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Abdulfattah S, Ai E, Quairoli M, Eftekharzadeh S, Fischer K, Aghababian A, Weaver J, Godlewski K, Long C, Weiss D, Mittal S, Shukla A, Srinivasan A. Robot-assisted Laparoscopic Ureteral Reimplantation in Pre-toilet Trained Children With Vesicoureteral Reflux. Urology 2024:S0090-4295(24)00911-7. [PMID: 39447876 DOI: 10.1016/j.urology.2024.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 10/01/2024] [Accepted: 10/09/2024] [Indexed: 10/26/2024]
Abstract
OBJECTIVE To evaluate the outcomes of pre-toilet trained children undergoing robot-assisted laparoscopic ureteral reimplantation (RALUR) for the treatment of primary VUR at our institution and compare these to an older cohort. MATERIALS AND METHODS This retrospective study analyzed data from a single institution's registry, comparing outcomes between pre-toilet trained and toilet trained children who underwent RALUR for primary VUR. Preoperative parameters, surgical details, and postoperative outcomes were evaluated. RESULTS The study included 158 patients, with 24 in the pre-toilet trained group and 134 in the toilet trained group. Both cohorts exhibited similar demographics and preoperative characteristics. Operative times, complication rates, and surgical outcomes were comparable between the groups, despite the pre-toilet trained group presenting with more severe VUR grades. Incidence of febrile urinary tract infection after surgery and need for further intervention did not significantly differ between the cohorts. CONCLUSION The current study demonstrates the feasibility, success, and safety of RALUR in pre-toilet trained compared to toilet trained children and thus supports the stance that it is a viable alternative to open surgery.
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Affiliation(s)
- Suhaib Abdulfattah
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Emily Ai
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Marina Quairoli
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sahar Eftekharzadeh
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Urology, Jefferson Einstein Medical Center, Philadelphia, PA
| | - Katherine Fischer
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Aznive Aghababian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - John Weaver
- Case Western Reserve University School of Medicine/Rainbow Babies and Children's Hospital, Division of Urology, Cleveland, OH
| | - Karl Godlewski
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Christopher Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Dana Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Aseem Shukla
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA
| | - Arun Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, Philadelphia, PA.
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Liang L, Wu H, Meng H, Fu L, Zhao J. Case report: A novel compound heterozygous variant in the TNXB gene causes single kidney agenesis and vesicoureteral reflux. Front Endocrinol (Lausanne) 2024; 15:1322395. [PMID: 38370350 PMCID: PMC10869528 DOI: 10.3389/fendo.2024.1322395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024] Open
Abstract
Primary vesicoureteral reflux (VUR) is the prevailing congenital anomaly of the kidneys and urinary tract, posing a significant risk for pyelonephritis scarring and chronic renal insufficiency in pediatric patients. Nevertheless, the precise genetic etiology of VUR remains enigmatic. In this current investigation, we conducted whole-exome sequencing on a child exhibiting single kidney, devoid of any familial VUR background, along with both biological parents. Two missense variants (NM_019105.8: exon11: c.4111G>A and NM_019105.8: exon2: c.31A>T) in the TNXB gene were identified through whole-exome sequencing of the child. These variants were found to be inherited from the child's parents, with each parent carrying one of the variants. Molecular dynamics simulations were conducted to assess the impact of these variants on the tenascin XB proteins encoded by them, revealing varying degrees of impairment. Based on our findings, it is suggested that the TNXB compound heterozygous variant, consisting of c.4111G>A and c.31A>T, may be the underlying cause of right renal agenesis and left hydronephrosis in afflicted child. This discovery broadens the genetic range of the TNXB gene and establishes a genetic foundation for disease-specific preimplantation genetic diagnosis (PGD) in prospective pregnancies involving the parents of this afflicted child.
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Affiliation(s)
- Lei Liang
- Center for Prenatal Diagnosis and Medical Genetics, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Haotian Wu
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Haixia Meng
- Center for Prenatal Diagnosis and Medical Genetics, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lin Fu
- Department of Ultrasound, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jianrong Zhao
- Department of Nephrology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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Nguyen C, Bachtel H, Koh CJ. Pediatric robotic urologic surgery: Pyeloplasty and ureteral reimplantation. Semin Pediatr Surg 2023; 32:151264. [PMID: 36736162 DOI: 10.1016/j.sempedsurg.2023.151264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Catherine Nguyen
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Hannah Bachtel
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Chester J Koh
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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Liu Y, Li M, Qiang L, Sun X, Liu S, Lu TJ. Critical size of kidney stone through ureter: A mechanical analysis. J Mech Behav Biomed Mater 2022; 135:105432. [DOI: 10.1016/j.jmbbm.2022.105432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/20/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022]
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Singhal N, Gopal M, Ali A, McGlade F, Ahmed I, Harkensee C, Gittins N, Senasi R, Peace R, Athiraman N, Tse Y. The prevalence of familial vesicoureteric reflux in infants with normal antenatal scans. Acta Paediatr 2022; 111:1808-1813. [PMID: 35642352 DOI: 10.1111/apa.16434] [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: 05/10/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022]
Abstract
AIM To determine the prevalence of familial vesicoureteric reflux (VUR) by studying the outcomes of screening in a contemporary cohort of newborns with normal antenatal kidney scans. METHODS A review of screening outcomes in newborns with a first degree relative with VUR, normal antenatal scans and no prior urine infections between 2014-2019 at three maternity units in the North East of England was conducted. Imaging consisted of micturating cystourethrogram (MCUG) in all and renal tract ultrasound scan (RUS) routinely in two units and by clinician preference in one unit. RESULTS At a median age of 59 days, 265 infants underwent MCUG. High-grade VUR (Grades 3-5) was detected in 13 (4.9%) and low-grade VUR (Grades 1-2) in 24 (9.1%). In the 152 infants who had a RUS, abnormalities were detected in 21 (13.8%). An abnormal postnatal RUS has a low positive predictive value (14.3%) for high-grade VUR, but a normal RUS has a high negative predictive value (95.4%). CONCLUSION Compared to historical cohorts from two decades ago, the yield from familial VUR screening is low and unjustifiable in the setting of normal antenatal anomaly scans.
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Affiliation(s)
- Nidhi Singhal
- Department of Paediatric Nephrology Great North Children’s Hospital Newcastle Upon Tyne UK
| | - Milan Gopal
- Department of Paediatric Urology Great North Children’s Hospital Newcastle Upon Tyne UK
| | - Alaa Ali
- Department of Paediatric Nephrology Great North Children’s Hospital Newcastle Upon Tyne UK
| | - Fiona McGlade
- Department of Neonatology Sunderland Royal Hospital Sunderland UK
| | - Imran Ahmed
- Department of Neonatology Sunderland Royal Hospital Sunderland UK
| | | | - Nicola Gittins
- Department of Paediatrics Queen Elizabeth Hospital Gateshead UK
| | - Ramdas Senasi
- Department of Radiology Sunderland Royal Hospital Sunderland UK
| | - Richard Peace
- Department of Nuclear Medicine Royal Victoria Infirmary Newcastle Upon Tyne UK
| | - Naveen Athiraman
- Department of Neonatology Royal Victoria Infirmary Newcastle Upon Tyne UK
| | - Yincent Tse
- Department of Paediatric Nephrology Great North Children’s Hospital Newcastle Upon Tyne UK
- Faculty of Medical Sciences Newcastle University Newcastle Upon Tyne UK
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Esposito C, Castagnetti M, Autorino G, Coppola V, Cerulo M, Esposito G, Escolino M. Robot‑Assisted Laparoscopic Extra-Vesical Ureteral Reimplantation (Ralur/Revur) for Pediatric Vesicoureteral Reflux: A Systematic Review of Literature. Urology 2021; 156:e1-e11. [PMID: 34324913 DOI: 10.1016/j.urology.2021.06.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/05/2021] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
This literature review aimed to assess the outcomes of robot-assisted laparoscopic extra-vesical ureteral reimplantation (RALUR/REVUR) in standard, complex and re-operative cases. Twenty-two studies (period 2008-2019) containing 1362 children receiving RALUR/REVUR, were included. Unilateral repair was faster compared to bilateral (P = .0000). The overall patient success rate was 92%. The mean post-operative complications rate was 10.7%. The mean re-operations rate was 3.9%. The available data show that RALUR/REVUR can be a first line surgical approach for pediatric vesicoureteral reflux at most centers with the caveat that learning curves for the surgeons are expected as with most new surgical procedures.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Castagnetti
- Division of Pediatric Urology, Medical University of Padua, Padua, Italy
| | - Giuseppe Autorino
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Vincenzo Coppola
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Giorgia Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy.
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7
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Verbitsky M, Krithivasan P, Batourina E, Khan A, Graham SE, Marasà M, Kim H, Lim TY, Weng PL, Sánchez-Rodríguez E, Mitrotti A, Ahram DF, Zanoni F, Fasel DA, Westland R, Sampson MG, Zhang JY, Bodria M, Kil BH, Shril S, Gesualdo L, Torri F, Scolari F, Izzi C, van Wijk JA, Saraga M, Santoro D, Conti G, Barton DE, Dobson MG, Puri P, Furth SL, Warady BA, Pisani I, Fiaccadori E, Allegri L, Degl'Innocenti ML, Piaggio G, Alam S, Gigante M, Zaza G, Esposito P, Lin F, Simões-e-Silva AC, Brodkiewicz A, Drozdz D, Zachwieja K, Miklaszewska M, Szczepanska M, Adamczyk P, Tkaczyk M, Tomczyk D, Sikora P, Mizerska-Wasiak M, Krzemien G, Szmigielska A, Zaniew M, Lozanovski VJ, Gucev Z, Ionita-Laza I, Stanaway IB, Crosslin DR, Wong CS, Hildebrandt F, Barasch J, Kenny EE, Loos RJ, Levy B, Ghiggeri GM, Hakonarson H, Latos-Bieleńska A, Materna-Kiryluk A, Darlow JM, Tasic V, Willer C, Kiryluk K, Sanna-Cherchi S, Mendelsohn CL, Gharavi AG. Copy Number Variant Analysis and Genome-wide Association Study Identify Loci with Large Effect for Vesicoureteral Reflux. J Am Soc Nephrol 2021; 32:805-820. [PMID: 33597122 PMCID: PMC8017540 DOI: 10.1681/asn.2020050681] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/04/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vesicoureteral reflux (VUR) is a common, familial genitourinary disorder, and a major cause of pediatric urinary tract infection (UTI) and kidney failure. The genetic basis of VUR is not well understood. METHODS A diagnostic analysis sought rare, pathogenic copy number variant (CNV) disorders among 1737 patients with VUR. A GWAS was performed in 1395 patients and 5366 controls, of European ancestry. RESULTS Altogether, 3% of VUR patients harbored an undiagnosed rare CNV disorder, such as the 1q21.1, 16p11.2, 22q11.21, and triple X syndromes ((OR, 3.12; 95% CI, 2.10 to 4.54; P=6.35×10-8) The GWAS identified three study-wide significant and five suggestive loci with large effects (ORs, 1.41-6.9), containing canonical developmental genes expressed in the developing urinary tract (WDPCP, OTX1, BMP5, VANGL1, and WNT5A). In particular, 3.3% of VUR patients were homozygous for an intronic variant in WDPCP (rs13013890; OR, 3.65; 95% CI, 2.39 to 5.56; P=1.86×10-9). This locus was associated with multiple genitourinary phenotypes in the UK Biobank and eMERGE studies. Analysis of Wnt5a mutant mice confirmed the role of Wnt5a signaling in bladder and ureteric morphogenesis. CONCLUSIONS These data demonstrate the genetic heterogeneity of VUR. Altogether, 6% of patients with VUR harbored a rare CNV or a common variant genotype conferring an OR >3. Identification of these genetic risk factors has multiple implications for clinical care and for analysis of outcomes in VUR.
