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OBJECTIVE: To assess the effect of bladder neck morphology and its incision (BNI) in patients with posterior urethral valve (PUV) on early reintervention rate. PATIENTS AND METHODS: Infants undergoing PUV ablation (PVA) before 24 months of age and had at least 18 months of follow-up, were categorized into three groups according to the bladder neck appearance on baseline radiological and endoscopic examination: group 1; normal bladder neck underwent PVA, group 2; high bladder neck underwent PVA plus BNI, group 3; high bladder neck underwent PVA only. Early reintervention was defined as the need for check cystoscopy because of persistent renal function deterioration, worsening hydronephrosis and/or unsatisfactory VCUG improvement during the 1st six months post primary PVA. RESULTS: Between 2000 and 2017, a total of 114 patients underwent PVA and met the study criteria with a median follow-up of 58 (18-230) months. For group 1, 16 (22.9%) patients needed readmission. Check cystoscopy was free and no further intervention was performed in 5(7.5%) and re-ablation was performed in 11(15.7%) patients. For group 2, 3(14.3%) patients needed reintervention. Re-ablation and re-ablation plus BNI were performed in 1(4.8%) and 2(9.5%), respectively. For group 3, cystoscopy was free in 1(4.3%), re-ablation and re-ablation plus BNI were performed 2(8.7%) and 1(4.3%), respectively. There were no significant differences in the re-admission and re-intervention rates among the three study groups (p=0.65 and p=0.50, respectively). CONCLUSION: In morphologically high bladder neck associated PUV, concomitant BNI with PVA doesn't reduce early re-intervention rate.
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Uretra , Vejiga Urinaria , Cistoscopía , Cistotomía , Estudios de Seguimiento , Humanos , Lactante , Masculino , Estudios Retrospectivos , Uretra/cirugía , Vejiga Urinaria/cirugíaRESUMEN
PURPOSE: We studied the effect of oxybutynin on bladder and upper urinary tract outcomes in infants following posterior urethral valve ablation. MATERIALS AND METHODS: Patients younger than 12 months old who had undergone primary endoscopic valve ablation for posterior urethral valves were screened for eligibility. Patients who had undergone urinary diversion or had other conditions that could affect lower urinary tract function were excluded. Study patients were randomized to either oxybutynin (0.2 mg/kg 3 times daily) until toilet training or active observation. The study end points were serum creatinine, estimated glomerular filtration rate, hydronephrosis improvement, vesicoureteral reflux resolution, febrile urinary tract infection and toilet training. RESULTS: A total of 49 infants (24 receiving oxybutynin and 25 undergoing observation) were enrolled between December 2013 and September 2015 and completed at least 1 year of followup. Oxybutynin was discontinued before toilet training in 5 patients due to facial flushing in 2, bladder and upper tract dilatation in 2, and cognitive changes in 1. After a median followup of 44.2 months (range 12 to 57.6) median serum creatinine and estimated glomerular filtration rate were not significantly different between the groups (p=0.823 and p=0.722, respectively). Renal units in the oxybutynin group had a greater likelihood of hydronephrosis improvement (61.9% vs 34.8%, p=0.011) and resolution of vesicoureteral reflux (62.5% vs 25%, p=0.023). Febrile urinary tract infection (29.2% vs 40%, p=0.404), completion of toilet training (70.8% vs 76%, p=0.748) and age at toilet training (p=0.247) did not differ significantly between the oxybutynin and observation groups. CONCLUSIONS: Oxybutynin enhances hydronephrosis improvement and vesicoureteral reflux resolution following primary endoscopic valve ablation in infants but periodic monitoring is warranted.
