Abstract: Objective Vesicoureteral reflux (VUR) is a common finding in the pediatric population with the risk of repeated infections and renal damage. There is little is known about the natural history of primary bilateral high-grade reflux. Herein we present our experience in the management of primary high-grade bilateral VUR and the long-term outcome of renal function in this specific group of patients. Materials and methods We retrospectively evaluated all patients with congenital bilateral VUR between 2006 and 2014. Records were reviewed for patient age at diagnosis, antenatal history, clinical presentation, the grade of VUR on voiding cystourethrogram (VCUG), presence of scars on dimercaptosuccinic acid (DMSA) scan, indications for surgical intervention, and surgical approaches. Clinical and radiological outcomes of this subgroup of patients were assessed. Results A total of 67 patients with bilateral VUR were identified, of whom 31 (20 boys and 11 girls) had primary high-grade (grade IV and V) bilateral VUR. The mean age at diagnosis was seven months. DMSA scans showed renal scars in 19 patients (61%) and eight of them were bilateral. Surgical intervention was necessary for 81% of patients with a success rate of 58% after endoscopic correction and 100% after reimplantation. Chronic kidney disease (CKD) developed in 13 patients (42%) after a mean follow-up of eight years. Conclusions Primary bilateral high-grade VUR carries a high rate of surgical intervention. The endoscopic correction has an acceptable success rate and efficient long-term outcome. Nevertheless, a significant proportion of patients progresses to CKD even after VUR management.

Abstract: Background Urethral duplication associated with epispadias is a rare malformation. Few cases are described in Literature. We report the experience of two centers to add to the literature. Methods A retrospective study was conducted in two Italian Centers. All patients with urethral duplication associated with epispadias, treated from 1997 to 2017 were included. The preoperative work-up included renal-urinary ultrasonography and voiding cystourethrogram. All patients underwent surgery according to the Mitchell-Caione technique. Cosmetic result, urinary continence and satisfaction degree of patients at the last follow-up were evaluated as outcomes. Six male patients with urethral duplication in epispadias were included. Two patients presented penile epispadias and four penopubic epispadias. Only one patient had urinary incontinence as presenting symptomatology. The diagnosis of urethral duplication was accidental during preoperative evaluation in the remaining five patients. Results At last follow-up (mean 8.3 years) all patients but one presented good cosmetic result, one patient presented mild stress urinary incontinence, one presented nocturnal enuresis. The physical genital appearance was improved in all patients. Urethral duplication in association with epispadias is a rare urogenital abnormality. No classification is universally accepted. Conclusions Based on our experience, we believe that the presence of any duplication should be carefully searched during surgery for male epispadias.

Abstract: Background: The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful. Objectives: We aimed to review the role of the ‘ideal’ ratio on predicting residual PUV post-ablation. Methods: A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included ‘Urethral Ratio and Posterior urethral valve ablation’. All cited reference lists were further evaluated for additional inclusive studies. Results: Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 ( p = 0.001), 2.5–3 and 3.5. Conclusion: Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2–3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.

Abstract: Acute urinary tract infection (UTI) is among the most common bacterial infections in infants and children. Diagnosis requires evidence of infection and the presence of at least 50,000 colony-forming units (CFU)/mL of a pathogen cultured from an appropriately collected urine specimen. Febrile UTIs (ie, temperature 38°C [100.4°F] or greater) are most common during the first two years of life. Risk factors for UTI in febrile female infants are white race, age younger than 12 months, temperature 39°C (102.2°F) or greater, fever lasting 2 days or more, and absence of another source of infection. For febrile male infants, risk factors include being uncircumcised. If circumcised, risk factors include nonblack race, temperature 39°C (102.2°F) or greater, fever for more than 24 hours, and absence of another source of infection. Antibiotic treatment should be continued for 7 to 14 days. Renal and bladder ultrasonography is indicated for infants ages 2 to 24 months with a febrile UTI. If ultrasonography results are abnormal, a voiding cystourethrogram (VCUG) is indicated. VCUG also is indicated for children with recurrence of febrile UTI to identify vesicoureteral reflux and/or other anatomic findings associated with recurrent UTI. Recent studies have shown a statistically significant benefit of continuous antibiotic prophylaxis for prevention of recurrent UTI.

