Pub Date : 2026-04-01Epub Date: 2026-01-09DOI: 10.1016/j.jpurol.2026.105727
C. Corbett , J.S. Kim , H. Aboughalia , V. Kucherov , B. Hisam , T. Myint , A. Krill
Introduction
Anterior posterior renal pelvis diameter (APRPD) and minimal parenchymal thickness ratio (MPTR) on renal ultrasonography (RUS) have been identified as measures to help risk stratify patients with hydronephrosis for adverse findings on diuretic renography (DR). Widespread adoption of these measures requires reliable assessment by providers to ensure accurate risk stratification.
Objective
To assess the inter-rater reliability between pediatric radiologists measuring APRPD and minimum parenchymal thickness (MPT) on RUS in patients who also underwent DR for evaluation of hydronephrosis. A secondary objective was to assess whether individual radiologist measurements for APRPD and MPT differed based on Society for Fetal Urology (SFU) grade, prolonged drainage time on DR, or decreased differential renal function (DRF) (<40 %).
Study design
We conducted a retrospective cohort study of children who underwent DR within 120 days of RUS for the evaluation of hydronephrosis. We included patients with isolated unilateral SFU grade 3 and 4 hydronephrosis. Non-parametric tests were used to compare cohorts with and without prolonged drainage time (t1/2 > 40 min) or decreased DRF (<40 %) on DR. Covariables included SFU grade, laterality, sex, antenatal diagnosis of hydronephrosis, and time interval between studies. Intraclass-correlation coefficient (ICC) for absolute agreement was calculated for APRPD and MPT.
Results
112 patients met inclusion criteria. Studies occurred between October 2011 and January 2024. Median age at the time of DR was 1.6 years and the median interval between RUS and DR was 30 days. The majority of patients were male (71 %), had antenatal detection of hydronephrosis (85 %), and had left sided hydronephrosis (63 %). Rates of SFU grade 3 and 4 hydronephrosis were similar (45 % and 55 %, respectively). Patients with decreased DRF or prolonged drainage time were more likely to have SFU grade 4 hydronephrosis. For APRPD and MPT, ICC values were good to excellent, with ICC of 0.88 (95 % CI 0.82–0.92) and 0.86 (95 % CI 0.77–0.91) respectively, and remained so on subgroup analysis by SFU grade. APRPD and MPT measurements were significantly different in patients with SFU grade 3 vs 4 hydronephrosis for both radiologists.
Discussion and conclusion
APRPD and MPT were reliably measured by radiologists with good to excellent ICC. These have the potential to serve as objective measures to assess risk of abnormal findings on DR. Future prospective studies to assess their utility in risk stratifying patients with hydronephrosis and suspected UPJ obstruction are warranted.
肾超声（RUS）上的前后肾盂直径（APRPD）和最小实质厚度比（MPTR）已被确定为有助于对利尿肾造影（DR）不良表现的肾积水患者进行风险分层的措施。这些措施的广泛采用需要提供者进行可靠的评估，以确保准确的风险分层。目的评估儿科放射科医师在接受DR的患者中测量APRPD和最小实质厚度（MPT）来评估肾积水的可信度。第二个目的是评估个体放射科医生对APRPD和MPT的测量是否因胎儿泌尿学会（SFU）分级、DR引流时间延长或差性肾功能（DRF）降低（40%）而有所不同。研究设计：我们对RUS术后120天内接受DR的儿童进行了回顾性队列研究，以评估肾积水。我们纳入了孤立的单侧SFU 3级和4级肾积水患者。非参数检验用于比较有和没有延长引流时间（t1/2 >； 40分钟）或dr减少DRF （< 40%）的队列。辅助变量包括SFU分级、侧边性、性别、肾积水的产前诊断和研究之间的时间间隔。计算APRPD和MPT的绝对一致性的类内相关系数（ICC）。结果112例患者符合纳入标准。研究时间为2011年10月至2024年1月。DR发生时的中位年龄为1.6岁，RUS和DR之间的中位间隔为30天。大多数患者为男性（71%），产前检出肾积水（85%），左侧肾积水（63%）。SFU 3级和4级肾积水发生率相似（分别为45%和55%）。DRF降低或引流时间延长的患者更有可能发生SFU级4级肾积水。APRPD和MPT的ICC值为良至优，分别为0.88 （95% CI 0.82-0.92）和0.86 (95% CI 0.77-0.91)，按SFU分级亚组分析仍为如此。两名放射科医生对SFU 3级和4级肾积水患者的APRPD和MPT测量结果有显著差异。讨论与结论aprpd和MPT由具有良好至优秀ICC的放射科医师可靠地测量。这些有可能作为评估dr异常发现风险的客观措施，未来的前瞻性研究将评估其在肾积水和疑似UPJ梗阻患者风险分层中的效用。
{"title":"Assessing inter-rater reliability of objective renal sonographic measurements for identification of clinically significant ureteropelvic junction obstruction","authors":"C. Corbett , J.S. Kim , H. Aboughalia , V. Kucherov , B. Hisam , T. Myint , A. Krill","doi":"10.1016/j.jpurol.2026.105727","DOIUrl":"10.1016/j.jpurol.2026.105727","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior posterior renal pelvis diameter (APRPD) and minimal parenchymal thickness ratio (MPTR) on renal ultrasonography (RUS) have been identified as measures to help risk stratify patients with hydronephrosis for adverse findings on diuretic renography (DR). Widespread adoption of these measures requires reliable assessment by providers to ensure accurate risk stratification.