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Rivetti G, Marzuillo P, Guarino S, Di Sessa A, La Manna A, Caldamone AA, Papparella A, Noviello C. Primary non-refluxing megaureter: Natural history, follow-up and treatment. Eur J Pediatr 2024; 183:2029-2036. [PMID: 38441661 PMCID: PMC11035438 DOI: 10.1007/s00431-024-05494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 11/06/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 04/23/2024]
Abstract
Primary non-refluxing megaureter (PMU) is a congenital dilation of the ureter which is not related to vesicoureteral reflux, duplicated collecting systems, ureterocele, ectopic ureter, or posterior urethral valves and accounts for 5 to 10% of all prenatal hydronephrosis (HN) cases. The etiology is a dysfunction or stenosis of the distal ureter. Most often PMU remains asymptomatic with spontaneous resolution allowing for non-operative management. Nevertheless, in selective cases such as the development of febrile urinary tract infections, worsening of the ureteral dilatation, or reduction in relative renal function, surgery should be considered. CONCLUSION Ureteral replantation with excision of the dysfunctional ureteral segment and often ureteral tapering is the gold-standard procedure for PMU, although endoscopic treatment has been shown to have a fair success rate in many studies. In this review, we discuss the natural history, follow-up, and treatment of PMU. WHAT IS KNOWN • PMU is the result of an atonic or stenotic segment of the distal ureter, resulting in congenital dilation of the ureter, and is frequently diagnosed on routine antenatal ultrasound. WHAT IS NEW • Most often, PMU remains asymptomatic and clinically stable, allowing for non-operative management. • Nevertheless, since symptoms can appear even after years of observation, long-term ultrasound follow-up is recommended, even up to young adulthood, if hydroureteronephrosis persists. • Ureteral replantation is the gold standard in case surgery is needed. In selected cases, however, HPBD could be a reasonable alternative.
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Affiliation(s)
- Giulio Rivetti
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Angela La Manna
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Anthony A Caldamone
- Division of Urology, Warren Alpert School of Medicine at Brown University/Hasbro Children's Hospital, Providence, RI, USA
| | - Alfonso Papparella
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Carmine Noviello
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
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Morizawa Y, Aoki K, Fukui S, Tomizawa M, Shimizu T, Onishi K, Hori S, Gotoh D, Nakai Y, Miyake M, Torimoto K, Fujimoto K, Otani T, Fujimoto K. Long-term follow-up of congenital hydronephrosis in a single-center study. Int J Urol 2024; 31:507-511. [PMID: 38205874 DOI: 10.1111/iju.15391] [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: 05/15/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES Many congenital hydronephroses spontaneously resolve. This study evaluated a long-term follow-up of more than 4 years of patients with congenital hydronephrosis at a single center. METHODS In total, 215 patients (286 kidneys) with congenital hydronephrosis were included. Hydronephrosis outcomes (resolution, improvement, and persistence) and time-to-outcome were evaluated. RESULTS Fourteen patients underwent early surgical intervention until the age of 2 years. A total of 189 congenital hydronephrosis cases (66%) showed resolution at a median of 16 months (interquartile range: 7-21 months) and 169 (80%) of 210 kidneys with grade I to II hydronephrosis showed resolution at a median of 14 months (interquartile range: 6-23 months). Of 76 kidneys with grade III to IV hydronephrosis, 24 (32%) showed resolution at a median of 29 months (interquartile range: 24-41 months), and 56 (74%) showed improvement to grade II or less at a median of 12 months (interquartile range: 5-23 months). Of the 76 kidneys with grade III to IV hydronephrosis, five required delayed pyeloplasty at a median of 66 months (interquartile range: 42-89 months). One patient was asymptomatic, with a marked worsening of hydronephrosis and decreased renal function 6 years after the resolution of hydronephrosis. CONCLUSIONS None of the patients with grade I to II hydronephrosis required surgical treatment, and a shorter follow-up may be sufficient. Grade III to IV severe hydronephrosis should be considered for a longer and more careful follow-up, given the possibility of asymptomatic exacerbation of hydronephrosis.
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Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
- Department of Pediatric Urology, Nara Prefecture General Medical Center, Nara, Nara, Japan
- Department of Urology, Okanami General Hospital, Iga, Mie, Japan
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan
| | - Katsuya Aoki
- Department of Pediatric Urology, Nara Prefecture General Medical Center, Nara, Nara, Japan
| | - Shinji Fukui
- Department of Urology, Yamato Takada Municipal Hospital, Yamato Takada, Nara, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Ken Fujimoto
- Department of Urology, Okanami General Hospital, Iga, Mie, Japan
| | - Takeshi Otani
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka, Mie, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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Anton Sagayanathan P, Goai XY, Loganathan A, Pridgeon S. Intrinsic ureteric obstruction secondary to endometriosis: a rare clinical entity causing obstructive uropathy and renal failure. BMJ Case Rep 2024; 17:e258026. [PMID: 38373806 PMCID: PMC10882363 DOI: 10.1136/bcr-2023-258026] [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: 02/21/2024] Open
Abstract
Ureteral endometriosis is rare and can be a silent clinical entity, which can potentially lead to serious complications such as obstructive uropathy, sepsis and renal failure. A high clinical suspicion is required especially in childbearing age groups due to non-specific presentation such as renal colic, recurrent urinary tract infection (UTI), renal failure or asymptomatic hydronephrosis.A woman in her 40s presented with febrile UTI and flank pain. She reportedly suffered from recurrent UTIs in the past. Initial workup revealed an infected, obstructed left renal collecting system with gross hydronephrosis and hydroureter to the distal ureter on a significant gynaecological background of severe endometriosis requiring hysterectomy in the past.CT showed chronic obstructive changes and soft tissue nodules within the renal pelvis with no radio-opaque stones. She underwent emergent ureteric stent insertion. Functional imaging demonstrated only 1% contribution of the left kidney with a preserved estimated glomerular filtration rate of 65 mL/min/1.73 m2Endoscopic evaluation of ureters found extensive soft tissue lesions throughout the dilated left collecting system with biopsy-confirmed endometriosis. Subsequently, she underwent laparoscopic nephroureterectomy due to extensive ureteric involvement and chronically obstructed non-functioning kidney. Histopathology demonstrated completely obstructing ureteral endometriosis.Ureteric obstruction secondary to endometriosis can be due to extrinsic or intrinsic disease. In addition to initial assessment with CT urogram MRI may be helpful to evaluate soft tissue thickening. Endoscopic assessment with ureteroscopy and biopsy is required for tissue diagnosis. Surgery is often the treatment of choice, ranging from ureteroureterostomy, ureteroneocystostomy or nephroureterectomy in severe cases.Ureteral endometriosis is a rare clinical entity, clinicians should remain vigilant about common presentations of this rare entity, early diagnosis and prompt treatment is crucial to prevent progression to renal failure.
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Affiliation(s)
| | - Xin Yi Goai
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | | | - Simon Pridgeon
- Department of Surgery, Cairns Hospital, Cairns, Queensland, Australia
- James Cook University, Townsville, Queensland, Australia
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Fwu CW, Barthold JS, Mendley SR, Bennett K, Chan K, Wilkins KJ, Parsa A, Norton JM, Eggers PW, Kimmel PL, Schulman IH, Kirkali Z. Epidemiology of Infantile Ureteropelvic Junction Obstruction in the US. Urology 2024; 183:185-191. [PMID: 37802192 PMCID: PMC10843281 DOI: 10.1016/j.urology.2023.09.024] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To describe sex- and diagnosis-specific comorbidities, outcomes, and secular trends associated with ureteropelvic junction obstruction (UPJO) in a large, real-world population diagnosed with hydronephrosis in infancy. MATERIALS AND METHODS We identified all infants ≤1 year old with ≥1 claim in the Optum Clinformatics 2007-2020 nationwide population database and used univariable and multivariable Cox regression analyses to estimate associations of demographic and clinical characteristics of infants with a UPJO diagnosis with surgical status. RESULTS Of 22,349 infants with hydronephrosis (1.1% of infants; males-1.4%, females-0.7%), 1722 (7.7%; 7.9%-males, 7.2%-females) had UPJO. Follow-up was ≥1 year in 1198 (70%) and ≥3 years in 555 (32%) cases, and UPJO repair was performed in 542 children (31.5%; 32.3%-males, 29.5%-females); 77.7% within 1 year and 97.3% within 3 years. UPJO repair was associated with prior urinary tract infection (UTI) (hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.12-1.76) and South (HR 1.42, 95% CI 1.14-1.78) or Midwest (HR 1.60, 95% CI 1.26-2.04) geographic region but did not change over time. CONCLUSION This population-based study provides a real-world view of postnatally diagnosed hydronephrosis, focusing on UPJO, for which 522 cases (∼1/3) had ≥3 years continuous coverage. UPJO-associated comorbidities were more common in females, and the frequencies of UPJO-associated surgery and comorbidities were higher than in other studies. Other than UTI, no other associated kidney or urinary tract diagnoses were associated with UPJO repair. We identified unique sex- and diagnosis-specific differences in associated comorbidities and interventions in children diagnosed with UPJO in the first year of life.
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Affiliation(s)
- Chyng-Wen Fwu
- Division of Public Health Research, Social & Scientific Systems, Inc., a DLH Holdings Corp Company, Atlanta, GA.
| | - Julia S Barthold
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Susan R Mendley
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Kara Bennett
- Division of Public Health Research, Social & Scientific Systems, Inc., a DLH Holdings Corp Company, Atlanta, GA.
| | - Kevin Chan
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Kenneth J Wilkins
- Biostatistics Program, Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Afshin Parsa
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Jenna M Norton
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Paul W Eggers
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Paul L Kimmel
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Ivonne H Schulman
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
| | - Ziya Kirkali
- Division of Kidney, Urologic & Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
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Kim DH, Park HS, Bang JS, Shin HJ, Yoon BJ, Kim S, Jeong JC, Park S, Lee T. Routine Ureteral Stenting in Kidney Transplant Reduces Postoperative Hydronephrosis and Percutaneous Ureteral Interventions: A Single-Center Experience. EXP CLIN TRANSPLANT 2024; 22:9-16. [PMID: 38284370 DOI: 10.6002/ect.2023.0349] [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: 01/30/2024]
Abstract
OBJECTIVES The effect of routine ureteral stenting on postoperative hydronephrosis and percutaneous ureteral intervention in kidney transplant remains unknown. This study aimed to evaluate the effects of routine ureteral stenting on hydronephrosis and percutaneous ureteral intervention and the cost benefit of ureteral stenting in kidney transplant. MATERIALS AND METHODS We retrospectively analyzed patients who underwent kidney transplant at a tertiary institution between 2005 and 2021. We adopted a ureteral stentingprotocol in2017, anda comparisonwas performed with previous patients without stents. RESULTS In total, 539 patients underwent kidney transplant(271 with stents [51.3%], 268 without stents [49.7%]). Hydronephrosis was detected in 16 cases (5.9%) and 30 cases (11.2%) of groups with and without stents,respectively (P = .041). Among patients with hydronephrosis, the number of patients who underwent percutaneous ureteral intervention was significantly lower in the stent group than in the nostent group (1 [6.25%] vs 10 [33.33%]; P= .014).Twenty patients (3.71%) experienced major urologic complications (19 [7.1%] in the no-stent group, and 1 [0.4%] in the stent group; P = .001). No significant differences between the groups were shown in the incidence of urinary tract infections within 3 months of transplant (24 [8.9%] vs 22 [8.2%]; P = .846). No differences were shown between the groups in ureterovesical anastomosis time (24.4 vs 24.03 min; P = .699) or 1-year graft survival (97% vs 97.8%; P = .803). The healthcare cost was significantly lower in the stent group than in the no-stent group by $1702.05 ($15000.89 vs $16702.95; P < .001). CONCLUSIONS Routine ureteral stenting in kidney transplant significantly decreased the incidence of postoperative hydronephrosis and percutaneous ureteral intervention. Stenting did notlead to increased urinary tract infections and was cost-effective.
