Pediatric Urology Department Research Articles

Endoscopic combined intrarenal surgery versus percutaneuos nephrolithotomy for complex pediatric stone disease: A comparative analysis of efficacy and safety

INTRODUCTIONDecision-making for complex pediatric urinary system stone disease is still a challenge for pediatric urologists. The interest in supine percutaneous nephrolithotomy (PCNL) is increasing among centers to achieve high surgical success rates with less morbidity. Despite advanced retrograde intrarenal surgery armamentarium, percutaneous approaches remain the first-line surgical treatment modality for >2 cm and complex renal stones. There are no comparative studies yet in the literature for pediatric endoscopic combined intrarenal surgery (ECIRS) OBJECTIVEIn this study, we aimed to contribute to the literature by evaluating the safety and efficacy of ECIRS by comparing it with PCNL. STUDY DESIGNPatients under 18 years of age who underwent PCNL and ECIRS for urinary tract stone disease at our Pediatric Urology department between 2012 and 2024 were included. Preoperative (demographic characteristics, stone characteristics, biochemical parameters), perioperative (duration of surgery, number of accesses, lasing and fluoroscopy times, endoscopic and fluoroscopic stone-free rates) and postoperative (hospital stay, urinary tract infection, complication and radiological stone-free rates) parameters were retrospectively evaluated. RESULTSA total of 68 children [28 (41%) girls and 40 (59%) boys] aged 5 (0-17) years were included in the study. ECIRS was performed in 19 (28%), supine in 28 (41%) and prone PCNL in 21 (30%) patients. Age (p = 0.029), Guy's stone score (p<0.001), S.T.O.N.E. (p<0.001), and Seoul National University Renal Stone Complexity (S-ReSC) scores (p=0.001) for preoperative parameters were found to be higher in ECIRS group over both PCNL methods (Summary Table). However, Clinical Research Office of the Endourological Society (CROES) score was seen lower for ECIRS group patients compared to other groups (p=0.028).Surgery time (in favor of supine over prone PCNL), fluoroscopy time (in favor of ECIRS and Supine PCNL over Prone PCNL), preferred laser type (prone PCNL group was mostly performed with holmium laser, whereas other groups were balanced between Holmium and Thulium Fiber Laser) and exit strategy (the preferred exit strategy was DJ Stent in most of the ECIRS patients, whereas nephrostomy tube was used in some of the PCNL group) showed significant difference among the groups as perioperative parameters (p=0.042, <0.001, <0.001, <0.001, respectively). Surgery time was lower for supine PCNL compared to prone PCNL. For postoperative parameters, stone-free rates, complication rates and urinary tract infections were similar between the 3 groups, while a difference was detected in terms of length of hospital stay in favor of ECIRS over both supine and prone PCNL (p = 0.006). DISCUSSIONThe current trial suggests that stone-free and complication rates of ECIRS and supine PCNL were similar in the pediatric complex stone patients. Although, the stones in the ECIRS group we found to be more complex. Also, ECIRS was superior to PCNL in terms of fluoroscopy exposure and hospital stay. CONCLUSIONWith the widespread use of new generation ureteral access sheaths and flexible ureterorenoscopes, ECIRS may have an important role in treatment of complex pediatric kidney stones.

Totally implantable venous ports in infants and children: a single-center retrospective study of indications and safety.

Totally Implantable Venous Access Devices (TIVADs) contribute significantly to the treatment progress and comfort of patients requiring long-term therapy. However, the procedure for implanting TIVADs, as well as its very presence, may be associated with complications. This study evaluates the indications, safety, and complication rates of venous port implantations in pediatric patients. It also explores factors influencing the occurrence of early and late complications post-implantation. The study included 383 pediatric patients treated at the Department of Pediatric Surgery, Traumatology, and Urology in Poznan between 2013 and 2020 who underwent 474 implantations of intravenous ports. Venous access was achieved using the Seldinger technique. Statistical analysis was performed using Statistica 13 with TIBCO and PQStat 1.8.2.156 with PQStat. Venous ports were used in 345 oncology patients requiring chemotherapy (90% of the total group) and in 38 children (10%) with non-oncology indications. There were 36 early complications (7.6%) and 18 late complications (3.8%), excluding infectious complications. The most common early, non-infectious complications included pneumothorax (15 patients; 3%) and port pocket hematoma (12 patients; 2.5%). The most common late, non-infectious complications observed were venous catheter obstruction (8 children; 1.7%) and port system leakage (5 children; 1%). Infectious complications occurred in 129 cases (27.2%). Children with a diagnosis of non-Hodgkin's lymphoma, acute myeloid leukemia, and acute lymphoblastic leukemia had a significantly higher incidence of port infections. Venous ports equipped with a polyurethane catheter, compared to systems with a silicone catheter, functioned significantly shorter. The Seldinger method of port implantation is quick, minimally invasive, and safe. The type of port, including the material of the port's venous catheter, and the underlying disease have an impact on the durability of implantable intravenous systems. The experience of the surgeon is related to the frequency of complications associated with the procedure.