</div></div><div><h3>Objective</h3><div>To assess the inter-rater reliability between pediatric radiologists measuring APRPD and minimum parenchymal thickness (MPT) on RUS in patients who also underwent DR for evaluation of hydronephrosis. A secondary objective was to assess whether individual radiologist measurements for APRPD and MPT differed based on Society for Fetal Urology (SFU) grade, prolonged drainage time on DR, or decreased differential renal function (DRF) (<40 %).</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study of children who underwent DR within 120 days of RUS for the evaluation of hydronephrosis. We included patients with isolated unilateral SFU grade 3 and 4 hydronephrosis. Non-parametric tests were used to compare cohorts with and without prolonged drainage time (t<sub>1/2</sub> > 40 min) or decreased DRF (<40 %) on DR. Covariables included SFU grade, laterality, sex, antenatal diagnosis of hydronephrosis, and time interval between studies. Intraclass-correlation coefficient (ICC) for absolute agreement was calculated for APRPD and MPT.</div></div><div><h3>Results</h3><div>112 patients met inclusion criteria. Studies occurred between October 2011 and January 2024. Median age at the time of DR was 1.6 years and the median interval between RUS and DR was 30 days. The majority of patients were male (71 %), had antenatal detection of hydronephrosis (85 %), and had left sided hydronephrosis (63 %). Rates of SFU grade 3 and 4 hydronephrosis were similar (45 % and 55 %, respectively). Patients with decreased DRF or prolonged drainage time were more likely to have SFU grade 4 hydronephrosis. For APRPD and MPT, ICC values were good to excellent, with ICC of 0.88 (95 % CI 0.82–0.92) and 0.86 (95 % CI 0.77–0.91) respectively, and remained so on subgroup analysis by SFU grade. APRPD and MPT measurements were significantly different in patients with SFU grade 3 vs 4 hydronephrosis for both radiologists.</div></div><div><h3>Discussion and conclusion</h3><div>APRPD and MPT were reliably measured by radiologists with good to excellent ICC. These have the potential to serve as objective measures to assess risk of abnormal findings on DR. Future prospective studies to assess their utility in risk stratifying patients with hydronephrosis and suspected UPJ obstruction are warranted.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105727"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-21DOI: 10.1016/j.jpurol.2026.105747
Ioana Fugaru , Richard Liu , Alexa Ehlebracht , Sophie Turpin , John-Paul Capolicchio
Introduction
Ureteropelvic junction obstruction (UPJO) is a frequent cause of congenital hydronephrosis (CHN). There is no gold standard diagnostic test for UPJO. Serial diuretic renogram is often used as a surrogate for diagnosing UPJO. Cortical transit time (CTT) is a renogram parameter reported helpful for management. Our primary objective was to study the association of CTT with other diuretic renogram parameters, and secondarily with clinical management.
Methods
We retrospectively reviewed 295 charts for CHN and pyeloplasty. We included 64 consecutive pyeloplasties (treatment group), and 44 conservatively managed CHN with available diuretic renogram (conservative group). Excluded were 55 patients >1 year old at presentation and 133 patients with other urinary abnormalities or incomplete data. Pyeloplasty indication profile included worsening hydronephrosis, initial DRF ≤40 % with prolonged diuretic drainage time, decrease in DRF ≥5 %, prolonged diuretic drainage time and symptomatic. Ultrasounds (RBUS) were reviewed for HN grade and anterior-posterior diameter (APD). MAG-3 diuretic renograms were reviewed for differential renal function (DRF), CTT, diuretic half-time (T1/2) and global washout (GWO). Delta (Δ) CTT between the affected and contralateral renal unit was calculated.
Results
Regarding T1/2, the cut-off with the highest area under the curve (AUC) on the ROC curves was CTT >5 min (AUC = 0.84) and Δ CTT ≥3 min (AUC = 0.91). Regarding GWO, the best cut-offs were the same: CTT >5 min (AUC = 0.88) and Δ CTT ≥3 min (AUC = 0.91). A cut-off of >3 min for CTT had the highest sensitivity for pyeloplasty (80 %) but poor specificity (55 %). CTT >5 min had the best specificity (96 %). A cut-off for Δ CTT of ≥3 min had the highest specificity for pyeloplasty (98 %).
