Endoscopic Correction Research Articles

Incidence of UVJ obstruction during long-term follow-up after endoscopic correction of VUR utilizing polyacrylate polyalcohol copolymer (PPC)

We present a long-term follow-up of patients who underwent VUR correction with polyacrylate polyalcohol copolymer (PPC) injection with an emphasis on UVJ obstruction and urinary tract infection. During 2009–2012, 157 children (106 girls and 51 boys) with mean age of 4.8 ± 2.8 years (mean ± SD) underwent endoscopic correction of VUR using PPC. VUR was unilateral in 74 patients and bilateral in 83, comprising 240 renal reflux units (RRU). Of these, primary VUR was present in 197 RRU (82.1%) and 43 (17.9%) were complex cases. Median follow-up was 7 years (range 6–10 years). Average volume of PPC was 1.2 ml (range 0.6–1.8 ml) Reflux was corrected in 222 RRU (92.5%) after a single injection, and in 10 RRU (4.2%) after the second injection. In RRU 7 (2.9%), reflux downgraded to Grade I and II, and they were taken off antibiotic prophylaxis. One patient (0.4%) failed endoscopic correction and required ureteral reimplantation (UR). 11 (4.6%) RRU developed UVJ obstruction, of which 9 (3.8%) required UR. All patients developed obstruction between 1 and 2 years after injection. Nineteen (12.1%) patients developed low UTI, and 12 (7.6%) patients developed febrile UTI during follow-up. None of these patients demonstrated reflux recurrence. Our data indicate that endoscopic correction utilizing PPC does not increase the risk of obstruction during long-term follow-up.

467 - Effectiveness of the endoscopic correction of vesicourethral anastomosis strictures after radical prostatectomy

467 - Effectiveness of the endoscopic correction of vesicourethral anastomosis strictures after radical prostatectomy

Treatment of primary obstructive megaureter in children using minimally invasive technologies

Introduction. The final formation of the child's functional systems completed during postnatal ontogeny. To create optimal conditions for the functioning of the body is necessary either to decrease the level of functional requirements to the immature system, or the creation of new operating conditions under which the extended maturation time factor.
 Relevance. Currently, the most common treatment for obstructive uropathies is surgical treatment. To create optimal conditions for the functioning of the body, it is necessary either to reduce the level of requirements for an immature functional system, or to create new functioning conditions under which the ripening time factor is extended.
 Objective: Rationale and introduction of minimally invasive endoscopic draining techniques aimed at restoring urodynamics by using a PVC intraluminal drainage (stent).
 Materials and methods. The possibility of stenting with determination of the size of the ureteric orifice was investigated. The study involved 32 children aged from birth to three years. A retrospective analysis of previously treated 41 patients with obstructive ureterohydronephrosis was performed.
 Results. The study found that the optimal age for endoscopic correction of the intramural ureter is up to 3 months of life, when telescopic bougienage with dilation of the intramural compartment of the compromised ureter can be performed with calibration of the ureteric orifice and stent of the ureter with a corresponding stent.
 Retrospective analysis of previously treated patients allowed us to determine the same dependence. Thus, out of 41 patients with obstructive ureterohydronephrosis positive result was achieved in 29 children (70.73%) up to 1 year and 6 (14.63%) over 1 year. The impossibility of performing endoscopic correction of the orifice and stenting of the ureters in the age group up to 1 year was noted only in 1 patient (2.43%), whereas in the group from 1 year to 3 years - in 5 patients (12.19%).
 Conclusions. The proposed tactics of treatment of obstructive uropathy in children has advantages in terms of open surgical techniques in the technical simplicity, minimally invasive, maximum physiological, reducing the incidence of postoperative complications. It should be remembered that the effectiveness of endoscopic stenting of the lower parts of the ureter depends on the age of the child.

Splenoptosis in a dairy cow and endoscopic correction of left displacement of abomasum

A third lactation Holstein dairy cow was presented with history of acute reduction in milk yield (‘milk drop’). On combined auscultation and percussion of the left costal area and paralumbar...