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Affiliation(s)
- Miguel Verbitsky
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Priya Krithivasan
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | | | - Atlas Khan
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Sarah E. Graham
- Department of Internal Medicine, Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Maddalena Marasà
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Hyunwoo Kim
- Department of Urology, Columbia University, New York, New York
| | - Tze Y. Lim
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Patricia L. Weng
- Department of Pediatric Nephrology, University of California, Los Angeles Medical Center and University of California, Los Angeles Medical Center-Santa Monica, Los Angeles, California
| | | | - Adele Mitrotti
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Dina F. Ahram
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Francesca Zanoni
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - David A. Fasel
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Rik Westland
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
- Department of Pediatric Nephrology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands
| | - Matthew G. Sampson
- Division of Nephrology, Boston Children’s Hospital, Boston, Massachusetts
| | - Jun Y. Zhang
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Monica Bodria
- Division of Nephrology, Dialysis, Transplantation, and Laboratory on Pathophysiology of Uremia, Istituto G. Gaslini, Genoa, Italy
| | - Byum Hee Kil
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Shirlee Shril
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Loreto Gesualdo
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Fabio Torri
- Department of Pediatric Surgery, Spedali Civili Children’s Hospital of Brescia, Brescia, Italy
| | - Francesco Scolari
- Chair and Division of Nephrology, University and Spedali Civili Hospital, Brescia, Italy
| | - Claudia Izzi
- Division of Nephrology and Department of Obstetrics and Gynecology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Joanna A.E. van Wijk
- Department of Pediatric Nephrology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands
| | - Marijan Saraga
- Department of Pediatrics, University Hospital of Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Conti
- Department of Pediatric Nephrology, Azienda Ospedaliera Universitaria “G. Martino,” Messina, Italy
| | - David E. Barton
- University College Dublin School of Medicine, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
- Department of Clinical Genetics, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
| | - Mark G. Dobson
- Department of Clinical Genetics, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
- National Children’s Research Centre, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
| | - Prem Puri
- National Children’s Research Centre, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
- Department of Pediatric Surgery, Beacon Hospital, University College Dublin, Dublin, Ireland
| | - Susan L. Furth
- Division of Nephrology, Departments of Pediatrics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bradley A. Warady
- Division of Nephrology, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Isabella Pisani
- Nephrology Unit, Parma University Hospital and Department of Medicine and Surgery, Parma University Medical School, Parma, Italy
| | - Enrico Fiaccadori
- Nephrology Unit, Parma University Hospital and Department of Medicine and Surgery, Parma University Medical School, Parma, Italy
| | - Landino Allegri
- Nephrology Unit, Parma University Hospital and Department of Medicine and Surgery, Parma University Medical School, Parma, Italy
| | - Maria Ludovica Degl'Innocenti
- Division of Nephrology, Dialysis, Transplantation, and Laboratory on Pathophysiology of Uremia, Istituto G. Gaslini, Genoa, Italy
| | - Giorgio Piaggio
- Division of Nephrology, Dialysis, Transplantation, and Laboratory on Pathophysiology of Uremia, Istituto G. Gaslini, Genoa, Italy
| | - Shumyle Alam
- Department of Pediatric Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Maddalena Gigante
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Gianluigi Zaza
- Renal and Dialysis Unit, Department of Medicine, School of Medicine, University of Verona, Verona, Italy
| | - Pasquale Esposito
- Department of Internal Medicine, Nephrology, Dialysis and Transplantation Clinics, Genoa University and IRCCS Policlinico San Martino, Genova, Italy
| | - Fangming Lin
- Division of Pediatric Nephrology, Department of Pediatrics, Columbia University, New York, New York
| | - Ana Cristina Simões-e-Silva
- Department of Pediatrics, Unit of Pediatric Nephrology, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Andrzej Brodkiewicz
- Department of Pediatrics, Child Nephrology, Dialysotheraphy and Management of Acute Poisoning, Pomeranian Medical University, Szczecin, Poland
| | - Dorota Drozdz
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Zachwieja
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Maria Szczepanska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Piotr Adamczyk
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Katowice, Poland
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Daria Tomczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Przemyslaw Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | | | - Grazyna Krzemien
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland
| | | | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| | - Vladimir J. Lozanovski
- University Clinic for General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- University Children’s Hospital, Medical Faculty of Skopje, Skopje, Macedonia
| | - Zoran Gucev
- University Children’s Hospital, Medical Faculty of Skopje, Skopje, Macedonia
| | | | - Ian B. Stanaway
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - David R. Crosslin
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Craig S. Wong
- Division of Pediatric Nephrology, University of New Mexico Children’s Hospital, Albuquerque, New Mexico
| | - Friedhelm Hildebrandt
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Barasch
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
- Department of Urology, Columbia University, New York, New York
| | - Eimear E. Kenny
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ruth J.F. Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York
| | - Brynn Levy
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis, Transplantation, and Laboratory on Pathophysiology of Uremia, Istituto G. Gaslini, Genoa, Italy
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anna Latos-Bieleńska
- Department of Medical Genetics, Poznan University of Medical Sciences, and NZOZ Center for Medical Genetics GENESIS, Poznan, Poland
| | - Anna Materna-Kiryluk
- Department of Medical Genetics, Poznan University of Medical Sciences, and NZOZ Center for Medical Genetics GENESIS, Poznan, Poland
| | - John M. Darlow
- Department of Clinical Genetics, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
- National Children’s Research Centre, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
| | - Velibor Tasic
- University Children’s Hospital, Medical Faculty of Skopje, Skopje, Macedonia
| | - Cristen Willer
- Department of Internal Medicine, Cardiology, University of Michigan, Ann Arbor, Michigan
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan
- Department of Computational Medicine and Bioinformatics, Ann Arbor, Michigan
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | - Simone Sanna-Cherchi
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
| | | | - Ali G. Gharavi
- Division of Nephrology, Department of Medicine, Columbia University, New York, New York
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Oukhouya MA, Andaloussi S, Tazi M, Mahmoudi A, Khattala K, Bouabdallah Y. [Long-term evolution of vesicoureteral reflux in children]. Pan Afr Med J 2019; 33:304. [PMID: 31692745 PMCID: PMC6815501 DOI: 10.11604/pamj.2019.33.304.18966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/31/2019] [Indexed: 11/11/2022] Open
Abstract
Vesicoureteral reflux is very common in children, requiring a long follow-up period to reduce its progression toward chronic renal failure. This study aims to analyze the epidemiological diagnostic features, the management of vesicoureteral reflux and long term course of patients with this disease. We conducted a retrospective study of 42 patients with suspected vesicoureteral reflux hospitalized in the Department of Visceral Paediatric Surgery at the Hassan II University Hospital of Fez over a period of 6 years from January 2010 to December 2015. Mean age of patients at diagnosis was 3 years and 2 months. The boy is to girl sex ratio was 1.8. Vesicoureteral reflux was isolated in 81% of patients and secondary or associated in 19% of patients. The most common initial manifestation was urinary tract infection (90.4%). Renal function was impaired in 54.8% of children. The treatment was based on antibiotics against diagnosed UTI (90.4%), antibiotic prophylaxis in the case of recurrence and Cohen reimplantation (97.62%). Surgical indication readily concerned all patients with grades IV and V vesicoureteral reflux (73.9%) as well as patients with impaired kidneys and 26.1% of patients after medical treatment. Early and late postoperative course was in general satisfactory: disappearance of vesicoureteral reflux in 92.68% of cases. Upper urinary tract regressed except for 9.52% of patients; 95.23% of patients had complete recovery of renal function. There was a reduction in UTI recurrence (in 19.04% of cases after surgery). The majority of parents judged positively the clinical course of their children (54.76%) after surgery.
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Affiliation(s)
- Mohamed Amine Oukhouya
- Service de Chirurgie Pédiatrique, CHU Hassan II, Faculté de Médecine et de Pharmacie, Fès, Maroc
| | - Saad Andaloussi
- Service de Chirurgie Pédiatrique, CHU Hassan II, Faculté de Médecine et de Pharmacie, Fès, Maroc
| | - Mohammed Tazi
- Service de Chirurgie Pédiatrique, CHU Hassan II, Faculté de Médecine et de Pharmacie, Fès, Maroc
| | - Abdelhalim Mahmoudi
- Service de Chirurgie Pédiatrique, CHU Hassan II, Faculté de Médecine et de Pharmacie, Fès, Maroc
| | - Khalid Khattala
- Service de Chirurgie Pédiatrique, CHU Hassan II, Faculté de Médecine et de Pharmacie, Fès, Maroc
| | - Youssef Bouabdallah
- Service de Chirurgie Pédiatrique, CHU Hassan II, Faculté de Médecine et de Pharmacie, Fès, Maroc
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10
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Primary vesicoureteral reflux; what have we learnt from the recently published randomized, controlled trials? Pediatr Nephrol 2019; 34:1513-1519. [PMID: 30132079 DOI: 10.1007/s00467-018-4045-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
In recent years, progress has been made on understanding the relationship between vesicoureteral reflux (VUR) and urinary tract infection (UTI). The findings on recent prospective, randomized, controlled studies have questioned the conventional VUR clinical significance and, therefore, have challenged the traditional diagnostic and therapeutic recommendations. These new studies have redefined the pathogenic role of vesicoureteral reflux in UTI as well as have disputed the routine use of urinary antibiotic prophylaxis to prevent UTI and renal damage in VUR patients. The time to overinvestigate and treat the vast majority of otherwise healthy children who have an uncomplicated UTI with long-term antibiotic prophylaxis seems to be over. Is there a role of severe VUR in the development of chronic renal disease and renal failure? New ideas are needed to answer these questions with the goal to avoid repeating past mistakes when therapeutic choices were based on expert opinions rather than facts.
