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Contini G, Mele E, Barneschi AC, Esposito C, Castagnetti M. Voiding cystourethrography in patients undergoing endoscopic decompression of duplex system ureteroceles: to do or not to do? Pediatr Surg Int 2024; 40:103. [PMID: 38598017 PMCID: PMC11006722 DOI: 10.1007/s00383-024-05665-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To assess the role of voiding cystourethrography (VCUG) in patients with duplex system ureterocele (DSU) undergoing endoscopic decompression (ED). MATERIALS AND METHODS This is a retrospective study of 75 consecutive patients with DSU undergoing ED [median (range) age, 6 (1-148) months]. Patients were divided into 3 groups, 33 with a VCUG showing vesicoureteral reflux (VUR) before ED (VUR-group), 22 with a VCUG negative for VUR (No-VUR-group), and 20 who did not undergo a VCUG (No-VCUG-group). Secondary surgery (SS) rate was compared among groups. RESULTS Groups were comparable for baseline characteristics. SS rate was 82% (27/33) in VUR-group vs. 32% (7/22) in the No-VUR-group (p = 0.0001), and 25% (5/20) in the No-VCUG-group (p = 0.001 vs. VUR-group, and 1 vs. No-VUR-group). In the VUR-group, 9 patients underwent preemptive endoscopic treatment of VUR during ED and SS rate was 44% (4/9) vs. 96% (23/24) in the remainder, p= 0.003. In the No-VCUG-group, a VCUG was performed during follow-up in 9/15 patients and showed reflux in all, although only 2 of these developed a (single) urinary tract infections. CONCLUSIONS SS rate was significantly higher in patients with preoperative VUR. Instead, it was not significantly different between patients without VUR and those who did not undergo a VCUG before ED, despite all the latter who underwent a VCUG during follow-up had evidence of VUR generally in the absence of symptoms. In our opinion, a VCUG could be limited to patients developing symptoms after ED. If a VCUG is performed before ED, a preemptive treatment of VUR should be taken into consideration.
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Affiliation(s)
- Giorgia Contini
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Ermelinda Mele
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Andrea Celeste Barneschi
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Castagnetti
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy.
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Chen J, Kang Y, Lin S, He S, He Y, Xu X, Xu H, You G, Xu D. Single-port plus one in pediatric robotic-assisted Lich-Gregoir ureteral reimplantation for vesicoureteral reflux, a comparative analysis with short-term outcomes. BMC Urol 2024; 24:81. [PMID: 38589861 PMCID: PMC11000388 DOI: 10.1186/s12894-024-01467-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/25/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE To observe the safety and short-term outcomes of a new way of laparoscopic trocar placement in pediatric robotic-assisted Lich-Gregoir ureteral reimplantation for vesicoureteral reflux. METHODS The retrospective study included 32 patients under 14 years diagnosed with primary vesicoureteral reflux (VUR). All these patients underwent robotic-assisted Lich-Gregoir ureteral reimplantation in our department from December 2020 to August 2022. These patients were divided into the following groups according to the different ways of trocar placement: 13 patients in group single-port plus one (SR) and 19 patients in group multiple-port (MR). Patients' characteristics as well as their perioperative and follow-up data were collected and evaluated. RESULTS There was no significant difference in the data regarding patients' characteristics and preoperative data. These data included the grade of vesicoureteral reflux according to the voiding cystourethrogram (VCUG), and the differential degree of renal function (DRF) at the following time points: preoperative, postoperative, and comparison of preoperative and postoperative. There was no difference between the two groups. During surgery, the time of artificial pneumoperitoneum establishment, ureteral reimplantation time, and total operative time in the SR group were longer than those in the MR group. Yet only the time of artificial pneumoperitoneum establishment shows a statistical difference (P < 0.0001). Also, the peri-operative data, including the volume of blood loss, fasting time, hospitalization, and length of time that a ureteral catheter remained in place, and the number of postoperative complications demonstrate no difference. In addition, the SFU grade and VCUG grade at the following time point also show no difference between the two groups. CONCLUSION The study demonstrates that SR in robotic-assisted Lich-Gregoir ureteral reimplantation has reached the same surgical effects as MR. In addition, the single-port plus one trocar placement receives a higher cosmetic satisfaction score from parents and did not increase the surgical time and complexity.
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Affiliation(s)
- Jianglong Chen
- Department of Pediatric Surgery, Pediatric Medical Center, Fujian Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China, 350001
- Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China
| | - Yingquan Kang
- Department of Pediatric Surgery, Pediatric Medical Center, Fujian Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China, 350001
- Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China
| | - Shan Lin
- Department of Pediatric Surgery, Pediatric Medical Center, Fujian Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China, 350001
- Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China
| | - Shaohua He
- Department of Pediatric Surgery, Pediatric Medical Center, Fujian Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China, 350001
- Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China
| | - Yufeng He
- Department of Pediatric Surgery, Pediatric Medical Center, Fujian Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China, 350001
- Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China
| | - Xinru Xu
- Department of Pediatric Surgery, Pediatric Medical Center, Fujian Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China, 350001
- Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China
| | - Huihuang Xu
- Department of Pediatric Surgery, Pediatric Medical Center, Fujian Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China, 350001
- Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China
| | - Guangxu You
- Department of Pediatric Surgery, Pediatric Medical Center, Fujian Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China, 350001
- Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China
| | - Di Xu
- Department of Pediatric Surgery, Pediatric Medical Center, Fujian Provincial Hospital, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China, 350001.
- Shengli Clinical Medical College of Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, Fujian Province, China.
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Chandrasekharam VVS, Babu R, Shah M. How effective is nephrectomy in curing hypertension in children with unilateral poorly functioning kidney? A systematic review. Pediatr Surg Int 2024; 40:96. [PMID: 38568219 DOI: 10.1007/s00383-024-05676-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Some children with hypertension (HTN) have unilateral poorly functional kidney (PFK). This provides an opportunity for the clinician to cure the HTN by removal of the PFK, thereby avoiding the problems of long-term medication. However, there is sparse data in children regarding the effect of PFK nephrectomy on curing HTN. In this review, we analysed the etiology of PFK causing HTN and the effectiveness of nephrectomy in curing HTN in children. METHODS We searched the databases to identify papers between January 2000 to December 2020 pertaining to children with PFK and HTN who underwent nephrectomy. Outcome analyzed was the resolution of HTN following nephrectomy. Duplicate publications, review articles and incomplete articles were excluded. Meta-analysis of heterogeneity was reported with I2statistics. Forest plot was constructed to compare the pooled prevalence of HTN resolution. RESULTS Five articles with 88 patients were included. Majority (43%) of PFK were due to the unilateral atrophic kidney with or without vesicoureteral reflux (VUR); ureteropelvic junction obstruction and multicystic dysplastic kidney together accounted for 35% of cases and renovascular pathology for 22% of cases. With a follow-up of 1.5 to 3.3 years, nephrectomy was effective to cure HTN in 65.9% (95% CI 55-75%) children. CONCLUSIONS In children with HTN and a unilateral PFK, nephrectomy cured the HTN in two-thirds of children. Unilateral atrophic kidney due to VUR was the most common cause of PFK. An increase in the utilisation of laparoscopy was observed in recent publications, hence laparoscopic nephrectomy may be considered a first choice of treatment in these children.
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Affiliation(s)
- V V S Chandrasekharam
- Pediatric Urology, Pediatric Surgery & MIS, Ankura Hospitals for Women and Children, Hyderabad, India.
| | | | - Mehul Shah
- Pediatric Nephrology, Apollo Hospitals, Hyderabad, India
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Zvizdic Z, Vranic S. Response to Commentary "The correlation between ureteric orifice morphology and primary vesicoureteral reflux grade and the impact on the effectiveness of endoscopic reflux correction". J Pediatr Urol 2024; 20:302. [PMID: 38087725 DOI: 10.1016/j.jpurol.2023.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 04/22/2024]
Affiliation(s)
- Zlatan Zvizdic
- Department of Pediatric Surgery, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Goyal A. Commentary to Vesicoureteral reflux severity is not associated with unplanned urinary catheterization or length of hospital stay after ureteroneocystostomy. J Pediatr Urol 2024; 20:192. [PMID: 37949809 DOI: 10.1016/j.jpurol.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
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Obata S, Nagata K, Suematsu S, Nishiyama K, Okabe Y, Kondo T, Maniwa J, Fukuta A, Kawakubo N, Yanagi Y, Miyata J, Matsuura T, Ohga S, Nakamura M, Tajiri T. The Effectiveness of Deflux® Treatment for Vesicoureteral Reflux Following Pediatric Renal Transplantation: A Single-Institution Challenging Experience. J Pediatr Surg 2024; 59:616-620. [PMID: 38161090 DOI: 10.1016/j.jpedsurg.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To validate the effectiveness of Deflux® treatment for vesicoureteral reflux (VUR) following pediatric renal transplantation (RT), based on our single-institution experience. METHOD A retrospective study was conducted using the medical records of pediatric patients who underwent Deflux® treatment for VUR after RT from April 2008 to March 2022. RESULTS Sixty-eight pediatric patients underwent RT. VUR was subsequently detected in 22 (32 %) of these patients. Seven of the 22 patients (32 %) underwent Deflux® treatment to avoid renal dysfunction due to urinary infection (UTI). The median age at the time of RT was 4 years (range:2-12). All 7 patients had urinary UTIs before Deflux® treatment. The median estimated glomerular filtration rate (eGFR) before Deflux® treatment was 67 ml/min/1.73 m2 (range:42-138 ml/min/1.73 m2). After Deflux® treatment, VUR was downgraded in three cases (43 %). Four patients (57 %) experienced postoperative UTI, two of who underwent a second Deflux® treatment, one underwent submuscular tunnel reconstruction, and the other one experienced UTI without VUR after 1st Deflux® treatment but did not reoccur. All seven patients continued prophylactic medication after Deflux® treatment, without any history of recurrent UTIs during the observation period after treatment (median 37 months [range 7-86 months]). Furthermore, the eGFRs did not significantly decrease after Deflux® treatment (median eGFR 58 ml/min/1.73 m2 [range:33-99 ml/min/1.73 m2], p > 0.1). CONCLUSION Deflux® treatment for VUR after RT is technically challenging because the new ureteral orifice is ventrally anastomosed at the bladder. We believe our results indicate the possibility of reducing the frequency of UTIs and contributing to preservation of the renal function after RT. TYPE OF STUDY Retrospective Study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Satoshi Obata
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan; Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, Fukuoka 814-0180, Japan.
| | - Kouji Nagata
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Shinya Suematsu
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Kei Nishiyama
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Takuya Kondo
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Junnosuke Maniwa
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Atsuhisa Fukuta
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Naonori Kawakubo
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Yusuke Yanagi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Junko Miyata
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka 812-8582, Japan
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Chertin L, Kocherov S, Bakaleyshchik P, Baranov Y, Dubrov V, Kagantsov I, Karpachev S, Kuzovleva G, Pirogov A, Rudin Y, Sablin D, Sizonov V, Shmyrov O, Zisman A, Chertin B, Neheman A, Bondarenko S. Laparoscopic and Robot-assisted Laparoscopic Reimplantation for Lower Ureter Pathology. A Multi-institutional Comparative Study in 1343 Patients. Urology 2024; 186:166-171. [PMID: 38401810 DOI: 10.1016/j.urology.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/12/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To evaluate the outcomes of children with vesicoureteral reflux (VUR) and obstructive megaureter (OM) utilizing various laparoscopic and robot-assisted approaches. MATERIALS AND METHODS Retrospective review of all pediatric laparoscopic and robot-assisted cases for lower ureter pathology was performed between 2016-2022 in 13 academic centers worldwide. Five surgical approaches were assessed: LEUR, LVCUR, LDECUR, RALUR, and RADECUR. RESULTS One thousand three hundred forty-three patients (490 boys and 853 girls) with a median age of 30 months (IQR 12-63) were treated at 13 centers. Nine hundred and eight patients (68%) underwent reimplantation due to VUR (unilateral in 818 and bilateral in 90 patients). Four hundred thirty-five (32%) had a surgery due to ureterovesical junction (UVJ) obstruction. Mean length of follow-up was 14 months (IQR 8-33). Median operative time was 202 minutes (IQR 142-220) in the robotic arm compared to 240 minutes (IQR 160-267) in the laparoscopic (P = .45). Intracorporeal excisional tapering was performed in 118 (8%) of the patients. Six patients in the OM group required additional surgery due to progressive obstruction. In the VUR group, 84% underwent voiding cystourethrography postoperatively. 5.6% showed residual reflux. Grade 1-2 Clavien-Dindo complications occurred in 10 patients (0.7%) and 6 (0.4%) in the laparoscopic and robotic arm, respectively. Grade 3 complications occurred in 17 (1.2%) and 8 (0.5%) in both arms, respectively. Surgical success was achieved in 96% of patients. CONCLUSION Laparoscopic and robot-assisted laparoscopic approaches are simple, safe, and effective for treating all grades of VUR and OM. Robot-assisted approach is beneficial in terms of operative time, intracorporeal suturing, and lower complications rate.
