Contralateral Vesicoureteral Reflux Research Articles

Unilateral Multicystic Dysplastic Kidney Management: A National Survey.

Risks of contralateral kidney abnormalities and chronic kidney disease necessitate follow-up for unilateral multicystic dysplastic kidneys (MCDK). A nationwide survey of senior UK pediatricians was conducted. Of the 60 responses obtained, 62% routinely perform a dimercaptosuccinic acid scan to confirm diagnosis. Eight percent routinely perform a cystogram to investigate contralateral vesicoureteric reflux. Sixty-two percent would routinely measure renal function (frequency ranging from once only to "every 2 years"). Twenty-five percent recalled MCDK nephrectomy being performed within the previous 5 years. Respondents voiced concerns that national guidance may result in an overcautious approach but could balance consensus and safe variation, and offer families choice and reassurance. The mean estimated cost of follow-up from birth to 18 years ranged from £258 to £3854. Results demonstrate significant variation in management, highlighting the need for a clear pathway to decrease unwanted variability and to ensure those at high risk of renal sequelae are recognized early, without undue investigatory burden.

Utility of renal scintigraphy in diagnosis of multicystic dysplastic kidney.

To compare the prevalence of vesicoureteral reflux (VUR), febrile urinary tract infection (fUTI), and chronic kidney disease (CKD) among patients with multicystic dysplastic kidney (MCDK) diagnosed by renal scintigraphy (RS) versus follow-up renal ultrasound (RUS) alone. This was a retrospective review of patients seen at a tertiary care center from 2010 to 2020 with MCDK diagnosed by RS or follow-up RUS. Differences in the prevalence of VUR, fUTI, and CKD by cohort were assessed using logistic regression analysis, Pearson X2 , and Fisher's Exact tests. Temporal trends in diagnostic methods used (RUS versus RUS + RS) were evaluated using the Cochran-Armitage trend test. One-hundred seventy-two patients were included: 50% (n=86) underwent RUS + RS and 50% (n=86) underwent RUS alone to diagnose MCDK. Prevalence of VUR, fUTI, and CKD did not significantly vary between groups. Among patients who had a VCUG, 4.4% had contralateral VUR (1.7% RUS + RS group; 7.4% RUS group; p=0.19) and 14.5% had at least one fUTI (16.3% RUS + RS group; 12.8% RUS group; p=0.52). Females were significantly more likely to have at least one fUTI (p=0.04). Four patients (2.3%) developed CKD, all in the RUS + RS cohort (p=0.12). Diagnosis of MCDK by RUS versus RUS + RS did not significantly vary over time (p=0.17). Patients with unilateral MCDK confirmed by RS versus RUS alone do not significantly vary in the prevalence of VUR, fUTI, or CKD. Renal scintigraphy studies may not be necessary in unilateral MCDK diagnosis but continue to be used.

Extravesical Common Sheath Ureteral Reimplantation Versus Intravesical Techniques for Refluxing Duplex Systems in Children.

Retrospective comparative study of the efficacy of extravesical non-dismembered common sheath ureteral reimplantation (ECSR) versus intravesical common sheath ureteral reimplantation (ICSR) techniques for the correction of vesicoureteral reflux (VUR) in complete duplex systems. Between 2010 and 2019, ECSR was performed in 38 children (8 bilaterally), and the mean ages at presentation and at surgery were 31 and 57 months, respectively. The ICSR technique was performed in 25 units (25 patients). Voiding cystography and ultrasound of the kidney and bladder were performed 3 and 12 months postoperatively. We analyzed the surgical outcomes for both groups. The mean follow-up times for the ECSR and ICSR groups were 15 and 18 months, respectively. The success rate of the ECSR group was 93.5% at 3 months, improving to 95.7% at an average of one year; the rate of the ICSR group was 96% at 3 months and was the same after one year, with no significant difference between the two groups (p = .66). Postoperative complications were compared in the ECSR and ICSR groups: transient contralateral VUR was seen in 5 renal units versus 4, de novo hydronephrosis was seen in 3 units versus 2, and UTIs were observed in 3 patients versus 4. Both (ECSR) and (ICSR) surgeries are highly successful for the correction of VUR in uncomplicated complete duplex systems. The results of the extravesical approach are comparable with those of the intravesical technique with less morbidity and a shorter hospital stay. Thus, ECSR is our preferred technique when open surgical repair is indicated. ICSR should be reserved for complicated duplex systems necessitating concomitant reconstructive surgery.