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Robot-assisted laparoscopic ureteral reimplantation in children: a valuable alternative to open surgery. World J Urol 2019; 38:1849-1854. [PMID: 31004205 DOI: 10.1007/s00345-019-02766-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/09/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Robot-assisted laparoscopic surgical systems have led to new minimally invasive options for complex reconstructive procedures in children including for vesicoureteral reflux (VUR). Robot-assisted laparoscopic ureteral reimplantation has been shown to be a viable minimally invasive surgical option for children with VUR. However, higher-than-expected complication rates and sub-optimal reflux resolution rates at some centers have also been reported. METHODS This article provides a focused literature review as well as current perspectives on open reimplantation and robot-assisted laparoscopic ureteral reimplantation as non-endoscopic surgical options for pediatric VUR. RESULTS The heterogeneity of surgical outcomes may, in part, be due to the learning curve inherent with all new technology and procedures. As a result, the current gold standard surgical option for VUR continues to be open ureteral reimplantation. While it remains to be seen if robot-assisted laparoscopic surgery will gradually replace open surgery as the most utilized surgical option for VUR in pediatric patients, robot-assisted laparoscopic ureteral reimplantation with the current robotic surgical systems may be just one step toward an eventual minimally invasive option that all experienced surgeons can offer with the requisite high success rates and low major complication rates. CONCLUSION Robot-assisted laparoscopic ureteral reimplantation remains a viable minimally invasive surgical option for children with VUR, but with the expected learning curve associated with all new technologies.
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12
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Tham MS, Smyth IM. Cellular and molecular determinants of normal and abnormal kidney development. WILEY INTERDISCIPLINARY REVIEWS-DEVELOPMENTAL BIOLOGY 2018; 8:e338. [DOI: 10.1002/wdev.338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Ming S. Tham
- Department of Anatomy and Developmental Biology Monash Biomedicine Discovery Institute, Monash University Melbourne Victoria Australia
| | - Ian M. Smyth
- Department of Anatomy and Developmental Biology Monash Biomedicine Discovery Institute, Monash University Melbourne Victoria Australia
- Department of Biochemistry and Molecular Biology Monash Biomedicine Discovery Institute, Monash University Melbourne Victoria Australia
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Takaddus AT, Chandy AJ. A three-dimensional (3D) two-way coupled fluid-structure interaction (FSI) study of peristaltic flow in obstructed ureters. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3122. [PMID: 29939493 DOI: 10.1002/cnm.3122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/14/2018] [Accepted: 06/16/2018] [Indexed: 06/08/2023]
Abstract
Obstruction in the ureter flow path is one of the most common problems in urinary-related diseases. As the ureter transports the urine using the expansion bolus created by the peristaltic pulses, an obstruction in its path can cause unwanted backflow and can also result in damage to the wall. But in order to understand this further, and specifically to quantify and parametrize the effect of the obstruction in the ureter, a detailed study investigating various level of obstructions in peristaltic ureter flow is necessary. In the current study, full 3D numerical simulations of peristalsis in an obstructed ureter are carried out using a finite element solver along with a two-way coupling between the fluid and structural domain with the arbitrary Eulerian-Lagrangian method. Analysis of the results shows that the larger the obstruction, the higher the wall shear stress and pressure gradient in the fluid. In addition, the amount of backflow increases with increase in the obstruction.
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Affiliation(s)
| | - Abhilash J Chandy
- Department of Mechanical Engineering, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India
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14
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Takaddus AT, Gautam P, Chandy AJ. A fluid-structure interaction (FSI)-based numerical investigation of peristalsis in an obstructed human ureter. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3104. [PMID: 29737631 DOI: 10.1002/cnm.3104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/09/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
Urine moves from the kidney to the bladder through the ureter. A series of compression waves facilitates this transport. Due to the highly concentrated mineral deposits in urine, stones are formed in the kidney and travel down through the urinary tract. While passing, a larger stone can get stuck and cause severe damage to ureter wall. Also, stones in the ureter obstructing the urine flow can cause pain and backflow of urine which in turn might require surgical intervention. The current study develops a 2D axisymmetric numerical model to gain an understanding of the ureter obstruction and its effects on the flow, which are critical in assessing the different treatment options. Transient computational analysis involving a two-way fully coupled fluid-structure interaction with the arbitrary Lagrangian-Eulerian method between the ureteral wall and urine flow is conducted with an obstruction in the ureter. The ureter wall is modeled as an anisotropic hyperelastic material, data of which, is based on biaxial tests on human ureter from previous literature, while the incompressible Navier-Stokes equations are solved to calculate urine flow. A finite element-based monolithic solver is used for the simulations here. The obstruction is placed in the fluid domain as a circular stone at the proximal part of the ureter. One of the objectives of this study is to quantify the effect of the ureteral obstruction. A sharp jump in pressure gradient and wall shear stress, as well as retrograde urine flow, is observed as a result of the obstruction.
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Affiliation(s)
| | - Prashanta Gautam
- Department of Mechanical Engineering, The University of Akron, Akron, Ohio, USA
| | - Abhilash J Chandy
- Department of Mechanical Engineering, Indian Institute of Technology Bombay, Mumbai, India
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15
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Attini R, Kooij I, Montersino B, Fassio F, Gerbino M, Biolcati M, Versino E, Todros T, Piccoli GB. Reflux nephropathy and the risk of preeclampsia and of other adverse pregnancy-related outcomes: a systematic review and meta-analysis of case series and reports in the new millennium. J Nephrol 2018; 31:833-846. [PMID: 30066252 DOI: 10.1007/s40620-018-0515-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/12/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Reflux nephropathy is a common urinary tract malformation, and a substantial cause of morbidity in women of childbearing age. While recent studies provide further new information on pregnancy-related outcomes, their results are heterogeneous and a systematic meta-analysis may help the interpretation. The aim of this review was to analyze pregnancy-related outcomes in the recent literature on reflux nephropathy (2000-2016), to perfect the estimation of risks, and to identify specific research needs. METHODS We searched Medline, EMBASE and the Cochrane review databases for the period 2000-2016 (PROSPERO registration no. 42016042713). SELECTION CRITERIA all case series and case reports dealing with reflux nephropathy and reporting on at least one pregnancy outcome. Data were extracted from eligible case series (≥ 6 cases). For the outcomes preeclampsia (PE), pregnancy-induced hypertension (PIH), preterm birth, and newborns small for gestational age, we employed as a control group the low-risk pregnancies from a multicenter database including 1418 live-born singletons. Case reports were analyzed narratively. RESULTS The search retrieved 2507 papers, of which 7 case series and 4 case reports were retained. The series report on 434 women with 879 pregnancies; no study reported controls. Compared to the low-risk controls, the meta-analysis showed an increased risk of PIH (odds ratio, OR 5.55; confidence interval, CI 3.56-8.66), PE (OR 6.04; CI 2.41-15.13), and all hypertensive disorders combined (OR 10.43; CI 6.90-15.75). No difference was observed in preterm delivery and caesarean sections. A higher incidence of stillbirth was reported in one paper. Conversely, the 4 case reports (on 10 pregnancies) alert us to a potentially severe complication, hydro(uretero)nephrosis with or without infection. CONCLUSION Reflux nephropathy is associated with an increased risk of PIH and PE, but not of preterm delivery, suggesting the occurrence of late 'maternal' PE. The finding of a higher incidence of stillbirths in one series requires further analysis. Strict follow-up of these women is needed, in particular in late pregnancy stages, to avoid and manage in particular hypertensive pregnancy complications.
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Affiliation(s)
- Rossella Attini
- Unità Materno-Fetale, Dipartimento di Chirurgia, Università di Torino, Turin, Italy
| | - Isabelle Kooij
- Unità Materno-Fetale, Dipartimento di Chirurgia, Università di Torino, Turin, Italy
- Nephrologie, Centre Hospitalier Le Mans, 194 Avenue Roubillard, 72000, Le Mans, France
| | - Benedetta Montersino
- Unità Materno-Fetale, Dipartimento di Chirurgia, Università di Torino, Turin, Italy
| | - Federica Fassio
- Unità Materno-Fetale, Dipartimento di Chirurgia, Università di Torino, Turin, Italy
| | - Martina Gerbino
- Unità Materno-Fetale, Dipartimento di Chirurgia, Università di Torino, Turin, Italy
| | - Marilisa Biolcati
- Unità Materno-Fetale, Dipartimento di Chirurgia, Università di Torino, Turin, Italy
| | - Elisabetta Versino
- Epidemiologia, Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy
| | - Tullia Todros
- Unità Materno-Fetale, Dipartimento di Chirurgia, Università di Torino, Turin, Italy
| | - Giorgina Barbara Piccoli
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy.
- Nephrologie, Centre Hospitalier Le Mans, 194 Avenue Roubillard, 72000, Le Mans, France.
