Journal of Pediatric Urology最新文献

Introduction: Sacrococcygeal teratomas (SCT), which are the most common germ cell tumours in the neonatal period, have frequent long-term complications including gastrointestinal and urological problems due to the anatomical region of origin. This study evaluates the lower urinary tract and bowel functions in patients who underwent surgery for SCT.

Patients and methods: Fifteen patients who underwent sacrococcygeal teratoma surgery between 2007 and 2021 were retrospectively evaluated for lower urinary tract and bowel functions. Bladder function was assessed using patient interviews, urinalysis, voiding diaries, uroflowmetry, ultrasonography, and pressure-flow studies. In the bowel function evaluation, constipation and continence were assessed. Descriptive statistics were used to present the results as mean, standard deviation, median, frequency, and percentage.

Results: Consequently, 15 patients were included, with a mean follow-up period of 8.5 years. The majority of patients were female, with a female-to-male ratio of 2.75:1. Based on the Altman classification, 73.3 % of the patients had type I SCT, 20 % had type II, and 6.6 % had type IV. The mean follow-up period of the patients was 8.5 years (2 years-15 years). Of the 15 patients whose lower urinary tract functions were assessed, 13 achieved full urinary continence and exhibited normal voiding volumes and frequency for their age. Ultrasonography findings were normal in all evaluated patients, with no residual urine or bladder abnormalities detected. Urodynamic tests showed normal detrusor activity and bladder capacities in most cases, though one patient exhibited a higher-than-expected bladder capacity during the filling phase. Voiding phase assessments revealed normal patterns in most patients, except for an 8-year-old case with Altman type IV SCT showing staccato voiding pattern and pelvic floor electromyography (EMG) activity. Anorectal examinations revealed normal anal anatomy, though fecalomas were detected in two cases. (Altman type II and IV SCT). Constipation, based on Rome IV criteria, was identified in 3 patients (1 Altman type I, 1 type II, and 1 type IV SCT). Based on the Holschneider scale, 11 patients achieved normal scores, while 3 (2 Altman type I, 1 Altman type II SCT). demonstrated good scores, reflecting overall satisfactory bowel control.

Conclusion: Bladder function was uneffected in Altman type I and II cases, except for dysfunction in one type IV case. Constipation was noted in one case each of types I, II, and IV, with no other bowel abnormalities detected. Non-invasive investigations should be prioritized for type I and II cases, while invasive methods may be necessary for those with intrapelvic extension.

Introduction: Children with primary vesicoureteral reflux (VUR) may be placed on continuous antibiotic prophylaxis (CAP) to reduce the risk of urinary tract infections (UTI). Despite the use of CAP, up to 36 % of children with VUR still develop febrile breakthrough UTI (BT-UTI). It has been suggested that ureteral diameter ratio (UDR) may predict febrile BT-UTI in children with primary VUR. We sought to validate this finding in a large cohort of children with primary VUR on CAP.

Methods: We reviewed a prospectively maintained database of children with primary VUR at a single children's hospital from October 2015 to May 2023. Children were treated at clinician discretion. We included children with primary VUR on CAP with available voiding cystourethrogram (VCUG) imaging. UDR was calculated on VCUG by measuring the largest distal ureteral diameter within the false pelvis and dividing by the distance between the bottom of the L1 vertebral body and the top of the L3 vertebral body, as previously described. In children with bilateral VUR, the higher-grade reflux and the larger UDR were used. Children with ureteroceles, duplicated systems, and secondary VUR were excluded. The primary endpoint was febrile BT-UTI. Univariate and multivariate statistical analyses were conducted.