Removal of the central venous port system in children. Is this an appropriate training procedure for resident physicians? A single-center retrospective study.

&lt;b&gt;Introduction:&lt;/b&gt; A venous port system consists of a port chamber attached to a central catheter, which is implanted into the central venous system. The removal of the vascular port includes all items of this system. This procedure is usually simple and quick. Complications with port removal are rare but possible.&lt;b&gt;Aim:&lt;/b&gt; The study aimed to summarize venous port removal procedures performed by pediatric surgeons.&lt;b&gt;Material and methods:&lt;/b&gt; The single-center, retrospective study was conducted on 360 pediatric patients treated during the years 2010-2022 in the Department of Pediatric Surgery, Traumatology, and Urology in Poznan.&lt;b&gt;Results:&lt;/b&gt; The port usage time before the removal ranged from 3 days to 8 years and 3 months, with an average of 22 months. The leading cause of vascular port removal was the end of treatment (78.06%). Other less frequent reasons were the infection (13.89%) and mechanical damage of the port (3.33%). There were almost no complications connected with the procedure of vascular port removal (92.2%). If the complications occurred, they included bleeding during surgery (3%), covering the vascular catheter with bone tissue of the clavicle, causing difficulties with the catheter removal from the vein (1.4%), and connected with the previous complications-prolonged clavicle pain after surgery (1.4%) and hematoma after surgery (2%).&lt;b&gt;Conclusions:&lt;/b&gt; Removing the venous port is a safe procedure with a low risk of complications. This procedure can be considered as an appropriate training procedure for young trainees. A more extended period of use of the vascular port before its removal may be associated with more difficulties during surgery.

A Peristaltic Pump to Improve Bladder Emptying and Irrigation in Patients Who Use Clean Intermittent Catheterization

Background: Neurogenic bladder patients who intermittently catheterize may have systems that drain slowly and incompletely. These limitations can lead to urinary tract infections and bladder stone formation and be time consuming. We hypothesize that a catheter accessory device could improve drainage, reduce residual bladder volume, and save time. Methods:&amp;nbsp;A yearlong collaboration between an undergraduate biomedical engineering student design team and client mentors from the pediatric urology department led to an evaluation of solutions to enhance emptying of bladders that require intermittent catheterization. Students performed market analysis, identified design requirements, generated design concepts, conducted usability testing, and constructed alpha and beta prototypes verified through benchtop experimentation during the yearlong project. Prototypes were verified using a phantom bladder model built from a compliant stress ball with an attached catheter and placed under an external pressure of 5 cm H 2 O. Tests were conducted to measure the diff erence between passive drainage and device-assisted drainage at various bladder volumes and catheter sizes. Eight student peers compared passive emptying, irrigating, and aspirating a phantom bladder model using the prototype or syringe to assess the usability of the device. Results:&amp;nbsp;We developed a pump that interfaces with commercially available catheters. The&amp;nbsp;pump housing was designed and 3D printed. Fluid can be moved bi-directionally with&amp;nbsp;a battery-powered peristaltic pump and microcontroller. The pump has a built-in current&amp;nbsp;sensing threshold with an automatic shutoff safety mechanism. Testing results showed&amp;nbsp;that for all bladder volumes and catheter sizes, the pump emptied more completely and&amp;nbsp;drained between 1.6 and 6.3 times faster when compared to passive drainage. Usability&amp;nbsp;feedback showed that the pump required less time to irrigate the bladder and was preferred&amp;nbsp;when compared to the manual syringe technique. Conclusions: This portable catheter pump improves phantom bladder emptying by increasing flow rate, decreasing residual volume, and making irrigation easier. Future design improvements will work to implement safety mechanisms and miniaturize the pump. This project demonstrates the feasibility of a catheter accessory device to improve patient quality of life and the ability for understudied clinical problems to be addressed through collaborations between capstone engineering design teams and physicians.

The application of machine learning based on computed tomography images in the identification of renal tumors in children.