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Hidronefrosis/terapia , Ácidos Mandélicos/administración & dosificación , Uretra/anomalías , Obstrucción Uretral/cirugía , Agentes Urológicos/administración & dosificación , Reflujo Vesicoureteral/terapia , Creatinina/sangre , Estudios de Seguimiento , Tasa de Filtración Glomerular/fisiología , Humanos , Hidronefrosis/etiología , Hidronefrosis/fisiopatología , Lactante , Recién Nacido , Riñón/efectos de los fármacos , Riñón/fisiopatología , Masculino , Resultado del Tratamiento , Obstrucción Uretral/etiología , Obstrucción Uretral/fisiopatología , Reflujo Vesicoureteral/etiología , Reflujo Vesicoureteral/fisiopatologíaRESUMEN
PURPOSE: We sought to evaluate long-term outcomes of the Bricker conduit urinary diversion in children. MATERIALS AND METHODS: We retrospectively reviewed the database of a single tertiary center for children who had undergone ileal conduit between 1981 and 2011. Patients followed for less than 1 year were excluded. Patient files were reviewed for demographics, diversion indication, preoperative imaging, surgical details, hospital readmissions and followup data. Renal function at baseline and last followup was assessed by estimated glomerular filtration rate, calculated using the modified Schwartz or MDRD (Modified Diet in Renal Disease) formula. Growth charts elucidated patient growth patterns, while an internally designed quality of life questionnaire demonstrated patient and family satisfaction with the procedure. RESULTS: We evaluated 29 children who underwent Bricker conduit at a median age of 10 years (range 2 to 18) and were followed for a median of 91 months (16 to 389). Neuropathic bladder was the underlying diagnosis in 72.4% of cases. Hydronephrosis improved or remained stable in 39 of 55 studied renal units (70.9%). Although no statistically significant difference was observed between mean ± SD baseline (64.5 ± 46 ml/minute/1.73 m(2)) and last followup estimated glomerular filtration rate (54.1 ± 44.9 ml/minute/1.73 m(2)), chronic kidney disease stage had worsened in 13 patients (44.8%), end-stage kidney disease had developed in 11 patients and 9 patients had died. Six patients underwent undiversion after stabilization of renal function. Linear growth was negatively affected in 12 patients (41.4%), and 85% reported poor quality of life. A total of 19 hospital readmissions were required in 14 patients to treat diversion related complications. CONCLUSIONS: The Bricker conduit does not seem to halt renal deterioration in children. Negative impact on growth and quality of life, and the anticipated rate of complications are significant limitations of the procedure in the pediatric population.
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Íleon/cirugía , Enfermedades Renales/cirugía , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Derivación Urinaria/métodos , Adolescente , Niño , Preescolar , Egipto/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Derivación Urinaria/psicologíaRESUMEN
PURPOSE: Staging of childhood renal tumors is crucial for treatment planning and outcome prediction. We sought to identify whether computerized tomography could accurately predict the local stage of childhood renal tumors. MATERIALS AND METHODS: We retrospectively reviewed our database for patients diagnosed with childhood renal tumors and treated surgically between 1990 and 2013. Inability to retrieve preoperative computerized tomography, intraoperative tumor spillage and nonWilms childhood renal tumors were exclusion criteria. Local computerized tomography stage was assigned by a single experienced pediatric radiologist blinded to the pathological stage, using a consensus similar to the Children's Oncology Group Wilms tumor staging system. Tumors were stratified into up-front surgery and preoperative chemotherapy groups. The radiological stage of each tumor was compared to the pathological stage. RESULTS: A total of 189 tumors in 179 patients met inclusion criteria. Computerized tomography staging matched pathological staging in 68% of up-front surgery (70 of 103), 31.8% of pre-chemotherapy (21 of 66) and 48.8% of post-chemotherapy scans (42 of 86). Computerized tomography over staged 21.4%, 65.2% and 46.5% of tumors in the up-front surgery, pre-chemotherapy and post-chemotherapy scans, respectively, and under staged 10.7%, 3% and 4.7%. Computerized tomography staging was more accurate in tumors managed by up-front surgery (p <0.001) and those without extracapsular extension (p <0.001). CONCLUSIONS: The validity of computerized tomography staging of childhood renal tumors remains doubtful. This staging is more accurate for tumors treated with up-front surgery and those without extracapsular extension. Preoperative computerized tomography can help to exclude capsular breach. Treatment strategy should be based on surgical and pathological staging to avoid the hazards of inaccurate staging.
