Vesicoureteral Reflux Research Articles

Adherence to the Swedish paediatric guidelines for urinary tract infections.

To audit adherence to the Swedish paediatric guidelines for urinary tract infections (UTIs) in infants. Secondary objectives were to compare findings on imaging performed according to the guidelines with imaging without guideline support and to identify predictors of non-adherence. A prospective multicentre study of infants <1 year treated at paediatric hospitals for their first UTI. Adherence to recommendations was assessed for diagnosis, treatment, and imaging of the urinary tract with a follow-up period of 1 year. Vesicoureteral reflux on voiding cystourethrography and findings on renal scintigraphy according to recommendations were compared to imaging without recommendation. A total of 1357 infants were included. Adherence to recommended diagnostic procedures, antibiotic treatment, and imaging was 86.1%, 91.0% and 64.2%, respectively. Non-adherence to imaging recommendations was associated with inpatient management and smaller hospitals but was also more often due to excessive rather than refrained imaging. High adherence rates to diagnostic and treatment recommendations indicate careful attention to infant UTI among paediatricians. Lower adherence to imaging recommendations raises concerns regarding the guideline algorithm; particularly, early DMSA scans seem to be challenging for smaller hospitals.

Reduced kidney size and renal function of high-grade vesicoureteral reflux and intrarenal reflux in contrast-enhanced voiding urosonography

BackgroundVesicoureteral reflux (VUR) is a common pediatric urological condition associated with renal scarring, hypertension, and chronic kidney disease. Contrast-enhanced voiding urosonography (ceVUS) has emerged as a promising technique for diagnosing and evaluating VUR, with intrarenal reflux (IRR) often detected using this method. This study aimed to explore the relationship between different VUR grades and IRR on ceVUS, and assess the impact of VUR and IRR on kidney size and function.MethodsWe reviewed all ceVUS studies from January 2019 to December 2023 conducted at West China Hospital, Sichuan University. Both video clips and digital images of the ceVUS examinations were recorded. A total of 220 uretero-renal units (URUs) of 110 children (67 males and 43 females) were included in this study.ResultsAmong the 220 URUs assessed, 134 were diagnosed with VUR, and 25 exhibited IRR, with IRR exclusively observed in patients with grade II VUR or higher. Upon age and sex matching, the severity of IRR showed a significant positive correlation with high-grade VUR (P &amp;lt; 0.001). Notably, patients with high-grade VUR and IRR displayed reduced kidney size compared to those without VUR or IRR (P &amp;lt; 0.05). Furthermore, patients with high-grade VUR and IRR had reduced DMSA renal function (P = 0.015, P = 0.012, respectively), and patients with high-grade VUR had more DMSA scars (P = 0.027), compared with those without VUR or IRR.ConclusionOur study highlights that on ceVUS, the IRR degree was associated with the high-grade VUR, along with reductions in kidney size and renal function in patients with high-grade VUR and IRR.

Smooth Muscle Mechanosensitivity Generates and Maintains Pressure Gradients Across the Intestine.

The gut, the ureter, or the Fallopian tube all transport biological fluids by generating trains of propagating smooth muscle constrictions collectively known as peristalsis. These tubes connect body compartments at different pressures. We extend here Poiseuille's experiments on liquid flow in inert tubes to an active, mechanosensitive tube: the intestine. We use as a miniature myogenic peristaltic pump model, the fetal chicken gut, and measured the flow and contractile wave propagation as a function of the initially applied pressures and pressure gradients. We dissect the molecular pathways of smooth muscle mechanosensitivity by measuring the force generated by gut rings in different pharmacological conditions. We demonstrate that smooth muscle contractions in response to stretch or pressure is mediated by L-type Ca2+ channels and IP3 receptors. We show that this positive-feedback mechanosensitive behavior can spontaneously generate pressure gradients across gut segments initially subject to equal pressure; this same mechanism tends to stabilize initially applied pressure gradients; it can act jointly or compete with the pressure gradient induced by directional peristaltic waves. We demonstrate that high pressure differentials can reverse the physiological propagation direction of contractile waves imparted by interstitial cell of Cajal pacemaker activity. We find that flow rate increases with tube length, but that the maximum pressure differential generated depends solely on smooth muscle contractile force and on the initial resting pressure applied inside the organ. We provide fundamental mechanical and hydrodynamic insight into the myogenic mechanisms of transport in the gastrointestinal tract. We scale up our results to other human peristaltic organs and discuss their implications for pathophysiology of intestinal obstruction, vesicoureteral reflux and endometriosis.

