Ipsilateral Multicystic Dysplastic Kidney Research Articles

MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES?

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES? Aznive Aghababian, Sameer Mittal, Sahar Eftekharzadeh, John Weaver, Katherine Fischer, Christopher Long, Dana Weiss, Jason Van Batavia, Mark Zaontz, Thomas Kolon, Stephen Zderic, Douglas Canning, Aseem Shukla, and Arun Srinivasan Aznive AghababianAznive Aghababian More articles by this author , Sameer MittalSameer Mittal More articles by this author , Sahar EftekharzadehSahar Eftekharzadeh More articles by this author , John WeaverJohn Weaver More articles by this author , Katherine FischerKatherine Fischer More articles by this author , Christopher LongChristopher Long More articles by this author , Dana WeissDana Weiss More articles by this author , Jason Van BataviaJason Van Batavia More articles by this author , Mark ZaontzMark Zaontz More articles by this author , Thomas KolonThomas Kolon More articles by this author , Stephen ZdericStephen Zderic More articles by this author , Douglas CanningDouglas Canning More articles by this author , Aseem ShuklaAseem Shukla More articles by this author , and Arun SrinivasanArun Srinivasan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal management for ureteroceles has long been under debate, due to the anatomic variability and severity of this entity. Treatment strategies range from upper pole heminephrectomy or major bladder reconstruction, to isolated endoscopic incision. We hypothesize that a carefully selected group of ureteroceles can be successfully managed without surgical intervention. METHODS: We retrospectively reviewed medical records of all patients with a diagnosis of ureterocele who were managed at our institution from 2010-2019. Patients were categorized into two groups: non-surgical management and surgical management. Non-surgical management included those who had at least 6-month follow-up with no interventions including ureterocele puncture. We analyzed baseline demographics, clinical presentation, imaging details, history of urinary tract infection (UTI), and if any procedures were performed during the follow-up period. RESULTS: We identified 240 ureteroceles in 231 patients: 56 (23%) were managed without immediate puncture and 184 (77%) surgically. Patients who underwent non-puncture management were more likely to have an intravesical ureterocele, ipsilateral multi-cystic dysplastic kidney, and were unlikely to have hydronephrosis and/or reflux on the ipsilateral side. Of 56 patients in the non-incision cohort, 6 (10%) required surgery after a median observation of 2.5 years (IQR 2.1-4.5), with 4 ureteroceles associated with a duplex system (3 intravesical and 1 ectopic) and the other 2 associated with absent kidney and an ectopic insertion. The remaining 50 (90%) did not require any surgical intervention during a median follow-up of 2.4 years (IQR 0.9-4.6). In the cohort of 50 patients who did not undergo intervention, 35 (70%) were on antibiotic prophylaxis, and febrile UTIs occurred in 12 (24%) patients from this group. Multivariate regression analysis showed that intravesical ureteroceles were more likely to be successfully managed non-operatively than ectopic ureteroceles (OR: 103.6, 95% CI: 1.4–733.5). CONCLUSIONS: Children with ureteroceles without evidence of obstruction, and/or functional renal tissue can be successfully managed without puncturing the ureterocele. An intravesical ureterocele in these children may be a predictor of success. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e899-e899 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aznive Aghababian More articles by this author Sameer Mittal More articles by this author Sahar Eftekharzadeh More articles by this author John Weaver More articles by this author Katherine Fischer More articles by this author Christopher Long More articles by this author Dana Weiss More articles by this author Jason Van Batavia More articles by this author Mark Zaontz More articles by this author Thomas Kolon More articles by this author Stephen Zderic More articles by this author Douglas Canning More articles by this author Aseem Shukla More articles by this author Arun Srinivasan More articles by this author Expand All Advertisement PDF downloadLoading ...

A Newborn with Retrovesical Cysts and an Ipsilateral Multicystic Dysplastic Kidney

We present a clinical imaging question focusing on a newborn with known prenatal history of a multicystic dysplastic kidney, and incidental ipsilateral retrovesical seminal vesical cysts, raising the diagnosis of Zinner syndrome. The diagnosis is challenging in this age group. Surgical management is generally proposed for symptomatic cases at an older age.