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Affiliation(s)
| | | | | | - Yuri Baranov
- Regional Children's Clinical Hospital, Ekaterinburg, Russian Federation
| | | | - Iliya Kagantsov
- Almazov National Medical Research Center, Saint Petersburg, Russian Federation
| | - Sergey Karpachev
- National Medical Research Center for Chidren's Health, Moscow, Russian Federation
| | | | - Alexander Pirogov
- Regional Children's Clinical Hospital named after N. Silishcev, Astrachan, Russian Federation
| | - Yuri Rudin
- N. Lopatkin's Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Radiological Center of Ministry of Health Russian Federation, Moscow, Russian Federation
| | - Dmitriy Sablin
- Archangelsk Regional Children's Clinical Hospital named after P.G. Vyzhletsov, Archangelsk, Russian Federation
| | - Vladimir Sizonov
- Rostov Regional Children's Clinical Hospital, Rostov-on-Don, Russian Federation
| | - Oleg Shmyrov
- Morozovskaya Children's City Clinical Hospital, Moscow, Russian Federation
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Quiring ME, Son Y, Thaker R, Davidson N, Wu E, Fink BA, Thomas B, Gentry NB, Yossef A, DeMario VK, Earnshaw L, Weldekidan B, Dean G. Vesicoureteral reflux severity is not associated with unplanned urinary catheterization or length of hospital stay after ureteroneocystostomy. J Pediatr Urol 2024; 20:183-190. [PMID: 37770341 DOI: 10.1016/j.jpurol.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Vesicoureteral reflux (VUR) is a common urologic condition affecting approximately 1% of all children. Surgical success often depends on the grade of VUR, as patients with grades 4 or 5 have been have a greater risk for postoperative complications. Unplanned urinary catheter placement (UCP) postoperatively and prolonged length of hospital stay (LOS) are indicative of unexpected complications. The association between VUR severity and such metrics remain unclear. OBJECTIVE The study's objective is to determine if the severity of VUR is associated with higher rates of UCP or prolonged LOS after ureteroneocystostomy (UNC). STUDY DESIGN The 2020 National Surgical Quality Improvement Program Pediatric database was analyzed for patients with VUR. A total of 1742 patients were initially evaluated with 1373 meeting exclusion criteria. The patients were divided into 3 groups of varying voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC) severity: VCUG Grade 1 or RNC Grade 1 (Group A), VCUG Grade 2 or 3 or RNC Grade 2 (Group B), and VCUG Grade 4 or 5 or RNC Grade 3 (Group C). Basic statistical analysis was performed, and logistic regression was performed with both UCP and LOS as dependent variables. RESULTS Among the 1373 patients, 2.9% were included in Group A, 32.5% were in Group B, and 64.6% were in Group C. Significant differences were found among the groups for mean age, gender, inpatient status, rate of congenital malformation, ureteral stents, and ASA classification. Regarding surgical treatment, differences were also found comparing mean operative time, LOS, laterality and type of procedure, urine culture results, rates of UTI, surgical site infections, postoperative returns to the emergency department, and unplanned procedures and catheterization. Multivariate analysis demonstrated no significant association between the rate of UCP and VUR severity, while postoperative UTI and unplanned procedure were both independent factors associated with UCP postoperatively. Additionally, postoperative UTI, ASA classification, mean operation time, ureteral stent placement, unplanned procedure, and UCP were independent factors found to contribute to LOS. CONCLUSION Greater VUR severity does not appear to increase the need for catheterization or prolong hospital stay, while the development of a UTI postoperatively or having an additional unplanned procedure are associated with an increased likelihood of both. The postoperative course after UNC also appears to be influenced more so by other factors such as the operative approach and whether complications arise.
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Affiliation(s)
- Mark E Quiring
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA.
| | - Young Son
- Jefferson Health New Jersey, Department of Urology, 18 E Laurel Rd, Stratford, NJ 08084, USA.
| | - Ranel Thaker
- Lake Erie College of Osteopathic Medicine, 1858 W Grandview Blvd, Erie, PA 16509, USA.
| | - Noah Davidson
- Lake Erie College of Osteopathic Medicine, 1858 W Grandview Blvd, Erie, PA 16509, USA.
| | - Edward Wu
- Alabama College of Osteopathic Medicine, 445 Health Sciences Blvd, Dothan, AL 36303, USA.
| | - Benjamin A Fink
- Jefferson Health New Jersey, Department of Urology, 18 E Laurel Rd, Stratford, NJ 08084, USA; Rowan University, School of Osteopathic Medicine, 113 E Laurel Rd, Stratford, NJ 08084, USA.
| | - Brian Thomas
- Rowan University, School of Osteopathic Medicine, 113 E Laurel Rd, Stratford, NJ 08084, USA.
| | - Nathaniel B Gentry
- New York Institute of Technology College of Osteopathic Medicine, 2405 Aggie Rd, Jonesboro, AR 72401, USA.
| | - Angie Yossef
- Pacific Northwest University of Health Sciences College of Osteopathic Medicine, 200 University Parkway, Yakima, WA 98901, USA.
| | - Virgil K DeMario
- University of the Incarnate Word, School of Osteopathic Medicine, 7615 Kennedy Hill Dr, San Antonio, TX 78235, USA.
| | - Lance Earnshaw
- Jefferson Health New Jersey, Department of Urology, 18 E Laurel Rd, Stratford, NJ 08084, USA.
| | - Blen Weldekidan
- Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205, USA.
| | - Gregory Dean
- Temple University, Department of Urology, 3401 N Broad St, Philadelphia, PA 19140, USA.
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Sforza S, Marco BB, Haid B, Baydilli N, Donmez MI, Spinoit AF, Paraboschi I, Masieri L, Steinkellner L, Comez YI, Lammers RJM, 't Hoen LA, O'Kelly F, Bindi E, Kibar Y, Silay MS. A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV-V) vesicoureteral reflux. J Pediatr Urol 2024; 20:283-291. [PMID: 38000950 DOI: 10.1016/j.jpurol.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/27/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Traditionally, open ureteral reimplantation (OUR) has been the standard treatment for primary vesicoureteral reflux (VUR) requiring reimplantation. Robotic-assisted laparoscopic ureteral reimplantation (RALUR) is gaining popularity and high success rates have been reported. OBJECTIVE In this multi-institutional study, we aimed to compare the perioperative and postoperative outcomes of OUR and RALUR for high-grade (IV + V) VUR in children. STUDY DESIGN A retrospective evaluation was performed collecting data from 135 children (0-18 years) who underwent high grade VUR surgical correction at nine European institutions between 01/01/2009 and 01/12/2020, involving either open or robotic approaches. Institutional review board approval was obtained. Patients with lower grades of VUR (≤III), previous history of open or endoscopic ureteral surgery, neurogenic bladder, or refluxing megaureter in need of ureteral tapering were excluded. Pre-, peri- and post-operative data were statistically compared. RESULTS Overall, 135 children who underwent either OUR (n = 68), or RALUR (n = 67) were included, and their clinic and demographic features were collected. The mean age of the open group was 11 months (interquartile range [IQR] 9.9-16.6 months), in the RALUR group it was 59 months (IQR 29-78mo) (p < 0.01); the open cohort had a weight of 11 kg (IQR 9.9-16.6 kg) while the RALUR group had 19 kg (IQR 13-25 kg) (p < 0.01). No significant differences were found for intraoperative (1.5 % vs 7.5 %, p = 0.09) or for postoperative complication rates (7.4 % vs 9 %, p = 0.15). Favorable outcomes were reported in the RALUR group: shorter time to stooling (1 vs 2 days), fewer indwelling urethral catheter days (1 vs 5 days), perioperative drain insertion time (1 vs 5 days) and a shorter length of hospital stay (2 vs 5 days) (p < 0.01). The success rate was 94.0 % and 98.5 % in the open and RALUR groups, respectively. The long-term clinical success rates from both groups was comparable:42 vs 23 months for open and RALUR, respectively. DISCUSSION This study reported a large multicentric experience focusing on high grade VUR. Furthermore, this study compares favorably to OUR in a safety analysis. There was also a trend towards higher success rates with RALUR utilizing an extravesical approach which has not been previously reported. CONCLUSION RALUR is an efficacious and safe platform to use during ureteral reimplantation for high grade VUR. The overall peri-operative and post-operative complication rates are at least equivalent to OUR, but it is associated with a faster functional recovery and time to discharge. Medium to long term success rates are also equivalent to OUR.
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Affiliation(s)
- Simone Sforza
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy.
| | - Beatriz Bañuelos Marco
- Department of Urology, Charité University Clinic, Division of Paediatric Urology, Berlin, Germany
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Muhammet Irfan Donmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anne-Françoise Spinoit
- Department Urology ERN Centre, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lorenzo Masieri
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Lukas Steinkellner
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Yusuf Ilker Comez
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, 9713 GZ Groningen, the Netherlands
| | - Lisette Aimée 't Hoen
- Department of Paediatric Urology, Sophia Children's Hospital, Erasmus University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, DK18 AK68 Dublin, Ireland
| | - Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy
| | - Yusuf Kibar
- Department of Urology, University, Koru Hospital, Ankara, Turkey
| | - Mesrur Selçuk Silay
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
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10
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Misseri R. Commentary to a multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV-V) vesicoureteral reflux. J Pediatr Urol 2024; 20:292. [PMID: 38081757 DOI: 10.1016/j.jpurol.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 04/22/2024]
Affiliation(s)
- Rosalia Misseri
- Division of Pediatric Urology, Riley Children's Health, Indiana University School of Medicine, United States.
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11
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Weinstein C, Kirsch A. Commentary to "The correlation between ureteric orifice morphology and primary vesicoureteral reflux grade and the impact on the effectiveness of endoscopic reflux correction". J Pediatr Urol 2024; 20:303-304. [PMID: 38065758 DOI: 10.1016/j.jpurol.2023.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 04/22/2024]
Affiliation(s)
- Corey Weinstein
- Children's Health Care of Atlanta, Emory University, Atlanta, GA, USA.
| | - Andrew Kirsch
- Children's Health Care of Atlanta, Emory University, Atlanta, GA, USA
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12
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Quiring M. Response to "Commentary to Vesicoureteral Reflux Severity is Not Associated with Unplanned Urinary Catheterization or Length of Hospital Stay After Ureteroneocystostomy". J Pediatr Urol 2024; 20:191. [PMID: 37932197 DOI: 10.1016/j.jpurol.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Mark Quiring
- University of North Texas Health Science Center, United States.
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Sforza S, Marco BB, Haid B, Baydilli N, Donmez MI, Spinoit AF, Paraboschi I, Masieri L, Steinkellner L, Comez YI, Lammers RJM, Aimée 't Hoen L, O'Kelly F, Bindi E, Kibar Y, Silay MS. Response to Editorial Commentary Regarding 'A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV-V) vesicoureteral reflux?'. J Pediatr Urol 2024; 20:293-294. [PMID: 38065759 DOI: 10.1016/j.jpurol.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 04/22/2024]
Affiliation(s)
- Simone Sforza
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy.
| | - Beatriz Bañuelos Marco
- Department of Urology, Charité University Clinic, Division of Paediatric Urology, Berlin, Germany
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Muhammet Irfan Donmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anne-Françoise Spinoit
- Department Urology ERN Centre, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lorenzo Masieri
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Lukas Steinkellner
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Yusuf Ilker Comez
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, 9713 GZ Groningen, the Netherlands
| | - Lisette Aimée 't Hoen
- Department of Paediatric Urology, Sophia Children's Hospital, Erasmus University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, DK18 AK68 Dublin, Ireland
| | - Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy
| | - Yusuf Kibar
- Department of Urology, University, Koru Hospital, Ankara, Turkey
| | - Mesrur Selçuk Silay
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
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Zirngibl M, Weitz M, Luithle T, Tönshoff B, Nadalin S, Buder K. Current management of symptomatic vesicoureteral reflux in pediatric kidney transplantation-A European survey among surgical transplant professionals. Pediatr Transplant 2024; 28:e14621. [PMID: 37830523 DOI: 10.1111/petr.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Vesicoureteral reflux (VUR) is common in children and adolescents undergoing kidney transplantation (KTx) and may adversely affect allograft kidney function. METHODS To explore the current management of symptomatic native and allograft VUR in pediatric KTx recipients, an online survey was distributed to European surgical transplant professionals. RESULTS Surgeons from 40 pediatric KTx centers in 18 countries participated in this survey. Symptomatic native kidney VUR was treated before or during KTx by 68% of the centers (all/selected patients: 33%/67%; before/during KTx: 89%/11%), with a preference for endoscopic treatment (59%). At KTx, 90% favored an anti-reflux ureteral reimplantation procedure (extravesical/transvesical approach: 92%/8%; preferred extravesical technique: Lich-Gregoir [85%]). Management strategies for symptomatic allograft VUR included surgical repair (90%), continuous antibiotic prophylaxis (51%), bladder training (49%), or noninterventional surveillance (21%). Redo ureteral implantation and endoscopic intervention for allograft VUR were equally reported (51%/49%). CONCLUSIONS This survey shows uniformity in some surgical aspects of the pediatric KTx procedure. However, with regard to VUR, there is a significant variation in practice patterns that need to be addressed by future well-designed and prospective studies. In this way, more robust data could be translated into consensus guidelines for a more standardized and evidence-based management of this common condition in pediatric KTx.
