To demonstrate that the CA19-9/creatinine level could be a potential biomarker in children with obstruction by including ureteropelvic junction obstruction (UPJO) patients and comparing them not only with healthy controls but also with children with non-obstructive hydronephrosis (HN). Children with HN and healthy controls with no HN were prospectively enrolled into study from March 2021 to December 2022. The children with HN were divided into two separate groups. Group 1 consisted of children with UPJO, while Group 2 included children with lower urinary tract dysfunction (LUTD). Data collected from study and control groups included age, gender, spot urine CA 19 - 9/Cr ratio at the initial visit and at the 6-month follow-up, the Society of Fetal Urology (SFU) grade, antero-posterior (AP) diameter, renal function and diuretic response on mercaptoacetyltriglycine (MAG-3) dynamic renal scintigraphy and surgical or conservative management selection. Spot urine CA 19 - 9 levels were measured using the ELISA method. Out of 283 children, Group 1 consisted of 40 children (11 girls, 29 boys; median age: 7 years), Group 2 comprised 18 children (10 girls, 8 boys; median age:8 years) and 225 healthy controls (83 girls, 142 boys; median age: 8 years). The spot urine CA 19 - 9/Cr ratio was significantly higher in the Group 1 and 2 compared to controls (respectively 86.7, 64.5, 47.1 U/mg Cr, p = 0.0001). When the two patient groups with HN were compared with each other, no statistically significant difference was observed in the urinary CA19-9/creatinine levels (p = 0.358). No correlation was found between CA 19 - 9/Cr ratio and HN severity and/or dynamic renal scintigraphy findings. Surgical management of unilateral UPJO revealed a decrease in CA 19 - 9/Cr in the study group. This study suggests that the spot urine CA 19 - 9/creatinine ratio may serve as a promising, non-invasive biomarker for distinguishing children with unilateral UPJO and non-obstructive HN from healthy controls. Although elevated levels in patients and postoperative decline were observed, its inability to predict HN severity or the necessity for surgical intervention limits its clinical utility.

This study aimed to evaluate the correlation of Hounsfield unit (HU) to the success rate of medical expulsive therapy (MET) for distal ureteric calculus of size 4-10 mm. All recruited patients were divided into two groups: Group A, who successfully passed the stone, and group B, who failed to expel the stone. All patients were prescribed with silodosin for a maximum period of 4 weeks. The stone expulsion rate, mean stone area, mean HU, stone expulsion time, number of pain episodes, grades of hydronephrosis (HDN) and laterality of stone were studied. Out of 87 patients, eight patients were excluded from the study: Four patients had adverse drug reactions, and other four patients were lost to follow up. Hence, 79 patients were finalised for the study. Group A comprised 57 patients, and group B comprised 22 patients. No statistical difference was found between the two groups in terms of mean age, gender, stone density (HU) and side or grade of HDN (p > 0.05). The mean stone area (p = 0.001) and number of pain episodes per day (p = 0.0004) were significantly less in patients who successfully passed stone. The HU was lower in the MET success group (816.04) than in the failure group (900.86), but the difference was not statistically significant (p = 0.123). Receiver operating characteristic analysis showed that the cut off values for stone area and stone density were ≤38 mm2 and ≤992 HU, respectively. MET is undoubtedly a treatment modality for lower ureteric stones of size 10 mm. On computed tomography (CT) scan, stone area can be used as an effective parameter, but stone density (HU) cannot determine MET success. Further studies that include more patients and an evaluation of stone composition are required.

This study aims to assess the effect of pre-stenting and bladder drainage on intrapelvic pressure (IP) during Retrograde Intrarenal Surgery (RIRS). Eighty-five consecutive patients were prospectively enrolled and meticulously recorded in a data form. Forty-two patients meeting the inclusion criteria after applying exclusion factors. The patients were divided into two groups: Group 1 (21 patients with preoperative JJ stents) and Group 2 (21 patients without preoperative JJ stents). IP was measured during RIRS, and the impact of various factors, including pre-stenting, bladder drainage and hydronephrosis (HN) grade, on IP was analysed through univariate and multiple linear regression. The perioperative mean highest IP (78 ± 18.2 mmHg vs. 110 ± 23.9mmHg), median lowest IP (29 mmHg vs. 42 mmHg) and median overall IP (41 mmHg vs. 69 mmHg) were significantly lower in Group 1 compared to Group 2 (all p < 0.001). Multivariate analysis showed that pre-stenting and mild HN (Grade 0-1) were independent predictors of reduced IP. Pre-stenting led to a significant reduction in IP during RIRS, likely due to passive ureteral dilation. Additionally, bladder drainage with urethral catheter further decreased IP. These findings suggest that pre-stenting and bladder drainage should be considered as strategies to reduce IP during RIRS, potentially improving surgical outcomes.

