Abstract: PATIENTS AND METHODS Thirty operated patients of myelodysplasia were clinically evaluated for the age at presentation, the extent of lesion and neurological deficit. Urological assessment was done with urine cultures, serum creatinine, radiological (ultrasound of kidney, ureters and bladder, voiding cystourethrogram) and urodynamic (water cystometry) parameters. An objective scoring for bladder (Galloway, et al.) was applied. Dimercapto-succinic acid (DMSA) scan was done in all the patients for evidence of renal scars. The results of above investigations were correlated with presence or absence of renal scars (renal injury) on DMSA scan. None of the patients had received any prior bladder care. RESULTS Twenty one patients had no renal scars and 9 patients had evidence of renal scarring. Patients with renal scars were older at presentation, they had greater degree of hydroureteronephrosis (P 25 cm of water, P 5, P 1 mg/dl (P 5) define a high risk bladder in our population and predispose to renal injury in patients of myelodysplasia. Early referral for bladder risk assessment and management of all myelodysplasia patients is recommended.

Abstract: OBJECTIVES In children diagnosed with vesicoureteral reflux (VUR), the identification of reflux is made during either the filling (filling reflux) or voiding (voiding reflux) phase of the voiding cystourethrogram. A retrospective study was performed to determine whether this radiologic distinction has prognostic significance. METHODS A retrospective chart review was performed of patients who had undergone voiding cystourethrography from July 1999 to June 2004. Patient age, sex, and reflux grade (unilateral and bilateral) were independently examined in relation to spontaneous resolution, surgical intervention, or observation. These data were subjected to chi-square, analysis of variance with post hoc test, and Kaplan-Meier analysis. RESULTS The diagnosis of primary VUR was identified in 218 patients, and sufficient chart information and hardcopy films to permit identification of filling versus voiding reflux were available for 201. Of 201 patients, 115 (57%) had filling reflux and 86 (43%) had voiding reflux. Of the 115 with filling reflux, 53 (46%) underwent surgery and 27 (23%) had spontaneous resolution (P 0.001). Of the 86 patients with voiding reflux, 12 (14%) underwent surgery and 57 (66%) had spontaneous resolution (P 0.0001). Advanced age and grade of reflux were independently associated with surgical intervention (P 0.0001 and P 0.04, respectively). CONCLUSIONS Our results have shown that VUR that is first identified during the filling phase of the initial voiding cystourethrogram is more likely to require surgical intervention. In contrast, VUR that is first identified during the voiding phase was independently associated with a greater rate of spontaneous resolution. This radiologic distinction, in addition to reflux grade, might be useful in predicting the clinical outcome for children diagnosed with primary VUR. UROLOGY 70: 351‐354, 2007. © 2007 Elsevier Inc.

Abstract: OBJECTIVE: Report the results of laparoscopic upper-pole nephroureterectomy in infants. MATERIALS AND METHODS: Six consecutive infants underwent 7 laparoscopic upper-pole nephroureterectomy. Pre and postoperative evaluation included renal sonography, voiding cystourethrogram and renal scintigraphy. All infants showed upper-pole exclusion. Surgery was performed through a transperitoneal approach with full flank position in all infants. Three or 4 ports were used according to the necessity of retracting the liver. The distal ureter was ligated close to the bladder whenever reflux was present and the dysplastic upper-pole was divided with the help of an electrocautery. Data regarding operative time, postoperative use of analgesics, time to resume oral feeding, hospital stay and tubular function were collected and analyzed. RESULTS: All procedures were concluded as planned. Mean operative time was 135 min. One patient underwent staged bilateral upper-pole nephrectomy. There were no complications and the postoperative hospital stay was 48 hours in 5 procedures and 24 hours in 2 procedures. Pain medication was required only in the first day. Renal tubular function showed improvement in half of the cases. CONCLUSION: Laparoscopic partial nephrectomy is a safe and feasible procedure in infants. Due to the magnification provided by the lenses, a better vision of the structures is achieved, facilitating selective dissection of vascular upper-pole, renal parenchyma and distal ureter. This approach is less damaging to the lower pole, and is associated to low morbidity and a short hospital stay.