Conclusions
Increasing CTT correlated with increasing diuretic drainage times and decreasing diuretic global washout. The previously reported cut-off of CTT >3 min was sensitive but not specific for impaired diuretic drainage times. We identified that a CTT >5 min and the novel Δ CTT ≥3 min were associated with significantly impaired drainage times. We conclude that a CTT greater than 5 min may be a better indicator of severity than 3 min. Similarly, a CTT <3 min is likely an indicator of a favorable outcome. These indicators of severity for children presenting with CHN could help tailor the frequency and type of follow-up imaging. Further prospective studies are required to validate these findings.
导读：肾盂输尿管连接处梗阻（UPJO）是先天性肾盂积水（CHN）的常见原因。UPJO没有金标准诊断测试。连续利尿肾图常被用作诊断UPJO的替代方法。皮质传输时间（CTT）是一种被报道有助于治疗的肾图参数。我们的主要目的是研究CTT与其他利尿肾图参数的关系，其次是与临床管理的关系。方法回顾性分析295例CHN和肾盂成形术病例。我们纳入了64例连续的肾盂成形术（治疗组）和44例有利尿肾图的保守治疗CHN（保守组）。排除了55例发病时年龄在10 ~ 10岁的患者和133例有其他泌尿系统异常或资料不完整的患者。肾盂成形术指征包括肾盂积水加重、初始DRF≤40%且利尿剂引流时间延长、DRF下降≥5%、利尿剂引流时间延长及出现症状。回顾超声（RBUS）检查HN分级和前后径（APD）。我们回顾了MAG-3利尿肾图的差异肾功能（DRF）、CTT、利尿半衰期（T1/2）和整体洗脱期（GWO）。计算患侧与对侧肾单元间的Δ （Δ） CTT。结果：T1/2在ROC曲线上曲线下面积（AUC）最高的临界值分别为CTT≥5 min （AUC = 0.84）和Δ CTT≥3 min （AUC = 0.91）。对于GWO，最佳临界值相同：CTT bb0 5 min （AUC = 0.88）和Δ CTT≥3 min （AUC = 0.91）。CTT的截止时间为30min，对肾盂成形术的敏感性最高（80%），但特异性较差（55%）。CTT bbb50 min特异性最高，为96%。Δ CTT≥3分钟的临界值对于肾盂成形术具有最高的特异性（98%）。结论：CTT增加与利尿剂引流次数增加和利尿剂整体冲洗减少相关。先前报道的CTT的截止时间为30min，对利尿剂引流受损的时间是敏感的，但不是特异性的。我们发现CTT bb0 5分钟和新型Δ CTT≥3分钟与引流时间显著受损相关。我们得出结论，CTT大于5分钟可能是一个比3分钟更好的严重程度指标。类似地，CTT
{"title":"Comparison of nuclear renographic renal cortical transit time with diuretic drainage time parameters in congenital hydronephrosis","authors":"Ioana Fugaru , Richard Liu , Alexa Ehlebracht , Sophie Turpin , John-Paul Capolicchio","doi":"10.1016/j.jpurol.2026.105747","DOIUrl":"10.1016/j.jpurol.2026.105747","url":null,"abstract":"<div><h3>Introduction</h3><div>Ureteropelvic junction obstruction (UPJO) is a frequent cause of congenital hydronephrosis (CHN). There is no gold standard diagnostic test for UPJO. Serial diuretic renogram is often used as a surrogate for diagnosing UPJO. Cortical transit time (CTT) is a renogram parameter reported helpful for management. Our primary objective was to study the association of CTT with other diuretic renogram parameters, and secondarily with clinical management.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 295 charts for CHN and pyeloplasty. We included 64 consecutive pyeloplasties (treatment group), and 44 conservatively managed CHN with available diuretic renogram (conservative group). Excluded were 55 patients >1 year old at presentation and 133 patients with other urinary abnormalities or incomplete data. Pyeloplasty indication profile included worsening hydronephrosis, initial DRF ≤40 % with prolonged diuretic drainage time, decrease in DRF ≥5 %, prolonged diuretic drainage time and symptomatic. Ultrasounds (RBUS) were reviewed for HN grade and anterior-posterior diameter (APD). MAG-3 diuretic renograms were reviewed for differential renal function (DRF), CTT, diuretic half-time (T1/2) and global washout (GWO). Delta (Δ) CTT between the affected and contralateral renal unit was calculated.</div></div><div><h3>Results</h3><div>Regarding T1/2, the cut-off with the highest area under the curve (AUC) on the ROC curves was CTT >5 min (AUC = 0.84) and Δ CTT ≥3 min (AUC = 0.91). Regarding GWO, the best cut-offs were the same: CTT >5 min (AUC = 0.88) and Δ CTT ≥3 min (AUC = 0.91). A cut-off of >3 min for CTT had the highest sensitivity for pyeloplasty (80 %) but poor specificity (55 %). CTT >5 min had the best specificity (96 %). A cut-off for Δ CTT of ≥3 min had the highest specificity for pyeloplasty (98 %).