Cathelicidin in Urinary Tract Diseases: Diagnostic, Prognostic and Therapeutic Potential of an Evolutionary Conserved Antimicrobial Protein

Despite being one of the most common infectious diseases, urinary tract infections (UTIs) still represent a challenge for clinicians to diagnose and treat, especially in the era of growing antibiotic resistance among uropathogenic bacteria. Recent studies investigating the pathophysiology of UTIs have discovered the prominent role of antimicrobial peptides in the urinary tract defense system. Cathelicidin is an evolutionary conserved antimicrobial peptide encoded by one single gene in humans. Except for being stored in neutrophil cytoplasmic granules, cathelicidin is produced by uroepithelial cells rapidly upon contact with a uropathogen, even before leukocytes invade the urinary tract. In addition to its bactericidal effect, cathelicidin acts as a chemoattractant for multiple immune cells and a potent inductor of numerous cytokine synthesis. Such a crucial role in the initial pathogenesis of a UTI makes cathelicidin a potential biomarker for an early UTI diagnosis. Indeed, multiple studies over the last two decades have proved the potential clinical utility of cathelicidin as a UTI diagnostic biomarker. Furthermore, since patients after the resolution of a UTI have been found to express a lower urinary cathelicidin level than healthy controls, decreased cathelicidin levels have been suggested as a risk factor for developing UTI recurrence. Therefore, measuring cathelicidin levels in urine might help in distinguishing patients with a higher risk for a recurrent UTI. Interestingly, except in UTIs, cathelicidin has also been evaluated in other urinary tract diseases and proposed as a biomarker for diagnosing severe vesicoureteral reflux (VUR) and for recognizing renal scar development in patients with VUR. Finally, a prominent role in UTI pathogenesis also makes cathelicidin an attractive therapeutic target for treating UTIs and, lately, different therapeutic agents up-regulating cathelicidin expression have been investigated in this matter. Therefore, the present review aims to summarize the current body of knowledge on the diagnostic, prognostic and therapeutic potential of cathelicidin in urinary tract diseases. For this purpose, three databases (Scopus, Medline and Web of Science) were extensively searched to cover all the published articles. This exhaustive review will update clinicians on the contemporary state of knowledge about the potential clinical utility of cathelicidin in urinary tract diseases and hopefully encourage further research, resulting in improvement in the current management of urinary tract diseases.

ChatGPT-4o's performance on pediatric Vesicoureteral reflux.

Vesicoureteral reflux (VUR) is a common congenital or acquired urinary disorder in children. Chat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence-driven platform offering medical information. This research aims to assess the reliability and readability of ChatGPT-4o's answers regarding pediatric VUR for general, non-medical audience. Twenty of the most frequently asked English-language questions about VUR in children were used to evaluate ChatGPT-4o's responses. Two independent reviewers rated the reliability and quality using the Global Quality Scale (GQS) and a modified version of the DISCERN tool. The readability of ChatGPT responses was assessed through the Flesch Reading Ease (FRE) Score, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG). Median mDISCERN and GQS scores were 4 (4-5) and 5 (3-5), respectively. Most of the responses of ChatGPT have moderate (55%) and good (45%) reliability according to the mDISCERN score and high quality (95%) according to GQS. The mean±standard deviation scores for FRE, FKGL, SMOG, GFI, and CLI of the text were 26±12, 15±2.5, 16.3±2, 18.8±2.9, and 15.3±2.2, respectively, indicating a high level of reading difficulty. While ChatGPT-4o offers accurate and high-quality information about pediatric VUR, its readability poses challenges, as the content is difficult to understand for a general audience. ChatGPT provides high-quality, accessible information about VUR. However, improving readability should be a priority to make this information more user-friendly for a broader audience.

Robot-assisted redo ureteral reimplantation in adults after failed primary surgery: technique and outcomes from two centers.

