Urinary Ultrasonography Research Articles

Long-Term Follow-up Results of Children with Urolithiasis Followed in Our Clinic

Title and Objective: Urolithiasis is a prevalent condition frequently observed in childhood within the Turkish population. The aim of this study was to evaluate the metabolic, radiological, and clinical features of pediatric patients with urolithiasis. Materials and Methods: Records of 158 children referred to the Pediatric Nephrology Department of Celal Bayar University between 2010 and 2020 with suspected urolithiasis and microlithiasis were retrospectively reviewed. The complaints and ages of the cases during hospital admission, their medical histories, and the location of the stones were determined. All patients underwent complete urine analysis, spot urine electrolytes, urine culture, serum electrolytes, kidney function tests, uric acid, albumin measurements, and urinary ultrasonography. 24-hour urine electrolytes were studied in patients capable of urine collection. Stone analysis using X-ray diffraction was performed on patients from whom stones were obtained. Results: Out of the individuals, 88 (55.7%) were male, and 70 (44.3%) were female, resulting in a male-to-female ratio of 1.25:1. The average age at the time of diagnosis was determined to be 89.82 ± 57.35 months. A family history of urolithiasis was reported in 108 (68.3%) patients, and 46 individuals (29%) were born from consanguineous marriages. At the time of diagnosis, 32 patients (20%) had a urinary tract infection. Stones were predominantly situated in the upper urinary system in 129 patients (81.6%), with 123 (77.8%) having unilateral stones and 35 (22.2%) having bilateral stones. Calcium oxalate stones were the most commonly observed (80%) in patients who underwent stone analysis. Hypercalciuria emerged as the most frequently identified urinary metabolic risk factor. At the end of the follow-up period, 14 patients experienced a recurrence, while 67 patients remained free of stones. Conclusion: Urolithiasis continues to be a significant concern among children in our nation. Due to the higher recurrence rate and more frequent underlying metabolic disorders in children with stone diseases compared to adults, metabolic assessment and stone analysis are recommended procedures, emphasizing the need for lifelong monitoring in these cases.

Hybrid laparoscopic ureteral reimplantation for the treatment of primary vesicoureteral reflux and obstructive megaureter

Laparoscopic ureteral reimplantation has gained increasing popularity in treating pediatric primary vesicoureteral reflux (VUR) and obstructive megaureter (OM). However, it is technically challenging with a relatively low success rate compared to open surgery. Here we designed a hybrid technique which incorporates laparoscopic surgery and pneumovesical ureteral reimplantation. From 2023 February to 2024 February, five boys and four girls underwent the hybrid reimplantation smoothly. There were seven children with VUR and two with OM. Patient age ranged from eight months to ten years. The mean time was 201.5min (range 155-240min) for unilateral operation and 260min for bilateral operation. Follow-up ranged from 6.4 to 18.7 months. All patients remained asymptomatic, with voiding cystourethrogram showing cure or urinary ultrasonography showing significant improvement. In conclusion, the hybrid laparoscopic ureteral reimplantation appeared to be a simple and effective minimally invasive surgery for treating primary VUR and OM in children.

Factors affecting the need for ureteral catheterization in symptomatic pregnancy hydronephrosis.

In our study, considering the clinical parameters we aimed to determine the most appropriate treatment approach for symptomatic gestational hydronephrosis and conditions requiring DJS insertion. Our study was a retrospective cross-sectional study and 137 patients were included. The patients were divided into two groups: those with conservative follow-up and those with DJS. Demographic and clinical data, the degree of HUN detected in urinary ultrasonography and the anteroposterior diameter of the renal pelvis were evaluated. Factors affecting the need for DJS between groups were investigated. Also, it was aimed to determine the cut-off value for the HUN degree and renal pelvis AP diameter in patients with DJS. The presence of urinary system stones was statistically significantly higher in the group with DJS than in the group without DJS (p = 0.014). HUN degrees and AP diameter were statistically significantly higher in the DJS group (p < 0.001, p < 0.001, respectively). HUN degree and renal pelvis AP diameter were the two most important predictors for DJS insertion (p = 0.005, p = 0.015, respectively). The AP diameter cut-off value for DJS installation was determined as 20.5mm. Although there are conservative and surgical treatment options for symptomatic hydronephrosis of pregnancy, the factors at the decision point between these options are still a matter of debate. In our study, we concluded that the most important determinants at this decision point are the HUN degree and renal pelvis AP diameter. We think that the cut-off values we have determined for these markers will guide clinicians in deciding on treatment.

