Vesicoureteric Junction Obstruction Research Articles

Eosinophilic cystitis-an obscure case of obstructive uropathy in infancy.

We report on an infant with features of intermittent obstructive uropathy, acute kidney injury, hypertension and type 4 renal tubular acidosis (RTA) despite urethral catheterisation and fluid resuscitation. Radiological findings showed upper tract dilatation, likely bilateral vesicoureteric junction obstruction and bladder base thickening which was concerning for possible malignancy. Renal biopsy demonstrated eosinophilic infiltrate, suggestive of kidney involvement. Bladder biopsy was diagnostic for eosinophilic cystitis (EC) showing mature degranulating eosinophils. EC is a rare, easily treatable and important differential of bladder mass in children which may present with an atypical obstructive uropathy. This report adds to the limited literature of this condition within the paediatric population. EC should be considered early in children presenting with eosinophilia, urinary tract obstruction and kidney dysfunction, with uncertain aetiology. This case also highlights the need for detailed imaging, including visualisation of the bladder base, in cases of likely obstructive uropathy.

Clinical efficacy of laparoscopic Lich-Gregoir versus transvesicoscopic Cohen reimplantation for ureterobladder junction malformations in children.

To assess the clinical efficacy of laparoscopic Lich-Gregoir (LLG) and transvesicoscopic Cohen reimplantation (TCR) in the treatment of vesicoureteral junction obstruction (VUJO) and vesicoureteral reflux (VUR). This study retrospectively analyzed the clinical data of 66 pediatric patients with VUJO and VUR. They were classified into two groups, undergoing either the laparoscopic Lich-Gregoir operation (LLGO) (n = 35) or transvesicoscopic Cohen reimplantation operation (TCRO) (n = 31). The surgeries were performed between April 2018 and September 2022 at the First Affiliated Hospital of Guangxi Medical University, China. General characteristics, preoperative attributes, postoperative complications, renal function recovery, and improvement of hydronephrosis were compared between the two groups. All surgical procedures were successful with no requirement for reoperation. Both groups were comparable with respect to gender, affected side, weight, and postoperative complications. Nonetheless, the LLGO group contained a greater number of children younger than 12months. The LLGO group demonstrated superiority over the TCRO group regarding the duration of the operation, intraoperative blood loss, and length of postoperative hospital stay. In contrast, postoperative complications, recovery of renal function, and hydronephrosis improvement did not exhibit statistically significant differences between the two groups. Both LLGO and TCRO were demonstrated to be precise, safe, and reliable surgical methods for treating pediatric VUJO and VUR. LLGO ureteral reimplantation offers particular advantages in selecting cases and appears more suitable for children younger than 12months who have a small bladder capacity.

Assessment of Computed Tomography and Ultrasonography in Detection of Ureteric Calculi

Background: Urolithiasis, a common urological condition, presents diagnostic challenges. While CT scans are considered the gold standard for detecting ureteric calculi, the role of ultrasonography is also significant, especially in varied clinical scenarios. Objective: This study aims to assess the diagnostic accuracy of ultrasonography compared to CT scans in the detection of ureteric calculi. Methods: An observational study was conducted on 200 patients at the Combined Military Hospital, Peshawar. Participants included males and females aged 18-60 years, presenting with acute renal pain. Exclusion criteria included individuals without informed consent, multiple comorbidities, a history of kidney donations, or a family history of renal calculi. Ultrasonography was performed using an Ecoste Mylab 7 color Doppler machine with 3.5, 5, and 7.5 MHz probes. CT scans were conducted using the Siemens CT Somatom Sensation 64, without the administration of any contrast medium. Data were analyzed using SPSS version 26.0. Results: Ultrasonography detected ureteric calculi in 33% of patients (66 calculi), while CT scans detected 60% (118 calculi). The breakdown of calculi location for ultrasonography included 20 renal, 15 pelvic ureteric junction, 12 upper ureter, 8 lower ureter, 7 vesicoureteric junction obstruction, and 4 bladder. CT scan results showed 45 renal, 25 pelvic ureteric junction, 20 upper ureter, 11 lower ureter, 9 vesicoureteric junction obstruction, and 8 bladder calculi. The gender distribution in the study was 55% male and 45% female, with the mean age being 35 ± 16.79 years for males and 36 ± 17.24 years for females. The most common presenting complaints were flank pain (36%), lower back pain (25%), and burning micturition (15%). Conclusion: CT scans exhibit higher diagnostic accuracy for ureteric calculi compared to ultrasonography, thus reaffirming their role as the gold standard in this context. However, the radiation risks and economic implications of CT scanning necessitate a balanced approach to its use, emphasizing the importance of comprehensive patient evaluation and physician awareness of radiation risks.