The aim of this study was to report our technical experience and mid-term outcomes of robot-assisted redo ureteral reimplantation in adults following failed primary ureteral reimplantation. Twelve patients underwent robot-assisted redo ureteral reimplantation from December 2020 to May 2022 at double centers. Surgical procedures included anti-reflux dismembered submucosal tunnel reimplantation, anti-reflux dismembered nipple reimplantation, and anti-reflux non-dismembered submucosal tunnel reimplantation. The perioperative variables were prospectively collected, and the outcomes were assessed. Twelve patients underwent 13 robot-assisted redo ureteral reimplantations. Anastomotic stenosis was the primary cause of redo surgery, accounting for 83.3% of cases. Additionally, 83.3% of patients had received balloon dilation, stent placement, and other urological treatments after primary surgery. All patients successfully underwent robot-assisted redo ureteral reimplantation without conversion to open or laparoscopic surgery. All patients underwent anti-reflux technique, with 9 patients undergoing submucosal tunnel reimplantation (75%) and 3 nipple reimplantation (25%). Psoas hitch was required in eight patients (66.7%). The mean operative time was 129.3±29.0 minutes. The median postoperative hospitalization time was 3.0 (IQR, 3.0, 3.0) days. At a mean follow-up of 15.7±5.9 months, all patients achieved complete success with no severe complication. Two patients (16.7%) still experienced vesicoureteral reflux related symptoms postoperatively, which improved compared to preoperatively. Robotic redo ureteral reimplantation is safe and effective. The success of redo surgery is attributed to preoperative nephrostomy, clearing the fibrous scar surrounding the ureter, appropriate selection of anti-reflux technique, and psoas hitch when needed.

Long-term Effectiveness of Amoxicillin Prophylaxis for Children with Primary Vesicoureteral Reflux

Aim: The use of antibiotic prophylaxis in the conservative treatment of vesicoureteral reflux (VUR) has a long historical precedent. In this study, we investigated the long-term efficacy of amoxicillin as antibiotic prophylaxis. Materials and Methods: A retrospective investigation was conducted to examine the clinical characteristics and follow-up results of patients with VUR who received amoxicillin prophylaxis for at least of six months. Results: A total of 44 patients were included in the study, comprising 13 girls (29.5%) and 31 boys (70.5%), with a mean age of 2.9±1.3 months. During a mean follow-up period of 27.4±19.4 months, nine patients (20.5%) experienced one urinary tract infection (UTI), while two patients (4.5%) had a febrile UTI. Antibiotic revision was performed in a total of four patients (9%), including two patients with a febrile UTI and two patients with gastrointestinal side effects. Conclusion: The long-term follow-up of patients with VUR who have been treated with amoxicillin prophylaxis has demonstrated that this is an effective and safe treatment option.

URINARY TRACT INFECTIONS IN CHILDREN: A REVIEW OF CURRENT INTERNATIONAL GUIDELINES

Urinary tract infections (UTIs) are the most common bacterial infections in children, which can lead to renal dysfunction, especially in young children in case of complicated and recurrent course. The aim of this review was to analyze all the latest clinical guidelines on UTIs in children in the world, starting from 2018 to 2024. We analyzed current data on the incidence of UTIs in children depending on age and gender. A classification is presented, the main problems of diagnosis, the most modern approaches to treatment and prevention are discussed. Analysis of these guidelines indicates that UTIs should be diagnosed in all young children with fever over 38 ° C without a focus of infection. Empirical antibacterial therapy should be started within the first 24-48 hours, oral antibiotics have an advantage, third-generation cephalosporins are more often used today, but it is necessary to take into account the data on antibacterial resistance in your region. All modern clinical guidelines emphasize the growth of resistant pathogens and their decreasing sensitivity to protected penicillins. All guidelines recommend identifying a "high-risk recurrence group" that includes children with vesicoureteral reflux (VUR), neurogenic bladder dysfunction, constipation, and "uncircumcised" boys under 1 year of age, and timely conducting imaging diagnostics for such children. According to almost all international guidelines for the diagnosis and treatment of UTIs in children, long-term antibacterial prophylaxis should be carried out only according to strict indications, mainly in children with high VUR and low VUR, taking into account the "risk" factors. In recent years, a large number of modern international clinical guidelines on UTIs in children have appeared. This review, which includes all the latest guidelines on UTIs in children in the world over the past seven years, will allow the use of accumulated modern knowledge in the practical work of pediatricians, pediatric nephrologists, and pediatric urologists in the Russian Federation.

