Voiding Cystourethrography Research Articles

MP53-11 URODYNAMIC FINDINGS IN PATIENTS AFTER FETAL MYELOMENINGOCELE UMBILICAL CORD PATCH CLOSURE

You have accessJournal of UrologyCME1 Apr 2023MP53-11 URODYNAMIC FINDINGS IN PATIENTS AFTER FETAL MYELOMENINGOCELE UMBILICAL CORD PATCH CLOSURE Cheryl Samuels and Jason Au Cheryl SamuelsCheryl Samuels More articles by this author and Jason AuJason Au More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We seek to characterize the urodynamic findings of patients after fetal myelomeningocele (MMC) closure with a novel umbilical cord (UC) patch. METHODS: After IRB approval, patient characteristics, ultrasound, urodynamic, serum creatinine, and voiding cystourethrogram (VCUG) data were extracted in a retrospective fashion from two patient cohorts from 2020-2022: study cohort was comprised of patients who had undergone fetal myelomeningocele closure with UC patch and a control cohort of standard postnatal myelomeningocele repairs without patch. Patients were excluded if there was incomplete one-year urodynamic data. Fisher’s Exact Test and unpaired T test were calculated (Graph Pad Prism 9). RESULTS: Fourteen patients were included for analysis: 6 UC patch and 8 controls. No differences in demographics were noted (Figure 1). No significant urodynamic or VCUG differences were noted (Figure 2). No significant differences in hydronephrosis, UTIs, serum creatinine or vesicostomy status were noted (Figure 3). CONCLUSIONS: Despite use of a novel UC patch for fetal MMC repair, no significant urodynamic differences are noted at one year. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e716 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cheryl Samuels More articles by this author Jason Au More articles by this author Expand All Advertisement PDF downloadLoading ...

MP53-20 INITIAL UROLOGIC EVALUATION FOR ANORECTAL MALFORMATIONS: A PCPLC RETROSPECTIVE

You have accessJournal of UrologyCME1 Apr 2023MP53-20 INITIAL UROLOGIC EVALUATION FOR ANORECTAL MALFORMATIONS: A PCPLC RETROSPECTIVE Jennifer Ahn, Caitlin Smith, Samuel Rice-Townsend, Lauren Nicassio, Jeffery Avansino, Megan Durham, Jason Frischer, Casey Calkins, Rebecca Rentea, Matthew Ralls, Megan Fuller, Richard Wood, Michael Rollins, Justin Lee, Ron Reeder, Belinda Dickie, Payam Saadai, Mark Cain, and Paul Merguerian Jennifer AhnJennifer Ahn More articles by this author , Caitlin SmithCaitlin Smith More articles by this author , Samuel Rice-TownsendSamuel Rice-Townsend More articles by this author , Lauren NicassioLauren Nicassio More articles by this author , Jeffery AvansinoJeffery Avansino More articles by this author , Megan DurhamMegan Durham More articles by this author , Jason FrischerJason Frischer More articles by this author , Casey CalkinsCasey Calkins More articles by this author , Rebecca RenteaRebecca Rentea More articles by this author , Matthew RallsMatthew Ralls More articles by this author , Megan FullerMegan Fuller More articles by this author , Richard WoodRichard Wood More articles by this author , Michael RollinsMichael Rollins More articles by this author , Justin LeeJustin Lee More articles by this author , Ron ReederRon Reeder More articles by this author , Belinda DickieBelinda Dickie More articles by this author , Payam SaadaiPayam Saadai More articles by this author , Mark CainMark Cain More articles by this author , and Paul MerguerianPaul Merguerian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologic anomalies such as hydronephrosis, solitary kidney, and vesicoureteral reflux are common in individuals with anorectal malformations (ARM). These can lead to renal damage if not detected and managed appropriately. Optimal detection and surveillance strategies have not yet been established. We aim to evaluate current urologic evaluation practices in individuals with anorectal malformation utilizing a multi-center registry. METHODS: We performed a multicenter retrospective study of children with ARM evaluated at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). We included all subjects with ARM who had a colostomy or PSARP within 12 months of birth and were also seen at a PCPLC site within 3 months of birth or ARM diagnosis. The primary outcome was the proportion of subjects undergoing urologic evaluation within 12 months of ARM diagnosis. The secondary outcome was proportion of screened subjects with urologic anomalies. We evaluated associations between urologic evaluation and clinical and sociodemographic characteristics. p-value <0.05 was considered significant. RESULTS: A total of 427 subjects with ARM from 13 institutions were included, and only 22% (93/427) of subjects had a recorded urologic evaluation within 12 months of ARM diagnosis. For imaging studies performed within 12 months of ARM diagnosis, 25% (112/427) underwent renal ultrasound, 8% (34/427) had a voiding cystourethrogram (VCUG), and 1% had a renal scan performed. Kidney anomalies were reported in 58 subjects, with hydronephrosis seen most commonly, followed by horseshoe kidney and ectopic kidney. Vesicoureteral reflux was detected in 20 subjects, comprising 59% of those who had a VCUG performed. On univariate analysis, having a renal ultrasound performed within 12 months of ARM diagnosis was not associated with clinical characteristics, such as ARM complexity or spine/sacrum status. It was associated with Hispanic ethnicity (OR 1.73, CI 1.04, 2.84, p=0.034). CONCLUSIONS: Timely urologic evaluation was recorded only 25% of the time, with a high proportion yielding expected anomalies such as hydronephrosis and vesicoureteral reflux. This suggests many potentially harmful conditions may be going undetected or unrecorded, and routine early evaluation should be standardized. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e720 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Ahn More articles by this author Caitlin Smith More articles by this author Samuel Rice-Townsend More articles by this author Lauren Nicassio More articles by this author Jeffery Avansino More articles by this author Megan Durham More articles by this author Jason Frischer More articles by this author Casey Calkins More articles by this author Rebecca Rentea More articles by this author Matthew Ralls More articles by this author Megan Fuller More articles by this author Richard Wood More articles by this author Michael Rollins More articles by this author Justin Lee More articles by this author Ron Reeder More articles by this author Belinda Dickie More articles by this author Payam Saadai More articles by this author Mark Cain More articles by this author Paul Merguerian More articles by this author Expand All Advertisement PDF downloadLoading ...