Aims: Posterior Urethral Valve (PUV) is a common congenital urethral obstruction leading to significant morbidity. Despite successful fulguration of posterior urethral valve, the bladder dysfunction persists in most of the cases. Oxybutynin, an anticholinergic drug is commonly used to manage this bladder dysfunction. This study aimed to assess the impact of oxybutynin on bladder and urinary tract function in children with valve fulguration. Methods: A retrospective observational study was conducted on 41 children who underwent PUV fulguration at a tertiary care center in Bangladesh between 2020 and 2023. All subjects received oxybutynin for at least 6 months post-fulguration. Bladder wall morphology, hydronephrosis, vesicoureteral reflux (VUR), and post void residues (PVR) were assessed. Side effects of oxybutynin were also documented. Results: All patients had bilateral hydroureteronephrosis (HUN), except one, who was with unilateral HUN during primary diagnosis. Complete resolution of bilateral HUN was seen in Renal USG 14 patients at 6 months post fulguration. Correction of VUR documented in 13 units out of 32 units. Mean serum creatinine decreased to 0.52 ± 0.22from 0.73 ± 0.52 within 6 months of fulguration. Four patients exhibited significant PVR, leading to clean intermittent catheterization (CIC) initiation. Conclusion: Combined with PUV fulguration and oxybutynin therapy appears to be effective in improving bladder function. Further prospective studies incorporating urodynamic evaluations are warranted to validate these findings.

ABSTRACT The retrocaval ureter is an uncommon congenital anomaly caused by an anomaly in the formation of the infrarenal inferior vena cava. It can be asymptomatic or symptomatic. Generally, the diagnosis is confirmed by computed tomography urography or magnetic resonance urography. The surgical treatment is the anterior repositioning of the ureter and ureteroureterostomy. The usual presentation lies in the third to fourth decades, but it may be delayed. Here, we discuss a rare case of delayed presentation of the retrocaval ureter causing hydronephrosis (HDN) in a 50-year-old female. She had a ureteroureterostomy after confirmation of the diagnosis with a computed tomography urography/renal scan. She is doing fine at 3 years of follow-up without symptoms and HDN on ultrasound sonography. In this case report, we want to stress the delayed presentation of the retrocaval ureter in patients presenting with pain and HDN to diagnose uncommon etiologies.

Background: Fetal hydronephrosis (HN) is a prevalent condition detected in prenatal ultrasounds, affecting 1-5% of pregnancies. While mild cases often resolve without intervention, severe cases frequently require surgical treatment. Objectives: This study investigates the association between L-arginine levels and the severity of neonatal HN, as prior research has indicated L-arginine’s crucial role in kidney function. Methods: A prospective case-control study was conducted at the Children's Medical Center in Tehran from October 2021 to October 2023. Neonates with HN (n = 24) were compared with healthy control neonates (n = 24). Arginine levels in plasma and urine were measured using LC-MS/MS. Statistical analyses included Pearson correlation coefficients and receiver operating characteristic (ROC) curves to assess the need for surgical intervention. Results: Urine arginine levels were significantly lower in the HN group compared to the controls (P = 0.03), while plasma arginine levels showed no significant difference (P = 0.82). A significant positive correlation was found between urine arginine levels in the HN and control groups [r (24) = 0.44, P &lt; 0.05], but no significant correlations with kidney measurements or clinical outcomes were observed. Thirteen patients (54.2%) required surgery, with ROC analysis indicating low sensitivity (AUC = 0.53, P = 0.7). Conclusions: Our findings suggest that urine arginine levels may be lower in neonates with HN, indicating a potential link between arginine and kidney function. However, further research is needed to validate these findings and explore the utility of arginine as a cost-effective biomarker for the early detection of kidney abnormalities in pediatric nephrology.