The clinical manifestations of Wilms tumor and non-Wilms tumor in children are similar, and the only way to confirm the diagnosis is by postoperative pathology. Computed tomography (CT) is one of the main methods for preoperative diagnosis of the two, but it is also difficult to distinguish because it is easily affected by the subjective influence and the experience of the radiologists. The CT images of 82 children with renal tumors admitted to the Department of Pediatric Urology, Shandong Provincial Hospital from January 2011 to March 2022 were retrospectively analyzed. First, we drew the two-dimensional (2D) region of interest (ROI) of the largest cross-section on the corticomedullary phase (CMP) and nephrogenic phase (NP) images, and extracted seven types of 107 features in the ROI. Then, the texture features with similarity greater than 95% and repetition less than 90% were screened out, and the remaining texture features were further screened by analysis of variance (ANOVA) and recursive feature elimination (RFE). Finally, 15 texture feature were used to build the machine learning (ML) models. We used the synthetic minority oversampling technique (SMOTE) and 10-fold cross-validation to build ML models and verified them in the training, testing, and internal validation sets. The area under the receiver-operating characteristic curve (AUC) and calibration curve were used to evaluate the diagnostic performance. We collected 77 CMP and 81 NP images, which were randomly divided into the training set and the testing set according to the ratio of 7:3. In the internal validation of CMP, the Mean-PCC-ANOVA-5-AE pipeline model achieved the highest AUC 0.792 [95% confidence interval (CI): 0.653-0.930], and its accuracy (ACC), sensitivity (SEN), and specificity (SPE) were 0.833, 0.539 and 0.927, respectively. Correspondingly, in NP, the Mean-PCC-ANOVA-2-LR pipeline model achieved the highest AUC 0.655 (95% CI: 0.485-0.82) in the internal validation. The ACC, SEN, and SPE were 0.696, 0.539, and 0.744, respectively. The ML models based on CT images have good diagnostic efficiency in differentiating Wilms tumors from non-Wilms tumors in children.

Thyroid diseases in children and adolescents requiring surgical treatment-indications, techniques, results, and complications based on 10 years of the single center's own experience.

Although thyroid abnormalities are observed less frequently in children than in adults, the increased incidence of thyroid cancer makes it mandatory for all pediatric surgeons to be knowledgeable about the disorders of this gland. Thyroid abnormalities can be associated with hyperthyroidism or hypothyroidism and euthyroidism and/or symmetric or asymmetric enlargement of the gland. The present study was undertaken to retrospectively analyze the indications, surgical techniques used, results obtained, and complications found in the surgical treatment of thyroid diseases in children and adolescents in a surgical center for the macro-region of western Poland. The data of 148 patients undergoing total or partial thyroidectomy between 2013 and 2022 were analyzed from the medical records of the Department of Pediatric Surgery, Traumatology, and Urology of the Medical University of Poznan, Poland. A total of 95 children underwent subtotal thyroidectomy and 64 underwent total thyroidectomy, of which the procedure was widened to include prophylactic removal of neck lymph nodes in 45 patients. There were 113 girls (76%) in the analyzed group, and the average age of the patients at the time of surgical treatment was 15 years. The average time from the diagnosis of thyroid disease to surgery was 4 months, ranging from 2 weeks to 3 years. Of the 64 patients undergoing total thyroid resection, 35 (54.69%) were diagnosed with thyroid cancer. Collaboration within a multidisciplinary team ensures optimal surgical outcomes in children and adolescents with thyroid disease. With extreme caution, thyroid removal is a safe procedure with few complications, but the experience of the surgeon performing thyroid surgery in children remains crucial. Despite the absence of such a diagnosis in the first fine-needle aspiration biopsy, the high percentage of thyroid carcinomas in the analyzed group may be because the initial biopsy was performed in a less experienced center, also in terms of histopathological laboratory. Hence, we point out the necessity of performing a repeat fine-needle aspiration biopsy (according to the Bethesda classification) in a more experienced center before the final decision of thyroidectomy.

Clinical efficacy of transverse preputial island flap urethroplasty for single-stage hypospadias repair in Children Hospital Faisalabad” A Retrospective Study.