Abstract: OBJECTIVE: Report the results of laparoscopic upper-pole nephroureterectomy in infants. MATERIALS AND METHODS: Six consecutive infants underwent 7 laparoscopic upper-pole nephroureterectomy. Pre and postoperative evaluation included renal sonography, voiding cystourethrogram and renal scintigraphy. All infants showed upper-pole exclusion. Surgery was performed through a transperitoneal approach with full flank position in all infants. Three or 4 ports were used according to the necessity of retracting the liver. The distal ureter was ligated close to the bladder whenever reflux was present and the dysplastic upper-pole was divided with the help of an electrocautery. Data regarding operative time, postoperative use of analgesics, time to resume oral feeding, hospital stay and tubular function were collected and analyzed. RESULTS: All procedures were concluded as planned. Mean operative time was 135 min. One patient underwent staged bilateral upper-pole nephrectomy. There were no complications and the postoperative hospital stay was 48 hours in 5 procedures and 24 hours in 2 procedures. Pain medication was required only in the first day. Renal tubular function showed improvement in half of the cases. CONCLUSION: Laparoscopic partial nephrectomy is a safe and feasible procedure in infants. Due to the magnification provided by the lenses, a better vision of the structures is achieved, facilitating selective dissection of vascular upper-pole, renal parenchyma and distal ureter. This approach is less damaging to the lower pole, and is associated to low morbidity and a short hospital stay.

Abstract: BACKGROUND: Experience with vesicoureteral reflux (VUR) differs in different centers and there are plenty of controversies. OBJECTIVE: The aim of this study was to evaluate the outcome of primary VUR complications and the rate of recurrence of UTI. METHODS: The medical charts of all infants and children with primary VUR who were followed up by two nephrologist were reviewed. During 19 years (1985 to 2004), 330 patients (271 females, 59 males) with 496 refluxing ureters were followed up as primary VUR. RESULTS: The patients age at diagnosis was 54 days to 16 years (Mean: 4.1 years) and the mean duration of follow-up was 4.5 years. Urinary tract infection (UTI) was the presenting symptom in 95% and fever was recorded in 35% of cases. Frequencies of different grades of VUR at initial investigation were 10% 35% 30% 13% and 12% for grades I to V, respectively. Recurrence of UTI in VUR of grades I to V, were 22.2% 18.1% 20% 23.4% and 17.9% respectively. Follow-up voiding cystourethrogram revealed resolution of VUR in 55% improvement in 27.5%, no change in 12% and deterioration in 5.5% Complications such as chronic renal failure and hypertension were observed in 13 and 13 patients, respectively. Renal scarring was present in 52% of boys and 29% of girls. CONCLUSION: The present study indicates that symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not related to the grade of VUR.

Abstract: To the Editor .— We have read the thoughtful comments on our article1 on the significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis. Here we want to address the issues of methodologic flaws referred to by Wald.2 To address this concern, we have filled in missing values for each group assuming a worst-case scenario. That is, patients in the nonprophylaxis group who did not complete the study were all assumed to have presented a recurrence of the urinary tract infection and renal scars; patients in the prophylaxis groups who did not complete the study had no urinary tract infection or renal scars. With respect to the recurrence of urinary tract infections (any kind, because …

Abstract: Objective. Endoscopic treatment of children with primary vesicoureteral reflux (VUR) has become an alternative to long-term antibiotic prophylaxis and open surgery. The purpose of this study was to assess the efficiency and safety of endoscopic subureteral injections of collagen (STING) as a treatment for complicated VUR in children. Material and methods. Twenty-five patients (41 ureteral units) underwent a modified STING procedure for the correction of complicated VUR. Of these patients, five (nine refluxing units) had Hutch's diverticulum, 10 (17 refluxing units) had a duplex system, eight (10 refluxing units) had ureterocele, one (three refluxing units) had a unilateral triple ureter and one (two refluxing units) had a bilateral single ectopic ureter. Of these 41 ureteral units, 14 had grade III VUR, 17 grade IV and 10 grade V. Fourteen refluxing units (30%) received one session of STING, which was successful, and 27 (70%) needed a second session. A follow-up voiding cystourethrogram was performed 3 mo...