O-12 A rare cause of parathyroid hormone independent hypercalcemia: 1,25-(OH)2D-24 Hydroxylase (CYP24A1) deficiency

Abstract Background Common causes of parathyroid hormon (PTH)-independent hypercalcemia in adulthood are malignancy, granulomatous diseases, and endocrinopathies. Loss-of-function mutations of CYP24A1 gene, encoding for 1,25-dihydroxyvitamin D3 24-hydroxylase, can also be a rare cause of supressed intact PTH levels, usually associated with, nephrolithiasis and nephrocalcinosis. This disease, defined as idiopathic infantile hypercalcemia, classically presents with hypercalcemia in infants. However, some individuals have also been reported with late-onset clinical manifestation or late diagnosis in adulthood. Clinical Case A 59-year-old male patient with a known diagnosis of type 2 diabetes mellitus for 30 years. He had a history of recurrent kidney stones since 2006. His blood and urine tests revealed elevated creatinine level, hypercalcemia with normal phosphorus levels, normal 25-hydroxycholecalciferol levels, suppressed intact PTH level and normal 24-hour urinary calcium level (Table 1). Urinary ultrasonography was consisted with medullary nephrocalcinosis and chronic kidney disease. PTH-independent causes of hypercalcemia were investigated. Malignancies, granulomatous diseases and endocrinopathies were ruled out. The 1,25-dihydroxycholecalciferol level was within the normal range. Parathormone related peptide level was determined as 1.60 pmol/L (normal value &amp;lt;4.2). Genetic workup revealed a homozygous loss-of-function mutation p.E143del in the CYP24A1 gene. Thereupon, genetic screening started on the siblings of the patient which not been finalized yet. However, none of them were found to have hypercalcemia in the laboratory evaluation. Treatment was started with low-dose fluconazole, which inhibits enzymes (including 25-hydroxylases and 1-α-hydroxylase) synthesizing vitamin D. After a month of treatment at a dose of 50 mg/day, no change was observed in the patient's calcium values. Follow-up with calcium-restricted diet and adequate oral hydration therapy was planned. Conclusion Idiopathic infantile hypercalcemia may manifest later or diagnosed later in adulthood. Genetic examination should be considered in adult patients in whom other causes of PTH-independent hypercalcemia have been excluded.Table 1.Patient's laboratory parameters

