoxicillin-clavulanic acid and/or to other antibiotics when a recurrent infection occurred. RESULTS From May 2020 through September 2022, 175 children were assessed for eligibility and 142 underwent randomization. The recurrence rate within 30 days of the end of therapy was 2.8% (2/72) in the short group and 14.3% (10/70) in the standard group. The difference between the 2 groups was -11.51% (95% confidence interval, -20.54 to -2.47). The recurrence rate of fUTI within 30 days from the end of therapy was 1.4% (1/72) in the short group and 5.7% (4/70) in the standard group (95% confidence interval, -10.4 to 1.75). CONCLUSIONS This study demonstrates that a 5-day course is noninferior to a 10-day course of oral amoxicillin-clavulanate.
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Affiliation(s)
- Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Antimo Tessitore
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Karen Console
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Ronfani
- Department of Clinical Epidemiology, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Pennesi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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Griffith AM, Woodward PJ, Kennedy AM. Troubleshooting Tips for Diagnosing Complex Fetal Genitourinary Malformations. Radiographics 2024; 44:e230084. [PMID: 38127660 DOI: 10.1148/rg.230084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Fetal genitourinary anomalies can present a diagnostic challenge for the radiologist. The absence of a normally located kidney may represent agenesis or be secondary to a fusion or migration abnormality. A dilated renal pelvis should prompt evaluation for a specific cause, including ureteropelvic junction obstruction, reflux, or an obstructed duplicated system. Cystic parenchymal changes are characteristic of a multicystic dysplastic kidney but may also be seen in obstructive cystic dysplasia. There are numerous causes of megacystis including chromosomal (trisomy 18 syndrome), obstruction (posterior urethral valves, urethral atresia), or muscular dysfunction (prune belly syndrome, megacystis microcolon intestinal hypoperistalsis syndrome). Important mimics of a large bladder include hydrocolpos and urogenital sinus or cloacal malformation. Complications of genitourinary malformations are common and include oligohydramnios, urinary ascites, and urinoma. Making an accurate diagnosis often requires additional US views beyond those obtained in the standard fetal survey and occasionally performing fetal MRI. The appropriate use of orthogonal T2-weighted sequences, in conjunction with diffusion-weighted images for evaluation of the kidneys and gradient-recalled-echo sequences for evaluation of T1-hyperintense meconium in the colon, can play an integral role in diagnosis. Accurate diagnosis of fetal genitourinary malformations is vital to direct patient counseling and pregnancy management as outcomes are highly variable. Some conditions can be surgically corrected quite simply, some require multiple complex procedures, and some are lethal. The authors offer troubleshooting tips to narrow the differential diagnosis for four observations: unilateral absent kidney, dilated renal pelvis, cystic renal parenchyma, and megacystis and its mimics. ©RSNA, 2023 Test Your Knowledge questions are available in the Online Learning Center.
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Affiliation(s)
- April M Griffith
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30 N Mario Capecchi Dr, 2nd Floor South, Salt Lake City, UT 84112
| | - Paula J Woodward
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30 N Mario Capecchi Dr, 2nd Floor South, Salt Lake City, UT 84112
| | - Anne M Kennedy
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30 N Mario Capecchi Dr, 2nd Floor South, Salt Lake City, UT 84112
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Luithle T, Obermayr F, Dittmann H, Engel C, Etzler A, Kosch F, Menke IT, Schäfer M, Schuster T, Younsi N, Fuchs J. Determination of tissue tracer transit of Technetium-99m-mercaptoacetyltriglycine diuretic renography in infants with suspected ureteropelvic junction obstruction - A multicenter prospective observational study. J Pediatr Urol 2023; 19:780.e1-780.e7. [PMID: 37718234 DOI: 10.1016/j.jpurol.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION There is an ongoing controversy regarding management of ureteropelvic junction obstruction in infants, with a shift towards a non-operative approach. However, precise predictors of outcome are lacking. Recent studies postulated a high prognostic value of Technetium-99m-mercaptoacetyltriglycine tissue tracer transit with regard to the development of an impaired differential renal function and its potential improvement following pyeloplasty. OBJECTIVE To evaluate the prognostic value of Technetium-99m-mercaptoacetyltriglycine tissue tracer transit for the occurrence of changes in differential renal function in infants with suspected unilateral ureteropelvic junction obstruction in a prospective observational multicenter study. STUDY DESIGN Infants below 3 months of age with a unilateral isolated hydronephrosis ≥ grade 3 received ultrasound and Technetium-99m-mercaptoacetyltriglycine diuretic renography at two different time points (timepoint 1 and timepoint 2). Data were analyzed at local centers and at the study center and were collected in an internet-based database system. Tissue tracer transit was determined for each diuretic renography, inter-observer variation for tissue tracer transit and standard parameters for judgement of differential renal function development were assessed. RESULTS Thirty-seven patients were analyzed. Median age was 11 weeks (7-15) at timepoint 1 and 26 weeks (19-33) at timepoint 2. A delayed tissue tracer transit at timepoint 1 was not associated with deterioration of differential renal function at timepoint 2 in both, locally (10/37 cases) and centrally (4/37) analyzed cases. However, sensitivity and specificity were poor. The intraclass correlation coefficient comparing local and central findings of tissue tracer transit and renal drainage demonstrated poor or fair agreement. Analysis of standard parameters for differential renal function development revealed a prognostic value only for the dichotomized anteroposterior renal pelvic diameter (APD, p = 0.03, 95%-CI 1.2-22.2). DISCUSSION Regarding the primary endpoint of our study, we could not confirm the hypothesis that delayed tissue tracer transit reliably predicts a subsequent decline in differential renal function in the cohort of patients studied. Whether the low age of the patients, technical problems in the correct assessment of tissue tracer transit by the investigator in early infancy, the study design, or the parameter itself played a role is debated. CONCLUSION In the presented setting tissue tracer transit was not useful as a predictive parameter for deterioration of differential renal function in infants with suspected unilateral ureteropelvic junction obstruction. Sensitivity and specificity of tissue tracer transit were not sufficient for risk stratification. Improved utility of tissue tracer transit as a marker might be achieved using a different study setting.
