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Alavi-Dunn N, Waisanen KM, Marrara JA, Zawerton A, Monteiro A, Saade K, Young E. Renal-Protective Urinoma Formation in a Newborn Boy With Posterior Urethral Valves. Cureus 2023; 15:e39880. [PMID: 37404433 PMCID: PMC10315171 DOI: 10.7759/cureus.39880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Posterior urethral valves (PUV) are an uncommon urologic congenital anomaly in males often discovered antenatally and more rarely after birth. PUV can lead to obstructive nephropathy and voiding dysfunction, putting patients at increased risk for irreversible renal damage and subsequent progression to end-stage renal disease. Much of the renal damage caused by PUV is proportional to the amount of time that the kidney has been experiencing retrograde pressure. Although much debate exists within the field, spontaneous decompression within the collecting system (e.g., "pop-off" valve) such as urinoma formation or spontaneous ascites has been found to relieve pressure on and thus protect the kidney, decreasing the risk of progression to advanced stages of chronic kidney disease. Despite the significant mass effect on the renal parenchyma, the pressure-relieving function of urinoma formation is a net protective factor allowing renal function to be preserved. We report a unique case of antenatal detection of PUV in a male with postnatal complicated urinoma formation secondary to forniceal rupture. Remarkably, despite significant external compression of the kidney and the development of urosepsis from infection of the urinoma with a multidrug-resistant organism that required percutaneous drainage, renal function was preserved throughout the disease course. After ablation of the PUV and drainage of the septic urinoma, the patient recovered rapidly after intervention and was ultimately discharged in stable condition.
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Affiliation(s)
| | | | | | - Ash Zawerton
- Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA
| | - Ajit Monteiro
- Pediatrics, Wayne State University Detroit Medical Center, Detroit, USA
| | - Kiana Saade
- Urology, University at Buffalo, Buffalo, USA
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2
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Palma PL, Marzuillo P, Di Sessa A, Guarino S, Capalbo D, Marrapodi MM, Buccella G, Cameli S, Miraglia Del Giudice E, Torella M, Colacurci N, Capristo C. From Clinical Scenarios to the Management of Lower Urinary Tract Symptoms in Children: A Focus for the General Pediatrician. Healthcare (Basel) 2023; 11:healthcare11091285. [PMID: 37174827 PMCID: PMC10177757 DOI: 10.3390/healthcare11091285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Lower urinary tract symptoms (LUTS) are a relevant problem in the pediatric population, having a very high prevalence. Diurnal incontinence and nocturnal enuresis are surely the most frequent symptoms, presenting, respectively, in up to 30% of school-age children and up to 10% of children between 6 and 7 years. Stypsis is the most common comorbidity, and it must be considered in the management of LUTS; indeed, the treatment of constipation is curative in most cases for both incontinence and enuresis. The presence or absence of diurnal symptoms in nocturnal enuresis and urgency in diurnal incontinence helps in the differential diagnosis. Urotherapy is always the first-line treatment, while oxybutynin and desmopressin (where appropriate) may help if the first-line treatment is unsuccessful. It is essential to identify conditions that are potentially dangerous for kidney and urinary tract well-being, for which LUTS can be the first manifestation. Starting from a series of clinical scenarios, we will underline the diagnostic clues behind LUTS in children and we will summarize clinical and surgical approaches for the proper management of these conditions.