Abstract: Prostatic utricle (PU) is incomplete regression of Mullerian duct and may cause recurrent urinary tract infections (UTIs), stone formation, postvoid dribbling, and recurrent epididymitis. Although surgical excision is recommended to avoid complications, surgical access to PU has been challenging. Cystoscopy-guided laparoscopic management of PU in a 3-year-old boy is reported to discuss use of other endoscopic aids in the surgical treatment of PU. He was admitted with disordered sexual development with karyotype of 47,XYY/46,XY and has been experiencing recurrent UTIs. Voiding cystourethrogram (VCU) demonstrated large PU (IKOMA II). Cystoscopy was performed confirming PU and the cystoscope was left in situ to aid laparoscopic exploration after bladder was emptied. A 5-mm umbilical port and two 5-mm ports in both lower quadrants were inserted. The peritoneum was dissected behind bladder. The cystoscope in PU was used as guidance in identification and dissection of PU. The vas deferens was identified and could be secured. The neck of PU was ligated with surgiloop. PU was retrieved from umbilical port. Postoperative VCU revealed normal posterior urethra. He has been free of UTIs for the last 6 months. Laparoscopy is safe and feasible alternative in surgical management of PU, by providing good visual exposure, easy dissection in deep pelvis, and improved cosmesis. The cystoscopic guidance is an important aid in identification and dissection of PU.

Abstract: To determine the prevalence of postoperative urinary extravasation (POUE) following anterior urethroplasty, to analyze factors associated with its occurrence, and to study the impact of POUE on surgical success. Retrospective cohort study including all male patients who have undergone a urethroplasty at our center between 2011 and 2018. Subjects with posterior location stricture, those who did not undergo routine radiographic follow-up, or patients with inadequate follow-up were excluded. Urinary extravasation was defined as presence of evident contrast extravasation on the postoperative voiding cystourethrogram (VCUG). Impact was determined as “need-for-reoperation”. Uni- and multivariate analysis were performed to determine clinical and demographic variables associated with occurrence of extravasation and postoperative stricture. A total of 783 men underwent a urethroplasty and 630 fulfilled inclusion criteria. Urinary extravasation prevalence was 12.2%, and there was a “need-for-reoperation” in 1.1% of cases. On uni- and multivariate analysis, greatest stricture length (HR: 1.07 (1–1.2), p = 0.05) and penile urethral location (HR: 2.29 (1.1–4.6), p = 0.021) showed to be POUE predictors. POUE did not show to be a risk factor for postoperative stricture (HR: 1.57, 95% CI (0.8–3), p = 0.173). However, reoperation group showed to be a risk factor (HR: 6.6, 95% CI 1.4–31, p = 0.019). Prevalence of POUE was 12.2%. Stricture length and penile urethral strictures were POUE predictors. POUE occurrence with successful conservative management did not appear to have impact on urethroplasty outcomes as it did not predict re-stricture. POUE was reoperation cause in 1.1% of total cases.

Abstract: Objective: Voiding cystourethrogram is a minimally invasive diagnostic procedure used to visualize the urinary tract and bladder and diagnose vesicoureteral reflux disease. We aim to determine the likelihood of developing a UTI after the VCUG. Study design: A total sample of 125 children from the Jordan University Hospital who underwent 191 voiding cystourethrogram (VCUG) were retrospectively studied between 2002 and 2018, ages four days till 13 years old. Urine analysis and Culture were sent from selected patients, for post-VCUG-UTI. Methodology : Electronic records were retrospectively reviewed in 125 pediatric patients at Jordan University Hospital. Results: 60.7% of VCUG’s were abnormal (i.e., vesicoureteral reflux (VUR) or hydronephrosis). 5.24% had a negative urine analysis, 4.71% had a negative culture; 6.28% had a positive urine analysis, post-procedural urinary tract infection (ppUTI) was documented in 5.76% of the patients. The most common organism was Escherichia coli. Conclusions : Voiding cystourethrogram is a significant risk factor for urinary tract infection in the pediatric age group; it is still debated whether ascending infection due to catheterization or the presence of a urinary tract abnormality is the cause of infection. F urther studies on a larger scale must be considered to study other contributing factors.