P-18 Dent's Disease as a rare cause of rickets

Abstract Introduction Dent's disease is a rare recessive X-linked disorder characterized by hypophosphatemia, hematuria, proteinuria, hypercalciuria, nephrocalcinosis, and progressive renal failure. The majority of cases are caused by mutations in the CLCN5 or OCRL genes. The primary mechanisms of rickets in Dent's disease are a deficiency in phosphate absorption in the proximal tubules of the kidney and an increase in urinary calcium excretion. In order to draw attention to this rare disease, we present a patient diagnosed with Dent's disease while being evaluated for hypophosphatemic rickets. Clinical Case A 23-year-old male patient with Dent's disease was referred to an adult endocrinology clinic for follow-up after a CLCN5 mutation was identified during an examination for hypophosphatemic rickets and proteinuria at the age of three. Since the age of 18, he has been diagnosed with chronic kidney disease. At the age of 19, he has a history of hospitalization for osteomyelitis. No history of fracture. In his family history, both of his parents were cousins, that have short stature and Dent's disease mutation was found to be heterozygous. Both cousins had hypophosphatemic rickets diagnosis. On physical examination, he was mobile, 155 cm tall, weighed 55 kilograms, had bilateral genu valgum, and other system examinations revealed no pathology. The patient was taking 500 mg of phosphate three times per day in addition to 0.5 microgram of calcitriol. In laboratory evaluation, creatinine was 3.11 mg/ dL, GFR was 26 ml/min, PTH was 118 pg/mL, ALP was 82 IU/ml, phosphorus was 3.44 mg/ dL, and calcium was 10 mg/dL. 24-hour urine calcium: 195 mg/day; osteocalcin: 188 ng/mL; beta-crosslaps: 2 ng/mL. It was determined to be high-turnover chronic kidney disease-bone disorder. Urinary ultrasonography showed bilateral kidney diameters decreased and parenchymal thickness thinned, bilateral kidney echoes increased, and bilateral medullary nephrocalcinosis with high echogenicity and calcifications. Cataract and basal ganglia calcification were not detected. Dual Energy X-Ray Absorbsiometry evaluation revealed that the L1-L4 BMD: 0.915 gr/cm2 Z score: -1.1 and the femoral neck BMD: 0.614 gr/cm2 Z score: -3.1 were lower than anticipated for age. The patient's calcitriol dosage was reduced to three times per week after PTH suppression. Since the serum ALP concentration was normal, the oral phosphorus dose was not altered. A limited sodium diet was suggested for the patient. The patient with bilateral nephrocalcinosis was referred to the nephrology clinic for further evaluation. Conclusion Patients diagnosed with rickets should also be mindful of Dent's disease, which must be closely monitored alongside nephrology.Figure 1.Bilateral knee radiograph of the patient

Voiding Cystourethrogram Before Pyeloplasty: To Do or Not To Do?

To assess the incidence of concomitant vesicoureteral reflux (VUR) in unilateral cases of ureteropelvic junction obstruction(UPJO) and to identify factors that predict VUR. Files of 381 pediatric patients who underwent unilateral pyeloplasty between 2000 and 2017 were retrospectively reviewed.A total of 270 patients with available data and ≥5 years of follow-up were eligible for this study.Demographic parameters,preoperative hydronephrosis grade,renal pelvis anteroposterior diameter(APD),renal parenchymal thickness(PT),split renal functions on MAG-3 scan and VUR status were noted.The patients were divided into two groups:Those with concomitant VUR(Group I, n:24, 8.9%) and those without VUR(Group II,n:246, 91.1%). Among 270 patients(205 boys,75.9%) with a median age of 4 months(2-98),197 (72.9%)had antenatal hydronephrosis.Median follow-up was 11 years(5-22).Among 24 patients with concurrent VUR,6(25%) had Grade II VUR,whereas Grade III-V VUR was detected in 18(75%).Of these,12(50%) had ipsilateral VUR,3(12.5%) had contralateral,and 9(37.5%) had bilateral VUR.In a median 137-month follow-up,spontaneous VUR resolution was observed in 6(25%) patients,whereas 15 (62.5%) patients underwent endoscopic subureteral injection and 3(12.5%) patients ureteroneocystostomy,respectively.Preoperative APD[35.5, IQR(27.6-36.0) vs. 26.5 IQR(25.0-35.0), p=0.004] were significantly higher in Group I,whereas Group I had significantly lower PT[3.7, IQR(3.4-6.4) vs. 5.8 IQR(4.4-6.1), p=0.026].Predictive factors for concomitant VUR were presentation with febrile UTI(OR:2.769,p=0.048), PT<3.95 mm(OR:1.367,p=0.043),and APD>28.8 mm (OR:1.035,p=0.001). Our results indicated that concomitant VUR and UPJO might be detected in 1 out of every 11 patients undergoing pyeloplasty,while some type of surgical intervention for VUR was required in 75% of these patients.Thus,VCUG prior to pyeloplasty may be limited in those presenting with febrile UTI,having higher APD and lower PT on preoperative urinary ultrasonography.