Modified Martius Flap Urethroplasty: A New Technique

Introduction: Female urethral strictures are rare, and there is no consensus on proper surgical treatment. The literature is primarily limited to case reports and small case series. Surgical treatment has frequently been extrapolated from male urethroplasty techniques. However, female urethroplasty differs significantly from male urethroplasty because it is performed directly across the urinary sphincter.1 We describe our rationale and technique for female ventral urethroplasty utilizing a modified Martius flap. Materials and Methods: Two female patients, aged 46 and 58 years, with chronic urethral strictures underwent a ventral modified Martius flap urethroplasty. After guidewire and open-ended ureteral stent placement across the stricture, an inverted U-flap incision was made from the distal urethra to the bladder neck. A full thickness incision into the urethral lumen was made, extending past the bladder neck, and sounded with a 30F urethral sound. An ~5 × 2 cm portion of nonhair bearing inner labia tissue was harvested and mobilized on the anterior pedicle of a Martius flap. This was then tunneled under the vaginal wall and rotated over the area of the urethral defect. The flap was sutured in place with two 4-0 polyglactin running suture lines, covering the entire gap in the urethra with good mucosal apposition. The remaining fatty tissue of the Martius flap was rotated over the suture lines, adding an extra layer to the repair. The inverted U flap incision was closed over the repair and the skin edges of the Martius flap harvest site were closed in two layers with a deep 2-0 polyglactin layer and a superficial 4-0 poliglecaprone subcuticular suture, resulting in a cosmetic closure. Results: Postoperative voiding cystourethrogram revealed an open bladder neck and no recurrent stricture for both patients. Average Uroflow peak flow was 18 mL/s. The patients had no complaints of stress incontinence (SUI) and a negative cough leak test at 1 month follow-up. At 6 months follow-up, both patients continued to deny any SUI and had no obstructive voiding complaints with minimal post-void residuals. Conclusions: Our technique using a ventral approach to urethroplasty in women with a Martius flap is effective in the management of female urethral stricture disease. This approach offers lower risk of damage to the sphincter, avoids possible clitoral nerve injury, allows for better maintenance of urethral support, and is an approach familiar to most female pelvic medicine and reconstructive surgeons. Music utilized in video obtained royalty-free from (www.bensound.com). No competing financial interests exist. The authors have received and archived patient consent for video recording and publication in advance of video recording procedure. Runtime of video: 6 mins 33 mins This project was presented at the following academic conferences: Arizona Urological Society, August 1, 2021; Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), February 25, 2022; American Urological Association (AUA) General Meeting, May 14, 2022 (https://doi.org/10.1097/JU.0000000000002586.08).