</div></div><div><h3>Conclusions</h3><div>Increasing CTT correlated with increasing diuretic drainage times and decreasing diuretic global washout. The previously reported cut-off of CTT >3 min was sensitive but not specific for impaired diuretic drainage times. We identified that a CTT >5 min and the novel Δ CTT ≥3 min were associated with significantly impaired drainage times. We conclude that a CTT greater than 5 min may be a better indicator of severity than 3 min. Similarly, a CTT <3 min is likely an indicator of a favorable outcome. These indicators of severity for children presenting with CHN could help tailor the frequency and type of follow-up imaging. Further prospective studies are required to validate these findings.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105747"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146776442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-10DOI: 10.1016/j.jpurol.2025.11.022
Changkai Deng
{"title":"Letter to the Editor re: \"Laparoscopic single-stage orchidopexy followed by groin exploration: The best two-stage orchidopexy?\"","authors":"Changkai Deng","doi":"10.1016/j.jpurol.2025.11.022","DOIUrl":"10.1016/j.jpurol.2025.11.022","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105686"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The kidney is the most frequently injured organ in pediatric blunt abdominal trauma. The success of conservative treatment is well-demonstrated for American Association for the Surgery of Trauma (AAST) grade I—III renal injuries. However, the optimal management of grade IV trauma remains controversial. This study aims to enhance the understanding of the optimal therapeutic approach for children with such lesions.
Materials and methods
Medical records of all children presenting with blunt abdominal trauma at our center between January 2013 and January 2020 were reviewed. Renal injuries were classified according to the 2018 AAST grading system, and mechanisms of injury were recorded. Detailed analysis was conducted on the patients with grade IV renal trauma, including mechanism of trauma, associated injuries, imaging, management, length of hospital stay, and follow-up.
Results
All 16 children with grade IV renal trauma were initially managed conservatively. Six (38 %) required no further intervention. Minimally invasive measures—ureteral stenting or angioembolization—were necessary for seven (43 %) patients. Urgent surgical exploration was needed in three (19 %) patients due to hemodynamic instability or vascular trauma. Nephrectomy was avoided in all three and no patient developed hypertension during follow-up. Renal function loss was observed in the only patient with renal arterial dissection.
Discussion
Approximately 40 % of our patients with grade IV blunt renal trauma were successfully managed conservatively. When including both conservatively and minimally invasively treated patients, the success rate rose to 80 %. Many injuries resulted from high-velocity winter sports accidents. This may have contributed to the severity of trauma at presentation.
Conclusion
Conservative management was initially attempted in all patients with grade IV blunt renal trauma and succeeded in 40 % of cases. The success rate rose to 80 % when minimally invasive treatments were included. High-velocity winter sports injuries were associated with more severe trauma, but conservative management remained feasible in hemodynamically stable patients. This highlights the importance of mechanism of injury in guiding treatment and the potential need to adapt pediatric grade IV renal trauma classifications to optimize timing of intervention.