Risk factors for obstructive complications after endoscopic correction of vesico-ureteral reflux using polyacrylate polyalcohol copolymer

Use of polyacrylate-polyalcohol copolymer (PPC) after endoscopic correction (EC) of vesico-ureteral reflux (VUR) is highly effective but is associated with a higher risk of obstructive complications (OC) compared with other implants. We undertook a STROBE compliant retrospective investigation and studied the OC risk factors to increase the practical safety of PPC.Overall, 798 patients (464 [58.1%] girls and 334 [41.9%]) boys) from 5 hospitals in whom PPC was routinely used were evaluated retrospectively. The patients were subdivided into 2 groups. Group I consisted of 754 (94.5%) children (449 [59.5%] girls and 305 [40.5%] boys) without OC. Median age was 41 months [Q1: 18.0; Q3: 81.0]. Group II comprised 44 (5.5%) patients (29 [65.9%] boys and 15 [34.1%] girls) experiencing OC, and their median age was 21.5 months [Q1: 12.0; Q3: 43.0]. Clinical and renal ultrasound examinations were carried out 1 day and 1 month after EC, and then every 6 months after EC. At the follow-up examination approximately 6 months after EC, voiding cysto-urethrography (VCUG) was performed. All patients with OC underwent diuretic renography.OC occurred in 44 (5.5%) of 798 children, in some cases as late as 60 months after endoscopic injection of the bulking agent PPC for correction of VUR. Univariate analysis revealed that younger age (P < .001), higher grade of VUR (P < .001), male gender (P < .001), second injection (P = .003), and EC injection using hydrodistension implantation technique (HIT; P < .001) represented significant risk factors. At multivariate analysis, only male gender (P = .0078), younger age (P = .0044), HIT technique (P < .0001), and second injection (P = .04) represented significant risk factors for the occurrence of OC.We identified young age, male gender, high reflux grade, HIT technique, and second endoscopic injections as factors associated with the risk of OC after EC of VUR using PPC as a bulking agent. Thus, patients who have undergone EC with PPC must be monitored sonographically for occurrence of OC for at least 60 months after the intervention.

Duplex systems: Top-down or bottom-up approach?

Duplex systems can be complicated by reflux, ureterocele, obstruction (most commonly PUJ in a lower moiety) and wetting secondary to an ectopic ureteric insertion in girls. The decision making algorithm for selection of surgical approach is complex and there is no consensus. The authors described the outcomes following an upper urinary tract approach in 2011(1) and now compare these results in a similar group of patients managed using a lower approach. To assess whether a top-down or bottom-up approach results in different likelihoods for further surgery. A prospectively database was maintained for consecutive patients undergoing surgery for duplex systems by a single surgeon between 2003 and 2015. Patients were classified into 2 groups; Group 1 initial intention for upper urinary tract approach (heminephroureterectomy-HN) or Group 2 lower urinary tract approach (bladder reconstructive surgery-BRS). The requirement for further surgery was recorded-endoscopic incision (EI), bladder reconstructive surgery (BRS), endoscopic correction of reflux (ECR), heminephroureterectomy (HN). Indications for initial and subsequent surgery included urinary tract infection, VUJ obstruction and incontinence. Endoscopic incision was not performed for patients with an asymptomatic ureterocele. Statistical analysis consisted of Fisher's exact test with a 2 tail p value<0.05 being statistically significant. 79 patients underwent surgery for duplex systems. 39 patients had HN initially (Group 1) and 40 patients had BRS initially (Group 2). Further surgery was performed in 21% of patients from Group 1 (8 BRS) vs 5% of patients from Group 2 (1 redo BRS, 1 ECR). Significantly less additional surgical procedures were performed after BRS compared to HN (p=0.048). The presence of both reflux and ureterocele increases the chances of further surgery in those patients who had HN initially compared to BRS (p=0.01). No patients developed urinary retention or required intermittent catheterisation to improve bladder emptying. Bladder reconstructive surgery (BRS) reduces the requirement for further surgery compared to heminephroureterectomy (HN) in symptomatic patients with a duplex kidney and either dilating vesicoureteric reflux or ureterocele.

