Change in bladder capacity and prognostic predictors of post-transplant vesicoureteral reflux in pediatric kidney transplant recipients: a single-center retrospective cohort study

The purpose of this study was to compare the actual bladder capacity of children undergoing voiding cystourethrogram (VCUG) with existing formula-derived estimates and to describe any adverse effects of bladder overdistention during VCUG. This retrospective study involved review of 884 consecutive VCUG performed over 3 years. Cases with underlying conditions that could artificially increase bladder capacity, such as neurogenic bladders or vesicoureteral reflux, were excluded. Included were 440 normal VCUG procedures. Bladder volumes exceeded the expected bladder capacity set by the American Academy of Pediatrics (AAP) and American College of Radiology in 284 VCUG (65%). Of 261 VCUG performed on children <2 years of age, 164 (63%) VCUG exceeded the expected capacity. In the 2-14-year-old age group, 113 (68%) of the 165 VCUG performed exceeded the expected bladder capacity. Among the 14 VCUG performed on children >14 years of age, seven (50%) exceeded the bladder capacity. No adverse effects were found after the VCUG in the 32 VCUG (7.3%) requiring a contrast volume of more than two times the AAP estimates and in the 22 VCUG studies (5%) requiring a contrast volume of more than three times the AAP estimates. This study suggests that current guidelines often underestimate bladder capacity, and exceeding the expected bladder capacity appears to be reasonably safe without the occurrence of complications. Current AAP guidelines often underestimate the capacity of the urinary bladder. Exceeding the expected bladder capacity appears to be reasonably safe.

Pneumovesicoscopic Treatment of Subvesical Obstructing Ectopic Ureteroceles in Newborns, Infants and Children.

H3K9 lactylation drives FTO-mediated NRF2 suppression to exacerbate bladder epithelial ferroptosis and inflammation in diabetic bladder dysfunction.

Multicystic dysplastic kidney disease (MCDK) is a notable congenital anomaly of the kidney and urinary tract, with potential risk for chronic kidney disease, yet data from sub-Saharan Africa remain scarce. This study examined the pattern of MCDK, associated contralateral kidney abnormalities, determined the predictors of MCDK involution and assessed short-term outcomes in children followed beyond one year in South Africa. This retrospective study involved children under 13 years of age with suspected unilateral MCDK, confirmed on kidney ultrasound and [99mTc]Tc-MAG3 scans at the Red Cross War Memorial Children's Hospital between January 1, 2014, and December 31, 2023. Demographic, clinical, and radiologic data were obtained. The Log-rank test and Cox Proportional Hazards regression analyses were used to identify predictors of MCDK involution. Among 1,581 new cases, 98 (6.2%) had unilateral MCDK. 50% were male, and 57.1% had left-sided involvement. Median follow-up was 60 months (IQR: 12-72). Contralateral kidney abnormalities occurred in 17 (17.3%), most commonly duplex kidney (35.3%) and ureteropelvic junction obstruction (29.4%), but no vesicoureteric reflux was noted. Of 81 children followed beyond a year, 80.2% demonstrated contralateral hypertrophy, and 69.1% exhibited involution of the affected kidney. Initial kidney size ≤ 5.0cm was the sole predictor of involution (Hazard Ratio: 2.42, 95% CI: 1.31-4.48). Urinary tract infections occurred in 18.5%, proteinuria in 2.5%, hypertension in 1.2%, and 2.5% developed chronic kidney disease related to contralateral dysplasia. One nephrectomy was performed, and no malignancies or deaths. At last follow-up, 28.4% were lost to follow-up, and 12.3% had transitioned to adolescent clinics. All MCDK cases were unilateral, with duplex kidney being the most common contralateral abnormality, a distinctive finding previously unreported. Follow-up into adolescence may be beneficial, as progression of chronic kidney disease is rare in those without contralateral anomalies. Multicentre long-term studies are needed to provide standardised follow-up guidelines.

