Journal of Pediatric Urology最新文献

Introduction: Unilateral multicystic dysplastic kidney (UMCDK) is a congenital anomaly detectable already in utero. The affected kidney is non-functioning. While the ureter is typically absent, UMCDK may rarely associate with mesonephric duct (MND) remnants such as ureterocele or ureteral stump.

Objectives: To determine the frequency, clinical implications, and management of ipsilateral MND anomalies in children with UMCDK under comprehensive prenatal and postnatal surveillance.

Patients and methods: Retrospective analysis of 349 children (0-19 years) with UMCDK, followed by pediatric nephrologists and/or urologists in two tertiary centers between 2005 and 2024, was performed. MND anomalies were classified as: - Type Ia: Orthotopic ureterocele; - Type Ib: Orthotopic ureterocele plus ureteral remnant (stump); - Type II: Ectopic ureteral remnant (stump); - Type III: Complex anomalies involving seminal vesicles/epididymis.

Results: Based on medical record and imaging result evaluation, twenty-five patients (7.2 %) with MND anomalies (21 males, 4 females) were identified. Of those, four males (16 %) developed clinical complications (lower urinary tract dysfunction, urinary tract infection (UTI), recurring epididymitis) at different age (3, 8, 12 and 16 years). These symptomatic cases involved Type Ib and Type III anomalies. Median age at diagnosis of MND anomalies was 2 months and median follow-up duration was 10.7 years. All patients had normal glomerular filtration rate (GFR) at the beginning of the observation period, however, two children developed stage 2 chronic kidney disease (CKD 2) until the end of the follow-up. UMCDK resolved spontaneously in 15 patients. MND anomalies regressed below the USG detection threshold only in 3 conservatively managed children (type Ia or Ib). Five patients with MND anomalies required surgical management: 3 children endoscopic incision of ureterocele and 2 children exstirpation of ureterocele with ureteral stump.

Conclusions: MND anomalies in UMCDK are uncommon and mostly follow a benign course. Nevertheless, endoscopic or surgical intervention may be required due to late-onset complications, predominantly lower urinary tract dysfunction. Lifelong monitoring is suggested.

Background: Despite technological advances in minimally invasive surgery for pediatric oncology over recent decades and the fundamental role of surgery in Wilms tumor (WT) management, there are no standardized guidelines for these techniques in this population. This study compares outcomes between laparoscopic nephrectomy (LN) and open nephrectomy (ON) in pediatric patients with WT treated under the International Society of Paediatric Oncology (SIOP) protocol.

Methods: A systematic review and meta-analysis were conducted. Inclusion criteria encompassed randomized trials or nonrandomized cohorts comparing LN to ON, with patients treated according to the SIOP protocol. Clinical outcomes, including mortality, surgical morbidity, and oncological outcomes, were analyzed.

Results: Four nonrandomized cohort studies comprising 160 patients (60 LN, 100 ON) met the inclusion criteria. LN was associated with longer surgical times (mean difference, 23.79 min; p = 0.0002). There were no statistically significant differences between groups in postoperative complications (RR 0.56, p = 0.44), disease recurrence (RR 0.49, p = 0.26), mortality (RR 0.75, p = 0.70), local recurrence (RR 0.58, p = 0.45), or lymph node harvest (mean difference -2.71 nodes, p = 0.06).

Conclusion: Laparoscopic nephrectomy provides comparable oncological outcomes to open nephrectomy in pediatric WT. While numerical differences were observed in some outcomes, they did not reach statistical significance, likely due to the limited sample size.

Introduction and background: The aim of this study is to determine if spinal anesthesia (SA) for infant surgical circumcision results in shorter postoperative times compared to general anesthesia (GA). We hypothesized that, relative to GA, SA would have significantly shorter post-operative recovery times without increasing operative time or postoperative complications relative to GA.

Material and methods: A retrospective cohort study was conducted among infants receiving an outpatient surgical circumcision in the operating room (OR). The exposure was undergoing spinal anesthesia (n = 88) relative to unexposed patients undergoing general anesthesia (n = 105). The primary outcome was the total postoperative time (in minutes) from arriving in the post-anesthesia care unit (PACU) to discharging from the hospital. Secondary outcomes included total time in the operating room, time from entering the operating room to starting surgery, duration of the surgery, time from the end of surgery to leaving the operating room, and 30-day postoperative complications. Covariates of interest were age, weight, ASA class, anesthesiologist, and whether adjuvant anesthetics were administered. Patient and surgical characteristics were compared using non-parametric tests of association. Mixed-effect linear regression models were fit to test the association between SA and total post-op time and other outcomes.

Results: There were 88 male infants in the SA group and 105 male infants in the GA group; both groups were similar in age, weight, ASA class and insurance status. The unadjusted analysis demonstrated that median total postoperative time was significantly lower for the SA group (39.5 min) compared to the GA group (104 min; p < 0.001) (see figure). There was no difference in total OR time (median 51 versus 48, p = 0.1) (see figure), pre-surgery OR time (median 18 versus 18, p = 0.6) or surgical time (median 27 versus 24, p = 0.6). There was a very slight statistical difference in post-surgery OR time favoring spinal anesthesia (mean 6.5 vs. 4.8, p < 0.001). When controlling for anesthesiologist, age, weight and ASA class, patients receiving SA had a 65.5 min (p < 0.001) shorter PACU stay compared to GA. There was no difference in postoperative complications between the two groups.

Discussion: When compared to GA, male infants who underwent circumcision under SA had a faster hospital discharge by over an hour without impacting surgical or total OR times or complications. This reduction in recovery time may lead to cost savings for patients and hospitals, possibly allow for higher daily OR throughput and alleviate strain on PACU nurse staffing.

Background: Rhythmic bladder contractions (RBCs) are routinely observed in neurogenic bladders (NB) during urodynamic studies (UDS), often below the standard clinical threshold. These rhythmic bladder contractions may contribute to bladder hypertrophy despite low measured pressures, highlighting the need for objective quantification of this intrinsic activity.

Objective: This study aimed to validate Fast Fourier Transform (FFT) analysis for precisely characterizing RBCs in NB patients, assessing its relationship to visual inspection and its stability across varying bladder filling rates and motion artifact.

Methods: We retrospectively analyzed 115 UDS from 70 NB patients (0.5-18 years). Python-based FFT was applied to detrusor pressure data to derive the Highest Amplitude Frequency (HAF). The HAF was compared for reproducibility between same-day studies performed at identical and different filling rates. We used Bayes Factor (BF) analysis for robust statistical evaluation, Bland Altman analysis and Receiver Operating Characteristic (ROC) analysis to determine the lowest discernible amplitude measured on FFT.

Results: The HAF was the most reproducible measure (r = 0.85)and highly consistent across same-day UDS, irrespective of changes in filling rate (moderate evidence, BF). This key finding suggests the underlying RBC mechanism is filling rate independent. HAF closely aligned with the visually measured frequency (mean difference ≅ 5 %), validating the FFT method. ROC analysis determined the optimal amplitude cutoff for visually confirming a contraction was overall 1.06, and 1.53 when motion artifact was significant, demonstrating FFT's efficacy in penetrating noise.

Conclusion: FFT analysis is a reliable, objective, and reproducible method for quantifying bladder rhythmic activity, yielding an HAF that is stable regardless of filling rate or movement. The HAF is introduced as a robust, reproducible urodynamic parameter to objectively monitor neurogenic bladders.