A comparative study on the efficacy of laparoscopic ureteroureterostomy versus single ureteral bladder reimplantation in treating pediatric complete renal duplication.

To explore the therapeutic value of laparoscopic ureteroureterostomy compared to single ureteral bladder reimplantation in the treatment of pediatric complete renal duplication. This retrospective study included 80 pediatric patients with complete renal duplication who underwent surgical treatment at the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2022. Patients were divided into two groups based on the surgical approach: the laparoscopic ureteroureterostomy group (LUU group, n = 45) and the single ureteral bladder reimplantation group (UR group, n = 35). The two groups were compared in terms of operative time, intraoperative blood loss, number of stent placements, postoperative length of hospital stay, changes in ante-posterior diameter (APD) of the affected upper kidney pelvis before and after surgery, changes in upper ureteral diameter (UD), changes in upper renal cortex thickness (RCT) and variations in renal function. The LUU group demonstrated significantly shorter operative time (t = 3.480, P = 0.004), less intraoperative blood loss (t = -2.465, P = 0.0196), and reduced postoperative length of stay (t = 2.308, P = 0.027) compared to the UR group. There was no significant difference between the two groups regarding the number of stent placements (x2 = 0.762, P = 0.383). The UR group had four cases of long-term complications (two cases of anastomotic stricture, one case of vesicoureteral reflux, and one case of recurrent urinary tract infection), while the LUU group experienced one case of long-term complication (one case of anastomotic stricture), with no significant difference between groups (x2 = 1.493, P = 0.222). Both groups showed significant improvement in preoperative and postoperative APD, UD, RCT and affected side differential renal function (DRF). However, the differences in improvement values for upper kidney pelvis APD (ΔAPD; t = -0.032, P = 0.962), upper RCT (ΔRCT; t = -0.042, P = 0.957), ureteral diameter (ΔUD; t = 1.832, P = 0.079), and differential renal function (ΔDRF; Z = 1.895, P = 0.073) were not statistically significant. Both LUU and UR procedures are safe and effective in treating pediatric complete renal duplication. Compared to UR, LUU results in shorter operative time, less intraoperative blood loss, and reduced postoperative length of stay, while also causing less damage to the bladder.

Predicting chronic kidney disease progression in children with posterior urethral valves

ObjectivePosterior urethral valves (PUV) leads to early chronic kidney disease (CKD) and renal failure in some children, while others may maintain preserved kidney function even into adulthood. Our goal was to assess the association between early imaging features and CKD progression in children with PUVs. We hypothesized that imaging features identified on PRUS and VCUG would be associated with CKD progression and could` be used in conjunction with nadir creatinine to predict future renal function. MethodsFollowing individual institutional research board approvals, we performed a retrospective cohort study at two institutions. Electronic medical records were queried to identify all patients with a history of PUVs treated between 1990 and 2022. Children who presented in the first year of life and had their initial renal bladder ultrasound (RBUS) and voiding cystourethrogram (VCUG) performed within the first 90 days of life were included. The primary outcome, CKD progression, was defined as development of ESKD requiring dialysis or renal transplant or a decline in eGFR of greater than 50%. Clinical variables of interest included: findings on initial RBUS (urinoma, cystic dysplasia, solitary kidney), vesicoureteral reflux on initial postnatal VCUG (degree and laterality), and nadir creatinine. Hazard ratios (HRs) were calculated from Cox proportional hazards regression for univariate and multivariable regression. ResultsOut of 537 patients with PUVs, 274 met our inclusion criteria. Median follow up was 5.84 years (IQR 2-10.2), and 55 patients (20%) reached our primary outcome. Multivariable analysis showed the presence of any degree of vesicoureteral reflux, HR 3.1 (95% CI 1.62-5.93), and nadir creatinine, HR 5.53 (95% CI 4-7.64), were predictive of CKD progression When nadir creatinine within the first year of life is used as a sole predictor of CKD progression, the area under the receiver-operator curve was 0.89 (95% CI .83-.91). ConclusionsThis study confirms nadir creatinine as a strong predictor for CKD progression and ESKD in patients with PUVs. In our cohort, the presence of any degree or laterality of vesicoureteral reflux, was also a significant predictor for CKD progression.