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16
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Hay AD, Birnie K, Busby J, Delaney B, Downing H, Dudley J, Durbaba S, Fletcher M, Harman K, Hollingworth W, Hood K, Howe R, Lawton M, Lisles C, Little P, MacGowan A, O'Brien K, Pickles T, Rumsby K, Sterne JA, Thomas-Jones E, van der Voort J, Waldron CA, Whiting P, Wootton M, Butler CC. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness. Health Technol Assess 2018; 20:1-294. [PMID: 27401902 DOI: 10.3310/hta20510] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment. OBJECTIVES To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness. DESIGN Multicentre, prospective diagnostic cohort study. SETTING AND PARTICIPANTS Children < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms. METHODS One hundred and seven clinical characteristics (index tests) were recorded from the child's past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood ('clinical diagnosis') and urine sampling and treatment intentions ('clinical judgement') were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 10(5) colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the 'clinician diagnosis' AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with 'clinical judgement'. RESULTS A total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old, with 2.2% meeting the UTI definition. Among these, 'clinical diagnosis' correctly identified 46.6% of positive cultures, with 94.7% specificity and an AUROC of 0.77 (95% CI 0.71 to 0.83). Four symptoms, three signs and three dipstick results were independently associated with UTI with an AUROC (95% CI; bootstrap-validated AUROC) of 0.89 (0.85 to 0.95; validated 0.88) for symptoms and signs, increasing to 0.93 (0.90 to 0.97; validated 0.90) with dipstick results. Nappy pad samples were provided from the other 2277 children, of whom 82% were < 2 years old and 1.3% met the UTI definition. 'Clinical diagnosis' correctly identified 13.3% positive cultures, with 98.5% specificity and an AUROC of 0.63 (95% CI 0.53 to 0.72). Four symptoms and two dipstick results were independently associated with UTI, with an AUROC of 0.81 (0.72 to 0.90; validated 0.78) for symptoms, increasing to 0.87 (0.80 to 0.94; validated 0.82) with the dipstick findings. A high specificity threshold for the clean-catch model was more accurate and less costly than, and as effective as, clinical judgement. The additional diagnostic utility of dipstick testing was offset by its costs. The cost-effectiveness of the nappy pad model was not clear-cut. CONCLUSIONS Clinicians should prioritise the use of clean-catch sampling as symptoms and signs can cost-effectively improve the identification of UTI in young children where clean catch is possible. Dipstick testing can improve targeting of antibiotic treatment, but at a higher cost than waiting for a laboratory result. Future research is needed to distinguish pathogens from contaminants, assess the impact of the clean-catch algorithm on patient outcomes, and the cost-effectiveness of presumptive versus dipstick versus laboratory-guided antibiotic treatment. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Alastair D Hay
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Birnie
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - John Busby
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Brendan Delaney
- Department of Primary Care and Public Health Sciences, National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Harriet Downing
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jan Dudley
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Stevo Durbaba
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK
| | - Margaret Fletcher
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK.,South West Medicines for Children Local Research Network, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kim Harman
- Centre for Academic Primary Care, National Institute for Health Research (NIHR) School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Kerenza Hood
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Robin Howe
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Cardiff, UK
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Catherine Lisles
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | | | - Kathryn O'Brien
- Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Timothy Pickles
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Kate Rumsby
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Jonathan Ac Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Judith van der Voort
- Department of Paediatrics and Child Health, University Hospital of Wales, Cardiff, UK
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Institute for Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff, UK
| | - Penny Whiting
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Cardiff, UK
| | - Christopher C Butler
- Cochrane Institute of Primary Care & Public Health, School of Medicine, Cardiff University, Cardiff, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Robot-assisted laparoscopic versus open ureteral reimplantation for pediatric vesicoureteral reflux: a systematic review and meta-analysis. World J Urol 2018; 36:819-828. [PMID: 29374841 DOI: 10.1007/s00345-018-2194-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/19/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of robot-assisted laparoscopic ureteral reimplantation (RALUR) and open ureteral reimplantation (OUR) in treating primary pediatric vesicoureteral reflux (VUR) based on published literature. METHODS A comprehensive literature search of PubMed, Embase, Cochrane Library, CBM, CNKI and VIP databases was conducted to identify studies comparing the outcomes of RALUR with OUR for treating primary pediatric VUR. The last search was in January 2017. Summarized mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the differences in outcomes between RALUR and OUR. RESULTS A total of six studies containing 7122 children with primary VUR were included in this analysis. Significantly longer operation time was needed for RALUR than OUR (MD 66.69 min, 95% CI 41.71-91.67, P < 0.00001), while the RALUR group had significantly fewer days of hospital stay (MD - 17.80 h, 95% CI - 21.18 to - 14.42, P < 0.00001) and postoperative Foley placement (MD - 0.32 days, 95% CI - 0.57 to - 0.07, P = 0.01). No significant differences were found in estimated blood loss during operation, success rate, complications, and postoperative analgesia usage between the two groups. In subgroup analyses, a significantly higher rate of short-term postoperative complications in RALUR was found compared with OUR (OR 3.17, 95% CI 1.72-5.85, P = 0.0002). CONCLUSIONS Our study indicates that compared with OUR, RALUR is also an effective surgical approach for primary pediatric VUR and could help patients return to society more quickly; however, short-term postoperative complications of RALUR should be considered cautiously.
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18
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Pastore V, Bartoli F. Urinary excretion of EGF and MCP-1 in children with vesicoureteral reflux. Int Braz J Urol 2017; 43:549-555. [PMID: 28191787 PMCID: PMC5462148 DOI: 10.1590/s1677-5538.ibju.2015.0132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/17/2016] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim of this study was to investigate the urinary concentration of epidermal growth factor (EGF) and monocyte chemotactic protein-1 (MCP-1) as reflux nephropathy (RN) biomarkers before and after endoscopic treatment of moderate to severe vesico-ureteral reflux (VUR). Materials and methods A prospective study was carried out on 72 children with moderate to severe VUR. All patients underwent endoscopic treatment using Macroplastique® or Deflux®. Vesico-ureteral reflux resolution was tested by post-operative voiding cystourethrography after 3 months and 2 years. Follow-up urinary samples were collected at that time. Control samples were taken from healthy children with no clinical evidence of renal and bladder disease and no history of UTI. Results In VUR patients, pre-operative urinary EGF levels had a down-regulation when compared to controls. Following successful VUR repair, urinary EGF levels of VUR children progressively increased only at long term follow-up but without returning to normal levels. Urinary MCP-1 levels were highly expressed in pre-operative samples and decreased markedly during early post-operative measurements. Urinary MCP-1 levels did not further decreased in late post-operative follow-up. In fact, these levels remained significantly higher when compared to controls. Conclusions Urinary levels of EGF and MCP-1 may become useful markers for monitoring the response to surgical treatment in VUR patients. Although endoscopic VUR treatment is effective in reducing the inflammatory response, the persistence of significant abnormal levels of inflammatory cytokines (such as urinary MCP-1) at long term follow-up suggests that surgery alone may not completely treat the chronic renal inflammation evidenced in these children.
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Affiliation(s)
- Valentina Pastore
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Fabio Bartoli
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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19
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Do Routine Preoperative and Intraoperative Urine Cultures Benefit Pediatric Vesicoureteral Reflux Surgery? Adv Urol 2017; 2017:3197869. [PMID: 28487733 PMCID: PMC5405361 DOI: 10.1155/2017/3197869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/17/2016] [Accepted: 03/09/2017] [Indexed: 11/18/2022] Open
Abstract
Objective. To determine if routine preoperative and intraoperative urine cultures (UCx) are necessary in pediatric vesicoureteral (VUR) reflux surgery by identifying their association with each other, preoperative symptoms, and surgical outcomes. Materials and Methods. A retrospective review of patients undergoing ureteral reimplant(s) for primary VUR at a tertiary academic medical center between years 2000 and 2014 was done. Preoperative UCx were defined as those within 30 days before surgery. A positive culture was defined as >50,000 colony forming units of a single organism. Results. A total of 185 patients were identified and 87/185 (47.0%) met inclusion criteria. Of those, 39/87 (45%) completed a preoperative UCx. Only 3/39 (8%) preoperative cultures returned positive, and all of those patients were preoperatively symptomatic. No preoperatively asymptomatic patients had positive preoperative cultures. Intraoperative cultures were obtained in 21/87 (24.1%) patients; all were negative. No associations were found between preoperative culture results and intraoperative cultures or between culture result and postoperative complications. Conclusions. In asymptomatic patients, no associations were found between the completion of a preoperative or intraoperative UCx and surgical outcomes, suggesting that not all patients may require preoperative screening. Children presenting with symptoms of urinary tract infection (UTI) prior to ureteral reimplantation may benefit from preoperative UCx.
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20
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Involvement of interstitial cells of Cajal in bladder dysfunction in mice with experimental autoimmune encephalomyelitis. Int Urol Nephrol 2017; 49:1353-1359. [PMID: 28425078 DOI: 10.1007/s11255-017-1597-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bladder dysfunction is an important symptom of experimental autoimmune encephalomyelitis (EAE). Our previous study showed that EAE-induced upregulation of the E-prostanoid receptor 3 (EP3) and E-prostanoid receptor 4 (EP4) in the bladder was accompanied by bladder dysfunction. Although many other studies have evaluated the lower urinary tract symptoms in multiple sclerosis, the mechanism remains unclear. OBJECTIVES To investigate the effects of interstitial cells of Cajal (ICC) on bladder dysfunction in a novel neurogenic bladder model induced by experimental autoimmune encephalomyelitis. MATERIALS AND METHODS The EAE model was induced by a previously established method, and bladder functions in mice were evaluated. Bladders were harvested for the analysis of ICCs and the genes associated with bladder mechanosensation including pannexin 1 (Panx1) and Gja1 (encoding connexin43) by immunofluorescence and western blotting. The stem cell factor cytokine (SCF) was intraperitoneally injected at the beginning of EAE onset. RESULTS EAE mice developed profound bladder dysfunction characterized by significant urine retention, increased micturition and decreased urine output per micturition. EAE induced a significant decrease in c-Kit expression and ICCs number. EAE also induced a significant increase in pannexin 1 and connexin43. SCF treatment could ameliorate all of these pathological changes. CONCLUSIONS ICCs and stem cell factor play an important role in EAE-induced bladder dysfunction, which may be used as therapeutic options in treating patients with multiple sclerosis-related bladder dysfunction.
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Hollingworth W, Busby J, Butler CC, O'Brien K, Sterne JAC, Hood K, Little P, Lawton M, Birnie K, Thomas-Jones E, Harman K, Hay AD. The Diagnosis of Urinary Tract Infection in Young Children (DUTY) Study Clinical Rule: Economic Evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:556-566. [PMID: 28407997 PMCID: PMC5406157 DOI: 10.1016/j.jval.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 01/06/2017] [Accepted: 01/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of a two-step clinical rule using symptoms, signs and dipstick testing to guide the diagnosis and antibiotic treatment of urinary tract infection (UTI) in acutely unwell young children presenting to primary care. METHODS Decision analytic model synthesising data from a multicentre, prospective cohort study (DUTY) and the wider literature to estimate the short-term and lifetime costs and healthcare outcomes (symptomatic days, recurrent UTI, quality adjusted life years) of eight diagnostic strategies. We compared GP clinical judgement with three strategies based on a 'coefficient score' combining seven symptoms and signs independently associated with UTI and four strategies based on weighted scores according to the presence/absence of five symptoms and signs. We compared dipstick testing versus laboratory culture in children at intermediate risk of UTI. RESULTS Sampling, culture and antibiotic costs were lowest in high-specificity DUTY strategies (£1.22 and £1.08) compared to clinical judgement (£1.99). These strategies also approximately halved urine sampling (4.8% versus 9.1% in clinical judgement) without reducing sensitivity (58.2% versus 56.4%). Outcomes were very similar across all diagnostic strategies. High-specificity DUTY strategies were more cost-effective than clinical judgement in the short- (iNMB = £0.78 and £0.84) and long-term (iNMB =£2.31 and £2.50). Dipstick tests had poorer cost-effectiveness than laboratory culture in children at intermediate risk of UTI (iNMB = £-1.41). CONCLUSIONS Compared to GPs' clinical judgement, high specificity clinical rules from the DUTY study could substantially reduce urine sampling, achieving lower costs and equivalent patient outcomes. Dipstick testing children for UTI is not cost-effective.