Successful rescue pneumovesicoscopic surgery for post-Deflux® vesicoureteral junction obstruction.

Vesicoureteral junction (VUJ) obstruction after Deflux® subureteral injection for vesicoureteral reflux (VUR) is rare and minimally invasive management has not been reported. This work investigated the patients who underwent Deflux® injection for VUR and identified those with subsequent VUJ obstruction. Medical records of matched patients from October 2003 to March 2022 were reviewed, and parameters were retrospectively studied. All patients underwent Deflux® injection. The injection was performed under general anesthesia using the same manner. For patients complicated with VUJ obstruction, the symptoms, signs, management, images, renal ultrasounds, Tc-99m dimercaptosuccinic acid renal scintigraphy, histology of VUJ region, and outcomes were documented and reported. VUJ stenosis was diagnosed by performing renal ultrasound and magnetic resonance imaging. Totally 407 patients (554 ureterorenal units) received Dx/HA injections for VUR. VUJ obstruction was found in three patients (four ureterorenal units). Originally, three were grade V VUR, and one was grade IV. The repeated injection was not a risk factor for VUJ obstruction. The overall incidence of VUJ obstruction post-Dx/HA injection was 0.7% by ureter. The incidences were 0%, 0.75%, and 2.25% for grade I-III, IV, and V VUR, respectively. After the initial conversion case of pneumovesicoscopic ureteral reimplantation, the procedure was performed smoothly and successfully in the two following cases. Pneumovesicoscopic ureteral reimplantation offers an alternative for VUJ obstruction following Dx/HA injection for VUR. Fibrosis and foreign-body reaction may influence the feasibility. High-grade VUR and young age of injection were related to VUJ obstruction.

Surgical management of complicated duplex kidney: A tertiary referral centre 10-year experience.

The management of a complicated duplex kidney remains a challenge for paediatric urologists. The aim of this study is to report a 10-year experience of the surgical management of complicated duplex kidney in a single tertiary care paediatric referring hospital. Clinical records of all children who undergone a surgical procedure for complicated duplex systems between January 2009 and March 2019 at our institution were retrospectively reviewed. Clinical manifestations, surgical procedures, complications and follow-up were collected and analysed. Logistic regression was performed to explore if any patient's characteristic or underlying associated comorbidity (ureterocoele, ectopic ureter, obstruction, etc.,) could be positively linked to the chance to develop recurrent urinary tract infections (UTIs). We have identified 95 children who received a surgical treatment for 102 complicated duplex kidneys. The presence of an ureterocoele was recorded in 41 (43.2%) patients, an ectopic ureter in 25 (26.3%), a vesicoureteral reflux (VUR) in 40 (42.1%), a vesicoureteric junction obstruction in 24 (25.3%) and an ureteropelvic junction obstruction in 3 (3.2%). An invasive approach such as an heminephrectomy (71.6%) was required in the majority of cases. Higher risk of developing a UTI has been demonstrated in children diagnosed postnatally (P < 0.001) and in those with an associated obstruction (P < 0.05). No standardised management could be recommended for the surgical treatment of complicated duplex kidney. Children without antenatal diagnosis and with either an upper tract obstruction or VUR are at greater risk to develop UTI and need to be looked after more closely.

Hydronephrosis and free fluid identified by point-of-care ultrasound leads to diagnosis.