Viability of contrast-enhanced voiding urosonography as an alternative to fluoroscopy during video urodynamics.

Pediatric urodynamic studies are performed to evaluate bladder function, commonly in conjunction with a voiding cystourethrogram (VCUG). Contrast-enhanced voiding urosonography (CeVUS) has been approved in the evaluation of vesicoureteral reflux and has been shown to have equal or superior diagnostic value to VCUG. In this technical innovation, we have shown that ultrasound contrast agent microbubbles are compatible with the equipment used for urodynamic evaluation. We have also shown that it is feasible to use contrast ultrasound in pediatric urodynamic examinations.The purpose of our study was to assess the technical feasibility of CeVUS during urodynamics with an in vitro test followed by a vivo evaluation.This single-center prospective study enrolled 25 patients aged 0-18years who underwent CeVUS instead of VCUG at their regularly scheduled appointment.During the in vitro saline experiment, the radiologic and urologic equipment were found to be compatible. Microbubbles were observed at flow rates of 10 and 20 ml/min.

Utility of Positional Instillation of Contrast Cystography for Diagnosing Occult Vesicoureteral Reflux in Children: A Report of Two Cases.

Positional instillation of contrast (PIC) cystography is effective for detecting occult vesicoureteral reflux (VUR), which can not be revealed by standard voiding cystourethrography (VCUG). We experienced two cases of young female patients; one had repeated urinary tract infection with a negative VUR on standard VCUG, and the other had findings suggestive of reflux hydronephrosis and intolerance of standard VCUG. They underwent PIC cystography, and occult VUR was detected in both cases. Both were successfully treated with simultaneous endoscopic injection therapy with dextranomer/hyaluronic acid. PIC cystography is useful for detecting occult VUR in children with negative VUR findings on standard VCUG or who are unable to tolerate standard VCUG.

Vesicoscopic ureteral reimplantation with a modified Glenn-Anderson technique for vesicoureteral reflux

Vesicoureteral reflux (VUR), commonly referred to as urinary reflux, is one of the most common congenital urological anomaly to occur during childhood. Historically, open vesicoureteral reimplantation has been the gold standard in the surgical treatment of VUR. Currently, vesicoscopic ureteral reimplantation is used as a minimally invasive alternative to open ureteral reimplantation. Most vesicoscopic procedures are performed using the transtrigonal Cohen technique. As a non-transtrigonal technique, the vesicoscopic Politano-Leadbetter technique is also performed, but requires dissection outside the bladder under a narrow surgical field, and in boy carries a risk of vas deferens injury. This study evaluated surgical outcomes and perioperative findings for vesicoscopic ureteral reimplantation using a modified Glenn-Anderson technique in children with VUR. Eighteen consecutive children who underwent vesicoureteral ureteral reimplantation using a modified Glenn-Anderson technique were included in this study. The surgical procedure was explained and surgical outcomes and perioperative findings were evaluated. Patients comprised 9 boys and 9 girls with 29 cases of ureteral reflux (7 unilateral cases, 11 bilateral cases). All procedures were performed laparoscopically, with no cases requiring conversion to open surgery. Median operative time was 143min for unilateral VUR and 194min for bilateral VUR. Only one case showed a complication (Clavien-Dindo grade 1). The remaining 17 cases showed no complications, with removal of the urethral catheter and discharge 2 days postoperatively. Seventeen of the 18 cases underwent postoperative voiding cystourethrography, showing no VUR in all cases. Vesicoscopic ureteral reimplantation is a minimally invasive alternative to open surgery, with most procedures performed using a transtrigonal Cohen technique. Regardless of whether the surgery is open or laparoscopic, a disadvantage of the Cohen technique is that postoperative transureteral treatment may not be possible. The Politano-Leadbetter technique has been reported as a non-transtrigonal technique. However, this requires dissection outside the bladder under a narrow surgical field, and carries a risk of vas deferens injury in boys. In this study, vesicoscopic ureteral reimplantation using a modified Glenn-Anderson technique provided good surgical outcomes with minimal perioperative complications and easy manipulation under a wide field of view. Although many minimally invasive treatments are available, vesicoscopic ureteral reimplantation using a modified Glenn-Anderson technique is safe and effective for patients with VUR 4 years old. To demonstrate the further utility of this procedure, long-term outcomes and safety evaluations are needed in a larger number of cases.