Results: Of the 257 children in the VUR database, 132 met inclusion criteria. The median age at VCUG was 1.1 years (IQR 0.2-4.9). Females constituted 54.5 % of the cohort. VUR grades included grade 1 (9.8 %), grade 2 (15.9 %), grade 3 (31.8 %), grade 4 (25.0 %), and grade 5 (17.4 %). The average UDR was 0.312 (range: 0-0.951). For each 0.1 increase in UDR, there was a significant increase in the risk of breakthrough fUTI (OR = 1.43, 95 % CI 1.06-1.91; p = 0.016). With a median follow-up time of 2.4 years (IQR 1.2-4.6), 21 (15.9 %) children developed a breakthrough fUTI while on CAP. The area under the receiver operating characteristic curve (AUC) was 0.72 (p = 0.0006). UDR risk-stratification of febrile BT-UTI included low-risk UDR (<0.250; BT-UTI: 12.1 %), intermediate-risk UDR (0.250-0.500; BT-UTI: 17.1 %), and high-risk UDR (>0.500; BT-UTI: 24.0 %).

Conclusion: UDR is an independent risk factor to predict febrile BT-UTI in children with primary VUR on CAP. To our knowledge, this is the first and largest study to validate this finding. We propose a UDR risk stratification that may be useful in individualizing care among children with primary VUR.

Introduction: Isolated female epispadias is a rare congenital anomaly.

Objectives: We report on sub-symphseal repair of this anomaly.

Methods: Our study was an ambidirectional observational cohort one with minimum 6 months post operative evaluation. Surgical approach involved creation of paraurethral skin flap to lengthen the urethra and bladder neck (BN) plication under cystoscopic guidance. Second layer cover of the urethral tube using bilateral Maritus labial flap was performed.

Results: Of the 7 patients, 6 were fully continent.

Conclusions: Our approach is effective for gaining both urinary continence and cosmesis issues.

Background: Ureteropelvic junction obstruction (UPJO) is an important cause of congenital hydronephrosis and may result in impaired differential renal function (DRF) if not addressed in a timely fashion. Although pyeloplasty is generally effective, postoperative renal functional improvement varies among patients. Validated tools to estimate the probability of renal function improvement after surgery remain limited. Therefore, this study aimed to develop and externally validate a nomogram to predict postoperative renal function improvement in children with UPJO undergoing pyeloplasty.

Methods: We conducted a two-center retrospective study including UPJO patients under 16 years of age who underwent laparoscopic dismembered pyeloplasty, with or without robotic assistance. Clinical, imaging, and laboratory data were collected. Development-cohort patients had non-diuretic 99mTc-DTPA dynamic renal scintigraphy, while validation-cohort patients had diuretic 99mTc-DTPA dynamic renal scintigraphy, preoperatively and at postoperative follow-up. Renal function improvement was defined as a ≥5 % increase in affected-side DRF. Predictors were identified using least absolute shrinkage and selection operator (LASSO) and logistic regression analyses, and a nomogram was subsequently constructed. Model performance was assessed using the area under the curve (AUC), calibration plots, the Hosmer-Lemeshow test, and decision curve analysis (DCA).

Results: A total of 148 patients were included in the development cohort, and 30 in the external validation cohort. Demographic and baseline characteristics, laboratory and urinalysis findings, renal morphological and functional parameters, and surgical/perioperative variables, were collected and analyzed. Serum urea (UREA), preoperative anteroposterior diameter, preoperative affected-side glomerular filtration rate (GFR) and DRF, and the affected-to-contralateral GFR ratio were associated with postoperative DRF improvement. Combined with the LASSO regression and clinical relevance, the final nomogram incorporated gender, age (≥12 months vs. <12 months), preoperative affected-side DRF, and UREA. The nomogram demonstrated good performance, with AUCs of 0.836 in the development cohort and 0.880 in the validation cohort.

Conclusion: Most pediatric patients with UPJO demonstrate stabilization or modest improvement in renal function following pyeloplasty, with more pronounced benefits observed in those with lower preoperative DRF. The proposed nomogram provides individualized probability estimates of postoperative functional improvement, which may aid preoperative counseling and expectation setting.