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Affiliation(s)
- Dong-Hwan Kim
- >From the Department of Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
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Foryś A, Wroński J, Płaza M, Wisłowska M. Intestinal (pseudo-)obstruction and hydronephrosis - consider lupus. ARP Rheumatol 2024; 3:56-57. [PMID: 38558066 DOI: 10.63032/hiij8275] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Agnieszka Foryś
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Jakub Wroński
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Mateusz Płaza
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Małgorzata Wisłowska
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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Babu R, Venkatachalapathy E, Sai V. Re: Association of the Hydronephrosis Severity Score With Likelihood of Pyeloplasty. Urology 2023; 181:189. [PMID: 37598890 DOI: 10.1016/j.urology.2023.06.038] [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] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.
| | | | - Venkata Sai
- Department of Radiology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
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Taniguchi T, Yamamoto K, Tomita M, Iehara N. Renal tamponade in a patient with hydronephrosis-related Page kidney. CEN Case Rep 2023; 12:378-383. [PMID: 36856751 PMCID: PMC10620360 DOI: 10.1007/s13730-023-00779-6] [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] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
A 48-year-old woman presented with hyperreninemic hypertension and renal dysfunction and was diagnosed with hydronephrosis-related Page kidney. The pathophysiology was "renal tamponade", in which the kidney was compressed by the renal pelvis and Gerota's fascia, resulting in intrarenal microvascular ischemia. Ureteral stent placement promptly improved the hyperreninemic hypertension and renal dysfunction, and additional perirenal fluid drainage gradually improved these conditions. These observations indicated the following three points. First, renal compression-induced renin-angiotensin-aldosterone system upregulation plays an important role in the pathogenesis of Page kidney. Second, physicians should consider perirenal fluid drainage as a therapeutic option in addition to ureteral stenting in patients with hydronephrosis-related Page kidney. Third, bilateral perirenal subcapsular hematomas in this case could be caused by hydronephrosis. Hydronephrosis-induced intrarenal pressure elevation possibly caused chronic perirenal subcapsular hemorrhage at the vulnerable sites of the renal cortex and peeling of the renal capsule from the cortex, resulting in the bilateral massive subcapsular hematomas and Page kidney.
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Affiliation(s)
- Tomoki Taniguchi
- Department of Nephrology, Kyoto City Hospital, 1-2 Mibu Higashitakadacho, Nakagyo-Ku, Kyoto-Shi, Kyoto-Fu, Kyoto, 604-8845, Japan.
| | - Kojiro Yamamoto
- Department of Nephrology, Kyoto City Hospital, 1-2 Mibu Higashitakadacho, Nakagyo-Ku, Kyoto-Shi, Kyoto-Fu, Kyoto, 604-8845, Japan
| | - Mayumi Tomita
- Department of Nephrology, Kyoto City Hospital, 1-2 Mibu Higashitakadacho, Nakagyo-Ku, Kyoto-Shi, Kyoto-Fu, Kyoto, 604-8845, Japan
| | - Noriyuki Iehara
- Department of Nephrology, Kyoto City Hospital, 1-2 Mibu Higashitakadacho, Nakagyo-Ku, Kyoto-Shi, Kyoto-Fu, Kyoto, 604-8845, Japan
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Babu R, Venkatachalapathy E. Caveats of hydronephrosis severity scoring systems - Re: Introduction of mercaptoacetyltriglycine-suspected obstruction scoring system (MAG-SOS). J Pediatr Urol 2023; 19:662-663. [PMID: 37500321 DOI: 10.1016/j.jpurol.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Ramesh Babu
- Department of Pediatri Urology, Sri Ramachandra Institute of Higher Education & Research, India.
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Li J, Fu Y, Liu Q, Shen K, Yao R, Fu Y, Lu Y, Xie M, Jian W, Guo M, Dai L, Zhang W. Multiomics-based study of amniotic fluid small extracellular vesicles identified Moesin as a biomarker for antenatal hydronephrosis. Clin Transl Med 2023; 13:e1360. [PMID: 37531302 PMCID: PMC10395771 DOI: 10.1002/ctm2.1360] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023] Open
Affiliation(s)
- Jingzhi Li
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
- Hunan Engineering Research Center of Early Life Development and Disease PreventionChangshaChina
| | - Ying Fu
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics and State Local Joint Engineering Laboratroy for Anticancer DrugsXiangya Hospital, Central South UniversityChangshaChina
| | - Qiaoshu Liu
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
| | - Kuifang Shen
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
| | - Ruojin Yao
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
| | - Yimei Fu
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
| | - Yang Lu
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
- Hunan Engineering Research Center of Early Life Development and Disease PreventionChangshaChina
| | - Mingkun Xie
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
- Hunan Engineering Research Center of Early Life Development and Disease PreventionChangshaChina
| | - Wenyan Jian
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
| | - Ming Guo
- Department of Oncology, NHC Key Laboratory of Cancer Proteomics and State Local Joint Engineering Laboratroy for Anticancer DrugsXiangya Hospital, Central South UniversityChangshaChina
| | - Lei Dai
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
- Hunan Engineering Research Center of Early Life Development and Disease PreventionChangshaChina
| | - Weishe Zhang
- Department of ObstetricsXiangya Hospital Central South UniversityChangshaChina
- Hunan Engineering Research Center of Early Life Development and Disease PreventionChangshaChina
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Hester AG, Krill A, Shalaby-Rana E, Rushton HG. Initial observational management of hydronephrosis in infants with reduced differential renal function and non-obstructive drainage parameters. J Pediatr Urol 2022; 18:661.e1-661.e6. [PMID: 35989171 DOI: 10.1016/j.jpurol.2022.07.023] [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: 10/21/2021] [Revised: 04/03/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Hydronephrosis secondary to ureteropelvic junction (UPJ) obstruction is a common finding in infants with prenatally-diagnosed hydronephrosis and often results in pyeloplasty due to obstructive drainage parameters and/or renal function compromise. However, little is known regarding the natural history of hydronephrosis with reduced differential renal function (DRF) but non-obstructive drainage. OBJECTIVE We sought to explore our experience with initial observational management of these patients. STUDY DESIGN A retrospective review of our institutional database of all diuretic MAG-3 renal scans obtained between 2000 and 2016 was performed. We included patients with antenatally-detected unilateral hydronephrosis ≥ SFU grade 2, first MAG-3 scan prior to 18months of age, DRF <40% and post-furosemide half-time (T1/2) <20 min. Exclusion criteria were: hydroureter, VUR, solitary kidney, duplication anomalies. Outcomes of interest were a progression of T1/2 ≥ 20 min and/or further decline in DRF >5%. RESULTS Of 704 patients with unilateral hydronephrosis, 91 had DRF≤40%, of which 29 (18 boys, 11 girls) met our inclusion criteria and were followed for a mean of 2.8 years (1.4 months-6.6 years). Mean age at first sonogram was 2.3 months. 2 patients had SFU grade 2, 16 had grade 3, and 9 had grade 4 hydronephrosis, and 2 unknown grade. Median half-time on initial MAG-3 scan across all patients was 10 min (3-20 min). Initial MAG3 scan was performed at a median of 2.3 months of age (0.3-17 months). 22/29 patients had >1 MAG3 scan. Of the 7 remaining, 5 were lost to follow-up and 2 demonstrated improvement in hydronephrosis. Worsening drainage occurred in 10/22(45%), median final T1/2 was 45.5 min 8 of these underwent pyeloplasty and 2 were lost to follow up. 4/22 patients (18%) had progressive decline in DRF (mean 8.3%, range 6-10%). 3/4 maintained non-obstructive drainage patterns and stable/improved hydronephrosis, and 1 underwent pyeloplasty. 13/18 remaining patients had stable DRF and 5 had improvement in DRF. 7(39%) of these underwent surgery for worsening drainage (Summary Figure). Overall, 7/29(24%) patients had sufficient resolution of hydronephrosis to be discharged from our care, 8(28%) are under continued observation, 9(31%) underwent pyeloplasty, and 5(17%) were lost to follow-up. In the observational group [median follow-up 4.5 years (3.7-6.6 years)], all 8 demonstrated improved non-obstructive drainage (T1/2 <20 minutes) and/or improvement in hydronephrosis. 4/10(40%) with DRF <35% underwent pyeloplasty versus 5/19(26%) with DRF 35-40%(p=0.67). CONCLUSION Initial observational management of unilateral hydronephrosis with reduced DRF and nonobstructive drainage is recommended as most kidneys maintain nonobstructive drainage and do not demonstrate further decline in DRF. Even when DRF decreases, the majority remain non-obstructive. Worsening drainage over time more often leads to the decision for pyeloplasty rather than change in DRF.
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Affiliation(s)
- Austin G Hester
- Division of Urology, Children's National Medical Center, Washington, DC, USA.
| | - Aaron Krill
- Division of Urology, Children's National Medical Center, Washington, DC, USA
| | - Eglal Shalaby-Rana
- Department of Radiology, Children's National Medical Center, Washington, DC, USA
| | - H Gil Rushton
- Division of Urology, Children's National Medical Center, Washington, DC, USA
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12
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Eismann L, Stief CG, Chaloupka M. [Treatment of infected hydronephrosis]. MMW Fortschr Med 2022; 164:38. [PMID: 36064920 DOI: 10.1007/s15006-022-1804-0] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Lennert Eismann
- Urologische Klinik und Poliklinik, Klinikum Großhadern der LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Christian G Stief
- Urologische Klinik und Poliklinik, Klinik der Universität München, Campus Großhadern, München, Deutschland
| | - Michael Chaloupka
- Urologische Klinik und Poliklinik, Campus Großhadern der LMU München, München, Deutschland
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13
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Fitzpatrick G, Hanratty J, McDermott C, Breslin T, Davis NF. Bedside Ultrasound in the Emergency Department Enables Rapid Diagnosis of PUJ Obstruction Syndrome. Ir Med J 2022; 114:275. [PMID: 36331511] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Presentation A 27-year-old male presented to the Emergency Department with acute severe left flank pain following ingestion of 5 pints of beer. Approximately 20 bouts of similar episodes over the past year, in the setting of alcohol ingestion. Despite attending GP, no diagnosis reached yet. Diagnosis "Pelvo-ureteric junction (PUJ) obstruction Syndrome". Bedside ultrasound in the Emergency Department during the acute pain crisis: massive hydronephrosis left kidney. Finding confirmed on CT scan. Subsequent 99m-Tec renogram showed markedly decreased renal function on the left. Treatment Interval Pyeloplasty two months later. Conclusion Delayed recognition is the norm for PUJ obstruction syndrome, as CT/MRI/US studies often do not display hydronephrosis if the patient is asymptomatic. We could not find any reports in the literature of diagnosing PUJ obstruction syndrome using bedside ultrasound in the Emergency Department. We advise acquiring rapid bedside ultrasound imaging in suspected cases of PUJ obstruction syndrome, enabling earlier diagnosis.
