Journal of Pediatric Urology最新文献

Objective: This study evaluates long-term outcomes after pyeloplasty for unilateral ureteropelvic junction obstruction (UPJO), examines the correlation between early postoperative imaging and outcomes, and identifies predictors of functional recovery.

Material and methods: This retrospective study analyzed 116 pediatric patients who underwent open dismembered pyeloplasty for unilateral UPJO from 2010 to 2023, with a minimum of three years postoperative follow-up. Patients were classified as "recovered" if their differential renal function (DRF) improved by over 5 % on the final renogram. We examined various parameters, including the ipsilateral-to-contralateral renal parenchymal thickness ratio (ParT ratio), anteroposterior pelvic diameter (APD), percent regression in APD (APDred%), and APD/parenchymal thickness ratio (APD/PT) at baseline and monthly postoperative ultrasounds. Nonparametric tests were used for group comparisons, and multivariable logistic regression identified independent predictors of recovery. We also evaluated early postoperative measurements (3 and 6 months for ultrasound; 12 months for renography) against final values to determine correlations with long-term outcomes.

Results: The median age at surgery was 24 months (IQR 6-96), with a median follow-up of 96 months (IQR 60-120). Among patients with a ≥5 % increase in long-term differential renal function (n = 26), baseline renal function was lower (33.7 % vs. 41.5 %; p = 0.002) than in those who did not improve. The improved group also had a lower ParT ratio at baseline and six months (0.43 vs. 0.51; p = 0.046). A higher percentage of the improved group had surgery before one year of age (58 % vs. 33 %; p = 0.038). Logistic regression identified age under one year and lower baseline renal function as predictors of recovery. At one year postoperatively, renal function remained stable in 115 out of 116 patients (99 %) according to subsequent renograms. Six-month ultrasound results closely aligned with final pelvic diameter regression, whereas other measures did not significantly correlate with improvement. There were no significant differences in antenatal hydronephrosis, SFU grades, or rates of febrile urinary tract infections between the groups.

Conclusion: In pediatric UPJO, age at surgery <1 year and lower baseline DRF are associated with postoperative functional improvement. Six-month ultrasound measurements of AP diameter reduction accurately reflect pelvic outcome at long-term follow-up, while the one-year renogram provides an appropriate assessment of long-term renal function.

Purpose: This study compares anteroposterior diameter of the renal pelvis (APDRP) and urinary tract dilation (UTD) prenatal grading systems for their accuracy in predicting postnatal outcomes.

Materials and methods: A retrospective multicenter study (June 2013-December 2024) included 211 patients classified prenatally using APDRP and UTD systems. Postnatal outcomes included spontaneous resolution, urinary tract infections (UTI), vesicoureteral reflux (VUR), urinary obstruction, and surgical need. ROC curve analysis was performed to assess predictive performance.

Results: 46 % of cases encountered spontaneous resolution; both classifications showed strong correlation with dilation severity (p < 0.001). For VUR endpoint, severe APDRP grade was associated with an OR of 4.24 (95%Cl 1.26-14.29, p = 0.02); UTD A2-3 had an OR of 3.12 (95%Cl = 1.02-9.58, p-value = 0.04). Regarding UTI, severe APDRP grade had an OR of 7.66 (95%Cl = 1.59-36.96, p-value = 0.01), while OR for UTD A2-3 was 5.59 (95%Cl = 1.25-25.01, p-value = 0.02). For obstructive uropathy, severe APDRP grade had an OR of 22.5 (95%Cl = 7.24-69.91, p-value <0.001); OR of UTD A2-3 was 8.65 (95%Cl = 2.96-25.28, p-value <0.001). Regarding need for surgery, severe APDRP grade had an OR of 22.10 (95%Cl = 7.73-63.11, p-value < 0.001), while UTD A2-3 had an OR of 11.41 (95%Cl = 3.93-33.14, p-value <0.001). ROC analysis showed that APDRP outperformed UTD in predicting spontaneous resolution (AUC 0.811 vs. 0.736), VUR (0.649 vs. 0.614), UTI (0.690 vs. 0.650), obstruction (0.799 vs. 0.686), andsurgery (0.792 vs. 0.705).

Conclusions: The APDRP system appears to be more accurate than UTD for the prediction of spontaneous resolution of dilation, urinary tract obstruction and need for surgical intervention.

Purpose: We determined the efficacy of 3 corporotomies to straighten ventral curvature (VC) measuring 30-135° during the first stage of a 3-stage STAC repair in patients with proximal hypospadias, as confirmed by artificial erection (AE) at STAC 2 and STAC 3.

Methods: Consecutive males with proximal hypospadias and VC 30° or more underwent primary or reoperative STAC repair. Straightening was done by 3 ventral corporotomies during STAC 1, with AE repeated during STAC 2 and 3, and any reoperations after STAC repair for complications. Residual VC at STAC 2 was straightened by 1 Heineke-Mikulicz dorsal plication. The primary outcome was any ventral curvature. Secondary outcomes included bleeding complications requiring intraoperative or postoperative intervention, and reported change in erection quality in Tanner 4,5 patients.

Results: There were 237 primary and 163 reoperative STAC repairs done between 2019 and 2024. VC averaged 74° (median 75°) in primary cases, with 85 % having more than 30-45° and 1 in 4 more than 90°. VC in reoperations was less (p < 0.00001), averaging 54° (median 50°). All patients had at least 2 AE after corporotomies, with the final an average of 17 (11.5-58) months later. 81 % had no VC at STAC 2. Residual VC in the remainder was always 30° or less, was more common in those with >90° initially (p < 0.00001), and was successfully corrected with a single Heineke-Mikulicz dorsal plication in most. Therefore, 99 % of patients were proven by AE to have successful straightening. There were no bleeding complications requiring intervention. One adult reported 15 % decrease in erection fullness.

Conclusions: 3 corporotomies alone were successful in 81 %, which increased to 99 % with a subsequent dorsal plication in those with residual VC. The fact that residual curvature occurs after all straightening methods, including 3 corporotomies, emphasizes need for AE to be repeated at the next operation in staged repairs and during reoperations.