Effect of Endoscopic Correction on the Blood Pressure of Hypertensive Patients with Deviated Nasal Septum Symptoms

Introduction: The objective of the study is to evaluate the effect of endoscopic correction of septum on blood pressure in patients with deviated nasal septum symptoms and to assess positive changes occur between deviated nasal septum and hypertension. Materials & Methods: The study was conducted at various hospitals in the department of ENT, Madinah Munawarah, Saudi Arabia. Hundred adults, aged 20-45 years, with symptomatic nasal septal deviation, newly detected untreated hypertension (mean BP 140/90 mmHg), undergoing septoplasty operation and sub mucosal diathermy of hypertrophied inferior turbinate (when present), were included. Postoperative follow up for ENT examination and BP measurement was done at 1, 6 and at the end of year. Results: There are 68 patients were taken for this study from various hospitals in the department of ENT, Madinah Munawarah region, Saudi Arabia. Among 68 patients 42 Male and 26 Female patients at the mean age of 35.23±2.15 years with range of 29 to 44 with respective of male and female. Age distributed in group as 19% of patients were in 25-30, 43% of patients in 31-35, 22% of patients in 36- 40, and 16% of patients were in 41-45, major fall in age group of 31-35 years. Conclusion: In our study we conclude that control of blood pressure in patients with nasal septal deviation can be achieved by surgical correction effectively and safely. Consequently patients with symptomatic septal deviation should be assured of prevention of secondary cardiovascular problems due to high blood pressure.

Таргетирование процессов гетерохронии в рациональном подходе к диагностике и лечению обструктивного уретерогидронефроза у детей

The final formation of the child’s functional systems completed during postnatal ontogeny. To create optimal conditions for the functioning of the body is necessary either to decrease the level of functional requirements to the immature system, or the creation of new operating conditions under which the extended maturation time factor. Currently, the most common treatment for obstructive uropathies is surgical treatment. A promising alternative to open surgical treatment of obstructive megaureter is endoscopic stenting of the ureter, based on an assessment of the phenomena of growth imbalances and dysfunction, tissue and maturation of the urinary system.Objective: rationale and introduction of minimally invasive endoscopic draining techniques aimed at restoring urodynamics by using a PVC intraluminal drainage (stent).Materials and methods. The possibility of stenting with determination of the size of the mouth of the ureter was investigated. The study involved 32 children aged from birth to three years. A retrospective analysis of previously treated 41 patients with obstructive ureterohydronephrosis was performed.Results. The study found that the optimal age for endoscopic correction of the intramural ureter is up to 3 months of life, when telescopic bougienage with dilation of the intramural compartment of the compromised ureter can be performed with calibration of the mouth and stent of the ureter with a corresponding stent.Retrospective analysis of previously treated patients allowed us to determine the same dependence. Thus, out of 41 patients with obstructive ureterohydronephrosis positive result was achieved in 29 children (70.73%) up to 1 year and 6 (14.63%) over 1 year. The impossibility of performing endoscopic correction of the orifice and stenting of the ureters in the age group up to 1 year was noted only in 1 patient (2.43%), whereas in the group from 1 year to 3 years – in 5 patients (12.19%).Conclusions. The proposed tactics of treatment of obstructive uropathy in children has advantages in terms of open surgical techniques in the technical simplicity, minimally invasive, maximum physiological, reducing the incidence of postoperative complications. It should be remembered that the effectiveness of endoscopic stenting of the lower parts of the ureter depends on the age of the child.The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.

PNEUMATIC CONTACT TRANSURETHRAL ureterOLITHOTRIPSY in emergency urological practice

Relevance. Minimally invasive methods of removing the ureteral calculus in urological practice have steadily taken the leading position. According to the Russian clinical recommendations the indications for endoscopic correction of ureteral calculus are concrements with a low probable passage, constant pain symptomatic on the background of adequate analgesia, the varying degrees of obstruction severity and impaired renal function. The purpose of the work is to assess the efficacy of transurethral pneumatic contact lithotripsy of ureteral calculus in emergency urological practice. The research tasks included the refinement of the endoscopic lithotripsy results, depending on the localization level among men and women. Materials and methods. The results of endoscopic treatment of ureteral calculus among 360 patients of both sexes, hospitalized in a urological hospital with emergency indications of a renal colic diagnosis, are presented. Results. The efficiency of retrograde pneumatic contact ureterolithotripsy reached 91.8 %. The most optimal this method is with the localization of calculus in the lower third of the ureter, regardless of the concrement size and sex. The percentage of the calculus fragmentation of the middle third of the ureter among men and women was 91.6 and 93.4 respectively. The lithotripsy in the upper part of the ureter was 23.6 % more effective among women. Operational complications were registered in 7.5 % cases.