Pneumovesicoscopic Correction of Primary Vesicoureteral Reflux in Children: Our Initial Experience.

Purpose: The main objective of our prospective, descriptive, monocentric, longitudinal study is to demonstrate the feasibility of vesicoscopic cross-trigonal ureteral reimplantation under CO2 pneumovesicum in treatment on primary vesicoureteral reflux (VUR), analyze results, and specify the age limit of this approach. Materials and Methods: A total of 60 patients underwent transvesicoscopic ureteral reimplantation (33 boys, 27 girls) by the same surgeon from May 2011 to May 2015. All patients had primary VUR, and surgery was performed because of breakthrough urinary tract infection despite antibiotic prophylaxis and persistent high grade of VUR, especially in association with significant renal scarring, mean age at operation was 47.47 months (6 month-12 years). Of the 60 patients, 34 had bilateral reflux and 26 had unilateral reflux. The reflux grade in the total of 94 ureters was grade IV, V in 59.57%, grade III in 35.11%, and grade II in 5.32% in association with contralateral high-grade VUR. Results: The transvesicoscopic procedure was effectively completed in all patients without perioperative complication except one case of pneumoperitoneum that required exsufflation by open laparoscopy. The mean overall operative time decreased significantly with an average of 58.43 ± 11.26 minutes for unilateral reimplantation and 101.18 ± 26.5 minutes for bilateral reimplantation. The postoperative hospital stay was 3 days for all patients. The mean follow-up period was 3 years. Cystography was performed 3 months after surgery in all patients and showed the disappearance of VUR in 57/60 patients (95%) or 91/94 of ureters (97%). Persistent VUR was documented in 3 of 94 ureters and had resolved spontaneously at 12 months after reimplantation. Conclusion: Our preliminary results indicate that vesicoscopic ureteral reimplantation is safe and effective procedure with minimal morbidity when compared to traditional open method. It can be applied in children younger than 12 months.

Voiding Cystourethrogram in Children With Unilateral Multicystic Dysplastic Kidney: Is It Still necessary?

To evaluate the value of the voiding cystourethrogram (VCUG) in children with multicystic dysplastic kidney (MCDK) who have a normal versus abnormal contralateral kidney and bladder ultrasound (US), and assess the risk of having vesicoureteral reflux (VUR) or urinary tract infection (UTI) based on the US results. A retrospective chart review including children with unilateral MCDK with postnatal US and VCUG available at our institution between January 2008 and September 2017 was performed. Analysis was done to find association between abnormal contralateral US and contralateral VUR and UTI. One hundred and fifty-six children were analyzed; 118(75.6%) patients had a normal contralateral kidney US, while 38(24.4%) had abnormal US. The rate of severe contralateral VUR (grade IV and V) was 2 (1.7%) and 5 (13.2%) in children with normal and abnormal contralateral US, respectively. The risk analysis demonstrated a significant association between severe VUR on the contralateral kidney and an abnormal contralateral US (odds ratio=7.73; 95%CI: 1.43-41.81; P=0.018) and no significant association with UTI (odds ratio=1.58; 95%CI: 0.50-4.94; P=0.435). Our data suggests, the rate of severe contralateral VUR in children with unilateral MCDK and normal contralateral kidney is low. VCUG should be considered for infants with proven MCKD and alterations on the contralateral kidney on US. Following patients with MCDK and normal contralateral kidney without the use of VCUG is a reasonable approach, unless there is development of signs and symptoms of recurrent UTI or deterioration of the renal function. We found that abnormal contralateral kidney US was associated with severe VUR.

Could the Implantation of Dextranomer/Hyaluronic Acid Cause the Elevation of Neuron-Specific Enolase in Children Treated for Vesicoureteral Reflux?