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Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Tomografía Computarizada por Rayos X , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estadificación de Neoplasias/métodos , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
AIM: To analyze the status of renal function after pyeloplasty in a large contemporary adult series and to detect which variables predict improvement of renal function. MATERIALS AND METHODS: 85 adult patients were retrospectively identified who had undergone pyeloplasty between January 2002 and May 2011 with available pre- and postoperative diuretic scintigraphy. Preoperative differential renal function (DRF) and single-kidney GFR (SKGFR) were obtained by (99m)Tc-MAG-3 diuretic scintigraphy. Baseline-weighted (bw-) DRF and SKGFR were calculated between baseline conditions and time of last follow-up. Factors that explain the variance of bw-DRF and bw-SKGFR were determined. RESULTS: The mean (SD) preoperative DRF significantly increased from 34% (11.6) to 37.2% (11.8) after pyeloplasty (p < 0.001). Similarly, mean (SD) SKGFR showed a significant improvement from 31.2 (12.9) to 35.9 (15) ml/min (p < 0.001). Patients with a lower baseline DRF (≤40%) showed a significant improvement as opposed to those with a higher baseline DRF (>40%) (p < 0.001 and 0.3, respectively). Baseline DRF and cortical thickness explained the variance in bw-DRF and bw-SKGFR with more contribution of baseline DRF. CONCLUSIONS: Renal function showed improvement after pyeloplasty in adults and preoperative DRF and cortical thickness were the predicting variables.
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Riñón/fisiopatología , Obstrucción Ureteral/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adolescente , Adulto , Anciano , Femenino , Tasa de Filtración Glomerular , Humanos , Riñón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cintigrafía , Radiofármacos , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Stents , Tecnecio Tc 99m Mertiatida , Resultado del Tratamiento , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/diagnóstico , Obstrucción Ureteral/fisiopatología , Procedimientos Quirúrgicos Urológicos/efectos adversos , Procedimientos Quirúrgicos Urológicos/instrumentación , Adulto JovenRESUMEN
OBJECTIVE: To study the predictive value of 6 ultrasonographic (USG) parameters for early detection of children at risk of recurrent obstruction. PATIENTS AND METHODS: A prospective nonrandomized study included all patients who underwent pyeloplasty between 2010 and 2012. All of the patients had completed at least 6 months of follow-up and preoperative and postoperative USG imaging data were available. The primary outcome was the correlation between USG and diuretic scintigraphic parameters. The secondary outcome was the predictive ability of the pelvicalyceal system parameters, measured by USG, of parenchymal growth after surgery. RESULTS: Sixty-eight patients were evaluated. The mean age was 3.6 years (range 0.1-12). The mean (± standard deviation) differential renal function improved from 37.4 ± 11 ml/min to 37.7 ± 14 ml/min, which was a difference of no statistical significance. On the other hand, the mean (± SD) half-time (T1/2) significantly improved. After constructing a linear regression model of the 4 USG parameters and the parenchymal growth, the model explained 57.2% of the variance in parenchymal growth after pyeloplasty. The calyx-to-parenchyma ratio change was the largest unique contribution for explaining the variance in parenchymal growth, followed by anteroposterior diameter and calyceal dilatation. CONCLUSION: We proved that calyx-to-parenchyma ratio, anteroposterior diameter and calyceal dilatation are independent predictors of early success after pyeloplasty.
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Riñón/diagnóstico por imagen , Obstrucción Ureteral/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Factores de Edad , Niño , Preescolar , Diuresis , Femenino , Humanos , Lactante , Riñón/crecimiento & desarrollo , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Radiografía , Recuperación de la Función , Stents , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/fisiopatología , Procedimientos Quirúrgicos Urológicos/instrumentaciónRESUMEN
PURPOSE: Previous series showed controversial differential renal function outcomes after pyeloplasty in children. However, they were limited by study power, methodology and lack of comparable end points. We determined the status of differential renal function after pyeloplasty in children in what is to our knowledge the largest series to date. MATERIALS AND METHODS: After excluding patients with renal anomalies, solitary kidney or bilateral pyeloplasty from analysis, we retrospectively identified 196 younger than 18 years who were treated with pyeloplasty between May 2002 and January 2010 and had preoperative and postoperative renal scintigraphy available. Primary outcome measures were greater than 5% improvement in baseline differential renal function and baseline weighted differential renal function at last followup. Clinical variables predicting outcome measures were determined using univariable and multivariable analyses. RESULTS: During a median followup of 12 months, mean ± SD differential renal function improved from 35.8% ± 10% to 38.7% ± 11% (p <0.001). In the poor and intermediate groups baseline differential renal function improved, while in the good group function was static postoperatively (p <0.001). The linear regression model showed that only baseline differential renal function explained the variance in baseline weighted differential renal function (ß = -0.393, p <0.001). In the Cox proportional hazards model baseline differential renal function (less than 35% HR 3.196, p <0.001 and 35% to 40% HR 2.733, p = 0.002) and cortical thickness (HR 2.114, p = 0.029) were the only predictors of a greater than 5% improvement in postoperative differential renal function. CONCLUSIONS: Renal function improves after pyeloplasty in children. Baseline differential renal function and cortical thickness predict improvement after surgery.
