Journal of Pediatric Urology最新文献

Background: The Transverse Preputial Onlay Island Flap (TPOIF) technique is frequently used in cases with mild chordee and small glans. This study's objective was to evaluate the surgical outcomes of this technique at our center.

Materials and methods: This study consisted of hypospadias patients diagnosed with small glans (diameter <14 mm) and mild chordee (<30°), underwent TPOIF urethroplasty.

Results: A total of 64 cases were included in this study. The mean glans diameter was 10.6 mm. The complication rate was 9.4 %.

Conclusions: The TPOIF technique provides encouraging results for treating hypospadias with small glans, though larger studies are needed.

Introduction: Mercaptoacetyltriglycin (MAG3) diuretic renography is a frequently used method for evaluation of high grade hydronephrosis. Based on the time point of administration of furosemide, different protocols are in use. This retrospective cohort study was evaluating an institution wide protocol-change from F+20 (furosemide after 20') to F+0 (simultaneously injection of tracer and furosemide) in non-toilet trained children (<1a). We aimed at evaluating the impact of the MAG3 protocol used on time to surgery and number of MAG3 scans performed prior to surgery, as well as the cumulative radiation exposure.

Study design: A total of 59 patients were evaluated for isolated, unilateral high-grade hydronephrosis (SFU ≥°III). Of these, 24 consecutive patients were assessed before protocol change (F+20), 35 patients thereafter (F+0). Patients who underwent surgery due to loss of differential function were excluded. Since the groups were enrolled consecutively, the duration of follow-up would have differed in the F+0 group. To ensure comparability between the two cohorts, the follow-up period was censored at 2 years for both groups. Demographic data, outcomes, anterior posterior diameter, time to surgery and number of MAG3 scans prior to surgery were compared between the groups using Mann-Whitney test, Fisher's exact test and students t-test (Prism 10).

Results: The two groups (F+0 vs. F+20) were comparable in terms of age at first MAG3 (mean 5.1 months vs. 5.7 months p = 0.94) and anteroposterior (AP) diameter (mean 1.6 cm vs 1.69 cm p = 0.78). Pyeloplasty due to persistent or worsening obstructive patterns in MAG3 scans was performed in 54 % (19/35) of the F+0 group and 66 % (16/24) of the F+20 group within 2 years after the first MAG3 scan (p = 0.42). The time from the first MAG3 scan to pyeloplasty was significantly shorter in the F+0 group (8.9 vs. 13 months p = 0.01). Additionally, children in the F+0 group underwent fewer MAG3 scans before surgery compared to those in the F+20 group (2 vs. 3 p = 0.007). The F+0 group was exposed to lower median effective doses compared to the F+20 group (0.23 mSv vs 0.39 mSv, p = 0.012).

Conclusion: Changing the time of furosemide application in an otherwise fixed protocol for MAG3 scintigraphy from F+20 to F+0 in children with high grade hydronephrosis resulted in significantly shorter time to pyeloplasty and fewer MAG 3 scans prior to surgery and less radiation exposure - without a change in the probability of undergoing surgery.

We explored a "widening surgery" utilizing dorsal stricturotomy and lip mucosal graft inlay for post-pubertal long-segment urethral strictures (LSS). In 8 adolescents (median age 16.3 years), 6 underwent single-stage and 2 underwent planned two-stage repair due to infection. At a median follow-up of 39 months, the primary success rate was 87.5 % (7/8). One fistula occurred and was successfully repaired. Median maximum urinary flow (Qmax) improved from 4.4 to 24.5 ml/s. This study suggests dorsal inlay widening urethroplasty is a feasible strategy for complex LSS, preserving the urethral plate, though larger validation studies are required.

Introduction: In vascular hitch (VH) particular attention must be paid to preserving lower pole perfusion. Hypoperfusion is normally excluded by macroscopic visual assessment of parenchyma appearance. Our aim is to explore the possible role of indocyanine green (ICG) in highlighting focal hypoperfusion.

Materials and methods: This prospective study included pediatric patients with UPJO caused by crossing vessels, treated with robot-assisted VH. Intraoperative evaluation assessed UPJ appearance, reduction of hydronephrosis after vessel mobilization, and the adequacy of pelvic drainage during diuretic testing. ICG was used to assess renal perfusion via NIRF imaging. A 25 mg ICG solution was prepared in 10 mL and administered in 1 mL doses. Fluorescence distribution, operative time, and complications were recorded. Follow-up at 3, 6, and 12 months included clinical evaluations, blood pressure measurements, and Doppler ultrasound.

Results: Eight patients (median age 8years) were enrolled between October 2023 and February 2025. ICG assessed renal perfusion post-procedure; one case of focal hypoperfusion due to vessel tension was resolved with intraoperative revision. At a median follow-up of 18 months, no hypertension, pain, or UTIs were observed. Ultrasound demonstrated improved hydronephrosis and normal Doppler flow.

Conclusion: ICG angiography is a safe and effective tool for the real-time assessment of renal perfusion during pediatric VH procedures.