Background: Dextranomer/hyaluronic acid copolymer (Dx/HA) has been the most widely used bulking agent for the endoscopic treatment of vesicoureteral reflux. Case presentation: Here we report on a case of an 18-month-old male who underwent endoscopic treatment with Dx/HA for persistent high-grade unilateral vesicoureteral reflux (VUR). Three months later, due to the reappearance of contralateral VUR and indicated endoscopic treatment, a second cystoscopy was performed. A submucosal, well-vascularized mass localized on the left trigone and anteromedially to the left orifice was noted. Since it differed from the other similar implants previously detected on cystoscopy, it was misdiagnosed with a bladder tumor, indicating further evaluation. Extensive laboratory and imaging studies revealed normal findings, apart from high levels of neuron-specific enolase (NSE). A hypothesis made at that point was that the elevated level of NSE is due to the implantation of the Dx/HA. To test the hypothesis, two other healthy children previously treated with a Dx/HA implant were identified and their NSE levels measured. In both cases, the levels of NSE were elevated. Conclusion: The presented cases revealed that elevated levels of NSE are most likely due to a previous implantation of Dx/HA. This observation should be taken into consideration whenever there is a tentative diagnosis of bladder tumor following the endoscopic treatment of VUR with Dx/HA in a child.

Re: A Meta-Analysis of the Incidence and Fate of Contralateral Vesicoureteral Reflux in Unilateral Multicystic Dysplastic Kidney.

Re: A Meta-Analysis of the Incidence and Fate of Contralateral Vesicoureteral Reflux in Unilateral Multicystic Dysplastic Kidney.

A meta-analysis of the incidence and fate of contralateral vesicoureteral reflux in unilateral multicystic dysplastic kidney

Multicystic dysplastic kidney (MCDK) is the most common type of renal cystic disease. It is associated with urinary tract abnormalities in the contralateral kidney in up to 30% of cases, most commonly vesicoureteral reflux (VUR). The objective of this study was to describe the incidence and selected issues in management and evolution for each VUR grade in the contralateral kidney of patients with unilateral MCDK, in order to strengthen the scientific basis regarding the need for voiding cystourethrography (VCUG) screening. A comprehensive search of standard and gray literature was performed. Full-text screening, data abstraction, and quality appraisal were conducted in duplicates. Included studies reported a primary diagnosis of unilateral MCDK with contralateral VUR determined by VCUG. Articles had to include a distribution of VUR grade to meet the eligibility criteria. From 698 retrieved articles, 37 studies enrolling 2057 patients were analyzed. Of the patients, 80% were male; 50% had left unilateral MCDK; and 87% were diagnosed prenatally. A total of 1800 patients had VCUG, of whom 303 had VUR (weighted proportion: 17%; 95% confidence interval [CI]: 14-20%). Weighted proportions of VUR were 9%, 7%, and 17% for grades I-II, III-V, and I-V, respectively. Of the patients, 99% (95% CI: 97-100%) were on continuous antibiotic prophylaxis (CAP) and 18% (95% CI: 8-37%) had urinary tract infections (UTIs), with a higher rate of UTIs (23% vs 10%) in patients with dilating (grades III-V) VUR, over a mean follow-up of 40 months. In patients with dilating VUR, reflux resolved or downgraded to grade I in 52% (95% CI: 37-67%) of patients, and 32% (95% CI: 19-49%) had surgical correction of VUR. Among patients with unilateral MCDK, 17% have VUR in the contralateral kidney, 41% of which is dilating VUR. Of the cases with dilating VUR, half will resolve or downgrade to grade I during follow-up; 23% will develop a UTI despite CAP; and one-third will undergo ureteral re-implantation. While many physicians may thus choose to forego routine VCUG screening of the single functional kidney, shared decision-making with the patient's caregivers is currently recommended, where the risks and benefits of the different approaches can be discussed. The data from this analysis can help inform the discussions.

Positioning the Instillation of Contrast Cystography: Does It Provide Any Clinical Benefit?