Objective: To summarize the clinical outcomes of single stage hypospadias surgery with preputial-island flap method in the Children Hospital, Faisalabad. Study Design: Retrospective Study. Setting: Department of Paediatric Urology, Children Hospital, Faisalabad. Period: March 2018 to March 2023. Material &amp; Methods: First of all, approval of study from the Hospital Ethical Review Committee was taken for research work. For last five years, all patients of hypospadias repair were admitted in the ward via OPD of Pediatric Urology Department of Children Hospital, Faisalabad. According to inclusion and exclusion criteria, these patients were considered to be included in study. After analyzing the patients with history and physical examination, the diagnosis was confirmed and after the informed consent of surgery and consent of data for research purposes the patients were put in the research work. Results: There were one hundred and fifteen patients (n=115), who were operated using single stage hypospadias repair with method where we used dorsal prepuce in transverse manner as flap known as preputial-island-flap method during the study period time. The complication of surgery rate was found 48.7% in the study. There were five patients (4.34%) suffering from mild infection. Six patients (5.2%) had disruption of repair; secondary surgical correction was successful in all of them. Ten patients (6.7%) suffered necrosis and slugging of new urethral tube followed by disruption of repair. Urethro-cutaneous fistula was observed in sixteen patients (13-9%), it was single in eleven patients and the rest of five had more than one fistula. Four patients needed fistula repair, rest of the eleven healed with self-urethral dilatation, seven patients (6%) had meatal stenosis, while four patients (3.5%) had urethral stricture. Conclusion: Single staged hypospadias repair where dorsal prepuce in transverse manner were taken as flap known as preputial-island-flap is also an acceptable choice for surgery. Results of study showed transverse preputial-island-flap technique is an acceptable option. Because the vascularity of tube is intact and good, secondly results are better, thirdly this technique has lower rate of complications, fourthly we completed in single stage which was the time saving.

Safety and Cost-effectiveness of Mini Percutaneous Nephrolithotomy as Day Care Surgery in Paediatric Patients

Background: The increasing prevalence of urolithiasis in paediatric populations necessitates the exploration of efficient and safe treatment modalities. Mini percutaneous nephrolithotomy (PCNL), traditionally an inpatient procedure, has evolved with advancements in surgical techniques and pain management, prompting its consideration as a day care surgery. Objective: This study aims to evaluate the safety, efficacy, and cost-effectiveness of day care mini PCNL in paediatric patients with kidney stones. Methods: This prospective quasi-experimental study was conducted in a pediatric urology department. Patients aged 3 months to 14 years presenting with kidney stones were included. The procedure involved using a 16Fr mini PCNL nephroscope under general anesthesia and fluoroscopic guidance. Stone fragmentation was achieved using a pneumatic lithoclast, and fragmented stones were retrieved with wash and bifrong forceps. Inclusion criteria were stringent, considering factors like stone size, surgery duration, and patient recovery. Postoperative management included early mobilization, oral antibiotics, and analgesics. Follow-up was scheduled at 1 week and 1 month postoperatively. Data analysis employed SPSS version 20, focusing on variables like age, operative time, readmission rates, and cost comparisons. Results: The study involved 92 patients, with a gender distribution of 71.7% male and 28.3% female. The average stone size was 2.2 ± 0.7 cm, and the mean operative time was 74 ± 16 minutes. The mean hospital stay was 11 hours, with readmission rates of 6.7%. The cost savings in day care mini PCNL were significant, with an average reduction of 8000 PKR per procedure compared to inpatient care. The success rate of day care surgery was 93.7%. Conclusion: Day care mini PCNL is a viable, safe, and cost-effective treatment option for pediatric patients with kidney stones. It offers reduced hospital stay, lower costs, and high patient satisfaction without compromising on safety or treatment efficacy.

Characterizing psychosocial services in a pediatric urology practice

Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families. To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital. Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language. From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8-12.4); 48.4% were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4%), mental/behavioral/developmental health (29.1%), and referral and appointment management (19.9%). The largest proportion of time was spent on providing direct psychosocial support (45.9%), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9%). Relative time allocation across activities varied by provider type (p<0.001); care coordination constituted 64.2% of non-billable activities for the psychologist, 57.8% for the SW, and 12.3% for the CCLS. Activities were associated with treatment plan modification in 37.7% (n=357), outpatient coordination in 22.5% (n=213), and treatment plan adherence in 19.0% (n=180) of encounters. This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care. Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment.

Outcomes of a newly established transitional urology outpatient clinic: a real-world experience.