Concurrence of Vesicoureteral Reflux and Gastroesophageal Reflux Disease in Children

Background: There is anecdotal evidence regarding the simultaneous occurrence of vesicoureteral reflux (VUR) and gastroesophageal reflux disease (GERD), which indicates the probability of pathophysiological commonality. Objectives: In the present study, we evaluated the concurrence of VUR and GERD in children candidates for the voiding cystourethrogram (VCUG) study. Methods: This cross-sectional study was conducted on 62 children between 1 and 14 years old referred to a tertiary referral teaching hospital for VCUG in 2019 - 2020. All subjects underwent ultrasound to assess GERD and VCUG to rule out VUR. Results: According to the ultrasound assessment, 14.5% of subjects were diagnosed with GERD: 8.3% in males and 18.4% in females. VUR was detected in 48.4% of children (50.0% in males and 47.4% in females) using VCUG. Overall, seven (23.3%) had concomitant VUR and GERD: 4.2% in boys and 15.8% in girls, indicating no difference between the two genders (P = 0.125). The prevalence of concurrent GERD and VUR was also independent of age. In the two groups with and without VUR, the prevalence of GERD was 23.3% and 6.2%, respectively, indicating a relative risk of 2 (95% confidence interval [CI]: 1.32 - 3.02, P = 0.001). Conclusions: Regarding the relationship between GERD and VUR, despite the deletion of physiologic GER cases, the pathophysiological overlap between the two phenomena could be considered.

Retrograde urethrography in children: a decade of experience at a children's hospital.

Retrograde urethrography (RUG) is a radiologic procedure that optimizes imaging evaluation of the urethra, particularly in settings of difficulty with micturition or urethral injury. To review our experience with RUG at a large pediatric radiology practice. We conducted a retrospective review of medical records and fluoroscopic images of RUGs performed from January 2010 to December 2020. We identified 180 RUG exams (median frequency 17 exams per year), all in male children (median age 13years). The most common indications were stricture (42%; n=76), postsurgical evaluation (34%; n=62) and trauma (16%; n=29). The most commonly used catheter was Foley (40%; n=72), with a median catheter size of 5 French (Fr) for infants younger than 1year, 7 Fr for children ages 1-5years and 8 Fr for children older than 5years. About a third of the children (57; 32%) had combined voiding cystourethrography (VCUG)-RUG exams. Water-soluble contrast agent, either 17% or 43% Cysto-Conray, was used. Most RUG exams were normal (46%; n=83). The most common urethral pathology was stricture (30%; n=54), commonly involving a bulbar urethra (n=26). Urethral trauma was seen in 11 children (6%), 10 bulbar and 1 membranous. Most children with stricture were surgically treated (n=40; 74%), whereas most children with trauma were conservatively treated (n=8; 73%). The remaining diagnoses included diverticula, polyps, valves, fistulas and duplications, constituting <17% of our sample; most of these were surgically treated. Four exams (2%) were non-diagnostic. RUG showed 89% sensitivity and 97% specificity compared to cystourethroscopy/VCUG findings. Technical difficulties occurred in 14 (8%) children (e.g., pain or inappropriate catheter seal). Our experience indicates that when catheterization techniques are properly tailored, RUG provides a useful and successful radiologic method of evaluating the pediatric male urethra.

Peri-Urethral and Anterior Vaginal Wall Masses: Does Radiological Imaging Change the Predicted Diagnosis?