Single System Ectopic Congenital Giant Megaureter Associated with Ipsilateral Multicystic Dysplastic Kidney

Congenital anomalies of the kidney and urinary tract (CAKUT) is a disease spectrum of a wide range of structural and functional anomalies. In this report, we have presented a rare case of CAKUT displaying the wide spectrum of renal and urinary tract anomalies with an unusual association like single system ectopic giant megaureter with the ipsilateral multicystic dysplastic kidney.

Congenital giant megaureter associated with ipsilateral multicystic dysplastic kidney in newborn

Congenital giant megaureter presents as abdominal mass and impose diagnostic difficulties. It can be associated with other upper urinary tract anomalies. A female newborn with antenatal diagnosis of polycystic kidneys was admitted at birth due to lower abdominal mass. Ultrasound and CT scans diagnosed a multiloculated cystic lesion in the mid and lower abdomen along with right side multicystic kidney. At laparotomy, an extaperitoneal, lobulated cystic swelling was found due to rightside giant megaureter. Its lower end was of normal caliber and orthotopic. End cutaneous ureterostomy was done. Intravenous urogram and isotope renograms showed nonfunctioning right kidney. She also had grade II vesicoureteral reflux on left side. Child suffered urinary infection twice. At 9m age, right nephroureterectomy was done. Histopathologic examination was consistent with cystic renal dysplasia and dilated ureter. This is the first case report of giant megaureter associated with ipsilateral multicystic dysplastic kidney in newborn.

Pitfalls in the Diagnosis and Management of Obstructive Uterovaginal Duplication: A Series of 32 Cases

Obstructive uterovaginal duplication is rare and frequently misdiagnosed. The aims of this study were to review all the patients managed for this malformation in our institution, evaluate their long-term outcomes, and discuss the embryologic origin of this malformation. From 1984 to 2007, we treated 32 patients for obstructive uterovaginal duplication in our institution. We separated them in 2 groups (prepubertal [n = 8] and pubertal [n = 24]) and analyzed their clinical and radiologic presentations and their treatments. Patients >18 years of age (n = 22) were recontacted. For the prepubertal group, the median age at diagnosis was 6 months. Postnatal ultrasound showed an absent ipsilateral kidney in 6 case subjects, although 4 patients had a prenatal diagnosis of ipsilateral multicystic dysplastic kidney. This renal anomaly was associated with a pelvic sonolucent mass in 3 case subjects, allowing us to prenatally suspect the diagnosis. All of the patients were cured by vaginal approach. For the pubertal group, the median delay of diagnosis after menarche was 9 months. Among patients managed in an emergency setting (n = 11), there were 9 misdiagnoses with inappropriate abdominal surgeries, including 3 hysterectomies of the obstructed hemiuterus. Concerning long-term results, 5 patients were attempting to have children, with successful pregnancies for 4 of them. One patient suffered from infertility attributable to contralateral isthmic stenosis after a hysterectomy of the obstructed hemiuterus. Obstructive uterovaginal duplication is a benign pathology when properly managed. Therefore, management of abdominal pain in peripubertal girls should include systematic abdominal and gynecologic examinations completed by radiologic pelvic and renal evaluation. Surgical treatment should be performed by vaginal approach to avoid infertility. Concerning the origin of the malformation, the high association of prenatal dysplastic kidneys and postnatal absent kidneys suggests anomalies of both wolffian and müllerian duct development, contrasting with the classic definition of this malformation.

Seminal vesicle abscesses associated with ipsilateral multicystic dysplastic kidney in an infant

Seminal vesicle cysts are rare lesions and usually asymptomatic. However, when symptoms occur it is typically during the early sexually active period. Furthermore, seminal vesicle abscesses (SVAs) are extremely rare and often difficult to diagnose due to the absence of any typical clinical signs. We herein describe a 2-month-old boy with a left SVA and ipsilateral multicystic dysplastic kidney (MCDK) who presented with a recurrent urinary tract infection (UTI). Magnetic resonance imaging proved to be a valuable diagnostic tool in our patient. Percutaneous transrectal puncture and aspiration were performed, because of recurrent UTI when intravenous antibiotic therapy had been stopped. Three weeks after the procedure, however, the SVA recurred, and, therefore, a transperitoneal laparoscopic excision of the left SVA, ureteral remnant and dysplastic renal tissue was performed. To the best of our knowledge, this is the first case of infantile SVA associated with ipsilateral MCDK. Pediatric clinicians should consider this urological anomaly in boys presenting with intractable UTI, although it is extremely rare.