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Affiliation(s)
- Pier Luigi Palma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Stefano Guarino
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Daniela Capalbo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Giulia Buccella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Sabrina Cameli
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
| | - Carlo Capristo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy
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Neugeborenes/m mit Harnstauung beidseits, Blasenhochstand und verdickter Blasenwand. Urologe A 2022; 61:120-123. [DOI: 10.1007/s00120-021-01758-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
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Chan MT, Chan EE, Ng YH, Yap T, Ong LY, Narasimhan KL, Jacobsen AS. Outcome of boys with posterior urethral valves from a single tertiary hospital in Singapore. ANZ J Surg 2022; 92:1159-1164. [DOI: 10.1111/ans.17445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ming Tow Chan
- Department of Paediatric Surgery KK Women's and Children's Hospital Singapore Singapore
| | - Esther Ern‐Hwei Chan
- Department of Paediatric Surgery KK Women's and Children's Hospital Singapore Singapore
| | - Yong Hong Ng
- Department of Paediatrics KK Women's and Children's Hospital Singapore Singapore
| | - Te‐Lu Yap
- Department of Paediatric Surgery KK Women's and Children's Hospital Singapore Singapore
| | - Lin Yin Ong
- Department of Paediatric Surgery KK Women's and Children's Hospital Singapore Singapore
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Kumar N, Yadav P, Jain S, Kumar G A, Kaushik VN, Ansari MS. Evaluation of polyuria and polydipsia along with other established prognostic factors in posterior urethral valves for progression to kidney failure: experience from a developing country. Pediatr Nephrol 2021; 36:1817-1824. [PMID: 33462698 DOI: 10.1007/s00467-020-04837-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Up to 50% of children with posterior urethral valves (PUV) progress to kidney failure. This study aimed to evaluate polyuria and polydipsia and other established variables with later development of kidney failure in children with PUV. METHODS Retrospective analysis of 297 children with PUV who underwent ablation of valves between January 1992 and January 2015 at our tertiary care center. Patients were divided into two groups: those who developed kidney failure (group 1) and those who did not (group 2). Specific prognostic factors for progression to kidney failure were analyzed including age at presentation < 1 year, nadir serum creatinine > 1.0 mg/dl, bilateral grade 3 or higher VUR at diagnosis, recurrent febrile UTIs, severe bladder dysfunction, polyuria, and polydipsia. RESULTS Thirty-eight (12.8%) patients progressed to kidney failure. Twenty-four and 64 patients were polyuric in group 1 and group 2 respectively (p < 0.001, Z-4.4666). Twenty-two and 61 patients were polydipsic in both groups respectively (p < 0.001). On univariate analysis, predicting variables were as follows: age at presentation < 1 year (p < 0.001), nadir serum creatinine > 1 mg/dl (p < 0.001), B/L high-grade VUR (p < 0.001), severe bladder dysfunction (p < 0.001), recurrent febrile UTIs (p = 0.002), polyuria (p < 0.001), and polydipsia (p < 0.001). On multivariate Cox regression analysis, severe bladder dysfunction, recurrent febrile UTIs, polyuria, and polydipsia were identified as significant prognostic factors predictive of ultimate progression to kidney failure. CONCLUSION Polyuria and polydipsia along with recurrent febrile UTI and bladder dysfunction are major prognostic factors affecting long-term kidney outcome in cases of PUV. Graphical abstract.
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Affiliation(s)
- Naveen Kumar
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shrey Jain
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhay Kumar G
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vinay N Kaushik
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M S Ansari
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
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Neurophysiological control of urinary bladder storage and voiding-functional changes through development and pathology. Pediatr Nephrol 2021; 36:1041-1052. [PMID: 32415328 DOI: 10.1007/s00467-020-04594-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
The effective storage of urine and its expulsion relies upon the coordinated activity of parasympathetic, sympathetic, and somatic innervations to the lower urinary tract (LUT). At birth, all mammalian neonates lack the ability to voluntary regulate bladder storage or voiding. The ability to control urinary bladder activity is established as connections to the central nervous system (CNS) form through development. The neural regulation of the LUT has been predominantly investigated in adult animal models where comparatively less is known about the neonatal and postnatal neurophysiological development that facilitate urinary continence. Furthermore, congenital neurological or anatomical defects can adversely affect both storage and voiding functions through postnatal development and into adulthood, leading to secondary conditions including vesicoureteral reflux, chronic urinary tract infections, and end-stage renal disease. Therefore, the aim of the review is to provide the current knowledge available on neurophysiological regulation of the LUT through pre- to postnatal development of human and animal models and the consequences of congenital anomalies that can affect LUT neural function.