Abstract: A 77-year-old woman presented with right flank pain radiating to the ipsilateral groin and associated nausea, consistent with renal colic. In the emergency department, a non-contrast CT scan revealed severe right-sided hydronephrosis but failed to demonstrate a calculus or ureteropelvic obstruction. The patient improved with fluids and followed up with a community urologist. Initial work-up with cystoscopy and ureteroscopy, voiding cystourethrogram and diuretic renography failed to deduce a diagnosis. At our hospital, we used a modified dynamic (supine and upright) Whitaker test in a novel fashion to diagnose nephroptosis, a rare hypermobility condition of the kidney.

Abstract: Objective . While international guidelines necessitate Voiding Cystourethrogram (VCUG) for pediatric patients, it is unnecessary for the evaluation of adult patients without urological disorders as renal transplant candidates. The objective of this study was to evaluate the results of adult candidates who underwent VCUG before transplantation and to demonstrate the necessity for this imaging. Methods . A retrospective study of the data of 1265 adult candidates who underwent VCUG before transplantation at our center, was undertaken. VUR, the presence of Postvoiding residual urine (PVR) (>100 ml), Low bladder capacity (LBC) (<100 ml), and urethral pathologies were evaluated with VCUG. Results . The mean age was 42.3 ± 1.3. The mean dialysis period was 27.8 ± 4.2 months. According to the VCUG results, 19.2% of the patients had pathological findings. On the other hand, the rate of urological disorders was only 5.1%, according to end-stage renal disease (ESRD) etiologies. VCUG outcomes indicated bilateral high-grade reflux in native kidneys in 4.4% (n = 56) of the candidates, unilateral high-grade reflux in 4.1% (n = 52), bilateral low grade reflux in 2.1% (n = 26), unilateral low-grade reflux in 2.4% (n = 30), and reflux in rejected transplanted kidney in 2.3% (n = 29). In addition, significant LBC was noted in 4.8% (n = 61), significant PVR in 1.1% (n = 14), and urethral stricture in 0.5% (n = 6) of the candidates. Conclusion . VCUG should be considered as a part of routine evaluation in adult renal transplant recipient candidates as well as in pediatric candidates, even if their ESRD etiologies are not due to urological disorders.

Abstract: Background: Vesicourethral reflux (VUR) is a common urinary tract disorder in children, which may be associated with urolithiasis. Objectives: The current study aimed to investigate vesicoureteral reflux in children with and without urolithiasis. Methods: In this case-control study, 130 children younger than 10 years, with a confirmed diagnosis of urinary tract infection (UTI) are investigated. The demographic information and clinical status of all participants were recorded. Ultrasonography was performed for all children, and they were divided into two groups of 65 subjects based on the results: group 1, children with UTI+stone; and group 2, children with UTI+ non-stone. All children received Voiding Cystourethrogram to evaluate Vesicourethral reflux. Results: The mean age of participants was 7.48 ± 3.2 years, and 68 (52.7%) of them were male. Also, VUR was observed in 33 (25.38%) cases. The frequency of reflux in the UTI + stone group was 21 (32.3%), which was significantly higher than the other group (12 cases, or 18.46%) (P = 0.011). However, the association between UTI and stone (P = 0.3, CC = -0.01) was not significant. Conclusions: This study demonstrated a significant correlation between urinary tract stones and VUR in children with urinary tract infections. It is recommended to investigate the presence of stone or VUR in children suffering from any of the described disorders.