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Affiliation(s)
| | - John Busby
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kathryn O'Brien
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Kerenza Hood
- South East Wales Trials Unit (SEWTU Centre for Trials Research), Cardiff University, Cardiff, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Michael Lawton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Birnie
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU Centre for Trials Research), Cardiff University, Cardiff, UK
| | - Kim Harman
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Baek M, Koh CJ. Lessons learned over a decade of pediatric robotic ureteral reimplantation. Investig Clin Urol 2017; 58:3-11. [PMID: 28097262 PMCID: PMC5240282 DOI: 10.4111/icu.2017.58.1.3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/29/2016] [Indexed: 01/04/2023] Open
Abstract
The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR) has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR). However, higher-than-expected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer.
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Affiliation(s)
- Minki Baek
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chester J. Koh
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital and Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Piskunowicz M, Świętoń D, Rybczyńska D, Czarniak P, Szarmach A, Kaszubowski M, Szurowska E. Comparison of voiding cystourethrography and urosonography with second-generation contrast agents in simultaneous prospective study. J Ultrason 2016; 16:339-347. [PMID: 28138405 PMCID: PMC5269521 DOI: 10.15557/jou.2016.0034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022] Open
Abstract
Background The invasiveness and exposure to radiation in voiding cystourethrography led to the introduction of alternative methods of diagnosis of vesicoureteral reflux, including contrast enhanced voiding urosonography. While there is a limited number of studies comparing these methods using new generation ultrasound contrast agents, none of them compared both methods simultaneously. This study is aimed at assessing agreement between contrast enhanced voiding urosonography with second-generation ultrasound contrast agents and voiding cystourethrography. Methods From April 2013 to May 2014, 83 children (37 female and 46 male), mean age 3.5 years, age range from 1 month to 17.5 years, underwent prospective simultaneous assessment by contrast enhanced voiding urosonography and voiding cystourethrography, with a total of 166 uretero-renal units evaluated. Results The sensitivity of voiding cystourethrography and contrast enhanced voiding urosonography were comparable, amounting to 88%, however, neither reached 100% for the entire studied population. The negative predictive value of voiding urosonography and voiding cystourethrography was 97%, and there was no difference between both methods. Conclusion Voiding cystourethrography and contrast enhanced voiding urosonography are comparable methods in diagnosis of vesicoureteral reflux, and can be performed alternatively. However, some limitations of contrast enhanced voiding urosonography must be remembered.
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Affiliation(s)
- Maciej Piskunowicz
- Department of Radiology, Medical University of Gdańsk, Poland; M. Piskunowicz and D. Świętoń contributed equally to this work and are considered co-first authors
| | - Dominik Świętoń
- Department of Radiology, Medical University of Gdańsk, Poland; M. Piskunowicz and D. Świętoń contributed equally to this work and are considered co-first authors
| | | | - Piotr Czarniak
- Department of Paediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Poland
| | | | - Mariusz Kaszubowski
- Institute of Statistics, Department of Economic Sciences, Faculty of Management and Economics, Gdańsk University of Technology, Poland
| | - Edyta Szurowska
- Department of Radiology, Medical University of Gdańsk, Poland
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Resistance to oral antibiotics in 4569 Gram-negative rods isolated from urinary tract infection in children. Eur J Pediatr 2016; 175:1219-1225. [PMID: 27558493 DOI: 10.1007/s00431-016-2763-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/27/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED To investigate antibiotic resistance among pathogens isolated from urines in a tertiary care children's hospital in Italy. Retrospective analysis of prospectively collected data on antibiotic susceptibility of Gram-negatives isolated from urines at the Istituto Giannina Gaslini, Genoa - Italy from 2007 to 2014. Antibiotic susceptibility was evaluated. By means of CLSI criteria from 2007 to 2010, while from 2011 EUCAST criteria were adopted. Data on susceptibility to amoxicillin-clavulanate, co-trimoxazole, cefuroxime, nitrofurantoin, fosfomycin and ciprofloxacin were evaluated for Escherichia coli, while for other Enterobacteriaceae data were collected for amoxicillin-clavulanate, co-trimoxazole and ciprofloxacin and for ciprofloxacin against Pseudomonas aeruginosa. Univariate and multivariable analyses were performed for risk factors associated with resistance. A total of 4596 Gram-negative strains were observed in 3364 patients. A significant increase in the proportion of resistant strains was observed for E.coli against amoxicillin-clavulanate, cefuroxime and ciprofloxacin and for others Enterobacteriaceae against co-trimoxazole and ciprofloxacin. Resistance to nitrofurantoin and fosfomycin was very infrequent in E.coli. Logistic regression analysis showed that repeated episode of urinary tract infections was a risk factor for E.coli resistance to amoxicillin-clavulanate, co-trimoxazole and cefuroxime, while admission in one of the Units usually managing children with urinary tract malformations was significantly associated to resistance to amoxicillin-clavulanate and cefuroxime. CONCLUSION In conclusion the present study shows an increase in antibiotic resistance in pediatric bacteria isolated from urines in children, especially in presence of repeated episodes and/or urinary tract malformations. This resistance is worrisome for beta-lactams and cotrimoxazole, and start to increase also for fluoroquinolones while nitrofurantoin and fosfomycin still could represent useful drugs for oral treatment of these infections. WHAT IS KNOWN • Infections are frequent in patients with urinary tract malformations • Antibiotic prophylaxis can select for resistant pathogens What is New: • The increase in the resistance to β-lactams, co-trimoxazole or fluoroquinolones in pathogens causing urinary tract infections cause a reduction of drugs with oral formulations available for therapy • Old drugs like nitrofurantoin and fosfomycin can represent attractive compounds for oral treatment of urinary tract infections in children presence of resistance to other drug classes.
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Elahi S, Homstad A, Vaidya H, Stout J, Hall G, Wu G, Conlon P, Routh JC, Wiener JS, Ross SS, Nagaraj S, Wigfall D, Foreman J, Adeyemo A, Gupta IR, Brophy PD, Rabinovich CE, Gbadegesin RA. Rare variants in tenascin genes in a cohort of children with primary vesicoureteric reflux. Pediatr Nephrol 2016; 31:247-53. [PMID: 26408188 PMCID: PMC4747108 DOI: 10.1007/s00467-015-3203-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/10/2015] [Accepted: 08/26/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary vesicoureteral reflux (PVUR) is the most common malformation of the kidney and urinary tract, and reflux nephropathy is a major cause of chronic kidney disease in children. Recently, we reported mutations in the tenascin XB gene (TNXB) as a cause of PVUR with joint hypermobility. METHODS To define the role of rare variants in tenascin genes in the etiology of PVUR, we screened a cohort of patients with familial PVUR (FPVUR) and non-familial PVUR (NFPVUR) for rare missense variants inTNXB and the tenascin C gene (TNC) after excluding mutations in ROBO2 and SOX17. RESULTS The screening procedure identified 134 individuals from 112 families with PVUR; two families with mutations in ROBO2 were excluded from further analysis. Rare missense variants in TNXB were found in the remaining 110 families, of which 5/55 (9%) families had FPVUR and 2/55 (4%) had NFPVUR. There were no differences in high-grade reflux or renal parenchymal scarring between patients with and without TNXB variants. All patients with TNXB rare variants who were tested exhibited joint hypermobility. Overall we were able to identify causes of FPVUR in 7/57 (12%) families (9% in TNXB and 3% in ROBO2). CONCLUSIONS In conclusion, the identification of a rare missense variant in TNXB in combination with a positive family history of VUR and joint hypermobility may represent a non-invasive method to diagnose PVUR and warrants further evaluation in other cohorts.
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Affiliation(s)
- Shan Elahi
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Alison Homstad
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Duke Molecular Physiology Institute, Durham, NC
| | - Himani Vaidya
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Duke Molecular Physiology Institute, Durham, NC
| | - Jennifer Stout
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Gentzon Hall
- Duke Molecular Physiology Institute, Durham, NC
,Department of Medicine, Duke University Medical Center, Durham, NC
| | - Guanghong Wu
- Duke Molecular Physiology Institute, Durham, NC
,Department of Medicine, Duke University Medical Center, Durham, NC
| | - Peter Conlon
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Jonathan C. Routh
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
| | - John S. Wiener
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
| | - Sherry S. Ross
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
,Department of Urology, Pediatric Urology, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC
| | - Shashi Nagaraj
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Delbert Wigfall
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - John Foreman
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-5635, USA
| | - Indra R. Gupta
- Department of Pediatrics and Human Genetics, McGill University, Montreal, Quebec, Canada
| | | | | | - Rasheed A. Gbadegesin
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Duke Molecular Physiology Institute, Durham, NC
,To whom correspondence should be addressed:
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Abstract
Vesicoureteric reflux is defined as the retrograde passage of urine from the bladder into one or both ureters and often up to the kidneys, and mainly affects babies and infants. In severe cases dilatation of the ureter, renal pelvis, and calyces might be seen. Traditionally it was thought that only a low percentage of children have vesicoureteric reflux, but studies have suggested as many as 25-40% are affected. Guidelines recommend that the number of investigations for vesicoureteric reflux in children who have had a febrile urinary tract infection be reduced, but this approach is controversial. The recommendations also suggest that prophylactic antibiotics and surgery should be avoided in children with non-severe vesicoureteric reflux. In this Seminar I present data on the management of children with vesicoureteric reflux and give suggestions on how to navigate this difficult area.
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Affiliation(s)
- Kjell Tullus
- Department of Nephrology, Great Ormond Street Hospital for Children, London, UK.
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Awais M, Rehman A, Zaman MU, Nadeem N. Recurrent urinary tract infections in young children: role of DMSA scintigraphy in detecting vesicoureteric reflux. Pediatr Radiol 2015; 45:62-8. [PMID: 24993242 DOI: 10.1007/s00247-014-3062-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 04/29/2014] [Accepted: 05/21/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Performing micturiting cystourethrography (MCUG) in young children with recurrent urinary tract infections is controversial with discrepancy among the major guidelines. OBJECTIVE Previous studies have shown that a normal dimercaptosuccinic acid (DMSA) scintigraphy may avoid the need of performing MCUG for detecting vesicoureteric reflux in children with first febrile urinary tract infection. However, the role of DMSA for ruling out vesicoureteric reflux in children with recurrent urinary tract infections has not been studied. MATERIALS AND METHODS Approval from institutional ethical review committee was sought and the requirement of informed consent was waived. A total of 50 children under the age of 10 years with recurrent urinary tract infections underwent MCUG scan within 3 months of DMSA scan from January 2011 to September 2012 at our institution. Diagnosis of recurrent urinary tract infections and grading of vesicoureteric reflux was according to previously established standards. Abnormalities on DMSA scan - scarring, hydronephrosis and reduced differential renal function - were compared with presence of vesicoureteric reflux on MCUG. RESULTS High-grade vesicoureteric reflux was noted on MCUG in 22 (44%) cases. The findings on DMSA included hydronephrosis and scarring in 25 (50%) and 25 (50%) cases, respectively. Abnormalities on DMSA scan for detecting the presence of high-grade vesicoureteric reflux on MCUG examination had sensitivity, specificity, positive and negative predictive values of 95.45%, 35.71%, 53.85% and 90.91%, respectively. The positive and negative likelihood ratios were 1.48 and 0.13 respectively. CONCLUSION DMSA scan had high overall sensitivity and negative predictive value with a low negative likelihood ratio for ruling out high-grade vesicoureteric reflux on MCUG, which may obviate the need of invasive MCUG along with its associated drawbacks.