A 64-year-old man with a history of hypertension presented for evaluation of sudden-onset, right lower quadrant abdominal pain radiating to the right flank with associated non-bloody, non-bilious emesis. He denied dysuria, hematuria, fevers, chills, history of similar symptoms, or previous abdominal surgeries. On physical examination, he was afebrile and hypertensive to 189/113, with vitals otherwise within normal limits. He appeared uncomfortable, with moderate right upper and right lower quadrant tenderness with mild guarding but no costovertebral angle tenderness. Point-of-care ultrasound was performed, which identified moderate hydronephrosis with associated free fluid surrounding the right kidney, concerning for obstruction and collecting system rupture (Figure 1). A contrasted computed tomography of the abdomen and pelvis confirmed high-grade obstruction attributed to 5-mm calculus within the proximal ureter causing dilatation of the ureter with hydronephrosis and perinephric fluid (Figure 2). Findings were consistent with calyceal rupture, resulting in urology consult. The urology team took the patient to the operating room for ureteral stenting, antibiotics, and staged ureteroscopy and lithotripsy. Spontaneous rupture of the renal pelvis is a rare but critical diagnosis in patients with acute abdomen.1 A retrospective review found that 74% of cases were attributed to ureteric stones; less common causes included benign or malignant extrinsic ureteric compression, pelvic–ureteric junction and vesico–ureteric junction obstruction, bladder outlet obstruction, and iatrogenic disease.2 Treatment is tailored to the cause and is often managed conservatively with antibiotics but may require urologic intervention.3 Ultrasound is a helpful tool in identifying abnormalities consistent with calyceal rupture, which include hydronephrosis and perinephric free fluid.

Activation of the TGF-β1/Smads/α-SMA pathway is related to histological and functional changes in children with neurogenic bladder

This research is to investigate the expression of the TGF-β1/Smads/α-SMA pathway and its effect on bladder histology and function in children with neurogenic bladder (NB). The bladder specimens from 10 children with NB and 8 children with vesicoureteral junction obstruction were collected into the NB and control groups. The expression of TGF-β1, Smad2, Smad3, Smad4, Smad6, α-SMA, fibronectin, collagen I and collagen III in bladder tissues was detected. In addition, the histological characteristics of the bladder were evaluated. A preoperative urodynamic study was performed on all children with NB. We analysed the correlations among the expression of the marker protein a-SMA in myofibroblasts, effector cells of the pathway, and bladder function parameters. Compared with those in the control group, the expression of TGF-β1, Smad2, Smad3, Smad4, α-SMA, fibronectin, collagen I and collagen III was significantly increased in the NB group, while the expression of Smad6 was decreased (p < 0.01). HE and Masson staining in the NB group showed increased collagen levels and hypertrophy of smooth muscle cells. Children with NB had a low bladder volume ratio (BVR), low compliance (△C) and high maximum bladder pressure, low maximum flow rate, large postvoid residual volume, low bladder contraction index and low bladder voiding efficiency. The expression of α-SMA was negatively correlated with the BVR (r = − 0.7066, P = 0.0223) and △C (r = − 0.6516, P = 0.0412). We conclude that the TGF-β1/Smads/α-SMA pathway is activated in the bladder tissue of children with NB and may be involved in the processes causing histological and functional changes.

MO047: Biallelic pathogenic variants in ROBO1 associate with syndromic CAKUT

Abstract BACKGROUND AND AIMS Congenital anomalies of the kidney and urinary tract (CAKUT) represent the most common cause of chronic kidney failure in children. Despite growing knowledge of the genetic causes of CAKUT, the majority of cases remain etiologically unsolved. Genetic alterations in roundabout guidance receptor 1 (ROBO1) have been associated with neuronal and cardiac developmental defects in living individuals. Although Slit-Robo signaling is pivotal for kidney development, diagnostic ROBO1 variants have not been reported in viable CAKUT to date. METHOD We collected phenotypic data of all participants. Genetic analysis was conducted by either exome or whole genome sequencing, respectively. We used Sanger sequencing for variant confirmation and segregation analysis and performed in-silico analysis of identified missense variants. In an ENU-induced mouse model, we examined mice with the mutation Robo1Ile270Thr/Ile270Thr. RESULTS By next-generation-sequencing methods, we identified six unrelated individuals and two non-viable fetuses from Germany, France, Turkey, Japan and the USA with biallelic truncating or combined missense and truncating variants in ROBO1. Renal and genitourinary manifestation included unilateral or bilateral renal agenesis, vesicoureteral junction obstruction, vesicoureteral reflux, posterior urethral valve, genital malformation and increased renal echogenicity. Further clinical characteristics were remarkably heterogeneous, including neurodevelopmental defects, intellectual impairment, cerebral malformations, eye anomalies, and cardiac defects (Figure 1). By in-silico analysis, we determined the functional significance of identified missense variants and observed absence of renal ROBO1 expression in both human and murine mutant tissues (Figure 2). CONCLUSION This study describes six live-born and two non-viable individuals with syndromic CAKUT due to probably deleterious ROBO1 variants. While its expression in multiple tissues may explain heterogeneous organ involvement, variability of kidney disease suggests gene dosage effects due to a combination of null alleles with mild hypomorphic alleles. In conclusion, comprehensive genetic analysis in CAKUT should include ROBO1 as a new cause of recessively inherited disease. Conversely, in patients with already established ROBO1-associated cardiac or neuronal disorders, screening for renal involvement is indicated.