Abstract: Radiologic imaging serves many important functions in the evaluation and care of urology patients. Ordering the correct test for evaluation, while considering the need to expose a patient to radiation is a valuable skill. This chapter reviews the indications and goals of the many imaging studies available for evaluation of GU complaints and conditions. While providers may not always have immediate access to all form of imaging, many studies now offer the ability to obtain rapid results and 3D reconstructions.

Abstract: Background: During urethroplasty, if the stricture contains a 2 to 4 cm region that is particularly narrow and/or fibrotic, anastomotic repair is not ideal, so that portion may be excised with subsequent anastomosis of the ventral aspect of the urethra to shorten, widen and optimize the urethral wall onto which an onlay graft is to be placed. This procedure is termed augmented anastomotic urethroplasty Objectives: Evaluation of the outcome of augmented anastomotic urethroplasty with dorsal onlay for long segment bulbar urethral stricture. Patients and Methods: A prospective clinical trial was carried out during the period from March 2017 to September 2019 of 55 patients underwent dorsal onlay augmented anastomosis using buccal mucosa graft for long segment bulbar urethral strictures. All patients underwent pre-operative medical history taking and physical examination, sono-urethrography and voiding cystourethrogram. Patients were followed-up and re-assessed at 3 and 6 months post-operatively. Follow-up urethrography was performed at 6 months. The primary outcome was the procedure success rate defined by the successful voiding function. Stricture recurrence was defined the presence of intractable voiding symptoms or the need for any urethral interventions. The data were analyzed using the appropriate statistical tests. Results: During the study period, 55 patients completed the follow-up protocol and included in the study. The mean age was 41.93±10.70 years. The mean intra-operative stricture length was 3.39±0.59 cm. Buccal mucosal graft was used in all cases. Mean graft length was 4.15±0.62 cm. At 6 months follow up, 51 patients had no evidence of stricture recurrence and required no further intervention with an overall success rate of 92.7%. Stricture recurrence occurred in 4 patients (7.3%). No donor site major complications were detected. The urethroplasty complication rate was 20.0%, and all were minor. No effect of urethroplasty on erectile function in adult sexually active patients. No penile shortening or chordee. Conclusions: Dorsal onlay augmented anastomosis was a useful technique for long bulbar strictures. High stricture-free rates and complications are few and minor. Although longer follow up was needed.

Abstract: Background: The aim of the study is to retrospectively analyse the best mode of treatment for patients presenting with urinary bladder diverticulum. Methods: This study includes 46 patients who presented to the outpatient department between January of 2018 to March of 2020. They had lower urinary tract symptoms (LUTS) and were later found on investigations with imaging like ultrasound and voiding cystourethrogram (VCUG) as having bladder diverticulum with some cases associated with bladder outlet obstruction. Secondary causes were treated surgically or conservatively with clean intermittent catheterisation (CIC). Diverticulum was addressed with diverticulectomy when conservative management failed with recurrent LUTS or if the diverticulum was of a large size with significant post void residual urine. Results: Most of the patients with diverticulum associated with prostatomegaly or stricture urethra fared well after treatment of the underlying cause except one who underwent subsequent diverticulectomy. Four out of 5 patients with neurogenic bladder did well with CIC alone barring one who underwent diverticulectomy for a large sized diverticulum and refractory LUTS. Two patients with bladder growth involving the neck of diverticulum underwent partial cystectomy along with diverticulectomy. Four out of the remaining 8 patients with primary diverticulum were taken up for diverticulectomy directly and one underwent subsequent diverticulectomy for failed CIC. Conclusions: Not all urinary bladder diverticulum required surgical management per se. Most fared well with treatment of the underlying cause. So only those with large size, recurrent LUTS and failed management with CIC should be considered for diverticulectomy.