{"title":"Management of grade IV pediatric blunt renal trauma: Conservative, interventional or surgical? Our experience between 2013 and 2020","authors":"Sandrine Viaccoz , Marie Heyne-Pietschmann , Steffen Berger , Mazen Zeino","doi":"10.1016/j.jpurol.2026.105726","DOIUrl":"10.1016/j.jpurol.2026.105726","url":null,"abstract":"<div><h3>Introduction</h3><div>The kidney is the most frequently injured organ in pediatric blunt abdominal trauma. The success of conservative treatment is well-demonstrated for American Association for the Surgery of Trauma (AAST) grade I—III renal injuries. However, the optimal management of grade IV trauma remains controversial. This study aims to enhance the understanding of the optimal therapeutic approach for children with such lesions.</div></div><div><h3>Materials and methods</h3><div>Medical records of all children presenting with blunt abdominal trauma at our center between January 2013 and January 2020 were reviewed. Renal injuries were classified according to the 2018 AAST grading system, and mechanisms of injury were recorded. Detailed analysis was conducted on the patients with grade IV renal trauma, including mechanism of trauma, associated injuries, imaging, management, length of hospital stay, and follow-up.</div></div><div><h3>Results</h3><div>All 16 children with grade IV renal trauma were initially managed conservatively. Six (38 %) required no further intervention. Minimally invasive measures—ureteral stenting or angioembolization—were necessary for seven (43 %) patients. Urgent surgical exploration was needed in three (19 %) patients due to hemodynamic instability or vascular trauma. Nephrectomy was avoided in all three and no patient developed hypertension during follow-up. Renal function loss was observed in the only patient with renal arterial dissection.</div></div><div><h3>Discussion</h3><div>Approximately 40 % of our patients with grade IV blunt renal trauma were successfully managed conservatively. When including both conservatively and minimally invasively treated patients, the success rate rose to 80 %. Many injuries resulted from high-velocity winter sports accidents. This may have contributed to the severity of trauma at presentation.</div></div><div><h3>Conclusion</h3><div>Conservative management was initially attempted in all patients with grade IV blunt renal trauma and succeeded in 40 % of cases. The success rate rose to 80 % when minimally invasive treatments were included. High-velocity winter sports injuries were associated with more severe trauma, but conservative management remained feasible in hemodynamically stable patients. This highlights the importance of mechanism of injury in guiding treatment and the potential need to adapt pediatric grade IV renal trauma classifications to optimize timing of intervention.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105726"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-10-10DOI: 10.1016/j.jpurol.2025.09.036
Sylvia Weis, Ugo Maria Pierucci, Thibault Planchamp, Amane A Lachkar, Mahmoud S Amar, Eliane Raffet, Lise Natio, Capucine Sauques, Victoria Lenormand, Florence Julien-Marsollier, Pauline Lopez, Charlotte Duneton, Annabel Paye, Matthieu Peycelon, Alaa El-Ghoneimi
<p><strong>Background: </strong>Since the first description procedure in 1980, the Mitrofanoff procedure involving appendicovesicostomy has become a widely adopted method for continent urinary diversion in children and adults.</p><p><strong>Objective: </strong>This study aims to evaluate the feasibility and outcomes of employing a technically challenging minimally-invasive (MIS) approach in pediatric patients.</p><p><strong>Study design: </strong>A retrospective analysis of the prospective institutional database was conducted (2003-2020). Patients were categorized into two cohorts: (i) those who underwent surgery before 2013 (Group 1) and (ii) those who underwent surgery after 2013 (Group 2). Prior to surgery, urodynamic studies were performed to assess bladder compliance, capacity, and detrusor activity. Outcome measures included complications, revisions, stenosis, and stomal incontinence, with the latter classified according to the Schulte-Baukloh score.</p><p><strong>Results: </strong>A total of 29 children (Group 1, n = 15; Group 2, n = 14) with a median (IQR) age of 8 years (6-13) underwent a MIS Mitrofanoff procedure. Median (IQR) follow-up was 60 months (17-88). The procedure was completed by laparoscopy in 26 cases. Three laparoscopic surgeries were converted to an open procedure due to tearing of the bladder mucosa (n = 2) or appendix ischemia (n = 1). All conversions occurred before 2013 (p = 0.23). Median (IQR) operative time was 310 min (250-360) (295 (245-330) vs. 324 (273-351) min for Group 1 vs. Group 2, respectively; p = 0.44). Social continence was achieved in 21 patients (72 %) (n = 10/15 (67 %) vs. 11/14 (79 %), respectively; p = 0.68). Stomal urinary leakage was reported by nine (31 %) patients (6 (40 %) vs. 3 (21 %), respectively; p 0.68, no cases in robotic subgroup) of whom five (63 %) were managed successfully by hyaluronic acid/dextranomer injection and four required an open revision of the appendicovesical anastomosis (Group 1: n = 3; Group 2: n = 1). No patient developed stenosis of the catheterizable channel. One patient subsequently had a bladder augmentation. There was an improvement in outcomes with regards to continence and complications as the surgical team gained in experience: revision surgeries: Group 1 (n = 3; 20 %) vs. Group 2 (n = 1; 7 %) p = 0.61; conversions: Group 1 (n = 3; 20 %) vs. Group 2 (n = 0) (p = 0.23). The last three cases were performed robotically without any complications or conversion, and with stomal continence, in a shorter median operative time (300 min (293-330) vs. 338 min (245-344) laparoscopically, p = 0.70).</p><p><strong>Conclusion: </strong>The laparoscopic Mitrofanoff procedure is a safe and feasible option in children. A trend toward improved continence and fewer revisions was observed in the later cohort, although these differences did not reach statistical significance. None of the patients developed channel stenosis. Previous pediatric literature suggests that minimally invasiv
