Ureteropelvic Junction Obstruction Group Research Articles

Utility of ultrasound-based scoring system in post-pyeloplasty recovery.

Differentiation of uretero-pelvic junction obstruction (UPJO) from non-obstructive dilatation (NOD) is a major challenge. The aim of this retrospective study is to determine whether pyeloplasty prediction score (PPS) could predict the need for surgery and resolution after surgery. Among patients with antenatally diagnosed hydronephrosis, those who were stable during post-natal follow-up were considered NOD. The UPJO group were the ones who worsened and underwent pyeloplasty based on conventional indications. All patients with UPJO underwent laparoscopic dismembered pyeloplasty. PPS was determined based on three ultrasound parameters obtained retrospectively: Society of Fetal Urology (SFU) grade of hydronephrosis, transverse anteroposterior (APD), and the absolute percentage difference of ipsilateral and contralateral renal lengths. Among 137 patients included (R:L=59:73; M:F 102:35), 96 were conservatively managed (NOD), while 41 patients (29%) needed pyeloplasty (UPJO). Mean PPS was 4.2 (1.2) in the NOD group and it was significantly higher at 10.8 (1.63) in the UPJO group (p=0.001). All patients with PPS>8 needed a pyeloplasty, while two patients with PPS of 7 needed pyeloplasty due to drop in renal function. PPS cutoff value of >8 had a sensitivity 95%, specificity 100% and a likelihood ratio of 20. Post-pyeloplasty PPS resolution was proportional to the duration of follow-up. A PPS cutoff value of 8 or above is associated with the presence of significant UPJO. PPS is also useful in the assessment of hydronephrosis recovery post-pyeloplasty. The limitation of PPS: it can only be applied in the presence of contralateral normal kidney.

Comparison of Urinary Biomarkers in Diagnosis of Ureteropelvic Junction Obstruction and Differentiation from Nonobstructive Dilatation.

Differentiation of nonobstructive dilatation (NOD) from ureteropelvic junction obstruction (UPJO) is a challenge in children with antenatally detected hydronephrosis. The aim of this study is to compare the utility of urinary biomarkers: carbohydrate antigen (CA 19-9), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule (KIM) in diagnosing UPJO. A prospective study was conducted after obtaining ethical clearance between 2021 and 2022. Group 1 - control group (n = 30): children with normal antenatal ultrasound with no urinary symptoms. Group 2 - study group (n = 48): children with unilateral hydronephrosis: Group 2a - NOD (n = 24): children stable on ultrasound and diuretic renogram and Group 2b - UPJO (n = 24): children who worsened to Grade 4 hydronephrosis on ultrasound/worsening of differential renal function (10% drop) on renogram who underwent pyeloplasty. Urinary biomarkers NGAL, KIM-1, and CA 19-9 were measured using the enzyme-linked immune absorbent assay method. The urine CA 19-9 level was 128.05 ± 4.08 U/mL in the UPJO group, and this was significantly higher (P = 0.001) than NOD, 70.29 ± 4.41, and controls, 1.91 ± 1.57. The urine NGAL level was 21.41 ± 4.44 pg/mL in UPJO, and this was significantly higher than controls, 2.669 ± 0.513, but not NOD, 24.55 ± 2.67. The urine KIM level was 817 ± 15.84 pg/mL in the UPJO group, and this was significantly higher than controls, 285 ± 8.10, but not NOD, 768.23 ± 15.12. Receiver operating characteristic analysis of CA 19-9 revealed a urine biomarker cutoff of 95 U/mL for diagnosing UPJO (sensitivity 95%; specificity 96%; and area under the curve 0.99). CA 19-9 is a superior marker compared to NGAL and KIM in differentiating UPJO from NOD. Further studies with larger numbers are warranted.

Expression and clinical implications of PARs in the stenotic tissue of ureteropelvic junction obstruction.