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Affiliation(s)
- Matthias Zirngibl
- Department of General Pediatrics and Hematology/Oncology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Marcus Weitz
- Department of General Pediatrics and Hematology/Oncology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Luithle
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Kathrin Buder
- Department of General Pediatrics and Hematology/Oncology, University Children's Hospital, University Hospital Tübingen, Tübingen, Germany
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15
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Pensabene M, Cimador M, Spataro B, Serra G, Baldanza F, Grasso F, Corsello G, Salerno S, Di Pace MR, Sergio M. Intraoperative ultrasound-assisted endoscopic treatment of primary intermediate and high-grade vesicoureteral reflux in children in a long-term follow-up. J Pediatr Urol 2024; 20:132.e1-132.e11. [PMID: 37880015 DOI: 10.1016/j.jpurol.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Endoscopic treatment of vesicoureteral reflux (VUR) is an important minimally invasive surgical approach in patients undergoing surgical treatment of VUR. In our past experience, we observed that a bulking agent mound sagittal diameter of 10 mm is the main predictor of effectiveness of the procedure. Moreover we noticed that the use of intraoperative ultrasound, allows the surgeon to better identify the site, volume and shape of the bulking agent injected, finally reducing operative time. OBJECTIVE We aimed to evaluate if the intraoperative ultrasound assistance could definitively improve effectiveness of the endoscopic procedure. METHODS We retrospectively compared two series treated with endoscopic procedures for intermediate and high grade primary VUR, respectively without (series A) and with (series B) intraoperative ultrasound (IO-US). In all patients VCUG was performed to assess VUR grade and to verify resolution or VUR downgrading during the follow-up. RESULTS A total of 177 ureteric units were treated. Endoscopic procedures globally were effective in 68/96 ureters (70.8 %) in series A and in 68/81 ureters (83.9 %) in series B. No significant differences in effectiveness were observed comparing the series with regard to VUR grades, but a significant difference is shown (p < 0.05) when grouping grades III-V VUR. No significance in differences of volume injected were detected, but operative time was significantly lower in series B (27.5 min vs 19.6 min, p < 0.05). Mean sagittal mound diameter measured during cystoscopy in series B was 10.45 mm (range 8.5-14.2 mm). DISCUSSION The intraoperative ultrasound assistance during endoscopic treatment of VUR could represent a valid tool for surgeons to better identify location, volume and shape of the bulking agent. Furthermore, the use of an objective parameter of evaluation of the implant can overcome the subjective intraoperative evaluation of the implant itself, improving results for experienced surgeons and reducing the learning-curve for inexperienced ones. CONCLUSIONS Results of endoscopic injection of bulking-agent can be improved with intraoperative ultrasound, allowing at the same time a significant reduction of operative time.
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Affiliation(s)
- Marco Pensabene
- Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy.
| | - Marcello Cimador
- Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy
| | - Benedetto Spataro
- Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy
| | - Gregorio Serra
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Fabio Baldanza
- Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy
| | - Francesco Grasso
- Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo, PA, Italy
| | - Sergio Salerno
- Department of Biopathology and Medical Biotechnology, Section of Radiological Sciences, DIBIMED - University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Maria Rita Di Pace
- Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy
| | - Maria Sergio
- Paediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Piazza delle Cliniche, 2, 90127 Palermo PA, Italy
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16
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Della Corte M, Cerchia E, Fiori C, Mandaletti M, Ruggiero E, Porpiglia F, Catti M, Gerocarni Nappo S. JJ stent dislodgement in the distal ureter: how to recover it in preschool children? Minerva Urol Nephrol 2024; 76:116-119. [PMID: 38015551 DOI: 10.23736/s2724-6051.23.05550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Double-J ureteral stents are usually placed after various urological procedures. The dislodgement of their distal ringlet is a rare complication, whose retrieval is arduous in younger children, due to the small ureteral caliber. We propose our innovative endoscopic approach to recover the dislodged JJ stent. Under 8-9.8 Ch cystoscopy, the ureteral meatus is gently cannulated with a 00.18″ guidewire, then a balloon catheter Passeo 18 3-4 mm (Biotronik, Lake Oswego, OR, USA) is coaxially inserted. A pneumatic dilatation of the vesical-ureteral junction is performed up to 8 atmospheres for 5 minutes under direct vision. Consequently, the ureteral meatus allows the cystoscope passage, and the JJ-stent can be recovered thanks to endoscopic grasping forceps. A mono-J stent is then left in place for 24 hours. Four patients aged 8 months - 4 years have been successfully treated with this approach after that JJ migration was found intraoperatively or during ultrasonography. No intra- or postoperative complications occurred. Postoperative hospital stay was prolonged for one day. During 29.5 medium follow-up no clinical or ultrasonographic signs of vesical-ureteral reflux ensued. Our cystoscopic approach is effective and safe to ensure a prompt endoscopic JJ retrieval without changing neither surgical approach nor the anesthesiological support. We believe that all the pediatric urology centers should know the procedure and have small size balloon catheter available.
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Affiliation(s)
- Marcello Della Corte
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy -
| | - Elisa Cerchia
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Cristian Fiori
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Martina Mandaletti
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Elena Ruggiero
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Francesco Porpiglia
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Massimo Catti
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
| | - Simona Gerocarni Nappo
- Division of Pediatric Urology, Department of Pediatrics and Pediatric Specialties, Regina Margherita Children's Hospital, Turin, Italy
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Selvi I, Dönmez Mİ, Değirmenci E, Zoroğlu H, Ziylan O, Oktar T. Voiding Cystourethrogram Before Pyeloplasty: To Do or Not To Do? Urology 2024; 184:182-188. [PMID: 37866651 DOI: 10.1016/j.urology.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To assess the incidence of concomitant vesicoureteral reflux (VUR) in unilateral cases of ureteropelvic junction obstruction (UPJO) and to identify factors that predict VUR. METHODS Files of 381 pediatric patients who underwent unilateral pyeloplasty between 2000 and 2017 were retrospectively reviewed. A total of 270 patients with available data and ≥5 years of follow-up were eligible for this study. Demographic parameters, preoperative hydronephrosis grade, renal pelvis anteroposterior diameter (APD), renal parenchymal thickness (PT), split renal functions on MAG-3 scan and VUR status were noted. The patients were divided into two groups: those with concomitant VUR (group I, n: 24, 8.9%) and those without VUR (group II, n: 246, 91.1%). RESULTS Among 270 patients (205 boys, 75.9%) with a median age of 4 months (2-98), 197 (72.9%) had antenatal hydronephrosis. Median follow-up was 11 years (5-22). Among 24 patients with concurrent VUR, 6 (25%) had grade II VUR, whereas grade III-V VUR was detected in 18 (75%). Of these, 12 (50%) had ipsilateral VUR, 3 (12.5%) had contralateral, and 9 (37.5%) had bilateral VUR. In a median 137-month follow-up, spontaneous VUR resolution was observed in 6 (25%) patients, whereas 15 (62.5%) patients underwent endoscopic subureteral injection and 3 (12.5%) patients ureteroneocystostomy, respectively. Preoperative APD [35.5, (Inter Quantile Range) IQR (27.6-36.0) vs 26.5 IQR (25.0-35.0), P = .004] were significantly higher in group I, whereas group I had significantly lower PT [3.7, IQR (3.4-6.4) vs 5.8 IQR (4.4-6.1), P = .026]. Predictive factors for concomitant VUR were presentation with febrile UTI (odds ratio (OR): 2.769, P = .048), PT <3.95 mm (OR: 1.367, P = .043), and APD >28.8 mm (OR: 1.035, P = .001). CONCLUSION Our results indicated that concomitant VUR and UPJO might be detected in 1 out of every 11 patients undergoing pyeloplasty, while some type of surgical intervention for VUR was required in 75% of these patients. Thus, voiding cystourethrogram prior to pyeloplasty may be limited in those presenting with febrile urinary tract infection, having higher APD and lower PT on preoperative urinary ultrasonography.
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Affiliation(s)
- Ismail Selvi
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - M İrfan Dönmez
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey.
| | - Enes Değirmenci
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Hatice Zoroğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Orhan Ziylan
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Tayfun Oktar
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey; Koç University, School of Medicine, Department of Urology, Istanbul, Turkey
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Elbakry AA, Abdelhalim A, Al-Omar O. Tips and tricks for the extravesical robotic-assisted laparoscopic ureteral reimplantation for pediatric vesicoureteral reflux. J Pediatr Urol 2023; 19:816-817. [PMID: 37524572 DOI: 10.1016/j.jpurol.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/02/2023]
Abstract
Over the past few years, robotic-assisted laparoscopic ureteral reimplantation (RALUR) has gained popularity as an acceptable alternative for the traditional open approach if surgery is elected for children with vesicoureteral reflux (VUR). We present our technique including the tips and tricks for both male and female patients, including a stepwise approach for ureteral identification in female patients depending on the level of technical difficulty. Our series include 30 patients who represent a spectrum in which we presented the different tips and tricks included in this video.
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Affiliation(s)
- Amr A Elbakry
- Division of Pediatric Urology, Department of Urology, West Virginia University Hospital, Morgantown, WV, USA.
| | - Ahmed Abdelhalim
- Division of Pediatric Urology, Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
| | - Osama Al-Omar
- Division of Pediatric Urology, Department of Urology, West Virginia University Hospital, Morgantown, WV, USA
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19
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Comez I, Ucar T, Telli O, Gunaydin B, Silay MS. Does previous endoscopic subureteric injection (STING) effect the outcomes of robot-assisted laparoscopic ureteral reimplantation surgery (RALUR) in children? J Pediatr Urol 2023; 19:800.e1-800.e6. [PMID: 37607849 DOI: 10.1016/j.jpurol.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND There is lack of evidence on the success of robot-assisted laparoscopic ureteral reimplantation (RALUR) for the treatment of vesicoureteral reflux (VUR) who had prior intervention. OBJECTIVE This study aimed to evaluate the effect of previous unsuccessful STING on the outcomes of RALUR in children. STUDY DESIGN A total of 67 children treated with RALUR by a single surgeon for the treatment of VUR were scanned between February 2018 and April 2022. Two patients were excluded from the final data analysis due to the presence of a megaureter. Patients were divided into two groups: those with a history of STING (Group A - n:14) and those without STING (Group B - n:51). Patient characteristics, previous numbers of injections, console time, total operative time, perioperative and postoperative complications and clinical success data were collected. Clavien Dindo and Satava complication scales were used as the standard record of peri and postoperative complications. Radiographic success was defined as absence of reflux detected on postoperative voiding cystourethrography, whereas clinical success was defined as the absence of a febrile urinary tract infection during the follow-up. Mann-Whitney U and Chi-square tests and Fisher exact test were used where appropriate. RESULTS A total of 36 (55.3%) female versus 29 (44.6%) male patients were operated for 96 refluxive ureters. Nearly half of the patients were with bilateral VUR (n = 31). The mean follow-up was 20.2 ± 15.4 months. The median age of patients was 59 ± 31 (range: 28-132 months) versus 46 ± 33.1 (range: 7-206 months) for groups A and B respectively (p = 0.22). Gender, age, peri- and postoperative complication rates, and clinical success were comparable between the two groups. The median operative time and the console time was significantly higher in children with history of STING (op time: 142.5 ± 27.4 versus 120 ± 24.9 min (p = 0.008), console time: 117.5 ± 28.2 versus 100 ± 24.5 min (p = 0.011) for groups A and B, respectively. A total of six complications (9.2%) occurred with none of them were greater than Clavien grade 3b. The overall clinical success rate was 97%, with 2 cases of clinical failure. In both cases, VCUG demonstrated absence of VUR. DISCUSSION The outcomes of our study provided that RALUR is effective with more than 95% success rates despite failed endoscopic injection procedures. CONCLUSION The previous history of STING neither changes the success nor the complication rates of RALUR. However, this can lead to more challenging surgery by increasing the total operative times.
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Affiliation(s)
- Ilker Comez
- Memorial Hospitals Group, Urology, Istanbul; Uskudar University, Medical Faculty, Department of Urology, Istanbul, Turkey
| | - Taha Ucar
- Nigde Omer Halis Demir University Research and Training Hospital, Department of Urology, Turkey
| | - Onur Telli
- Memorial Hospitals Group, Urology, Istanbul
| | - Bilal Gunaydin
- Nigde Omer Halis Demir University, Department of Urology, Turkey
| | - M Selcuk Silay
- Memorial Hospitals Group, Urology, Istanbul; Biruni University, Department of Urology, Istanbul, Turkey.
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Ye ZL, Zhang LH, Zhu L, Chen WJ, Xu D, Lin N. Application of contrast-enhanced ultrasound in the surgical treatment of vesicoureteral reflux in children. Pediatr Surg Int 2023; 40:10. [PMID: 38006461 PMCID: PMC10676299 DOI: 10.1007/s00383-023-05605-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND To determine the utility of contrast-enhanced voiding urography (CeVUS) in the treatment of vesicoureteral reflux (VUR) through ureterovesical reimplantation in children. METHODS A total of 159 children with recurrent urinary tract infections were selected for CeVUS and voiding cystourethrography (VCUG) from December 2018 to December 2020, among whom 78 patients were eventually diagnosed with VUR. Overall, 60 pyelo-ureteric units (PUUs) were operated according to surgical indications. Accordingly, we determined the general clinical characteristics of all children, obtained two-dimensional ultrasound images, assessed the reflux status of children using the contrast-enhanced technique, and compared the obtained results via CeVUS and VCUG. Both imaging modalities were reperformed at 6, 12, and 18 months after surgery to evaluate postoperative outcomes. In particular, we assessed the consistency of the evaluation and calculated the diagnostic efficacy of CeVUS for different levels of reflux at different time points. RESULTS CeVUS showed considerable efficacy in the diagnosis of children with VUR. Notably, the diagnostic results of both CeVUS and VCUG achieved high agreement, with a kappa value of 0.966 (P < 0.001). The results of our follow-up at different stages and evaluation of postoperative efficacy revealed that CeVUS possessed substantial diagnostic efficacy and good consistency with VCUG. CONCLUSION CeVUS is an accurate and safe examination, with considerable clinical significance for diagnosing VUR in children, determining the treatment approach, conducting follow-up during treatment, and evaluating subsequent treatment outcomes.