Biallelic pathogenic variants in roundabout guidance receptor 1 associate with syndromic congenital anomalies of the kidney and urinary tract

Congenital anomalies of the kidney and urinary tract (CAKUT) represent the most common cause of chronic kidney failure in children. Despite growing knowledge of the genetic causes of CAKUT, the majority of cases remain etiologically unsolved. Genetic alterations in roundabout guidance receptor 1 (ROBO1) have been associated with neuronal and cardiac developmental defects in living individuals. Although Slit-Robo signaling is pivotal for kidney development, diagnostic ROBO1 variants have not been reported in viable CAKUT to date. By next-generation-sequencing methods, we identified six unrelated individuals and two non-viable fetuses with biallelic truncating or combined missense and truncating variants in ROBO1. Kidney and genitourinary manifestation included unilateral or bilateral kidney agenesis, vesicoureteral junction obstruction, vesicoureteral reflux, posterior urethral valve, genital malformation, and increased kidney echogenicity. Further clinical characteristics were remarkably heterogeneous, including neurodevelopmental defects, intellectual impairment, cerebral malformations, eye anomalies, and cardiac defects. By in silico analysis, we determined the functional significance of identified missense variants and observed absence of kidney ROBO1 expression in both human and murine mutant tissues. While its expression in multiple tissues may explain heterogeneous organ involvement, variability of the kidney disease suggests gene dosage effects due to a combination of null alleles with mild hypomorphic alleles. Thus, comprehensive genetic analysis in CAKUT should include ROBO1 as a new cause of recessively inherited disease. Hence, in patients with already established ROBO1-associated cardiac or neuronal disorders, screening for kidney involvement is indicated.

Manejo não cirúrgico da obstrução da junção vesicoureteral: um relato de caso

Objective:To report the case of a pediatric patient with bilateral hydronephrosis due to vesicoureteral junction obstruction (VUJO) that was treated non-surgically and to discuss the approach of this anomaly.Case Description:A 25-month-old boy was referred without complaints for consultation due to prenatal ultrasound showing kidneys with cysts. He was under antibiotic prophylaxis. No family history of kidney disease and/or inherited disorders was reported. Renal ultrasound (RUS) at 2 days of life showed bilateral hydronephrosis, thus ruling out the possibility of kidney cystic disease. Dynamic renal scintigraphy (DTPA) showed marked retention of the marker in the pyelocaliceal system bilaterally, with little response to diuretic drug. He was maintained under antibiotic prophylaxis, when a new RUS showed bilateral ureteral dilatation, abrupt stenosis in the ureterovesical transition region (0.2 cm caliber), moderate bilateral hydronephrosis, and slight renal cortical thickness, confirming the diagnosis of VUJO. At 2 years and 10 months of age, DTPA showed hydronephrosis and ureteral stasis in both kidneys secondary to stenosis at the vesicoureteral junction (VUJ) level, with preservation of kidney function and slow degree of emptying. We opted for a non-surgical approach. RUS at 10 years of age showed significant improvement of all parameters, with ureteral transverse diameter of 9 mm, preserved VUJ, and age-appropriate bilateral kidney development.Comments:VUJO is a major cause of prenatal hydronephrosis and can trigger a deterioration of kidney function. Its treatment is still controversial but should take into account the importance of clinical follow-up and serial imaging evaluation.

Primary obstructive megaureter in children; 10 years' experience from a tertiary care center.