To explore the expression and clinical implications of protease activated receptors (PARs) in the pathogenesis of children with ureteropelvic junction obstruction (UPJO). Immunohistochemistry was employed to investigate the distribution of PARs in both normal human ureteropelvic junction (UPJ) and cases of UPJO. Furthermore, PAR gene expression levels were assessed using real-time PCR (RT-PCR), and the patients in the UPJO group were stratified according to the Onen grading system. Subsequently, the clinical implications of PARs in UPJO were explored through RT-PCR analysis. Immunofluorescence showed robust PAR2 expression in the control group compared with the UPJO group. The results of RT-PCR analysis revealed a significant decrease in the relative mRNA expression of PAR2 in the UPJO group compared to the control group. Notably, the relative RNA expression of PAR1 was significantly lower in the Onen-4 group compared to the control group. Furthermore, the relative mRNA expression of PAR2 exhibited a statistically significant difference among the Onen-3 group, Onen-4 group, and control group. PARs are widely distributed throughout the SIP syncytium of the UPJ and play a role in maintaining smooth muscle cells (SMCs) membrane potential by interacting with interstitial cells of Cajal (ICCs), as well as platelet-derived growth factor receptor alpha-positive cells (PDGFR α+ cells). The decreased expression of PAR1 suggests a higher preoperative Onen grade in UPJO patients. Furthermore, the downregulation of PAR2 effects at the UPJ may be involved in the loss of inhibitory neuromuscular transmission, disrupting the rhythmic peristalsis of the UPJ.

The expression of platelet-derived growth factor receptor alpha-positive cells in the stenotic tissue of ureteropelvic junction obstruction in children .

By observing the expression and distribution of platelet-derived growth factor receptor α-positive (PDGFRα+) cells in ureteropelvic junction obstruction (UPJO), to explore their role in the pathogenesis of children with congenital hydronephrosis. The control group involved specimens of the normal ureter (nephrectomy for tumor; n=10), and the UPJO group contained specimens of ureteropelvic junction (UPJ) segment excised during pyeloplasty (n=30). The specimens were investigated using immunofluorescence for the expression and distribution of PDGFRα+ cells in each group by light microscopy with computerized image analysis. Real-time PCR (RT-PCR) was used to study PDGFRα gene expression levels. In addition, small conductance calcium-activated potassium channel 3 (SK3) and closely associated cells consisting of smooth muscle cells (SMCs), interstitial cells of Cajal (ICCs), and nerve fibers were investigated. PDGFRα+ cells were in close proximity to SMCs, ICCs, and nerve fibers. PDGFRα+ cells expressed SK3 channels, which are found to regulate purinergic inhibitory neurotransmission in SMCs. Regarding the expression of PDGFRα+ cells no significant difference was seen between the two groups, while the expression of SK3 channels in PDGFRα+ cells was significantly decreased in the UPJO group versus the control group. This study identified the expression of PDGFRα+ cells in the human UPJ. Our results demonstrate the expression of SK3 channels in PDGFRα+ cells was decreased in UPJO, and SK3 channels may be involved in the pathogenesis of UPJO by perturbing the UPJ peristalsis.

The role of urinary NGAL and serum cystatin C in assessing the severity of ureteropelvic junction obstruction in infants.

The ideal management of ureteropelvic junction obstruction (UPJO) remains debatable. This prospective case-control study aimed to investigate if urinary levels of Neutrophil Gelatinase-Associated Lipocalin (NGAL) and serum levels of cystatin C could distinguish surgical from non-surgical cases of UPJO and if they could detect earlier impairment of renal function. Biomarkers were measured in the following age-matched groups: (a) 22 infants with surgical UPJO, at initial diagnosis and 12months postoperatively (groups A1 and A2, respectively); (b) 19 infants with non-surgical UPJO (group B); and (c) 17 controls (group C). Based on serum cystatin C levels, estimated glomerular filtration rate (eGFR) was calculated. Urinary NGAL (uNGAL) was significantly higher in group A1 vs. group A2 (p = 0.02) and in group A1 vs. group C (p = 0.03), whereas there was no statistically significant difference between groups A2 and C (p = 0.77). Likewise, cystatin C levels were significantly higher in group A1 vs. group A2 and in group A1 vs. group C (p = 0.004 and p = 0.02, respectively), but no statistically significant difference between groups A2 and C (p = 0.82). uNGAL and serum cystatin C did not differ between groups B and A, nor did they differ between groups B and C. Cystatin C levels and eGFR of group A1 were significantly higher than those of group A2 and group C (p = 0.0001 and p = 0.02, respectively). It seems that NGAL and cystatin C are able to distinguish patients who were treated surgically from healthy controls, and their levels appear to improve significantly following surgery.

Co-Existing Pediatric Ureteropelvic Junction Obstruction and Vesicoureteric Reflux: Prevalence and Implications.