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Affiliation(s)
- Zhao Lan Ye
- Department of Ultrasound, Fujian Provincial Hospital, No.134, East Street, Fuzhou, Fujian, China
| | - Li Hua Zhang
- Department of Ultrasound, Fujian Provincial Hospital, No.134, East Street, Fuzhou, Fujian, China
| | - Lin Zhu
- Department of Ultrasound, Fujian Provincial Hospital, No.134, East Street, Fuzhou, Fujian, China
| | - Wei Ji Chen
- Department of Ultrasound, Fujian Provincial Hospital, No.134, East Street, Fuzhou, Fujian, China
| | - Di Xu
- Pediatric Surgery, Fujian Provincial Hospital, No.134, East Street, Fuzhou, Fujian, China
| | - Ning Lin
- Department of Ultrasound, Fujian Provincial Hospital, No.134, East Street, Fuzhou, Fujian, China.
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Davis E, Hinkley D, Quiring ME, Hamby T, Reyes KJ, Pinto K. Utility of preoperative urine cultures and cystoscopies before ureteral reimplantation in pediatrics. Urologia 2023; 90:709-714. [PMID: 37002702 DOI: 10.1177/03915603231166722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Ureteral reimplantation remains the primary surgical method used for patients with vesicoureteral reflux (VUR). Cystoscopy is commonly performed first to visualize anatomy and rule out possible abnormalities. Urine cultures may also be obtained. The objective of this study is to evaluate the prudency of preoperative urine cultures and cystoscopies in pediatric patients undergoing ureteral reimplantation. METHODS Pediatric urologists were surveyed regarding collecting urine cultures in asymptomatic patients and cystoscopies before reimplantation. A retrospective review was also conducted of patients who underwent ureteral reimplantation for VUR between March 2018 and April 2021 at Cook Children's Medical Center. RESULTS When physicians were asked the frequency they obtain urine cultures before reimplantation on asymptomatic patients, 36% said "never" and 38% said "always." Regarding cystoscopy, 53% said "never" and 32% said "always." Inclusion criteria were met by 101 patients. Cystoscopies were performed in 46 patients and never altered the reimplantation. There were 20 preoperative, 90 intraoperative, and 61 postoperative urine cultures. Complications were associated with positive cultures of urine collected intraoperatively and postoperatively only. CONCLUSION Cystoscopies and asymptomatic urine cultures obtained before ureteral reimplantation provide no additional benefit while increasing cost for patients' families. Further research is needed to thoroughly identify the prudency of such practices in ureteral reimplantation for VUR.
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Affiliation(s)
- Erin Davis
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Dawson Hinkley
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Mark E Quiring
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Tyler Hamby
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
- Department of Research Operations, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Kristy J Reyes
- Department of Research Operations, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Kirk Pinto
- Department of Urology, Cook Children's Medical Center, Fort Worth, TX, USA
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Molinaro F, Nascimben F, Todesco C, Fusi G, Chiarella E, Planchamp T, Cobellis G, Abbo O, Messina M, Angotti R. Robotic approach to the uretero-vesical junction in children: An international multicentric retrospective study. Int J Med Robot 2023; 19:e2539. [PMID: 37260098 DOI: 10.1002/rcs.2539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Robot-assisted approach to UVJ is getting more and more used in pediatric patients. METHODS In this retrospective study 26 patients affected by nephro-urological malformations, robotic-surgically treated from 2016 and 2021 at 3 Pediatric Surgery Department were included: 3 (11.5%) primary obstructive megaureter, 2 (7.7%) dysplastic kidneys, 3 (11.5%) duplex collecting system, 18 (69.2%) primary vescico-ureteral reflux (VUR). RESULTS Mean age at surgery was 6 years old. 22 (84.6%) underwent Lich Gregoire extravesical ureteral reimplantation, 4 (15.4%) total nephroureterectomy. Mean operative time was 230 min. No conversions or intraoperative complications. Median hospital stay was 4 days. There were 4 (15.38%) postoperative complications: 3 (11.54%) persistent VUR and 1 (3.84%) refluxing megaureter. 2 (7.7%) redo-surgery. CONCLUSIONS Robotic Surgery should be considered a safe and effective technique for treatment of UVJ anomalies in children, because it firstly allows surgeons to approach both upper and lower ureteral ends without modifying trocars' placement.
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Affiliation(s)
- Francesco Molinaro
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | - Francesca Nascimben
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | - Camilla Todesco
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
- Pediatric Surgery, Salesi Children Hospital, Università Politecnica Delle Marche, Ancona, Italy
| | - Giulia Fusi
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
- Service de Chirurgie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Elisa Chiarella
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | | | - Giovanni Cobellis
- Pediatric Surgery, Salesi Children Hospital, Università Politecnica Delle Marche, Ancona, Italy
| | - Olivier Abbo
- Service de Chirurgie Pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Mario Messina
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
| | - Rossella Angotti
- Department of Medical Sciences, Surgery and Neuroscience, Section of Pediatric Surgery, University of Siena, Siena, Italy
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Patil N, Javali T, Kadamba PS. Primary repair vs Delayed staged repair in infants with primary obstructive megaureters and their long term outcomes - A single centre experience. J Pediatr Urol 2023; 19:640.e1-640.e9. [PMID: 37468395 DOI: 10.1016/j.jpurol.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/19/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND There is paucity of literature in the management of infants with primary obstructive megaureters undergoing upfront primary repair with an extravesical technique of ureteral re implantation (with or without ureteral tailoring). OBJECTIVE To compare 2 different approaches in the management of infants with unilateral primary obstructive megaureters. STUDY DESIGN This was a retrospective analysis of a prospectively maintained data base between 2005 and 2021. Infants <1 year with unilateral primary obstructive megaureter were included. They were divided into 2 groups: those who underwent an upfront extravesical ureteric reimplantation with or without ureteral tailoring during infancy -Primary Repair (PR), and those who initially underwent a low end cutaneous ureterostomy during infancy followed by take down of ureterostomy and intravesical ureteric reimplantation after 1 year of age -Delayed staged repair (DSR). Children presenting with sepsis, in whom a diversion was imperative, were excluded. All children were followed up annually after their definitive repair with a renal ultrasound, diuretic renogram, estimated glomerular filtration rate and assessment of voiding dysfunction if present. The 1st year and 3rd year follow up details were collated and analysed. Failure was defined as persistent obstructive pattern on renogram with worsening differential renal function or presence of high grade reflux with recurrent breakthrough urinary tract infection; both of which necessitated a redo reimplantation following the definitive surgery. RESULTS There were 18 infants in Primary repair and 16 infants in Delayed Staged Repair. Urinary tract infections was the commonest presenting symptom amongst both groups i.e. > 50%.The post operative complication rate was 11% in Primary repair and 31% in Delayed Staged Repair. One child in each of the groups (2 girls) required redo reimplantation (5.8%). At the end of the 3rd year follow up (from the definitive repair) there was significant reduction in the hydronephrosis, improvement in the differential renal function with no evidence of obstruction and improvement in the estimated glomerular filtration rate amongst all in both groups which was statistically significant i.e. p < 0.05. The success rate was 94.4% in Primary Repair and 93.75% in Delayed Staged Repair. The mean follow up was 9.7 years amongst those undergone Primary Repair and 9 years amongst those undergone Delayed Staged Repair. DISCUSSION AND CONCLUSION Primary extravesical ureteral reimplantation may be considered as the preferred line of management of unilateral obstructed megaureters during infancy.
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Affiliation(s)
- Neehar Patil
- Department of Paediatric Surgery and Urology, Ramaiah Medical College and Hospital, Bangalore, 560054, India.
| | - Tarun Javali
- Department of Urology, Ramaiah Medical College and Hospital, Bangalore, 560054, India.
| | - Padmalatha S Kadamba
- Department of paediatric surgery, Ramaiah Medical College and Hospital, Bangalore, 560054, India.
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24
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Smith BR, Smith CJ, Sharma K, Sheth KR. Factors of transurethral incision effectiveness for ureteroceles in pediatric patients: A 28-year, single-institution retrospective review. J Pediatr Urol 2023; 19:536.e1-536.e8. [PMID: 37002026 DOI: 10.1016/j.jpurol.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND As a congenital anomaly, ureteroceles occur in 1 in 4000 children, and are usually diagnosed prenatally. However, there remains a lack of definite consensus on the optimal management of congenital ureteroceles. OBJECTIVE We evaluated factors associated with success of primary transurethral incision (TUI) in ureterocele pediatric patients. METHODS Demographic and clinical information for 120 pediatric patients who were diagnosed with congenital ureterocele between 1993 and 2021 at our institution were obtained through retrospective chart review. Data were analyzed using Fisher's exact tests, t-tests, and logistic regression with a significance threshold of p < 0.05. The primary outcome of ureterocele management was TUI effectiveness, defined by no need for further surgical intervention. RESULTS Of the 120 patients (39 boys, 81 girls) with ureteroceles, 75 patients (22 boys, 53 girls) met our inclusion criteria of undergoing initial TUI ureterocele. Initial TUI was effective in 51/75 patients (68.0%). We analyzed possible correlative factors for TUI efficacy. Simplex system was a significant predictor of primary TUI efficacy (85% effective in simplex systems, 62% in duplex systems). Prior urinary tract infection, prenatal diagnosis, and electrocautery technique were all associated with an increased risk of needing additional surgeries after primary TUI. DISCUSSION The most significant predictors of effective primary TUI were simplex system and the absence of preoperative vesicoureteral reflux. Prenatal diagnosis, preoperative febrile urinary tract infection, higher preoperative hydronephrosis grade, and the use of electrocautery were all associated with decreased primary TUI efficacy. Study limitations include that it was a retrospective chart review, and cohort size was limited by incomplete urology follow-up and operative records. CONCLUSIONS Initial TUI was an effective procedure for the majority of our pediatric ureterocele patients, a higher success rate compared to other cohorts. Patients with a simplex system were more likely to have an effective first TUI than patients with duplex systems, as were patients without preoperative reflux. Although not statistically significant, our data suggest prior UTI, prenatal diagnosis, higher preoperative hydronephrosis grade, and the use of electrocautery may be associated with having additional surgeries.
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Affiliation(s)
- Brian R Smith
- Department of Urology, Stanford University School of Medicine, 750 Welch Rd, Suite 218, Palo Alto, CA 94304, USA.
| | - Courtney J Smith
- Department of Genetics, Stanford University School of Medicine, 318 Campus Drive, Stanford, CA 94305, USA.
| | - Kritika Sharma
- Department of Urology, Stanford University School of Medicine, 750 Welch Rd, Suite 218, Palo Alto, CA 94304, USA.
| | - Kunj R Sheth
- Department of Urology, Stanford University School of Medicine, 750 Welch Rd, Suite 218, Palo Alto, CA 94304, USA.
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25
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Zhang Y, Zhang Y, Jiang J, Zhang K, Sun Q, Chao M. Clinical outcomes and risk factor analysis of early endoscopic puncture decompression for ureterocele associated with duplex kidney in children: a single-center retrospective study. Int Urol Nephrol 2023; 55:2373-2379. [PMID: 37393384 PMCID: PMC10499972 DOI: 10.1007/s11255-023-03694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/25/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE The aims of this study were to analyze the clinical outcomes of treating duplex system ureteroceles with early endoscopic puncture decompression and to identify the risk factors related to outcomes to help guide future work. MATERIALS AND METHODS We retrospectively reviewed the clinical records of patients with ureteroceles with duplex kidney that were treated with early endoscopic puncture decompression. Charts were reviewed for demographics, preoperative imaging, surgical indications, and follow-up data. Recurrent febrile urinary tract infections (fUTIs), de novo vesicoureteral reflux (VUR), persistent high-grade VUR, unrelieved hydroureteronephrosis, and the need for further intervention were considered unfavorable outcomes. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), type of ureterocele, ipsilateral VUR diagnosed before surgery, simultaneously upper-pole moiety (UM) and lower-pole moiety (LM) obstruction, the width of ureter affiliated to UM, and maximum diameter of ureterocele were all considered potential risk factors. A binary logistic regression model was used to identify the risk factors of unfavorable outcomes. RESULTS A total of 36 patients with ureteroceles related to duplex kidney underwent endoscopic holmium laser puncture from 2015 to 2023 at our institution. After a median follow-up of 21.6 months, unfavorable outcomes developed in 17 patients (47.2%). Three patients underwent ipsilateral common-sheath ureter reimplantation and one patient underwent laparoscopic ipsilateral upper to lower ureteroureterostomy combined with recipient ureter reimplantation. Three patients underwent laparoscopic upper-pole nephrectomy. Fifteen patients suffered from recurrent UTIs were treated with oral antibiotics and eight of them were diagnosed de novo VUR according to voiding cystourethrography (VCUG). In univariate analysis, patients with simultaneously UM and LM obstruction (P = 0.003), fUTIs before surgery (P = 0.044), and ectopic ureterocele (P = 0.031) were more likely to have unfavorable outcomes. Binary logistic regression analysis showed that ectopic ureterocele (OR = 10.793, 95% CI 1.248-93.312, P = 0.031) and simultaneously UM and LM obstruction (OR = 8.304, 95% CI 1.311-52.589, P = 0.025) were identified as independent factors for unfavorable outcomes. CONCLUSIONS Our study suggested that early endoscopic puncture decompression is not a preferred but an available treatment option to release BOO or to cure refractory UTIs. It was easier to fail if the ureterocele was ectopic or simultaneously UM and LM obstruction existed. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), ipsilateral VUR diagnosed before surgery, the width of ureter affiliated to UM, and maximum diameter of ureterocele were not significantly related to the success rate of early endoscopic punctures.