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Affiliation(s)
- Tobias Luithle
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
| | - Florian Obermayr
- Faculty of Medicine, University of Marburg, Baldingertrasse, 35043 Marburg, Germany.
| | - Helmut Dittmann
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Müller-Str.14, 72076 Tuebingen, Germany.
| | - Corinna Engel
- Center for Pediatric Clinical Studies (CPCS), University Children's Hospital Tuebingen, Frondsbergstr. 23, 72070 Tuebingen, Germany.
| | - Andrea Etzler
- Department of Pediatric Surgery and Pediatric Urology, Klinikum Bremen-Mitte, St.-Jürgen-Str. 1, 28205 Bremen, Germany.
| | - Ferdinand Kosch
- Department of Pediatric Surgery, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76131 Karlsruhe, Germany.
| | - Ines Theresa Menke
- Department of Pediatric Surgery and Pediatric Urology, Medical Center Dortmund, Beurhausstr. 40, 44137 Dortmund, Germany.
| | - Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopf'sche Kinderklinik, St. Johannis-Mühlgasse 19, 90419 Nuremberg, Germany.
| | - Tobias Schuster
- Department of Pediatric Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany.
| | - Nina Younsi
- Center for Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
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Randhawa H, Jones C, McGrath M, Braga LH. Non-refluxing Primary Megaureter in Children Resolves From Proximal to Distal. Urology 2023; 182:225-230. [PMID: 37776954 DOI: 10.1016/j.urology.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES To evaluate a population of children with non-refluxing primary megaureter (NRPM), we investigated spontaneous resolution of ureteral dilation and the pattern (proximal to distal or distal to proximal) in which it occurs. METHODS From our prospectively collected prenatal hydronephrosis (HN) database (0-24 months, 2008-2017), selecting those with NRPM (n = 92). We excluded patients who underwent surgery (n = 20), children with <6 months follow-up (n = 2) and without a voiding cystourethrogram (VCUG) (n = 4). Images were segregated into 198 ureteric segments (proximal/mid/distal). We defined resolution as Society for Fetal Urology (SFU) (0/1), anteroposterior diameter (APD) <10 mm, and ureteric dilatation <5 mm. Descriptive statistics and Kaplan-Meier curves were created for time-to-resolution analyses. RESULTS Of 66 patients and 198 ureteral segments, median age at presentation was 2 months (0-12), 83% were male (33% circumcised). Mean APD at baseline was 11 ± 4 mm, and 79% had (SFU 3/4) HN. Mean dilatation of ureteral segments (mm) at baseline was: 9 ± 2 proximal, 9 ± 2 mid, and 11 ± 3 distal. At a median follow-up time of 26 (7-83) months, dilation of 55 (83%) proximal, 48 (72%) mid, and 22 (33%) distal ureteric segments had resolved. Overall, HN resolution occurred in 76% of patients. Resolution rates were similar for proximal/mid-ureters (83% vs 72%; P = .20); however, they were significantly different from distal segments (83% proximal vs 33% distal; 72% mid vs 33% distal, P <.01). CONCLUSION Our data suggest that spontaneous resolution of NRPM follows a proximal to distal progression. Distal ureteric dilatation takes up to 10 months longer to resolve compared to that of proximal and mid-ureteric segments, as well as that of the renal pelvis.
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Affiliation(s)
- Harkanwal Randhawa
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Conor Jones
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Melissa McGrath
- Division of Pediatric Urology, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Luis H Braga
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Urology, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada; Department of Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
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Yılmaz S, Özçakar ZB, Cakar N, Biral Coşkun B, Burgu B, Yalcinkaya F. Long Term Follow-Up Of Patients With Nonrefluxing Hydronephrosis. KLINISCHE PADIATRIE 2023. [PMID: 37989212 DOI: 10.1055/a-2183-8351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGOUND The aim of this study is to examine the long-term prognosis of children with ureteropelvic junction obstruction-like hydronephrosis (UPJO-like HN). PATIENTS AND METHODS The files of children with hydronephrosis (HN) were analyzed retrospectively. Patients with vesicoureteral reflux (VUR) and other genitourinary anomalies were excluded. The final status of the HN, the need for surgery, and urinary tract infection (UTI) frequency were evaluated. RESULTS The study included 219 patients with 302 renal units (RU) with HN. Surgery rate was higher in RUs with larger kidney size and parenchymal thinning (p:<0.001 for both). Hydronephrosis resolved in 113 (40.2%) RUs, improved in 66 (23.3%), unchanged in 100 (35.5%) and worsened in 4 (1.4%). The frequency of recovery and improvement was found to be less in RUs with severe HN, large kidney size, and thin parenchyma. The UTI frequency was higher in severe HN group (12.2% vs 30.6% p:<0.001). CONCLUSIONS Children with mild HN had an excellent prognosis. Although the majority of the patients with high-grade HN had also a good prognosis, it seems important to closely follow up patients with severe HN, increased kidney size, and accompanying parenchymal thinning. Clinicians should be aware of the increased frequency of UTIs in children with severe HN.