Purpose:The purpose of this study is to ascertain the coexistence of ipsilateral vesicoureteric reflux (VUR) with ureteropelvic junction obstruction (UPJO) and to compare postpyeloplasty outcome in patients with and without associated VUR.Materials and Methods:Prospective study from 2014 to 2016 of consecutive children (n = 135) undergoing pyeloplasty. Data of patients without (Group 1) and with (Group 2) associated ipsilateral VUR were compared.Results:Thirty-five patients (25.9%) had ipsilateral VUR along with UPJO (Group 2). This group showed the following unique features: (1) Higher percentage of infants (31/35) compared to Group 1 (62/100) (P = 0.003) (2) VUR in the contralateral (normal) kidney in 21/35 (60%) cases and nil in Group 1 (3) Significantly less preoperative differential renal function in children above 1 year (P = 0.007) (4) Presence of renal scars (18 units) and pyelonephritic changes (6 units) in Group 2 at the 1-year follow-up dimercaptosuccinic acid renal scan. Both groups showed improvement in function 3 months after pyeloplasty with no statistically significant difference. Improvement in drainage on the renal scan was better in Group 1 at 3 months postoperative (P = 0.015) as well as between 3 months and 1-year follow-up (P = 0.052).Conclusion:The prevalence of VUR was 25.9% in this study and 33.3% in ≤1 year age group. There was a loss of function in delayed presenters with associated ipsilateral VUR. There was delayed drainage postpyeloplasty in patients with VUR. A preoperative voiding cystourethrogram should be done in children <1 year age before pyeloplasty so that associated VUR if detected can be concurrently managed along with pyeloplasty and preserve nephrons affected by the dual pathology.

Urinary carbohydrate antigen 19-9/creatinine ratio: A non-invasive marker for follow-up of unilateral ureteropelvic junction obstruction in children

Ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis in children. One major challenge in the management of UPJO is to select the patients that must be subjected to early obstruction relief. Currently, there is no gold standard for this assessment. Therefore, the aim of the present study was to evaluate the urinary levels of carbohydrate antigen (CA) 19-9 and normalized CA 19-9 (Ca 19-9/Cr ratio) in UPJO patients before and after surgery and compare them with a control group to assess their potential clinical application as an assisting tool in diagnosis of UPJO patients. From Jan 2013 to Jun 2016, 30 children with history of inguinal hernia, circumcision, hydrocele, and undescended testis as the control group (group 1) and 30 children with unilateral congenital UPJO (group 2) were enrolled in the study. Random CA 19-9 and random creatinine were measured in the voided urine samples of control group and proven congenital UPJO group preoperatively (group 2A) and at 6 months after dismembered pyeloplasty (group 2B). In addition, the random urinary CA 19-9/CR ratio was evaluated as a marker to normalized urinary CA 19-9. The urinary CA 19-9/Cr ratio was significantly greater in the UPJO group than in the control group. The urinary CA 19-9 also was more in group 2A than in group 1; however, it was not statistically significant. The urinary CA 19-9/Cr ratio and renal pelvis anteroposterior diameter decreased significantly in the group 2B 6 month after complete relief of obstruction in comparison with group 2A preoperatively. Urinary CA 19-9 also decreased in 2B group though it was not significant. Urinary CA 19-9/Cr ratio is suggested as a non-invasive marker that can assist in diagnosis and long-term follow-up of UPJO patients. This ratio is superior to urinary CA 19-9 as it is more strongly correlated with UPJ obstruction.

Acoustic radiation force impulse (ARFI) elastography in the evaluation of renal parenchymal stiffness in patients with ureteropelvic junction obstruction.

To investigate the role of acoustic radiation force impulse (ARFI) elastography in the detection of renal parenchymal damage in kidneys with and without ureteropelvic junction obstruction (UPJO). Twenty-five pediatric patients with a diagnosis of UPJO who underwent surgery and 15 pediatric patients with conservatively managed UPJO were prospectively evaluated with ARFI elastography. Sixteen healthy volunteers constituted the control group. Shear wave velocity (SWV) measurements in the upper, mid, and lower poles of the affected kidney were performed. SWV values of kidneys based on presence of UPJO and hydronephrosis grade were compared. The correlation of SWV values with residual renal function obtained from diethylenetriaminepentaacetic acid or mercaptoacetyltriglycine-3 renal scan was evaluated. Significantly, higher SWV values were found in control kidneys compared to kidneys affected by UPJO. The median SWVs were 2.82 (2.51-3.07) m/s for the control kidneys and 2.36 (2.09-2.53) m/s for the kidneys in the UPJO group (p<0.001). When UPJO patients were grouped according to the grade of hydronephrosis, grade 0 hydronephrotic kidneys [2.35 (2.11-2.50) m/s] and grade 3-4 hydronephrotic kidneys [1.86 (1.96-2.25) m/s] had significantly lower SWV values compared to grade 1-2 hydronephrotic kidneys [2.62 (2.37-2.90) m/s] (p<0.05). ARFI as a noninvasive, radiation-free procedure for evaluating parenchymal stiffness may prove useful in the diagnostic work-up and follow-up of children with UPJO-induced renal disease.