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Tasa de Filtración Glomerular/fisiología , Corteza Renal/fisiopatología , Procedimientos de Cirugía Plástica/métodos , Uréter/cirugía , Obstrucción Ureteral/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Corteza Renal/diagnóstico por imagen , Pruebas de Función Renal , Masculino , Periodo Posoperatorio , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía , Obstrucción Ureteral/diagnóstico , Obstrucción Ureteral/fisiopatología , UrografíaRESUMEN
Introduction and Objectives: Wilms' tumor (WT) relapse occurs in 15% of patients. We aim to investigate the association between the expression of several genetic markers and WT relapse risk. Materials and methods: The study included 51 children treated for WT at a tertiary center between 2001 and 2019: 23 patients had disease relapse (group A) and 28 remained relapse-free after at least 2 years of follow-up (group B). Patients with syndromic, bilateral synchronous or anaplastic WT were excluded. Autologous renal tissue from 20 patients served as control. Total RNA was isolated from tumor tissue and control. Gene expression levels of WT1, HIF1α, b-FGF, c-MYC and SLC22A18 were assessed using quantitative RT-PCR and normalized to GAPDH. Immunohistochemical staining for WT1 and gene expression levels were compared between the study groups. Results: Median patient age was 3 (IQR = 2-5) years and 36 (70.6%) had stage I disease. Baseline characteristics were similar between study groups. Relapse occurred at a median of 6.8 (2.8-24.7) months, predominantly in the lungs (11/23, 47.8%). Tumors that relapsed expressed significantly higher levels of WT1, HIF1α, b-FGF and c-MYC and lower levels of SLC22A18 (p < 0.001). Strong immunohistochemical staining for WT1 was seen in 73.9% of group A and 14.29% of group B (p < 0.001). These associations retained statistical significance irrespective of patient and tumor characteristics. Conclusions: Higher expression levels of WT1, HIF1 α, b-FGF and c-MYC and lower level of SLC22A18 are associated with increased risk of WT relapse. These genetic markers can serve as future prognostic predictors and help stratify patients for treatment.
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PURPOSE OF REVIEW: Complete penile disassembly (CPD) is a widely utilized procedure for epispadias repair. The rarity of the anomaly and limited number of patients in published series limit our ability to fully evaluate the outcome of such a technique. RECENT FINDINGS: We reviewed the literature for published data on CPD. We looked at different complications of the procedure and the main modifications to alleviate such complications. We looked at functional data on the effect of such a technique on erectile function. This review should be helpful in parents/patient counseling. Future areas for research are suggested. SUMMARY: CPD is a safe and highly successful technique for epispadias repair in infants, boys and adults. There is an ongoing concern with the procedure in neonates. The procedure has a satisfactory outcome when performed for isolated epispadias. In the exstrophy population, long-term data are required to evaluate the outcome of the technique on urinary continence and sexual functions.
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Epispadias/cirugía , Pene/cirugía , Uretra/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos , Adolescente , Adulto , Niño , Preescolar , Eyaculación , Epispadias/fisiopatología , Humanos , Lactante , Recién Nacido , Masculino , Satisfacción del Paciente , Erección Peniana , Pene/anomalías , Pene/fisiopatología , Recuperación de la Función , Conducta Sexual , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Uretra/anomalías , Uretra/fisiopatología , Incontinencia Urinaria/etiología , Incontinencia Urinaria/fisiopatología , Procedimientos Quirúrgicos Urológicos Masculinos/efectos adversos , Adulto JovenRESUMEN
Objective: To evaluate whether p53, cyclin A and ki67 immunohistochemical (IHC) assay can be used as predictors for Wilms' tumor (WT) unfavorable outcomes. Methods: It is a non-concurrent cohort study including patients who underwent nephrectomy for WT from January 2000 to December 2015 in a tertiary referral center. Over a 5- year follow-up, unfavorable events, including relapse and cancer-specific mortality (CSM), were recorded. P53, cyclin A, and ki67 IHC assay were carried out for formalin-fixed paraffin-embedded WT samples. Results: After excluding those who did not meet the inclusion criteria, 75 patients were enrolled. Of the patients, 15/75 (20%) experienced WT relapse while 11/75 (14.6%) died of WT over five years. Unfavorable histology (UFH), including prominent blastemal components and anaplasia, was found in 15/75 (20%) children.Cyclin A immunopositivity was associated with high rates of relapse and CSM. P53 and ki67 positive IHC assay did not show any statistically significant association with unfavorable outcomes. Other risk factors e.g. advanced staging, UFH, extracapsular extension, tumor rupture, lymphadenopathy, and venous thrombosis were not associated with poor prognosis. However, the presence of residual tumors was accompanied by lower survival rates. Conclusion: Cyclin A IHC assay can be used as a predictor of WT recurrence and CSM. Further studies with prospective patterns and a larger sample size are needed.Abbreviations: WT: Wilms' tumor, UFH: unfavorable histology, IHC: immunohistochemical, PI: proliferation index, RFS: relapse-free survival, CSS: cancer-specific survival, FH: favorable histology, CSM: cancer-specific mortality, CDK: cyclin-dependent kinase.