Effect of overnight bladder drainage on posterior urethral valve sequelae: A randomized controlled trial

Posterior urethral valves may lead to persistent hydronephrosis (HN) and bladder dysfunction despite successful endoscopic valve ablation (EVA). To evaluate the effect of overnight bladder drainage (OBD) on upper urinary tracts and bladders of boys post EVA. Boys who had persistent HN after EVA were included. Patients were randomly allocated into OBD or no OBD groups. Timed voiding, anticholinergics and antibiotic prophylaxis were offered for both groups. After 12 months, patients were evaluated for compliance to OBD, daytime continence, febrile urinary tract infections (UTIs), renal function by serum creatinine and 99mTc-dimercaptosuccinic acid scan, HN, vesicoureteral reflux (VUR) and bladder morphology assessed by ultrasound and voiding cystourethrogram. Ninety-nine patients; 47 underwent OBD while 52 had no OBD, completed 12 months of follow-up. Compliance to OBD was reported in 87.04%. OBD group showed significant improvement in daytime continence, HN, VUR, bladder capacity and outline. However, febrile UTIs, renal function affection, bladder wall thickness and post-void urine residual were comparable between both groups. OBD might improve daytime continence, HN, VUR and abnormal bladder morphology that persist after EVA with no subsequent febrile UTIs or renal function affection. Yet, compliance to OBD remains a matter of concern.

Repeated ureterocystoneoimplantation in a 13-year child with recurrent vesicoureteral reflux in both segments of a doubled kidney

Introduction. Doubling of the urinary tract is a common developmental anomaly (0.8–1.0%). With complete doubling, vesicoureteral reflux (VUR) is detected in 66-72%, mainly in the lower segment. The aim of the work is to optimize the surgical treatment of VUR with doubling of the urinary tract by endoluminal plasty of the ureteral mouths and reimplantation of the ureter. Materials and methods. In a 13-year child, a laparoscopic longitudinal intravesical ureterocystoneoimplantation technique was used in conditions of ureteral length deficiency and a proximal intervertebral anastomosis was applied. Results. With the doubling of the urinary tract, a number of patients experience a recurrence of VUR, which determines the need for repeated reconstructive surgery. We present a clinical case of successful surgical treatment of recurrent VUR in both segments of a doubled kidney in a 13-year child. In the treatment, the technique of laparoscopic longitudinal intravesical ureterocystoneoimplantation was successfully applied in conditions of ureteral length deficiency and a proximal intervertebral anastomosis was applied. Conclusion. The performed surgical intervention meets the requirements of efficiency and safety and can be used in conditions of ureteral length deficiency in patients with recurrent VUR after previously performed reconstructive operations.

Diphallia with associated congenital malformations

BACKGROUND: Diphallia is an extremely rare congenital pathology in which children are born with a double penis. Diphallia is usually accompanied by systemic abnormalities, and their degree varies from no associated abnormalities to multiple abnormalities, including genitourinary, gastrointestinal, and musculoskeletal ones. Mortality among infants born with diphallia is higher due to infectious diseases accompanying developmental anomalies. CLINICAL CASE DESCRIPTION: The presented case is an example of diphallia with associated developmental malformations and the staged surgical treatment which resulted in good outcomes. DISCUSSION: Diphallia is treated surgically, but in each case, it is necessary to take into account the concomitant pathology. The main cause of death in children with diphallia are concomitant severe developmental defects, so the treatment is carried out in stages. In this case, because of the anorectal defect, intestinal obstruction was eliminated first by forming a sigmoid colostomy. Subsequently, after the child’s condition improved and he developed further, a staged surgical treatment was performed: removal of a lipoma in the cauda equina, simultaneous surgery (removal of the penis, elimination of the rectovesical fistula, lowering the rectum and forming the anus, elimination of vesicoureteral reflux, plastic surgery of the anterior abdominal wall), osteotomy with reduction of the right femur head and fixation with an L-shaped plate. The next stage of surgical treatment is the correction of the curvature of the spine and pelvic bones. CONCLUSION: In case of diphallia associated with other pathologies of organs and systems, especially of anorectal malformations, the initial formation of a double-barreled sigmostostomy helps to stabilize the child’s condition and to postpone radical surgery to the time more convenient for the patient and the doctor.