The effect of alfuzosin on renal resistive index, urinary electrolytes and β2 microglobulin levels and TGF β-1 levels of kidney tissue in rats with unilateral ureteropelvic junction obstruction

Background: In this study, it was aimed to determine the effects of alfuzosin on experimentally generated unilateral partial ureteropelvic junction obstruction (UPO) in rats.Materials and methods: Thirty Long–Evans rats were randomly allocated into five groups. In control group (C), nothing was performed; in group Sham (S) only laparotomy was done; in Alfuzosin group (A) only alfuzosin was administered for two weeks (10 mg/kg/day p.o.) without any surgery; in UPO group, unilateral UP junction obstruction was produced; and in the Group UPT (ureteropelvic obstruction + treatment), alfuzosin was administered for two weeks (10 mg/kg/day p.o.) in addition to UPO production. Renal pelvic anteroposterior diameters were determined with ultrasonography (USG) and renal arterial resistivity indexes by color Doppler USG. Urine was collected both at the beginning and at the end of the experiment for 24 h in all the groups and at the end of the experiment, blood samples were obtained. Blood and urine electrolytes and TGF-β1, urine density, urine β2 microglobulin levels were determined. Renal tissue samples harvested from all of the rats were histopathologically evaluated. Results were determined using one-way ANOVA t-test; p < 0.05 was accepted as significant.Results: Urine density in the UPT group was lower with respect to UPO group and blood electrolytes were preserved as close to normal (p < 0.05). In the UPT group, urine TGF-β1 and blood TGF-β1, blood β2 microglobulin levels and histopathologic damage scores were lower compared to the UPO group (p < 0.05).Conclusion: It is shown in this experimental unilateral partial UPO model that alfuzosin treatment prevents obstructive renal damage.

Changes in Cajal cell density in ureteropelvic junction obstruction in children

Congenital ureteropelvic junction obstruction is one the most common causes of neonatal hydronephrosis. The etiology of the ureteropelvic junction (UPJ) obstruction has not been clearly established. The presence of a hypoplastic, adynamic ureteral segment is thought to be the major cause of an UPJ obstruction. We evaluated the distribution of Cajal cells using immunohistologic methods coupled with light microscopy of the UPJ tissues in obstructed and normal UPJs. The study group consisted of 19 patients who underwent pyeloplasty for UPJ obstruction. Twelve patients who had been operated on for oncological indications constituted the control group. The sections were stained immunohistochemically using CD117 (c-kit) antibody; the numbers of CD117 (+) interstitial cells of Cajal were counted in 10 consecutive high-power fields under the light microscope and the cell density was determined for each case. The mean age of the cases who underwent dismembered pyeloplasty and the control group were 116 ± 116 months (14 male, 5 female; 6-420 months) and 279 ± 312 months (9 male, 3 female; 24-948 months) (p = 0.1), respectively. The mean interstitial Cajal cell number in the UPJ obstruction and the control groups were 2.37 ± 2.19 and 24.5 ± 9.73, respectively (p < 0.0001). Thirteen (68.4%) patients had very few, five (26.3%) patients had few, and one (5.3%) patient had many Cajal cells in the UPJ obstruction group. In the control group, all patients had more than seven cells per high-power field. We found that in cases of UPJ, obstruction the numbers of interstitial Cajal cells were decreased, being either absent or significantly reduced. Although data about the motility are currently not sufficient, the decrease in the number of Cajal cells in patients with UPJ highlights that they might be responsible for the initiation, coordination, and conduction of peristaltic activity along the pelvicalyceal system. Improvement and enhancement of contraction waves arising from the upper urinary system depend on interstitial cells of Cajal, which are the pacemaker cells in smooth muscles. We think that a decreased number of interstitial cells of Cajal have a close relationship with changing ureteral motility when we compare our UPJ obstruction cases with the limited data in the literature. Further investigations on these cells will probably give detailed information about the neurophysiology of the urinary system and the diseases that cause congenital hydronephrosis.