Effect of overnight bladder drainage on posterior urethral valve sequelae: A randomized controlled trial

BackgroundMalignant ureteral obstruction (MUO) is a serious health condition in which a malignant tumor compresses the ureter. The optimal decompressive intervention in MUO remains unclear. This study was conducted to assess and compare renal function, the occurrence of ureterohydronephrosis (UHN), intraoperative, and postoperative complications among patients with MUO who underwent double J stenting (DJS) and percutaneous nephrostomy (PCN) in the Palestinian practice.MethodsThis study was conducted in retrospective design in one of the main tertiary care hospitals in the West Bank of Palestine. The data were collected from the electronic health information system of the hospital for the patients with MUO who received either DJS or PCN as a decompressive intervention from January 2018 to January 2024.ResultsIn this retrospective analysis, 62 patients who had stage 2 to stage 4 cancer and suffered MUO were included. The mean age of the patients was 60.8 ± 13.6 years. Of the patients, 40 (64.5%) were male and 22 (35.5%) were female. Of the patients, 26 (41.9%) had urinary bladder cancer. Of the patients, 23 (37.1%) had flank pain and 16 (25.8%) had lower urinary tract symptoms. Of the patients, 34 (54.8%) experienced bilateral UHN and 28 (45.2%) experienced unilateral UHN. In this study, 43 patients (69.4%) received PCN, and 19 (30.6%) received DJS as a decompressive intervention. Of the patients, 36 (58.1%) suffered postoperative complications. Stent migration/slip, UTIs, and urosepsis were the most commonly reported postoperative complications. There were no statistically significant differences in the occurrence of intraoperative complications, postoperative complications, time elapsed from receiving the decompression intervention to the diagnosis of complications, ICU admission, prognosis of UHN, serum creatinine, and serum BUN between both decompressive interventions.ConclusionDespite improvements in renal functions, creatinine and BUN levels remained abnormal even after receiving a decompressive intervention. Postoperative complications were frequently reported among patients who received DJS or PCN as decompressive interventions. Larger prospective studies are still needed to determine the optimal interventions to improve outcomes, quality of life, and survival rates of patients with DJS or PCN.

Antenatal hydronephrosis (HN) impacts up to 5% of pregnancies and requires close, frequent follow-up monitoring to determine who may benefit from surgical intervention. To create an automated HN Severity Index (HSI) that helps guide clinical decision-making directly from renal ultrasound images. We applied a deep learning model to paediatric renal ultrasound images to predict the need for surgical intervention based on the HSI. The model was developed and studied at four large quaternary free-standing paediatric hospitals in North America. We evaluated the degree to which HSI corresponded with surgical intervention at each hospital using area under the receiver-operator curve, area under the precision-recall curve, sensitivity, and specificity. HSI predicted subsequent surgical intervention with > 90% AUROC, > 90% sensitivity, and > 70% specificity in a test set of 202 patients from the same institution. At three external institutions, HSI corresponded with AUROCs ≥ 90%, sensitivities ≥ 80%, and specificities > 50%. It is possible to automatically and reliably assess HN severity directly from a single ultrasound. The HSI stratifies low- and high-risk HN patients thus helping to triage low-risk patients while maintaining very high sensitivity to surgical cases. HN severity can be predicted from a single patient ultrasound using a novel image-based artificial intelligence system.

Female hypospadias is a rare congenital malformation, often underdiagnosed compared to its male counterpart. We present the case of a 4-year-old girl with a history of poorly managed heart disease, diagnosed at the age of 2 after several episodes of recurrent urinary tract infections. Abdominopelvic ultrasound revealed bilateral pyonephrosis and bilateral uretero-hydronephrosis (UHN). Clinical examination and additional investigations led to the diagnosis of female hypospadias with a common channel measuring between 1 to 15 cm in length. Treatment involved the apicalization of the urethral meatus and a meatoplasty using Hendren’s technique, followed by uncomplicated postoperative recovery. This study highlights the importance of distinguishing female hypospadias from urogenital sinus in females to optimize diagnosis and treatment. The results show that surgical correction is effective, offering good postoperative outcomes.