Utility of ureteral diameter ratio for clinical decision-making in children with vesicoureteral reflux: a systematic review and meta analysis.

The aim of this study was to investigate the utility of ureteral diameter ratio (UDR) as a tool to prognosticate and manage vesicoureteral reflux (VUR). Four scientific databases (PubMed, EMBASE, Web of Science, and Scopus) were systematically searched. Inclusion criteria were all studies in which UDR was used in prognostication and/or management of VUR. An independent assessment of the methodological quality was performed by two authors using the Newcastle Ottawa Quality scale. The statistical analysis was performed using a random-effects model. Thirteen studies (all retrospective) were included in this review. Pooling the data demonstrated a significantly lower UDR in the spontaneous resolution vs. persistence of VUR group (p = 0.001). Also, the pooled data showed significantly higher values of UDR in the breakthrough UTI group (p < 0.00001), those requiring operative intervention (p = 0.03), and those with persistence of VUR after endoscopic treatment (p < 0.0001). The estimated heterogeneity for two outcomes, i.e., spontaneous resolution and requirement of operative intervention in VUR were substantial and statistically significant. All except one of the included studies were of good methodological quality. However, further studies are required to identify the cut-off values for these respective outcomes.

Clinical characteristics of primary vesicoureteral reflux in children with an allergic constitution.

This study was designed to compare the clinical data of vesicoureteral reflux (VUR) in children with and without an allergic constitution. The clinical data of patients hospitalized with VUR due to a urinary tract infection (UTI) between September 1, 2019, and December 31, 2020, were retrospectively analyzed. The patients were divided into two groups: an anallergic constitution group (AC group) and a non-allergic constitution (NAC group), and their UTIs and VUR were compared at baseline and during the follow-up period. (1) Between September 1, 2019, and December 31, 2020, a total of 284 children were hospitalized at Shengjing Hospital Affiliated to China Medical University due to a UTI. These children included 37 cases with primary VUR and 247 cases without VUR (including 59 cases of non-VUR urinary malformation). The proportion of children with an allergic constitution was significantly higher in the patients with VUR than it was in those without VUR or with other urinary malformations (72.97% vs. 48.18% vs. 50.85%, P = 0.005, 0.032). (2) At baseline, the levels of immunoglobulin and immunoglobulin E in the AC group were significantly higher than those in the NAC group (P = 0.042, 0.017). (3) During the follow-up period, the number of recurrent UTI cases in the AC group was significantly higher than that in the NAC group (0.70 ± 0.91 vs. 0.10 ± 0.32, P= 0.005). The difference between the two groups in the VUR remission rate was not statistically significant (40% vs. 50%, P = 0.563). (4) During the follow-up period, the differences in the remission rates of recurrent UTIs and VUR in the two groups were not statistically significant. The incidence of having an allergic constitution is high in patients with VUR, and patients with an allergic constitution present with a higher frequency of recurrent UTIs.

Subureteric injection for the treatment of vesicoureteral reflux in transplant kidneys.

Treatment of de novo vesicoureteral reflux (VUR) into the transplanted kidney constitutes a clinical challenge. Herein, we present our data on patients who underwent endoscopic subureteric injection for the treatment of VUR following renal transplantation (RT) in our center. The patients who underwent endoscopic subureteric injection for VUR into the transplanted kidney after RT in our department between 2008 and 2023 were reviewed retrospectively. Indication for subureteric injection, age, gender, laterality, number of injections, amount of material used, renal failure etiology, auxiliary procedures, and treatment success were noted. All interventions were performed by pediatric urologists who also perform RT. During a median followup of 27.5 (4-160) months, 22 patients (17 women, 77.2%) and 23 transplanted ureters (13 right, eight left, one bilateral) were treated with subureteric injections. In all patients, the indications for subureteric injection were recurrent febrile urinary tract infection (UTI), and the grades of VUR varied between I and IV. Patients received a median of 1.65 cc (0.7-2.7) dextranomer-hyaluronic acid copolymer. In total, 10 RTs (eight from living donors, two from cadaveric donors) were performed in another center, whereas 13 RTs were carried out in our center (eight from cadaveric donors and five from living donors). Among the patients who were transplanted in our center, the rate of subureteric injections due to de novo symptomatic VUR after RT was 2.2% (13/593 patients). After subureteric injections, five patients required a second injection due to the recurrence of VUR. Ureteroureterostomy (to the native ureter) was performed in two patients who had further UTIs after the second endoscopic treatment. Eventually, 19/21 patients (90.4%) benefited clinically from the endoscopic treatment and none of the patients underwent re-do ureteroneocystostomy. It is noteworthy that the etiology of renal failure was VUR nephropathy in seven (31.8%) patients. Subureteric injection provides a high clinical success for the treatment of de novo VUR after RT.