Ureter, the Guardian Angel of Nephron: The Impact of Pelvicalyceal System on Apoptotic Activity in an Experimental Obstructive Uropathy Model

Objective: We aimed to assess the impact of obstructive uropathy and its revision on renal apoptotic and inflammatory activity in an experimental model in rabbits. Methods: Twenty-four rabbits were separated into four different groups. Ureteropelvic junction (UPJ) obstruction model was performed in Group 1 and 2. Ureterovesical junction (UVJ) obstruction model was performed in Group 3 and 4. Thirty days after the operations, bilateral nephrectomy was performed in Group 1 and 3. Thirty days after the initial surgery, the obstruction was revised in Group 2 and 4. Thirty days after the revision surgeries, bilateral nephrectomy was performed in Group 2 and 4. The apoptotic and inflammatory activity was measured at the protein level and nephrectomy specimens were examined histologically. Results: Caspase 3 levels were significantly higher in operated left kidneys than the levels obtained in the right counterparts. The increase in procaspase 9 and caspase 3 activities in the UVJ obstruction group was less than those of the UPJ obstruction group (p 0.05, p>0.05, respectively). Conclusion: The rabbits with a UVJ obstruction had lower apoptotic indexes as compared to those with a UPJ obstruction. The apoptotic activity decreased to almost normal levels following an adequate revision of the obstruction in both groups, but this improvement was more significant in animals with a UVJ obstruction.

Association of urinary transforming growth factor-β1 with the ureteropelvic junction obstruction.

Background:We aimed to compare the level of urinary transforming growth factor-beta 1 (TGF-β1) in children with ureteropelvic junction obstruction (UPJO) with the normal peers.Materials and Methods:In this case-control study, we enrolled children with UPJO and matched normal peers. Sterile urine was collected from the subjects and urinary TGF-β1 was measured by ELISA method. Also, degree of the UPJO and the magnitude of the renal injury were assessed by ultrasonography and measuring glomerular filtration rate (GFR), respectively. Study variables were then compared between the study groups regarding the level of urinary TGF-β1.Results:A total of 25 children with UPJO (age = 7.4 ± 4.5 years; male = 16) were compared with 25 healthy peers (age = 6.8 ± 5.6 years; male = 16). Mean GFR in the UPJO and the control group were 112.4 ± 10.1 and 123.29 ± 4.4, respectively. Mean urinary TGF-β1 in the UPJO group was 87.1 ± 12.6 pg/ml vs 30.5 ± 14.5 pg/ml in the control group. The level of urinary TGF-β1 was significantly associated with the degree of TGF-β1 and patients with grade IV hydronephrosis had the highest level of urinary TGF-β (P = 0.0001).Conclusion:Based on our findings, biomarkers such as TGF-β1 can successfully be used for confirming UPJO. However, further studies are needed to determine the proper cut point for diagnosis confirmation.

Urinary Proteome Analysis in Patients With Stable SFU Grade 4 Ureteropelvic Junction Obstruction Differs From Normal

To evaluate and analyze the urinary proteome in infants with stable grade 4 ureteropelvic junction obstruction (UPJO) and compare to age-matched normal controls. Bladder urine specimens were obtained from 21 healthy infants with normal maternal/fetal ultrasound and 25 infants with grade 4 unilateral UPJO. All patients had >40% ipsilateral individual kidney function by renal scanning and the anteroposterior (AP) diameter of the hydronephrotic kidney ranged from 1.6-3.9 cms at presentation. Over a 5-year follow-up period, the disease progressed in 7 infants (28%), resolved in 4 (16%), and remains stable in the majority (56%). The urinary specimens were prepared using standard methods and subjected to LC/MS/MS analysis. The normalized data were annotated utilizing the Ingenuity Pathways Analysis (IPA; www.Ingenuity.com) knowledge platform. In the stable UPJO group, the urinary proteomes obtained in infancy differed significantly from the age-matched controls. Analysis revealed important differences in a number of biologic functions including inflammation, apoptosis, tubular injury and fibrosis, and reactive oxygen species response. The urinary proteomes from the bladder in patients with stable grade 4 UPJO (by imaging criteria) are significantly different at birth and during the first year of life and seem to indicate the presence of an ongoing active renal response to UPJO. The imminent discovery of surrogate urinary biomarkers may result in reconsideration of the watchful waiting strategy during this critical period of renal maturation and development in infancy.