Introduction:Primary obstructive megaureter (POM) is a congenital dilatation of the ureter due to an adynamic segment of vesicoureteric junction obstruction. Surgical intervention is needed if nuclear scan shows obstructive curve. We analyzed our data and outcome of conservative and surgical treatment in such cases at our tertiary care hospital.Materials and Methods:We evaluated all cases of POMs during the study period. Investigations included ultrasonography (USG), voiding cystourethrogram, diethylene pentacetic acid (DTPA) scan, and dimercaptosuccinyle acid scan. In antenatal cases, any pelvic dilatation ≥12 mm after 6 weeks were subjected to reonography. Patients with anterior-posterior pelvic diameter (APPD) ≥12 mm had to undergo DTPA scan to look for DRF and drainage. Follow-up USG was done in all cases of mild-to-moderate hydroureteronephrosis, with APPD <12 at 3 months interval.Results:A total of 270 megaureters were registered and treated during the study period (2008–2019). The total number of patients included was 50 (64 ureters). The mean age of presentation in these 30 children was 21.78 ± 18.1 months (range 1–72 months) and the mean weeks of gestation in antenatal cases at presentation as megaureter was 24 ± 7 weeks (range 13–37 weeks). The mean weight of babies was 2.72 ± 0.7 g. The duration of follow-up ranged from 16 to 1W12 months. The mean APPD on the affected side was 19.99 ± 10.3 mm (range 11–43 mm). The mean ureteric diameter was 1.67 ± 0.33 mm (range 0.78–2.66 cm). The mean split function of patients with POM was 34.88% ± 11.5% on the affected side. Twenty patients (40%) had spontaneous resolution over a mean time period of 24.1 ± 11.1 months. Thirty patients underwent surgical procedures. In three children, HTN was observed over a mean follow-up period of 3 years.Conclusion:The babies with POM need a close follow-up. Surgery is indicated in prolonged t½/Tmax on renal scan, function <40% at the initial scan, or >5% split function deterioration in the subsequent renal scan.

Double ureteric obstruction mimicking bowel obstruction managed by minimal invasive surgery

This case highlights bowel obstruction like symptoms post-laparoscopic pyeloplasty for pelvi-ureteric junction obstruction (PUJO), caused by concomitant vesico-ureteric-junction obstruction (VUJO). The endoscopic management is presented along with a review of the literature. A 16-month-old-girl was diagnosed antenatally with a left hydronephrosis. The post-natal scan confirmed severe left pelvi-calyceal dilatation with cortical thinning, no ureteric dilatation, and a 32 mm anterior-posterior (AP) renal pelvis. The mercaptoacetyltriglycine (MAG-3) renogram demonstrated thinned cortex with steady accumulation of contrast and poor drainage along with split renal function of 26% on left side. The patient underwent a laparoscopic pyeloplasty for PUJO, with some difficulty in passing the JJ stent distally. Postoperatively, the patient developed symptoms of ileus, that were progressively unsettled with bilious vomiting and abdominal distension. An ultrasound examination revealed the distal end of stent still positioned in the distal ureter with stable upper tract dilatation. Serial radiographs showed progressive distended bowel loops with the stent coiled in ureter. On the fourth day; as symptoms did not improve, emergency laparoscopy was performed that confirmed no mechanical cause of obstruction and no bowel injury. Cystourethroscopy in the same session revealed ipsilateral VUJO. The left ureteral orifice was cannulated with difficulty using a 0.0014 inch guide wire, following which the vesico-ureteric junction was dilated with 4Fr ureteric catheter and a 3.7Fr JJ stent was placed. The newly inserted JJ stent displaced the existing stent into the renal pelvis. Post-operative course showed dramatic improvement in obstructive symptoms. Both JJ stents were subsequently removed after 3 months using a cystoscope and rigid uretero-renoscope. Pre-operative diagnosis of coexistent VUJO and to PUJO is clinically challenging and requires high level of suspicion especially when postoperative recovery is not smooth. With the availability of endo-ureterotomy procedures PUJO and VUJO could be managed together without the risk of endangering ureteric vascularity.

"Killing two birds with one stone": endoscopic management of PUJ and VUJ obstructions with a renal stone in a congenital solitary kidney

SUMMARY We report on the diagnosis and management of a 25-year-old female with a congenital solitary kidney associated with simultaneous pelviureteric (PUJ) and vesicoureteric (VUJ) junction obstructions complicated by a lower pole renal stone. The patient was successfully managed completely endoluminally over two procedures with the use of double-J stents and a laser fibre to incise the VUJ and perform endopyelotomy at the PUJ followed by extraction of the stone. This case demonstrates the efficacy and minimal invasive endoscopic urological surgery even in the face of numerous pathologies, which traditionally required more invasive procedures. Keywords: solitary kidney, pelviureteric junction obstruction, vesicoureteric junction obstruction, renal calculus, endoscopy