Diagnostic accuracy of ureteric jet angle and location in children with vesicoureteric reflux: A retrospective study

AbstractBackgroundVesicoureteral reflux (VUR) is a common urological abnormality in children that can lead to urinary tract infections and renal scarring. Micturating cystourethrogram (MCU) is the gold standard for diagnosis but is invasive and involves radiation exposure. This study investigates the diagnostic accuracy of ureteric jet angle (UJA) and midline to ureteric orifice distance (MOD) measurements using colour Doppler ultrasonography as a non‐invasive alternative.ObjectivesTo determine the association between UJA and MOD with the presence and severity of VUR in children referred for MCU.MethodsThis retrospective diagnostic accuracy study in an Australian quaternary paediatric hospital included 42 children (68 renal units) referred for MCU to investigate suspected VUR. Colour Doppler ultrasonography was used identify the ureteric jets, permitting measurement of UJA and MOD, which were compared to MCU results (reference standard). Analysis included ROC curves, Mann–Whitney and Kruskal–Wallis tests.ResultsVUR was present in 25 of 68 units (36.8%). Thirty‐two males and 10 females included; mean age 10 months 18 days (range: 26 days to 8 years). Median UJA for VUR units 67.0° (IQR 46.0°) versus non‐VUR 51.0° (IQR 26.0°), p = 0.002. Median MOD for VUR units 8.9 mm (IQR 7.2 mm) versus non‐VUR 5.8 mm (IQR 4.2 mm), p = 0.006.Diagnostic AccuracyUJA: AUC 0.728 (95% CI: 0.590–0.866), optimal cut‐off 56.5°. MOD: AUC 0.701 (95% CI: 0.568–0.835), optimal cut‐off 6.7 mm.DiscussionUJA and MOD measurements show potential as non‐invasive indicators of VUR presence. However, they did not reliably differentiate between individual grades of VUR severity.RegistrationNot applicable.

Vesico-ureteral reflux diagnosis after initial kidney abscess: Results from a Paediatric Tertiary Hospital.

Guidelines regarding voiding cystourethrogram (VCUG) indications following a paediatric kidney abscess are lacking. This study evaluates vesicoureteral reflux (VUR) prevalence and outcome after a first kidney abscess. This retrospective study included all children presenting to a tertiary paediatric reference centre with de-novo kidney abscesses from 2011 to 2022, diagnosed through imaging (ultrasonography or computed tomography). VCUG's clinical utility was assessed by exploring outcomes related to interventions. Among the 17 patients (median age 9 months, IQR; 6 months-6 years), VCUG identified VUR in 7 (41%; 95% CI: 18-65%), including two with grade IV-V. Median abscess size was 19 mm (IQR; 14-27). 7/8 (88%) children with DMSA scan presented scars, including 4 with hypofunctioning (20%-44%), and one with a non-functioning kidney. Scarring on the DMSA scan was similar regardless of identified VUR. Six children had subsequent pyelonephritis. Three of the remaining 11 had grade I-III and two IV-V VUR. Surgery was required in four children overall: three for recurrent pyelonephritis and one for high-grade VUR and scars. Among initial kidney abscess cases, 41% had VUR, similar to children experiencing their first uncomplicated pyelonephritis. VCUG results guided antibiotic prophylaxis but not surgical decisions. We suggest considering VCUG following recurrent pyelonephritis/kidney abscess and/or kidney scarring.

Laparoscopic Lich - Gregoir ureteroneocystostomy versus open surgery: Are there benefits from the minimally invasive procedure?