455 ANALYSIS OF THE WHOLE URINARY PROTEOME OF STABLE INFANTS WITH GRADE 4 URETEROPELVIC JUNCTION OBSTRUCTION: A FORGOTTEN MAJORITY

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Kidney & Ureter1 Apr 2011455 ANALYSIS OF THE WHOLE URINARY PROTEOME OF STABLE INFANTS WITH GRADE 4 URETEROPELVIC JUNCTION OBSTRUCTION: A FORGOTTEN MAJORITY Hrair-George Mesrobian, Michael Mitchell, Travis Groth, William See, Brian Halligan, Shama Mirza, and Bassam Wakim Hrair-George MesrobianHrair-George Mesrobian Milwaukee, WI More articles by this author , Michael MitchellMichael Mitchell Milwaukee, WI More articles by this author , Travis GrothTravis Groth Milwaukee, WI More articles by this author , William SeeWilliam See Milwaukee, WI More articles by this author , Brian HalliganBrian Halligan Milwaukee, WI More articles by this author , Shama MirzaShama Mirza Milwaukee, WI More articles by this author , and Bassam WakimBassam Wakim Milwaukee, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.547AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The management of newborns and infants with unilateral grade 4 ureteropelvic junction obstruction (UPJO) is dictated by its natural history as it unfolds over time. Attention has focused appropriately over progression, which can be observed in approximately 30%, and these patients clearly benefit from surgery. In another 10–30%, there is spontaneous resolution. In the remaining patients, management is in question and indefinite follow up is required because of the inability of current technology to predict outcomes. This communication reports the results of urinary proteome analysis in this latter patient population, the forgotten majority. METHODS Bladder urine specimens were obtained from 21 healthy infants-with normal maternal/fetal ultrasound- and 25 with grade 4 unilateral UPJO. All patients had > 40% ipsilateral individual kidney function by renal scanning and the antero-posterior diameter of the hydronephrotic kidney ranged from 1.6–3.9 cms at presentation. Over a 3 year follow up period, the disease progressed in 5 (20%) and resolved in 1 (4%) and remains stable in the majority (76%). All urinary specimens were prepared using standard methods and subjected to LC/MS/MS analysis. The normalized data were annotated utilizing the Ingenuity Pathways Analysis knowledge platform (IPA; www.Ingenuity. com)and compared to age matched normals. RESULTS In the stable UPJO group (76%), 35 and 47 candidate biomarker proteins were respectively identified by comparing the urinary proteomes to age matched controls (1–6 and 7–12 months). More importantly, a number of essential biologic functions were perturbed (Fig 1l72 illustration for 1–6 months age group). In addition, analysis uncovered production of reactive oxygen species, most prominent in the 7–12 months age group. CONCLUSIONS The urinary proteomes from the bladder in patients with stable grade 4 UPJO (by imaging criteria) are significantly perturbed at birth and appear to undergo change-relative to normal- throughout the first year of life. The imminent discovery of surrogate urinary biomarkers may result in reconsideration of the watchful waiting strategy during this critical period of renal maturation and development in infancy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e185 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hrair-George Mesrobian Milwaukee, WI More articles by this author Michael Mitchell Milwaukee, WI More articles by this author Travis Groth Milwaukee, WI More articles by this author William See Milwaukee, WI More articles by this author Brian Halligan Milwaukee, WI More articles by this author Shama Mirza Milwaukee, WI More articles by this author Bassam Wakim Milwaukee, WI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of the application of retroperitoneal laparoscopy and open surgery in ureteropelvic junction obstruction

Objective To review and analyze the application of retroperitoneal laparoscopy and open surgery in ureteropelvic junction obstruction, sum up clinical expeirence, and improve the skills of retropeirtoneal laparoscopic surgery. Methods Retroperitoneal laparoscopic surgery was carired out in 22 csaes of ureteropelvic junction obstruction(retroperitoneal laparoscopy group). Open surgery was carried out in 21 cases(Open surgery group). The two groups were compared in operation time, blood loss postoperative discharge time and postoperative hospital stay respectively. Results Ureteropelvic junction obstruction group was significantly less than open surgery group in intraoperative bleeding time,postoperative bleeding time and average length of stay. Operation time in ureteropelvic junction obstruction group was slightly longer than that in open surgery group [(32.0 ± 10.0) ml vs (70.0 ± 11.9) ml, (31.0 ±5.7)h vs(52.0 ±6.9)h,(7.0 ± 1.6) d vs(14.0 ± 1.4) d, (113.0 ±7.6) min vs(72.0 ± 6.8) min] (t = 7.06,8. 14,11.37,11.36, all P ＜ 0.05). Conclusions Retroperitoneal laparoscopic technology was in the treatment of ureteropelvic junction obstruction for its direct way, had non interference and pollution to laparoscopic internal organs,less damage,less pain, rapid recovery and short hospitla stay. With on going training and constantly updating technical skills and equipments, retroperitoneal laparoscopic technology will shotren the operation time, and will substitute open surgery. Key words: Ureteral obstruction; Laparoscopy; Retroperitoneal space