{"title":"Laparoscopic Mitrofanoff procedure in children: Feasibility and outcome analysis over 18 years in a single centre.","authors":"Sylvia Weis, Ugo Maria Pierucci, Thibault Planchamp, Amane A Lachkar, Mahmoud S Amar, Eliane Raffet, Lise Natio, Capucine Sauques, Victoria Lenormand, Florence Julien-Marsollier, Pauline Lopez, Charlotte Duneton, Annabel Paye, Matthieu Peycelon, Alaa El-Ghoneimi","doi":"10.1016/j.jpurol.2025.09.036","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.09.036","url":null,"abstract":"<p><strong>Background: </strong>Since the first description procedure in 1980, the Mitrofanoff procedure involving appendicovesicostomy has become a widely adopted method for continent urinary diversion in children and adults.</p><p><strong>Objective: </strong>This study aims to evaluate the feasibility and outcomes of employing a technically challenging minimally-invasive (MIS) approach in pediatric patients.</p><p><strong>Study design: </strong>A retrospective analysis of the prospective institutional database was conducted (2003-2020). Patients were categorized into two cohorts: (i) those who underwent surgery before 2013 (Group 1) and (ii) those who underwent surgery after 2013 (Group 2). Prior to surgery, urodynamic studies were performed to assess bladder compliance, capacity, and detrusor activity. Outcome measures included complications, revisions, stenosis, and stomal incontinence, with the latter classified according to the Schulte-Baukloh score.</p><p><strong>Results: </strong>A total of 29 children (Group 1, n = 15; Group 2, n = 14) with a median (IQR) age of 8 years (6-13) underwent a MIS Mitrofanoff procedure. Median (IQR) follow-up was 60 months (17-88). The procedure was completed by laparoscopy in 26 cases. Three laparoscopic surgeries were converted to an open procedure due to tearing of the bladder mucosa (n = 2) or appendix ischemia (n = 1). All conversions occurred before 2013 (p = 0.23). Median (IQR) operative time was 310 min (250-360) (295 (245-330) vs. 324 (273-351) min for Group 1 vs. Group 2, respectively; p = 0.44). Social continence was achieved in 21 patients (72 %) (n = 10/15 (67 %) vs. 11/14 (79 %), respectively; p = 0.68). Stomal urinary leakage was reported by nine (31 %) patients (6 (40 %) vs. 3 (21 %), respectively; p 0.68, no cases in robotic subgroup) of whom five (63 %) were managed successfully by hyaluronic acid/dextranomer injection and four required an open revision of the appendicovesical anastomosis (Group 1: n = 3; Group 2: n = 1). No patient developed stenosis of the catheterizable channel. One patient subsequently had a bladder augmentation. There was an improvement in outcomes with regards to continence and complications as the surgical team gained in experience: revision surgeries: Group 1 (n = 3; 20 %) vs. Group 2 (n = 1; 7 %) p = 0.61; conversions: Group 1 (n = 3; 20 %) vs. Group 2 (n = 0) (p = 0.23). The last three cases were performed robotically without any complications or conversion, and with stomal continence, in a shorter median operative time (300 min (293-330) vs. 338 min (245-344) laparoscopically, p = 0.70).</p><p><strong>Conclusion: </strong>The laparoscopic Mitrofanoff procedure is a safe and feasible option in children. A trend toward improved continence and fewer revisions was observed in the later cohort, although these differences did not reach statistical significance. None of the patients developed channel stenosis. Previous pediatric literature suggests that minimally invasiv","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"105630"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-09-17DOI: 10.1016/j.jpurol.2025.09.010
Cherdpong Choenklang, Patpicha Arunsan, Schawanya K Rattanapitoon, Nathkapach K Rattanapitoon
{"title":"Letter to the Editor re: \"Antegrade genitography - A new diagnostic modality of obstructive abnormalities in the female reproductive tract\".","authors":"Cherdpong Choenklang, Patpicha Arunsan, Schawanya K Rattanapitoon, Nathkapach K Rattanapitoon","doi":"10.1016/j.jpurol.2025.09.010","DOIUrl":"10.1016/j.jpurol.2025.09.010","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105604"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-13DOI: 10.1016/j.jpurol.2026.105737
Ashorne K. Mahenthiran, Christopher Ferari, Shelly King, Jin Kyu Kim, Rosalia Misseri, Martin Kaefer, Richard C. Rink, Benjamin M. Whittam, Joshua Roth, Kirstan K. Meldrum, Mark P. Cain, Konrad M. Szymanski, Pankaj P. Dangle
Introduction
Pediatric urologists are often tasked with recognizing upper urinary tract obstruction and managing these cases appropriately. The Whitaker test (WhT) is a diagnostic modality created to identify obstruction by measuring pressure differentials along the renal pelvis and bladder via antegrade contrast administration. Over time, the diuretic renogram has become preferred in the workup of pediatric obstruction due to concerns regarding need for percutaneous nephrostomy tube placement and variability in findings based on technique during WhT.
Objective
This study evaluates the clinical utility of the WhT in a contemporary pediatric cohort — especially in patients with equivocal diuretic renograms or prior interventions for urinary tract obstruction.