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Affiliation(s)
- G Fitzpatrick
- Emergency Department, Mater Misericordiae University Hospital, Dublin
| | - J Hanratty
- Emergency Department, Mater Misericordiae University Hospital, Dublin
| | - C McDermott
- Emergency Department, Mater Misericordiae University Hospital, Dublin
| | - T Breslin
- Emergency Department, Mater Misericordiae University Hospital, Dublin
| | - N F Davis
- Department of Urology, Beaumont Hospital, Dublin
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Knox B, Reddington C, Healey M, Dior U, Cheng C. Surgical Management of Ureteral Endometriosis with Stenosis and Hydronephrosis: A Third Way? Isr Med Assoc J 2021; 23:670-671. [PMID: 34672452] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Benita Knox
- Department of Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Charlotte Reddington
- Department of Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Gynaecology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Martin Healey
- Department of Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Uri Dior
- Department of Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Claudia Cheng
- Department of Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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Bayram N, Yaman Y, Elli M, Dogan MS, Ayyildiz S, Telhan L, Çakir A, Unal D, Sebirli F, Anak S. Unusual Clinical Presentation of Hodgkin Lymphoma in a Child: Both Spinal Cord Compression and Hydronephrosis. J Pediatr Hematol Oncol 2021; 43:e900-e902. [PMID: 34001784 DOI: 10.1097/mph.0000000000002186] [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: 06/07/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is predominantly a nodal disease with extranodal presentation being uncommon. Presentation with neurological symptoms is not uncommon in adult patients with HL. Subdiaphragmatic involvements are less common especially in childhood. In the literature, there has been no case which presented with both spinal cord compression and bilateral hydronephrosis in pediatric patients with HL. OBSERVATION We report a 9-year-old boy diagnosed with HL who presented with bilateral hydronephrosis and epidural involvement. CONCLUSION Differential diagnosis of abdominal mass in patients presenting with spinal cord compression and/or hydronephrosis should include HL. Retrograde J ureteral stenting is the treatment of choice for malignant ureteral obstruction.
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Affiliation(s)
- Nihan Bayram
- Departments of Pediatric Hematology and Oncology
| | - Yontem Yaman
- Departments of Pediatric Hematology and Oncology
| | - Murat Elli
- Departments of Pediatric Hematology and Oncology
| | | | | | | | | | | | - Fatih Sebirli
- Pediatrics, Istanbul Medipol University, Istanbul, Turkey
| | - Sema Anak
- Departments of Pediatric Hematology and Oncology
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Anton-Păduraru DT, Miron IC, Lupu VV, Lupu A, Hanganu E. Ovarian teratoma in a teenager causing ureterohydronephrosis: Case report and literature review. Medicine (Baltimore) 2021; 100:e26472. [PMID: 34232179 PMCID: PMC8270627 DOI: 10.1097/md.0000000000026472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Teratomas are solid tumors that may occur in both gonadal and extragonadal locations, depending on the age of the child. Benign cystic teratomas are relatively common tumors among women of reproductive age, but they can occur at any age. The clinical presentation is not specific. They can be found incidentally when patients are investigated for other conditions or they can present as emergencies when the ovarian teratoma is torsioned or ruptured. PATIENT CONCERNS We present the case of a 17-year-old adolescent girl that was seen in our emergency department on several occasions for recurrent episodes of abdominal pain ongoing for 6 months. DIAGNOSIS An ultrasonography (US) was performed as an outpatient and a left ovarian mass was found along with right ureterohydronephrosis (UHN). Further assessment of the mass was done by abdominal and pelvic CT and tumoral markers. CT appearance was more suggestive of a teratoma. INTERVENTIONS She underwent laparotomy with complete excision of the tumor. OUTCOME The patient had an uneventful recovery. A renal US follow up showed reduction of the dilatation, demonstrating that the condition was secondary to tumor compression. LESSONS In a teenager with nonspecific symptoms, a high suspicion index for tumors is mandatory. An early diagnosis and management avoid complications like UHN.
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Affiliation(s)
| | | | | | | | - Elena Hanganu
- Discipline of Rehabilitation in Pediatrics, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania
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Abstract
RATIONALE Ureteral obstruction of the graft kidney is a common complication of kidney transplantation. However, ureteral obstruction caused by inguinal hernia has rarely been reported. We present a rare case of ureteral obstruction with allograft dysfunction caused by an inguinal hernia. PATIENT CONCERNS A 76-year-old man, who was a renal transplant recipient, presented with bilateral pitting oedema, reduced urine output, and right inguinal hernia. DIAGNOSES Abdominal computed tomography revealed severe hydroureteronephrosis of the kidney allograft. A right inguinal hernia with ureteral incarceration was observed. INTERVENTIONS The patient underwent graft percutaneous nephrostomy, followed by antegrade insertion of a double-J tube (DJ). Gradual improvement was observed in his renal function. Right inguinal herniorrhaphy was performed 5 days later. OUTCOMES The renal function returned to normal after percutaneous nephrostomy and insertion of the DJ. A right inguinal direct-type hernia with ureter adhesion to the hernial sac was observed during the surgery. The posterior wall defect was repaired by the McVay technique. The DJ was removed after 1 month. The patient's renal function remained stable at 6-month follow-up. LESSONS The orientation of the graft kidney has a significant influence on the location of the ureter. Upward orientation of the hilum will result in superficial location of the ureter, rendering it close to the hernial sac and susceptible to incarceration. The transplant surgeon should be aware of such a presentation of graft dysfunction with inguinal hernia to prevent a delay in the diagnosis and graft loss.
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Affiliation(s)
- Tian-You Chang
- Department of Urology, China Medical University Hospital
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital
- School of Medicine, College of Chinese Medicine, China Medical University
| | - Ping-Chin Lai
- The Kidney Institute and Division of Nephrology, China Medical University Hospital
| | - Wei-Ching Lin
- Department of Radiology, China Medical University Hospital
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
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Deng Q, Wang H, Lai Y, Liang H. Secondary stone formation 8 weeks after percutaneous nephrolithotomy treatment: A case report. Medicine (Baltimore) 2021; 100:e26091. [PMID: 34032746 PMCID: PMC8154477 DOI: 10.1097/md.0000000000026091] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION This work reports a patient with recurrent renal calculi subjected to three surgeries in half a year to be in the same position, and the high-throughput sequencing data showed different species in the renal pus and urine samples, which suggested that partial renal infection or stone formation can be judged by the bacteria in urine. PATIENT CONCERNS The female patient aged 43 years was referred to the authors' department on April 13, 2020, due to left waist pain and fever for 3 days. DIAGNOSIS Kidney stones and hydronephrosis were determined by a urinary system computed tomography scan. INTERVENTIONS On April 20, 2020 and June 15, 2020, the patient was successfully treated with left percutaneous nephrolithotomy twice under general anesthesia. An investigation on the health and eating habits of the patient within 6 months was completed at the last admission. The components of the second renal calculus sample were analyzed with an infrared spectrum analyzer. The third renal stone (renal pus, triplicates) was subjected to microbial metagenome sequencing, and urine samples before and after surgery were subjected to 16S RNA sequencing by SEQHEALTH (Wuhan, China). OUTCOMES After percutaneous nephrolithotomy, the left kidney stones were basically cleared, stone analysis revealed that the main components were calcium oxalate monohydrate, silica, and a small amount of calcium oxalate dehydrate. Although the urine samples exhibited differences, the renal pus and urine sample shared a single species. CONCLUSION It is not clear that the prospects of partial renal infection or stone formation can be judged by the bacteria in urine.
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Affiliation(s)
- Qiong Deng
- Department of Urology, Affiliated Longhua People's Hospital
- College of Basic Medicine, Southern Medical University, Shenzhen, Guandong, China
| | - Hongliang Wang
- Department of Urology, Affiliated Longhua People's Hospital
| | - Yulin Lai
- Department of Urology, Affiliated Longhua People's Hospital
| | - Hui Liang
- Department of Urology, Affiliated Longhua People's Hospital
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19
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Jin Q, Qiang R, Cai B, Wang X, Cai N, Zhen S, Zhai W. The genotype and phenotype of chromosome 18p deletion syndrome: Case series. Medicine (Baltimore) 2021; 100:e25777. [PMID: 33950970 PMCID: PMC8104293 DOI: 10.1097/md.0000000000025777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The chromosome 18p deletion syndrome is a syndrome with a deletion of all or a portion of the short arm of the chromosome 18. The phenotypes of the chromosome 18p deletion syndrome vary widely among individuals due to differences in size and breakpoints and the involved genes on the deletions. Given the varied and untypical clinical presentation of this syndrome, the prenatal diagnosis of the syndrome still presents as a challenge. PATIENT CONCERNS We described 4 China cases with different chromosomal breakpoints. In case 1, a woman who with mild phenotypes gave birth to a severely deformed fetus. Three other cases were for prenatal diagnosis. Their phenotypes are the increased nuchal translucency (INT) and the noninvasive prenatal testing (NIPT) indicated deletions on the chromosome 18p and severe hydronephrosis respectively. DIAGNOSIS The 4 cases were diagnosed with chromosome 18p deletion syndrome through karyotype analysis and array-based comparative genomic hybridization (array-CGH). INTERVENTIONS Karyotype analysis and array-based comparative genomic hybridization were used to analyze the abnormal chromosome. OUTCOMES Case 1 and case 2 revealed 11.51 and 12.39 Mb deletions in 18p11.32p11.21. Case 3 revealed 7.1 Mb deletions in 18p11.3218p11.23. Case 4 revealed 9.9 Mb deletions in 18p11.3218p11.22. LESSONS In our report, we are the first to report that mother and progeny who have the same chromosomal breakpoint have different phenotypes, significantly. In addition, we found a new phenotype of chromosome 18p deletion syndrome in fetus, which can enrich the phenotypes of this syndrome in the prenatal diagnosis. Finally, we demonstrate that the individuals with different chromosomal breakpoints of 18p deletion syndrome have different phenotypes. On the other hand, the individuals with the same chromosomal breakpoints of 18p deletion syndrome may also have remarkably different phenotypes.