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Alsaywid BS, Mohammed AF, Jbril SM, Bahashwan M, Mukharesh L, Al Khashan M. Renal outcome among children with posterior urethral valve: When to worry? Urol Ann 2021; 13:30-35. [PMID: 33897161 PMCID: PMC8052897 DOI: 10.4103/ua.ua_112_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/19/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Posterior urethral valve (PUV) is a congenital obstructive defect of male urethra that is diagnosed early during antenatal period with a presence of hydroureteronephrosis and associated with several morbidities including chronic kidney disease (CKD) that requires management, therefore, this study aim to evaluate the renal outcome of endoscopic valve ablation and urinary tract diversion in children with PUV, "when to worry, and what to do." METHODOLOGY This is a retrospective cohort study reviewing medical records of all patients diagnosed with PUV that has been managed in Pediatric Urology Unit at King Abdul-Aziz Medical City, Jeddah in the period of 1998-2008 with proven diagnosis at age younger than 16 accounted for 39 patients, and with different multiple demographics such as antenatal and postnatal ultrasound findings, serum levels of preoperative creatinine, mode of surgical treatment (i.e., endoscopic valve ablation and urinary diversions). Patients were divided into two groups according to the initial surgical intervention. Patient's characteristics and other variables were analyzed; t-test and Chi-square test were used. RESULTS During the follow-up period, (45%) developed CKD with a mean time of 5.5 years, 18% reach to end stage renal disease (ESRD), (10%) requiring dialysis. Abnormal creatinine level was detected in 69% (27/39) of our patients before the intervention and normalized in 97% after intervention. In comparison between the two intervention groups, CKD were developed in 60% of patients with urinary diversion in comparison to 33% for the endoscopic ablation group with no statistical significance with P = 0.09. The time to develop CKD was faster in the diversion group with mean age of 18 months (standard deviation [SD] 2 years) in comparison to endoscopic ablation group with mean age 6 years (SD 4 years). Similar results were observed for development of ESRD, patients who underwent diversion had slightly higher incidence of ESRD. In our cohort group, the main determinant for deterioration of the future kidney function was the level of serum creatinine, preoperatively. Moreover, recurrent urinary tract infections (UTIs) were developed in 64% of our cohort group and 49% of our population diagnosed with voiding dysfunction at 6 years of age. CONCLUSION A child with PUV who has a risk factor does have an increased potential of developing CKD, knowing that the type of intervention offered to treat PUV has no impact on the outcome. Furthermore, not having any of the study mentioned risk factors doesn't rule out the possibility of developing comorbidities which suggest that any child with PUV always need to be worried about and longer follow-up is indicated. Early intervention, check cystoscopy after ablation, close follow-up with appropriate laboratory and radiological investigation when necessary are recommended, and to improve the quality of data to the level reaching to a meaningful conclusion with high accuracy, a national database system from all centers across the country should be implemented.
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Affiliation(s)
- Basim Saleh Alsaywid
- Department of Surgery, Urology Section, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia
- Department of Research and Development, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Research and Development Unit, Saudi Commission for Health Specialties, Jeddah, Saudi Arabia
| | - Afrah Fathi Mohammed
- Department of Surgery, Section of Urology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Samaher M. Jbril
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Marya Bahashwan
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Louai Mukharesh
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muneera Al Khashan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Co-existence of CPAM with Megacystis Due to Posterior Urethral Valve and Cardiac Dysfunction in a Monozygotic Twin Pregnancy. JOURNAL OF FETAL MEDICINE 2019. [DOI: 10.1007/s40556-019-00220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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Janjua HS, Lam SK, Gupta V, Krishna S. Congenital Anomalies of the Kidneys, Collecting System, Bladder, and Urethra. Pediatr Rev 2019; 40:619-626. [PMID: 31792045 DOI: 10.1542/pir.2018-0242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Vedant Gupta
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, OH
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Buffin-Meyer B, Klein J, van der Zanden LFM, Levtchenko E, Moulos P, Lounis N, Conte-Auriol F, Hindryckx A, Wühl E, Persico N, Oepkes D, Schreuder MF, Tkaczyk M, Ariceta G, Fossum M, Parvex P, Feitz W, Olsen H, Montini G, Decramer S, Schanstra JP. The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design. Clin Kidney J 2019; 13:371-379. [PMID: 32699617 PMCID: PMC7367108 DOI: 10.1093/ckj/sfz107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease.
A major issue in the management of PUV is prenatal prediction of postnatal renal
function. Fetal ultrasound and fetal urine biochemistry are currently employed for this
prediction, but clearly lack precision. We previously developed a fetal urine peptide
signature that predicted in utero with high precision postnatal renal
function in fetuses with PUV. We describe here the objectives and design of the
prospective international multicentre ANTENATAL (multicentre validation of a fetal urine
peptidome-based classifier to predict postnatal renal function in posterior urethral
valves) study, set up to validate this fetal urine peptide signature. Methods Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until
2023 in >30 European centres endorsed and supported by European reference networks
for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The
endpoint will be renal/patient survival at 2 years postnatally. Assuming α = 0.05,
1–β = 0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400
patients need to be enrolled to validate the previously reported sensitivity and
specificity of the peptide signature. Results In this largest multicentre study of antenatally detected PUV, we anticipate bringing a
novel tool to the clinic. Based on urinary peptides and potentially amended in the
future with additional omics traits, this tool will be able to precisely quantify
postnatal renal survival in PUV pregnancies. The main limitation of the employed
approach is the need for specialized equipment. Conclusions Accurate risk assessment in the prenatal period should strongly improve the management
of fetuses with PUV.