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Affiliation(s)
- Ye Zhang
- Anhui Provincial Children's Hospital, Anhui, China
| | - Yin Zhang
- Anhui Provincial Children's Hospital, Anhui, China
| | - Jiabin Jiang
- Anhui Provincial Children's Hospital, Anhui, China
| | | | - Qihang Sun
- Anhui Provincial Children's Hospital, Anhui, China
| | - Min Chao
- Anhui Provincial Children's Hospital, Anhui, China.
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Garcia-Aparicio L, Martin-Sole O, Capdevila-Vilaro B, Perez-Bertolez S. Long-term outcome of randomized clinical trial between polyacrylate-polyalcohol copolymer (PPC) and dextranomer-hyaluronic acid copolymer (Dx/HA) as bulking agents for endoscopic treatment of primary vesicoureteral reflux (VUR). World J Urol 2023; 41:2855-2859. [PMID: 37584692 DOI: 10.1007/s00345-023-04548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/23/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVE The aim of our study is to compare long-term outcome of endoscopic treatment of VUR using PPC or Dx/HA. PATIENTS AND METHODS From October 2014 to April 2017 patients with VUR grades from 3 to 5 that needed endoscopic treatment were eligible for this RCT. Patients were randomized in two groups: PPC and Dx/HA. A VCUG was performed at 6 months; if VUR > 3 was still present a second ET was performed. We included for this long-term follow-up study those patients that were successfully treated at short-term follow-up. At 36 months postoperative VCUG was performed to assess outcome. Success was considered if postoperative VUR grade was 0 at 36 months, and there was no ureteral obstruction. RESULTS In the previous study, 60/73 ureters were successfully treated in 36/44 patients, and then we have analyzed 60 ureters in 36 patients. Three patients were lost in long-term follow-up, and then we analyzed 57 ureters in 33 patients divided. PPC group 18 patients (28 ureters); and Dx/HA group 15 patients (29 ureters). After 3 years of follow-up the VCUG showed a success rate of 26/28 of RU in PPC and 26/29 of DX/HA. Two RU in PPC group had ureteral obstruction, and then the successful rate for PPC group dropped to 24/28. The overall successful rate at long-term was 72.7% of the RU in PPC group and 70.3% in Dx/HA group. CONCLUSION PPC and Dx/HA has similar long-term outcome in VUR resolution, but ureteral obstruction could be present at long-term follow-up in PPC group.
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Affiliation(s)
- Luis Garcia-Aparicio
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu 2, 08950, Barcelona, Spain.
| | - Oriol Martin-Sole
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu 2, 08950, Barcelona, Spain
| | - Blanca Capdevila-Vilaro
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu 2, 08950, Barcelona, Spain
| | - Sonia Perez-Bertolez
- Pediatric Urology Division, Pediatric Surgery Department, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu 2, 08950, Barcelona, Spain
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27
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Hewitt IK, Montini G, Marks SD. Vesico-ureteric reflux in children and young people undergoing kidney transplantation. Pediatr Nephrol 2023; 38:2987-2993. [PMID: 36279046 PMCID: PMC10432351 DOI: 10.1007/s00467-022-05761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Abstract
Vesico-ureteric reflux (VUR) into transplanted kidneys in children and young people is a common occurrence, found in 19 to 60% of those who had an anti-reflux procedure and up to 79% in the absence of such a procedure. While VUR is unlikely to be of concern without evidence of symptomatic urinary tract infections, less certainty exists regarding outcomes when the VUR is associated with urinary tract infection (UTI) and transplant pyelonephritis. Issues explored will include additional risk factors that might predispose to UTI, any effect of pyelonephritis on acute and long-term kidney allograft function and practical strategies that may reduce the prevalence of infection.
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Affiliation(s)
- Ian K Hewitt
- Perth Children's Hospital, Monash Avenue, Nedlands, WA, Australia
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via della Commenda 9, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
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Yang LY, Chou CM, Huang SY, Chen HC. Successful rescue pneumovesicoscopic surgery for post-Deflux ® vesicoureteral junction obstruction. Pediatr Surg Int 2023; 39:254. [PMID: 37642740 DOI: 10.1007/s00383-023-05538-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Vesicoureteral junction (VUJ) obstruction after Deflux® subureteral injection for vesicoureteral reflux (VUR) is rare and minimally invasive management has not been reported. This work investigated the patients who underwent Deflux® injection for VUR and identified those with subsequent VUJ obstruction. METHODS Medical records of matched patients from October 2003 to March 2022 were reviewed, and parameters were retrospectively studied. All patients underwent Deflux® injection. The injection was performed under general anesthesia using the same manner. For patients complicated with VUJ obstruction, the symptoms, signs, management, images, renal ultrasounds, Tc-99m dimercaptosuccinic acid renal scintigraphy, histology of VUJ region, and outcomes were documented and reported. VUJ stenosis was diagnosed by performing renal ultrasound and magnetic resonance imaging. RESULTS Totally 407 patients (554 ureterorenal units) received Dx/HA injections for VUR. VUJ obstruction was found in three patients (four ureterorenal units). Originally, three were grade V VUR, and one was grade IV. The repeated injection was not a risk factor for VUJ obstruction. The overall incidence of VUJ obstruction post-Dx/HA injection was 0.7% by ureter. The incidences were 0%, 0.75%, and 2.25% for grade I-III, IV, and V VUR, respectively. After the initial conversion case of pneumovesicoscopic ureteral reimplantation, the procedure was performed smoothly and successfully in the two following cases. CONCLUSIONS Pneumovesicoscopic ureteral reimplantation offers an alternative for VUJ obstruction following Dx/HA injection for VUR. Fibrosis and foreign-body reaction may influence the feasibility. High-grade VUR and young age of injection were related to VUJ obstruction.
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Affiliation(s)
- Li-Yu Yang
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, 1650, Sec. 4, Taiwan Boulevard, Taichung, 407219, Taiwan
| | - Chia-Man Chou
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, 407219, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 402202, Taiwan
| | - Sheng-Yang Huang
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, 407219, Taiwan.
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 402202, Taiwan.
| | - Hou-Chuan Chen
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, 407219, Taiwan
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Carlucci M, Damasio MB, Parodi S, Anfigeno L, Caprioli S, Ottolenghi S, Piaggio G, Fiorenza V, Mattioli G. Does the distal ureteral diameter ratio (UDR) matter in the surgical management of vesicoureteral reflux in children? Pediatr Surg Int 2023; 39:249. [PMID: 37589822 DOI: 10.1007/s00383-023-05535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To evaluate UDR reliability, sensitivity, specificity and to identify the best treatment basing on UDR among single or double endoscopic injections and ureteral reimplantation. METHODS Data of patients affected by primary VUR and treated by endoscopic injection over a 10 years period were retrospectively analyzed. Two radiologist attributed reflux grade and UDR on voiding cystourethrogram twice and blinded. Follow-up focused on resolution after 1 or 2 endoscopic injections. Relation between UDR, reflux grade and outcomes were analyzed. RESULTS Patient enrolled were 198. Low grade VUR was present in 24.8%, grade 3 in 41.6%, grade 4-5 in 33.6%. Resolution after one injection was obtained in 88 patients; among 110 not resolved 104 cases had a second injection. Success after 2 injections was reported in 138 cases. UDR showed a higher reliability compared with reflux grade both in intra than inter-reader measurement (ICC > 90%). Success after 1 or 2 injections was reported for UDR < 0.33 and UDR < 0.47 respectively. CONCLUSION UDR shows to be a more reliable measurement that allows for an objective estimation of VUR severity and prognosis. It represents a quantitative parameter that might be useful to identify patients who may benefit endoscopic or surgical treatment, avoiding unnecessary under or over-treatment.
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Affiliation(s)
- Marcello Carlucci
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy.
| | - Maria B Damasio
- Pediatric Radiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Parodi
- Statistic and Epidemiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lorenzo Anfigeno
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Simone Caprioli
- Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Sara Ottolenghi
- Radiology Unit, ASL2, Santa Corona di Pietra Ligure Hospital, Pietra Ligure, Italy
| | - Giorgio Piaggio
- Pediatric Nephrology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Venusia Fiorenza
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Unit, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16147, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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Paraboschi I, Giannettoni A, Mantica G, Polymeropoulos A, Mishra P, Clothier J, Garriboli M. Posterior Urethral Valves, Unilateral Vesicoureteral Reflux, and Renal Dysplasia (VURD) Syndrome: Long-Term Longitudinal Evaluation of the Kidney Function. Int J Environ Res Public Health 2023; 20:6238. [PMID: 37444086 PMCID: PMC10341772 DOI: 10.3390/ijerph20136238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
The presence of unilateral vesicoureteral reflux (VUR), and renal dysplasia associated with posterior urethral valves (PUV) (VURD syndrome) was believed to represent a pressure-released pop-off mechanism protecting kidney function. We aimed to investigate its role with respect to long-term kidney function in a cross-sectional and longitudinal analysis. We compared the iohexol glomerular filtration rate (GFR) measured at 5 (GFR5) and 10 (GFR10) years of age in children with (Group A) and without (Group B) VURD syndrome, who underwent PUV resection under 2 years of age. VURD syndrome was diagnosed in cases of unilateral loss of kidney function (<15% on nuclear medicine test) associated with ipsilateral grade IV-V VUR. VURD syndrome was diagnosed in 16 (12.8%) out of 125 patients who met the inclusion criteria. While the median GFR5 was similar in the 2 groups [Group A: 87.3 (74.7-101.2) mL/min/1.73 m2 vs. Group B: 99.6 (77-113) mL/min/1.73 m2, p-value: 0.181], the median GFR10 values were significantly lower in children with VURD syndrome [Group A: 75.7 (71.2-85.9) mL/min/1.73 m2 vs. Group B: 95.1 (81.2-114.2) mL/min/1.73 m2, p-value: 0.009]. Similar results were obtained in a longitudinal analysis of the children with GFR measurement available both at 5 and 10 years of age [GFR5 in Group A: 93.1 (76.9-103.5) mL/min/1.73 m2 vs. Group B: 97.5 (80-113) mL/min/1.73 m2, p-value: 0.460; GFR10: Group A: 71.9 (71.9-85.9) mL/min/1.73 m2 vs. Group B: 94.8 (81.5-110.6) mL/min/1.73 m2, p-value: 0.024]. In conclusion, VURD syndrome does not show a protective role in kidney function preservation. On the contrary, it seems to be associated with a deterioration of the kidney function on a long-term follow-up.
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Affiliation(s)
- Irene Paraboschi
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy
| | - Adele Giannettoni
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Guglielmo Mantica
- Department of Urology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Alexios Polymeropoulos
- Department of Statistics ad Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Pankaj Mishra
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Joanna Clothier
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Massimo Garriboli
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London WC1N 1EH, UK
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Cianci MC, Tocchioni F, Mantovani A, Ghionzoli M, Morini F. Unexpected Pediatric Uretero-Inguinal Hernia: Case-Report and Literature Review. Urology 2023; 176:178-182. [PMID: 36841359 DOI: 10.1016/j.urology.2023.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/27/2023]
Abstract
Uretero-inguinal hernia (UIH) is a rare condition in children. We present our experience with an unexpected UIH in a male infant with associated anomalies and a literature review of pediatric cases. A full-term male newborn was referred to our hospital for microcolon and right hydroureteronephrosis. Voiding cystourethrography showed grade-IV right vesicoureteral reflux and a dilated, convoluted, ureter protruding in the right inguinal canal, suggesting a right UIH, which was uneventfully repaired at 2 months of life. UIH is a rare type of inguinal hernia in children that pediatric urologists and surgeons should be aware of. In experienced hands, and when preoperatively suspected, surgical management is safe and effective.