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Yin S, Peng Q, Li H, Zhang Z, You X, Fischer K, Furth SL, Fan Y, Tasian GE. Multi-instance Deep Learning of Ultrasound Imaging Data for Pattern Classification of Congenital Abnormalities of the Kidney and Urinary Tract in Children. Urology 2020; 142:183-189. [PMID: 32445770 PMCID: PMC7387180 DOI: 10.1016/j.urology.2020.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 03/31/2020] [Accepted: 05/08/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To reliably and quickly diagnose children with posterior urethral valves (PUV), we developed a multi-instance deep learning method to automate image analysis. METHODS We built a robust pattern classifier to distinguish 86 children with PUV from 71 children with mild unilateral hydronephrosis based on ultrasound images (3504 in sagittal view and 2558 in transverse view) obtained during routine clinical care. RESULTS The multi-instance deep learning classifier performed better than classifiers built on either single sagittal images or single transverse images. Particularly, the deep learning classifiers built on single images in the sagittal view and single images in the transverse view obtained area under the receiver operating characteristic curve (AUC) values of 0.796 ± 0.064 and 0.815 ± 0.071, respectively. AUC values of the multi-instance deep learning classifiers built on images in the sagittal and transverse views with mean pooling operation were 0.949 ± 0.035 and 0.954 ± 0.033, respectively. The multi-instance deep learning classifiers built on images in both the sagittal and transverse views with a mean pooling operation obtained an AUC of 0.961 ± 0.026 with a classification rate of 0.925 ± 0.060, specificity of 0.986 ± 0.032, and sensitivity of 0.873 ± 0.120, respectively. Discriminative regions of the kidney located using classification activation mapping demonstrated that the deep learning techniques could identify meaningful anatomical features from ultrasound images. CONCLUSION The multi-instance deep learning method provides an automatic and accurate means to extract informative features from ultrasound images and discriminate infants with PUV from male children with unilateral hydronephrosis.
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Affiliation(s)
- Shi Yin
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Qinmu Peng
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Hongming Li
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Zhengqiang Zhang
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Xinge You
- School of Electronic Information and Communications, Huazhong University of Science and Technology, Wuhan, China
| | - Katherine Fischer
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Susan L Furth
- Department of Pediatrics, Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Gregory E Tasian
- Department of Surgery, Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, The University of Pennsylvania, Philadelphia, PA
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21
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García Nieto VM, Monge Zamorano M, Pérez-Etchepare E, García Rodríguez V, Tejera-Carreño P, Luis Yanes MI, Arango Sancho P. Usefulness of basic renal function tests in the management of hydronephrosis. Cir Pediatr 2020; 33:125-130. [PMID: 32657096] [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: 06/11/2023]
Abstract
OBJECTIVE Nowadays, the algorithms for the study of hydronephrosis in children include voiding cystourethrogram (VCUG) and diuretic renogram (DR) in all patients. Both are invasive, distressing, and associated with radiation risk. However, basic renal function tests (bRFTs) are not included. This study was designed to determine whether bRFTs may help avoid VCUG and/or DR in some children. METHODS Retrospective review of hydronephrosis (≥20 mm renal pelvis) patient records over one year (n = 38) (pyeloureteral stenosis (PUS) n = 12; high-grade vesicoureteral reflux (VUR) n = 8; non-obstructive hydronephrosis (NOH) n = 18. Data from the three protocolized bRFTs (maximum urine osmolality after DDAVP (UOsm), albumin/creatinine ratio (Alb/Cr), and NAG/creatinine ratio (NAG/Cr), together with VCUG and DR, were analyzed. RESULTS 38 hydronephrosis patients (pyeloureteral stenosis (PUS) n = 12; high grade vesicoureteral reflux (VUR) n = 8; non-obstructive hydronephrosis (NOH) n = 18. UOsm was decreased in 100% of VUR patients, 75% of PUS patients, and 16.7% of NOH patients. Alb/Cr ratio was increased in 62.5% of VUR patients, 8.3% of PUS patients, and 11.1% of NOH patients. NAG/Cr ratio was increased in 42.8% of VUR patients, 25% of PUS patients, and 6.7% of NOH patients. UOsm was decreased in most patients who required surgery (100% of VUR patients and 74% of PUS patients), but only in 11.1% of patients who did not (NOH group). CONCLUSIONS These results suggest that bRFTs may be useful in delaying or avoiding VCUG in some hydronephrosis cases. UOsm is the most sensitive test. No child with (high grade) VUR had a normal UOsm. VCUG could have been avoided in 43% of our patients -with a normal UOsm- without missing any high grade VUR.
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Affiliation(s)
- V M García Nieto
- Nuestra Señora de Candelaria University Hospital. Santa Cruz de Tenerife (Spain)
| | - M Monge Zamorano
- Nuestra Señora de Candelaria University Hospital. Santa Cruz de Tenerife (Spain)
| | - E Pérez-Etchepare
- Nuestra Señora de Candelaria University Hospital. Santa Cruz de Tenerife (Spain)
| | - V García Rodríguez
- Nuestra Señora de Candelaria University Hospital. Santa Cruz de Tenerife (Spain)
| | - P Tejera-Carreño
- Nuestra Señora de Candelaria University Hospital. Santa Cruz de Tenerife (Spain)
| | - M I Luis Yanes
- Nuestra Señora de Candelaria University Hospital. Santa Cruz de Tenerife (Spain)
| | - P Arango Sancho
- Nuestra Señora de Candelaria University Hospital. Santa Cruz de Tenerife (Spain)
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Guler Y, Erbin A, Kafkasli A, Ozmerdiven G. Factors affecting success in the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy in adult patients. Urolithiasis 2020; 49:51-56. [PMID: 32279108 DOI: 10.1007/s00240-020-01186-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/12/2019] [Accepted: 04/01/2020] [Indexed: 11/27/2022]
Abstract
The aim of the study was to analyze the factors predicting success for the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy (SWL) in adult patients. Between January 2014 and December 2018, 480 adult patients in total underwent SWL and data were retrospectively evaluated. Patients with multiple ureteral stones, solitary kidney, congenital abnormality, skeletal system abnormality, history of previous urinary system surgery and SWL, renal insufficiency, patients who could not tolerate SWL and pediatric patients were excluded from the study. The remaining 415 patients were divided into two groups as success (Group 1, n = 307) and failure (Group 2, n = 108). The overall success rate was 73.9%. The values of stone size, Hounsfield Unit (HU), skin to stone distance (SSD), ureteral wall thickness (UWT), proximal ureter diameter, renal pelvis diameter, hydronephrosis grade, and duration of renal colic were significantly higher in Group 2 compared to Group 1. In binary logistic regression analyses, HU, UWT, and proximal ureter diameter were found to be independent predictors. HU, UWT, and proximal ureter diameter had sensitivity and specificity of 92-92%, 88-23%, and 87-46%, with cutoff values of 740 HU, 2.5 mm and 8.5 mm, respectively. The area under the curve values were 0.96, 0.97, and 0.96 for HU, UWT, and proximal ureter diameter, respectively. The CT-based parameters, including HU, UWT, and proximal ureter diameter are independent predictive factors with excellent accuracy for the treatment of proximal ureteral stones larger than 1 cm with SWL in adult patients. Based on these factors, SWL can be considered for proximal ureteral stones larger than 1 cm.
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Affiliation(s)
- Yavuz Guler
- Department of Urology, Private Safa Hospital, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey.
| | - Alper Kafkasli
- Department of Urology, Dr. Lutfi Kirdar Kartal Traning and Research Hospital, Istanbul, Turkey
| | - Gokhun Ozmerdiven
- Department of Urology, Istanbul Aydin University Medical Faculty, Istanbul, Turkey
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Bueno-Jiménez A, Serradilla J, Nava B, Rivas S, Lobato R, Amesty V, López-Pereira P, Castillo S, Martínez-Urrutia MJ. Preliminary results of complete delayed primary bladder exstrophy reconstruction in male patients. Cir Pediatr 2020; 33:75-78. [PMID: 32250070] [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: 06/11/2023]
Abstract
INTRODUCTION The success of primary bladder closure in bladder exstrophy (BE) is the determining factor for future capacity and continence. In recent years, owing to the unsatisfactory results of staged repair, complete delayed primary reconstruction has gained prominence. OBJECTIVE To analyze short-term results in male patients with BE undergoing delayed primary closure and compare them with early bladder closure as part of staged repair in our healthcare facility. MATERIALS AND METHODS The success of bladder closure, postoperative management, complications, and hydronephrosis was assessed over a 12-month follow-up period in both groups: early primary closure (group A) and delayed primary closure (group B). RESULTS In group A (n=13), mean age at closure was 25 hours and mean pubic diastasis was 32 mm. Patients had respiratory support and muscle relaxation for an average of 4 days postoperatively. Closure success was 85%, and 1 patient presented maintained hydronephrosis beyond the first 6 months. In group B (n=6), mean at closure was 58 days, and mean pubic diastasis was 34 mm. Patients had epidural analgesia and no respiratory support postoperatively. Closure success was 100%. 33% had transient hydronephrosis, and 1 patient (17%) presented maintained bilateral hydronephrosis. The same immobilization technique was used in both groups for 3 weeks. CONCLUSIONS Delayed primary reconstruction is safe as it allows for closure success without increasing complications as compared to staged repair. A long-term follow-up is required to assess urinary continence, esthetic results, and genital functionality.
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Affiliation(s)
| | | | - B Nava
- Hospital Universitario La Paz. Madrid
| | - S Rivas
- Hospital Universitario La Paz. Madrid
| | - R Lobato
- Hospital Universitario La Paz. Madrid
| | - V Amesty
- Hospital Universitario La Paz. Madrid
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Sharma J, Singhal J. A child with urosepsis and a bladder with a halo: Questions. Pediatr Nephrol 2020; 35:73-74. [PMID: 31420728 DOI: 10.1007/s00467-019-04323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jyoti Sharma
- Pediatric Nephrology, KEM Hospital, Sardar Moodliar Road, Pune, Maharashtra, 411011, India.
| | - Jyoti Singhal
- Pediatric Nephrology, KEM Hospital, Sardar Moodliar Road, Pune, Maharashtra, 411011, India
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25
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Vitkovskyy VF. TWO CASES OF THE CALCIFIED RENAL ARTERY ANEURYSM. DIFFERENTIAL DIAGNOSIS AND TREATMENT (OWN EXPERIENCE). Wiad Lek 2020; 73:2086-2089. [PMID: 33148865] [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: 06/11/2023]
Abstract
Renal artery aneurysm is defined as the dilated segment of renal artery exceeding twice the diameter of the normal renal artery. As more than half of such aneurysms have the annular calcification, they must be differentiated from the stones. Differential diagnosis of the renal artery aneurysm includes the parapelvical cysts, hydronephrosis and kidney tumors. Renal artery aneurysm can be diagnosed by CT, MRI, as well by ultrasonography and color dopplerography. Unfortunately presence of calcification renders the ultrasonographic examination impossible. In this article we share our own experience of two cases of calcified renal aneurysms diagnosed and treated at our hospital.