Effect of Multidisciplinary Assessment on Paediatric Patients with Monosymptomatic Nocturnal Enuresis.

This study aimed to investigate the effect of multidisciplinary assessment in paediatric patients with monosymptomatic nocturnal enuresis (MNE). From July 2018 to June 2021, 242 patients with enuresis who received diagnosis and treatment in our hospital were retrospectively enrolled. They were divided into the multidisciplinary assessment group (n = 130) and routine assessment group (n = 112). Multidisciplinary assessments were completed by a multidisciplinary team, and the data included structured medical history, physical and neurological examinations, bladder and bowel diaries, sleep diaries, questionnaires, psychological assessments, urinary ultrasonography, blood and urine laboratory tests, polysomnography and balance assessments. A higher proportion of patients with enuresis associated with other conditions was identified in the multidisciplinary assessment group than in the routine assessment group (27.7% vs 15.2%, p = 0.019). With regard to treatment response to the enuresis alarm, the treatment response rate was 52.9% (17/33) in the conventional assessment group, whereas such a response was significantly higher in the multidisciplinary assessment group (82.1%, 32/39; p = 0.028). Compared with the routine assessment group, the multidisciplinary assessment group had a significantly higher treatment response rate for desmopressin (83.3% vs 52.0%; p = 0.022) and alarms combined with desmopressin (74.2% vs 44.4%; p = 0.045). After treatment, the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) score in the multidisciplinary assessment group was significantly higher than that in the routine assessment group (91.9 ± 6.3 vs 87.1 ± 7.3; p < 0.001). Multidisciplinary evaluation can identify more children with enuresis caused by other diseases, which promotes the differential diagnosis of MNE. In addition, multidisciplinary assessment can determine the appropriate treatment response in children with MNE.

The association of urinary BDNF, ATP, and MMP-2 with bladder compliance in children with myelodysplasia.

The purpose of our study was to evaluate the relationship of urinary brain-derived neurotrophic factor (BDNF),adenosine triphosphate (ATP),matrix metallopreteinase-2 (MMP-2) with urodynamic findings and upper urinary tract deterioration (UUTD) in children with myelodysplasia. Children with myelodysplasia evaluated in outpatient clinic between 2022 and 2023 were included. All patients underwent urinary ultrasonography, voiding cystourethrography, urodynamics, and DMSA scintigraphy. Urine samples were collected before urodynamics. Control urine was collected from 10 healthy children. Urinary biomarker values of patients and controls were compared, and subgroup analysis was performed. The median age of 40 children (26 girls) included in the study was 108 (8-216) months, and the control group (sixgirls) was 120 (60-154) (p = 0.981). Urinary BDNF, MMP-2, and ATP were found to be significantly higher in children with myelodysplasia compared to the control (p = 0.007, p = 0.027, p = 0.014, respectively). The three biomarker values were similar in children with bladder compliance below or above 10 cmH2O/mL(p = 0.750, p = 0.844, p = 0.575). No difference was found in terms of UUTD in all three biomarkers (p = 0.387, p = 0.892, p = 0.705). A negative correlation was found between urinary ATP and compliance (p < 0.05). In this study, all three biomarkers were found to be higher in children with myelodysplasia than in controls. There was a negative correlation between urinary ATP and compliance. Urinary biomarkers may contribute the follow-up of children with neurogenic lowerurinary tract deterioration in future with their noninvasive features. However, the lack of standardization and the inability to reliably predict risky groups are important shortcomings of urinary biomarkers.

Why is childhood urolithiasis increasing? Etiology, diagnosis and management: a single-center experience.