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Affiliation(s)
- Maria Chiara Cianci
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy; Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Francesca Tocchioni
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Alberto Mantovani
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Francesco Morini
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy; Neonatal Surgery Unit, Meyer Children's Hospital IRCCS, Florence, Italy
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Babajide R, Andolfi C, Kanabolo D, Wackerbarth J, Gundeti MS. Postoperative hydronephrosis following ureteral reimplantation: Clinical significance and importance of surgical technique and experience. J Pediatr Surg 2023; 58:574-579. [PMID: 35918238 DOI: 10.1016/j.jpedsurg.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Though common, postoperative hydronephrosis (POHN) following ureteroneocystostomy raises concern for an underlying obstruction. We aimed to determine the clinical significance of POHN following open (OUR) or robotic (RALUR) ureteral reimplantation. METHODS We retrospectively reviewed pediatric patients who underwent ureteral reimplantation for vesicoureteral reflux (VUR) from 2008 to 2019 by a single surgeon. Baseline characteristics, operative outcomes, and trends in POHN were assessed. POHN was defined as new onset hydronephrosis or exacerbation of pre existing hydronephrosis. Renal ultrasounds were performed 1, 4, and 12 months postoperatively. Voiding cystourethrograms were performed 4 months postoperatively. Surgical experience for RALUR cases was defined as number of ureters operated over time. RESULTS Altogether, 93 patients (127 ureters) underwent RALUR and 19 patients (26 ureters) underwent OUR. POHN was found in 27.6% and 30.8% of ureters after RALUR and OUR, respectively. Rate and time to POHN resolution for RALUR (91.4%, 112 days) and OUR (75%, 211 days) were statistically similar. Odds of POHN after RALUR were directly related with preoperative VUR grade (Range OR: 2.82[2.26-3.52]) and surgical experience (Range OR: 8.88[7.16-11.02]). Surgical experience was inversely related with odds of VUR recurrence (Range OR: 0.41[0.32-0.54]). Rates of VUR resolution were comparable for OUR and RALUR patients. No patient required additional intervention for POHN. CONCLUSIONS Incidence and resolution rate of POHN after OUR and RALUR were similar. Higher VUR grades were associated with increased odds of POHN after RALUR. Increasing RALUR experience improved VUR resolution rate but increased odds of POHN. Surgical success rates were similar for RALUR and OUR. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rilwan Babajide
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Ciro Andolfi
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Diboro Kanabolo
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Joel Wackerbarth
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Mohan S Gundeti
- Section of Urology, The University of Chicago Pritzker School of Medicine, Chicago, IL, United States; Director Pediatric Urology, Comer Children's Hospital: The University of Chicago Medicine & Biological Sciences, 5841 S. Maryland | P- 217 | MC 7122, Chicago, IL 60637, United States.
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Escolino M, Kalfa N, Castagnetti M, Caione P, Esposito G, Florio L, Esposito C. Endoscopic injection of bulking agents in pediatric vesicoureteral reflux: a narrative review of the literature. Pediatr Surg Int 2023; 39:133. [PMID: 36806763 PMCID: PMC9938816 DOI: 10.1007/s00383-023-05426-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/21/2023]
Abstract
In the last 20 years, endoscopic injection (EI) has affirmed as a valid alternative to open surgery for management of pediatric vesicoureteral reflux (VUR). This study aimed to investigate and discuss some debated aspects such as indications, bulking agents and comparison, techniques of injection and comparison, predictive factors of success, use in specific situations. EI is minimally invasive, well accepted by patients and families, with short learning curve and low-morbidity profile. It provides reflux resolution rates approaching those of open reimplantation, ranging from 69 to 100%. Obviously, the success rate may be influenced by several factors. Recently, it is adopted as first-line therapy also in high grade reflux or complex anatomy such as duplex, bladder diverticula, ectopic ureters. The two most used materials for injection are Deflux and Vantris. The first is absorbable, easier to inject, has lower risk of obstruction, but can lose efficacy over time. The second is non-absorbable, more difficult to inject, has higher risk of obstruction, but it is potentially more durable. The two main techniques are STING and HIT. To date, the ideal material and technique of injection has not yet clearly established, but the choice remains dependent on surgeon's preference and experience.
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Affiliation(s)
- Maria Escolino
- Pediatric Surgery Unit, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
| | - Nicolas Kalfa
- Pediatric Surgery Unit, University Hospital of Montpellier, Montpellier, France
| | | | - Paolo Caione
- Pediatric Urology Unit, Salvator Mundi International Hospital, Rome, Italy
| | | | - Luisa Florio
- Pediatric Surgery Unit, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy
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Liu S, Lu R, Guo Y, Xiucheng G. Laparoscopic triple-ureteral ureteroureterostomy in a patient with ureteral triplication: A case report. Medicine (Baltimore) 2022; 101:e31580. [PMID: 36343058 PMCID: PMC9646508 DOI: 10.1097/md.0000000000031580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
RATIONALE Ureteral triplication (UT) is a very rare disorder, with a challenging diagnosis and varied therapeutic methods. In the past, the treatment usually involved heminephrureterectomy of the stunted moiety. Here, we reported a case of complete UT that was treated by laparoscopic triple-ureteral ureteroureterostomy (UU). PATIENT CONCERNS A 2-year-old girl presented with frequent urine incontinence. Intravenous pyelography and voiding cystourethrography revealed a 3-segment left kidney with pelvi-ureteric dilation of the upper and middle moieties and grade IV to V vesicoureteral reflux. Laparoscopic triple-UU was successfully performed in the child, after which vesicoureteral reflux and urinary incontinence disappeared completely, hydronephrosis was improved, and hemirenal resection was avoided. DIAGNOSIS Based on the imageological examination results, the final diagnosis of the 2-year-old girl was as follows: left 3 renal pelvis with complete ureteral duplication, combined with upper and middle hydronephrosis, and upper and middle vesicoureteral reflux grade IV to V. INTERVENTION Laparoscopic triple-ureteral ureteroureterostomy was performed under general anesthesia. OUTCOMES The patient recovered smoothly without complications after surgery. At 6 months follow-up, ultrasonography of the urinary system showed that hydronephrosis of the dilated kidney segment was attenuated. LESSONS Laparoscopic triple-ureteral UU was successful in our patient. For children with duplex kidney and multiple ureteral duplications, minimally invasive urinary tract reconstruction can be a suitable intervention.
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Affiliation(s)
- Saisai Liu
- From the Division of Pediatric Urology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Rugang Lu
- From the Division of Pediatric Urology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
- * Correspondence: Rugang Lu, Children’s Hospital of Nanjing Medical University, 72 Guangzhou Road, Gulou District, Nanjing, Jiangsu Province 210008, China (e-mail: )
| | - Yunfei Guo
- From the Division of Pediatric Urology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Gao Xiucheng
- From the Department of Radiology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Pérez Costoya C, Gómez Farpón A, Paz Aparicio A, Pontón Martino B, Parada Barcia A, Álvarez Muñoz V, Granell Suárez C. Usefulness of intraoperative voiding cystourethrogram as an indicator of success in the endoscopic treatment of vesicoureteral reflux. Cir Pediatr 2022; 35:135-140. [PMID: 35796086 DOI: 10.54847/cp.2022.03.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Up until now, serial voiding cystourethrogram (SVCU) has been regarded as the gold standard technique in the diagnosis of vesicoureteral reflux (VUR). The aim of intraoperative SVCU during endoscopic treatment is to detect those patients eligible to receive more biosynthetic material as a result of persistent VUR. The objective of this study was to assess the usefulness of SVCU as a predictor of treatment success. MATERIALS AND METHODS An analytical, retrospective study of patient medical records was carried out. Patients included had undergone endoscopic VUR surgery from 2000 to 2019, and they were measured in ureteral units. VUR persistence at intraoperative SVCU following treatment was compared with SVCU results after 3 months. RESULTS Of a total of 167 ureteral units undergoing surgery, persistent reflux immediately after surgery was observed in 17 cases (10% of the sample). Only 3 cases had other urological malformations. In the SVCU carried out after 3 months, reflux was found in 38% of the sample (64 cases). When comparing the results, intraoperative SVCU demonstrated a specificity of 92.6%, and a sensitivity of 15.6%. CONCLUSIONS Given the low sensitivity (15.6%) of intraoperative SVCU to detect cases of persistent reflux in the mid-term, and considering the risks associated with radiation in the pediatric population - which is extremely sensitive to it -, intraoperative SVCU should be ruled out as a useful indicator of endoscopic treatment success.
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Affiliation(s)
- C Pérez Costoya
- Pediatric Surgery Department. Asturias Central University Hospital. Oviedo (Spain)
| | - A Gómez Farpón
- Pediatric Surgery Department. Asturias Central University Hospital. Oviedo (Spain)
| | - A Paz Aparicio
- Anesthesiology Department. Asturias Central University Hospital. Oviedo (Spain)
| | - B Pontón Martino
- Pediatric Surgery Department. Asturias Central University Hospital. Oviedo (Spain)
| | - A Parada Barcia
- Pediatric Surgery Department. Asturias Central University Hospital. Oviedo (Spain)
| | - V Álvarez Muñoz
- Pediatric Surgery Department. Asturias Central University Hospital. Oviedo (Spain)
| | - C Granell Suárez
- Pediatric Surgery Department. Asturias Central University Hospital. Oviedo (Spain)
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Kogan MI, Sizonov VV. [Bradis anti-reflux ureterocysto-anastomosis in children with recurrent obstructive megaureter]. Urologiia 2022:5-10. [PMID: 35485808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Congenital ureterovesical junction (UVJ) obstructions quite rarely serve as an indication for ureteral reimplantation, and recurrent obstructions resulting from surgical treatment are even less frequent. Cases of acquired UVJ obstruction following endoscopy and ureteral reimplantation done for vesicoureteral reflux correction are fairly rare. The lack of known publications analyzing treatment of recurrent obstructive megaureter predetermines topicality of our research. PURPOSE Evaluate the efficiency and safety of extravesical anti-reflux uretero-cysto-anastomosis performed using Bradis technique for children with recurrent obstructive megaureter (OM). MATERIALS AND METHODS The work is based on the experience of surgical OM correction in 5 children aged 1 to 4 years, 4 boys and a girl with a recurrent UVJ obstruction following prior ureteral reimplantation for correction of UVJ obstruction (4 children) or vesicoureteral reflux (1 patient). Antenatal UVJ obstruction had been diagnosed in 2 patients. In all cases the examination included urine analysis, its culture study, ultrasonography of the kidneys and urinary tracts, dynamic renal scintigraphy, micturating cystography, and, where indicated, intravenous urography and SCT of the kidneys. All patients underwent Bradis extravesical reimplantation. RESULTS During postoperative care period, a considerable reduction of the dilatation of renal collecting system was accomplished in all five patients along with the differential renal function preserved on the pre-surgery level and a steady remission of urinary tract infection based on clinical manifestations and laboratory findings. CONCLUSIONS The simplicity of Bradis extravesical ureteral reimplantation represents its advantage over intravesical methods. Extravesical approach allows easy ureteral length and width correction. Limited experience of Bradis surgery in pediatric cases of recurrent OM requires confirmation with further randomized clinical trials.
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Affiliation(s)
- M I Kogan
- Rostov State Medical University of the Russian Federation Ministry of Public Health, Rostov-on-Don, Russia
- Rostov Regional Childrens Clinical Hospital, Rostov-on-Don, Russia
| | - V V Sizonov
- Rostov State Medical University of the Russian Federation Ministry of Public Health, Rostov-on-Don, Russia
- Rostov Regional Childrens Clinical Hospital, Rostov-on-Don, Russia
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Rudin YE, Marukhnenko DV, Galitskaya DA, Aliev JK, Lagutin GV, Vardak AB. Pneumovesicoscopic ureteral reimplantation with intravesical tailoring of obstructive megaureter in pediatric patient. J Pediatr Urol 2022; 18:224.e1-224.e8. [PMID: 34991990 DOI: 10.1016/j.jpurol.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/06/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION According to available data, there are only few articles describing pneumovesicoscopic (PNV) ureteral reimplantation (UR) for obstructive megaureter without tailoring and with ex vivo tailoring in children. AN OBJECTIVE To present our experience of the PNV UR using intravesical ureteral tailoring for symptomatic primary obstructive megaureter in children. STUDY DESIGN Between 2014 and 2020, 42 patients (mean age: 3.1 years) underwent a correction of primary obstructive megaureter (POM) via a vesicoscopic approach. Nine of them with the megaureter (diameter > 25 mm) underwent the intravesical ureteral tailoring. The analysis included only 9 patients who underwent intravesical tailoring of the ureter using the original technique. The dilated ureter is fixed intravesical by the loop in extended position. This simplifies the tailoring step of the ureter. The tailoring is performed by continuous suture (Star). RESULTS 43 UR were analyzed (1 bilateral, 1 with diverticulum, 1 with ureterocele). The mean operative time was 142 min (83-235 min). The mean manipulation time for intravesical tailoring of the megaureter was 18 min. After the surgery, the average kidney function doesn't reduce. We observed an increase in renal function by an average of 7% in three patients after the surgery. One patient required a conversion. It was in the early stages of mastering the technique. All patients underwent US 1-3 weeks 3-6-12 months after the operation, the size of the pelvic system and ureter decreased. Eight patients are asymptomatic, and only one has the clinical changes (a persistent leukocyturia, the size of the pelvic-ureteric segment, and the ureter remain unchanged or increased). According to the VCUG vesicoureteral reflux was detected in this case. An endoscopic correction used successful. DISCUSSION This possibility of applying our technique is confirmed according to folow-up data and should be used in other researches. The drainage of the ureter with an external stent for 1 month helps to form properly the neo-ureterovesical anastomosis and to prevent episodes of ureteral obstruction as a result the incidence of urinary tract infections reduces in the postoperative period. CONCLUSIONS The use of the Tuohy needle with the loop simplifies the fixation of the ureter. This helps to make the intravesical tailoring of the megaureter easier and faster. It is original and less traumatic for the ureter than existing methods.