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Hecht SL, Walker JP, Treece AL, Cost NG. Isolated Pure Malignant Rhabdoid Tumor (MRT) of the Bladder: Case Report and Lessons Learned. Urology 2019; 137:164-167. [PMID: 31733273 DOI: 10.1016/j.urology.2019.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/01/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 11/19/2022]
Abstract
Pediatric extrarenal malignant rhabdoid tumors (MRTs) are rare, aggressive tumors with a poor prognosis (20% 5-year survival). There are currently fewer than 10 published case reports of primary MRT of the bladder. We report the case of an 18-month-old female with an isolated MRT of the bladder which was initially misdiagnosed as an inflammatory myofibroblastic tumor on biopsy. We review the history, tumor biology, histology, and current management of extrarenal MRT, along with lessons learned from the difficulty with the patient's initial diagnosis.
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Affiliation(s)
- Sarah L Hecht
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO.
| | - Jonathan P Walker
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO
| | - Amy L Treece
- Children's Hospital of Colorado, Department of Pathology, Aurora, CO
| | - Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado, Aurora, CO
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Harper SN, Hale LP, Ferrandino MN, Moul JW. Acute Presentation of Previously Unrecognized Congenital Ureteropelvic Junction Obstruction 5 Weeks After Radical Retropubic Prostatectomy. Urology 2019; 135:20-23. [PMID: 31421142 DOI: 10.1016/j.urology.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Shelby N Harper
- Duke University School of Medicine, Durham, NC; Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | - Laura P Hale
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Michael N Ferrandino
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | - Judd W Moul
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC.
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Arora M, Prasad A, Kulshreshtha R, Baijal A. Significance of third trimester ultrasound in detecting congenital abnormalities of kidney and urinary tract-a prospective study. J Pediatr Urol 2019; 15:334-340. [PMID: 31031163 DOI: 10.1016/j.jpurol.2019.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/27/2018] [Revised: 02/13/2019] [Accepted: 03/29/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Antenatal hydronephrosis is defined as dilatation of the renal pelvis with or without dilatation of calyces in the developing fetus. Although second trimester scan is more sensitive in detecting congenital abnormalities of kidney and urinary tract (CAKUT), it has been suggested that the third trimester scan is more predictive of postnatal outcome. OBJECTIVES This study aims to determine the incidence of antenatal hydronephrosis at our institution and the significance of third trimester scan in detecting CAKUT postnatally. STUDY DESIGN It is a prospective observational study. During the 3-year study period from June 2013 to May 2016, all cases of antenatal hydronephrosis, defined as renal pelvic diameter (RPD) ≥4 mm in the second trimester and ≥7 mm in the third trimester scan, diagnosed in the fetal medicine unit of our hospital, were included and were followed up postnatally for 6 months. RESULTS In the fetal medicine unit, 32,443 women were screened for anomalies, and hydronephrosis was detected in 269 cases. Incidence of antenatal hydronephrosis was observed to be 0.83% in our institution. In second trimester scan, of 80 cases with the left hydronephrosis, only 22 (27.5%) had postnatal CAKUT and of 70 cases with the right hydronephrosis, 18 (25.7%) had CAKUT. In the third trimester scan, it was observed that with RPD >10 mm, on the left side hydronephrosis, 87% had CAKUT on postnatal scan, and 85% with the right hydronephrosis had CAKUT. CONCLUSION Sixty percent cases of hydronephrosis detected in the second trimester scan resolve in utero. In the third trimester scan with RPD <10 mm, the possibility of postnatal CAKUT is 23%, whereas if RPD is > 10 mm, then the possibility of postnatal CAKUT is 86%.
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Affiliation(s)
- M Arora
- Pediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - A Prasad
- Department of Pediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India.
| | - R Kulshreshtha
- Department of Pediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - A Baijal
- Department of Fetal Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Fontanella F, Duin LK, Adama van Scheltema PN, Cohen‐Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Gracchi V, Oepkes D, Bilardo CM. Prenatal diagnosis of LUTO: improving diagnostic accuracy. Ultrasound Obstet Gynecol 2018; 52:739-743. [PMID: 29266464 PMCID: PMC6587765 DOI: 10.1002/uog.18990] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/13/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To propose a clinical score for the optimal antenatal diagnosis of fetal lower urinary tract obstruction (LUTO) in the second and third trimesters of pregnancy, as an alternative to the commonly used ultrasound triad of megacystis, keyhole sign and hydronephrosis. METHODS This was a national retrospective study carried out at the eight tertiary fetal medicine units (FMUs) in The Netherlands. Only cases referred for megacystis from the second trimester onwards and with a clear postnatal diagnosis were included in the study. At referral, data were collected on amniotic fluid volume, renal cortical appearance, bladder volume, hydronephrosis, fetal ascites, ureteral size, keyhole sign, fetal sex and gestational age. Multivariate analysis was performed, starting by including all antenatal variables, and then excluding the weakest predictors using the backward stepwise strategy. RESULTS Over a 7-year period, 312 fetuses with a diagnosis of megacystis were referred to the eight Dutch tertiary FMUs. A final diagnosis was achieved in 143 cases, including 124 of LUTO and 19 reclassified after birth as non-obstructive megacystis. The optimal bladder volume cut-off for prediction of LUTO was 35 cm3 (area under the curve (AUC) = 0.7, P = 0.03). The clinical score formulated on the basis of the multivariate analysis included fetal sex, degree of bladder distension, ureteral size, oligo- or anhydramnios and gestational age at referral. The combination of these five variables demonstrated good accuracy in discriminating LUTO from non-obstructive megacystis (AUC = 0.84, P < 0.001), compared with the poor performance of the ultrasound triad (AUC = 0.63, P = 0.07). CONCLUSIONS We propose a clinical score that combines five antenatal variables for the prospective diagnosis of congenital LUTO. This score showed good discriminative capacity in predicting LUTO, and better diagnostic accuracy compared with that of the classic ultrasound triad. Future studies to validate these results should be carried out in order to refine antenatal management of LUTO and prevent inappropriate fetal interventions. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F. Fontanella
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center GroningenUniversity of GroningenThe Netherlands
| | - L. K. Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center GroningenUniversity of GroningenThe Netherlands
| | - P. N. Adama van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - T. E. Cohen‐Overbeek
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal MedicineErasmus MC University Medical CenterRotterdamThe Netherlands
| | - E. Pajkrt
- Department of ObstetricsAcademic Medical Center AmsterdamAmsterdamThe Netherlands
| | - M. Bekker
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisRadboud University Medical CenterNijmegenThe Netherlands
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - C. Willekes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical CenterGrow School for Oncology and Medical BiologyMaastrichtThe Netherlands
| | - C. J. Bax
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisVU University Medical CenterAmsterdamThe Netherlands
| | - V. Gracchi
- Department of PediatricsUniversity Medical Center Groningen, University of GroningenThe Netherlands
| | - D. Oepkes
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - C. M. Bilardo
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center GroningenUniversity of GroningenThe Netherlands
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Babu R, Ninan B, Sai V. Evaluating Neonates With Antenatal Hyderonephrosis Using a Standard Protocol: An Audit of Hospital Records. Indian Pediatr 2018; 55:966-968. [PMID: 29941698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIMS To audit the extent of evaluation of neonates with antenatal hydronephrosis. METHODS Records of all neonates with antenatal hydronephrosis between January 2013 and December 2016 were audited to look for patient factors and investigation results. RESULTS 290 records were evaluated, 93 (32%) of which had abnormalities detected on voiding cystourethrogram. In the presence of hydroureter, 65% had an abnormality while in the absence only 11% were abnormal. In the presence of pelvis ≥20 mm, 93% had abnormal diuretic renogram, while with pelvis <20 mm, only 1.5% were abnormal (P=0.001). Numbers needed to harm calculation revealed 1 in 2 patients would receive an unnecessary voiding cystourethrogram in the absence of hydroureter, and unnecessary diuretic renogram when pelvis <20 mm. CONCLUSIONS While evaluating neonates with antenatal hydronephrosis invasive tests can be limited, if evaluation is guided by ultrasonographic criteria.
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Affiliation(s)
- Ramesh Babu
- Department of Pediatric Urology, Sri Ramachandra University, Porur, Chennai, India. Correspondence to:Dr Ramesh Babu, Professor of Pediatric Urology, Sri Ramachandra University, Porur, Chennai 600 106, India.
| | - Binu Ninan
- Department of Neonatology, Sri Ramachandra University, Porur, Chennai, India
| | - Venkata Sai
- Department of Radiology, Sri Ramachandra University, Porur, Chennai, India
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Rahman AJ, Hanif S, Baloch NUA, Rehman A, Sheikh T, Ladhani MI. Spectrum, management and outcomes of structural and functional uropathies in children attending a tertiary care center in Karachi; Pakistan. J PAK MED ASSOC 2018; 68:1699-1704. [PMID: 30410153] [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: 06/08/2023]
Abstract
Causes and outcomes of children diagnosed with hydronephrosis in resource-limited countries with a low utilization of antenatal ultrasonography remain unexplored. We performed a retrospective, crosssectional study of all paediatric patients diagnosed with hydronephrosis and managed at a tertiary care center in Karachi, Pakistan between 2005 and 2010. Data relating to demographics, clinical features, etiologies and treatment modalities were systematically collected. Of a total of 234 cases (74.4% male), 83 (35.5%) and 42 (17.9%) were neonates and infants respectively. Congenital urinary tract pathologies were noted in 192(72.2%) patients, of which only 96(50%) had undergone foetal ultrasonography and 77(40.1%) first presented after the age of 1 year. At a median follow-up of 4 years, 24(12.5%) of these patients had evidence of renal dysfunction. Worse urologic outcomes in this study were most likely attributable to delayed diagnosis of congenital urinary tract abnormalities.
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Affiliation(s)
| | - Saima Hanif
- Medical College, Aga Khan University, Karachi
| | | | - Abdul Rehman
- Internal Medicine Section, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Kotidis E, Stamatiou I, Ioannidis O, Pramateftakis MG, Kanellos I, Tsalis K. Laparoscopic resection of large pelvic lipoma causing obstructive uropathy in a 66 year old female - A case report from Greece. J PAK MED ASSOC 2018; 68:1400-1402. [PMID: 30317275] [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: 06/08/2023]
Abstract
Lipomas are benign, usually asymptomatic, tumours and pelvic lipomas are extremely rare. We describe the case of a giant pelvic lipoma causing obstructive uropathy to a 66-year-old morbidly obese female treated in the 4th Surgical Department of the Medical School of Aristotle University of Thessaloniki in General Hospital "G. Papanikolaou" in March 2016. The patient presented with a history of nocturia and frequent daytime urination for 1 year. Her medical history included diffuse lipomatosis. Computer tomography revealed a giant pelvic mass which lead to left side hydronephrosis, hydrouterer and a pear-shaped bladder, with the differential diagnosis including pelvic lipoma or liposarcoma. An ultrasound guided biopsy excluded the diagnosis of liposarcoma. The patient was submitted to laparoscopic resection of the pelvic lipoma, with complete remission of urinary symptoms. The key-point is to consider the possibility that the pelvic mass is a well-differentiated liposarcoma and to manage it adequately and thus, we recommend intact excision of the mass through a wound protector, and extreme caution to avoid any rupture of the capsule.