Background: The management of ureteric obstruction secondary to pelvic malignancies (UOPM) presents a significant challenge. Objectives: Our study aimed to assess the factors affecting the feasibility of interventions for patients with UOPM - including retrograde and antegrade double J (DJ) stenting, and percutaneous nephrostomy (PCN) insertion. Methods: We conducted a retrospective analysis of patients who underwent intervention for UOPM over two years, from January 2022 to December 2023. Patients were categorized into groups based on intervention type: Group 1: Retrograde DJ stenting, group 2: Antegrade DJ stenting, and group 3: PCN insertion. Demographic, clinical, radiological, cystoscopic, and laboratory data were compared between the three groups. Analysis of Variance (ANOVA), logistic regression, and marginal mean plots were utilized for statistical analysis. Results: Fifty–nine patients were included in the study, consisting of 14 males and 45 females, and the mean age of the study population was 60.1 ± 10.8 years. Retrograde DJ stenting was successfully achieved in 59.3% of patients, with 10.2% undergoing antegrade DJ stenting and 30.5% needing PCN insertion. Serum albumin (P = 0.04), serum creatinine (P = 0.02), albumin creatinine ratio (P &lt; 0.001), and severity of hydroureteronephrosis (HDUN) (P = 0.02) were significantly associated with intervention outcomes. There was an increased likelihood of PCN insertion in higher serum creatinine and lower serum albumin levels. Multinomial logistic regression with univariate and multivariate analysis revealed significance among the above-mentioned variables. Conclusions: Even though DJ stenting remains common, a significant proportion of patients require PCN insertion. Serum albumin, serum creatinine, albumin creatinine ratio, and HDUN severity are significant predictors of intervention success. Further research is warranted to validate these findings and enhance management strategies for UOPM.

Assessment of ureteric jets as a supportive diagnostic modality for unilateral pelvi-ureteric junction obstruction and its utility in follow-up: A pilot study

Isolated Posterior Urethral Valves and Anterior Urethral Valves With and Without Concomitant PUV: Matched Cohort Study at a High-risk Pediatric Center

IntroductionInflammatory and immunological responses are reported involved in the pathogenesis and progression of obstructive nephropathy (ON). This study was designed to investigate the characteristics of peripheral immunity in patients with upper urinary tract urolithiasis and analyze the underlying associations with renal function.MethodsPatients with unilateral upper urinary tract urolithiasis meeting the operation indications were prospectively enrolled. Preoperative circulating immune cells and inflammatory cytokines were detected in our clinical laboratory, and the indicators of renal function and calculi related parameters were particularly recorded. Patients were sectionalized into subgroups on the basis of the lesion of calculi. Characteristics of peripheral immunity in each subgroup were investigated by statistical approaches, and the underlying correlations with the degree of hydronephrosis (HN) and renal function were discussed in corresponding group.ResultsPatients with ureteral calculi presented severer HN compared with renal calculi, especial middle ureteral calculi, acting as the chief culprit of ON, exhibiting the highest serum creatine and blood urea nitrogen, most impaired estimated glomerular filtration rate, and severest HN. In addition, serum interleukin-8 (IL-8) and IL-6 were demonstrated presenting statistical differences between ureteral calculi and renal calculi patients, exhibiting underlying values in comprehending ON. However, circulating immune cells were demonstrated no obvious differences among groups.ConclusionsCirculating inflammatory cytokines, referred in particular to serum IL-8 and IL-6 were partially associated with kidney injury in patients with upper urinary tract urolithiasis. But the specific influences and mechanisms between them needed to be investigated furthermore.