Abstract: Background Congenital aniridia involves total or partial hypoplasia of the iris and is due to a deficiency in PAX6 gene expression. WAGR syndrome is comprised of Wilms tumor, aniridia, genitourinary abnormalities, and intellectual disability. Numerous genitourinary pathologies may be associated with WAGR syndrome, necessitating an evaluation of the genitourinary anatomy. The WT1 is vital for the development of kidneys, ovaries in females, and testes in males. WT1 gene mutations result in a WT1 protein with a decreased ability to bind to DNA, leading to uncontrolled growth, and cell division in the kidney which permits the development of Wilms tumor. A congenital ureteral valve is an exceedingly rare cause of obstructive uropathy. Results A renal and bladder ultrasound demonstrated a renal cyst. A voiding cystourethrogram revealed grade 3 vesicoureteral reflux, and a MAG3 renal scan showed ureteropelvic junction obstruction and hydronephrosis. A ureteral stent was inserted at 3 months of age after which the renal cyst resolved. The patient was urinary tract infection-free at 27 months of age. Genetic testing confirmed a heterozygous alteration in PAX6 (c.495delG, p.Thr166Leufs*41) and no abnormalities of WT1, excluding WAGR syndrome. Conclusion The genitourinary risks potentially associated with aniridia necessitate prompt genetic analysis to evaluate for WAGR syndrome.

Abstract: Anterior Urethral Valves (AUV) are a less common cause of lower urinary tract obstruction than Posterior Urethral Valves (PUV). AUV may present with symptoms of mild to severe obstruction and renal impairment at any age. Here we report possibly the first case of AUV presenting as hydrops fetalis. This late preterm infant presented with postnatal presentation of hydrops leading to respiratory failure. There was marked ascites, a left-sided inguinal hernia and hypospadias. Immune and most non-immune causes of hydrops were ruled out. Mild hydronephrosis with poor renal function and dependency on bladder catheterization for urinary output remained. While the ascites gradually improved, the bladder outlet obstruction persisted without evidence for PUV. Voiding cystourethrogram (VCUG) led to suspicion of AUV which was confirmed and managed with cystoscopic valve ablation. We review the physiology, clinical presentations, treatment and outcomes of AUV in the context of a differential diagnosis based on neonatal ascites values.

Abstract: The aim of this study is to evaluate the incidence of vesicoureteral reflux (VUR) in patients with febrile convulsion (FC). For this, patients that were diagnosed with FC in 2018 were retrospectively reviewed. Those with epilepsy, motor/mental retardation, or spina bifida were excluded. Mid-stream urine samples were collected in children who were toilet trained while sterile bags were used in the smaller. Urinary tract infection (UTI) was defined as ˃ 5 leucocytes/HPF in urinalysis and a subsequent positive urine culture (≥ 10.000 CFU/ml). Children with UTI were further investigated via voiding cystourethrogram (VCUG) and dimercaptosuccinic acid (DMSA) scintigraphy for VUR. Urinalysis was present in 79 among a total of 181 patients (43.6%). Forty-five of the patients were male (57%). Mean age was 2.6 ± 1.4 years. UTI was diagnosed in 6 (7.6%) patients (5 females, 1 male). Three of the girls had recurrent febrile UTI and subsequently, VUR was diagnosed in two of them. VUR is found in 2.5% of the FC cases with urine sampling. Urinalysis should not be ignored in patients with FC as it may lead to diagnosis of VUR.

Abstract: Background: Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. To analyse the incidence of ureteropelvic junction (UPJ) obstruction in antenatally detected hydronephrosis cases. Methods: This prospective study was conducted February 2019 to August 2019 at the Institute of Child Health and Hospital for Children Egmore, Chennai. All the cases of hydronephrosis which were detected antenatally and those children presented with hydronephrosis in the neonatal period were taken for this study. Totally 58 cases were analyzed in the study, among that 32 cases detected antenatally with UPJ obstruction. Their epidemiology and their immediate postnatal findings (USG abdomen by 3-7 days, IVP and DTPA by 4-6 weeks) were recorded and the percentage of cases in which pelvic-ureteric junction obstruction was significant. Results: Among the cases that were diagnosed to have hydronephrosis antenatally (46), 69% (32/46) had UPJ obstruction, 21% (10/46) had bilateral hydronephrosis, 6.5% (3/46) had vesicoureteric reflux and rest had other anomalies (1/46). Conclusions: Antenatal hydronephrosis (ANH), one of the most common abnormal findings on the antenatal ultrasound (US), continues to increase as the standard of care includes the 2nd trimester US. US is the mainstay of the postnatal evaluation and voiding cystourethrogram may be safely reserved for high-grade ANH or dilated distal ureter. New urinary biomarkers may offer promising potential for more accurate risk stratification in the near future.