To evaluate the demographic and clinical characteristics of patients who visited our transitional urology (TU) outpatient clinic formed by pediatric urologists with urology background within the first year upon its establishment. Files of 130 consecutive patients who visited our TU outpatient clinic, which was established in 01 March 2021, between 01 March 2021 and 01 March 2022 were retrospectively collected. Patients were divided into two groups: those with a previous follow-up in our pediatric urology department (Group I, n: 81, 62.3%) and those who were followed up in other clinics during childhood (Group II, n: 49, 37.7%) afterwards. Demographic characteristics, complaints at admission, previous medical history, and management plans at the recent clinical visit were noted. We defined a successful and smooth transition from childhood to adult care as not being without follow-up within the first year after the age of 18years and not requiring extraordinary medical assistance (e.g., emergency room visits, hospitalization, intensive care unit admissions) from the last urological control to the TU outpatient clinic visits. The most common diagnoses were vesicoureteral reflux (n: 32, 24.6%), neuropathic bladder accompanied by spina bifida (n: 31, 23.8%), obstructive uropathy (n: 25, 19.2%), hypospadias (n: 20, 15.3%), non-neurogenic lower urinary tract dysfunction (n: 19, 14.6%), and bladder exstrophy (n: 8, 6.1%). The distribution of primary diagnosis in the two patient groups was similar. The median time from the last pediatric urology visit to the current TU clinical visit was significantly longer in Group II (12 vs. 60months, p < 0.001),consequently, the median patient age at admission was significantly higher in Group II (21 vs. 23years, p = 0.020). The rate of a successful and smooth transition was 86.4% in Group I, whereas Group II had a completely unsuccessful transition period. Upon admission to TU outpatient clinic, the requirement of a surgical intervention was lower in Group I (21% vs. 38.8%, p = 0.028).Also,the need for medical treatment changes was higher in Group II (9.9% vs. 53.1%, p < 0.001). Our findings emphasize the importance of patient referral to a TU clinic that deal with lifelong problems of congenital genitourinary diseases. Delays in receiving medical or surgical treatments during transition from childhood to adulthood may be associated with higher need for subsequent surgical interventions in this vulnerable patient population.

The role of surgery in the treatment of neuroblastoma metastases at rare sites

PurposeTreatment of neuroblastoma metastases usually consists of chemotherapy and irradiation. However, in selected cases, surgical treatment is also indicated. In this study, we present three cases of patients with neuroblastoma metastases at rare sites that underwent surgery.Materials and methodsWe retrospectively analyzed data of patients who underwent surgery for neuroblastoma at our department of Pediatric Surgery and Pediatric Urology at the University Children’s Hospital in Tuebingen and selected those patients who had surgery explicitly for a metastasis.ResultsBetween 2002 and 2020, 277 children underwent surgical treatment for neuroblastoma. Three cases with metastases at exceptional sites are presented here after therapy according to protocols. One patient had a penile metastasis and received surgery including a plastic reconstruction. The patient showed no signs of erectile or urinary dysfunction at follow-up. Another patient had a metastasis in the proximal ulna, which remained vital even after exhausted treatment after two relapses. Afterward there was no restriction of movement of the extremity. The third patient had, amongst others, metastases to the pancreatic body and to the liver. Both were surgically removed during primary tumor resection. This patient died after local tumor relapse. The other two patients showed no evidence of tumor relapse after a follow-up of 18 and 17 months, respectively.ConclusionAlthough children with neuroblastoma often present with metastases, there is no recommendation for surgical treatment other than diagnostic biopsies. In case of persistence of metastasis or after exhaustion of high-risk therapy, surgical resection must be considered.

Применение «безнефростомной» перкутанной нефролитотрипсии у детей.

Introduction. Currently, percutaneous renal surgery is a common surgical procedure in urologic practice for the treatment of large and staghorn renal stones. Placement of a nephrostomy tube has been well recognized as a standard procedure to provide hemostasis, adequate drainage, and access for additional endoscopic procedures. At the same time, the use of a nephrostomy tube has negative consequences such as discomfort/pain symptom, longer hospital stay and possible urine extravasation. In view of the above, draining of the access tract raises questions in some cases. The aim of the study was effectiveness of tubeless percutaneous nephrolithotripsy in the treatment of urolithiasis in children. Materials and methods. Between 2013 and 2019, 66 patients (aged 1-17 y/o) underwent tubeless percutaneous nephrolithotomy (PNL) at the Department of Pediatric Urology of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology. Patients were divided into three groups depending on the size of the instruments and the way the operation was completed. The first group (n=28) underwent surgery using the mini-PNL technique with the closure of the access tract. The second group (n=21) underwent surgery using the mini-PNL technique in the end of the surgery, moderate bleeding along the tract was detected in order to stop bleeding, a hemostatic matrix with thrombin was introduced. The third group (n=17) underwent surgery using the standard PNL technique and moderate bleeding was also determined in this group with the aim of tubeless completion, a hemostatic matrix with thrombin was introduced. Drainage of the upper urinary tract in the postoperative period was carried out by "JJ"-internal and "J"-external ureteral stents, which were held for up to 14 days. Results. The complete removal of the calculus in one surgical session was similar in all three groups. In the first group there were 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). In the first group it was 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). The need for additional interventions after surgical treatment was 21.4% in the first group, 23.7% in the second and 17.5% in the third group. Febrile fever (persistent temperature 380 C) most often occurred in the first group – in 10.7% of cases, while in the second and third groups this complication was detected in 4.7% and 5.8% of cases, respectively. Gross hematuria in the postoperative period was noted in the group without the use of a hemostatic matrix, averaging 35 (2-115) hours. Conclusion. The proposed tubeless PNL with the use of a hemostatic matrix is indicated for children without bacteriuria, with complete removal of the calculus, in the absence of trauma of the pelvicalyceal system and intensive bleeding. The duration of gross hematuria decreased with the introduction of the matrix in standard tubeless PNL by 51.4% and in mini-PNL by 25.8% compared with the 1-st group