Study design
A retrospective chart review was conducted to identify patients less than 18 years old who underwent WhT between 2019 and 2025 at our tertiary referral center. Data collected included patient demographics such as prior upper tract reconstruction, renogram interpretations by radiologists, indications for and results of WhT, and concordance versus discordance between renogram and WhT. In cases of discordance, we examined whether ultimate decision-making reflected the findings of WhT or renogram.
Results
38 patients underwent WhT between 2019 and 2025. Approximately 60 % of the cohort was male and 60 % of the cohort had prior upper tract urinary reconstruction. The most common indication for WhT was concern for recurrent unilateral ureteropelvic junction obstruction (UPJO) after pyeloplasty (30.8 %). Overall, almost 80 % of treatment decisions, regarding whether to intervene or observe, were aligned with WhT findings of whether obstruction was present.
Discussion
This study confirms that there remains clinical value to WhT in the workup of pediatric urinary tract obstruction. Our findings align with prior literature that WhT is a useful supplemental tool to renogram, particularly in equivocal cases or for patients with prior reconstruction. The retrospective, single-center design of this study inherently limits its evidentiary strength and generalizability.
Conclusion
Our study found that select patients with inconclusive renal scans and complex urologic history may benefit from WhT for conclusive decisions regarding whether surgical intervention is needed to manage upper urinary tract obstruction.
{"title":"The utility of the Whitaker test in the modern era of pediatric urology: A retrospective cohort study","authors":"Ashorne K. Mahenthiran, Christopher Ferari, Shelly King, Jin Kyu Kim, Rosalia Misseri, Martin Kaefer, Richard C. Rink, Benjamin M. Whittam, Joshua Roth, Kirstan K. Meldrum, Mark P. Cain, Konrad M. Szymanski, Pankaj P. Dangle","doi":"10.1016/j.jpurol.2026.105737","DOIUrl":"10.1016/j.jpurol.2026.105737","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric urologists are often tasked with recognizing upper urinary tract obstruction and managing these cases appropriately. The Whitaker test (WhT) is a diagnostic modality created to identify obstruction by measuring pressure differentials along the renal pelvis and bladder via antegrade contrast administration. Over time, the diuretic renogram has become preferred in the workup of pediatric obstruction due to concerns regarding need for percutaneous nephrostomy tube placement and variability in findings based on technique during WhT.</div></div><div><h3>Objective</h3><div>This study evaluates the clinical utility of the WhT in a contemporary pediatric cohort — especially in patients with equivocal diuretic renograms or prior interventions for urinary tract obstruction.</div></div><div><h3>Study design</h3><div>A retrospective chart review was conducted to identify patients less than 18 years old who underwent WhT between 2019 and 2025 at our tertiary referral center. Data collected included patient demographics such as prior upper tract reconstruction, renogram interpretations by radiologists, indications for and results of WhT, and concordance versus discordance between renogram and WhT. In cases of discordance, we examined whether ultimate decision-making reflected the findings of WhT or renogram.</div></div><div><h3>Results</h3><div>38 patients underwent WhT between 2019 and 2025. Approximately 60 % of the cohort was male and 60 % of the cohort had prior upper tract urinary reconstruction. The most common indication for WhT was concern for recurrent unilateral ureteropelvic junction obstruction (UPJO) after pyeloplasty (30.8 %). Overall, almost 80 % of treatment decisions, regarding whether to intervene or observe, were aligned with WhT findings of whether obstruction was present.</div></div><div><h3>Discussion</h3><div>This study confirms that there remains clinical value to WhT in the workup of pediatric urinary tract obstruction. Our findings align with prior literature that WhT is a useful supplemental tool to renogram, particularly in equivocal cases or for patients with prior reconstruction. The retrospective, single-center design of this study inherently limits its evidentiary strength and generalizability.</div></div><div><h3>Conclusion</h3><div>Our study found that select patients with inconclusive renal scans and complex urologic history may benefit from WhT for conclusive decisions regarding whether surgical intervention is needed to manage upper urinary tract obstruction.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105737"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-29DOI: 10.1016/j.jpurol.2026.105773
Shuting Lin , Rifang Pan , Sentian Liu , Chao Chen
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.
{"title":"A clinical nomogram for predicting postoperative renal function improvement in children with UPJO","authors":"Shuting Lin , Rifang Pan , Sentian Liu , Chao Chen","doi":"10.1016/j.jpurol.2026.105773","DOIUrl":"10.1016/j.jpurol.2026.105773","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105773"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-06-24DOI: 10.1016/j.jpurol.2025.06.016
Michele Gnech, Anna Bujons, Christian Radmayr, Lisette 't Hoen, Guy Bogaert, Berk Burgu, Yazan F Rawashdeh, Mesrur Selcuk Silay, Fardod O'Kelly, Josine Quaedackers, Niklas Pakkasjärvi, Allon van Uitert, Martin Skott, Uchenna Kennedy, Yuhong Yuan, Alexandra Zachou, Marco Castagnetti
Background and objective: These guidelines aim to provide a practical approach for both diagnosis and management of urinary tract infections (UTI).