Holmium Laser Ureteroscopic Treatment of Various Pathologic Features in Pediatrics

To assess the outcome of pediatric patients treated by ureteroscopy for various pathologic findings. A total of 31 children (median age 5 years, range 0.3 to 14) were ureteroscopically treated for ureteropelvic junction obstruction (UPJO) (n = 6, 1 primary and 5 secondary), ureteral strictures (n = 4), and calculi (n = 21). Miniscopes with a holmium laser were used for lithotripsy and ureterotomy. The average age in the UPJO group was 1.8 years (range 0.3 to 4), the operative time was 40 minutes (range 30 to 50), and the hospitalization was 1.2 days (range 1 to 2). A successful clinical and functional outcome was maintained after an average follow-up of 16 months (range 8 to 30). The 4 cases of ureteral stricture included two located in the middle ureter and two at the ureterovesical junction. No failures had occurred in this group after an average follow-up of 25 months (range 8 to 40). The calculi cases comprised 10 lower ureteral, 2 upper ureteral, and 9 renal stones, with an average stone burden of 11 mm (range 5 to 20). Three patients (14%) underwent preoperative stenting. Two patients (10%) required ureteral orifice dilation. Postoperatively, 4 patients (18%) had a ureteral catheter left in place, 15 (71%) had an internal stent with an externalized string, and 2 (10%) did not require drainage. The average operative time was 39 minutes (range 15 to 90), and the hospitalization was 1 day (range 0.5 to 2). All patients were rendered stone free. The results of our study have shown that the ureteroscopic approach in children with UPJO, ureteral strictures, and urinary calculi is safe and highly effective. Routine preoperative stenting and intraoperative ureteral dilation are not necessary. Stents with external strings were well tolerated and easily removed without anesthesia.

The utility of fetal renal pelvis dilation in distinguishing between obstructive and nonobstructive postnatal hydronephrosis

BETWEEN OBSTRUCTIVE AND NONOBSTRUCTIVE POSTNATAL HYDRONEPHROSIS JEFFREY M. DICKE, DOUGLAS COPLEN, Washington University in St. Louis, Obstetrics & Gynecology, St. Louis, MO OBJECTIVE: To determine the efficacy of current thresholds for fetal renal pelvis dilation (RPD) in identifying significant postnatal urinary tract obstruction. STUDY DESIGN: A retrospective analysis of prospectively collected measurements of fetal RPD. The entire study population consists of 287 fetuses who underwent ultrasound (U/S) examination in the Department of Obstetrics and Gynecology with isolated RPD of $4 mm at 33 wks and known postnatal follow-up at St. Louis Children’s Hospital. All cases had postnatal U/S and evaluation by Ped Urology. RESULTS: Postnatal diagnoses included nonobstructive hydronephrosis (NOH) (40%), ureteropelvic junction obstruction (UPJO) (19%), megaureter (9%), reflux (7%),multicystic dysplastic kidney (7%), ureterocele (7%), normal (NL) (5%), and other (7%). One-way ANOVA indicated no difference in fetuses with normal postnatal ultrasound and those with NOH, defined as RPD that resolved or did not progress and did not require surgery. Receiver operating characteristic (ROC) analysis was performed comparing the maximum RPD in the NL/NOH (n = 128) group and the UPJO group (n = 53). ROC analysis revealed that the renal pelvis diameter that correctly classified the highest percentage (85%) of fetuses with respect to obstructive or nonobstructive postnatal hydronephrosis was 17 mm, with a sensitivity of 70% and specificity of 91%. Area under the ROC curve equals 0.859 with a standard error of 0.032 and a 95% confidence interval of 0.795 to 0.923. CONCLUSION: The current threshold for fetal pathologic RPD utilized at this institution was devised to ensure 100% sensitivity with less regard for specificity. When fetal RPD is associated with 100% sensitivity for detection of postnatal obstructive hydronephrosis, the false-positive rate is >90%. If maximum sensitivity is desired, consideration should be given to a single postnatal U/S rather than serial prenatal U/Ss in cases of mild ( < 10 mm) RPD.