Abstract: To evaluate the outcome of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) disease in renal transplantation patients and to determine the factors that were associated with the success rate of the treatment. A total of 121 symptomatic VUR diseases diagnosed between 2014 and 2018 in 3560 renal transplant patients. The results of 49 VUR cases that presented with febrile urinary tract infection (UTI) and were hospitalized for antibiotic treatment were included in the study. Reflux was detected by voiding cystourethrogram and treatment was performed by endoscopic Deflux® injection. The result of endoscopic treatment was evaluated clinically by 3 months periods. The mean time between transplantation and endoscopic treatment was 59.6 (5–132) months, and the mean follow-up period after the endoscopic treatment was 14 (6–48) months, respectively. The success rate after the first injection was 59.1% (n = 29) and 67.3% (n = 33) after the second injection. One patient developed anuria, one patient febrile UTI and four patients developed minimal macroscopic hematuria after the procedure. Endoscopic treatment of symptomatic VUR in transplanted kidney is a safe and feasible procedure. The amount of bulking agent or duration between the transplantation and diagnosis of VUR does not have any impact on the success of the treatment. However, the younger age of the patients and the female gender seem to have a positive effect on the outcome of the procedure.

Abstract: Bladder volume at the onset of vesicoureteral reflux (VUR) is an important prognostic indicator of spontaneous resolution and the risk of pyelonephritis. We aim to determine whether pediatric urologists and pediatric radiologists can accurately estimate the timing of reflux by examining voiding cystourethrogram (VCUG) images without prior knowledge of the instilled contrast volume. Total bladder volume and the volume at the time of reflux were collected from VCUG reports to determine the volume at the onset of VUR. Thirty-nine patients were sorted into three groups: early-/mid-filling reflux, late-filling and voiding only. Thirty-nine images were shown to three pediatric urologists and two pediatric radiologists in a blinded fashion and they were then asked to estimate VUR timing based on the above categories. A weighted kappa statistic was calculated to assess rater agreement with the gold standard volume-based report of VUR timing. The mean patient age at VCUG was 3.1±2.9 months, the median VUR was grade 3, and 20 patients were female. Overall agreement among all five raters was moderate (k=0.43, 95% confidence interval [CI] 0.36–0.50). Individual agreement between rater and gold standard was slight to moderate with kappa values ranging from 0.13 to 0.43. Pediatric radiologists and urologists are unable to accurately and reliably characterize VUR timing on fluoroscopic VCUG. These findings support the recently published American Academy of Pediatrics protocol recommending the routine recording of bladder volume at the onset of VUR as a standard component of all VCUGs to assist in a more accurate assessment of the likelihood of resolution and risk of recurrent urinary tract infections.

Abstract: Pyonephrosis is a rare condition in both adult and pediatric population. Here, the author presents a rare case of pyonephrosis induced by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a 12-month-old girl presenting with a picture of urosepsis. The patient presented with febrile urinary tract infection and was unresponsive to intravenous meropenem. Physical examination revealed huge, firm and irregular right renal swelling. Ultrasound and computed tomography imaging revealed severely hydronephrotic right kidney, and laboratory investigations showed elevated C-reactive protein level (22.9 mg/dl). Emergency percutaneous nephrostomy tube was inserted, pus was drained (20 ml) and intravenous vancomycin and amikacin were started. Her general condition improved, and urine culture was negative. Functional assessment with dimercaptosuccinic acid renal scan revealed that the split renal function was 5% on the right and 95% on the left side, and the bladder outline was smooth with no reflux in voiding cystourethrogram. A right nephrectomy was done a week later using the anterior subcostal approach. The postoperative course was smooth. Histopathological examination was diagnostic for xanthogranulomatous pyelonephritis. No adverse events were reported in the follow-up over 12 months. It can be concluded that a high degree of suspicion, rapid initiation of appropriate antibiotics and drainage of pus are crucial in the management of pyonephrosis.