Breakthrough urinary tract infection (BT-UTI) among children with vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP) remains a clinical challenge with heterogeneous risk profiles and no validated prediction tools. We aimed to identify robust risk factors and develop an evidence-based predictive score for BT-UTI. We conducted a systematic review and meta-analysis following PRISMA and Cochrane guidance, searching PubMed, Web of Science, and Embase for cohort studies. Pooled effect estimates were calculated using appropriate fixed- or random-effects models; a scoring system was derived by natural logarithm transformation of pooled estimates. External validation used a cohort of 158 children with VUR receiving CAP at Children's Hospital of Chongqing Medical University (2021-2024). Twenty-four cohort studies (n = 3,264) were included; pooled BT-UTI incidence was 30.5%. From 26 candidate factors, eight stable predictors were retained and incorporated into the score: age < 1year (OR 2.04), bilateral reflux (OR 1.81), high-grade reflux IV-V (OR 2.65), symptomatic UTI (OR 2.74), history of recurrent UTI (OR 2.17), bladder and bowel dysfunction (BBD; OR 1.81), increased ureteral diameter ratio (UDR; MD 0.139), and DMSA renal scar formation (OR 4.40). External validation showed AUC 0.88 (95% CI 0.82-0.93); at a cutoff of 17 points accuracy was 0.84, and sensitivity 0.93. Calibration and decision-curve analyses indicated good agreement and a positive net clinical benefit. We developed and externally validated an eight-item BT-UTI risk score for children with VUR on CAP that demonstrates high discrimination and clinical utility for individualized risk stratification and prevention planning and implementation guidance available.

Urinary tract infections (UTIs) among infants ≤ 3 months old are associated with a high risk of recurrence and renal scarring, yet evidence identifying high-risk infants remains limited. We aimed to identify predictors of UTI recurrence and factors associated with renal scarring in this population. A retrospective chart review was conducted on febrile infants ≤ 3 months at a tertiary paediatric hospital in Singapore, between January 2018 and June 2023. We defined recurrence as any episode occurring within 1 year of the index UTI and renal scarring based on the Technetium-99m 2,3-dimercapto-succinic-acid (DMSA) scan. Multivariable logistic regression was performed to predict for UTI recurrence and renal scarring, using covariates selected a priori. We presented the adjusted odds ratio (aOR) with corresponding 95% confidence interval (95%CI). Among 401 infants (median age: 49 days [28-70]; 76% male), 49 (12.2%) experienced recurrent UTI. Male sex (aOR = 2.80, 95%CI:1.14-8.46, p = 0.041) and ultrasound kidney, ureter, and bladder (US KUB) abnormalities (aOR = 2.72, 95%CI:1.40-5.27, p < 0.05) independently predicted recurrence. Among 161 infants with DMSA performed, 21 (13.0%) developed renal scarring. Scarring was associated with bacteraemia (OR = 4.38, 1.54-12.05, p < 0.05), elevated procalcitonin ≥ 0.5 ug/L (OR = 16.82, 4.53-109.39, p < 0.001), non-E.coli uropathogen (OR = 6.18, 2.37-17.49, p < 0.001), hydronephrosis (OR = 3.04, 1.17-7.87, p < 0.05), and vesicoureteral reflux (VUR) (OR = 18.70, 4.31-133.32, p < 0.001), particularly high-grade severity ≥ 3 (OR = 25.50, 5.74-185.47, p < 0.001). Additionally, multivariable analysis identified US KUB abnormalities (aOR = 3.00, 1.57-5.73, p < 0.001) as an independent predictor of renal scarring. We reported independent predictors of UTI recurrence and risk factors for renal scarring. These patients should receive more intensive monitoring after their index UTI.

Robotic surgery has changed pediatric urology more and more by giving pediatric urologists less invasive options for complicated reconstructive surgeries. Thanks to advances in technol ogy, pediatric urologists can now execute procedures with better dexterity, 3-dimensional vis ibility, and accuracy. These are especially important for congenital malformations that need precise dissection. Robotic-assisted laparoscopic pyeloplasty is now the most prevalent technique. It boasts success rates that are similar to those of open surgery and benefits including less pain, shorter hospital stays, and better appearance. Robotic ureteral reimplantation is also a safe and successful alternative to open repair for vesicoureteral reflux and primary obstruc tive megaureter, although it takes longer to learn how to do it. More and more often, complex surgeries like heminephrectomy, augmentation ileocystoplasty, Mitrofanoff appendicovesicos tomy,andbladder neck reconstruction are being done with robots, and the results are looking excellent. Robotic methods in pediatric uro-oncology are changing, but it’s important to choose patients carefully because of worries about tumor spilling. Robotic surgery is a useful technique in pediatric urology because it ismoreprecise, comfortable, and quick to recover from, even if it costs more and takes longer to do. As robotic surgery becomes more common and its tech nology improves, it is likely to become a major part of both simple and complicated pediatric urology treatments in the future. Cite this article as: Kırlı EA, Önal B. An overview of robotic surgery in pediatric urology: Techniques, outcomes, and future prospects. Turk Arch Pediatr. Published online November 26, 2025. doi:10.5152/ TurkArchPediatr.2025.25218.