To outline positioning the instillation of contrast cystography (PICC)'s benefits in clinical practice. A total of 198 patients underwent PICC with the following indications: patients with positive preoperative conventional voiding cystourethrography (VCUG) for a single ureteric side, patients with urinary tract infection (UTI), and negative VCUG for both ureteric sides. Patients with positive VCUG served as the control group. Preoperative, intraoperative, and postoperative features of all patients were compared. The reflux rate for the contralateral vesicoureteric reflux (VUR) investigation group was 39.1%. Only the cystoscopic view of the anatomically deficient ureteric orifice was found to be a significant predictor of contralateral reflux (P = .002). For patients who presented with UTI, the reflux rate was 58.3%. Resolution of infection was assessed for patients who presented with UTI, and 54.1% of these patients had a complete response in the follow-up period. When the patients were classified as PICC positive and negative, infection-free rates were 58.3% and 48%, respectively (P = .296). PICC is an effective diagnostic method for revealing occult reflux. However, the clinical significance of this finding is vague. In patients with UTI, PICC was useful for diagnosing occult VUR and clearing the symptoms in more than half of the patients. Further, the symptom-free state in the follow up period was slightly higher but not more significant than it was in those with no VUR diagnosed.

Laparoscopic re-implantation of refluxing ureter in children: A feasibility study

ObjectiveTo report our initial experience in the application of laparoscopy in the management of children with unilateral vesico-ureteric reflux (VUR) using the laparoscopic extravesical transperitoneal approach following the Lich–Gregoir technique, and to evaluate the results and benefits of this technique for such patients. Patients and methodsBetween February 2013 and August 2014, 17 children [13 girls and four boys, with a median (range) age of 60 (24–120)months] presented with recurrent febrile urinary tract infections and were diagnosed with unilateral VUR. They underwent transperitoneal extravesical laparoscopic ureteric re-implantation following the Lich–Gregoir technique. Postoperatively abdomino-pelvic ultrasonography was done at 1month after surgery and voiding cystourethrography (VCUG) at 3months after surgery, and in cases with persistent VUR or de novo contralateral VUR another VCUG was done at 6months after surgery. ResultsThe median (range) operative time was 90 (80–120)min and the postoperative hospital stay was 2 (2–5)days. Intraoperative and postoperative complications were minimal. Patients were followed-up for a median (range) of 6 (3–21)months. All the children had complete resolution symptomatically and on VCUG, without further intervention. ConclusionsThe laparoscopic extravesical transperitoneal approach for ureteric re-implantation, following the Lich–Gregoir technique, is feasible and very effective in the management of VUR. Prospective randomised studies are eagerly awaited to define the benefits of this technique to patients, as well as to determine the cost-effectiveness of this approach.

Technique of Tubularized Bladder Mucosa Method for Treating Recurrent Vesicoureteral Reflux.

Technique of Tubularized Bladder Mucosa Method for Treating Recurrent Vesicoureteral Reflux.

Diagnostic value of hydrodistention of the ureteral orifice

The dynamic hydrodistention (HD) classification is a basic and objective way of rating the ureteral orifice opening. This study evaluated the value of hydrodistention of the ureteral orifice in the diagnosis of vesicoureteral reflux (VUR). Between January 2012 and March 2013 the HD grade in 106 ureters was prospectively assigned. A 9.5-Fr rigid cystoscope with a 0-degree lens was used in all procedures. Warm saline was used and the irrigation bag was placed approximately 1m above the bladder level on full flow. The grading is as follows: H0 denotes absence of ureteral dilation; H1 indicates dilation of the ureteral orifice only; H2 allows visualization of the intramural ureter; and H3 allows visualization of the extramural ureter. Indications for cystoscopy were endoscopic and open surgical treatment of VUR, stent removal, and any other diagnostic reasons. Exclusion criteria were patients with: infravesical obstruction, neuropathic bladder, severe detrusor over activity/dysfunctional voiding, duplex system, paraureteral diverticulum, bladder exstrophy and grade-1 VUR. The 51 refluxing ureters (RUs) were compared with 55 non-refluxing ureters (NRUs). Finally, sensitivity, specificity, positive and negative predictive values, and accuracy rate of HD were evaluated. A total of 106 ureters in 61 patients with a mean age of 5.3±3.9 years (range 2 months-15 years, median 5 years) were prospectively assigned. The mean HD grade in the RUs was 2.17±0.55. The mean HD grades were 2.0±0.63, 2.07±0.53, 2.38±0.5 and 2.5±0.57 for VUR grades 2-5, respectively. The mean HD grade in the NRUs was 1.60±0.70. The HD grades were H0 to H3 in 7.3%, 30.9%, 56.4% and 5.4% of the NRUs, respectively. The RUs group (2.17±0.55) showed a statistically higher HD grade than the NRUs group (1.60±0.70) (P<0.005). Sensitivity, specificity, positive and negative predictive values, and accuracy rate of HD grading in the diagnosis of VUR were 92%, 38%, 58%, 84%, and 64%, respectively. The mean HD grade in contralateral ureters of unilateral VUR was 1.55±0.72 and HD grades were H0-H3 in 0%, 55.6%, 33.3% and 11.1% of these nine ureters, respectively. In these nine non-refluxing contralateral ureters, after endoscopic correction of ipsilateral VUR, new contralateral VUR did not occur. Even though HD grade was high in the VUR group and popularity of the HD grading is on the increase, HD grading by itself still has a low diagnostic value.