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Affiliation(s)
- Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Loes F M van der Zanden
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elena Levtchenko
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | | | - Nadia Lounis
- Unité de Recherche Clinique Pédiatrique, Module Plurithématique Pédiatrique du Centre D'Investigation Clinique Toulouse 1436, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Françoise Conte-Auriol
- Unité de Recherche Clinique Pédiatrique, Module Plurithématique Pédiatrique du Centre D'Investigation Clinique Toulouse 1436, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - An Hindryckx
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicola Persico
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy.,Sergio Bonelli Centre for the Prevention of Renal Failure from Fetal to Pediatric Age, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dick Oepkes
- Department of Prenatal Diagnosis and Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Gema Ariceta
- Servei de Nefrologia Pediátrica Hospital, Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Magdalena Fossum
- Section of Pediatric Urology, Department of Highly Specialized Pediatric Surgery and Pediatric Medicine, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Paloma Parvex
- Pediatric Nephrology, Unité Romande de Néphrologie Pédiatrique, Hôpitaux Universitaire Genève (HUG), Genève, Switzerland
| | - Wout Feitz
- For ERN eUROGEN, Department of Urology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henning Olsen
- For ERN eUROGEN, Paediatric Urology, Department of Urology, Aarhus University Hospital & Aarhus University, Aarhus, Denmark
| | - Giovanni Montini
- For ERN ERKNet, Pediatric Nephrology-Centro Sergio Bonelli for the Prevention and Treatment of Urinary Tract Malformations, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France.,Service de Néphrologie Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France.,Centre De Référence des Maladies Rénales Rares du Sud-Ouest (SORARE), Toulouse, France
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
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Kumar M, Batra G, Maletha M, Malhotra A. Hirschsprung's disease in a child with posterior urethral valve: An unwanted association. Indian J Urol 2018; 34:223-225. [PMID: 30034135 PMCID: PMC6034409 DOI: 10.4103/iju.iju_9_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Urinary bladder and the rectum share a common embryological origin, and the anatomical proximity of these two organs suggest that a dysfunction in either may influence the function of the other. Although, the coexistence of bladder and bowel dysfunction has been previously reported in the literature, there are hardly any reports on coexistence of posterior urethral valve (PUV) with Hirschsprung's disease. Here, we report a case of a 20-month-old male child who was initially treated for PUV and was later found to have coexisting Hirschsprung's disease.
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Affiliation(s)
- Mritunjay Kumar
- Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Gaurav Batra
- Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Madhukar Maletha
- Department of Surgery, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Ankur Malhotra
- Department of Radiodiagnosis, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
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12
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Long-term renal outcome in infants with congenital lower urinary tract obstruction. Prog Urol 2018; 28:596-602. [PMID: 29980359 DOI: 10.1016/j.purol.2018.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/30/2018] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Congenital Lower Urinary Tract Obstructions (LUTO) is a heterogeneous group of diseases in which urine elimination is obstructed at the level of bladder neck or urethra. The aim of the study is to evaluate the long-term renal outcome of patients suffering of congenital LUTO. PATIENTS AND METHOD We retrospectively reviewed patients with congenital LUTO. All patients had at least 1 year follow-up. Data on surgery, renal imaging and Schwartz estimate creatinine clearance were collected. Incidence of Chronic Renal Disease (CRD) is presented with Kaplan-Meier method. RESULTS 40 patients were included, 23 patients with Posterior Urethral Valve (PUVs) and 17 patients with other aetiologies: anterior urethral valve (2), urethral atresia (2), urethral stenosis (2), cloacal malformations (2), obstructive ureterocele (1), bladder trigone malformation (1) and neonatal bladder-sphincter dysfunction without neurological abnormalities (7). Incidence of CRD at age 10 years was 37% in congenital LUTO, 42% in PUVs and 30% in other aetiologies, and was significantly higher in PUVs (P=0.032). Renal prognosis was significantly worsened by discover of retentional bladder wall changes in initial cystoscopy, and by loss of parenchymal differentiation or cortical microcysts in first ultrasonography. The use of urinary diversion was significantly higher in LUTO of other aetiologies. CONCLUSION A high incidence of CRD is observed in patients with congenital LUTO, significantly higher in patients with PUV. LUTO of other aetiologies require step by step surgical management and higher use of urinary diversion. Precise initial evaluation in cystoscopy and ultrasonography is required and participate to evaluate future renal outcome. LEVEL OF INCIDENCE 4.