In patients with spina bifida (SB), even if kidney function is normal at birth, the risk of developing chronic kidney failure later in life is high due to neurogenic deficits that impair bladder emptying as the child grows. The aim of this study is to investigate the correlation between neurological deficits and structural anomalies, which dominate the clinical presentation in children with spina bifida, and renal cortical function using Tc99m-labeled DMSA (Dimercaptosuccinic acid) scintigraphy. 206 pediatric cases (100M, 106 F; age 0-18 years, mean:7.2) with SB who underwent DMSA scintigraphy for recurrent urinary tract infections (RUI) were included in this retrospective study. In 78 cases SPECT/CT (Single Photon Emission Computed Tomography) was used for demarcation of the anatomical structures. clinical findings, renal functions, structural and neurological anomalies of the patients, the history of urinary tract surgery, the frequence of RUI and vesicoureteral reflux (VUR), the frequency of Clean Intermittent Catheterization (CIC), prophylactic antibiotic use, hypertension, proteinuria, ultrasound findings and serum urea-creatinine levels. The patients were grouped according to the severity of neurological deficits. DMSA scintigraphy findings were compared with the clinical data and the severity of ND. Among 206 patients with SB, 126 had severe neurogenic dysfunction (ND), 41 had moderate ND, and 39 had no ND. A total of 117 children presented with complicated meningomyelocele at birth and underwent surgical repair. Ventriculoperitoneal shunt implantation was performed in 104 cases, while 2 had cervical SB and 1 had thoracolumbar SB. Neurogenic bladder was identified in 199 patients. Clean intermittent catheterization (CIC) was performed by 156 patients, and 134 received prophylactic antibiotic therapy. Unilateral renal agenesis was detected in 8 cases, and horseshoe kidney anomaly in 5 cases. When kidneys were evaluated separately, among a total of 404 renal units, stage ≥3 hydronephrosis was observed in 38 units, and stage ≥2 VUR was detected in 73 units on voiding cystourethrograms (VCUG). Ultrasound revealed structural renal dysmorphism in 176 renal units. The incidence of ≥stage 2 VUR on VCUG was significantly higher in children with dysmorphic kidneys compared to those without dysmorphism (26% vs. 13%, p = 0.01). A significant positive correlation was found between structural renal dysmorphism and cortical defects on DMSA scintigraphy. Cortical defects were detected in 74% of patients with dysmorphic kidneys, compared with 21% of those without ( p = 0.001). DMSA scans showed cortical damage in 66% (44 renal units) with ≥stage 3 VUR and in 38% (128 renal units) with stage ≤2 VUR on VCUG. Overall, cortical defects consistent with renal scarring were observed in 174 renal units on DMSA scintigraphy. The presence of renal cortical damage was significantly associated with the severity of ND. The rate of cortical damage was 52% in children with severe ND, 39% in those with moderate ND, and 28% in patients without ND (p = 0.008). In 78 children who underwent SPECT/CT imaging, planar DMSA images from 11 children were re-evaluated using anatomical correlation data. CT was performed as a low-dose anatomical correction procedure. This study demonstrated that renal scarring and cortical loss are common in children with spina bifida. Renal dysmorphism, vesicoureteral reflux, and neurogenic bladder contribute significantly to renal parenchymal injury. Furthermore, the severity of neurogenic dysfunction correlates with the extent of cortical loss. DMSA scintigraphy remains a reliable, non-invasive modality for the assessment of renal cortical function in children with SB. •Cortical loss in the kidneys increases mortality and morbidity in patients with spina bifida. •DMSA scintigraphy is highly valuable in demonstrating cortical function. •Over the past three decades, patients with spina bifida have achieved longer life expectancy due to advances in medical care. • Contrary to common belief, DMSA scintigraphy still plays an effective role in the follow-up and management of this patient group forthe preservation of renal function. It remains valuable in assessing and preserving cortical function in adult patients with spina bifida.