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OBJECTIVES: To examine the durability of continent cutaneous catheterizable urinary channels (CCCC) in children and assess whether channel complications continue to arise with extended follow-up. Previous studies demonstrated that complications of CCCC cluster in the early years following surgery. METHODS: The database of a tertiary center was queried for patients≤21 years who underwent CCCC. Patients with <6 years of follow-up were excluded. Patients were invited for follow-up to assess continence. Clinic visits and hospital admissions were reviewed for channel complications requiring reoperation. Complications were analyzed against patient and channel characteristics and time since initial surgery. RESULTS: Between 1993 and 2012, a total of 120 patients underwent CCCC at a median age of 6.8(0.4-21) years and a median follow-up of 11.4(6.6-27) years. CCCC were created using the appendix, Monti channels and tapered ileal segments in 74(61.7%), 33(27.5%) and 13(10.8%), respectively. Continence relied on the extra-mural serous lined principle in 85.8% and the stoma was anastomosed to the umbilicus in 90%. Dryness with catheterization intervals of 3 hours or longer was eventually achieved in 90.8% with similar rates among different channel types (P=.149). 26(21.7%) required 42 interventions to treat channel complications with 32.5% occurring >5 years following initial surgery irrespective of the channel type (P=.978). On multivariate analysis, ileal channels had 3.372 higher odds of needing reoperation compared to appendicovesicostomy (95%CI=1.240-9.166; P = .037). CONCLUSION: A high reoperation rate is anticipated throughout the lifetime of CCCC. Appendicovesicostomy has a low complication risk relative to ileal channels.
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Cistostomía/métodos , Complicaciones Posoperatorias , Cateterismo Urinario , Incontinencia Urinaria , Reservorios Urinarios Continentes , Procedimientos Quirúrgicos Urológicos , Apéndice/cirugía , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Procedimientos de Cirugía Plástica/métodos , Reoperación/métodos , Reoperación/estadística & datos numéricos , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/métodos , Cateterismo Urinario/estadística & datos numéricos , Incontinencia Urinaria/diagnóstico , Incontinencia Urinaria/etiología , Incontinencia Urinaria/prevención & control , Reservorios Urinarios Continentes/efectos adversos , Reservorios Urinarios Continentes/estadística & datos numéricos , Procedimientos Quirúrgicos Urológicos/efectos adversos , Procedimientos Quirúrgicos Urológicos/instrumentación , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
INTRODUCTION AND OBJECTIVES: The management of bilateral ureteropelvic junction obstruction (UPJO) is greatly debated. We aim to identify the risk of early postoperative acute kidney injury (AKI) in relation to the sequence of intervention in children with bilateral UPJO managed in a sequential manner. METHODS: A single center database was retrospectively reviewed for children ≤2 years who underwent bilateral pyeloplasty. According to the differential renal function on the preoperative renograms, patients were categorized into group A: pyeloplasty on the poorer functioning kidney first and group B: pyeloplasty on the better functioning side first. Serum creatinine and eGFR, using the modified Schwartz formula, were evaluated at four time points (I): before the first intervention (II): within 48 h of the first intervention (III): before the second intervention and (IV): within 48 h of the second intervention. Preoperative and postoperative values were compared. The incidence of early postoperative AKI in both groups was defined according to the Acute Kidney Injury Network (AKIN) criteria. RESULTS: The study comprised 46 children treated by staged pyeloplasty, 28 of them underwent pyeloplasty on the poorer functioning side first. Baseline serum creatinine and eGFR were not significantly different between both groups. Patients who underwent pyeloplasty on the poorer functioning side first, had a significant decline of eGFR after the first intervention (p = 0.006). Conversely, no significant eGFR changes were observed after the first or second interventions in the other group (figure). Overall, 64.3% and 33.3% of patients developed some degrees of AKI when intervention was started on the poorer and better functioning renal units, respectively (p = 0.04). DISCUSSION: Bilaterality is seen in approximately » of patients with UPJO. Oftentimes, both renal units are asymmetrically affected with little data to guide surgeons on the optimal sequence of intervention. Following pyeloplasty, 52.2% of the evaluated children with bilateral UPJO had early postoperative AKI, mostly of low stage. Our data suggest that intervening first on the better functioning side allows for better recovery of the renal functional reserve and lowers the risk of postoperative AKI. CONCLUSION: In children with bilateral UPJO, starting intervention on the poorer functioning kidney is associated with increased risk of postoperative AKI. Long-term prospective studies are needed to confirm our findings.