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Radhakrishna V, Govindarajan KK, Sambandan K, Jindal B, Naredi B. Solitary functioning kidney in children: clinical implications. ACTA ACUST UNITED AC 2018; 40:261-265. [PMID: 29944157 PMCID: PMC6533948 DOI: 10.1590/1678-4685-jbn-3942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/29/2017] [Indexed: 12/03/2022]
Abstract
Introduction: Children with solitary functioning kidney (SFK) are prone to develop long
term problems, which are not well represented in the literature. The extent
to which the presence of associated congenital anomalies of kidney and
urinary tract (CAKUT) further de-stabilize renal function is to be
addressed. Objective: This study was conducted to evaluate the etiology, presentation, presence of
CAKUT, and renal damage in children with SFK. Methods: All children with SFK who presented to the department of pediatric surgery
from March 2014 to May 2016 were included in the study. Children with
malignancy were excluded from the study. Results: Of the 20 patients with SFK, 14 (70%) had primary SFK (8 with agenesis and 6
with multicystic dysplastic kidney), 6 (30%) belonged to secondary SFK
group, among them 3 had pelviureteric junction obstruction, 2 had posterior
urethral valves and 1 had vesicoureteric reflux. Eight (40%) had associated
CAKUT, 4 (20%) were asymptomatic while 8 (40%) had UTI and 6 (30%) had
hypertension. Ten (50%) patients had reduced glomerular filtration rate
(GFR) suggesting compromised renal function. Conclusion: Children with SFK have high morbidity especially when associated with
ipsilateral CAKUT. Long-term periodical follow up is essential in these
patients to improve clinical outcome.
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Affiliation(s)
- Veerbhadra Radhakrishna
- Jawaharlal Institute of Postgraduate Medical Education & Research, Department of Pediatric Surgery, Pondicherry, 605006, India
| | - Krishna Kumar Govindarajan
- Jawaharlal Institute of Postgraduate Medical Education & Research, Department of Pediatric Surgery, Pondicherry, 605006, India
| | - Kumaravel Sambandan
- Jawaharlal Institute of Postgraduate Medical Education & Research, Department of Pediatric Surgery, Pondicherry, 605006, India
| | - Bibekanand Jindal
- Jawaharlal Institute of Postgraduate Medical Education & Research, Department of Pediatric Surgery, Pondicherry, 605006, India
| | - BikashKumar Naredi
- Jawaharlal Institute of Postgraduate Medical Education & Research, Department of Pediatric Surgery, Pondicherry, 605006, India
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14
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Willig L, Paquette E, Hester DM, Warady BA, Lantos JD. Parents Refusing Dialysis for a 3-Month-Old With Renal Failure. Pediatrics 2018; 141:peds.2017-2096. [PMID: 29490907 DOI: 10.1542/peds.2017-2096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 11/24/2022] Open
Abstract
A 3-month-old boy with failure to thrive was referred to a nephrology clinic after a diagnostic workup for failure to thrive revealed a serum urea nitrogen level of 95 mg/dL and creatinine level of 3.6 mg/dL. A renal ultrasound revealed marked bilateral hydronephrosis with little remaining renal cortex in either kidney. A voiding cystourethrogram revealed evidence of posterior urethral valves. The child had no evident comorbidities. Fulguration of the valves was successfully performed but did not lead to improvement in kidney function. The nephrologists recommended the initiation of dialysis with the hope that the child would be able to receive a kidney transplant in the future. After careful consideration, the family stated that they did not want this child to suffer with a lifetime of dialysis and transplant care. They were also concerned about the impact of this child's illness on their other 2 children and their family. They requested that their son be provided with palliative care only. Experts in nephrology, bioethics, and critical care discuss the ethical issues raised by this parental request.