Urinary biomarkers of latent inflammation and fibrosis in children with vesicoureteral reflux.

To investigate the urinary levels of TGF-β1, VEGF, and MCP-1 as potential biomarkers of latent inflammation and fibrosis in the kidney before and 6months after correction of vesicoureteral reflux (VUR) in children. A total of 88 patients (mean age 26months) with VUR were divided into three groups: group A-patients with grades II-III VUR, conservative treatment; group B-patients with grades III-V VUR, endoscopic correction of VUR; group C-patients with grades III-V VUR, ureteral reimplantation after failed endoscopic correction. Control group included 20 healthy children. Biomarker levels were measured by ELISA. 99mTc-DMSA scintigraphy and renal histology were performed if possible. At admission, TGF-β1 was close to control in all study groups, VEGF increased with severity of the disease, and MCP-1 increased in group C. Six months after correction of VUR, despite clinical and laboratory improvement, TGF-β1 and MCP-1 increased while VEGF decreased compared to the admission values in all groups; no amelioration of renal scarring was detected either by 99mTc-DMSA scintigraphy or renal histology. The results support our hypothesis that successful correction of VUR is not sufficient to stop or reduce the latent inflammatory and fibrotic processes that have already started in the kidney regardless of the reflux grade and treatment option. Measuring the urinary levels of TGF-β1, VEGF, and MCP-1 may aid in the development of non-invasive, pathophysiologically relevant approach to diagnosis and monitoring of kidney injury and fibrosis in children with VUR.

Endoscopic treatment of vesico-ureteric reflux in children of early age

The purpose of the study was to study the long-term results of endoscopic treatment of infants and young children with vesicoureteral reflux (VUR). Materials and methods . The analysis of the long-term results of endoscopic correction of reflux in infants and young children operated in the hospital from January 2015 to December 2018. Of these, up to 3 years there were 115 patients (67%), up to a year – 56 children (33%). The duration of follow-up was from 2 to 4 years. Polyacrylamide gel DAM+was used as an implant in 70% of cases (191 ureters). Endoscopic treatment with DAM+ was performed in 77 (70%) children from one to 3 years, as well as 23 patients (41%) of infancy. In other cases, used collagen, uradex. Introduction was carried out by methods of STING, HIT 1 and HIT 2. Results and discussion . Evaluation of the effectiveness of the use of drugs: collagen, DAM+, urodex. The type, degree of reflux, kidney function, presence of concomitant pathology were taken into account in the analysis of the correction results, and the effectiveness was evaluated by changing the degree of reflux and the course of the inflammatory process after 6 months – year after endoscopic correction. The disappearance of reflux after a single application of DAM+ took place in 86% of cases. Re-introduction of the implant was performed in 55 children, 3-fold – 20 at 3–4th degree of reflux. Neoimplantation of the ureter was performed in 9 patients with 4–5th degree of reflux, concomitant pathology of the upper urinary tract and signs of reflux nephropathy. Conclusion. The analysis of long-term results showed that the use of endoscopic techniques of reflux correction with the use of the domestic drug DAM+, including in infants, allows to completely cure reflux or reduce its degree to 1–2, providing optimal conditions for the maturation of the uretero-vesical segment.

Can distal ureteral diameter measurement predict primary vesicoureteral reflux clinical outcome and success of endoscopic injection?