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Lesión Renal Aguda , Obstrucción Ureteral , Niño , Humanos , Lactante , Pelvis Renal/cirugía , Estudios Retrospectivos , Creatinina , Obstrucción Ureteral/complicaciones , Lesión Renal Aguda/etiología , Procedimientos Quirúrgicos Urológicos , Resultado del TratamientoRESUMEN
PURPOSE: We evaluated the functional outcome of continent catheterizable outlet using the serous lined extramural tunnel technique as a continence mechanism in children and adolescents. MATERIALS AND METHODS: We retrospectively studied all patients who underwent continent catheterizable stoma using the serous lined extramural technique between May 1993 and March 2008. Patient records were reviewed for age, sex, indication for surgery, surgical details and postoperative course. All patients were evaluated for continence with emphasis on frequency of clean intermittent catheterization. Urodynamic evaluation was done for patients with leaking stoma. Stoma related complications were also recorded. RESULTS: A total of 37 boys and 23 girls 3 to 18 years old underwent continent catheterizable stoma using the serous lined extramural technique. Total bladder substitution was performed in 13 patients using continent ileal W-shaped reservoir, and 47 patients underwent augmentation ileocystoplasty mounted with serous lined outlet. The outlet channel was appendix in 39 patients (65%), tapered ileal segment in 13 (21.5%) and Monti ileal tube in 8 (13.5%). After a median followup of 43 months (range 10 to 180) 55 patients (91.6%) achieved continence, with catheterization frequency of 3 to 5 times during the daytime and 1 to 2 times at night. Stoma related complications were leaking stoma in 5 patients (8.4%), stomal stenosis in 6 (10%), parastomal hernia in 2 (3.3%) and reservoir stones in 8 (13.3%). Reoperation rate was 18.3% (11 patients). CONCLUSIONS: The serous lined continent outlet seems to be a durable and efficient technique for treating children with incontinence, with an acceptable complication rate.
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Cateterismo Urinario , Reservorios Urinarios Continentes , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
INTRODUCTION AND OBJECTIVES: We aim to assess the long-term oncological outcomes of children with bladder/prostate rhabdomyosarcoma (B/P RMS) treated with multiagent chemotherapy as a monotherapy. We hypothesize that a highly select patient subset can be treated with multiagent chemotherapy as a monotherapy and spared the morbidity of local treatment with similar oncological outcomes. METHODS: Patients (≤21-year-old) treated for non-metastatic non-alveolar B/P RMS at a tertiary center and followed for>one year, were retrospectively reviewed. After pathological confirmation, patients received 12 weeks of induction VAC chemotherapy (IC) followed by second-look biopsies. Between 1996 and 2006 (group A), patients with>50% tumor size reduction and negative second-look biopsies following IC were spared local treatment and followed-up closely. Between 2007 and 2020 (group B), local treatment was routinely given at 12 weeks according to the COG protocols, irrespective of IC response. For all patients, consolidation chemotherapy was administered for additional 12-18 months. RESULTS: Between 1996 and 2020, 27 patients (10 stage II, 17 stage III) with a median age of 3(1-21) years were included. Median follow-up was 87.5(15.3-247.1) months. Among 15 patients in group A, 3 were ineligible for the monotherapy protocol and received local treatment. The remaining 12 patients [9 complete (CR) and 3 incomplete response (IR) to IC] were treated exclusively with chemotherapy, of whom 9 were alive free of relapse at last follow-up. Two patients with IR to IC had disease relapse: one had pulmonary relapse at 8.2 months and one had local relapse at 35 months. The 5-year OS and EFS of group A were 86.7% and 80%, respectively. Analyzing survival according to IC response, CR to IC was achieved in 10 patients (9 group A and one group B) and was associated with significantly better OS and EFS than IR(p = 0.026 and 0.004, respectively) (Summary figure). All patients with CR to IC were alive free of relapse at last follow-up. DISCUSSION: Treatment of RMS is traditionally multimodal. Local treatment of B/P RMS is associated with significant patient morbidity. In this study, CR to IC predicted better OS and EFS. Patients who achieved CR (radiological and pathological) to IC remained alive free of relapse irrespective of local treatment. CONCLUSIONS: Our results suggest that patients with non-metastatic non-alveolar B/P RMS who achieve CR to IC can be treated with combination chemotherapy as a monotherapy and spared the morbidity of local treatment with durable survival outcomes. Prospective validation in a larger patient cohort is needed to support our hypothesis.