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Affiliation(s)
- Songül Yılmaz
- Pediatric Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Nilgun Cakar
- Pediatric Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burcu Biral Coşkun
- Pediatric Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Berk Burgu
- Pediatric Urology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatoş Yalcinkaya
- Pediatric Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
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Khatib N, Bronshtein M, Bachar G, Beloosesky R, Ginsberg Y, Zmora O, Weiner Z, Gover A. Fetal Renal Duplicated Collecting System at 14-16 Weeks of Gestation. J Clin Med 2023; 12:7124. [PMID: 38002736 PMCID: PMC10672134 DOI: 10.3390/jcm12227124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: To examine the incidence of the prenatal diagnosis of the renal double-collecting system (rDCS) and describe its clinical outcome and associated genetic abnormalities. (2) Methods: This retrospective study included women who attended the obstetric clinic for early fetal anatomic sonography with findings of a renal DCS. Diagnosis was conducted by an expert sonographer using defined criteria. (3) Results: In total, 29,268 women underwent early ultrasound anatomical screening at 14-16 weeks, and 383 cases of rDCS were diagnosed (prevalence: 1:76). Associated abnormalities were diagnosed in eleven pregnancies; four had chromosomal aberrations. No chromosomal abnormalities were reported in isolated cases. Ectopic uretrocele and dysplastic kidney were diagnosed in 6 (1.5%) and 5 (1.3%) fetuses, respectively. One girl was diagnosed with vesicoureteral reflux and recurrent UTIs, and two boys were diagnosed with undescended testis. The recurrence rate of rDCS was 8% in subsequent pregnancies. (4) Conclusions: In light of its benign nature, we speculate that isolated rDCS may be considered a benign anatomic variant, but a repeat examination in the third trimester is recommended to assess hydronephrosis.
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Affiliation(s)
- Nizar Khatib
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel (Y.G.)
- Department of Ob/Gyn, RAMBAM Health Care Campus-Israel, Haifa 3109601, Israel;
| | - Moshe Bronshtein
- Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3200003, Israel;
| | - Gal Bachar
- Department of Ob/Gyn, RAMBAM Health Care Campus-Israel, Haifa 3109601, Israel;
| | - Ron Beloosesky
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel (Y.G.)
- Department of Ob/Gyn, RAMBAM Health Care Campus-Israel, Haifa 3109601, Israel;
| | - Yuval Ginsberg
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel (Y.G.)
- Department of Ob/Gyn, RAMBAM Health Care Campus-Israel, Haifa 3109601, Israel;
| | - Osnat Zmora
- Sackler School of Medicine, Tel-Aviv-University, Tel Aviv 6997801, Israel;
| | - Zeev Weiner
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel (Y.G.)
- Department of Ob/Gyn, RAMBAM Health Care Campus-Israel, Haifa 3109601, Israel;
| | - Ayala Gover
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa 3200003, Israel;
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Guo K, Zhao D. The correlation between GFR and unit renal volume in infants with hydronephrosis measured by two imaging methods. Sci Rep 2023; 13:19556. [PMID: 37945690 PMCID: PMC10636024 DOI: 10.1038/s41598-023-46996-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023] Open
Abstract
The purpose of this study was to investigate the correlation between GFR and unit renal volume in infants with congenital hydronephrosis measured by 99mTc-DMSA static renal imaging and ultrasonography. According to the classification of hydronephrosis, 38 infants aged 0-12 months with congenital hydronephrosis were divided into six groups: healthy kidney groups, mild hydronephrosis groups, and severe hydronephrosis groups. Within one week, all patients underwent ultrasound, diuretic dynamic renal imaging, static renal imaging and lateral imagings of both kidneys after static renal imaging respectively. Pediatric renal volume was calculated using the improved formula length × width × thickness × 0.674, and then the renal function in per unit volume (GFR/unit volume, ml/cm3) was obtained. All statistical analysis was done with SPSS Statistics version 24.0. The renal function in per unit volume was a minimum of 1.62 ml/cm3 in left healthy kidney in static renal imaging, but the renal function in per unit volume was a maximum value of 2.20 ml/cm3 in right healthy kidney in ultrasonography. There was a strong positive correlation observed between GFR and renal volume in left healthy kidney group and left and right kidneys with mild hydronephrosis groups (r = 0.865, r = 0.872, r = 0.822). A moderate positive correlation was found between GFR and renal volume in right healthy kidney group and left and right kidneys wih severe hydronephrosis groups (r = 0.783, r = 0.542, r = 0.798). GFR in per unit volume ranged from 1.62 to 2.20 ml/cm3 in healthy kidney, and was significantly higher in right kidney as compared to in left kidney, and also decreased with the progression of hydronephrosis.
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Affiliation(s)
- Ke Guo
- Department of Nuclear Medicine, The Second Hospital of Shanxi Medical University, No.382 Wuyi Road, Taiyuan, 030001, Shanxi Province, China
| | - Deshan Zhao
- Department of Nuclear Medicine, The Second Hospital of Shanxi Medical University, No.382 Wuyi Road, Taiyuan, 030001, Shanxi Province, China.
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González-Bertolín I, Barbas Bernardos G, García Suarez L, López López R, García Sánchez P, Bote Gascón P, Calvo C. Hyponatremia and other potential markers of ultrasound abnormalities after a first febrile urinary tract infection in children. Eur J Pediatr 2023; 182:4867-4874. [PMID: 37587378 PMCID: PMC10640435 DOI: 10.1007/s00431-023-05149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
Urinary tract infections are the initial manifestation in 30% of urinary tract malformations. Identifying these patients, who could benefit from a specific treatment, is still challenging. Hyponatremia during urinary tract infection has been proposed as a urinary tract malformation marker. We evaluate the prevalence of hyponatremia during febrile urinary tract infections and its association with subjacent urinary tract malformations. We performed a retrospective study of healthy patients under 16 years, diagnosed with a first episode of febrile urinary tract infection, who had undergone blood testing in the acute episode and at least one renal ultrasound during follow-up (January 2014-November 2020). Hyponatremia was defined as (serum sodium ≤ 130 mEq/L). According to imaging findings, we classified patients into three groups: normal kidney ultrasound, mild pelviectasis, and significant urinary tract malformation. We performed logistic regression models to identify independent risk factors for urinary tract malformation and mild pelviectasis. We included 492 patients and 2.8% presented hyponatremia. We identified normal ultrasound in 77%, mild pelviectasis in 10.8%, and urinary tract malformation in 12% of patients. We found an association between mild pelviectasis and hyponatremia [OR 6.6 (CI95% 1.6-26.6)]. However, we found no association between hyponatremia and urinary tract malformation. The parameters that were associated with malformations were presenting a non-E. coli infection, C-reactive-protein levels over 80 mg/L, and bacteremia. CONCLUSION Hyponatremia during the first episode of febrile urinary tract infection is present in 2.8% of patients and is associated with mild pelviectasis in imaging. However, hyponatremia does not indicate a greater need for complementary tests to screen for urinary tract malformations. WHAT IS KNOWN • Urinary tract infection is the first manifestation in 30% of children with urinary tract malformation. • Hyponatremia could be a marker to identify these children and guide the imaging approach. WHAT IS NEW • Around 12% of children with a first episode of febrile urinary tract infection have a urinary tract malformation. • Non-E. coli infection, C-reactive protein levels over 80 mg/L, and bacteremia are markers for malformations to guide diagnostic imaging tests, but hyponatremia (Na ≤ 130 mEq/l) is not a reliable marker.