The objective of the study was to evaluate the predictive value of distal ureteral diameter ratio (UDR) on outcome of primary vesicoureteral reflux (VUR) and reflux resolution after endoscopic injection. Three hundred eighty-three patients treated for primary VUR between January 2010 and October 2015 were retrospectively reviewed. The parameters analyzed wereage at diagnosis, sex, grade and lateralite of VUR, complaints at admission (febrile urinary tract infection, antenatal hydronephrosis, family history),bladder-bowel dysfunction (urgency, incontinence, constipation), dimercaptosuccinic acid (DMSA) scintigraphy findings, follow-up period, clinical course (spontaneous resolution or surgical correction), time of spontaneous resolution, surgical treatment time and age, materials used for injection and success of endoscopic injection. Ureteral diameter ratio was calculated on the initial VCUG at the time of the diagnosis as the largest ureteral diameter within the false pelvis divided by the distance between L1-L3.The correlation between UDR, clinical outcome (spontaneous resolution/surgical correction) and success of endoscopic injection was evaluated by logistic regression analysis. To compare the effect of UDR and grade of reflux on spontaneous resolution, multivariate logistic regression analysis was performed in three models together with sex, age, resolution time, presence of febrile UTI and DMSA scan findings. Three hundred eighty-three patients were enrolled. There was a strong correlation between UDR and grade of reflux (p<0,0001). Ureteral diameter ratio was higher in patients whose complaints at admission were family history and febrile UTI, but this correlation was not statistically significant (p>0.05). When the correlation between UDR and the DMSA scan findings was evaluated, UDR was found to be significantly higher in patients with moderate and severe scarring. Bladder-bowel dysfunction was present in 111 patients (28.9%). There was no significant correlation between BBD and UDR (p>0.05). 62 patients showed spontaneous resolution in a median duration of 1.55 years. The predictive value of UDR for spontaneous resolution was more significant than grade (p<0.001).There was no spontaneous resolution in patients with UDR over 0.45.321 patients underwent operation (248 endoscopic injection, 17 ureteroneocystostomy, 56 endoscopic injection+ureteroneocystostomy). When the predictive value of the reflux grade and UDR in the success rate of endoscopic correction was compared, UDR was shown to be significantly more predictive than the grade of reflux (p<0.05). Ureteral diameter ratio was significantly higher in patients whose injection treatment was unsuccessful. Each 0.05 unit increase in UDR affected the success of endoscopic injection negatively (95% CI:<0.001-0.071). Ureteral diameter ratio is an objective measurement of VUR and appears to be a new predictive tool for clinical outcome and success after endoscopic injection.

Ureteral Obstruction After Endoscopic Treatment of Vesicoureteral Reflux: Does the Type of Injected Bulking Agent Matter?

Endoscopic injection of bulking agents for the treatment of vesicoureteral reflux (VUR) has become a therapeutic alternative to antibiotic prophylaxis and ureteral reimplantation. Although considered as a safe and efficient procedure, several studies have reported cases of ureteral obstruction (UO) after endoscopic correction of VUR. This review article evaluates the present VUR literature to estimate the incidence of UO following endoscopic injection of different substances, while also discussing the impact of injection technique and implant volume. Twenty-five publications were identified that provided detailed information on 64 females and 32 males (age range, 7months-48years) that developed UO after endoscopic treatment of VUR using dextranomer/hyaluronic acid (Dx/HA), polyacrylate polyalcohol (PP), polydimethylsiloxane (PDMS), calcium hydroxyapatite (CaHA), polytetrafluoroethylene (PTFE), or collagen. There was some variation in the reported incidence of UO among these materials: Dx/HA (0.5-6.1%), PP (1.1-1.6%), PDMS (2.5-10.0%), CaHA (1.0%), and PTFE (0.3%). Postoperative UO was described following subureteric transurethral injection (STING), intraureteric hydrodistension implantation technique (HIT), combined HIT/STING and double HIT. The injected volume ranged widely, also depending on the type of bulking agent: Dx/HA (0.3-3.0mL), PP (0.3-1.2mL), PDMS (1.0-2.2mL), CaHA (0.4-0.6mL), and PTFE (1.5-2.0mL). The timing of UO varied from immediately after the procedure to 63months. Over half of patients showed asymptomatic hydroureteronephrosis on follow-up imaging, whereas the remaining presented with symptoms of acute UO or fever. UO remains a rare complication after endoscopic correction of VUR, generally reported in less than 1% of treated cases, which appears to be independent of the injected substance, volume, and technique. However, long-term follow-up is recommended as asymptomatic or delayed UO can occur, potentially leading to deterioration of renal function.