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Affiliation(s)
- Yu E Rudin
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
| | - D V Marukhnenko
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
| | - D A Galitskaya
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation.
| | - J K Aliev
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
| | - G V Lagutin
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
| | - A B Vardak
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology - Branch of the National Medical Research Centre of Radiology of Ministry of Health of Russian Federation, Russian Federation
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García M, Casal I, Somoza I, Dargallo T. [Factors involved in the success or failure of endoscopic treatment in paediatric primary vesicoureteral reflux: A systematic review.]. ARCH ESP UROL 2021; 74:836-850. [PMID: 34726615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The objective of this paper isidentifying the factors that may condition the success or failure of endoscopic therapy for vesicoureteral reflux in the paediatric population.MATERIAL AND METHODS: A bibliographic review was performed in the Cochrane Library and PUBMED of all the studies which the principal subject was about identifying factors involved in the success or failure of endoscopic therapy for vesicoureteral reflux in the paediatric population. RESULTS Of a total of 1410 studies, 14 studies and17 factors potentially involved in the success or failure of endoscopic therapy were fully analysed according to the different studies reviewed. After analyzing these studies, we identified that the most widely accepted factors that determine the success or failure of endoscopic therapy are the high degree of pre-surgical reflux, the previous injection of antireflux material, the surgical experience and the presence of dysfunction of the lower urinary tract (UTD). Other factors such as the amount of bulking substance used, meatal morphology, renal damage and age at the time of injection could be potentially involved. The technique used and the bulking material do not seem to be associated with the response to therapy. Exists a great heterogeneity of the reviewed studies, both in relation to the characteristics of the patients included, criteria and surgical technique and evaluation of results. CONCLUSIONS The degree of pre-surgical reflux, the presence of UTD, previous injections and surgical experience are the most widely accepted determining factors in the results of endoscopic therapy according to the different studies published in this topic.
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Affiliation(s)
- Miriam García
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica. Complejo Hospitalario Universitario de A Coruña. Hospital materno-infantil Teresa Herrera. A Coruña. España
| | - Isabel Casal
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica. Complejo Hospitalario Universitario de A Coruña. Hospital materno-infantil Teresa Herrera. A Coruña. España
| | - Iván Somoza
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica. Complejo Hospitalario Universitario de A Coruña. Hospital materno-infantil Teresa Herrera. A Coruña. España
| | - Teresa Dargallo
- Servicio de Cirugía Pediátrica, Sección de Urología Pediátrica. Complejo Hospitalario Universitario de A Coruña. Hospital materno-infantil Teresa Herrera. A Coruña. España
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Tokat E, Gurocak S, Ozkan S, Dogan HS, Citamak B, Satar N, Izol V, Deger M, Sarikaya S, Bostanci Y, Gulsen M, Onal B, Altinay Kirli E, Burgu B, Soygur T, Haciyev P, Agras K, Karabulut B, Akbal C, Akin Sekerci C, Demirci D, Baydilli N, Tekgul S, Ozgur Tan M. Clinical practice in vesicoureteral reflux with respect to EAU guidelines: A multicenter study. Int J Clin Pract 2021; 75:e14339. [PMID: 33966353 DOI: 10.1111/ijcp.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/04/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to European Association of Urology (EAU) Guidelines in Urology clinics of our country. MATERIALS AND METHODS The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to vesicoureteral reflux (VUR) (between years 2003 and 2017) in nine different institutions. Patients were divided into two groups according to time of initial treatment and also grouped according to risk factors by "EAU guidelines on VUR." RESULTS In this series, 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (P = .046, P = .0001, respectively), while success rates were not significantly different in high risk group (P = .46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (P = .096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (P = .000 and P = .0001, respectively) after 2013. Overall success rates of endoscopic treatments and ureteroneocystostomy (UNC) operations were 65% and 92.9% before 2013 and 60% and 78.5% after 2013, respectively. Thus, the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013 (P = .000), while the difference was not significant in the injection group (P = .076). CONCLUSION Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups despite these reliable and accepted guidelines were expected to influence our daily approach.
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Affiliation(s)
- Eda Tokat
- Department of Urology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Serhat Gurocak
- Department of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Secil Ozkan
- Department of Public Health, Gazi University School of Medicine, Ankara, Turkey
| | - Hasan Serkan Dogan
- Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Burak Citamak
- Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nihat Satar
- Department of Urology, Cukurova University School of Medicine, Adana, Turkey
| | - Volkan Izol
- Department of Urology, Cukurova University School of Medicine, Adana, Turkey
| | - Mutlu Deger
- Department of Urology, Cukurova University School of Medicine, Adana, Turkey
| | - Saban Sarikaya
- Department of Urology, Samsun Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Yakup Bostanci
- Department of Urology, Samsun Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Murat Gulsen
- Department of Urology, Samsun Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Bulent Onal
- Department of Pediatric Urology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Elif Altinay Kirli
- Department of Pediatric Urology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Tarkan Soygur
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Perviz Haciyev
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Koray Agras
- Department of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Bilge Karabulut
- Department of Pediatric Urology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Trainig and Research Hospital, Ankara, Turkey
| | - Cem Akbal
- Department of Urology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Cagri Akin Sekerci
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Deniz Demirci
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Numan Baydilli
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Serdar Tekgul
- Department of Pediatric Urology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mustafa Ozgur Tan
- Department of Pediatric Urology, Gazi University School of Medicine, Ankara, Turkey
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Yağız B, Demirel BD. Ureteral reimplantation aligned laparoscopically: Pneumovesicoscopic Politano-Leadbetter reimplantation in children. J Pediatr Urol 2021; 17:413.e1-413.e8. [PMID: 33637456 DOI: 10.1016/j.jpurol.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/26/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ureteroneocsytostomy is a well-established procedure for correction of certain ureterovesical conditions like vesicoureteral reflux and ureterevesical obstruction. Amazing developments in technology paved the way for minimally invasive surgery and conventional procedures are increasingly being performed minimal invasively during the recent decades. Although Politano-Leadbetter ureteroneocystostomy is an anatomical repair, lost its popularity against Cohen's technique as it is more challenging to perform and requires extravesical dissection which may increase the complication rates. OBJECTIVE In this study, we evaluated our results and feasibility of laparoscopic intravesical (pneumovesicoscopic) repair of certain ureterovesical conditions by Politano-Leadbetter principle in children. STUDY DESIGN Twenty one children who underwent pneumovesicoscopic uretero-neocystostomy are enrolled in the study. Surgical procedure is described and surgical duration, complications, conversion rate and success rates are evaluated. RESULTS Fourteen (67%) of the patients were girls and 7 were boys (33%). Median age at operation was 6 years (1.5-15 years). Main indications for surgery were vesicoureteral reflux, megaureter and bladder diverticulum. Fourteen of the patients underwent bilateral (67%) intervention while the 5 left (24%) and 2 right (9%). Four patients were converted to open surgery (16%; 4/25). Median surgical duration was 265 min (190-320 min) for bilateral and 180 min (115-260 min) for unilateral procedures. Success rates confirmed by a contrast study were 92% for VUR. DISCUSSION It appears that minimally invasive intravesical surgery fails to keep up with the other minimally invasive procedures secondary to restricted working field in the bladder, technically demanding procedures and well-documented high succes rates of open counterpart techniques. Although developing relatively slower, minimally invasive technology offers better vision, better cosmesis, lesser pain and lesser tissue disturbance. Although cross-trigonal reimplantation is the most popular technique, Politano-Leadbetter technique provides an anatomical alignment of ureters and is a good option for caudally located ectopic ureters. In our study, pneumovesicoscopic approach provided anatomical reimplantation, identification and sparing of vas deferens and better cosmesis. Major limitations of our study are the limited number of cases, longer operation times, higher complication rates and short follow up duration which we hope to improve with increasing experience. CONCLUSION Although not brilliant as its open counterpart yet, initial results of pneumovesicoscopic reimplantation with Politano-Leadbetter technique is promising and growing experience would further improve the results and lower the complication and conversion rates.
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Affiliation(s)
- Beytullah Yağız
- Dr Sami Ulus Gynecology, Obstetrics and Child Health And Diseases Training and Research Hospital, Department of Pediatric Surgery and Pediatric Urology, Beştepeler Mah, Alparslan Türkeş Cad. No: 27 06560, Beştepe, Ankara, Turkey; Ondokuz Mayıs University, Department of Pediatric Surgery Division of Pediatric Urology, Ondokuz Mayıs Üniversitesi Kurupelit Kampüsü, Atakum, Samsun, 55270, Turkey.
| | - Berat Dilek Demirel
- Ondokuz Mayıs University, School of Medicine, Department of Pediatric Surgery, Ondokuz Mayıs Üniversitesi Kurupelit Kampüsü, Atakum, Samsun, 55270, Turkey.
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Kogan MI, Belousov II, Krasulin VV, Gusev AA. [Extravesical reimplantation of heavily-dilated ureters according to Bradi technique]. Urologiia 2021:56-60. [PMID: 34251102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Surgery of the ureterovesical anastomoses lesions in case of weakly-dilated ureters is well developed by the Cohen and Lich-Grgoire techniques. However, there are no generally accepted approaches for heavily-dilated ureters. The experience of creating ureterocystoneoanastomosis according to the Bradi technique (1975) for the first time in the literature is presented. MATERIALS AND METHODS The authors modification of the Bradi technique was used in 12 patients of both sexes with a dilated ureters diameter of more than 10 mm. Two cases of refluxogenic and 10 cases of obstructive megaureter were operated on 2010-2019. The follow-up period was 1-10 years. All patients underwent resection of the ureter in width. RESULTS No intraoperative complications were noted. One case of acute pyelonephritis with acute urinary retention was noted as postoperative complications. All patients showed a decrease in dilatation of the pyelocaliceal system and ureter according to multispiral computed tomography after 6 months of follow-up. Two patients had vesicoureteral reflux of the first degree. Glomerular filtration rates decreased in 41.7% of cases after 12 months of follow-up. No recurrence of urinary tract infection and stenosis of the anastomosis was detected for 1-10 years monitoring. CONCLUSION The Bradi technique along with the Hodgsons ureter reconstruction provides superior results for heavily-dilated ureters in adults.
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Affiliation(s)
- M I Kogan
- Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - I I Belousov
- Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - V V Krasulin
- Rostov State Medical University, Rostov-on-Don, Russian Federation
| | - A A Gusev
- Rostov State Medical University, Rostov-on-Don, Russian Federation
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Rudin YE, Marukhnenko DV, Galitskaya DA, Lagutin GV, Aliev KK, Vardak AB. [The opportunities of pneumovesicoscopic approach for correction of disorders of vesicoureteral junction in children]. Urologiia 2021:95-102. [PMID: 33818943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND pneumovesicoscopic approach gives new possibilities for endovideosurgical correction of congenital ureteral and bladder pathology. AIM To increase the efficiency of ureteral reimplantation in patients with vesicoureteral reflux (VUR), obstructive megaureter and bladder pathology by using pneumovesicoscopic access. MATERIALS AND METHODS For the period 2014 - 2020 a total of 52 children aged from 10 months up to 15 years (median 2.5 years) were treated. In all patients, pneumovesicoscopic ureteral reimplantation according to the Cohen technique was performed, and in six cases bilateral procedure was done. 30 patients with obstructive megaureter (32 ureters) were treated, and intravesical suturing with ureteral plication was performed in 9 patients. Reimplantation for grade 3-5 VUR was performed in 22 patients (26 ureters), in combination with excision of the bladder diverticulum was done in 3 patients, while 3 children were undergone to simultaneous excision of the ureterocele. An original technique for fixation of the mobilized dilated ureter with a ligature to the bladder neck is proposed to simplify its intravesical suturing according to the Starr technique. RESULTS The mean operation time was 142 (83-235 minutes). Conversion to open surgery was required in 1 (1.9%) child during the learning curve. The length of stay was 5-6 days, with an average of 5.21 days. According to ultrasound data, after 1, 3, 6 months there was a decrease in the size of the collecting system and ureter in all cases. At cystography after 6-12 months, VUR was detected in 3 (5.7%) children: in 2 (9%) patients with grade 3-5 VUR and in 1 (3.3%) patient with obstructive megaureter and ureteral suturing. CONCLUSION Pneumovesicoscopic access for ureteral reimplantation in patients with VUR, obstructive megaureter, bladder diverticulum and ureterocele has proven its efficiency and reliability with a minimal complication rate (5.7%). Our proposed method of fixing the mobilized ureter with a ligature to the bladder neck helps to simplify the suturing of the ureter and to shorten the operation time.