Persistence and recurrence of vesicoureteric reflux in children after endoscopic therapy - implications of a risk-adapted follow-up.

IntroductionThere is no well-defined follow-up scheme available to reliably detect persistent or recurrent vesicoureteric reflux (VUR) after endoscopic therapy (ET), but also to reduce postoperative invasive diagnostics in these children.Our aim was the evaluation of possible predictors of persistence and recurrence of VUR, in order to elaborate and test a risk-adapted follow-up regimen.Material and methods92 patients (85/92%f, 7/8%m, age 2.99y) underwent direct isotope cystography (DIC) three months after ET. Persistent or recurrent VUR, scarring on dimercaptosuccinic acid (DMSA) scans and further fUTIs after therapy (follow-up 24.6 m) were documented and analysed.ResultsVUR persistence 3 months after ET was found in 11 (11.9%) patients; recurrent VUR in 4 (4.3%) patients. Scarring on preoperative DMSA and dilating VUR (°III and °IV) were significantly associated with recurrent VUR. If only children with preoperative positive DMSA scan or dilating VUR would have undergone DIC, only 58/92 DICs (64%) would have been necessary. Only 45.5% of otherwise detected VURs would have been identified using this risk-adapted strategy.ConclusionsLimiting invasive follow-up diagnostics (VCUG) and, therewith, the radiation burden in a predefined group of patients at risk for persistence or recurrence of VUR is not recommended, due to the significant chance of missing persistent or new onset contralateral VUR. Therefore, we recommend a routine follow-up VCUG after ET. Further prospective scientific efforts to evaluate new, alternative factors influencing persistence and recurrence of VUR, in order to establish an effective follow-up strategy, are warranted.

Unilateral Ureteral Reimplantation and Management of Contralateral Low Grade or Resolved Vesicoureteral Reflux

New contralateral vesicoureteral reflux after unilateral ureteral reimplantation is well described in the literature. Management of high grade vesicoureteral reflux with resolved contralateral reflux is less extensively studied. Most surgeons perform a bilateral procedure in these cases. We report the results when an open procedure was deferred on the contralateral side. A retrospective cohort study was performed of all patients with unilateral vesicoureteral reflux undergoing ureteral reimplantation performed by 1 surgeon between 2003 and 2012. Resolved or low grade contralateral reflux was observed if the kidney was normal. Dextranomer/hyaluronic acid copolymer injection was also offered for persistent grade I contralateral reflux. Outcomes were abstracted from the medical record and compared to those in patients undergoing bilateral ureteral reimplantation. Of 78 patients undergoing unilateral ureteral reimplantation 15 met inclusion criteria. Median age was 5.5 years, and median followup was 7.6 years. Extravesical detrusorrhaphy was performed in all cases. The 15 study patients initially had contralateral reflux that either resolved (8) or persisted as grade I (7). Six patients had results on 2 cystograms that were negative for contralateral reflux before ureteral reimplantation. Length of stay was 1 day less and costs were 59% lower for patients undergoing unilateral vs bilateral ureteral reimplantation. Postoperatively 2 of 15 patients (13%) had an afebrile urinary tract infection. All 15 patients had normal contralateral kidneys on postoperative ultrasound. Observation of contralateral resolved or low grade vesicoureteral reflux at unilateral ureteral reimplantation is feasible, with minimal morbidity and a shorter hospital stay compared to performance of bilateral ureteral reimplantation. This approach appears to be a reasonable option to discuss with parents during preoperative counseling.