Abstract: SUMMARY: Background: Urinary tract infection (UTI) is one of the most common causes of unexplained fever in infants with a reported prevalence range of 5–11%. The clinical and laboratory findings were reviewed, and diagnosis and treatment for 95 infants with primary UTI were evaluated in this study. Methods: All patients underwent renal ultrasonography, voiding cystourethrogram and 99mTc dimercaptosuccinic acid (DMSA) scan during hospitalization before treatment, with treatment consisting of 2- or 4-week appropriated antibiotic therapy for the patients associated upper UTI, followed by a second DMSA scan 6 months after therapy. Results: In the present study the main symptom of UTI in infants was fever. High white blood cell count was not necessarily present, and urinalysis was also an imperfect diagnostic tool for discriminating UTI. In addition, colony count from urine culture and kidney ultrasonography was not efficacious in terms of predicting the occurrence of pyelonephritis. Intravenous antibiotic for 1 week followed by 3 weeks of the same oral antibiotic provided good prophylaxis for uncomplicated pyelonephritis. Conclusion: Four weeks of antibiotic treatment resulted in good recovery from pyelonephritis in the present sample of infant primary UTI cases. voiding cystourethrogram, DMSA and ultrasonography scanning should be performed in primary infant UTI.

Abstract: PURPOSE: In the last two decades, many reports have confirmed the efficacy and safety of the conservative treatment of non-refluxing megaureter in asymptomatic patients and many cases of ureteral dilatation tend to resolve spontaneously. We report our experience on 108 patients with primary non-refluxing megaureter detected prenatally or diagnosed after birth and we discuss our results with long-term non surgical treatment. MATERIAL AND METHODS: All patients were evaluated by ultrasound (US), voiding cystourethrogram (VCUG) and MAG3 renography. Observation period ranged from 6-72 months (mean 29.1). RESULTS: Surgery was performed in 12 patients (11.1%) with severe hydroureteronephrosis. Complete resolution or significant improvement was noted in 80 cases (74%) and persisted in 16 cases (14.8%). In the group with spontaneous resolution the ureteral diameter was less than in patients without resolution. Megaureters grade 1 to 3 tended to resolve between 12 and 36 months of observation. CONCLUSION: Conservative management is the treatment of choice in primary non refluxing megaureter. The grade of hydroureteronephrosis is an important predictor factor and infants should be followed periodically with renal ultrasound and diuretic renography.

Abstract: 1. In the differential diagnosis of the male infant with bilateral upper urinary tract dilatation and recurrent infection, bilateral primary vesicoureteral reflux, bilateral obstructed primary mega-ureter, agenesis of the bladder and obstructive anomalies of the urethra, such as posterior urethral valve (PUV), should be considered. 2. Ultrasound should be performed for urethral swelling. A voiding cystourethrogram (VCUG) should be performed to examine the bladder and the entire urethra. 3. Owing to the presence of swelling on the ventral surface of the penis (Fig.1), discharge of urine from the external meatus after palpation of this mass, and a medical history of transient obstructive uropathy in the neonatal period, the most likely diagnosis is a urethral diverticulum. 4. We can treat this patient with diverticulectomy and urethroplasty.