Background: Vesicoureteral reflux (VUR) is a prevalent congenital urinary tract anomaly in children, often associated with recurrent urinary tract infections (UTIs), renal scarring, and long-term complications such as hypertension and chronic kidney disease. The optimal management of primary VUR—particularly in intermediate grades—remains debated, with both conservative and endoscopic treatments widely used. Objective: To compare clinical and functional outcomes of endoscopic injection therapy versus conservative management in pediatric patients with primary VUR, focusing on reflux resolution, UTI recurrence, renal scarring, and renal function. Methods: This retrospective study included 70 pediatric patients with primary VUR treated at a tertiary center between 2015 and 2018. Thirty-five patients underwent endoscopic subureteric injection with dextranomer/hyaluronic acid copolymer, and 35 received conservative management with antibiotic prophylaxis. Comparative analysis assessed changes in VUR grade, recurrence of UTIs, renal scarring (via technetium-99m dimercaptosuccinic acid [DMSA] scintigraphy), renal function by kidney side, and serum creatinine levels. Results: Endoscopic treatment achieved complete reflux resolution in 74.3% of cases. A significant reduction in reflux grade and improvement in right kidney function were observed in the intervention group (p &lt; 0.001). The conservative group showed higher rates of recurrent febrile UTIs and no significant improvement in renal function. Renal scarring was present in both groups but slightly less frequent following endoscopic therapy. Post-treatment left kidney function was significantly higher in the conservative group (p = 0.020), likely reflecting baseline differences. Conclusions: Endoscopic injection therapy is a safe and effective treatment for moderate-to-high-grade VUR in children, associated with superior reflux resolution and better infection control compared to conservative management. Conservative therapy remains appropriate for select low-grade cases but may confer higher risk for recurrent infections and limited renal recovery. Individualized treatment selection is essential to optimize pediatric VUR outcomes.

To assess the efficacy and safety of robot-assisted ureteral reimplantation (RUR) ± psoas hitch/Boari flap using anti-reflux techniques for distal ureteral stenosis, with a focus on the prevalence and clinical significance of postoperative reflux-related symptoms. This prospective study included 76 patients who underwent RUR ± psoas hitch/Boari flap with an anti-reflux technique between November 2018 and November 2023. Anti-reflux methods included submucosal tunneling or nipple valve reconstruction. Patient demographics, symptoms, laboratory findings, imaging results, perioperative data, complications, and follow-up outcomes were analyzed. Surgical success was defined as symptom relief, improved or stable hydronephrosis, and preserved renal function. All 76 procedures were completed successfully, with a median operative time of 141min and a median blood loss of 20 mL. The overall surgical success rate was 94.5%. During a median follow-up of 13.9 months, 50 patients experienced complete symptom resolution, while 22 reported symptom improvement. Eleven patients reported reflux-related symptoms, such as flank pain during urination, while postoperative vesicoureteral reflux (VUR) was detected in 5 patients via cine magnetic resonance urography. No patients required secondary surgical intervention, and symptoms either improved or remained stable over time. Robot-assisted ureteral reimplantation ± psoas hitch/Boari flap with an anti-reflux technique is a safe and effective treatment for distal ureteral stenosis. Postoperative reflux-related symptoms do not necessarily indicate VUR and should not be the sole criterion for further intervention.