Utility of computed tomographic renal angiogram in the management of childhood hypertension.

The purpose of this study was to evaluate the utility of computed tomography (CT) renal angiogram (CTRA) in the management of childhood hypertension. This is a retrospective study of 24 children with clinical suspicion of renovascular disease who underwent CTRA examinations. CTRA demonstrated surgically correctable etiology of hypertension in 38% of the patients [5 with renal artery stenosis (RAS) and 4 with renal pathology]. In 5 patients, CTRA findings of RAS were confirmed by catheter angiogram. CTRA missed RAS in 1 patient in whom catheter angiogram showed beaded narrowing of the renal artery. All 6 patients with RAS had resolution of hypertension immediately after angioplasty or surgery. One patient with diffuse renal artery stenosis had an ipsilateral multicystic dysplastic kidney. In this patient hypertension resolved spontaneously as the dysplastic kidney shrunk in size. Seven patients had a renal etiology for hypertension. In 3 of these patients hypertension resolved after nephrectomy. Malignant hypertension in the 4th patient with reflux nephropathy was controlled medically after she underwent bilateral ureteral reimplantation. The remaining 3 patients with renal etiology were managed medically. We found that the etiology was central for hypertension in 4 patients with brain abnormalities, obesity in 1 overweight patient, essential hypertension in 4 patients, and thoracic aorta coarctation in 1 patient. Our study showed that in all except 1 instance CTRA could diagnose a surgically correctable cause for hypertension. CTRA provided useful information for the management of pediatric hypertension in all our patients.

Single-system ureteroceles in infants and children: imaging features.

The purpose of this manuscript is to describe the clinical and imaging findings in children who have single-system ureteroceles. We reviewed the urology records and imaging studies in 32 consecutive infants and children who were diagnosed in our department with single-system ureteroceles. There were 35 ureteroceles in the 32 patients-- 29 were unilateral (14 right-sided, 15 left-sided) and 3 were bilateral. Twenty-five patients were boys (78 %) and 7 girls. Mean age at presentation was 0.7 years (0-9.2 years). Prenatally detected hydronephrosis or cystic renal dysplasia was the most common presentation (24 patients). Four presented with urinary infection, 2 with abdominal mass, 1 had myelomeningocele, and 1 had hypospadias. Three patients also had multiple non-urologic, congenital anomalies. Thirty-three ureteroceles were intravesical, and 2 were ectopic to the bladder neck. Twenty-four ureteroceles were associated with ipsilateral hydroureteronephrosis and 10 with ipsilateral multicystic dysplastic kidney. One patient had a normal ipsilateral kidney and a contralateral multicystic dysplastic kidney. The ureterocele was identified on at least one imaging study in each patient. Sixteen ureteroceles (47%) everted at VCUG, mimicking paraureteral diverticula. Other variations included ureterocele prolapse and inadvertent ureterocele catheterization (1 each). Single-system ureterocele is an important, although uncommon cause of hydronephrosis and renal dysplasia in infants and children. Single-system ureterocele is distinguished clinically from the more common duplex-system ureterocele by its frequent occurrence in boys and its association with multicystic dysplastic kidney. Because these ureteroceles are frequently small and have a propensity to evert at VCUG, they can be mistaken for paraureteral diverticula.

Absent vas deferens and ipsilateral multicystic dysplastic kidney in a child: M.J. Drake and F.M.J. Quinn. Br J Urol 77:756–757, (May), 1996

Absent vas deferens and ipsilateral multicystic dysplastic kidney in a child: M.J. Drake and F.M.J. Quinn. Br J Urol 77:756–757, (May), 1996