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Próstata , Rabdomiosarcoma , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Niño , Preescolar , Humanos , Lactante , Masculino , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Rabdomiosarcoma/tratamiento farmacológico , Resultado del Tratamiento , Vejiga Urinaria , Adulto JovenRESUMEN
Ureteral extension of childhood renal tumors is exceedingly rare. Hematuria, hydronephrosis, poorly or nonfunctioning kidney should raise suspicion for ureteral tumor extension. Identifying ureteral extension on preoperative imaging or intraoperatively before ureteral transection is crucial to obtain good oncological outcome without unnecessary exposure to radiation therapy or more intensive chemotherapy. In this report, we present three children with cystic renal tumors extending into the ureter and review the relevant literature.
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Neoplasias Renales/patología , Neoplasias Quísticas, Mucinosas y Serosas/patología , Uréter/patología , Tumor de Wilms/patología , Preescolar , Humanos , Lactante , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/cirugía , Masculino , Neoplasias Quísticas, Mucinosas y Serosas/diagnóstico por imagen , Neoplasias Quísticas, Mucinosas y Serosas/cirugía , Uréter/diagnóstico por imagen , Tumor de Wilms/diagnóstico por imagen , Tumor de Wilms/cirugíaRESUMEN
INTRODUCTION AND OBJECTIVE: Continent cutaneous diversion is an appealing option when orthotopic diversion is not feasible and continence preservation is desired. We describe the surgical technique of creating an ileal w-neobladder with a continent catheterizable channel using the extramural serous lined (Mansoura) principle in a bladder exstrophy patient. MATERIALS AND METHODS: A 9-year-old boy born with classic bladder exstrophy, underwent cystectomy and a sigma rectosigmoid pouch after multiple unsuccessful attempts of exstrophy reconstruction. Colonic diversion was complicated by refractory metabolic acidosis, ureteral obstruction and recurrent pyelonephritis. Ileal neobladder with a continent stoma was recommended after family counseling. RESULTS: A 50-cm segment of the terminal ileum is isolated. The proximal 7 cm of the isolated segment are partly tailored and used as an afferent limb. The appendix is used for creating the catheterizable channel. The remainder of the ileal segment is fashioned in a w-configuration. Extramural serous-lined tunnels are created between the lateral limbs of the pouch. The appendix and afferent ileal segment are embedded in the serous lined tunnels to achieve continence and antireflux mechanisms, respectively. The ureters are, thereafter, anastomosed to the afferent ileal segment in an end-to-side fashion. Umbilicoplasty was done using the VQZ-plasty technique. CONCLUSION: Conversion to an ileal neobladder is an option in patients who suffer the complications of colonic diversion. The extramural serous-lined technique is a versatile technique that can be used for creating antireflux and continence mechanisms.
Asunto(s)
Extrofia de la Vejiga/cirugía , Reservorios Urinarios Continentes , Niño , Procedimientos Quirúrgicos Dermatologicos , Humanos , Íleon/cirugía , Masculino , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
Keloid scars result from excess collagen deposition in the dermis or subcutaneous tissue in response to surgery or tissue trauma. The penis is a rare site for keloid formation, even in predisposed individuals. Only few cases of penile keloids have been reported so far. In this report, we present penile keloids complicating neonatal circumcision in twin brothers. Risk of recurrence in previous reports and measures to guard against its occurrence are also discussed.