Endoscopic correction of primary VUR by using polyacrylate polyalcohol copolymer (Vantris) in young girls: 2-Year follow-up

ObjectiveOur aim was to evaluate the efficacy and safety of single endoscopic injection of Vantris in young girls affected by primary vesicoureteral reflux (VUR) at more than 2 years of prospective follow-up. Material and methodsOver the last 4 years, 73 girls with primary VUR of grades (G) I–IV underwent a single endoscopic injection of Vantris. The mean age was 8.48 (SD = 4.8) years. VUR was unilateral in 73 and bilateral in 13 patients, comprising 86 renal refluxing units (RRUs). Pre-operative evaluation consisted of: blood biochemistry, urine analysis and culture, ultrasound scan, voiding cystourethrogram (VCUG), and dimercaptosuccinic acid (DMSA) renal isotope scan. Patients were followed using ultrasound scans at 1 month and every 3 months for the first year and then 2 years after injection. Direct radionuclide cystography with technetium pertechnetate was performed at 3 and 12 months after injection. VCUG was performed only in confirmed cases of failure and downgraded VUR at 3, 12, and 24 months after endoscopic correction. ResultsSixty-nine (95%), 61 (83.4%), and 52 (71%) patients completed 3, 12, and 24 months' follow-up respectively. VUR was corrected and downgraded to G I in 81% and 3.3% of RRUs at 3 months' follow-up. The corrected and downgraded RRUs at 12 and 24 months' follow-up were 77%, 10%, and 77%, 11% respectively. De novo contralateral G I VUR was demonstrated in 8.6% of normal ureters. Contralateral GI VUR with normal DMSA isotope renal scans was resolved in 71% of RRUs. Febrile urinary tract infection decreased to 4.1% in the patients. ConclusionAccording to our study, a single Vantris injection provides a high level of efficacy and safety in the treatment of primary G I–IV VUR in young girls, at 2 years' prospective follow-up.

Multicystic dysplastic kidney: Impact of imaging modality selection on the initial management and prognosis

ObjectiveTo evaluate the impact of imaging modalities on the evaluation and prognosis of children with multicystic dysplastic kidney (MCDK) disease. Patients and methodsA retrospective analysis of all children with MCDK diagnosed from 2004 until 2012 was performed. The study included 63 patients for whom all postnatal imaging modalities were available: renal bladder ultrasound (RBUS), dimercaptosuccinic acid scan (DMSA) and voiding cystourethrogram (VCUG). Cases with major congenital abnormalities or incomplete data were excluded. Abnormalities in the contralateral kidney and the fate of MCDK were also addressed. ResultsAt diagnosis, the average age was four-and-a-half months. The majority of cases were detected antenatally (87%). Postnatal RBUS and DMSA scans established the diagnosis of MCDK in 92% and 98% of patients, respectively. DMSA showed photopenic areas in the contralateral kidneys in 10% of patients; all of them had hydronephrosis and were confirmed to have vesicoureteral reflux (VUR). Contralateral VUR was detected in 16 patients; 63% of them had hydronephrosis. After a mean follow-up of three-and-a-half years, involution occurred in 62% of patients and the involution rate was inversely proportional to the initial size. ConclusionsThe classical appearance of MCDK on RBUS was sufficient to establish the diagnosis in most patients. DMSA scan was more accurate in confirming the diagnosis and evaluating the contralateral kidney. Selective screening for VUR in patients with contralateral hydronephrotic kidney should be considered.