Interventions for primary vesicoureteric reflux.

Interventions for primary vesicoureteric reflux.

Endoscopic-assisted craniosynostosis surgery: First case series in India

<br><b>Introduction:</b> Craniosynostosis is a congenital pathological condition resulting from premature fusion of sutures of the cranial vault and leads to an abnormal head shape with a significant risk of raised intracranial pressure. Surgical correction techniques have seen a constant evolution from an extensive open procedure to the relatively new minimally invasive craniosynostosis technique. The current center introduced this new procedure in India since 2015. <b>Aims and Objectives:</b> This article documents our experience as the first team in the country to correct craniosynostosis endoscopically with emphasis on planning, surgical techniques, and helmet therapy to achieve the optimum result. <b>Materials and Methods:</b> This is a prospective case series of six patients with anterior craniosynostosis corrected endoscopically and followed up with postoperative custom-made cranial helmet. All patients were nonsyndromic with no associated anomalies. The mean age of surgical intervention was 92.6 days (84–100 days), mean duration of surgery was 61.7 min (54–74 min), mean blood loss was 55 ml (50 ml–60 ml), and mean duration of hospital stay was 2 days (2–3 days). No complications and mortality were reported. <b>Conclusion:</b> This case series has demonstrated that endoscopically assisted craniosynostosis correction is a safe, effective, and reliable technique in the armamentarium of a craniofacial surgeon. The minimally invasive nature allows early intervention in children. Parental compliance is important in helmet therapy which forms an integral part of this surgery for correction of the abnormal head shape. We believe that every patient with nonsyndromic single-suture craniosynostosis should be offered endoscopic correction before the age of 6 months.<br>

The functional outcomes of open vertical resections of the larynx

The early diagnostics of the malignant tumours of the larynx provides a basis for the timely beginning of their conservative treatment and endolaryngeal surgical interventions. However, neither the conservative treatment nor endolaryngeal surgery ensures the sufficiently efficient treatment when the tumour spreads over the anterior commissure, subglottic space, and/or laryngeal ventricles. The open surgical resection of the larynx is indicated for the management of the patients presenting with this condition. Our experience is based on the performance of vertical resection of the larynx in 98 patients including the fronto-lateral and extended fronto-lateral interventions in 63 and 35 of them, respectively. The formation of the malignant tumour is known to result in the alteration of the acoustic characteristics of the patient's voice as compared to the initially normal ones in the preceding period. Specifically, the mean values of the fundamental tone frequency increases, the intensity of the sound signal decreases, and the amplitudes of the fundamental tone harmonics tend to be reduced. At the same time, both the dispersion and the variability of the acoustic characteristics being studied undergo an enhancement in comparison with the normal values. Open resection of the larynx with its simultaneous endoscopic correction made it possible to restore the respiratory and vocal functions in 90.8% and 92.1% of the treated patients respectively.

Clinical and endoscopic assessment of patients in the long-term after endoscopic papillosphincterotomy

The objectiveof the study was to evaluate the long-term results of endoscopic papillosphincterotomy in cases of choledocholithiasis and papillary stenosis.Material and methods. We carried out retrospective analysis of the results of endoscopic papillosphincterotomy (EPST) due to the presence of choledocholithiasis (group 1, n=117) and papillary stenosis (group 2, n=55) along with the combination of the above (group 3, n=6) in a total of 178 patients. Clinical and endoscopic results of the intervention were studied in all patients in the long-term (from 1 to 30 years).Results. Based on the analysis of the complex examination, including endoscopic functional tests, treatment results were evaluated as good in 80 % of patients, satisfactory in 16 % of patients and unsatisfactory in 4 % of patients (after endoscopic correction of papillary stenosis).Conclusion.The cicatrisation process in the papillotomy opening exhibits the most intensively in patients with papillary stenosis combined with choledocholithiasis and without it, lasts until 4.5–5 years after surgery. Dynamic observation of patients after EPST is obligatory for early diagnosis of restenosis in the papillotomy opening.