This study aims to determine the accuracy of radiological imaging compared with surgical pathology in patients with periurethral (PU) and anterior vaginal wall (AVW) lesions. This study is a retrospective analysis of 126 women who underwent surgical treatment for PU and AVW masses between 2011 and 2020. Clinicopathological data were extracted along with radiological findings from medical records. The primary outcome was the diagnostic accuracy of preoperative imaging compared to the gold standard, pathological diagnosis. The secondary outcome was the rate of imaging correcting the clinical diagnosis. A total of 126 women with a median age of 42 underwent surgical treatment for PU and AVW masses. The most diagnoses were periurethral cysts (PUC) (52%) and urethral diverticulum (UD) (39%). Clinical diagnosis was accurate in 102 cases (81%) for the group of pathological diagnoses. Magnetic resonance imaging (MRI) and transvaginal ultrasound (TV US) were performed in 82 (65%) and 22 (17%) cases. The accuracy of MRI and TV US for the diagnosis of PU and AVW lesions was 76% and 82%, respectively. MRI and TV US corrected the clinical diagnosis in five (6%) and two (9%) cases, respectively. Voiding cystourethrography (VCUG) and double balloon urethrography (DBU), each performed in six (5%) cases, were accurate in four (67%) and three (50%) cases. No statistical difference was found for any imaging modality compared to clinical diagnosis. Clinical diagnosis based on pelvic and cystoscopy examinations was sufficient for diagnosing PU and AVW masses and was not significantly different from imaging diagnosis. Imaging may be helpful with preoperative surgical planning in selected cases.

Imaging in urethral stricture disease: an educational review of current techniques with a focus on MRI.

Urethral stricture disease refers to narrowing of the urethral lumen obstructing the flow of urine. Urethral strictures can significantly impact daily life due to incontinence, incomplete emptying, hesitancy, and increased risk of urinary tract infections. Imaging is central to the evaluation of suspected urethral stricture, as assessment of stricture length and severity is crucial for guidance of surgical management. The currently employed modalities include radiography, chiefly retrograde urethrography (RUG) and voiding cystourethrography (VCUG); magnetic resonance urethrography (MRU); and sonourethrography (SUG). MRU has become a recent focus of research as it provides high spatial resolution, multiplanar capacity, and soft tissue type differentiation for evaluation of periurethral compartments and concurrent soft tissue defects. The protocol for MRU has evolved over the years to now include dynamic micturition imaging and image reconstruction options. In this review, we discuss each of the imaging modalities used in the diagnosis and evaluation of urethral stricture and provide an overview of literature on MRU over the last decade, including suggested indications that have not yet been incorporated into current guidelines. We delineate scenarios where special diagnostic imaging beyond radiography is beneficial, providing examples from our practice and description of our techniques for each modality.

Complex urinary reconstruction in a case of genitourinary tuberculosis post micturating cystogram bladder perforation

Voiding cystourethrogram (VCUG) is done for lower urinary tract disorders. Even though easy to perform, can be associated with serious complications if not done properly. A sound knowledge of the technicalities and what is being expected of the study is essential. Different factors such as patient age, underlying diseases, and proper technique are important factors to be kept in mind. Here, we present a 26-year-old female of genitourinary tuberculosis (GUTB) with lower urinary tract symptoms (LUTS). While undergoing evaluation for LUTS refractory to medical therapy, VCUG study was done which was complicated by bladder perforation with spillage of contrast into the peritoneal cavity. Patient was managed conservatively and later complex triple urinary reconstruction was done by left ileocalicostomy with orthotopic neobladder (ONB) with right ureteric reimplantation. While performing VCUG, proper technique should be used and due principals to be followed, especially in cases of GUTB by the attending doctor to avoid rare but grievous complications like bladder perforation. Complex reconstructive surgery is possible but is extremely challenging and should be offered to the patients with very good results.