Globally, urolithiasis is becoming more and more common among children. We aimed to determine the etiology, and the diagnostic and therapeutic approaches in patients with urolithiasis. This was a retrospective study which included all patients (aged 1month-18years) admitted to the pediatric nephrology clinic in Elazığ Fethi Sekin City Hospital with urolithiasis between November 2019 and 2021. Only patients whose diagnosis of urolithiasis was confirmed by urinary ultrasonography were included in the study, while patients with chronic diseases (neurological diseases such as epilepsy, cerebral palsy, chronic bowel diseases, etc.) predisposing to kidney stone formation were not. Demographic characteristics, serum and urine biochemical parameters, urine metabolic and kidney stone metabolic and chemical analyses, urinary tract ultrasonography findings and treatment modalities were collected. One hundred ninety-seven patients (91 female and 106 male) were included in the study. Hypervitaminosis D was detected in 4 (2%) patients, suppressed parathyroid hormone in 12 (6%) and hypercalcemia in 27 (14%) patients. Metabolic screening showed hypercalciuria in 69 (35%) patients, hypocitraturia in 39 (20%), hyperoxaluria in 15 (8%) and cystinuria in 6 (3%) patients. Eighty three (42%) patients had a positive family history for kidney stones. One hundred eighteen (60%) patients received potassium citrate treatment, 71 (36%) were given hydration and diet recommendations without medical treatment, 6 (3%) received tiopronin treatment, and 2 (1%) patients were treated surgically. Our study suggests that Vitamin D supplementation at doses higher than 400IU/day may be a risk factor for kidney stonesin children. We observed that mothers tend not to give water to infants who are breastfed or formula-fed in the first year of life. K-citrate treatment can be a good option for prevention and dissolution of stones by alkalinization.

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

The Effects of Consanguineous Marriage on Small Kidney in Chronic Kidney Disease Small Kidneys in Chronic Kidney Disease

Aim: To determine the effects of small kidney and consanguineous marriage in chronic kidney disease (CKD). Materials and Methods: Patients with a vertical kidney size of 100 mm or less, who applied to the outpatient clinic between September 2021 and 2022, were included in the study. Urinary ultrasonography and renal function tests were recorded one year apart. Two groups, with and without relatives, were compared. SPSS 22.0 program was used for statistics. p&lt; .05 was considered significant. Results: The parents of 50 of the 94 cases with small kidney included in the study were related and 44 of them were not related. 57.4% were female, mean age was 49.86. Urea, creatinine, e-GFR, hemoglobin, albumin, phosphorus, calcium, PTH, ferritin, and urinary USG used in chronic kidney disease progression follow-up were compared between the groups with and without parental consanguinity. Conclusion: Early application of prevention measures with ultrasound detection of small kidney related to consanguineous marriage at an earlier age before kidney dysfunction is established will slow down the progression.

Antenatal Hyperechogenic Colon and Cystinuria.

A male newborn was investigated for history of antenatal hyperechogenic colon (HEC) detected at 32 weeks of gestation. In the first week of life, urinary ultrasonography showed nephrolithiasis. Urinary amino acid analysis expressed increased excretion of dibasic amino acids, and high urinary cystine levels were detected in both spot and 24-hour urine specimens. He was diagnosed as cystinuria, and genetic analysis of the patient revealed a heterozygous mutation in SLC7A9 gene. Antenatal presentation of cystinuria with HEC is rare and reported to be associated with a more severe disease course.

Can Impaired Distal Ureteral Contraction Detected by Urinary Ultrasonography Indicate Presence of VUR?