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Affiliation(s)
| | | | - Leire García Suarez
- Pediatric Nephrology Department, La Paz University Hospital, Madrid, Spain
- Pediatric Nephrology Department, Fuerteventura Virgen de la Peña General Hospital, Fuerteventura, Spain
| | | | | | | | - Cristina Calvo
- Pediatrics and Infectious Disease Department, La Paz University Hospital, IdiPaz Foundation. Traslational Research Network in Pediatric Infectious Diseases (RITIP), CIBERINFEC. ISCIII, Madrid, Spain
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Sloan M, Li H, Lescay HA, Judge C, Lan L, Hajiyev P, Giger ML, Gundeti MS. Pilot study of machine learning in the task of distinguishing high and low-grade pediatric hydronephrosis on ultrasound. Investig Clin Urol 2023; 64:588-596. [PMID: 37932570 PMCID: PMC10630684 DOI: 10.4111/icu.20230170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Hydronephrosis is a common pediatric urological condition, characterized by dilation of the renal collecting system. Accurate identification of the severity of hydronephrosis is crucial in clinical management, as high-grade hydronephrosis can cause significant damage to the kidney. In this pilot study, we demonstrate the feasibility of machine learning in differentiating between high and low-grade hydronephrosis in pediatric patients. MATERIALS AND METHODS We retrospectively reviewed 592 images from 90 unique patients ages 0-8 years diagnosed with hydronephrosis at the University of Chicago's Pediatric Urology Clinic. The study included 74 high-grade hydronephrosis (145 images) and 227 low-grade hydronephrosis (447 images). Patients were excluded if they had less than 2 studies prior to surgical intervention or had structural abnormalities. We developed a radiomic-based artificial intelligence algorithm incorporating computerized texture analysis and machine learning (support-vector machine) to yield a predictor of hydronephrosis grade. RESULTS Receiver operating characteristic analysis of the classifier output yielded an area under the curve value of 0.86 (95% CI 0.81-0.92) in the task of distinguishing between low and high-grade hydronephrosis using a five-fold cross-validation by kidney. In addition, a Mann-Kendall trend test between computer output and clinical hydronephrosis grade yielded a statistically significant upward trend (p<0.001). CONCLUSIONS Our findings demonstrate the potential of machine learning in the differentiation between low and high-grade hydronephrosis. Further studies are warranted to validate our findings and their generalizability for use in clinical practice as a means to predict clinical outcomes and the resolution of hydronephrosis.
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Affiliation(s)
- Matthew Sloan
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
| | - Hui Li
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Hernan A Lescay
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
| | - Clark Judge
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
| | - Li Lan
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Parviz Hajiyev
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
| | | | - Mohan S Gundeti
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA.
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Taghavi K, Van Haltren K, Woods J, Tai D, Teoh M, Pacilli M, Nataraja RM, Kimber C. Influence of foetal position on the degree of isolated antenatal hydronephrosis. ANZ J Surg 2023; 93:2706-2709. [PMID: 37461270 DOI: 10.1111/ans.18611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/12/2023] [Accepted: 07/06/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUNDS The effect of foetal position on the degree of antenatal hydronephrosis (ANH) is unknown. We hypothesized that foetal position is an important contextual factor in ANH, with consequences on prenatal counselling and postnatal management. The current study aimed to investigate the effect of foetal position on the degree of ANH. METHODS A retrospective study was carried out on consecutive pregnancies with isolated ANH over a 10-year period. Gestational age, foetal presentation (cephalic vs. breech), and degree of ANH (as measured by the AP diameter) were retrieved. Foetuses with other ultrasound findings of the renal tract (renal parenchymal abnormality, ureteric dilatation, or bladder abnormalities) were excluded. Logistic regression analysis was conducted to examine the relationship between the anterior-posterior diameter (APD) and the mode of presentation (cephalic or breech). A P-value of <0.05 was considered significant. RESULTS Initially 745 scans were identified, with 436 included in the final analysis. Overall, there was an association between foetal presentation and APD regardless of trimester, with cephalic presentations having a greater APD (OR 1.07, 95% CI 1.02-1.11, P = 0.04). CONCLUSION Cephalic presentations are associated with a significantly greater APD indicating that foetal position should be considered when stratifying ANH. Furthermore, foetal position may be a contributing factor in the mechanism of 'physiological' hydronephrosis.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Keith Van Haltren
- Monash Health Imaging, Monash Children's Hospital, Monash Health, Melbourne, Australia
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Australia
| | - Jessica Woods
- Monash Health Imaging, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Davina Tai
- Fetal Diagnostic Unit, Monash Health, Melbourne, Australia
| | - Mark Teoh
- Fetal Diagnostic Unit, Monash Health, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, Monash University, Melbourne, Australia
- Department of Paediatric Surgery, Monash Children's Hospital, Monash Health, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatrics, Monash University, Melbourne, Australia
- Department of Paediatric Surgery, Monash Children's Hospital, Monash Health, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Chris Kimber
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