Introduction: Hydronephrosis (HN) refers to the dilation of the pelvicalyceal system. The current study aims to evaluate various presentations and causes of HN in children and adults with the help of ultrasound (US) as the primary diagnostic modality. Methodology: This cross-sectional prospective study was conducted in a tertiary care hospital in Lahore, Pakistan on patients between 0-70 years of age, who were diagnosed with HN in the US. Data was collected using self-designed proforma including gender, age, symptomatology, and anthropometry. Percentages and frequencies were calculated for categorical data. chi-square test was applied to compare urinary calculi in gender, age, BMI, and side. Results: The total number of patients was 73. The mean age was 31 years. Adults were 74% (54) while 26% (19) were of the pediatric age group. Males were 67.6% (50) and 31.5%(23) were females. Lumbar pain was the commonest presenting complaint. Hydronephrosis was bilateral in 20.5%(15), 43.8% (32) in the left and in the right kidney (35.6%) 26. In adult patients, renal calculi were the commonest cause of 69.9%(51) of HN. In the case of children, PUJ obstruction and renal calculi were equally common 31.6%(6) each. The ureter was the most common site of calculi 35.6% (26). A significant association was found between HN with side of involvement (p-value &lt; 0.001) and age of the patient (0.041). Conclusion: Ultrasound imaging is helpful in the diagnosis, determination of etiology, and grading of hydronephrosis. Ureteric calculi is the most frequent cause of hydronephrosis followed by pelvic ureteric junction obstruction.

: Anorectal malformations are one of the common congenital anomalies with an incidence of 1-3000 to 5000. Up to 70% of the patients have associated anomalies. Urogenital anomalies are the most common associated anomalies. : This study was done to determine the type and frequency of urogenital anomalies associated with different variants of ARMs according to the Krickenbeck classification.: 150 patients were included in the study. A full physical examination of the child was conducted followed by an infantogram, echocardiogram, spinal ultrasound scan, and KUB ultrasound was done to investigate different associated anomalies. MRI was done if further clarity was needed. The patients were classified according to the Krickenbeck classification.: ARM with perineal fistula was the common type of ARM. 73% had associated anomalies, and 32% of patients had urogenital (UG) anomalies. 70.8% of patients had urinary anomalies. 52.1% of patients had genital anomalies. The most common type of urinary anomaly found in the present study was hydroureteronephrosis (HUN) (41.2%). 32.4% of the patients with urinary anomalies had vesicoureteral reflux (VUR). Renal agenesis was found in 32.4%, neurogenic bladder 5.9%, hydronephrotic kidney 5.9%, ectopic ureter 5.9%, cross fused ectopic kidney 5.9%.: Urogenital anomalies associated with different subtypes of anorectal malformation vary drastically from patient to patient. The knowledge of these associated anomalies will help the surgeons in planning the course of treatment which can determine the prognosis and quality of life of the patients.

Introduction Decreased renal function after radical nephroureterectomy is one of the most important complications because it contributes to the decision to initiate adjuvant chemotherapy. This study aimed to investigate clinical factors associated with changes in renal function after radical nephroureterectomy in elderly patients. Methodology A total of 145 patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma were evaluated. The renal function was calculated preoperatively, postoperatively, and one month postoperatively, and the long-term change in renal function was investigated once a year. The association between clinical factors and changes in renal function following radical nephroureterectomy in univariate and multivariate analyses was stratified by age ≥75 years and <75 years. Results The median age of the patients was 71 years, with 94 patients (65%) aged <75 years and 51 patients (35%) aged ≥75 years. The median estimated glomerular filtration rates (eGFRs) were 57.1 (21.8-100) preoperatively, 36.1 (9.1-100) postoperatively, and 42.4 (19.5-100) in one month after radical nephroureterectomy. The median eGFRs in elderly patients were 50.8 (21.8-85.4) preoperatively. In the elderly group, only 8% had an eGFR of ≥50 as cisplatin-eligible at one month postoperatively. The long-term renal function in the elderly may decline further than during the stable postoperative periods. In the multivariate analysis, hydronephrosis (HN) was a significant predictor of decreased renal function in patients aged ≥75 years between the pre- and postoperative periods. Conclusions Elderly patients with HN who have upper tract urothelial carcinoma have a lower risk of decreased renal function after radical nephroureterectomy. This result may be useful in determining adjuvant therapy.