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Affiliation(s)
- Yu E Rudin
- N.A. Lopatkin Research Institute of Urology and Interventional Radiology branch of the National Medical Research Radiological Center, Moscow, Russia
| | - D V Marukhnenko
- N.A. Lopatkin Research Institute of Urology and Interventional Radiology branch of the National Medical Research Radiological Center, Moscow, Russia
| | - D A Galitskaya
- N.A. Lopatkin Research Institute of Urology and Interventional Radiology branch of the National Medical Research Radiological Center, Moscow, Russia
| | - G V Lagutin
- N.A. Lopatkin Research Institute of Urology and Interventional Radiology branch of the National Medical Research Radiological Center, Moscow, Russia
| | - K K Aliev
- N.A. Lopatkin Research Institute of Urology and Interventional Radiology branch of the National Medical Research Radiological Center, Moscow, Russia
| | - A B Vardak
- N.A. Lopatkin Research Institute of Urology and Interventional Radiology branch of the National Medical Research Radiological Center, Moscow, Russia
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Roupakias S, Sinopidis X, Spyridakis I, Tsikopoulos G, Karatza A, Varvarigou A. Endoscopic Injection Treatment of Vesicoureteral Reflux in Children: Meeting with the Factors Involved in the Success Rate. Acta Medica (Hradec Kralove) 2021; 64:193-199. [PMID: 35285440 DOI: 10.14712/18059694.2022.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The challenges and controversies in vesicoureteral reflux intervention guidelines resulted in a more individualized treatment planning. Endoscopic injection therapy is now widely used and is considered preferable, but still remains less successful than ureteral reimplantation. Τhe endoscopic vesicoureteral reflux approach should be risk-adapted to current knowledge, so more experience and longer-term follow-up are needed. The precise of preoperative, intraoperative, and postoperative factors that affecting endoscopic injection therapy success rates and outcome have not yet been clearly determined. The aim of this study was to investigate these associated factors. Although the reflux grade is the most well-known factor that can affect the success of the procedure, there is no agreement on which factors are the most influential for the efficacy of endoscopic reflux treatment. So, we carried out a broad review of published papers on this topic, and we presented all the potential predictive variables of endoscopic reflux resolution in children.
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Affiliation(s)
- Stylianos Roupakias
- Department of Pediatric Surgery, University of Patras Medical School, Patra, Greece.
| | - Xenophon Sinopidis
- Department of Pediatric Surgery, University of Patras Medical School, Patra, Greece
| | - Ioannis Spyridakis
- Department of Pediatric Surgery, Aristotelian University of Thessaloniki Medical School, Thessaloniki, Greece
| | - George Tsikopoulos
- Department of Pediatric Surgery, Hippocrateion General Hospital, Thessaloniki, Greece
| | - Ageliki Karatza
- Department of Pediatrics, University of Patras Medical School, Patra, Greece
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Babu R, Chandrasekharam VVS. A systematic review and meta-analysis comparing outcomes of laparoscopic extravesical versus trans vesicoscopic ureteric reimplantation. J Pediatr Urol 2020; 16:783-789. [PMID: 33023851 DOI: 10.1016/j.jpurol.2020.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE When considering treatment for vesico ureteric reflux via inimally invasive surgery there is a dilemma to choose between laparoscopic extravesical (LEVUR) and transvesicoscopic (TVUR) ureteric reimplantation. In this systematic review and meta-analysis we have analyzed the articles on LEVUR and TVUR and compared the outcomes. METHODS We searched the databases to identify all papers pertaining to TVUR and LEVUR in the pediatric population. Duplicate publications, review articles, incomplete articles and robotic assistance were excluded. Systematic review was performed to identify patient data, reflux grades, laterality, duration of surgery, time to discharge, success rate and complications. Meta-analysis of heterogeneity was reported with I 2 statistics. Once heterogeneity was found low, the pooled outcomes were compared with students t test and Fishers exact test, wherever appropriate. RESULTS After screening a total of 45 articles, 23 articles were included (13 articles on TVUR and 10 articles on LEVUR). The I 2 statistics for TVUR and LEVUR showed low heterogeneity with I 2 of 0% (95% C.I 0-37%) and 25% (95% C.I 0-64%) respectively. With low heterogeneity both were suitable to be considered to have been conducted under similar conditions with possibility of using fixed effect model. The percentage of Grade 5 VUR was significantly higher (p = 0.001; X 2) in TVUR (11.9%) compared to LEVUR (2.2%). The proportion of bilateral reimplantation was significantly higher (p = 0.001; X 2) in TVUR compared to LEVUR (summary table). The success rate of LEVUR was significantly higher at 96.7% compared to TVUR at 93.7% (p = 0.007 X 2). Unilateral/Bilateral TVUR took significantly longer duration of surgery (155/194 min vs 107/161 min) compared to LEVUR (p = 0.001; Fishers). The mean (s.d) time to discharge was longer at 3.2 (1.6) days for TVUR compared to 1.6 (0.4) days for LEVUR (p = 0.001; Fishers). The complication rate was comparable, 7.35% for TVUR and 5.35% for LEVUR (p = 0.167; X 2). DISCUSSION In this meta-analysis we found that LEVUR had shorter operating time, higher success, and shorter hospital stay compared to TVUR. A probable explanation could be higher number unilateral VURs and lower number of grade 5 VUR cases in LEVUR group. Both the techniques had comparable overall complication rate: LEVUR had more post-operative urinary retention while TVUR had more port-related problems.
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Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education & Research, Chennai, 600116, India.
| | - V V S Chandrasekharam
- Department of Pediatric Surgery, Pediatric Urology & MAS, Ankura Children's Hospital, Hyderabad, India
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Abstract
Almost 30 years have passed since the inception of minimally invasive surgery in urology and specifically in pediatric urology. Laparoscopy has now become an essential tool in the pediatric urologic armamentarium. The application of robot-assisted surgery in pediatrics has allowed for widespread utilization for common reconstructive procedures such as pyeloplasty and ureteral reimplantation. Understanding the implementation, technical considerations, and outcomes are critical for continued success and adoption. This has allowed for increased use in more complex urologic procedures such as redo pyeloplasty, dismembered ureteral reimplantation, catheterizable channel creation, and bladder augmentation.
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Affiliation(s)
- Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Arun Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Desai TJ, Shah AA, Smith MT, Zderic SA, Long CJ. Management of Vesicoureteral Reflux in a Patient With Recurrent Febrile Urinary Tract Infections, Neurogenic Bladder, and Ureteral Triplication. Urology 2020; 148:264-266. [PMID: 32707269 DOI: 10.1016/j.urology.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/05/2020] [Indexed: 11/19/2022]
Abstract
Ureteral triplication is a rare anomaly with about 100 total cases reported in the literature. In this case presentation, we present a case of ureteral triplication in a young female with a history of neurogenic bladder secondary to L5 lipomeningocele who presented with recurrent febrile urinary tract infections (UTIs) and vesicoureteral reflux despite antibiotic prophylaxis. Given her high grade reflux, she underwent ureteral reimplantation which ultimately led to resolution of her UTIs and reflux. Later in her clinical course, toilet training unmasked additional bladder dysfunction and she was successfully managed with clean intermittent catheterization and anticholinergics. To the best of our knowledge, this is the first case report to describe ureteral triplication, recurrent febrile UTIs and vesicoureteral reflux in the setting of a concomitant neurogenic bladder with a successful outcome.
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Affiliation(s)
- Tej J Desai
- Department of Urology, University of Texas Health Science Center, San Antonio, TX.
| | - Ankur A Shah
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Matthew T Smith
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Stephen A Zderic
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Chris J Long
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
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Tran THT, Melamed J, Deng FM. Gastric Adenocarcinoma Arising in Gastrocystoplasty. Urology 2020; 148:270-273. [PMID: 32683064 DOI: 10.1016/j.urology.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/28/2020] [Accepted: 07/05/2020] [Indexed: 11/18/2022]
Abstract
Gastric cancer is a rare long-term complication in gastrocystoplasty. We report 2 cases of gastric adenocarcinoma and review the literature for similar cases. A total of 14 cases are identified. The majority of patients are males, presented with hematuria, and developed cancer at a younger age, more than 10 years after gastrocystoplasty. Long-term follow up information was limited, but 5 patients (36%) died within 5 years of diagnosis. Annual surveillance for malignancy may not be effective due to its rarity. However, symptomatic patients, particularly those 10 years after the surgery, warrant detailed evaluation to rule out neoplastic transformation.
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Affiliation(s)
- Tuyet Hong T Tran
- Department of Pathology, New York University Langone Health, New York, NY
| | - Jonathan Melamed
- Department of Pathology, New York University Langone Health, New York, NY
| | - Fang-Ming Deng
- Department of Pathology, New York University Langone Health, New York, NY.
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Luo J, Tan XH, Liu X, He DW, Lin T, Li XL, Wei GH. Anatomy and management of upper moiety vascular variation in children with duplex kidney. J Pediatr Surg 2019; 54:2130-2133. [PMID: 31072676 DOI: 10.1016/j.jpedsurg.2019.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/20/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the upper pole vascular anatomy of duplex kidney and provide our experience with laparoscopic upper pole partial nephrectomy (LUPPN). METHODS A retrospective study was performed among patients with duplex kidney who underwent computed tomography angiography at one single institution, some of whom were subsequently treated with LUPPN. According to imaging results and intraoperative findings, the arterial supply to the upper moiety of a duplex system was classified based on number and branching pattern. RESULTS A total of 84 children were included in the study. Twenty patients (23.8%) were managed conservatively and LUPPN in lateral position was performed in the others. All laparoscopic procedures were successfully completed as planned without conversion. No major intraoperative complications occurred. Of these patients, 68 cases (73.1%) were supplied with one branch of the renal artery. The vascular anatomy of duplex kidney was classified into three patterns according to the variation of arteries. In 71 cases (76.3%), the renal artery separated into two or more arteries near the renal parenchyma, called perihilar arterial branching. Other branching patterns featured accessory renal arteries and branches of the adrenal artery. Gender was not significantly associated with the vascular number (p = 0.19) and the pattern of variation (p = 0.83). CONCLUSIONS LUPPN is an effective technique for children with duplex kidney. The upper renal moiety is mainly supplied by one branch of the renal artery and the most common pattern is perihilar arterial branching. Determining vascular variation before surgery might be beneficial to avoid intraoperative hemorrhage and accidental vessel injury. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jin Luo
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Hui Tan
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Da-Wei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Liang Li
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
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49
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Dionise ZR, Gonzalez JM, Garcia-Roig ML, Kirsch AJ, Scales CD, Wiener JS, Purves JT, Routh JC. Parental Preferences for Vesicoureteral Reflux Treatment: A Crowd-sourced, Best-worst Scaling Study. Urology 2019; 128:71-77. [PMID: 30878684 PMCID: PMC6525647 DOI: 10.1016/j.urology.2019.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/14/2019] [Accepted: 01/31/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To quantitatively evaluate parental preferences for the various treatments for vesicoureteral reflux using crowd-sourced best-worst scaling, a novel technique in urologic preference estimation. METHODS Preference data were collected from a community sample of parents via 2 best-worst scaling survey instruments published to Amazon's Mechanical Turk online community. Attributes and attribute levels were selected following extensive review of the reflux literature. Respondents completed an object case best-worst scaling exercise to prioritize general aspects of reflux treatments and multiprofile case best-worst scaling to elicit their preferences for the specific differences in reflux treatments. Data were analyzed using multinomial logistic regression. Results from the object-case provided probability scaled values (PSV) that reflected the order of importance of attributes. RESULTS We analyzed data for 248 and 228 respondents for object and multiprofile case BWS, respectively. When prioritizing general aspects of reflux treatment, effectiveness (PSV = 20.37), risk of future urinary tract infection (PSV = 14.85), and complication rate (PSV = 14.55) were most important to parents. Societal cost (PSV = 1.41), length of hospitalization (PSV = 1.09), and cosmesis (PSV = 0.91) were least important. Parents perceived no difference in preference for the cosmetic outcome of open vs minimally invasive surgery (P = .791). Bundling attribute preference weights, parents in our study would choose open surgery 74.9% of the time. CONCLUSION High treatment effectiveness was the most important and preferred attribute to parents. Alternatively, cost and cosmesis were among the least important. Our findings serve to inform shared parent-physician decision-making for vesicoureteral reflux.
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Affiliation(s)
| | | | - Michael L Garcia-Roig
- Department of Pediatric Urology, Emory University and Children's Healthcare of Atlanta, Atlanta, GA
| | - Andrew J Kirsch
- Department of Pediatric Urology, Emory University and Children's Healthcare of Atlanta, Atlanta, GA
| | - Charles D Scales
- Division of Urology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - John S Wiener
- Division of Urology, Duke University Medical Center, Durham, NC
| | - J Todd Purves
- Division of Urology, Duke University Medical Center, Durham, NC
| | - Jonathan C Routh
- Division of Urology, Duke University Medical Center, Durham, NC.
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50
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Marzullo-Zucchet L, March-Villalba JA, Domínguez Hinarejos C, Polo Rodrigo A, Serrano-Durbá A, Boronat Tormo F. Usefulness of the classification of urinary dysfunction for the prognosis of the first endoscopic treatment of vesicoureteral reflux in children over the age of 3. Actas Urol Esp 2019; 43:212-219. [PMID: 30833101 DOI: 10.1016/j.acuro.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. MATERIAL AND METHODS: Ambispective cross-cutting study of a sample of 50 children. EXCLUSION CRITERIA previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry+electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. RESULTS: Mean age: 6.8±2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n=38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%). CONCLUSIONS Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR.
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Affiliation(s)
- L Marzullo-Zucchet
- Sección de Urología Infantil, Servicio de Urología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - J A March-Villalba
- Sección de Urología Infantil, Servicio de Urología, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | - C Domínguez Hinarejos
- Sección de Urología Infantil, Servicio de Urología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - A Polo Rodrigo
- Sección de Urología Infantil, Servicio de Urología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - A Serrano-Durbá
- Sección de Urología Infantil, Servicio de Urología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - F Boronat Tormo
- Sección de Urología Infantil, Servicio de Urología, Hospital Universitari i Politècnic La Fe, Valencia, España
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