The optimal treatment of vesicoureteral reflux is controversial. When patients need surgery, the gold standard is open vesicoureteral reimplantation. Despite the more frequent use of laparoscopy when managing vesicoureteral reflux, we have found scarce comparative studies comparing the open versus the laparoscopic Lich-Gregoir reimplantation. The aim of this study is to compare the open Lich-Gregoir reimplantation technique versus the laparoscopic approach, in patients with primary vesicoureteral reflux in terms of complications and the procedure´s success, to document the benefits of minimal invasion. This is a cross-sectional retrospective study of a single Institution, in which we collected the information of pediatric patients with primary vesicoureteral reflux from their clinical charts, in whom either an open or laparoscopic reimplantation following the Lich- Gregoir technique was performed, between January 1, 2013, and December 31, 2017. Patients with incomplete records were excluded. This was a non-probabilistic, consecutive case sample. The Chi-square test or Mann-Whitney´s U were used, as appropriate, to establish between-group differences. Sixty-eight patients were included, 27 in the open Lich-Gregoir group (OLG), and 41 in the laparoscopic Lich- Gregoir group (LLG). We found no statistical differences in operative times and mean hospital stay. Post-operative complications in the OLG versus the LLG group were similar. The open procedure was successful in 85.2% and in 90.2% laparoscopic cases, with no statistically significant difference between groups. We found no statistically significant differences between an open and a laparoscopic approach. The percentage of success was below the expected, this could be result of the large percentage of patients with high-grade reflux and the patients' complex anatomy in both groups. Our study is limited by the small number of patients and by its retrospective design. The laparoscopic approach with the Lich-Gregoir technique yields similar results to the open technique. However, in this study, we were unable to demonstrate any additional benefits from the laparoscopic approach.

Effect of early tethered cord release on urodynamic findings and lower urinary tract function in myelomeningocele patients.

Detecting neurological deterioration and diagnosing tethered cord syndrome (TCS) in patients with myelomeningocele (MMC) can be challenging due to the presence of symptoms at birth and the lack of objective indicators. This retrospective analysis focused on urological manifestations and evaluated whether tethered cord release (TCR) for TCS at an early stage could improve or stabilize video urodynamic study (VUDS) findings and lower urinary tract function. This study analyzed 55 of 64 children who underwent MMC repair at Miyagi Children's Hospital, Sendai, Japan, between 2003 and 2016. The follow-up duration for these children exceeded 6 years. Clinical records were reviewed, and surgical indicators and outcomes of TCR and preoperative and postoperative results of VUDS were evaluated. The duration of follow-up was mean ± SD (range) 12.6 ± 3.5 (6.0-19.0) years. TCR was performed on 27 (49.1%) of 55 patients with MMC, totaling 33 procedures. Five patients underwent 2 TCR procedures, whereas 1 received 3 TCR procedures. The mean ± SD (range) age was 7.5 ± 2.9 (2.2-12.7) years at the first TCR procedure (n = 27) and the mean (range) was 10.9 (10.1-11.7) years at the second TCR (n = 5); in addition, 1 patient underwent a third TCR procedure at age 15.9 years. There were no identified risk factors associated with the TCS. The first TCR procedure was performed due to worsened lower-extremity (LE) motor symptoms in 1 patient, worsened LE sensory symptoms in 3 patients, and worsened VUDS findings in 26 patients. After the procedure, LE motor symptoms improved in 1 patient (100%), LE sensory symptoms improved in 2 patients (66.7%), and VUDS findings improved in 18 patients (66.7%). Preoperative VUDS revealed urological deterioration characterized by a high-pressure bladder, reduced bladder capacity, increased detrusor overactivity (DO), and vesicoureteral reflux. Postoperative VUDS showed improvements in bladder function, including decreased bladder pressure and DO, increased bladder capacity, and compliance. None of the patients underwent augmentation cystoplasty or had renal dysfunction. Routine VUDS can detect urological deterioration, which can be a significant indicator for early diagnosis of TCS. Performing TCR at an early stage is beneficial, not only to protect renal function but also to improve VUDS findings and lower urinary tract function in patients with MMC. It is important to explore a standardized approach for the diagnosis and treatment of TCS.