Ureteropelvic junction obstruction and coexisting renal calculi in children: role of metabolic abnormalities

Objectives. To identify the role of metabolic risk factors in the development of renal calculi associated with ureteropelvic junction obstruction (UPJO) in children. Methods. A metabolic evaluation, including serum biochemistry and measurement of daily urinary calcium, creatinine, oxalate, citrate, magnesium, urate, and inorganic phosphorus, was carried out in three different populations as follows: UPJO group, 12 children with UPJO and coexisting nephrolithiasis (median age 6 years); calcium stone formation (CSF) group, 90 children with normal urologic anatomy and calcium urolithiasis (median age 7 years); control group, 24 healthy children (median age 7.3 years). The investigation data of the three groups were compared. Results. The stone composition was calcium oxalate in 9 of the 12 children with UPJO. The investigation data of the UPJO group and CSF group were not significantly different. Both groups differed from the control group in a similar manner. The UPJO and CSF groups excreted more oxalate ( P = 0.067 and 0.014, respectively) and less citrate ( P = 0.020 and 0.010, respectively) than did the control subjects. Conclusions. Abnormal urinary biochemistry seems to have an additional role in the high incidence of nephrolithiasis in children with upper tract anatomic anomalies, and the urinary biochemistry should be screened in such children.

Urine levels of transforming growth factor-beta 1 in children with ureteropelvic junction obstruction

Objectives To determine if there are measurable quantities of transforming growth factor-beta 1 (TGF- β1) in the urine of children with either normal or pathologic conditions of the urinary tract, specifically vesicoureteral reflux (VUR) and ureteropelvic junction obstruction (UPJO). We also sought to determine if the urine TGF- β level could distinguish between renal obstruction and no obstruction. Methods Preoperative bladder urine from consecutive patients undergoing pyeloplasty (UPJO group; n = 13), ureteral reimplantation (VUR group; n = 11), or circumcision/orchiopexy (control group; n = 19) as well as urine from the renal pelvis of the UPJO group was collected. The urine level of TGF- β1 was measured using a quantitative sandwich enzyme immunoassay technique. Results Urine level of TGF- β1 was detected in each group: control (26.6 ± 6.3 pg/mL), reflux (22.1 ± 9.6), UPJO-pelvic urine (82.4 ± 19.3), UPJO-bladder urine (31.2 ± 8.2). The urine TGF- β1 concentration in pelvic urine in the UPJO group was significantly higher than that in bladder urine in children in the UPJO group ( P = 0.03). TGF- β1 concentrations were similar from the bladder of children in all three study groups ( P = NS). Conclusions Urine TGF- β1 is detectable in children with normal and pathologic urinary tracts. The level of this urine marker is elevated in the renal pelvis of children with UPJO compared to the level in the bladder of either obstructed or nonobstructed upper urinary tracts.

Stratégie diagnostique postnatale des uropathies malformatives dépistées avant la naissance

Background. — The increasing experience with prenatal ultrasonographic diagnosis allows detection of more and more mild urinary tract anomalies. Thus, the clinical significance of many pyelectasis detected before birth is not known. Patients and methods. — From a retrospective study of 78 patients, we determined the positive predictive value (PPV) of prenatal ultrasound findings for urinary tract malformations. Results. — This PPV was 27.3% when the prenatal pelvic dilatation was isolated, but grew up to 100% if a caliceal dilatation was associated. Renal pelvic diameter in the third trimester of pregnancy could predict the degree of post-natal renal impairment, as pelvic size was 6.7 ± 2.15 mm for the post-natal pyelectasis group, significatively smaller than 13.4 ± 3 mm in the ureteropelvic junction obstruction group (grade I) and than 17 ± 9 mm in other pathological renal units. On the other hand, antenatal ultrasound had a bad sensibility for vesico-ureteral reflux detection, four primary reflux among 14 being detected without homolateral antenatal ultrasound anomaly. Conclusion. — According these results, we propose a post-natal diagnostic strategy. Urological explorations are performed when the prenatal renal pelvic diameter is larger than 10 mm. If the postnatal ultrasound shows an isolated pyelectasis below this level, a clinical follow-up is advised, the parents being informed of the possibility of vesico-ureteral reflux and of the necessity to perform a cytobacteriological exam of urines in case of unexplained fever.