Cutoff Value of Ureteral Diameter Ratio for Predicting Spontaneous Resolution of Vesicoureteral Reflux

Purpose: The five-grade international scale for vesicoureteral reflux (VUR) has been the mainstay for describing VUR severity. The concept of the distal ureteral diameter to the L1–L3 vertebral body distance ratio has been validated. We validated the ureteral diameter ratio (UDR) for predicting VUR outcomes and determined the cutoff value for spontaneous resolution. Materials and Methods: This retrospective review included children with primary VUR and detailed serial voiding cystourethrograms (VCUGs) between March 2005 and December 2016. Patient characteristics, VUR grade, laterality, UDR, laboratory data, and follow-up results were collected. UDR was estimated as the largest distal ureteral diameter within the pelvis divided by the distance of the L1–L3 vertebral bodies. The primary outcome was the prediction of spontaneous VUR resolution. The secondary outcome was the determination of the cutoff value of UDR in the present cohort. Results: We recruited 101 children (59 boys and 42 girls) diagnosed as having primary VUR based on VCUGs at a mean age of 23.48 months. VUR resolved spontaneously in 31 (30.7%) children, 40 (39.6%) children had persistent disease, and 30 (29.7%) received surgical correction. In univariate analysis, laterality, VUR grade, and UDR were significantly associated with spontaneous resolution (P = 0.017, P = 0.026, and P = 0.001, respectively). Multivariate analysis revealed UDR as the prognostic factor for spontaneous VUR resolution (odds ratio, 4.167; P = 0.023). The area under the curve of UDR indicates that the prediction accuracy was 0.74. The optimal cutoff value for UDR in this study was 0.264 (sensitivity, 0.81 and specificity, 0.63). Conclusion: UDR is superior to the VUR grade for predicting spontaneous VUR resolution. Our findings add significant prognostic value for children with primary VUR. A cutoff value of 0.264 may assist with clinical assessment and future management.

Vesicoureteral Reflux Causes Interstitial Inflammation in Pediatric Kidney Allograft: A Clinicopathological Analysis of 1-Year Protocol Biopsies

Introduction: At present, there is limited evidence of the histological impact of vesicoureteral reflux (VUR) on pediatric kidney allografts. In this study, we aimed to investigate the relationship between VUR diagnosed by voiding cystourethrography (VCUG) and 1-year protocol biopsy results. Methods: One hundred thirty-eight pediatric kidney transplantations were performed in Toho University Omori Medical Center between 2009 and 2019. We included 87 pediatric transplant recipients who were evaluated for VUR by VCUG prior to or at the time of the 1-year protocol biopsy and underwent a 1-year protocol biopsy after transplantation. We evaluated the clinicopathological findings of the VUR and non-VUR groups, and histological scores were evaluated using the Banff score. Tamm-Horsfall protein (THP) within the interstitium was identified by light microscopy. Results: Of the 87 transplant recipients, 18 cases (20.7%) were diagnosed with VUR by VCUG. The clinical background and findings were not significantly different between the VUR and non-VUR groups. The pathological findings revealed a significantly higher Banff total interstitial inflammation (ti) score in the VUR group than in the non-VUR group. Multivariate analysis indicated a significant relationship between the Banff ti score and THP within the interstitium, and VUR. The 3-year protocol biopsy results (n = 68) revealed a significantly higher Banff interstitial fibrosis (ci) score in the VUR group than in the non-VUR group. Conclusion: VUR caused interstitial fibrosis in the 1-year pediatric protocol biopsies, and interstitial inflammation at the 1-year protocol biopsy may affect interstitial fibrosis at the 3-year protocol biopsy.

Iatrogenic Urethral Stenoses: Epidemiological Aspects Clinics and Therapeutic in the Urology Department of the National Hospital of Conakry

The aim is to highlight the epidemiological, clinical and therapeutic aspects of iatrogenic urethral strictures. Methodology: This was a retrospective study, descriptive type, 6 years from January 1st 2012, to December 31st 2017 carried out in the Urology-Andrology department of the National Hospital Ignace Deen of Conakry. All records of patients carrying the Diagnosis of iatrogenic urethral stricture were included in this study. Results: We collected 30 cases of iatrogenic urethral stricture, with a frequency of 2.5%. The average age of the patients was 62.33 years. The most affected age group is from 71 to 80 years (33.33%). Dysuria was the main reason for consultation. Retrograde urethrocystography plus voiding cystourethrography (RUC-VCU) allowed us to make the diagnosis. The treatment was essentially surgical and several techniques were used. Endoscopic internal urethrotomy alone was the most performed surgical technique, followed by segmental uretrectomy associated with end-to-end urethrography. Conclusion: Iatrogenic urethral stricture is easy to diagnose but difficult to manage due to the frequency of recurrences. Improving the quality of care, in particular urethral catheterizations and transurethral endoscopic maneuvers, makes it possible to prevent it.