ABSTRACT We aimed to evaluate the effects of the antioxidant thymoquinone on treated and untreated kidneys on histological and oxidative parameters as well as Kidney Injury Molecule (KIM-1) levels in an experimental unilateral ureteropelvic junction obstruction (UPJO) with resultant hydronephrosis (HN) model. In adherence to the Animal research: reporting of in vivo exepriments guidelines, 34 male Wistar rats were randomly divided into four groups which were named accordingly: “CO” (corn oil), “TQ” (thymoquinone and corn oil), “HNCO” (UPJO-HN and corn oil), “HNTQ” (UPJO-HN, thymoquinone and corn oil). Histologically, pelvic epithelial damage, glomerular shrinkage and sclerosis, tubular damage, interstitial edema-inflammation-fibrosis (IEIF), and vascular congestion were assessed. Biochemically, malondialdehyde (MDA), superoxide dismutase (SOD), glutathione reductase (GR) and KIM-1 levels were assessed. Macroscopic HN developed in all obstructed kidneys. Ipsilateral obstructed kidneys deteriorated in all histological parameters. Thymoquinone attenuated glomerular shrinkage and sclerosis alterations but increased vascular congestion. Contralateral non-obstructed kidneys also showed histological deterioration. Thymoquinone had beneficial effects in terms of IEIF presence in contralateral kidneys but it increased vascular congestion. MDA and SOD results were inconclusive. UPJO caused decreased GR levels in the ipsilateral kidneys but not in the contralateral ones. This effect was not ameliorated by thymoquinone treatment. KIM-1 levels were increased in ipsilateral obstructed kidneys with a lower level in HNTQ group than in HNCO. KIM-1 level of the ipsilateral HNTQ group was higher than in both non-obstructed ipsilateral kidney groups. The effect of thymoquinone in ameliorating bilaterally observed histological alterations was limited and controversial. Oxidative damage detected by GR measurements was not prevented by thymoquinone. Thymoquinone partially decreased the damage as evidenced by reduced KIM-1 levels in thymoquinone-treated obstructed kidneys.

Recent studies have reported conflicting findings regarding the significance of hydronephrosis (HN) in muscle-invasive bladder cancer (MIBC). The molecular characteristics of MIBC with HN are unclear, therefore, we aimed to address the gaps in previous research and elucidate HN's molecular significance in patients with MIBC. Clinical, genetic, and imaging information on bladder cancer patients enrolled in The Cancer Genome Atlas were obtained from public databases to analyze the association between the presence of hydronephrosis and genetic alterations and molecular subtyping. A total of 108 patients who underwent total cystectomy for MIBC at the Hiroshima University Hospital were enrolled in the study to verify the association between HN and renal function with patient prognosis. We observed a statistically significant difference in the distribution of molecular subtypes (p=0.0146). The proportion of patients with the luminal papillary subtype was approximately twice as high in patients with HN (48.8%) than in those without HN (25.0%). The mutation frequency of fibroblast growth factor receptor (FGFR) 3 was approximately three-fold higher in patients with HN (20.9%) than in those without HN (7.1%). Multivariate analysis, which considered HN and estimated glomerular filtration rate as confounding factors in our MIBC cohort, revealed that reduced renal function, but not HN, was an independent predictor for overall survival. MIBC presenting HN exhibits a high frequency of mutations in the FGFR3 gene. In addition, not HN itself, but reduced renal function due to HN may worsen the prognosis for MIBC.

This study's objective is toassess the effect of preoperative factors on postoperative hydroureteronephrosis (HUN) after radical cystectomy (RC) in patients with bladder cancer (BC). Patients who underwent RC for BC between January 2019 and November 2022 and had unilateral or bilateral postoperative HUN were retrospectively analyzed. Patients without preoperative HUN but with postoperative HUN constituted the patient group, while patients without both preoperative and postoperative HUN constituted the control group, and they were compared with each other. Neoadjuvant chemotherapy (NAC) and postoperative metastasis were positively correlated with postoperative HUN (r = 0.238, P = 0.007, and r = 0.203, P = 0.021, respectively). Multivariate logistic regression analysis showed that the postoperative HUN was significantly associated with NAC (P= 0.048; Exp(B) = 6.896, 95% confidence interval [CI]1.02-46.9) but not associated with the presence of metastasis (P = 0.054). Moreover, NAC increased the possibility of undergoing revision surgery (P = 0.002; Exp(B) = 26.9, 95% CI3.2-225). NAC is an independent factor for impaired anastomotic healing, increased postoperative HUN, and the need for revision surgery in patients with BC.