Objective: The aim of this study was to determine if impaired distal ureteral contraction detected by urinary ultrasonography (US) could predict presence of vesicoureteral reflux (VUR). Materials and Methods: A Retrospective analysis of patients’ files between November 2016 and September 2020 was performed. A total of 248 children with demonstrated VUR on voiding cystourethrogram (VCUG) and who underwent urinary US within one week of the VCUG examination were included in the study. The degree of hydronephrosis was classified as per Society for Fetal Urology grading system and grading of VUR was done by the International Reflux Study Group grading system. The impaired distal ureteral contraction was defined as the reduced movement of the distal ureter as well as the deficiency of urine discharge into the bladder. Results: There was a significant correlation between the grade of VUR and the grade of hydronephrosis (p=0.0028). Also, the presence of distal ureteral dilation was related to increasing grades of VUR (p=0.001). The impaired distal ureteral contraction was present only in children with dilating VUR (grades III IV V) while its relationship between VUR grade was significantly high for grades IV and V VUR (p=0.001). Conclusion: In children, the impaired distal ureter contraction as well as the increase of grades of hydronephrosis, and the presence of distal ureteral dilation may aid decision-making in terms of requesting VCUG to detect dilating VUR.

Reliability and validity of the Turkish language version of the Core Lower Urinary Tract Symptom Score.

The purpose of this study was to develop the Turkish version of the Core Lower Urinary Tract Symptom Score (CLSS) and determine its psychometric properties in Turkish subjects. A total of 428 subjects, 259 with lower urinary tract symptoms (LUTS) and 169 without any complaints, were included in the study. In addition, 40 subjects were included in the study for test-retest analysis. After the Turkish version of the CLSS was created, all patients underwent medical history, physical examination, complete urinalysis, urinary ultrasonography, and filled out a CLSS. In addition, men were asked to fill in International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Male LUTS and National Institutes of Health Chronic Prostatitis Symptom Index. Women completed the Bristol Female LUTS-Short Form and IPSS. The patients from the test-retest group were asked to fill out the CLSS two times at 2-week intervals. CLSS showed high internal consistency (Cronbach's α for men and women was 0.909 and 0.767, respectively). The test-retest reliability of CLSS was high for subdomains (intraclass correlation coefficient was 0.739-0.962). Scores of CLSS were significantly higher in the study group than the control group (P < 0.001). In men and women, it showed very strong convergent validity (P < 0.0001) with subdomain related to other questionnaires. In our confirmatory factor analysis, the original model of CLSS was found to be compatible. The Turkish version of CLSS is a valid and reliable questionnaire to evaluate the symptoms and disorders of patients with LUTS.

Ultrasonography Results in First Urinary Tract Infection During Childhood: Which Age Group Should Be Screened?

To determine the frequency of urinary system anomaly in children aged 0-18 y suffering from first urinary tract infection (UTI) and to establish which age group requires urinary ultrasonography (USG) screening. Age and gender, urine culture, urinary USG, and urological imaging results among 247 children in the 0-18 y age group with a first diagnosis of UTI were investigated retrospectively. Anomaly was detected at USG in 68 (27.5%) of the 247 patients suffering from first UTI. The most common anomaly was hydronephrosis. Non-E. coli micro-organisms were the pathogenic agents in 61.8% of patients with anomalies detected at USG. Being in the 0-5 y age group (OR: 0.524, 95% CI 0.284-0.970, p = 0.040) and presence of atypical UTI (OR: 4.746, 95% CI: 1.675-13.450, p = 0.003) emerged as independent predictive markers of severe urinary system pathologies on multiple regression analysis. Based on the data in the present study, routine USG screening is recommended for children suffering from first UTI under the age of 5 y and for the children suffering from atypical UTI at all ages.

The clinical outcomes of flexible ureteroscopy and laser lithotripsy (FURSL) for treatment of the upper urinary tract calculi