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Affiliation(s)
- Muhammad Awais
- Department of Radiology, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan,
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Lee JS, Koo BI, Shin MJ, Chang JH, Kim SY, Ko HY. Differences in urodynamic variables for vesicoureteral reflux depending on the neurogenic bladder type. Ann Rehabil Med 2014; 38:347-52. [PMID: 25024958 PMCID: PMC4092175 DOI: 10.5535/arm.2014.38.3.347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/14/2014] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the urodynamic study variables at the onset of vesicoureteral reflux (VUR) between the overactive and underactive bladders in patients with spinal cord injury who presented with VUR. Methods A total of 28 (13 cases of detrusor overactivity and 15 detrusor underactivity) men were enrolled. We compared the urodynamic variables between the two groups; detrusor pressure and bladder compliance, the infused volume at the onset of VUR measured on a voiding cystourethrography and cystometric capacity, maximum detrusor pressure, and bladder compliance during filling cystometry were recorded. Results At the onset of VUR, the bladder volume and compliance, except for the detrusor pressure, showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance relative to the cystometric capacity showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance at the onset of VUR relative to the cystometric bladder capacity did not show any significant difference between the two groups. Conclusion There were differences in some variables at the onset of VUR depending on the type of neurogenic bladder. The VUR occurred at a lower capacity in neurogenic bladder with detrusor overactivity than in neurogenic bladder with detrusor underactivity at the same pressure. VUR occurred at a lower intravesical pressure compared to that known as the critical detrusor pressure (≥40 cm H2O) required for the development of VUR. The results of our study demonstrate that the detrusor pressure should be maintained lower than the well known effective critical detrusor pressure for the prevention and treatment of VUR.
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Affiliation(s)
- Je Sang Lee
- Division of Spinal Cord Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Medical Research Institute, Pusan National University, Busan, Korea
| | - Bon Il Koo
- Division of Spinal Cord Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Myung Jun Shin
- Division of Spinal Cord Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Medical Research Institute, Pusan National University, Busan, Korea
| | - Jae Hyeok Chang
- Division of Spinal Cord Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Medical Research Institute, Pusan National University, Busan, Korea
| | - Soo-Yeon Kim
- Division of Spinal Cord Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-Yoon Ko
- Division of Spinal Cord Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Korea. ; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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The role of genetic polymorphisms of the Renin-Angiotensin System in renal diseases: A meta-analysis. Comput Struct Biotechnol J 2014; 10:1-7. [PMID: 25210592 PMCID: PMC4151998 DOI: 10.1016/j.csbj.2014.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Renal failure has a complex phenotype resulting from an underlying kidney disease as well as environmental and genetic factors. In the present study we performed a systematic review and meta-analyses to evaluate the association of the A1166C polymorphism of Angiotensin II type 1 Receptor gene (AGTR1) with Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD), IgA Nephropathy (IgAN) and Vesicoureteral Reflux (VUR) as well as the association of A1332G polymorphism of Angiotensin II type 2 Receptor (AGTR2) gene with Vesicoureteral Reflux (VUR). We found that neither AGTR1 Α1166C, nor AGTR2 A1332G polymorphisms were significantly associated with any of the aforementioned renal diseases, suggesting that they cannot be used as predictive markers in either general or subgroup ethnic populations.
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Moradi M, Diamond D. Summary of recent AUA guidelines for the management of vesicoureteral reflux in children. AFRICAN JOURNAL OF UROLOGY 2013. [DOI: 10.1016/j.afju.2013.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Koçyiğit A, Bayram R, Yüksel S, Yılmaz I, Karabulut N. Diffusion weighted magnetic resonance imaging of kidneys in children with vesicoureteral reflux. Eur J Radiol 2013; 83:e56-60. [PMID: 24161782 DOI: 10.1016/j.ejrad.2013.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/25/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The apparent diffusion coefficient (ADC) which obtain from diffusion-weighted magnetic resonance imaging (DWI), is a quantitative parameter representing the renal function and parenchymal damage in some renal disorders. The primary aim of this study was to investigate whether renal tissue alterations associated with vesicoureteral reflux (VUR) can be displayed by DWI. The secondary aim was to assess how ADC values change with age in kidneys with and without VUR. MATERIALS AND METHODS This prospective study included 46 patients (8 boys, 38 girls; mean age 7.3 ± 4.2; range 1-15 years) with VUR and 54 control subjects (21 boys, 33 girls; mean age 7.7 ± 5.2; range 1-17 years). All subjects underwent DWI of the kidneys using b value of 600s/mm(2) in addition to MR urography. The ADC values of 71 kidneys with VUR were compared with those of 81 kidneys without VUR. RESULTS The mean ADC values were (1.93 ± 0.36)×10(-3)mm(2)/s, (1.97 ± 0.24)× 10(-3)mm(2)/s, (1.83 ± 0.37)× 10(-3)mm(2)/s, (1.98 ± 0.20)×10(-3)mm(2)/s and (2.08 ± 0.42)× 10(-3)mm(2)/s in normal kidneys, and in those with grade 1, grade 2, grade 3 and grade 4 VUR, respectively. There was no significant difference in ADC values between kidneys with and without VUR. There was a significant positive correlation between the age and ADC values both in kidneys with and without VUR (r=0.79, p<0.001 and r=0.82; p<0.001, respectively). CONCLUSION DWI does not reveal probable parenchymal alterations in reflux nephropathy. ADC values increase with age during childhood not only in normal kidneys but also in kidneys with VUR.
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Affiliation(s)
- Ali Koçyiğit
- Pamukkale University Faculty of Medicine, Department of Radiology, Denizli, Turkey.
| | - Recep Bayram
- Pamukkale University Faculty of Medicine, Department of Radiology, Denizli, Turkey
| | - Selçuk Yüksel
- Pamukkale University Faculty of Medicine, Department of Pediatric Nephrology, Denizli, Turkey
| | - Ismail Yılmaz
- Pamukkale University Faculty of Medicine, Department of Radiology, Denizli, Turkey
| | - Nevzat Karabulut
- Pamukkale University Faculty of Medicine, Department of Radiology, Denizli, Turkey
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Ellsworth P. Evaluation of a process-of-care model for open intravesical ureteral reimplantation in children from a contemporary health care perspective. Hosp Pract (1995) 2013; 41:24-30. [PMID: 24145586 DOI: 10.3810/hp.2013.10.1077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Surgical management of patients with vesicoureteral reflux consists of both open and minimally invasive approaches. Open approaches are associated with postoperative hospitalization and stays of 2 to 3 days, dependent on the type of procedure; alternately, when endoscopic correction is performed, it is a same-day procedure. Changes in health care policy emphasize reduction in cost while maintaining and improving quality of care. We sought to evaluate the impact of a "1-night cost-saving process-of-care" model for open surgical correction of vesicoureteral reflux in children on quality of care, which was defined as a return to the emergency room (ER)/office or readmission to the hospital within 2 days of discharge. MATERIALS AND METHODS An institutional review board-approved retrospective chart review of all open ureteral reimplantations for uncomplicated vesicoureteral reflux from January 2009 through January 2013 was performed. Children who underwent ureteral stent placement and those who did not have a caudal anesthetic were excluded from the study. Length of postoperative stay, ER records, hospitalizations, and office records were reviewed to assess for presentation to the ER/office or readmission to the hospital within 2 days of discharge. RESULTS During the 4-year study period, 92 children (23 males, 69 females) underwent open ureteral reimplantation-there were 83 (89.1%) discharges on the first postoperative day; 9 (9.8%) on the second postoperative day; and 1 (1.1%) on the third postoperative day. One patient presented to the ER within 2 days of discharge, and 4 patients presented to the ER/office or were readmitted > 2 days after discharge. CONCLUSION Use of a caudal anesthetic, earlier catheter removal, a knowledgeable nursing team, and parental education allowed us to decrease the length of stay to 1 night in 82 of 92 patients (89.1%). These procedural changes allowed for a decrease in hospital stay comparable with and potentially shorter than robotic-assisted laparoscopic approaches. Additionally, these changes did not seem to increase the risk of early (≤ 2 days of discharge) presentation to the ER/office or readmission.
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Affiliation(s)
- Pamela Ellsworth
- Professor of Urology/Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI.
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The association of cytokine gene polymorphism with reflux nephropathy. J Pediatr Urol 2013; 9:653-8. [PMID: 22906585 DOI: 10.1016/j.jpurol.2012.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/13/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify genetic risk factors for the progression of vesicoureteral reflux (VUR) to reflux nephropathy, we examined polymorphisms of multiple cytokine genes among VUR patients with or without renal scarring. METHODS A total of 238 VUR patients aged between 1 and 18 years with (n = 113) or without renal scarring (n = 125) were included. The presence of renal scarring was demonstrated by renal parenchymal examination using Technetium-99m dimercaptosuccinate scintigraphy. Sera of the patients were examined for tumor necrosis factor-alpha (TNF-α, -308), transforming growth factor-beta1 (TGF-β1, +869, +915), interleukin-6 (IL-6, -174), interleukin-10 (IL-10, -1082, -819, -592) and interferon-gamma (IFN-γ, +874) gene polymorphisms using the polymerase chain reaction sequence-specific primer method. RESULTS Among patients with renal scarring, frequencies for the T/T G/C and C/C G/C genotypes of TGF-β1 gene (p = 0.003), GCC/GCC genotype of IL-10 gene (p = 0.015), GC phenotype of IL-6 gene (p = 0.001) and T/T genotype of IFN-γ gene (p = 0.001) were higher compared to patients without renal scarring. Regarding the TNF-α gene, among patients with low grade VUR only, the G/G genotype was associated with an increased risk. CONCLUSIONS Certain genotypes of cytokine gene polymorphisms seem to be associated with an increased or decreased susceptibility to reflux nephropathy, which may explain why only a proportion of VUR patients progress to reflux nephropathy. This information may aid in prediction of prognosis and implementing more aggressive management strategies at earlier stages. Further immunogenetic studies may identify novel targets for the management and prevention of the condition.