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Affiliation(s)
- Efstathios Kotidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iliana Stamatiou
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Orestis Ioannidis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ioannis Kanellos
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tsalis
- Fourth Surgical Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
RATIONALE Schwannomas are usually benign tumors arising from well-differentiated schwann cells, which rarely occur in the retroperitoneal space. The lack of specific signs and radiologic imaging characteristics makes preoperative diagnosis rather difficult. Most retroperitoneal schwannomas are benign and the primary treatment choice for retroperitoneal schwannomas is surgical excision, however, the involvement of the urinary system is scarcely reported. PATIENT CONCERNS A 34-year-old woman presented with progressive left abdominal pain and rebound abdominal mass at the left lower quadrant for 1 month. Radiological imaging suggested capsulated solid mass with cystic and necrotic areas in the retroperitoneum accompanied by severe left kidney hydronephrosis and preoperative biopsy result was inconclusive. DIAGNOSES We believe this is a rare case of retroperitoneal schwannoma complicated with severe hydronephrosis. INTERVENTIONS After preparation, the patient underwent laparoscopy exploration and converted to open surgical exploration. The patient accepted complete surgical excision of the retroperitoneal tumor and left kidney. Postoperative pathology diagnosis of the mass was proven to be benign retroperitoneal schwannoma. OUTCOMES Postoperative course of the patient was uneventful and the left abdominal pain was greatly improved. After 12-month follow up, no evidence of recurrence or any other complication including renal failure was observed. LESSONS Preoperative imaging and preoperative ultrasound-guided biopsy are helpful to make accurate diagnosis. The final diagnosis is based on postoperative histological and immunohistochemical findings. The primary treatment option is complete surgical resection of the retroperitoneal schwannoma and the involved upper urinary system when severe hydronephrosis occured. Local recurrence and overall survival are closely correlated with negative resection margins and pathology types.
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Affiliation(s)
- Liandong Zhang
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Ming Gao
- Department of Nephrology, Xi’an No. 4 Hospital, Xi’an, Shaanxi, PR China
| | - Tongdian Zhang
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Tie Chong
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Ziming Wang
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Wenpin Liu
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
| | - Hecheng Li
- Department of Urology, The Second Affiliated Hospital, Xi’an Jiaotong University
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Carpenter CP, Tolley E, Tourville E, Sharadin C, Giel DW, Gleason JM. Hydronephrosis After Pyeloplasty: "Will It Go Away?". Urology 2018; 121:158-163. [PMID: 30125645 DOI: 10.1016/j.urology.2018.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/08/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify attributes of pediatric patients with hydronephrosis due to ureteropelvic junction obstruction and of their surgical encounters which are predictive of resolution of dilatation in order to provide more effective counseling about expected outcomes. This study was inspired by the suggestion in recent literature that greater than 20% improvement in anteroposterior diameter (APD) of the renal pelvis after pyeloplasty is indicative of resolution of obstruction. The remaining dilatation, however, is often distressing to caregivers, and there are no data to guide clinicians in counseling about its likelihood to resolve. METHODS We retrospectively reviewed children who underwent surgery at our institution for ureteropelvic junction obstruction between 1/01/2010 and 6/30/2017. APD of the pre- (preAPD) and postoperative (postAPD) renal pelves were documented. In children with more than 1 postoperative ultrasound, lastAPD was the measurement on their most recent study. Appropriate statistical tests examined the effects of clinical and surgical variables on hydronephrosis resolution. RESULTS PostAPD and lastAPD were obtained at medians of 3 months and 1.9 years after surgery, and were 0 cm in 12 of 105 (11.5%) and 9 of 65 (13.8%) patients, respectively. None of the variables analyzed significantly impacted complete resolution at either time point. Of those that did not resolve, 80.6% (75/93) showed greater than 20% improvement in APD; however, 3 of these children required reoperation due to secondary obstruction. In our study, no one with APD reduction greater than 43% required reintervention. CONCLUSION Complete resolution of hydronephrosis is uncommon and unpredictable. All caregivers should be counseled to expect dilatation to persist after obstruction is corrected.
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Affiliation(s)
- Christina P Carpenter
- Department of Urology, Division of Pediatric Urology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN; Department of Urology, Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York, Columbia University Medical Center, New York, NY
| | - Elizabeth Tolley
- Department of Preventive Medicine, Biostatistics & Epidemiology, University of Tennessee Health Science Center, Memphis, TN
| | - Elizabeth Tourville
- Department of Urology, Division of Pediatric Urology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Cynthia Sharadin
- Department of Urology, Division of Pediatric Urology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Dana W Giel
- Department of Urology, Division of Pediatric Urology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Joseph M Gleason
- Department of Urology, Division of Pediatric Urology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
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Stevenson SM, Lau GA, Andolsek WC, Presson AP, Cartwright PC. Bladder debris on ultrasound as a predictor for positive urine culture in a pediatric population. J Pediatr Urol 2018; 14:254.e1-254.e5. [PMID: 29456120 DOI: 10.1016/j.jpurol.2017.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 05/26/2017] [Accepted: 11/29/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Debris within the bladder is commonly seen on ultrasound. The etiology of bladder debris is varied and the likelihood that urinary debris represents positive urine culture is under investigation. We hypothesize that bladder debris will increase the likelihood that a urine culture is positive compared to those without bladder debris. METHODS We performed a retrospective review on children aged 0-17 years who had a voiding cystourethrogram with a catheterized urinalysis or urine culture, and who also had a renal and bladder ultrasound up to 1 week prior, the day of, or up to 2 days after their urine studies. Presence of bladder debris and debris severity was recorded. Positive urine culture was defined as a single bacterial strain ≥50,000 cfu/mL. Demographic information, including findings of reflux and hydronephrosis were compared. Sensitivity, specificity, and risk ratios were calculated for predicting positive urine culture in patients with urinary debris on ultrasound. RESULTS A total of 445 patients met inclusion criteria between January and December 2014. The positive urine culture rate was 20%, and the rate of bladder debris was 22%. The mean age for those with and without bladder debris was 6.6 and 5.5 years, respectively (p = 0.02). 23% of girls had bladder debris, compared to 12% of boys (p = 0.04, see results table). The sensitivity and specificity for bladder debris in detecting positive urine cultures was 52% and 86%, respectively. Forty-seven percent of those with bladder debris had positive cultures, compared with 12% of those without debris (p < 0.01). The relative risk of positive urine culture if debris is present is 3.90 (95% CI 2.73-5.55). Hydronephrosis or vesicoureteral reflux did not affect the relationship between bladder debris and positive urine cultures. CONCLUSIONS Nearly half of pediatric patients undergoing urological evaluation found to have bladder debris on ultrasound will have a positive urine culture. Debris is noted more commonly in girls and at a slightly higher age. The presence of debris is associated with a fourfold increase in detecting a positive urine culture, regardless of debris severity, hydronephrosis, or vesicoureteral reflux. Given this, it is of value to routinely document and look for the presence of any amount of bladder debris seen on ultrasound, as this finding can be used to augment clinical decision-making and warrants strong consideration for obtaining urine culture.
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Affiliation(s)
- Scott M Stevenson
- Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Glen A Lau
- Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - William C Andolsek
- Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Patrick C Cartwright
- Division of Urology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Dudek-Warchoł T, Warchoł S, Bombiński P, Toth K, Szmigielska A, Krzemień G. Pyonephrosis as the first symptom of congenital hydronephrosis in a 6-year old girl. Pol Merkur Lekarski 2018; 44:196-200. [PMID: 29775448] [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: 06/08/2023]
Abstract
UNLABELLED Pyonephrosis in the course of hydronephrosis usually provides to total or near-total loss of renal function. In adults pyonephrosis usually results from urolithiasis. In children usually congenital urinary tract anomalies are present as contributing factors. CASE REPORT 6-year old girl was admitted to the hospital because of 2-day history of high fever, abdominal pain, progressive deterioration of general condition and ultrasonographically (US) detected left hydronephrosis. US on admission showed grossly dilated left renal collecting system together with extensive echogenic debris and laboratory tests highly elevated inflammatory markers. Once diagnosis of pyonephrosis was established on the basis of clinical picture and US as well as laboratory tests results, nephrostomy tube was placed percutaneously. Pus culture obtained during placement of nephrostomy showed E.Coli ESBL (-) growth. Intensive antibiotic treatment (Meropenem) was continued for 3 weeks, nephrostomy was removed after 12 days after receiving normal urine. Further evaluation of urinary tract (US and computed tomography urography) showed large hydronephrosis due to ureteropelvic junction obstruction, while dynamic scintigraphy obstructive renogram with grossly diminished left kidney function to 20% of differential renal function. The girl was referred for operative treatment on urgent basis. Intraoperatively long distance utreteropelvic junction stenosis was found and dismembered Anderson- Hynes pyeloplasty was performed. During 2-years follow-up postoperatively US showed gradually decrease of dilatation of left renal collecting system, while dynamic scintigraphy revealed permanent improvement of drainage together with almost normal renal function (up to 45%). No urinary tract infections were noted. CONCLUSIONS Proper management of pyonephrosis in hydronephrotic kidney due to congenital ureteropelvic junction obstruction enables good final result of treatment.
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Affiliation(s)
| | - Stanisław Warchoł
- Department of Pediatric Surgery and Urology, Medical University of Warsaw
| | | | | | | | - Garżyna Krzemień
- Department of Pediatrics and Nephrology, Medical University of Warsaw
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Bumbu GA, Berechet MC, Nacer K, Bumbu G, Ionovici N, Bumbu BA. The urologist and child hydronephrosis caused by ureteral anomalies. Rom J Morphol Embryol 2018; 59:197-201. [PMID: 29940628] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Congenital hydronephrosis caused by ureteral anomalies, like ureteral duplicity, megaureter, ureteral ectopy and ureterocele, must be differentiated from ureteropelvic junction obstruction (UJO) hydronephrosis and from the hydronephrosis caused by vesicoureteral reflux. These represent a differentiated branch of congenital abnormalities in children even if not so common, but this fact should not be disconsidered. Over a five years period, from 111 operated children in our Clinic, we performed 13 interventions for congenital hydronephrosis, 11 (84.61%) being caused by ureteral abnormalities. Here, there were described particular cases, with diagnosis steps and treatment decisions. Ureteral ectopy can be manifested by loss of urine drops in cases where ureteral holes are located in the vagina, septum or urethra, inferior to the sphincter mechanism. Incontinence in boys never occurs because the ectopic ureter never opens under the sphincter mechanism. If the ureter opens in the genital tract, patients may clinically present with the epididymitis symptom. From autopsy statistics in the US, the incidence of ureteral duplex is estimated to be less than 1%. When the duplex is associated with urinary infection, the incidence of ureteral duplex increases up to 8%.