Giant infected hydronephrosis: A kidney bag filled with 6300 cc pus

Giant hydronephrosis has been variably defined in literature as that one that contains more than 1 liter of fluid or comprising >1.6% of the body weight. It is also described as that occupying a hemiabdomen, crossing the midline and occupying more than five vertebral heights. Congenital uretero-pelvic junction obstruction is the most common cause of giant hydronephrosis in children and young adults. Other important causes include vesico-ureteric junction obstruction, ureteral atresia and primary obstructed megaureter. We herein report a rare case of giant hydronephrosis secondary to pelvi-ureteric junction obstruction presenting as an acute abdomen in a young female.

Tubercular Stricture at Lower End of Ureter Causing Vesicoureteric Junction Obstruction: Our Experience in Rangpur Medical College

Objective: To determine the outcome of ureteroneocystostomy for vesicoureteric junction obstruction due to tubercular stricture. Patients and Method: Twelve patients age from 19 years to 47 years were underwant uretroneocystostomy with ifilateral D-J stanting for vecicoureteric junction obstruction (VUJO) with proximal hydroureteronephrosis tissue from the lower of the ureter shows granunation lesion complatable with tuberculosis. D-J stant were remove and patients were put into antitubercular chemotherapy Results: Patients were symptom free and follow up IVU at six months interval shows free passage of contrast at 10 minutes film. Conclusion: Vesicoureteric junction obstruction (VUJO) due to lower ureteric stricture by tuberculus lesion, though rare, should be searched, because if not treated properly may lead to damage of ipsilateral renal unit. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.13-17

Vesico-Ureteric Junction Obstruction and Calyceal Rupture Secondary to a UroLift Implant

Prostatic urethral lift is a minimally invasive procedure used to improve the symptoms of benign prostatic enlargement. It utilizes the UroLift device to insert small implants through occlusive lateral lobes of the prostate, thereby creating an open anterior channel through the prostate. We describe a previously unreported complication of UroLift whereby a patient presented with loin pain post-procedure and was found to have a UroLift clip across the vesico-ureteric junction , leading to ureteric obstruction, hydronephrosis and calyceal rupture.

Robot-Assisted Simultaneous Pyeloplasty and Ureteric Reimplantation for Unilateral Double Obstruction of the Ureter: Technical feasibility, Tips and Tricks

ObjectiveTo highlight the feasibility and technical details of performing simultaneous ipsilateral pyeloplasty and ureteric re-implantation for simultaneous proximal and distal obstruction of the ureter. MethodsTwo patients with preoperative diagnosis of proximal and distal ureteric obstruction underwent robot-assisted simultaneous pyeloplasty and ureteric re-implantation. The patients were placed in right lateral oblique position and pyeloplasty was performed in standard manner. In both cases, Double J stent could not be negotiated beyond the vesicoureteric junction into the bladder. The robot was dedocked and recentred around different ports to successfully perform uretero-neocystostomy over a 4.8 F double J stent. ResultsThe mean operative times were 154 minutes with operative blood loss of approximately 50 ml. The postoperative convalescence was good in both cases and Double J stents were removed after 6 weeks. Follow-up diuretic renograms demonstrated stable renal function with unobstructed drainage. ConclusionSimultaneous repair of ipsilateral pelviureteric and vesicoureteric junction obstruction is safe and feasible contrary to traditional teachings. To the best of our knowledge this is the first description of robotic simultaneous pyeloplasty and ureteric reimplantation.

Efficacy of pneumocystoscopic Cohen ureteric reimplantation for congenital malformation of vesicoureteral junction obstruction