Videolaparoscopic lower pole heminephrectomy for treatment of a duplex kidney

In a duplicated renal collecting system, or duplex kidney, the most frequent pathology presenting at the lower pole is the vesicoureteral reflux (VUR), which could lead to urinary tract infections (UTI) or even renal dysplasia. Under some circumstances, such as recurrent UTIs or impaired kidney function, heminephrectomy of the pathologic moiety is indicated. However, there are only few academic videos of laparoscopic lower pole heminephrectomy in the pediatric population available in literature. Therefore, we present a descriptive video of this procedure. This video exhibits a case report of a 15-month-old male patient who underwent a videolaparoscopic lower pole heminephrectomy as treatment of a refluxing non-functional lower moiety of a right duplex kidney. Moreover, the patient presented a refluxing contralateral ureter which was endoscopically corrected at the same time. A laparoscopic right lower pole heminephrectomy associated with an endoscopic contralateral reflux treatment was performed. No complication occurred during hospital stay or at 30-day follow up. Videolaparoscopic lower pole heminephrectomy is a safe and feasible procedure in the pediatric population. Associating an endoscopic correction of the contralateral side reflux at the same moment shows no additional morbidity or complication.

Avoiding routine postoperative voiding cystourethrogram: Predicting radiologic success for endoscopically treated vesicoureteral reflux.

Variability in the success rates for the endoscopic correction of vesicoureteral reflux (VUR) has prompted a debate regarding the use of routine postoperative voiding cystourethrogram (VCUG). This study examines the predictive performance of intraoperative mound morphology (IMM) and the presence of a postoperative ultrasound mound (PUM) on radiologic success, as well as investigates the role of using these two predictive factors as a composite tool to predict VUR resolution after endoscopic treatment. This retrospective study included children with primary VUR who underwent endoscopic correction with a double hydrodistension-implantation technique (HIT) and dextranomer/hyaluronic acid copolymer. IMM was assessed intraoperatively. The presence of a PUM and VUR resolution were assessed by postoperative ultrasound (US) and VCUG, respectively. Radiologic success was defined as VUR resolution. A total of 70 children (97 ureters) were included in the study. The overall radiologic success rate was 83.5%. There was no statistically significant association between radiologic success and IMM (85.2% with excellent and 87.5% with "other" morphology; p=0.81). The sensitivity and specificity of PUM for radiologic success in this study was 98% and 71%, respectively, while the sensitivity and specificity of the combined prediction model were 81.9% and 85.7%, respectively. We objectively demonstrated that IMM was a poor predictor of radiologic success and should be used with caution. In addition, the performance of a combined prediction model was inferior to the presence of a PUM alone. As such, selective use of postoperative VCUG may be guided solely by the presence of a PUM.

Safety Outcomes in Endoscopic Versus Open Repair of Metopic Craniosynostosis

Premature fusion of the metopic suture leads to a range of clinical presentations, with more severe patients presenting characteristically with trigonocephaly. Endoscopic-assisted correction of craniosynostosis is emerging as an alternative to the gold-standard open cranial vault remodeling. While there are several documented benefits of endoscopic correction, the management of craniosynostosis varies widely in the literature with little consensus as to the preferred timing and surgical technique for repair. The purpose of this study was to investigate the safety outcomes of endoscopic versus open surgery at our institution. This retrospective cohort study included all patients diagnosed with metopic craniosynostosis who underwent open or closed surgical management and received at least 6 months of follow-up. Data extraction was performed via chart review and included demographic information and safety outcome variables. During the study period, 17 patients who met our inclusion criteria were treated by the multidisciplinary craniofacial team at our institution. Eight patients underwent endoscopic surgery and 9 underwent open surgery. The mean age at surgery was significantly higher in the open surgery group than the endoscopic surgery group (13.7 months versus 2.3 months, respectively). Estimated blood loss, percent estimated blood volume lost, transfusion volume, procedure length, hospital length of stay, and intensive care unit (ICU) length of stay were all significantly higher in the open surgery group compared with the endoscopic group. In our patient population, endoscopic surgery for metopic craniosynostosis had an improved safety profile versus open surgery based on reduced procedure length, estimated blood loss, volume of blood transfusion, and length of stay in the ICU and hospital.