Clinical profile, diagnosis and treatment of pediatric urolithiasis: a single center experience in Kazakhstan

Objective: The aim of our study to present the results of the clinical profile, diagnosis and treatment of children with urolithiasis in the Pediatric Urology Department of the Scientific center of Pediatria and Pediatric surgery in Almaty, Kazakhstan. Materials and methods: A retrospective data from pediatric patients with urolithiasis admitted from January 2015 to December 2021. The data was obtained from medical records and included those with diagnosis confirmed by imaging and laboratory test, as 24-hour urine exams corrected for creatinine, stone composition. Results: We reviewed 204 children with urolithiasis. The male‐to‐female ratio was 1.34:1. Congenital anomalies of the urinary tract were found in 40 patients (19.6%).Urolithiasis was more common in adolescent girls, whereas in boys the frequency of observation is higher between 11 and 17 years old (p = 0.006). Majority of the patients were from southern regions (51%) in our country. Renal colic, urinary tract infection and macroscopic hematuria were the most common clinical manifestations. Urinary tract infection was diagnosed in 185 patients (90.6%). The most frequent metabolic disorders were hypercalciuria, hyperoxaluria. In 35% of cases there was a metabolic disorder and appropriate therapy was prescribed. In the remaining cases, surgical treatment was used. Conclusion: In this study we presented the prevalence of urolithiasis in the pediatric population in different regions of our country. We identified a high prevalence of infective stone as an etiological factor of pediatric urolithiasis. Clinical symptoms depending on the age and location of the stones. Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 297-304

Posterior Urethral Valve: Factors Affecting the Renal Outcome

Background: Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male children with associated sequlae. Different factors, such as age at presentation, initial and nadir serum creatinine, renal parenchymal echogenicity on initial USG, vesicoureteric reflux (VUR) , recurrent UTI, bladder dysfunction and the presence or absence of pop-off mechanism like VURD have significant impact on ultimate renal outcome. The main aim of the study was to observe the effects of different prognostic factors like age of presentation and preoperative VUR of the PUV respondents on postoperative long term renal outcome as well as changes of renal function status on the basis of initial and postoperative serum creatinine level in our settings. Material Methods: This was a quasi-experimental study and conducted in the Department of Pediatric urology of Bangladesh Shishu Hospital and Institute, Dhaka. We enrolled 58 male children of different ages having posterior urethral valve, who were admitted in the pediatric urology department from July,2018 to Dec,2021. Results: Total 58 patients included in our study. Among all patients 53.4% were aged between 1 month to 1 year, 39.7% of them were more than 1 year old and 6.9% of them were neonates. Among 31 respondents, 32.3 % had poor renal function 35.5 % of them also had moderately impaired renal function. Again, out of 23 respondents, 30.4% had poor renal function 6% had moderately impaired renal function. The relation between age category and postoperative renal function status (On the basis of postoperative eGFR) of the posterior urethral valve respondents were statistically not significant. Patients who had no VUR, 66.7% of them had normal renal function, 25% had moderately impaired renal function and 8.3% had poor renal function. Respondents who had bilateral VUR, 55% of them had poor renal function and 35% had moderately impaired renal function. Among respondents who had unilateral VUR, 28.6% of them had poor renal function and 28.6% had moderately impaired renal function but 42.9% had normal renal function. The relation between preoperative VCUG findings and postoperative long term renal function status of the PUV patients were statistically significant. 7 (100%) respondents who had preoperative abnormal renal function, more than 71.4% of them had returned to normal renal function after operative procedure. But abnormal renal function was present in 2 (28.6%) patients during follow up. In our study we found 29.3% of our patients had poor renal outcome and 29.3% patients had moderately impaired renal function within the mean follow up period of 19.33±12.38 months (ranges from 9months to 4 years). Conclusion: Our research highlights the significance of age at presentation, despite its statistically negligible effect on long-term renal outcomes. However, among the children with PUV following valve ablation and with a long-term follow-up, beginning serum creatinine and the presence of various types of VUR on initial VCUG had a significant effect (p.05) on postoperative renal function on the basis of serum creatinine.