To evaluate efficacy and safety of flexible ureteroscopy and laser lithotripsy (FURSL) for treatment of the upper urinary tract calculi. We retrospectively analyzed 784 patients who underwent FURSL between January 2015 and October 2020 in our unit. All patients were preoperatively evaluated with urine analysis, serum biochemistry, urinary ultrasonography, non-contrast computed tomography and intravenous urography. The procedure was considered as successful in patients with complete stone disappearance or fragments < 4 mm on B ultrasound or computed tomography. The operative parameters, postoperative outcomes and complications were recorded and analyzed respectively. The average operative time and postoperative hospital stay were 46.9±15.8 min and 1.2±1.1 days, respectively, among 784 patients. In addition, 746 patients were followed up and 38 patients were lost. In these patients, 700 (93.8%) cases met the stone removal criteria and 46 cases (6.2%) did not meet the stone removal criteria who need further treatment. The stone free rate (SFR) is 92.5%after 1-3 months and SFR of middle and upper calyceal calculi was higher than that of lower calyceal calculi significantly. The most common complications were fever (58/784, 7.4%), gross hematuria (540/784, 68.9%) and lpsilateral low back pain (47/784, 6.0%). The incidence rate of serious complication was 1.28%(10/784), including 5 cases of septic shock and 5 cases of subcapsular hematoma, which were cured after active treatment. FURSL is a reliable treatment for small and medium calculi patients of upper urinary tract. The curative effect of stone removal is clear. The complications are few and the safety is high. However, there are certain limitations to the efficacy in treating larger stone and lower calyceal calculi.

Evaluation of the Relationship of the Time of Vesicoureteral Reflux Between Renal Scar Development and Endoscopic Treatment Success in Early Childhood

INTRODUCTION: Vesicoureteral reflux (VUR) is an important cause of urinary tract infection and chronic renal disease. Voiding cystourethrography (VCUG) is the gold standard diagnostic test in the diagnosis of VUR. In recent years, new parameters related to VCUG have been more objectively studied to evaluate the clinical prognosis. It is aimed to evaluate the effect of reflux time in primary VUR in terms of predicting endoscopic treatment success and treatment timing in VUR management. METHOD: In our study, the records and imaging findings of children with primary VUR who underwent VCUG examination between 2012 and 2019, who were treated with endoscopic injections, were retrospectively reviewed. Forty one children (67 renal units) were included in our study. Patients with preoperative VCUG, urinary ultrasonography, dimercaptosuccinic acid (DMSA) renal scan, and post-operative control VCUG were included in this study. RESULTS: Patients with preoperative VUR grade 1-2 were divided into two groups as “low grade” and patients with stage 3-4-5 as “high grade”. In the general patient population, endoscopic success rates in terms of renal unit deficit were found to be 46.3% (31/67). When the subgroup was analyzed, the endoscopic treatment success rate was 72.2% (13/18) in the low-grade group, versus 36.7% (18/49) in the high-grade group (p = 0.010). In the multivariate logistic regression analysis performed to identify independent predictors of scarring, reflux degree and reflux time were found to be independent predictors of scarring. CONCLUSION: In our study, we found that in VCUG evaluated preoperatively, VUR time as well as VUR grade were effective on endoscopic success rate and scar development. Based on these results, it could be thought that VUR time may be effective in selecting the best candidates for surgery and in the management and timing of treatment of VUR patients.

Urinary biomarkers can identify the need for pyeloplasty in presence of supranormal differential renal function in antenatally diagnosed unilateral hydronephrosis