Abstract: Introduction: Conservative management of primary obstructive megaureter (POM) appears as the best option in patients with adequate ureteral drainage. Nevertheless, surgical intervention is indicated in cases of recurrent urinary tract Infections (UTIs), deterioration of split renal function, and significant obstruction. The gold standard includes: Ureteral reimplantation with or without tapering by open approach. Our objective is to report our results in the treatment of POM by Laparoscopic-Assisted Extracorporeal Ureteral Tapering Repair (EUTR) and Laparoscopic Ureteral Extravesical Reimplantation (LUER) and to evaluate the efficacy and security of this procedure. Materials and Methods: From January 2011 to January 2018 a retrospective study was carried out by reviewing the clinical records of 26 patients diagnosed with POM. All patients underwent laparoscopic ureteral reimplantation following Lich Gregoir technique. In cases of ureteral tapering, an EUTR was performed with Hendren technique. Results: In all patients LUER and EUTR were performed without conversion. No ureteral tapering was necessary in six patients. There were no intraoperative complications. At 3 months in postoperative, 1 patient presented a febrile UTI, and subsequently, a vesicoureteral reflux (VUR) grade III was diagnosed by voiding cystourethrogram. In this case, a redo laparoscopic surgery was performed. After long-term follow-up, all patients were asymptomatic without recurrence of POM or VUR. Conclusion: Laparoscopic-assisted EUTR and LUER following Lich Gregoir technique for POM constitutes a safe and effective option, with a success rate similar to that of open procedure. Nevertheless, larger randomized prospective trials and long-term follow-up are required to validate this technique.

Abstract: Background Neonates with congenital urinary tract dilatation (UTD) may have an increased risk of urinary tract infections (UTI). At present, the management of these patients is controversial and the utility of continuous antibiotic prophylaxis (CAP) remains uncertain as the literature presents contradicting evidence. The aim of this observational study was to assess UTI occurrence in children with prenatal diagnosis of urinary collecting system dilatation without antibiotic prophylaxis. Methods Between June 2012 and August 2016, we evaluated the incidence of UTI and the clinical and ultrasonography evolution in 407 children with a prenatally diagnosed UTD. All subjects underwent two prenatal ultrasounds scans (USs) at 20 weeks and 30 weeks of gestation and within 1 month of birth. Patients with a confirmed diagnosis of UTD underwent US follow-up at 6, 12 and 24 months of life. According to the UTD classification system stratify risk, after birth UTD were classified into three groups: UTD-P1 (low risk group), UTD-P2 (intermediate risk group), and UTD-P3 (high risk group). Voiding cystourethrogram was performed in all patients who presented a UTI and in those with UTD-P3. No patient underwent CAP. Results Postnatal US confirmed UTD in 278 out of 428 patients with the following rates: UTD-P1 (126), UTD-P2 (95) and UTD-P3 (57). During postnatal follow-up, 6.83% patients presented a UTI (19 out of 278). Eleven out of 19 had vesicoureteral reflux (VUR), and other four were diagnosed with obstructive uropathy and underwent surgical correction. Five patients presented a UTI reinfection. Conclusion The occurrence of UTI in patients with urinary collecting system dilatation was low. The recent literature reports an increased selection of multirestistant germs in patients with VUR exposed to CAP. This study constitutes a strong hint that routine continuous antibiotic prophylaxis could be avoided in patients with UTD.