Objective: To highlight 2025 update of the Guidelines of the European Association of Urology (EAU) and the European Society for Paediatric Urology (ESPU) on UTI in children.
Methods: A structured literature review was performed for all relevant litterature from the last update (2021) up to 20th February 2024.
Key findings and limitations: UTIs represent the most common bacterial infections in children. The leading causative organism is Escherichia Coli (E. Coli), however, other bacteria have been increasing in prevalence, as has the prevalence of multi-resistent E. Coli infections. UTIs can be classified in several ways including upper vs. lower urinary tract UTIs; febrile vs. non febrile UTIs; first vs. recurrent vs. breakthrough episode; typical vs. atypical. Urine samples for analysis can be collected by urine bag, clean catch, catheterization, or suprapubic aspiration. Methods for urinalysis include dipstick, microscopy and flow imaging analysis technology. Each collection and analysis method has its own advanatages and drawbacks. Microscopic urinalysis is recommended after a positive dipstick test. In terms of additional investigations, the Panel generally recommends a renal and bladder ultrasound after an initial febrile UTI, whereas additional investigations should be considered based on the characteristics of the patient and of the infection. A flow-chart is proposed. The cornerstone of UTI management is prompt antimicrobial therapy. The administration route should be chosen based on several variables. The agent should be chosen based on local antimicrobial sensitivity patterns, and adjusted according to sensitivity-testing. Interventions can be considered to prevent UTI recurrence including chemoprophylaxis, non-antibiotic prophylaxis, and treatment of phimosis, bladder-bowel dysfunction and lower urinary tract dysfunction.
Conclusions and clinical implications: This paper is a summary of the 2025 updated (Table) of EAU/ESPU Guidelines and provides practical considerations for the management and diagnostic evaluation of UTI in children.
{"title":"Update and summary of the EAU/ESPU paediatric guidelines on urinary tract infection in children.","authors":"Michele Gnech, Anna Bujons, Christian Radmayr, Lisette 't Hoen, Guy Bogaert, Berk Burgu, Yazan F Rawashdeh, Mesrur Selcuk Silay, Fardod O'Kelly, Josine Quaedackers, Niklas Pakkasjärvi, Allon van Uitert, Martin Skott, Uchenna Kennedy, Yuhong Yuan, Alexandra Zachou, Marco Castagnetti","doi":"10.1016/j.jpurol.2025.06.016","DOIUrl":"10.1016/j.jpurol.2025.06.016","url":null,"abstract":"<p><strong>Background and objective: </strong>These guidelines aim to provide a practical approach for both diagnosis and management of urinary tract infections (UTI).</p><p><strong>Objective: </strong>To highlight 2025 update of the Guidelines of the European Association of Urology (EAU) and the European Society for Paediatric Urology (ESPU) on UTI in children.</p><p><strong>Methods: </strong>A structured literature review was performed for all relevant litterature from the last update (2021) up to 20th February 2024.</p><p><strong>Key findings and limitations: </strong>UTIs represent the most common bacterial infections in children. The leading causative organism is Escherichia Coli (E. Coli), however, other bacteria have been increasing in prevalence, as has the prevalence of multi-resistent E. Coli infections. UTIs can be classified in several ways including upper vs. lower urinary tract UTIs; febrile vs. non febrile UTIs; first vs. recurrent vs. breakthrough episode; typical vs. atypical. Urine samples for analysis can be collected by urine bag, clean catch, catheterization, or suprapubic aspiration. Methods for urinalysis include dipstick, microscopy and flow imaging analysis technology. Each collection and analysis method has its own advanatages and drawbacks. Microscopic urinalysis is recommended after a positive dipstick test. In terms of additional investigations, the Panel generally recommends a renal and bladder ultrasound after an initial febrile UTI, whereas additional investigations should be considered based on the characteristics of the patient and of the infection. A flow-chart is proposed. The cornerstone of UTI management is prompt antimicrobial therapy. The administration route should be chosen based on several variables. The agent should be chosen based on local antimicrobial sensitivity patterns, and adjusted according to sensitivity-testing. Interventions can be considered to prevent UTI recurrence including chemoprophylaxis, non-antibiotic prophylaxis, and treatment of phimosis, bladder-bowel dysfunction and lower urinary tract dysfunction.</p><p><strong>Conclusions and clinical implications: </strong>This paper is a summary of the 2025 updated (Table) of EAU/ESPU Guidelines and provides practical considerations for the management and diagnostic evaluation of UTI in children.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105481"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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