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Affiliation(s)
| | - Erin Paquette
- Division of Critical Care, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; and
| | - D Micah Hester
- Division of Medical Humanities, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Kansas City, Kansas City, Missouri;
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15
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Abstract
Intrauterine surgery is being performed with increasing frequency. Correction of foetal anomalies in utero can result in normal growth of foetus and a healthier baby at delivery. Intrauterine surgery can also improve the survival of babies who would have otherwise died at delivery, or in the neonatal period. There are three commonly used approaches to correct foetal anomalies: open surgery, where the foetus is exposed through hysterotomy; percutaneous approach, where needle or foetoscope is inserted through the abdominal wall and the uterine wall; finally, ex utero intrapartum treatment (EXIT) surgery, where the intervention is performed on the baby before terminating the maternal umbilical support to the baby. Anaesthetic management of the mother and the foetus requires good understanding of maternal physiology, foetal physiology, and pharmacological and surgical implications to the foetus. Uterine relaxation is a critical requisite for open foetal procedures and EXIT procedures. General anaesthesia and/or regional anaesthesia can be used successfully depending on the nature of foetal intervention. Foetal surgery poses complications not only to the foetus but also to the mother. Therefore, the decision for undertaking foetal surgery should always consider the risk to the mother versus benefit to the foetus.
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Affiliation(s)
| | - Shobana Bharadwaj
- University of Maryland Medical Center, University of Maryland, Baltimore, Maryland, USA
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16
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Iguchi N, Malykhina AP, Wilcox DT. Inhibition of HIF Reduces Bladder Hypertrophy and Improves Bladder Function in Murine Model of Partial Bladder Outlet Obstruction. J Urol 2016; 195:1250-6. [PMID: 26926557 DOI: 10.1016/j.juro.2015.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Posterior urethral valves are the most common cause of partial bladder outlet obstruction in the pediatric population. However, to our knowledge the etiology and the detailed mechanisms underlying pathological changes in the bladder following partial bladder outlet obstruction remain to be elucidated. Recent findings suggest that hypoxia and associated up-regulation of HIFs (hypoxia-inducible factors) have a key role in partial bladder outlet obstruction induced pathology in the bladder. We examined the effects of pharmacological inhibition of HIF pathways by 17-DMAG (17-(dimethylaminoethylamino)-17-demethoxygeldanamycin) in pathophysiological phenotypes after partial bladder outlet obstruction. MATERIALS AND METHODS Partial bladder outlet obstruction was surgically created in male C57BL/6J mice. The animals received oral administration of 17-DMAG or vehicle daily starting from the initiation of obstruction up to 5 days. Sham operated mice served as controls. Bladders were harvested from each group 2, 4 and 7 days postoperatively, and analyzed for histological and biochemical changes. Bladder function was assessed by in vitro muscle contractility recordings. RESULTS Partial bladder outlet obstruction caused a significant increase in the bladder mass accompanying enhanced collagen deposition in the bladder wall while 17-DMAG treatment suppressed those increases. Treatment with 17-DMAG attenuated the degree of up-regulation of HIFs and their target genes involving the development of tissue fibrosis in obstructed bladders. Treatment with 17-DMAG improved the decreased responses of obstructed bladder strips to electrical field stimulation and KCl. CONCLUSIONS In vivo 17-DMAG treatment decreased partial bladder outlet obstruction induced pathophysiological changes in the bladder. HIF pathway inhibition has a potential clinical implication for the development of novel pharmacological therapies to treat bladder pathology associated with partial bladder outlet obstruction.
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Affiliation(s)
- Nao Iguchi
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Anna P Malykhina
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Duncan T Wilcox
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colorado.
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17
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Abstract
This article describes the anesthetic management of pregnant women undergoing fetal surgery. Discussion includes general principles common to all fetal surgeries as well as specifics pertaining to open fetal surgery, minimally invasive fetal surgery, and ex utero intrapartum therapy (EXIT) procedures.
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Affiliation(s)
- Hans P Sviggum
- Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
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18
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Klein J, Lacroix C, Caubet C, Siwy J, Zurbig P, Dakna M, Muller F, Breuil B, Stalmach A, Mullen W, Mischak H, Bandin F, Monsarrat B, Bascands JL, Decramer S, Schanstra JP. Fetal Urinary Peptides to Predict Postnatal Outcome of Renal Disease in Fetuses with Posterior Urethral Valves (PUV). Sci Transl Med 2013; 5:198ra106. [DOI: 10.1126/scitranslmed.3005807] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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