Introduction: Vesicoureteral reflux (VUR) is a frequent pediatric urological anomaly associated with recurrent urinary tract infections and renal scarring. Evidence on robot-assisted extravesical ureteral reimplantation (RALUR-EV) continues to grow; however, reports from Latin America remain limited. Objectives: We report an initial single-center experience with transperitoneal RALUR-EV (Lich–Gregoir) in a public pediatric hospital in Ecuador, detailing operative metrics, perioperative outcomes, and short-term radiographic efficacy using standardized definitions. Methods: A retrospective, observational study was conducted at a public tertiary referral center in Quito (January 2021–May 2025). Consecutive children (0–17 years) with VUR or ureterovesical junction (UVJ) obstruction who underwent RALUR-EV with the Lich Gregoir technique were included. The primary outcome was radiographic resolution of VUR at 3–6 months on voiding cystourethrogram. Secondary outcomes were operative times (total, console, docking), length of stay, postoperative UTI (culture-confirmed), and complications (Clavien–Dindo). Analyses were descriptive; success was reported as both evaluable-only and intention-to-treat (ITT). The study received institutional ethics approval. Results: Nine children were included (median age 4.4 years; 5 girls). Eight had VUR (5 unilateral, 3 bilateral); one had isolated UVJ obstruction. Procedures were left-sided in 7 cases and right-sided in 2. Median total operative time was 135 min (IQR 129–153); median console and docking times were 120 and 15 min, respectively. No intraoperative complications or conversions occurred. Median length of stay was 4 days (IQR 3–4). Two culture-confirmed postoperative UTIs occurred (2/9; Clavien II); no complications ≥ III were observed. Postoperative imaging was available in 6/9 cases (66.7%): radiographic resolution was 6/6 (100%) overall and 5/5 (100%) among VUR-only. ITT success was 6/9 (66.7%) overall and 5/8 (62.5%) for VUR-only. Conclusions: Transperitoneal RALUR-EV is feasible and safe in a public tertiary setting, with early effectiveness comparable to international series. Standardized pathways, structured follow-up, and multicenter collaboration are warranted to confirm durability and support broader regional adoption.

Tubularized bladder mucosa technique was introduced for managing recurrent vesicoureteral reflux after failed reimplantation. Its application in cases of primary vesicoureteral reflux has not previously been reported. This prospective cohort study compares the tubularized bladder mucosa technique with the established Politano-Leadbetter procedure for the treatment of primary vesicoureteral reflux. Patients with a confirmed diagnosis of primary vesicoureteral reflux who met the inclusion criteria were enrolled. They were prospectively assigned to either the tubularized bladder mucosa group or the Politano-Leadbetter group. The outcomes included vesicoureteral reflux recurrence rates at 3 months, febrile urinary tract infection incidence and postoperative development of ureterovesical junction stenosis. Between January 2024 and January 2025, 56 children (84 ureters) with median age 38.07 months were were enrolled and assigned to either tubularized bladder mucosa (27 patients/40 ureters) or Politano-Leadbetter group (29 patients/44 ureters). The tubularized bladder mucosa group demonstrated significantly shorter operative times (108.15 ± 16.25 vs. 123.79 ± 25.67min, p = 0.018). During the 3-month follow-up, no significant differences were observed between the two groups in terms of vesicoureteral reflux recurrence rate (p = 0.43) or febrile urinary tract infection rate (p = 0.97). No cases of ureterovesical junction stenosis occurred in either group. This study demonstrates that the tubularized bladder mucosa technique is a safe and effective treatment treatment for primary vesicoureteral reflux, with excellent short-term outcomes comparable to those of conventional procedures. Its distinct advantages - including procedural simplicity, minimal tissue dissection, and shorter operative duration - position it as an ideal candidate for pneumovesicoscopic adaptation. ChiCTR2400081850; Date: March 15th, 2024.