Asunto(s)
Antiinflamatorios/uso terapéutico , Betametasona/uso terapéutico , Queloide/prevención & control , Masaje , Prevención Secundaria/métodos , Preescolar , Circuncisión Masculina/efectos adversos , Humanos , Queloide/etiología , Queloide/cirugía , Masculino , Pene , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , RecurrenciaRESUMEN
OBJECTIVE: To detect whether grafting the incised plate during Snodgrass repair would improve outcome. MATERIALS AND METHODS: Sixty patients with primary distal hypospadias were included. Patients were equally randomized using closed envelop method to either Snodgrass or grafted tubularized incised plate repair (GTIP). All operations were performed by a single surgeon. All intaroperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meatus at the tip of the glans with no stenosis, fistula or diverticulum. RESULTS: All 60 patients were evaluated at 1 year of follow-up. Mean age at surgery was 40±15months. Both groups were comparable as regard to patients' age, meatus location, length and width and depth of urethral plate and glans width. Success was documented in 29/30 patients (96.7%) in the Snodgrass group. The only complication was meatal stenosis in one patient, whereas success was documented in 28/30 patients (93.3%) in the GTIP group. The two failures were secondary to partial glans dehiscence. Success rate was not statistically different. Flow rate data at 1 year showed insignificant difference between both groups as regards Q-max and voiding time. The only statistically significant difference between both groups was a longer operative time 106±12min in the GTIP group compared to only 77±9 for the Snodgrass group (p = 0.005). CONCLUSIONS: Snodgrass and GTIP techniques for primary distal hypospadias repair have similar outcome. With a significantly shorter operative time, Snodgrass repair remains the first choice for primary distal hypospadias repair. TYPE OF THE STUDY: Prospective randomized study. LEVEL OF EVIDENCE: Level I.
Asunto(s)
Hipospadias/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Uretra/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Preescolar , Fístula/cirugía , Estudios de Seguimiento , Humanos , Lactante , Masculino , Estudios Prospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To demonstrate the long-term outcome of a contemporary series of 64 children who underwent complete primary repair of bladder exstrophy (CPRE) in a single tertiary referral center. MATERIALS AND METHODS: Between 1998 and 2012, 64 children, 47 boys and 17 girls, were identified. Only 60 of the 64 cases were available for follow-up. The follow-up was done by renal bladder ultrasound and serum creatinine every 3 months and voiding cystourethrogram from 6 to 12 months postoperatively. Continence was defined as dryness ≥3 hours. RESULTS: Median (range) follow-up is 14 years (from 5 to 19 years). Voided continence was achieved in 14 children (23%) after CPRE only. Additionally, 6 children were continent after bladder neck reconstruction (BNR) and 2 after bladder neck injection (BNI), raising the percentage of voided continence to 36%. The remaining 38 (64%) patients were using clean intermittent catheterization. All cases were continent at last assessment. The results of BNR or BNI were better in de novo than in redo cases (P <.05). The percentage of cases that needed augmentation ileocystoplasty in combination with multiple bladder neck procedures was lower in both female and de novo cases (P <.05). CONCLUSION: The percentage of children with classic bladder exstrophy who underwent CPRE who will achieve continence with volitional voiding via the urethra is 36%. The continence results after BNR and BNI are better in de novo cases than in redo ones. Continence in female and de novo cases is more likely to be achieved with lower number of continence procedures.
Asunto(s)
Extrofia de la Vejiga/fisiopatología , Extrofia de la Vejiga/cirugía , Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria/fisiopatología , Incontinencia Urinaria/etiología , Extrofia de la Vejiga/complicaciones , Preescolar , Creatinina/sangre , Femenino , Humanos , Lactante , Recién Nacido , Cateterismo Uretral Intermitente , Masculino , Procedimientos de Cirugía Plástica , Reoperación , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía , Vejiga Urinaria/cirugía , Micción , Procedimientos Quirúrgicos UrogenitalesRESUMEN
Bladder neck closure (BNC) is the ultimate bladder neck reconstruction. If reconstruction fails, closure must be considered as it gives the highest continence rate. The vast majority of BNCs are performed through an abdominal approach (either transvesical or extravesical approach), but perineal approach remains an option for BNC with considerable success rate. Perineal hernia, which is defined as protrusion of abdominal contents through the perineal defect, is a very rare complication after urologic procedures. We report a case of perineal hernia post perineal BNC.