Endourological treatment of ectopic ureterocele. Our experience in the last 15 years.

To assess the efficacy of the endourological treatment of ectopic ureterocele in children in a large series and with a long-term follow-up. A retrospective, descriptive study of patients with ectopic ureterocele who had undergone surgery in our institution in the last 15years was carried out. All patients were treated using an endourological approach, both for ureterocele and postoperative vesicoureteral reflux (VUR). 40 patients were treated -55% with left involvement and 5% with bilateral involvement. Mean age at diagnosis was 4.97 months, with diagnosis being established prenatally in 54.1% of cases. In all patients but one, endourological puncture of the ureterocele was conducted. Mean age at surgery was 6.96months (0-1.11). Surgery was performed on an outpatient basis in 94.9% of patients. No perioperative complications were recorded. In the last 30 patients, preoperative voiding cystourethrography was not carried out. 72.5% of patients had postoperative VUR (44.8% into the upper pyelon, 10.3% into the lower pyelon, 17.2% into both, 6.9% into the contralateral system, and 20.7% into the bilateral system), but it was resolved with a single endoscopic procedure in 48.1% of cases (65% of patients were healed with two procedures). VUR was not endoscopically resolved in 3 patients who required ureteral re-implantation. 6patients required heminephrectomy (n=3) or nephrectomy (n=3) as a result of functional impairment and infections. The endourological treatment of ectopic ureterocele is a little aggressive and little invasive technique that allows the obstruction to be resolved on an outpatient basis, which means bladder surgery -if required- can be performed outside the neonatal period.

Clinical Profile and Outcome of Children who Underwent Micturating Cystourethrogram : A Tertiary Hospital Experience

Introduction: Micturating cystourethrogram (MCUG) is the gold standard test for the diagnosis of vesicoureteric reflux (VUR). The study aims to establish the association between the presence of VUR and renal outcomes. Methods: A cross-sectional retrospective study was conducted in children who were referred for MCUG at a tertiary centre over a 10-year period. Baseline characteristic data and the results of renal ultrasound, MCUG, with renal function were compiled and analysed. Fisher Exact test was used to compare between the grade of VUR and renal outcomes. Simple and multiple logistic regressions were used to examine the risk factors that may contribute to the development of VUR. Results: There were 136 children included in total. Forty-five had VUR, (31 [68%] high-grade, 14 [32%] low-grade, respectively). One third (33.3%) were surgically treated, 29 (64.4%) developed chronic kidney disease (CKD), and 18 (40%) developed renal scarring. Children with urinary tract infection (UTI) and hydroureter have 4.19 and 3.40 times the odds of developing VUR, respectively. Conclusion: The presence of hydroureter from ultrasound is a strong indicator of underlying VUR and justifies the rationale of requesting for MCUG, especially for those with recurrent UTI. However, this study failed to demonstrate significant association between the presence of VUR and complications of renal scarring and CKD.

Incidence of renal scarring on technetium-99m dimercaptosuccinic acid renal scintigraphy after acute pyelonephritis, acute focal bacterial nephritis, and renal abscess.

To evaluate the association between the incidence of renal scarring on technetium-99m dimercaptosuccinic acid (DMSA) renal scintigraphy and the severity of renal parenchymal infections, such as acute pyelonephritis (APN), acute focal bacterial nephritis (AFBN), and renal abscess, based on computed tomography (CT) diagnosis. Sixty-one children with renal parenchymal infections were included and classified into two groups: those with (renal scarring group) and without renal scarring (non-renal scarring group) on chronic-phase DMSA renal scintigraphy. The severity of renal parenchymal infection was classified into three grades using CT: APN, AFBN, and renal abscess as grades 1, 2, and 3, respectively. The severity of renal parenchymal infection, vesicoureteral reflux (VUR) grade, and intrarenal reflux occurrence during voiding cystourethrography (VCUG) were evaluated between the renal and non-renal scarring groups. Fisher's exact test and Mann-Whitney U test were used for statistical analysis. Renal scars were detected in 28 (45.9%) of the 61 patients. We found that 2/9 (22.2%), 18/41 (43.9%), and 8/11 (72.7%) patients with APN (grade 1), AFBN (grade 2), and renal abscess (grade 3) had renal scarring, respectively. There was a significant difference in the grade of severity of renal parenchymal infection between the renal (median = 2 [interquartile range, 2-3]) and non-renal (median = 2 [interquartile range, 2-2]) scarring groups (p = 0.023). There was a significant difference in the grade of VUR between the renal (median = 3 [interquartile range, 0-4]) and non-renal (median = 0 [interquartile range, 0-2]) scarring groups (p = 0.004). No significant difference in intrarenal reflux occurrence was observed between the renal (present/absent: 3/25) and non-renal (present/absent: 0/29) scarring groups (p = 0.112). Our results showed that pediatric patients with renal scarring on chronic-phase DMSA renal scintigraphy tended to have a more severe renal infection.