Decision for surgery can be challenging in children with AH (Antenatal Hydronephrosis) especially in the setting of supranormal differential renal function (SnDRF). Aim of this study is to investigate whether IP-10 (interferon gamma-induced protein 10), MCP-1 (monocyte chemotactic protein-1), NGAL (neutrophil gelatinase-associated lipocalin), CA 19-9 (carbohydrate antigen 19-9), and KIM-1 (kidney injury molecule-1) can identify the need for pyeloplasty in presence of SnDRF in antenatally diagnosed unilateral hydronephrosis. A prospectively collected urinary biomarker database was used for the study. There was a total of 53 patients in the AH group. Nineteen children with no history of AH and a normal urinary ultrasonography were taken as controls. Patients with initial ipsilateral DRF (Differential Renal Function) over 50% were included in the SnDRF group while the remaining were named as non-SnDRF. Patients that didn't undergo surgery were classified as non-obstructive dilation (NOD) in both groups. Pyeloplasty was performed in 6/20 patients in SnDRF group, and in 19/33 patients in non-SnDRF group. Biomarker levels in the pyeloplasty and NOD groups were not affected by the presence or absence of SnDRF (p=1.00, for both). Urinary NGAL, and CA 19-9 could determine the need for surgery in SnDRF group with 83% and 100% sensitivity, 86% and 79% specificity, respectively whereas urinary IP-10 and KIM-1 could with 84% and 83% sensitivity, 57% and 71% specificity, respectively. Urinary MCP-1 could differentiate patients who underwent surgery with 83% sensitivity and 50% specificity in SnDRF groups. Our results showed that biomarker levels were not affected whether the kidney has SnDRF. Furthermore, in patients with SnDRF, NGAL and CA 19-9 appear to better estimate requirement for surgical correction before deterioration of renal function.

New strategy of color and power doppler sonography combined with DMSA in the assessment of acute pyelonephritis in infants

BackgroundThe purpose of this study was to evaluate the clinical value of color and power doppler sonography (CPDS) when combined it with 99mTc-dimercaptosuccinic acid scintigraphy (DMSA) in assessment of acute pyelonephritis (APN) in infants.MethodsA total of 79 children with APN admitted to our hospital from June 2016 to Jan 2019 were enrolled, including 52 boys and 27 girls, age range 1 month to 3 years old. All cases followed the diagnostic criteria for acute pyelonephritis and excluded anatomical abnormalities of urinary system. All 79 patients were examined by urinary ultrasonography (US), CPDS, and DMSA within 48 h of fever and analyzed the clinical value of combining the two methods in the assessment of APN in infants.ResultsAmong 79 children, urinary ultrasonography revealed 2 cases of renal cortical echo changes, both located in the upper pole of the kidney, 24 cases of kidney enlargement, and 1 case of left kidney shrinkage. Ninety-five kidneys were shown to be diseased with DMSA, while 105 kidneys abnormal by CPDS. The sensitivity of CPDS was 69.4%, and the specificity was 38.1%. In children younger than 6 months, the sensitivity of CPDS was 56.9%, which was 84.2% in childeren between 6 months to 1 year, and 94.4% from 1 to 3 years old, respectively. The corresponding specificity of CPDS was 44.1, 26.7, and 35.7%. There was no significant correlation between CPDS levels and DMSA positive results. The abnormal rate of intermediate part in the kidneys was significantly lower than that in the upper and lower poles. Children with abnormal CPDS have a greater risk of renal scarring(p < 0.05).ConclusionAbnormalities detected by CPDS in a cohort of infants with APN poorly correlated with DMSA findings. But the sensitivity of CPDS is highly age-related, it can be used as a non-invasive helpful tool for early diagnosis of acute pyelonephritis in infants older than 6 months old.

Unilateral absence of ovary and fallopian tube

A 19-year-old young woman was admitted to our Unit for irregular menstrual cycles within 40- to 60-day intervals for 7 months. She had no history of abdomino-pelvic surgery or acute pelvic pain. Pelvic magnetic resonance imaging revealed a right ovarian mass (Figure1A &amp; B), measuring 6.0 cm X 5.1 cm X 5.0 cm. The patient underwent laparoscopy. At the laparoscopic examination, we evidenced a right ovarian teratoma about 6.0 cm X 6.0 cm and a small mesosalpinx cyst about 2.5 cm X 2.0 cm on the right fallopian tube (Figure 2A). On the left, neither fallopian tube nor ovary was detected (Figure 2B). We performed laparoscopic cystectomy and sutured residual ovarian tissues for hemostasis. Subsequent urinary ultrasonography demonstrated a normal urinary tract without any congenital anomaly. The pathological examination confirmed the diagnosis of mature teratoma and right mesosalpinx serous cyst. The patient was successfully discharged at the third day with no complications.