Objectives: The objectives of this study were to evaluate the postnatal outcomes of neonates with antenatally detected hydronephrosis (ANH), to determine the prevalence of associated urinary tract anomalies such as pelviureteric junction obstruction (PUJO), vesicoureteral reflux (VUR), and posterior urethral valves (PUV), and to assess the requirement for surgical versus conservative management Methods: This prospective observational study included 60 neonates diagnosed with ANH based on antenatal ultrasound criteria (anteroposterior renal pelvic diameter &gt;4 mm in the second trimester or &gt;7 mm in the third). Postnatal evaluations included serial ultrasonography and, in selected cases, micturating cystourethrogram. Hydronephrosis was graded using the Society for Fetal Urology system. Primary outcomes included resolution rates, incidence of urinary tract anomalies, surgical intervention rates, and urinary tract infection occurrence. Data were analyzed using SPSS v23. p&lt;0.05 was considered statistically significant. Results: Among 60 infants, 68.3% were male, with a male-to-female ratio of 2.2:1. Hydronephrosis was unilateral in 54 cases (90.0%) and most commonly left-sided. On initial postnatal ultrasound, 63.3% had mild, 25.0% moderate, and 11.7% severe hydronephrosis. Till the time of final follow-up, 44 (73.3%) cases resolved spontaneously without intervention. Specific pathologies identified were PUJO (11.7%), VUR (13.3%), and PUV (3.3%). Surgical intervention was required in 13.3% of infants. The reduction in hydronephrosis severity from antenatal to postnatal imaging was statistically significant (p&lt;0.001). Conclusion: Most cases of ANH resolve without any interventions. Serial postnatal follow-up using ultrasonography is important for identifying infants at risk for the presence of clinically significant anomalies such as PUJ obstruction, VUR, and PUV. Regular follow-up facilitates timely intervention while avoiding unnecessary procedures in low-risk cases.

Mice have been used as a valuable model for understanding pathophysiological mechanisms of urinary tract infection for almost six decades. Mice offer many advantages including genetic manipulation to test the role of genes and mechanisms, the availability of germ-free mice, and similarities to humans in innate immune defenses and the strain-dependent presence of vesicoureteral reflux. However, like with humans, the mouse bladder urine above the urinary sphincter has generally been assumed to be sterile. Yet, given the presence of urobiomes in other mammals and the emerging role of the human urobiome in the defense of the urinary bladder and upper urinary tract, the existence of a mouse urobiome should be critically examined as indigenous microbiota may influence experimental results. To determine if an indigenous murine urobiome exists, we obtained voided urine from two sets of female C57BL/6J mice during three different intervals using two different extraction and sequencing methods and analyzed them simultaneously by a single method. For one set, we also obtained urine by suprapubic aspiration, which we compared to the paired voided urine samples. We conclude that an indigenous murine urobiome exists and that voided urine contains post-urethral microbes.

BackgroundRecurrent UTIs (rUTIs) in children can lead to renal scarring and chronic renal failure, if not managed early. The current standard of care involves antibiotic prophylaxis, which benefits remain controversial. There is a need for new interventions, other than antimicrobial use, to reduce the occurrence of rUTIs as well as the identification of groups to target. Our objective was to describe the pediatric population most susceptible to rUTIs, including renal scarring and adverse events associated with prolonged antibiotic use.MethodWe conducted a single-centre retrospective chart review of patients with rUTIs, diagnosed with urinary tract abnormalities or functional disorders, followed at the Centre hospitalier universitaire (CHU) Sainte-Justine urology clinic between January 2015 and December 2020. We described the population and evaluated the antimicrobial usage and uropathogens resistance patterns.ResultsIdentified patients with rUTI (n = 107) had underlying medical conditions such as Spina Bifida or neurogenic bladder (31%), double collecting system (22%), vesicoureteral reflux (42%) and ureteropelvic junction obstruction (7%). Almost all patients (87%) were prescribed antimicrobial prophylaxis, and a significant proportion developed resistance, with 70% of breakthrough UTIs being resistant to at least one drug, and 41% demonstrating multi-drug resistance.ConclusionWhile most patients received prophylaxis, it was not universally effective, leading to persistent concerns like renal scarring and adverse events associated with prolonged antimicrobial use. There is a critical need for the development of new strategies to prevent rUTI that would minimize reliance on antibiotic prophylaxis, given the escalating global threat of antimicrobial resistance.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12887-025-06273-5.