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Gbadegesin RA, Brophy PD, Adeyemo A, Hall G, Gupta IR, Hains D, Bartkowiak B, Rabinovich CE, Chandrasekharappa S, Homstad A, Westreich K, Wu G, Liu Y, Holanda D, Clarke J, Lavin P, Selim A, Miller S, Wiener JS, Ross SS, Foreman J, Rotimi C, Winn MP. TNXB mutations can cause vesicoureteral reflux. J Am Soc Nephrol 2013; 24:1313-22. [PMID: 23620400 DOI: 10.1681/asn.2012121148] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Primary vesicoureteral reflux (VUR) is the most common congenital anomaly of the kidney and the urinary tract, and it is a major risk factor for pyelonephritic scarring and CKD in children. Although twin studies support the heritability of VUR, specific genetic causes remain elusive. We performed a sequential genome-wide linkage study and whole-exome sequencing in a family with hereditary VUR. We obtained a significant multipoint parametric logarithm of odds score of 3.3 on chromosome 6p, and whole-exome sequencing identified a deleterious heterozygous mutation (T3257I) in the gene encoding tenascin XB (TNXB in 6p21.3). This mutation segregated with disease in the affected family as well as with a pathogenic G1331R change in another family. Fibroblast cell lines carrying the T3257I mutation exhibited a reduction in both cell motility and phosphorylated focal adhesion kinase expression, suggesting a defect in the focal adhesions that link the cell cytoplasm to the extracellular matrix. Immunohistochemical studies revealed that the human uroepithelial lining of the ureterovesical junction expresses TNXB, suggesting that TNXB may be important for generating tensile forces that close the ureterovesical junction during voiding. Taken together, these results suggest that mutations in TNXB can cause hereditary VUR.
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Different imaging strategies in febrile urinary tract infection in childhood. What, when, why? Pediatr Radiol 2013; 43:436-43. [PMID: 23525769 DOI: 10.1007/s00247-012-2469-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/25/2012] [Accepted: 07/09/2012] [Indexed: 10/27/2022]
Abstract
Urinary tract infections (UTIs) are a common problem in childhood. During the last decade, published papers led to a deep revision in the use and usefulness of imaging tools in children with febrile UTIs. This new body of knowledge was partially endorsed by the guidelines published in 2007 by the UK's National Institute for Clinical Excellence and in 2011 by the American Academy of Pediatrics. Nevertheless, new data continuously arise and the scientific debate always revives. Recommendations of published guidelines and strengths and weaknesses of the available biochemical and imaging tools are here critically analysed for giving to the reader a complete, up-to-date and flexible overview on this hot topic.
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Preventing Urinary Tract Infections in Early Childhood. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 764:211-8. [DOI: 10.1007/978-1-4614-4726-9_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Prenatal ultrasound is an integral part of caring for pregnant women in the United States. Although surprisingly few data exist to support the clinical benefit of screening ultrasound during pregnancy, its use continues to rise. Urologic anomalies are among the most commonly identified, with overall detection sensitivity approaching 90%. Prenatal hydronephrosis is the most frequently identified finding and predicting postnatal pathology based on its presence can be difficult. As the degree of fetal hydronephrosis increases so does the risk of true urinary tract pathology. Diagnoses that require more urgent care include causes of lower urinary tract obstruction and bladder and cloacal exstrophy.
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Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urology, Vanderbilt University, Nashville, TN 37232, USA.
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Vasdev N, Coulthard MG, Lambert H, Keir M, Wyrley-Birch H, Rix D, Soomro N, Talbot D. The modified Barry technique to prevent vesicoureteric reflux in paediatric renal transplant recipients: initial recipient outcomes. J Pediatr Urol 2012; 8:97-102. [PMID: 21115401 DOI: 10.1016/j.jpurol.2010.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 10/01/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We present the initial clinical results of the 'modified Barry technique' for the prevention of VUR in paediatric renal transplant grafts. Ours is the only centre in the UK using this technique, as confirmed in a questionnaire developed in our department. PATIENTS AND METHODS We retrospectively analysed data of 15 paediatric renal transplant patients (operated June 2006-November 2009) who had their vesicoureteric anastomosis performed using the modified Barry technique with a 2-cm submucosal anti-reflux tunnel. The original Barry technique involved the creation of a 4-cm tunnel; this was modified by us to reduce the risk of ureteric stenosis. RESULTS At a median follow up of 23.7 months (6.3-39.4), the incidence of VUR was 7% (1/15). There was no evidence of postoperative urological complications, such as urinary leak, primary ureteric obstruction including anastomotic stricture/stenosis, transplant graft renal calculi and chronic rejection. At current follow up, graft and patient survival are 100%. CONCLUSION With the introduction of the modified Barry technique, the incidence of VUR in our series fell 10-fold to 7%, compared with our earlier study (P<0.0001), without any urological complications. Although the initial results are encouraging, larger patient numbers and longer follow up are required to validate this technique further.
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Affiliation(s)
- Nikhil Vasdev
- Department of Renal Transplant, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK.
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Boubnova J, Sergent-Alaoui A, Deschênes G, Audry G. Evolution and prognosis value of intrarenal reflux. J Pediatr Urol 2011; 7:638-43. [PMID: 20951095 DOI: 10.1016/j.jpurol.2010.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 09/27/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to evaluate the prognostic significance of intrarenal reflux (IRR) regarding urinary tract infection (UTI), renal scarring and spontaneous resolution after 3 years of follow up. PATIENTS AND METHODS 33 patients (42 refluxing units) with IRR were compared to 27 children (44 refluxing units) with high-grade vesicoureteral reflux (VUR) without IRR (controls) matched for gender, age and VUR grade. All patients received antibiotic prophylaxis during observation and antireflux surgery was performed in children with recurrent UTI. DMSA scan was performed at study entry, and 18 and 36 months. RESULTS DMSA scores at entry showed a higher proportion of moderate and severe damage in the IRR group (25/42) compared to the control group (16/44) (Chi squared, P < 0.03). During follow up the incidence of UTI was similar in the two groups, as well as the stability of DMSA scintigraphy and the rate of spontaneous disappearance of the reflux. A similar proportion of patients underwent surgery (18/33 patients with IRR and 13/27 control patients; Chi squared, not significant). CONCLUSIONS Under medical management, the prognosis for IRR is not different from high-grade VUR without IRR. The presence of IRR does not justify more aggressive management than a high-grade VUR without IRR.
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Affiliation(s)
- J Boubnova
- Armand-Trousseau Children's Hospital, Pediatric Surgery Department, 26, av. du Dr Arnold Netter, 75012 Paris, France.
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Fox JA, McGee SM, Routh JC, Granberg CF, Ashley RA, Hutcheson JC, Vandersteen DR, Reinberg YE, Kramer SA. Vesicoureteral reflux in children with urachal anomalies. J Pediatr Urol 2011; 7:632-5. [PMID: 21565560 DOI: 10.1016/j.jpurol.2011.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 04/15/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We report the largest known series of vesicoureteral reflux (VUR) in children with urachal anomalies (UA). METHODS Two institutions' records were reviewed for children with UA (1951‒2007). RESULTS Of 30 girls and 36 boys with UA (34 urachal cysts, 14 patent urachus, 10 urachal diverticula, 7 urachal sinuses, and 1 unknown), 57 (86%) underwent surgical resection or drainage. A voiding cystourethrogram was obtained in 22 (33%). VUR was demonstrated in 14 of the 22 children (64%), and rates were similar among the various types of UA. The median age with versus without VUR was not different (1.3 vs 1.7 years, P=0.97). Of 24 refluxing renal units, classification was grade≤3 in 71%, 4‒5 in 12%, and unspecified in 17%. Four children (26%) underwent ureteroneocystostomy and 10 observed patients resolved spontaneously. CONCLUSION To our knowledge, this is the first series of VUR associated with UA. The increased incidence of VUR (64%) in this small subset of patients warrants prospective studies to determine if there is a positive correlation with UA. We believe thorough genitourinary and family histories are important when evaluating children with UA to help detect clinically significant VUR.
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Affiliation(s)
- Janelle A Fox
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
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Khalil BA, Goyal A, Dickson AP. Surgical intervention in children with vesicoureteric reflux: are we intervening too late? Pediatr Surg Int 2010; 26:729-31. [PMID: 20512344 DOI: 10.1007/s00383-010-2621-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vesicoureteric reflux is usually managed medically. When medical management fails, the patient is referred for surgical intervention. The aim is to protect the kidneys from progressive damage. This study investigates if significant kidney damage has occurred during medical treatment prior to surgical intervention. MATERIALS AND METHODS Case notes of all children treated with ureteric re-implantation for vesicoureteric reflux in a 5-year period were reviewed. Demographic details, radiological investigations, surgery and follow-up were recorded. Indication for surgery was failure of medical treatment. Kidney damage was defined as the presence of a scar on the DMSA scans and/or kidney function below 45% in one kidney. RESULTS Forty-two patients underwent ureteric re-implantation with 24 having a bilateral procedure resulting in a total of 66 renal units. Mean age at surgery was 7.4 years. Thirty-eight kidneys (58%) showed reduced function prior to medical treatment. Twenty-four kidneys (36%) had deterioration of renal function associated with recurrent urinary tract infections during the course of medical treatment with the overall mean function of the worst affected kidney being 28%. Thirty-five patients (83%) demonstrated scarring on their kidneys on DMSA scan prior to surgery. CONCLUSIONS More than half of patients who eventually need ureteric re-implantation for vesicoureteric reflux have already suffered kidney damage prior to start of medical treatment. A third will have progressive deterioration of their renal functions. Early referral for medical management coupled with early surgical intervention in selected cases should hopefully reduce the number of children with renal damage due to VUR.
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Affiliation(s)
- Basem A Khalil
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, M27 4HA, UK
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Kljucevsek D, Kljucevsek T, Kersnik Levart T, Novljan G, Kenda RB. Catheter-free methods for vesicoureteric reflux detection: our experience and a critical appraisal of existing data. Pediatr Nephrol 2010; 25:1201-6. [PMID: 20069314 DOI: 10.1007/s00467-009-1391-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 10/29/2009] [Accepted: 11/05/2009] [Indexed: 11/26/2022]
Abstract
In recent years, the exact role of vesicoureteric reflux (VUR) in general has become controversial, though in some groups of children the knowledge of the existence or non-existence of VUR is still a very important issue. The number of techniques available for the assessment of VUR is increasing, and a new classification taking into account their real characteristics (direct/indirect, catheter-using/catheter-free, radiation-giving/radiation-free) has been proposed. The purpose of the following review is to evaluate the currently available evidence supporting the use of various catheter-free methods for VUR detection. We believe that as the clinical role of VUR has been questioned, it is even more important for the method of its detection to be user-friendly as regards catheterisation, radiation and availability. There is still no evidence supporting the assertion that any of the catheter-free methods of VUR detection might be the optimal one for any child. However, there are some groups of children who would benefit from using them. New studies using new, catheter-free methods of VUR detection or a combination of two or more of the methods described may prove useful in improving sensitivity and providing additional data on this important issue.