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Fischer KM, Samet E, Messina A, Berry A, Zderic SA, Van Batavia JP. Who needs an ultrasound? Using patient symptom questionnaire & UTI history to determine when to obtain an RBUS in children with non-neurogenic lower urinary tract dysfunction. J Pediatr Urol 2023; 19:542.e1-542.e7. [PMID: 37537092 PMCID: PMC10543542 DOI: 10.1016/j.jpurol.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Non-neurogenic lower urinary tract dysfunction (LUTD) is one of the most common reasons for presentation to a pediatric urologist, affecting up to 20% of children. Predicting who will benefit from RBUS as part of their work-up is challenging as the majority will have normal imaging. OBJECTIVE Our objective was to assess the utility of using the Dysfunctional Voiding and Incontinence Scoring System (DVISS) and urinary tract infection (UTI) history to predict which LUTD patients were most likely to have an abnormal RBUS as well as determine a DVISS cutoff to aid in making this prediction. We hypothesized that higher DVISS scores and a positive urinary tract infection (UTI) history would be associated with increased likelihood of RBUS abnormality. STUDY DESIGN We retrospectively reviewed outpatients seen for LUTD from 5/2014-1/2016 who received an RBUS. Association between prior UTI, DVISS score, gender, and race and RBUS abnormality were evaluated using logistic regression analysis. Receiver operating characteristic (ROC) curves were created to evaluate the predictive model and a Youden index calculated to determine the optimal cutoff for DVISS score to predict abnormal RBUS. RESULTS 15 of 333 patients (4.5%) had a clinically significant RBUS abnormality. Significantly more patients with abnormal RBUS had a positive UTI history and median DVISS was higher. UTI history and DVISS score were associated with RBUS abnormality whereas neither gender nor race were. A DVISS score cutoff of 12 was determined to be ideal for predicting abnormal imaging. Using DVISS≥12 and positive UTI history, patients with both risk factors were significantly more likely to have an abnormal RBUS than those with zero or one risk factor (Figure). DISCUSSION To the best of our knowledge this is the first study to try to identify risk factors associated with RBUS abnormality in pediatric LUTD patients and create an evidence-based approach to imaging these patients. We found both DVISS cutoff ≥12 and positive UTI history to be useful to risk stratify LUTD patients' likelihood of abnormal RBUS. Limitations include the study's retrospective nature as well as the fact the population was drawn from a tertiary care pediatric hospital with a large referral population and the fact that the decision to order an RBUS was based on individual clinician preference and decision making. CONCLUSIONS We found that DVISS score≥12 and UTI history are useful in guiding the decision to obtain RBUS in pediatric LUTD patients.
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Affiliation(s)
- Katherine M Fischer
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA.
| | - Ethan Samet
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
| | - Adriana Messina
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
| | - Amanda Berry
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
| | - Stephen A Zderic
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
| | - Jason P Van Batavia
- Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, USA
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Herthelius M. Antenatally detected urinary tract dilatation: long-term outcome. Pediatr Nephrol 2023; 38:3221-3227. [PMID: 36920569 PMCID: PMC10465645 DOI: 10.1007/s00467-023-05907-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/26/2023] [Accepted: 02/06/2023] [Indexed: 03/16/2023]
Abstract
This review provides updated knowledge on the long-term outcomes among children with antenatally diagnosed urinary tract dilatation (UTD), previously often referred to as antenatal hydronephrosis. Different definitions of UTD exist, which makes comparison between studies and generalized conclusions difficult. Roughly, one-third of antenatally diagnosed UTD, defined as a renal pelvis anterior posterior diameter (APD) of ≥ 4 mm in the second trimester and/or ≥ 7 mm in the third trimester, will resolve before birth, another third will resolve within the first years of life, and in the remaining cases, UTD will persist or a congenital abnormality (CAKUT) will be diagnosed postnatally. The risk of a postnatal CAKUT diagnosis increases with the degree of prenatal and postnatal dilatation, except for vesicoureteral reflux (VUR), which cannot be predicted from the degree of UTD. Urinary tract infections (UTIs) occur in 7-14% of children with UTD during the first years of life. The risk of UTI is higher in children with traditional risk factors for UTI, such as dilated VUR, hydroureteronephrosis, female gender, and intact foreskin. Continuous antibiotic prophylaxis may be considered in selected patients during the first years of life. In long-term follow-ups, permanent kidney damage is diagnosed in approximately 40% of children with moderate or severe UTD, but hypertension, proteinuria, and/or reduced eGFR are uncommon (0-5%). In children with mild UTD, the long-term outcome is excellent, and these children should not be subjected to unnecessary examinations and/or follow-up.
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Affiliation(s)
- Maria Herthelius
- Astrid Lindgren Children's Hospital, K88, Karolinska University Hospital, 141 86, Stockholm, Sweden.
- Division of Paediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
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Chen Z, Xu H, Wang C, Hu S, Ali M, Wang Y, Kai Z. Robot-assisted surgery versus laparoscopic surgery of ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Robot Surg 2023; 17:1891-1906. [PMID: 37310527 DOI: 10.1007/s11701-023-01648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
The clinical effectiveness and safety of robot-assisted laparoscopic pyeloplasty (RP) compared with laparoscopic pyeloplasty (LP) have not been clearly established in ureteropelvic junction obstruction (UPJO) children and require review. We searched in the Cochrane, MEDLINE, EMBASE, Web of Science, and CNKI database on 30 June 2022. This systematic review and meta-analysis were performed in RevMan 5.4 based on studies comparing RP versus LP in children with UPJO and subgroup analysis in children < 2 years of age has been performed. The Newcastle-Ottawa Scale was used to evaluate the studies. We included one RCT, and eighteen cohort studies, a total involving 3370 children. Compared with LP, RP showed higher surgical success rates (OR 2.57, 95%CI (1.24, 5.32), P < 0.05), lower postoperative complication rates (OR 0.61, 95%CI (0.38, 0.99), P < 0.05), shorter hospital stay (MD - 1.04, 95% CI (- 1.6, - 0.47), P < 0.05) as well as operative time (MD - 22.11, 95%CI (- 35.91, - 8.31), P < 0.05). No significant differences were detected for intraoperative complication rates or conversion to open surgery rates. RP is an alternative to UPJO with higher success rates, and less postoperative complications. Evidence on the effectiveness and safety of RP compared with LP for UPJO children is of low certainty. More quality evidence in the form of randomized controlled trials is needed to obtain more reliable analysis results.