PD4-09 MULTICYSTIC DYSPLASTIC KIDNEY: IMPACT OF IMAGING MODALITY SELECTION ON THE INITIAL EVALUATION AND PROGNOSIS

You have accessJournal of UrologyImaging/Radiology I1 Apr 2014PD4-09 MULTICYSTIC DYSPLASTIC KIDNEY: IMPACT OF IMAGING MODALITY SELECTION ON THE INITIAL EVALUATION AND PROGNOSIS Mustafa Alghanbar, Osama Sarhan, Abdulhakim Alotay, and Ziad Nakshabandi Mustafa AlghanbarMustafa Alghanbar More articles by this author , Osama SarhanOsama Sarhan More articles by this author , Abdulhakim AlotayAbdulhakim Alotay More articles by this author , and Ziad NakshabandiZiad Nakshabandi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.230AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multicystic dysplastic kidney (MCDK) is the most common cystic renal lesion in children. Nowadays, most cases are detected antenatally by ultrasound screening. However, postnatal renal bladder ultrasound (RBUS) will be required to establish the diagnosis. In addition, Technetium 99m-dimercaptosuccinic acid (DMSA) scintigraphy or voiding cystourethrogram (VCUG) may be performed to confirm the diagnosis, and screen for vesicoureteral reflux (VUR), respectively. METHODS We retrospectively reviewed the charts of all children with MCDK diagnosed at our hospital from 2004 until 2012. We included 63 patients in whom postnatal evaluation included RBUS, DMSA and VCUG. We evaluated the necessity of DMSA scan for confirming the diagnosis and VCUG for screening of VUR. Additionally the fate of MCDK was evaluated. RESULTS The average age of the children at the time of diagnosis was 4.5 months. The majority of cases were detected antenatally (87%). Postnatal RBUS established the diagnosis of MCDK in 92% of patients. Abnormalities on the contralateral kidney were detected in 11 patients (17%). The association of VUR with hydronephrotic contralateral kidneys was 62%. Contralateral VUR was diagnosed in 16 patients (25%); most of them were of lower grade. DMSA scan verified absent function in the affected kidney in 62 of the 63 patients (98%). It also showed photopenic areas in the contralateral kidneys in 6 patients (10%), all of them had hydronephrosis on initial renal ultrasound and confirmed to have VUR by VCUG. Follow up ranged from 1 to 9 years (mean of 3.5). Fate of the MCDK included involution in 39 patients (62%), and the involution rate was inversely proportional to the initial size. Ipsilateral nephrectomy was necessary in 3 patients (5%) while 33% continued to be followed up conservatively for unchanged appearance. On follow up, chronic kidney disease (CKD) developed in 2 (3%) and hypertension in 1 (2%) patients, respectively. No patients developed any neoplastic changes. CONCLUSIONS In our experience, the classical appearance of MCDK on the initial RBUS was sufficient to establish the diagnosis in most patients. DMSA scan was more accurate in confirming the diagnosis and evaluating the contralateral kidney. Selective screening for VUR in patients with contralateral hydronephrotic kidney should be considered and carefully managed. Ipsilateral nephrectomy was not required in most patients with MCDK. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e54 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mustafa Alghanbar More articles by this author Osama Sarhan More articles by this author Abdulhakim Alotay More articles by this author Ziad Nakshabandi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A rare case of unilateral left side multicystic dysplastic kidney and contralateral Vesico-ureteric reflux in a male neonate

Introduction: Multicystic dysplastic kidney (McDK) is a rare congenital disorder, resulting from malformation of the kidney during fetal development. It could be unilateral, bilateral or segmental and bilateral McDK is incompatible with survival. Unilateral McDK occurs in 1 in 4300 live births and combined incidence of

Segmental dilatation of ureter: Report of two cases

Segmental dilatation of ureter is a giant, focal segmental ureteral dilatation producing an elongated and distorted ureter. Two children presented with this condition, one had ipsilateral megacalycosis and contralateral vesicoureteric reflux. The other had duplication of the kidney. The non-functioning lower moiety showed structure of xanthogranulomatous pyelonephritis.

This Month in Pediatric Urology

No AccessJournal of UrologyThis Month in Pediatric Urology1 Feb 2014This Month in Pediatric Urology Michael L. Ritchey Michael L. RitcheyMichael L. Ritchey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.10.138AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Pediatric Urology." The Journal of Urology, 191(2), pp. 283–284 References 1 : Outcomes of incontinent ileovesicostomy in the pediatric patient. J Urol2014; 91: 445. Google Scholar 2 : Immunofluorescent analysis of testicular biopsies with germ cell and Sertoli cell markers shows significant MVH negative germ cell depletion with older age at orchiopexy. J Urol2014; 191: 458. Abstract, Google Scholar 3 : New contralateral vesicoureteral reflux after unilateral ureteral reimplantation: predictive factors and clinical outcomes. J Urol2014; 191: 451. Link, Google Scholar 4 : High recurrence rate at 5-year followup in children after upper urinary tract stone surgery. J Urol2014; 191: 440. Link, Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 191Issue 2February 2014Page: 283-284 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael L. Ritchey More articles by this author Expand All Advertisement PDF downloadLoading ...