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Affiliation(s)
- Damjana Kljucevsek
- Paediatric Radiology Unit, University Medical Centre, Bohoriceva 20, 1000, Ljubljana, Slovenia.
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Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, McTaggart SJ, Hodson EM, Carapetis JR, Cranswick NE, Smith G, Irwig LM, Caldwell PHY, Hamilton S, Roy LP. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 2009; 361:1748-59. [PMID: 19864673 DOI: 10.1056/nejmoa0902295] [Citation(s) in RCA: 262] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antibiotics are widely administered to children with the intention of preventing urinary tract infection, but adequately powered, placebo-controlled trials regarding efficacy are lacking. This study from four Australian centers examined whether low-dose, continuous oral antibiotic therapy prevents urinary tract infection in predisposed children. METHODS We randomly assigned children under the age of 18 years who had had one or more microbiologically proven urinary tract infections to receive either daily trimethoprim-sulfamethoxazole suspension (as 2 mg of trimethoprim plus 10 mg of sulfamethoxazole per kilogram of body weight) or placebo for 12 months. The primary outcome was microbiologically confirmed symptomatic urinary tract infection. Intention-to-treat analyses were performed with the use of time-to-event data. RESULTS From December 1998 to March 2007, a total of 576 children (of 780 planned) underwent randomization. The median age at entry was 14 months; 64% of the patients were girls, 42% had known vesicoureteral reflux (at least grade III in 53% of these patients), and 71% were enrolled after the first diagnosis of urinary tract infection. During the study, urinary tract infection developed in 36 of 288 patients (13%) in the group receiving trimethoprim-sulfamethoxazole (antibiotic group) and in 55 of 288 patients (19%) in the placebo group (hazard ratio in the antibiotic group, 0.61; 95% confidence interval, 0.40 to 0.93; P = 0.02 by the log-rank test). In the antibiotic group, the reduction in the absolute risk of urinary tract infection (6 percentage points) appeared to be consistent across all subgroups of patients (P > or = 0.20 for all interactions). CONCLUSIONS Long-term, low-dose trimethoprim-sulfamethoxazole was associated with a decreased number of urinary tract infections in predisposed children. The treatment effect appeared to be consistent but modest across subgroups. (Australian New Zealand Clinical Trials Registry number, ACTRN12608000470392.)
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Affiliation(s)
- Jonathan C Craig
- Screening and Test Evaluation Program and the School of Public Health, University of Sydney, Sydney, NSW, Australia
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ANANTASIT NATTACHAI, DISSANEEWATE PORNSAK, MCNEIL EDWARD, VACHVANICHSANONG PRAYONG. Is a repeat urine culture useful during antibiotic therapy for febrile urinary tract infection? Nephrology (Carlton) 2009; 14:675-80. [DOI: 10.1111/j.1440-1797.2009.01126.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sensitivity of ultrasonography in detecting renal parenchymal defects: 6 years' follow-up. Pediatr Nephrol 2009; 24:1193-7. [PMID: 19184119 DOI: 10.1007/s00467-008-1099-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 11/25/2008] [Accepted: 11/27/2008] [Indexed: 10/21/2022]
Abstract
While (99m)Tc-dimercaptosuccinic acid (DMSA) scanning is still considered the most accurate method for the assessment of renal parenchymal defects (RPDs), our study 6 years previously suggested that ultrasonography (US) could be a safe and efficient substitute for this purpose, provided that it is reliably performed and that renal function parameters are followed. By comparison of the original and follow-up study data from 67 children, the accuracy of our recommendations was re-evaluated. US was performed and renal function parameters investigated and correlated to the DMSA scans from the original study. US identified all six patients with clinically significant RPD and 52/61 with clinically insignificant RPDs, seen on the DMSA scans. Twenty two out of 22 severe RPDs, 21/23 moderate RPDs and 20/40 mild RPDs seen on the DMSA scans were detected by US. In ten cases normal US findings from the original study were rendered abnormal, correlating well with the DMSA scans with respect to RPD localization and kidney size. These results further support our previous suggestion that US is a safe and harmless alternative to DMSA scanning in the detection and follow-up of RPDs. While it cannot be excluded that small RPDs missed on the initial US might 'develop' clinical significance in later life, children with normal findings on initial US should have another sonogram done, at the shortest a year later, together with an investigation of renal function parameters.
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Simforoosh N, Hariri H. Management of vesicoureteral reflux without indwelling catheter and drain, using trigonoplasty technique. J Pediatr Urol 2008; 4:445-7. [PMID: 18678530 DOI: 10.1016/j.jpurol.2008.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 06/17/2008] [Indexed: 11/17/2022]
Abstract
PURPOSE Gil-Vernet trigonoplasty is a simple, fast and effective technique for treating primary VUR, and is the only technique used to manage unilateral reflux that does not result in contralateral new reflux, due to its inherent bilateral nature. We have tried to further simplify postoperative management of the procedure by eliminating the use of an indwelling urethral catheter and drain. PATIENTS AND METHODS In a prospective study during a 15-month period, 65 children with 103 refluxing units (56 girls, nine boys), aged 1-15 years, underwent the designed surgery. RESULTS Preoperative voiding cystourethrogram revealed bilateral reflux in 38 and unilateral reflux in 27 children. Of 130 renal units, 103 were associated with reflux grade I, II, III, IV and V in 8.73%, 24.27%, 35.92%, 30.9% and 0.9% units, respectively. Of 103 refluxing units, 97 units had stopped refluxing on cystogram 3 months after surgery, giving the overall success rate of 94.1% for all grades of reflux included in the study. Only 7.6% of the children needed urethral catheterization after surgery. No ureteral obstruction occurred. Two patients developed urinary extravasation, both managed conservatively. No patient needed reoperation. The procedure was done on an outpatient basis in 40% of cases, while 60% of the children were hospitalized with a mean admission time of 3.4 days. CONCLUSION The Gil-Vernet trigonoplasty technique is simple, safe and effective. Our study further simplified postoperative management by avoiding an indwelling catheter and drain. Also, we have shown that this can be done as an outpatient procedure.
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Affiliation(s)
- Nasser Simforoosh
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University (M.C.), Tehran, Iran.
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Riccabona M, Pilhatsch A, Haberlik A, Ring E. Three-dimensional ultrasonography-based virtual cystoscopy of the pediatric urinary bladder: a preliminary report on feasibility and potential value. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1453-1459. [PMID: 18809955 DOI: 10.7863/jum.2008.27.10.1453] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of this study was to validate the feasibility and potential of 3-dimensional ultrasonography (3DUS)-based virtual cystoscopy in the pediatric urinary bladder. METHODS Twenty patients (age range, newborn-14 years) underwent urinary tract ultrasonography and 3DUS of the urinary bladder. From this data set, virtual cystoscopy was reconstructed for visualization of the inner bladder surface. Three-dimensional ultrasonography was compared with 2-dimensional ultrasonographic (2DUS) findings, voiding cystourethrography (VCUG) results, and reports from cystoscopy or surgery when available. RESULTS Three-dimensional ultrasonography was feasible in all patients. Data quality was sufficient for virtual cystoscopy without major motion artifacts. The 3DUS results matched all other findings; particularly, 3DUS superiorly visualized the ureteral ostium and the bladder neck configuration; in 5 patients, 3DUS depicted pathologically shaped ostia not detected by 2DUS. This correlated with the presence of vesicoureteral reflux on VCUG. Performing virtual cystoscopy added 1 minute to the investigation time (range, 0.5-2 minutes) and 3 minutes for postprocessing and viewing (range, 2-5 minutes). CONCLUSIONS Three-dimensional ultrasonography-based virtual cystoscopy is feasible in the pediatric urinary bladder without sedation. It reveals surface information not accessible by 2DUS, improving detection of pathologic conditions such as atypically shaped ureteral ostia. Three-dimensional ultrasonography-based cystoscopy may become a valuable adjunct to 2DUS of the pediatric urinary tract, improving selection criteria for further imaging such as VCUG, and potentially may help reduce the need for endoscopic cystoscopy. However, these preliminary results still have to be confirmed in prospective studies with larger patient numbers.
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Affiliation(s)
- Michael Riccabona
- Department of Radiology, Division of Pediatric Radiology, University Hospital LKH Graz, Auenbruggerplatz, A-8036 Graz, Austria.
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The relationship between urinary tract infections and vesicoureteral reflux in Turkish children. Int Urol Nephrol 2008; 41:947-51. [DOI: 10.1007/s11255-008-9420-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Accepted: 06/23/2008] [Indexed: 12/29/2022]
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Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, Minisini S, Ventura A. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 2008; 121:e1489-94. [PMID: 18490378 DOI: 10.1542/peds.2007-2652] [Citation(s) in RCA: 213] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES There has been intense discussion on the effectiveness of continuous antibiotic prophylaxis for children with vesicoureteral reflux, and randomized, controlled trials are still needed to determine the effectiveness of long-term antibiotics for the prevention of acute pyelonephritis. In this multicenter, open-label, randomized, controlled trial, we tested the effectiveness of antibiotic prophylaxis in preventing recurrence of pyelonephritis and avoiding new scars in a sample of children who were younger than 30 months and vesicoureteral reflux. METHODS One hundred patients with vesicoureteral reflux (grade II, III, or IV) diagnosed with cystourethrography after a first episode of acute pyelonephritis were randomly assigned to receive antibiotic prophylaxis with sulfamethoxazole/trimethoprim or not for 2 years. The main outcome of the study was the recurrence of pyelonephritis during a follow-up period of 4 years. During follow-up, the patients were evaluated through repeated cystourethrographies, renal ultrasounds, and dimercaptosuccinic acid scans. RESULTS The baseline characteristics in the 2 study groups were similar. There were no differences in the risk for having at least 1 pyelonephritis episode between the intervention and control groups. At the end of follow-up, the presence of renal scars was the same in children with and without antibiotic prophylaxis. CONCLUSIONS Continuous antibiotic prophylaxis was ineffective in reducing the rate of pyelonephritis recurrence and the incidence of renal damage in children who were younger than 30 months and had vesicoureteral reflux grades II through IV.
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Affiliation(s)
- Marco Pennesi
- Clinica Pediatrica, Istituto per l'Infanzia IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34100 Trieste, Italy.
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