The Outcome of Posterior Urethral Valves among Children in Tertiary Care Hospital–A Prospective Study

Introduction: Posterior Urethral Valve (PUV) is the most common cause of lower urinary tract obstruction in male children. This obstruction in posterior urethra could lead to severe dilatation of upper urinary tract and functional impairment of one or both kidney. The presentations are not always same for all patients. Early diagnosis and appropriate treatment may reduce the progressive damage and helps in recovery. Aim of the Study: The aim of this study was to find out the presentation and to assess the short term functional outcome after fulgaration of the patients with PUV. Methods: This prospective study was conducted at Pediatric urology department, Bangladesh Shishu Hospital and Institute, Dhaka. We included fifty patients with Posterior urethral valve, who were treated at the pediatric urology department from Jan, 2019 to Nov, 2021. Result: Total 50 patients enrolled in the study. In our study we found 50% of our patients were aged between 1 month to 1 year, followed by 36% were more than 1 years old and 14% were less than 1 month old. 76% patients were presented with dribbling of urine. 40%,26%,10% and 6% patients had UTI, poor stream,, retention of urine and palpable bladder respectively. 45 patients had bilateral hydronephrosis ( HDN) at presentation and only 5 had unilateral hydronephrosis in USG. At follow up MCU, 14% patients had unilateral VUR and 10% patients had bilateral VUR. Mean postoperative serum creatinine was 0.585 mg/dl. We found residual Valve in 11(22%) patients during follow up who required repeat Valve ablation. Conclusion: In our study, we found that Cystoscopic valve ablation and follow up is the treatment of choice for PUV patients which may arrest the progressive damage of renal function and facilitate the improvement. Further multicenter study and long term follow up is necessary for understanding the ultimate outcome.

The Effectiveness and Safety of Percutaneous Cystolithotripsy for Vesicle Calculus in Children: A Single-Center Study

Background: Primary bladder stones are common among children from developing countries but may be difficult to cure. Transurethral cystolithotripsy, open cystolithotomy, and shock wave lithotripsy are the treatment modalities for vesical calculi in children. Transurethral lithotripsy is less efficient in children because of the small caliber of the urethra. PCCL is a less intrusive and efficient procedure for removing bladder stones in pediatric patients. Objectives: The objective of the study was to determine the safety and efficacy of PCCL in children with bladder stones in third-world nations. Materials and Methods: There was a search for( PCCL) in pediatric individuals diagnosed with vesical calculus. 90% male and 10% female total of 120 patients enrolled in the single-center trial at the Department of Pediatric Urology at the Institute of Kidney Diseases between January 2021 to January 2022. The surgery was performed under a general anesthetic. After a thorough inspection, a suprapubic puncture of the lower urinary tract (by cystoscopy) was done. The tract was only dilated up to 14 Fr. The stone was fragmented using pneumatic lithotripsy after passing the nephroscope. After 36 hours per urethral catheter was removed. Results: In this study, the mean age of the patients was 4.2.14 years. The majority of patients were kids. The average gem was 9.3 millimeters in diameter. Successful stone fragmentation and retrieval took place in an average of 40 min. The only major problems seen during or after surgery were hematuria, infection, and moderate mucosal injury; all three were managed conservatively. In 108 out of 120 cases (90%), ammonium acid urate was found to be the primary constituent of the stones and the core. Conclusion: The success rate of percutaneous cystolithotripsy in the treatment of bladder stones in children is higher, and it is ready for immediate use. The operation is quick and causes minimal discomfort. Keywords: Effectiveness, Percutaneous , Cystolithotripsy, Vesical Calculus, Children

Editorial Comment.

No AccessJournal of UrologyPediatric Article23 Dec 2022Editorial CommentThis article comments on the following:Dextranomer Endoscopic Injections for the Treatment of Urinary Incontinence in Bladder Exstrophy-epispadias Complex Luke Harper Luke HarperLuke Harper * E-mail Address: [email protected] Department of Pediatric Urology, Hôpital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003086.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. –

Reply by Authors.