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Affiliation(s)
- Zhuming Chen
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Huaiwen Xu
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Chaohui Wang
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Shuangjiu Hu
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Muhammad Ali
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yang Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhe Kai
- Department of General Surgery, Anqing First People's Hospital of Anhui Medical University, Anqing, China.
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Ostrowski DA, Logan JR, Antony M, Broms R, Weiss DA, Van Batavia J, Long CJ, Smith AL, Zderic SA, Edwins RC, Pominville RJ, Hannick JH, Woo LL, Fan Y, Tasian GE, Weaver JK. Automated Society of Fetal Urology (SFU) grading of hydronephrosis on ultrasound imaging using a convolutional neural network. J Pediatr Urol 2023; 19:566.e1-566.e8. [PMID: 37286464 DOI: 10.1016/j.jpurol.2023.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/14/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Grading of hydronephrosis severity on postnatal renal ultrasound guides management decisions in antenatal hydronephrosis (ANH). Multiple systems exist to help standardize hydronephrosis grading, yet poor inter-observer reliability persists. Machine learning methods may provide tools to improve the efficiency and accuracy of hydronephrosis grading. OBJECTIVE To develop an automated convolutional neural network (CNN) model to classify hydronephrosis on renal ultrasound imaging according to the Society of Fetal Urology (SFU) system as potential clinical adjunct. STUDY DESIGN A cross-sectional, single-institution cohort of postnatal renal ultrasounds with radiologist SFU grading from pediatric patients with and without hydronephrosis of stable severity was obtained. Imaging labels were used to automatedly select sagittal and transverse grey-scale renal images from all available studies from each patient. A VGG16 pre-trained ImageNet CNN model analyzed these preprocessed images. Three-fold stratified cross-validation was used to build and evaluate the model that was used to classify renal ultrasounds on a per patient basis into five classes based on the SFU system (normal, SFU I, SFU II, SFU III, or SFU IV). These predictions were compared to radiologist grading. Confusion matrices evaluated model performance. Gradient class activation mapping demonstrated imaging features driving model predictions. RESULTS We identified 710 patients with 4659 postnatal renal ultrasound series. Per radiologist grading, 183 were normal, 157 were SFU I, 132 were SFU II, 100 were SFU III, and 138 were SFU IV. The machine learning model predicted hydronephrosis grade with 82.0% (95% CI: 75-83%) overall accuracy and classified 97.6% (95% CI: 95-98%) of the patients correctly or within one grade of the radiologist grade. The model classified 92.3% (95% CI: 86-95%) normal, 73.2% (95% CI: 69-76%) SFU I, 73.5% (95% CI: 67-75%) SFU II, 79.0% (95% CI: 73-82%) SFU III, and 88.4% (95% CI: 85-92%) SFU IV patients accurately. Gradient class activation mapping demonstrated that the ultrasound appearance of the renal collecting system drove the model's predictions. DISCUSSION The CNN-based model classified hydronephrosis on renal ultrasounds automatically and accurately based on the expected imaging features in the SFU system. Compared to prior studies, the model functioned more automatically with greater accuracy. Limitations include the retrospective, relatively small cohort, and averaging across multiple imaging studies per patient. CONCLUSIONS An automated CNN-based system classified hydronephrosis on renal ultrasounds according to the SFU system with promising accuracy based on appropriate imaging features. These findings suggest a possible adjunctive role for machine learning systems in the grading of ANH.
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Affiliation(s)
- David A Ostrowski
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Joseph R Logan
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Translational Research Informatics Group, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Antony
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Reilly Broms
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dana A Weiss
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jason Van Batavia
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher J Long
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Stephen A Zderic
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca C Edwins
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raymond J Pominville
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jessica H Hannick
- Division of Pediatric Urology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Lynn L Woo
- Division of Pediatric Urology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Yong Fan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John K Weaver
- Division of Pediatric Urology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
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Cyphers E, Gaballah M, Acord M, Worede F, Srinivasan A, Vatsky SE, Escobar F, Krishnamurthy G, Cahill AM. Percutaneous Nephrostomy in Neonates and Young Infants. J Vasc Interv Radiol 2023; 34:1815-1821. [PMID: 37336489 DOI: 10.1016/j.jvir.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/26/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE To describe a single-center experience of placing percutaneous nephrostomy (PCN) tubes in neonates and young infants aged ≤3 months. MATERIALS AND METHODS This retrospective study evaluated PCN placement during a 19-year period. Medical records were reviewed for patient demographics, indications, procedure details, catheter-related adverse events, and outcomes. A total of 45 primary PCN insertions were attempted in 29 children (median age, 11 days [range, first day of life to 3 months]; median weight, 3.5 kg [range, 1.4-7.0 kg]). Salvage procedures resulted in 13 secondary catheters in 6 children. The most common indication was ureteropelvic junction obstruction (40.0%), and the most common urinary tract dilation classification was P3 (88.9%). RESULTS Technical success for primary placements was 95.6%; both technical failures were due to loss of access in the same patient. Of primary placements, 76.7% were electively removed, 6.9% were dislodged but not replaced, and the remaining 16.3% required salvage procedures. Mechanical adverse events occurred in 20.9% of primary and 53.8% of secondary catheters, including partial retraction, complete dislodgement, and occlusion. Urinary tract infections (UTIs) occurred in 18.6% of primary and 15.4% of secondary catheters. Urosepsis occurred in 2.3% of primary and 7.7% of secondary catheters. Median primary catheter dwell time was 41 days (range, 1-182 days) and median secondary catheter dwell time was 31 days (range, 10-107 days). CONCLUSION PCN placement in neonates and young infants has a high technical success rate, although not without particular procedural and management challenges of catheter malfunction and UTI.