Evaluation of Pediatric Patients with a Diagnosis of Ureterocele.

The presence and clinical importance of vesicoureteric reflux in patients with a double collecting system are being questioned. Therefore, the role of voiding cystourethrography in the management of patients with ureterocele is unclear. This study aimed to evaluate patients with a ureterocele in terms of urinary tract infection (UTI) and vesicoureteral reflux (VUR). The cases who were admitted to the Pediatric Nephrology Clinic of Health Sciences University Tepecik Training and Research Hospital between 2012 and 2022 and were diagnosed with ureterocele were evaluated retrospectively. Demographic, clinical, and laboratory data were obtained from file records. All patients diagnosed with ureterocele and voiding cystourethrography (VCUG) were evaluated. A total of 24 (female 13 (54.2%)) children were included. The reasons for admission were antenatal hydronephrosis in 13 (54.2%) patients, UTI in 9 (37.5%) patients, and incidentally diagnosed ureterocele in 2 (8.3%) patients. Urinary tract infection was observed in 20 patients at admission, recurrent UTI in 21 patients at follow-up, preoperative pyelonephritis in 12 patients. VUR was found in 11 patients, and severe VUR (≥stage 3) was found in 9 patients. Ten patients had ipsilateral hydronephrosis, and 14 patients had a double collecting system. The presence of VUR was found to be associated with female gender, UTI at admission, and recurrent UTI at follow-up (p &lt; 0.05). However, there was no difference between groups with or without VUR in terms of ipsilateral hydronephrosis, scar formation, and the need for surgery (p &gt; 0.05). We could not demonstrate any criteria to select patients to receive VCUG; on the other hand, VUR did not cause more kidney damage. Our study supports the need for more scientific data to determine management in patients with ureterocele.

A new recommendation for febrile urinary tract infection in children aged 2–24 months: Tepecik UTI Guideline-2

Urinary tract infections (UTIs) represent a common febrile illness in infancy. The study compared two UTI guidelines in terms of number of imaging studies, presence of parenchymal damage and radiation exposure in patients with the first febrile UTI between 2 and 24 months of age. The results of Tepecik UTI Guideline-1 used until 2012 (Group 1, n = 105) were retrospectively compared with Tepecik UTI Guideline-2 (Group 2) used after 2013. In Group 1, urinary tract ultrasonography (US), dimercaptosuccinic acid (DMSA) and voiding cystourethrography (VCUG) were made in all patients. In Group 2, if the US result was abnormal, patients were evaluated with VCUG and DMSA. If the US was normal, only DMSA was performed. If the DMSA was abnormal, the VCUG was undergone (n: 43, 40.9%). The abnormal VCUG detection rate was 69.2% in Group 1 and 30.8% in Group 2 (p = 0.09). Sensitivity and specificity of US in the diagnosis of vesicoureteral reflux (VUR) was 15.9% and 96.7% in Group 1 and 61.5% and 70.5% in Group 2, respectively. Abnormal DMSA findings were observed among 33.3% (Groups 1) and 66.7% (Groups 2) subjects, respectively (p > 0.05). The median radiation exposure (500 mrem) of patients in Group 1 was statistically significantly higher than those in Group 2 (200 mrem) (p < 0.001). The VCUG should not be the first examination to be considered in such patients. We think that Tepecik UTI Guideline-2 reduces unnecessary invasive procedure and radiation exposure and not missed VUR in the management of children with UTI at 2-24 months. Needs prospective follow-up studies before considering this recommendation.

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

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