No AccessJournal of UrologyAdult Urology1 Dec 2022Reply by Authorsis a reply to letterEditorial CommentEditorial CommentEditorial Comment Pawel Rachubinski, Jorn H. Witt, Lars Budäus, Joerg Zinke, Bernhard Fangmeyer, Tilmann Spieker, Malte Vetterlein, Kambiz Rahbar, Mykyta Kachanov, and Sami-Ramzi Leyh-Bannurah Pawel RachubinskiPawel Rachubinski https://orcid.org/0000-0001-9194-2877 Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany Co–first authors. More articles by this author , Jorn H. WittJorn H. Witt Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany Co–first authors. More articles by this author , Lars BudäusLars Budäus Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany More articles by this author , Joerg ZinkeJoerg Zinke Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany More articles by this author , Bernhard FangmeyerBernhard Fangmeyer Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany More articles by this author , Tilmann SpiekerTilmann Spieker Institute of Pathology, St. Franziskus-Hospital, Muenster, Germany More articles by this author , Malte VetterleinMalte Vetterlein Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany More articles by this author , Kambiz RahbarKambiz Rahbar Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany More articles by this author , Mykyta KachanovMykyta Kachanov Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany More articles by this author , and Sami-Ramzi Leyh-BannurahSami-Ramzi Leyh-Bannurah †Correspondence: Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Möllenweg 22, 48599 Gronau, Germany (telephone:+49-2562 915 2100; FAX:+49-2562 915 2105; email: E-mail Address: [email protected] Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002921.04AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, 208(6), p. 1213

Progressive Coil Penile Tourniquet Syndrome: Single Center Experience with 26 Cases at Department of Pediatric Urology at the Institute of Kidney Diseases MTI Hayatabad Peshawar

Objective: This study was conducted to know the causes of penile tourniquet injury, its complications and awareness about the condition to prevent its devastating outcomes. Methods: this study was completed in five year (2017-2022) at Institute of Kidney Diseases MTI Hayatabad Peshawar. The injuries were graded ‘as described by Bashir and El-Barbary. Results: this study is composed of 26 Patients. . The mean age of patients was noted seven years (6.93years) with range 2.3years to 11years. Human hair was found constricting agent (09 patients). All of the patients were circumcised. In most patients a delay in diagnosis of more than five weeks was noted. Conclusion: Penile tourniquet injury in children can cause devastating range of injuries from mild glans edema to penile amputation. The knowledge of such conditions/injuries can easily diagnose the condition and prevent its complications.

Precision-guidance vs Systematic Sampling: Optimizing Biopsy Assessment of Secondary Prostate Cancer Suspicious Multiparametric Magnetic Resonance Imaging Lesions.

We assessed the diagnostic yield of consecutive transperineal targeted biopsy of multiparametric magnetic resonance imaging index lesion and secondary lesion and additive systematic biopsy in patients who received combined targeted biopsy+systematic biopsy of prostate. Of 1,467 patients with targeted biopsy+systematic biopsy, analyses were restricted to 571 patients with index lesion+secondary lesion, Prostate Imaging-Reporting and Data System score ≥3. Index lesion was defined as having the greatest Prostate Imaging-Reporting and Data System score and/or lesion volume as opposed to secondary lesion. We retrospectively compared clinically significant prostate cancer rates (ie, Gleason Grade Group ≥2) between index lesion+secondary lesion and index lesion+secondary lesion+systematic biopsy. Subgroup analyses in men with ipsilateral index lesion+secondary lesion focused on contralateral systematic biopsy. Multivariable logistic regression analyses to predict any clinically significant prostate cancer included age, previous biopsies, prostate specific antigen density, respective index lesion/secondary lesion volumes, side relation, Prostate Imaging-Reporting and Data System strata, and number of targeted biopsy and systematic biopsy cores. Clinically significant prostate cancer rates for index lesion+secondary lesion vs index lesion+secondary lesion+systematic biopsy were 38% vs 42% (P = .2) at expense of significantly higher median number of biopsy cores (9 vs 25, P < .001). In the subgroup with ipsilateral index lesion+secondary lesion (n = 236), contralateral systematic biopsy detected clinically significant prostate cancer in 17%. In the narrower subgroup with ipsilateral index lesion+secondary lesion (n = 131) without any clinically significant prostate cancer, contralateral systematic biopsy detected clinically significant prostate cancer in 3.8%. Multivariable logistic regression analyses confirmed contralateral systematic biopsy as independent predictor, but performed similarly without systematic biopsy information (area under the curve 87.1% vs 86.6%). Targeted biopsy of secondary lesion should be included in targeted biopsy protocols due to added diagnostic information. However, for targeted biopsy of index lesion+secondary lesion additional systematic biopsy is of limited informative value in terms of overall clinically significant prostate cancer detection. However, when index lesion+secondary lesion are ipsilateral, contralateral systematic biopsy should be recommended for purpose of prostate lobe information. Our results indicate great potential to reduce systematic biopsy cores and associated potential morbidity, and warrant prospective evaluation.