Abstract: Purpose: Hinman syndrome is the most severe form of nonneurogenic neurogenic bladder causing damage of the upper urinary tract. Fourteen patients with Hinman syndrome followed at our institution were evaluated for their clinical characteristics and prognosis. Here we report the findings of this series of patients for this poorly understood syndrome. Materials and Methods: The medical records of 14 patients, 8 boys and 6 girls, diagnosed with Hinman syndrome from March 1993 to June 2006 were reviewed. The mean duration of follow up was 69 months. The ultrasonography, 99 Tc-dimercaptosuccinic acid renal scan (DMSA), voiding cystourethrogram (VCUG), and urodynamic study (UDS) results were retrospectively analyzed and efficacy of each treatment method was evaluated based on the medical records on follow up. Results: Hydronephrosis of grade III or greater on ultrasonography and renal scarring of both kidneys on the DMSA renal scan were observed in 12 and 14 patients, respectively. Severe bladder trabeculation and high grade VUR (IV, V) were observed on the VCUG in 14 and 8 patients, respectively. Decreased bladder compliance on the UDS was noted in 13 and detrussor-sphincter dyssynergia (DSD) was observed in eight. Medical treatment was not effective in all 14 cases and six patients who underwent botulinum injection of the bladder were unresponsive to that treatment as well. In spite of conservative treatments such as clean intermittent catheterization (CIC), seven patients eventually underwent bladder augmentations after a mean period of thirty-seven months from diagnosis because of concern about the loss of bladder capacity and renal function. One patient who did not perform CIC progressed to end-stage renal disease and had to be transferred to pediatric nephrology for dialysis. Conclusions: Patients diagnosed with the Hinman syndrome were treated similar to patients with neurogenic bladder. However, from the longtermfollow up data at our outpatient clinic, many patients eventually had bladder augmentation to prevent further loss of bladder capacity and renal function. Therefore, urologists must not hesitate in performing such treatment when necessary. (Korean J Urol 2007;48:1058-1063) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Abstract: Vesicouretal reflux (VUR) is the retrograde flow of urine from the bladder into the upper urinary system. It affects 1% of boys and girls. The ureterovesical junction is compromised by short submucosal ureteral length, insufficient detrusor backing to the ureter, and/or periureteral diverticuli. Vesicoureteral reflux is present in 29% to 70% of children with urinary infections1,2 and is typically diagnosed by contrast voiding cystourethrogram or nuclear cystogram. The association among VUR, urinary tract infections (UTIs), and renal scarring has been noted for years. The overall goal of managing the child with UTIs is to prevent renal scarring, hypertension, or chronic renal failure. In fact, 3% to 25% of children with end-stage renal disease lost their renal function because of reflux nephropathy.2,3 Renal scarring is detected best by DMSA scanning. However, some of the radiologically detected changes are congenital in nature and not acquired from postnatal UTIs (males > females).4,5

Abstract: Urethral polyp is a rare finding in young children. Fibroepithelial polyps of the urethra are usually diagnosed during the first decade of life. They present with obstruction, voiding dysfunction and hematuria. They can be associated with other congenital urinary tract anomalies. They are usually benign fibroepithelial lesions with no tendency to recur and are treated by surgical ablation, fulguration or laser therapy.

Abstract: Purpose: The aim of this study was to review the experience of a single institution with the Deflux (Q-Med Scandinavia; Uppsala, Sweden) procedure and assess its effectiveness in reducing the incidence of urinary tract infections (UTIs) in children with vesicoureteric reflux (VUR). Materials and Methods: After institutional review board approval, the charts of 100 patients with VUR, who presented between June 2003 and June 2005, were prospectively reviewed. Data collected included: demographics, the number of preoperative and postoperative UTIs, a radiologic grade of VUR on a voiding cystourethrogram (VCUG) and the presence of VUR on a radionuclide VCUG 3 months after the procedure. Patients were continued on oral antibiotics until urine culture at 3 months was negative and no reflux was demonstrated on VCUG. The student's t test was used for data analysis. Results: The mean age was 3.8 ± 0.3 years, and 76% were girls. From 155 ureters treated, 10 had Grade I reflux, 42 Grade II, 76 Grade III, 25 Grade IV...