Selecting optimal therapeutic interventions for febrile urinary tract infection (f-UTI) is crucial to prevent complications such as kidney scarring. While current clinical guidelines provide risk-stratified imaging recommendations, they are largely based on Western populations and lack specific predictors for which children will ultimately require therapeutic interventions. This study aimed to establish risk stratification criteria for East Asian children with first-episode f-UTI. This retrospective single-center study analyzed patients aged 2–24 months with first-episode f-UTI. All patients underwent a standardized diagnostic and management protocol, including kidney–bladder ultrasound (KBUS) and voiding cystourethrography (VCUG), to ensure uniform evaluation. The primary outcome was “requirement for therapeutic intervention,” defined as one or more of the following: (1) urological surgery (2) antimicrobial prophylaxis (for vesicoureteral reflux grade ≥III) and (3) antimicrobial treatment for recurrent f-UTI. Multivariate logistic regression was performed to identify independent predictors associated with the interventions. A total of 216 patients were included (median age: 4 months). Overall, 59 patients required therapeutic interventions. Non-Escherichia coli infection (OR 3.3, 95% CI 1.3–8.7) and abnormal KBUS findings (OR 5.3, 95% CI 2.7–10.6) were identified as independent predictors. The sensitivity and specificity of the factors for predicting therapeutic intervention were 64.4% and 73.2%, respectively. This study identified non-E. coli infection and abnormal KBUS findings as key predictors for therapeutic interventions in East Asian children with first-episode f-UTI. These findings suggest that a more targeted approach based on these factors may optimize risk stratification and patient selection for VCUG, improving clinical decision-making.

ObjectivesTo develop a predictive model for symptomatic postoperative febrile urinary tract infections (UTIs) in children undergoing open reimplantation for vesicoureteral reflux (VUR) and evaluate the association with VUR recurrence.Patients and methodsThis multicentre retrospective study included children with unilateral VUR (grades III–V) who underwent open Cohen or Lich‐Gregoir reimplantation (2010–2022), had recurrent febrile UTIs, and ≥1 year follow‐up. Analyses used 10‐pooled multiple imputation, with complete case for sensitivity. Full and Least Absolute Shrinkage and Selection Operator (LASSO) Weibull regression models with centre clustering, bootstrapping, and 10‐fold cross‐validation identified predictors. Prediction used demographic, clinical, procedural and antibiotic factors. The non‐scaled LASSO model informed the nomogram, evaluated using C‐indices, calibration and decision curve analysis (DCA). UTI and VUR recurrence were analysed via cumulative incidence.ResultsA total of 404 children (median age 8 (6–9) years; follow‐up 2.3 (2.0–3.3) years, 233 complete‐case) were analysed. Median preoperative febrile UTIs were four, 74.5% had antibiotic resistance and median postoperative prophylaxis was two days. The 3‐year cumulative incidence of postoperative UTI was 27.2% (95% CI: 22.9–31.6). LASSO‐significant predictors included operative time (HR 1.10, 95% CI 1.03–1.16); in sensitivity analyses, prior injection (HR 2.08, 95% CI 1.88–2.30) and postoperative antibiotic duration (HR 0.81, 95% CI 0.69–0.97) were also significant. The nomogram included preoperative fever, antibiogram resistance, renal defect, VUR phase, prior injection, surgical indication, catheterization, hospitalization and stenting. The model performed well (C‐indices = 0.743; calibration slope = 1), with DCA supporting clinical utility for 10–40% predicted risk. Recurrent VUR grade ≥II after 12 months (3.3%–12.7% at 1–3 years, n = 273) did not increase UTI risk.ConclusionsChildren with unilateral dilating VUR remained at risk of postoperative febrile UTIs. The nomogram can assist in identifying high‐risk children for targeted interventions, but requires external validation and refinement.

Clinician perspectives on imaging decisions for children with vesicoureteral reflux: A qualitative study.

Pelvic organ prolapse (POP) is common in elderly women but rarely causes upper urinary tract obstruction. We report the case of a 72-year-old multiparous woman (G5P5) with severe multicompartmental POP—grade IV uterine prolapse, grade III cystocele, and grade III rectocele—complicated by bilateral ureteropyelocaliceal dilatation. The patient also presented with cholestatic jaundice and a suspected hilar mass suggestive of cholangiocarcinoma. Cystoscopy showed ureteral orifices only visible after manual prolapse reduction, and cystography excluded vesicoureteral reflux. In the absence of acute infection or renal failure, and given her general frailty, we opted for conservative treatment with a vaginal pessary. After six weeks, the patient showed clinical improvement and imaging confirmed resolution of hydronephrosis. This case highlights the rare but significant impact of advanced POP on the upper urinary tract and supports pessary placement as a safe option in select frail patients.