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Affiliation(s)
- Eric Cyphers
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Marian Gaballah
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Acord
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fikadu Worede
- Department of Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Abhay Srinivasan
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Seth E Vatsky
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fernando Escobar
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ganesh Krishnamurthy
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne Marie Cahill
- Division of Interventional Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Bortnick EM, Nelson CP. Vesicoureteral Reflux: Current Care Trends and Future Possibilities. Urol Clin North Am 2023; 50:391-402. [PMID: 37385702 DOI: 10.1016/j.ucl.2023.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Although investigations over the past 2 decades have improved our understanding of the natural history of vesicoureteral reflux (VUR) and helped identify those at higher risk of both VUR itself as well as its potential severe sequelae, debate exists regarding key aspects of care, including when to perform diagnostic imaging and which patients benefit from continuous antibiotic prophylaxis. Artificial intelligence and machine learning have the potential to distill large volumes of granular data into practical tools that clinicians can use to guide diagnosis and management decisions. Surgical treatment, when indicated, remains highly effective and is associated with low morbidity.
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Affiliation(s)
- Eric M Bortnick
- Department of Pediatric Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Caleb P Nelson
- Department of Pediatric Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Yang S, Gill PJ, Anwar MR, Nurse K, Mahood Q, Borkhoff CM, Bijelić V, Parkin PC, Mahant S. Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2023; 177:764-773. [PMID: 37252727 PMCID: PMC10230373 DOI: 10.1001/jamapediatrics.2023.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/02/2023] [Indexed: 05/31/2023]
Abstract
Importance Controversy exists on the clinical utility of kidney ultrasonography after first febrile urinary tract infection (UTI), and clinical practice guideline recommendations vary. Objective To determine the prevalence of urinary tract abnormalities detected on kidney ultrasonography after the first febrile UTI in children. Data Sources The MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases were searched for articles published from January 1, 2000, to September 20, 2022. Study Selection Studies of children with first febrile UTI reporting kidney ultrasonography findings. Data Extraction and Synthesis Two reviewers independently screened titles, abstracts, and full texts for eligibility. Study characteristics and outcomes were extracted from each article. Data on the prevalence of kidney ultrasonography abnormalities were pooled using a random-effects model. Main Outcomes and Measures The primary outcome was prevalence of urinary tract abnormalities and clinically important abnormalities (those that changed clinical management) detected on kidney ultrasonography. Secondary outcomes included the urinary tract abnormalities detected, surgical intervention, health care utilization, and parent-reported outcomes. Results Twenty-nine studies were included, with a total of 9170 children. Of the 27 studies that reported participant sex, the median percentage of males was 60% (range, 11%-80%). The prevalence of abnormalities detected on renal ultrasonography was 22.1% (95% CI, 16.8-27.9; I2 = 98%; 29 studies, all ages) and 21.9% (95% CI, 14.7-30.1; I2 = 98%; 15 studies, age <24 months). The prevalence of clinically important abnormalities was 3.1% (95% CI, 0.3-8.1; I2 = 96%; 8 studies, all ages) and 4.5% (95% CI, 0.5-12.0; I2 = 97%; 5 studies, age <24 months). Study recruitment bias was associated with a higher prevalence of abnormalities. The most common findings detected were hydronephrosis, pelviectasis, and dilated ureter. Urinary tract obstruction was identified in 0.4% (95% CI, 0.1-0.8; I2 = 59%; 12 studies), and surgical intervention occurred in 1.4% (95% CI, 0.5-2.7; I2 = 85%; 13 studies). One study reported health care utilization. No study reported parent-reported outcomes. Conclusions and Relevance Results suggest that 1 in 4 to 5 children with first febrile UTI will have a urinary tract abnormality detected on kidney ultrasonography and 1 in 32 will have an abnormality that changes clinical management. Given the considerable study heterogeneity and lack of comprehensive outcome measurement, well-designed prospective longitudinal studies are needed to fully evaluate the clinical utility of kidney ultrasonography after first febrile UTI.
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Affiliation(s)
- Sarah Yang
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter J. Gill
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohammed Rashidul Anwar
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kimberly Nurse
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quenby Mahood
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vid Bijelić
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Patricia C. Parkin
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Cai PY, Lee RS. Ureteropelvic Junction Obstruction/Hydronephrosis. Urol Clin North Am 2023; 50:361-369. [PMID: 37385700 DOI: 10.1016/j.ucl.2023.04.001] [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: 07/01/2023]
Abstract
Congenital hydronephrosis can be classified and managed based on the Urinary Tract Dilation consensus scoring system. Ureteropelvic junction obstruction is one of the most common causes of hydronephrosis in the pediatric population. Although most cases can be managed conservatively with follow-up and serial imaging, some patients need surgical repair because of renal function deterioration, infections, or symptoms. Additional research to create predictive algorithms or develop noninvasive biomarkers for renal deterioration is necessary to better identify surgical candidates. The robotic-assisted approach for pyeloplasty is becoming increasingly widespread and associated with shorter hospital stay, high success rates, and low complication rates.