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Affiliation(s)
- Gheorghe Adrian Bumbu
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, Romania; ; Department of Occupational Medicine, University of Medicine and Pharmacy of Craiova, Romania;
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Krajewski W, Wojciechowska J, Dembowski J, Zdrojowy R, Szydełko T. Hydronephrosis in the course of ureteropelvic junction obstruction: An underestimated problem? Current opinions on the pathogenesis, diagnosis and treatment. ADV CLIN EXP MED 2017; 26:857-864. [PMID: 29068584 DOI: 10.17219/acem/59509] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 11/24/2022]
Abstract
Ureteropelvic junction obstruction (UPJO) causes a reduction in the urine flow from the renal pelvis into the ureter. Untreated UPJO may cause hydronephrosis, chronic infection or urolithiasis and will often result in progressive deterioration of renal function. Most cases of UPJO are congenital; however, the disease can be clinically silent until adulthood. Other causes, both intrinsic and extrinsic, are acquired and include urolithiasis, post-operative/inflammatory/ischemic stricture, fibroepithelial polyps, adhesions and malignancy. In the past, the most frequent symptom of UPJO in neonates and infants was a palpable flank mass. Nowadays, thanks to the widespread use of maternal and prenatal ultrasound examinations, asymptomatic hydronephrosis is diagnosed very early. In adults and older children symptoms may include intermittent abdominal or flank pain, nausea, vomiting and hematuria. In addition to high specificity and sensitivity in detecting UPJO, modern technologically advanced equipment such as ultrasound, magnetic resonance imaging and computed tomography provides a lot of information about the function of the affected kidney and the anatomy of the surrounding tissues. Treatment options for UPJO include a wide spectrum of approaches, from active surveillance or minimally invasive endourologic techniques to open, laparoscopic or robotic pyeloplasty. The main goal of therapy is to relieve symptoms and maintain or improve renal function, but it is difficult to define treatment success after UPJO therapy.
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Affiliation(s)
- Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Poland
| | - Joanna Wojciechowska
- Department of Otolaryngology and Surgery of the Head and Neck, Wroclaw Medical University, Poland
| | - Janusz Dembowski
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Poland
| | - Tomasz Szydełko
- Clinical Department of Urology, 4th Clinical Military Hospital, Wrocław, Poland
- Department of Palliative Care Nursing, Wroclaw Medical University, Poland
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Abstract
The postnatal treatment of asymptomatic unilateral hydronephrosis due to ureteropelvic junction obstruction remains controversial, and the timing of and indications for surgical intervention are continuously debated. There is no consensus on the best follow-up during expectant management. The various modalities and parameters have been discussed along with their pros and cons and an attempt has been made to clear up the controversies.
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Affiliation(s)
- Yogesh Kumar Sarin
- Department of Pediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, 110002, India.
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Zee RS, Herndon CDA, Cooper CS, Kim C, McKenna PH, Khoury A, Herbst KW. Time to resolution: A prospective evaluation from the Society for Fetal Urology hydronephrosis registry. J Pediatr Urol 2017; 13:316.e1-316.e5. [PMID: 28215834 DOI: 10.1016/j.jpurol.2016.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 09/06/2016] [Accepted: 12/09/2016] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The resolution rate of prenatal urinary tract dilation (UTD) has been documented in several retrospective studies. The present study analyzed prospective observational registry data, with the aim of determining time to resolution among patients prenatally identified with mild postnatal UTD. MATERIALS AND METHODS A total of 248 subjects, from four centers, were prospectively enrolled from 2008 to 2015. Exclusion criteria included other anomalies (n = 69), fewer than two ultrasounds, and/or <3 months follow-up (n = 26). Resolution was defined as Outcome A (SFU 0) and Outcome B (SFU 0/1). Fisher's exact test, Mann-Whitney U or Kruskal-Wallis test and Kaplan-Meier were used for analysis. RESULTS/DISCUSSION The median follow-up for 179 (n = 137 males) subjects was 15 months (IQR 7-24), range 0-56 months. VCUG was performed in 100 (57%) and VUR identified in 15 (15%). There was no association with reflux and resolution (P = 0.72). For resolution assessment (n = 153), lower grades were likely to resolve and demonstrated a higher rate in the Outcome B classification. Time to resolution also favored lower grades, with the majority resolving within 2 years (Figure). Surgical intervention was performed in 14 (8%). It is interesting to note that regardless of grade of UTD, there was no difference in frequency of US or the time that RUS was first performed. Practitioners performed the first RUS of life within a narrow window ranging from 0.27 RUS/month for Grade 1 UTD to 0.30 RUS/month for Grade 4 UTD. It was speculated that this practice pattern occurrence likely reflected the deficiency in knowledge by primary care providers, and identified a potential opportunity for education. The SFU registry substantiates that the vast majority of patients will demonstrate transient UTD and most cases that do not resolve will improve within 2 years of life. This data could be used to further an evidenced-based approach towards the evaluation and management of prenatal UTD, as outlined in the multidisciplinary consensus statement for prenatal urinary tract dilation. CONCLUSIONS This prospective registry confirms that the majority of prenatal UTD is transient, resolution occurs within the first 3 years of life, and most patients will not need intervention. Redefining SFU 1 as normal increased the resolution rate. A large proportion of patients were not evaluated with a VCUG, therefore impact of VUR could not be determined.
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Affiliation(s)
- R S Zee
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - C D Anthony Herndon
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | - C S Cooper
- Department of Urology, University of Iowa School of Medicine, Iowa City, IA, USA
| | - C Kim
- 100 Simsbury Road, Suite 208, Avon, CT 06001, USA
| | - P H McKenna
- Department of Urology, University of Wisconsin School of Medicine, Madison, WI, USA
| | - A Khoury
- Department of Urology, UC Irvine School of Medicine, Irvine, CA, USA
| | - K W Herbst
- Division of Urology, Connecticut Children's Medical Center, Hartford, CT, USA
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Gn MZ, Malik A, Hart LA, Mukherjee A, Reese AC. Hydronephrosis Secondary to an Ectopic Decidual Reaction in the Urinary Bladder. Urology 2017; 106:e11-e12. [PMID: 28499763 DOI: 10.1016/j.urology.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/10/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022]
Abstract
A 28-year-old pregnant woman at 19 weeks gestation presented with dysuria as well as lower abdominal and left flank pain. Imaging revealed left-sided hydronephrosis and a mass invading the posterior bladder wall. Management included placement of a left nephrostomy tube and transurethral resection of ~25% of the mass. Microscopy showed an ectopic decidual reaction within the muscularis propria. The patient improved symptomatically and continued prenatal care. Complete resolution of her ureteral obstruction was demonstrated during the postpartum period. Ectopic decidual reactions involving the urinary bladder are extremely rare, and ureteral obstruction secondary to this phenomenon has not yet been reported.
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Affiliation(s)
- Martus Z Gn
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Aatika Malik
- Department of Pathology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Laura A Hart
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Abir Mukherjee
- Department of Pathology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Adam C Reese
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
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Abstract
OBJECTIVE The present report aimed to present a unique case of idiopathic retroperitoneal fibrosis (RPF) presenting features of unilateral ureteral and sigmoid colon obstruction. RPF is a rare disorder with unclear etiology. CASE REPORT A 43-year-old female had a 10-day history of lower right abdominal and lumbar pain. Gynecological examination, ultrasound, and computed tomography (CT) were all suggestive of right ovarian tumor. An enhanced CT showed right-sided hydronephrosis. The patient was diagnosed as having ovarian cancer. Ten days after hospitalization, a right intraureteral stent with a double-J catheter was inserted. Upon exploring the abdomen, unyielding RPF was encountered. A partial sigmoidectomy and colostomy were performed. Postoperative pathological results suggested idiopathic RPF. She received steroid treatments. CONCLUSION RPF is a rare disease that can be misdiagnosed. Our understanding about its presentation has to be improved and it should be considered as a differential diagnosis for patients presenting with abdominal diseases.
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Affiliation(s)
- Ting Yan
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan
- Department of Gynecology
| | | | | | | | - Qian Wu
- Department of Pathology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Mingrong Xi
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan
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Byun HJ, Ha JY, Jung W, Kim BH, Park CH, Kim CI. The impact of obesity on febrile urinary tract infection and renal scarring in children with vesicoureteral reflux. J Pediatr Urol 2017; 13:67.e1-67.e6. [PMID: 28087230 DOI: 10.1016/j.jpurol.2016.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/17/2016] [Accepted: 08/31/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It has become clear that obesity is associated with a variety of infectious diseases, including urinary tract infection (UTI) and renal scarring. OBJECTIVE The aim of this study was to evaluate the association between obesity and the degree of febrile UTI (fUTI) and renal scarring in children with vesicoureteral reflux (VUR), and to stratify the results into obesity subcategories. STUDY DESIGN A total of 186 patients were diagnosed with VUR between January 2002 and December 2008. This study retrospectively reviewed the medical records of 72 children with primary VUR who had recurrent fUTI (more than twice). Overweight or obese status of the patients aged <2 years was defined using weight-for-length (WFL) measurements. For 2-5 year old children, body mass index (BMI) percentile-for-age was used. They were divided into three groups as follows; standard (<85%), overweight (85-95%), and obese (≥95%). The following clinical variables were compared: age at diagnosis of primary VUR (months), sex, VUR grade, hydronephrosis grade, presence of renal scarring, surgical treatment, and degree of inflammation during fUTI. RESULTS In the overweight and obese groups, VUR was diagnosed at a young age (P = 0.05), the degree of renal scarring was more severe (P = 0.006), and serum white blood cell count, C-reactive protein, and erythrocyte sedimentation rate (ESR) levels were significantly higher (P < 0.001, P < 0.001, and P < 0.001, respectively). Abnormal focal dimercaptosuccinic acid (DMSA) defects were present in 25 of the 72 children (35%). Cortical defects occurred more frequently in children with obesity, and they were associated with a higher grade of reflux and serum ESR levels (P = 0.007, P = 0.042, and P = 0.021, respectively). Among these risk factors, high-grade VUR (OR = 9.93, 95% CI = 1.13-86.71), and being overweight and obese (OR = 5.26, 95% CI = 1.75-15.82) were associated with increased renal scarring. However, ESR was not associated with renal scarring (OR = 1.01, 95% CI = 0.95-1.07). DISCUSSION The relationships between obesity and UTI are controversial. Some studies have shown positive results; however, other studies have shown opposite results. The main limitations of this study were the retrospective data collection via electronic medical records, and the small number of subjects. CONCLUSIONS This study showed that obesity in patients with VUR has an effect on fUTI and renal scar formation. If the patients with VUR have obesity, close follow-up should be performed, and VUR patients should be started on a weight-loss program, which could reduce the number of patients with chronic kidney disease in the future.