Objective To explore the efficacy of Cohen ureteric reimplantation for congenital malformation of vesicoureteral junction in children. Methods From February 2014 to August 2016, 12 children with congenital monstrositas of vesicoureteral junction obstruction who were treated with pneumoeystoscopic Cohen ureteric reimplantation in Guizhou Provincial People′s Hospital were selected.In these cases, 8 males and 4 females, their ages ranged from 2 months past 1 year to 11 years, and the average age was 5.26 years.In the 12 patients, there were 6 cases with left vesicoureteral junction obstruction, and 1 case with right vesicoureteral junction obstruction, 1 case with left ureter cyst and duplication of ureter ectopic opening, 1 case with right duplex kidney and ureter cyst, 1case with right primary vesicoureteric reflux and left vesicoureteral junction obstruction, 2 cases with bilateral primary vesicoureteric reflux and 1 case with ureter cyst.A foley catheter and ureteral stent was indwelled in each patient but no bladder fistula was made.All of the patients underwent pneumocystoscopic Cohen ureteric reimplantation.The stenting catheters were removed in 1-3 months after surgery.B ultrasonography was used to follow the degree of the dilatation of ureter and hydronephrosis.Urinalysis was conducted to detect the urinary tract infection.Intravenous urography examination was conducted to detect anastomotic stenosis.Voiding cystourethrography was performed to show ureteral reflux. Results All procedures were accomplished without conversion.The duration of operations ranged from 100 to 330 min (mean 207 min). All patients were followed up for 3 to 10 months, but no urinary tract infection and anastomotic obstruction occurred, and B ultrasonography showed that hydronephrosis or dilatation of ureter were improved in different degrees or disappeared.Two cases of ureteral reflux occurred in the early follow-up, and these cases recovered after being given symptomatic treatment. Conclusions The pneumocystoscopic Cohen ureteric reimplantation is a safe and effective option for congenital malformation of vesicoureteral junction in children. Key words: Pneumovesicoscopy; Reimplantation; Congenital malformation

Diagnosis and Treatment of Palpable Urological Mass in the Neonatal Period: A 5 Year Review

Introduction: Abdominal masses in the neonatal period often present a diagnostic challenge. The aim of this study was to evaluate which urological pathologies cause the formation of a neonatal mass, the diagnostic pathway and surgical outcome. Patients and methods: The medical and radiological records of 30 neonates who were admitted to the Neonatal Surgical Unit of Yorkhill Sick Children Hospital, Glasgow with an abdominal mass over a five-year period (2008-2013) were reviewed. Data collected included demographics, gestational age, radiological investigations, operative findings and complications. Result: Seventeen neonates (9 males, 8 females) were identified with an abdominal mass arising from the urological tract. Four boys were found to have posterior urethral valves while in 4 girls a duplex kidney with a ureterocele was identified. In the remaining 9 patients the palpable mass was caused by: vesicoureteric reflux (n=2), multicystic dysplastic kidney (n=2), polycistic kidney disease (n=1), ectopic kidney (n=1), pelvi-ureteric junction obstruction (PUJO) (n=1), unilocular renal cyst (n=1), PUJO and vesicoureteric junction obstruction (n=1). Nine patients required a form of urinary diversion and in two of these patients a nephrostomy was followed by a pyeloplasty, 2 required incision of ureteroceles, 1 nephrectomy, 1 partial nephrectomy, 1 STING and 1 primary valve ablation. Conclusion: Only 70% of newborns with abdominal masses were diagnosed antenatally, while 30% were detected postnatally. Posterior urethral valves remain the most common cause of a neonatal mass in a male, while duplex kidneys with ureterocele were seen in girls. Half of the patients will require a form of urinary diversion in the neonatal period. The large majority (88%) of abdominal masses of urological origin required surgical intervention.

Pneumovesical Ureteric Reimplantation in Pediatric Patients: An Intermediate Term Result.

Pneumovesical ureteric reimplantation has gained increasing popularity for the treatment of vesicoureteric reflux (VUR) and vesicoureteric junction obstruction (VUJO) in pediatric patients. In this study we reviewed our experience at an intermediate term basis. A retrospective review of all patients with pneumovesical ureteric reimplantation performed in a tertiary referral center between 2005 and 2015 was carried out. Patients' demographics, operative measures, and postoperative outcomes were recorded. Thirty-one patients were identified during the study period. Twenty-three patients had VUR and 8 patients had VUJO. A total of 42 ureteric reimplantation procedures were carried out. The mean age at operation was 6.1 years old. The mean operative time was 221 minutes. On average the length of hospital stay was 7.4 days. Four patients required conversion to open approach. Four patients had low-grade residual VUR after the operation and all of them were treated conservatively. There was no major complication or mortality. Pneumovesical ureteric reimplantation is safe and effective for pediatric patients. Intermediate term result confirmed its reliability and low recurrence rate. It has good potential to become the preferred approach of choice in the future.