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Affiliation(s)
- Peter Y Cai
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 390, Boston, MA 02115, USA
| | - Richard S Lee
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 390, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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Yeh YJ, Weng SC, Lin YH, Chen CL, Tsao SH, Tsai HY, Juang HH, Chang PL, Hou CP. Comparative Analysis of Surgical Outcomes of Flexible Ureteroscopy and Da Vinci Robotic Surgery in Community Patients with Renal Pelvic Stones Larger than 2 cm. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1395. [PMID: 37629685 PMCID: PMC10456386 DOI: 10.3390/medicina59081395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: This study evaluated and compared the surgical outcomes of retrograde intrarenal surgery (RIRS) lithotripsy versus robot-assisted laparoscopic pyelolithotomy (RAPL) in community patients with renal pelvic stones larger than 2 cm. Materials and Methods: A total of 77 patients who underwent RIRS (RIRS group, n = 50) or RAPL (RAPL group, n = 27) at our institution between December 2016 and July 2022 were recruited. A single surgeon performed all surgical operations. Preoperative, operative, and postoperative data were recorded. The study evaluated various clinical outcomes, namely, urinary tract infections, analgesic use, emergency room readmissions, stone clearance rates, surgical complications, and medical expenditures associated with the treatment courses, and compared them between the groups. Results: The RAPL group had a larger mean stone diameter and higher degree of hydronephrosis than the RIRS group did. The RIRS group had superior outcomes regarding operative time, length of postoperative hospital stay, surgical wound pain, and medical expenditures. Regarding postoperative outcomes, comparable rates of postoperative urinary tract infection, prolonged analgesic use, and emergency room readmissions were observed between the groups. However, the RAPL group had a higher stone clearance rate than the RIRS group did (81.5% vs. 52.0%, p = 0.014). Conclusions: For the surgical treatment of renal pelvis stones larger than 2 cm, RAPL has a superior stone clearance rate than RIRS; however, RIRS achieves superior outcomes in terms of medical expenditures, length of hospital stay, and surgical wound pain. Both procedures were equally safe.
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Affiliation(s)
- Yu-Ju Yeh
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Shu-Chuan Weng
- Department of Health and Management, Yuanpei University of Medical Technology, Hsinchu 330, Taiwan;
- Bachelor Degree Program of Senior Health and Management, Yuanpei University of Medical Technology, Hsinchu 330, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Han-Yu Tsai
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | | | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
- Department of Health and Management, Yuanpei University of Medical Technology, Hsinchu 330, Taiwan;
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Reed F, Recabal X, Echeverría P, Braga LH, Cherian A, Gatti JM, Garcia-Aparicio L, Perez-Bertolez S, de Badiola F, Bujons A, Moldes JM, Mushtaq I, López PJ. Are weight or age limits for pediatric laparoscopic pyeloplasty? Results of a multicentric study. World J Urol 2023; 41:1675-1679. [PMID: 36947174 DOI: 10.1007/s00345-023-04359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/21/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Anderson-Hynes pyeloplasty is the technique of choice for the treatment of pyeloureteral junction obstruction (PUJO) with an excellent success rate. Minimally invasive surgery has become the standard of care for the management of PUJO in children. Although it has been comparable to the open approach at all levels, its diffusion or employment in younger children has not been widely adopted. Our aim is to evaluate laparoscopic pyeloplasty outcomes from international academic centers in children under 1 year of age, focusing on feasibility and outcomes including possible complications. MATERIALS AND METHODS This is review of consecutive infants under 1 year of age who underwent laparoscopic pyeloplasty between 2009 and 2018 with more than 12 months of follow-up. Seven different training centers with different backgrounds participated in this study. Evaluation was carried out with ultrasound and renogram before and after surgery. Demographic data, perioperative characteristics, complications, and results are described and analyzed. RESULTS Over 9 years, 124 transperitoneal laparoscopic Anderson-Hynes pyeloplasties were performed on 123 children under 1 year of age; 88 males and 35 females, with 1 case of bilateral PUJO. Of the 124 renal units, 86 were left-sided. Mean age at surgery was 6.6 months (1 week-12 months), with 56% (n = 70) done before 6 months of age. Mean weight at surgery was 6.8 kg (3-12 kg), with 59% (n = 73) weighing less than 8 kg. Mean operative time (skin-to-skin) was 150 min (75-330 min). After a mean follow-up of 46 months (12-84 months), 12 (9%) patients developed complications, with only 1 needing a redo pyeloplasty also done laparoscopically. One child, with deterioration in renal function, underwent nephrectomy. CONCLUSION Laparoscopic pyeloplasty under 1 year of age and/or less than 12 kilos is feasible with lower complication rate. Furthermore, age younger than 6 months and weight less than 8 kg are no longer limiting factors for a successful pyeloplasty as shown by this multicentre study.
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Affiliation(s)
- Francisco Reed
- Hospital Exequiel González Cortés and Clínica Alemana, Santiago, Chile.
- Pediatric Urology Service, Hospital Dr. Exequiel González Cortés and Clínica Alemana, Universidad de Chile, Av Gran Avenida 3300, San Miguel, Santiago, Chile.
| | | | | | | | | | | | | | | | | | | | | | | | - Pedro-José López
- Hospital Exequiel González Cortés and Clínica Alemana, Santiago, Chile
- McMaster University, Hamilton, Canada
- Great Ormond Street Hospital, London, England
- Children's Mercy Hospital, Kansa City, MO, USA
- Hospital Saint Joan de Deu, Barcelona, Spain
- Hospital Italiano, Buenos Aires, Argentina
- Fundación Puigvert, Barcelona, Spain
- Facultad Medicina, Servicio Pediatria y Cirugia Infantil, Universidad de Chile, Santiago, Chile
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50
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Steele G, Tan W, Saleeby CE, Zanger K. Staphylococcus Epidermidis as a Uropathogen in Children. Urology 2023; 176:183-186. [PMID: 36858321 DOI: 10.1016/j.urology.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 03/02/2023]
Abstract
Historically, Staphylococcus epidermidis has been considered a contaminant when grown on urine cultures. However, a growing body of literature suggests that S. epidermidis can cause urinary tract infections (UTIs) in children with anatomic variants or a history of instrumentation. In this case report, we describe a previously healthy child who presented with symptoms of UTI and urine cultures grew this uropathogen. The patient was screened for anatomic abnormalities and none were found; nonetheless, appropriate treatment should be initiated even if no underlying pathology is found.
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Affiliation(s)
| | - Weizhen Tan
- Harvard Medical School, Boston, MA; Division of Nephrology, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Chadi El Saleeby
- Harvard Medical School, Boston, MA; Division of Infectious Diseases, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA; Division of Pediatric Hospital Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Kerstin Zanger
- Harvard Medical School, Boston, MA; Division of Pediatric Hospital Medicine, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.
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