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Affiliation(s)
- H J Byun
- Department of Urology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - J Y Ha
- Department of Urology, School of Medicine, Keimyung University, Daegu, Republic of Korea.
| | - W Jung
- Department of Urology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - B H Kim
- Department of Urology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - C H Park
- Department of Urology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - C I Kim
- Department of Urology, School of Medicine, Keimyung University, Daegu, Republic of Korea
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Wang L, Li Y, Zhao XP, Zhang WH, Bai W, He YG. Hydronephrosis caused by intrauterine contraceptive device migration: three case reports with literature review. CLIN EXP OBSTET GYN 2017; 44:301-304. [PMID: 29746046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Translocation of intrauterine contraceptive device (IUD) from the uterus rarely occurs, which can lead to serious complications. Here the authors reported three cases of IUD migration from into the ureter, bladder, and peritoneal cavity that caused hydronephrosis, respectively. All the three patients received minimally invasive surgeries and recovered.
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Ip IK, Silveira PC, Alper EC, Benson CB, Khorasani R. External validation of risk stratification strategy in the use of renal ultrasonography in the evaluation of acute kidney injury. J Hosp Med 2016; 11:763-767. [PMID: 27186959 DOI: 10.1002/jhm.2598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/03/2015] [Revised: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Per the American College of Radiology Appropriateness Criteria, renal ultrasound is the most appropriate imaging examination to evaluate patients with acute kidney injury. However, recent studies suggest that renal ultrasound may be more selectively performed, which could lead to reductions in the use of medical imaging. OBJECTIVE Evaluate a published risk stratification prediction model (the Licurse model) for using renal ultrasound in hospitalized patients with acute kidney injury. DESIGN Prospective, observational cohort study. SETTING A 793-bed, quaternary care, academic hospital. PATIENTS All adult hospitalized patients who underwent renal ultrasound for the indication of acute kidney injury. INTERVENTION/EXPOSURE None. MEASUREMENTS Primary outcome was rate of hydronephrosis diagnosed on ultrasound. Secondary outcome was rate of hydronephrosis resulting in urologic intervention. RESULTS Of 778 patients who underwent renal ultrasonography to evaluate acute kidney injury, hydronephrosis was present in 106 (13.6%); urologic intervention was performed in 23 patients (3.0%). The Licurse model had sensitivity of 91.3% (95% confidence interval [CI]: 73.2%-97.6%) for urologic intervention and 93.4% (95% CI: 87.2%-96.8%) for hydronephrosis, respectively. Specificity was low for urologic intervention (23.0% [95% CI: 20.2-26.2]) and hydronephrosis (25.1% [95% CI: 22.0-28.6]). We estimated that for 22.6% of patients, hydronephrosis could be ruled out based on clinical predictors. CONCLUSIONS We found that the Licurse renal ultrasonography risk stratification model was sufficiently accurate in classifying patients at risk for ureteral obstruction among hospitalized patients with acute kidney injury. Journal of Hospital Medicine 2016;11:763-767. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Ivan K Ip
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Patricia C Silveira
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily C Alper
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carol B Benson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Rickard M, Lorenzo AJ, Braga LH. Renal Parenchyma to Hydronephrosis Area Ratio (PHAR) as a Predictor of Future Surgical Intervention for Infants With High-grade Prenatal Hydronephrosis. Urology 2016; 101:85-89. [PMID: 27713070 DOI: 10.1016/j.urology.2016.09.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 08/12/2016] [Revised: 09/19/2016] [Accepted: 09/21/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the potential value of an objective assessment, renal parenchyma to hydronephrosis area ratio (PHAR), as an early predictor of surgery. METHODS Initial sagittal renal ultrasound (US) images of patients prospectively entered into a prenatal hydronephrosis database from January 2008 to January 2016 with baseline Society for Fetal Urology (SFU) grades III and IV prenatal hydronephrosis, without vesicoureteral reflux, were evaluated using the National Institutes of Health-sponsored image processing software. PHAR, anteroposterior diameter, SFU grade, and urinary tract dilation risk categories were contrasted with nuclear scan data (differential renal function and drainage time [t1/2]) and analyzed for predictive value in determining the decision to proceed with surgery by drawing receiver operating characteristic curves. RESULTS Out of 196 infants (162 male; 138 left sided hydronephrosis), 58 (30%) underwent surgery to address obstruction. Surgical patients compared with those managed conservatively had longer t1/2 (60 vs 18 min; P < .01) and lower differential renal function (46 vs 50%; P = .01). Of the initial US parameters, PHAR (area under the curve = 0.816; P < .001) had a better predictive performance than anteroposterior diameter, SFU grade, or urinary tract dilation classification. PHAR values correlated with subsequent parameters obtained on nuclear scan. CONCLUSION PHAR is a promising parameter that can be estimated on presentation US to help predict future need for surgery in newborns with high-grade hydronephrosis.
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Affiliation(s)
- Mandy Rickard
- Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Ontario, Canada
| | - Armando J Lorenzo
- Division of Pediatric Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Ontario, Canada.
| | - Luis H Braga
- Department of Surgery and McMaster Pediatric Surgery Research Collaborative, McMaster University, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Ontario, Canada; Division of Urology, Department of Surgery, McMaster University, Ontario, Canada
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Abstract
Purpose: To evaluate the accuracy of MR pyelography in the assessment of hydroureteronephrosis. Material and Methods: One hundred and fifteen patients, with variable degree of hydroureteronephrosis demonstrated by US and urography were subjected to MR pyelography obtained by means of two ultra-fast sequences. Results: Of the 228 kidneys examined, the collecting systems of 130 kidneys were dilated and correctly identified on MR pyelography, with only 2 false-positive results. The specificity of MR pyelography in detecting hydronephrosis was 98%. Accuracy in revealing level of obstruction was 100%. Sensitivity in detecting stones, strictures and congenital ureteropelvic junction obstructions was respectively 68.9%, 98.5% and 100%. Conclusion: MR pyelography can rapidly and accurately depict the morphological features of dilated urinary tracts with information regarding the degree and level of obstruction, without using contrast medium or ionizing radiation.
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Affiliation(s)
- A Blandino
- Department of Radiological Sciences, University of Messina, Messina, Italy
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Singla N, Hutchinson R, Haddad A, Sagalowsky A, Lotan Y, Margulis V. Preoperative hydronephrosis is associated with less decline in renal function after radical nephroureterectomy for upper tract urothelial carcinoma. Can J Urol 2016; 23:8334-8341. [PMID: 27544555] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION To compare renal function changes after radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) based on the presence of preoperative hydronephrosis. MATERIALS AND METHODS Clinicopathologic data of 208 patients with UTUC treated surgically from 1998 to 2013 were compiled. Patients with bilateral disease, less than 1 month follow up, missing hydronephrosis data, or who underwent nephron-sparing approaches were excluded. Estimated glomerular filtration rate (eGFR) was calculated preoperatively, at first follow up (within 3 months) and at last follow up using the Modification of Diet in Renal Disease equation. Events were defined as new-onset stage III chronic kidney disease (CKD) or worsening of CKD stage in preexisting CKD. Kaplan-Meier event-free survival was assessed. Cox regression was performed to identify predictors of events. RESULTS A total of 132 patients were analyzed, including 62 (47.0%) with hydronephrosis. Median follow up was 28.6 months. Patients with hydronephrosis had larger tumors (p = 0.045) and higher pathologic stage (p = 0.010) than those without hydronephrosis. Baseline eGFR was comparable between groups (p = 0.088). Patients without hydronephrosis experienced greater declines in eGFR following surgery (p < 0.001) and higher event rates at first (42.8% versus 24.2%, p = 0.028) and last (54.2% versus 30.6%, p = 0.008) follow up. On Cox regression, hydronephrosis predicted lower event likelihood in the long term (univariate HR 0.54, p = 0.033), while ureteral tumor location predicted lower event likelihood in the short term (HR 0.52, p = 0.030). CONCLUSIONS Patients with hydronephrosis undergoing RNU for UTUC experience less decline in renal function than those without hydronephrosis. Given the prevalence of renal dysfunction in patients with UTUC, our results may help inform preoperative counseling.
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Affiliation(s)
- Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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49
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Abstract
Nephrogenic diabetes insipidus (NDI) is a condition resulting from the kidney's impaired response to circulating antidiuretic hormone (ADH), leading to polydipsia and polyuria. Urinary tract dilatation caused by NDI is a rare situation. Here, we report a case of congenital NDI presented with bilateral hydronephrosis.A 15-year-old boy complaining a history of intermittent fever was admitted to Peking Union Medical College Hospital. He voided 10 to 15 L of urine daily. Radiographic examination revealed severe dilatation of bilateral renal pelvis, ureter, and bladder. Urinalysis shows hyposthenuria.He was diagnosed NDI since born. Transient insertion of a urethral catheter helped to relieve fever. Medical therapy of hydrochlorothiazide and amiloride was prescribed and effective.Dilatation of urinary tract caused by diabetes insipidus is rare, but may be present in severe condition. Therefore, it is crucial for clinicians to perform early treatment to avoid impairment of renal function.
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Affiliation(s)
- Kewen Zheng
- From the Department of Urology (KZ), the First Affiliated Hospital of Wenzhou Medical University, Wenzhou Medical University; and Department of Urology (KZ, YX, HL), Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, P.R. China
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Krzemień G, Szmigielska A, Bombiński P, Barczuk M, Biejat A, Warchoł S, Dudek-Warchoł T. Extreme hydronephrosis due to uretropelvic junction obstruction in infant (case report). Dev Period Med 2016; 20:139-142. [PMID: 27442699] [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: 06/06/2023]
Abstract
BACKGROUND Hydronephrosis is the one of the most common congenital abnormalities of urinary tract. The left kidney is more commonly affected than the right side and is more common in males. AIM OF THE STUDY To determine the role of ultrasonography, renal dynamic scintigraphy and lowerdose computed tomography urography in preoperative diagnostic workup of infant with extreme hydronephrosis. CASE REPORT We presented the boy with antenatally diagnosed hydronephrosis. In serial, postnatal ultrasonography, renal scintigraphy and computed tomography urography we observed slightly declining function in the dilated kidney and increasing pelvic dilatation. Pyeloplasty was performed at the age of four months with good result. CONCLUSIONS Results of ultrasonography and renal dynamic scintigraphy in child with extreme hydronephrosis can be difficult to asses, therefore before the surgical procedure a lower-dose computed tomography urography should be performed.
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Affiliation(s)
- Grażyna Krzemień
- Department of Pediatric Nephrology, The Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland tel. (+48-22) 628-97-22 fax. (+48-22) 621-41-55 e-mail:
| | | | | | - Marzena Barczuk
- Department of Pediatric Radiology, The Medical University of Warsaw, Poland
| | - Agnieszka Biejat
- Department of Pediatric Radiology, The Medical University of Warsaw, Poland
| | - Stanisław Warchoł
- Department of Pediatric Surgery and Urology, The Medical University of Warsaw, Poland
| | - Teresa Dudek-Warchoł
- Department of Pediatric Surgery and Urology, The Medical University of Warsaw, Poland
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