Management of hydronephrosis: a comprehensive review in pediatric urology perspective

Hydronephrosis, characterized by dilation of the renal pelvis and calyces due to urine flow obstruction, poses a significant clinical challenge. Although often asymptomatic and capable of spontaneous resolution, surgical intervention is necessary for specific scenarios such as febrile urinary tract infections, deteriorating hydronephrosis, or declining renal function. The efficacy of continuous antibiotic prophylaxis in preventing urinary tract infections remains controversial. Yet, it may benefit high-risk patients, emphasizing the importance of individualized patient selection, as surgical treatment methods for patients with hydronephrosis have become less invasive than in previous decades. However, long-term follow-up outcomes are lacking, necessitating further clarification. This review presents an overview of the etiology, natural progression, and modern management of hydronephrosis, encompassing advancements in minimally invasive procedures.

Hematuria in children: causes and evaluation

Hematuria is the presence of blood in the urine and is classified as either gross hematuria or microscopic hematuria. There are many causes of hematuria, and the differential diagnosis depends on the presence or absence of comorbidities and whether it is glomerular or non-glomerular. When hematuria in children is symptomatic or persistent, an evaluation of the cause is essential. The causes of hematuria and basic approaches to its diagnosis are discussed in this review.

Changes in Autonomic Nervous System Activity in Children With Spina Bifida: A Case-Control Study / 대한배뇨장애요실금학회지

Purpose@#We compared heart rate variability parameters between patients with spina bifida and a control group during urodynamic studies, with the goal of evaluating the autonomic nervous system dysfunction present in spina bifida. @*Methods@#Continuous heart rate variability parameters were recorded during 3 successive periods (P0, the 2 minutes prior to the start of filling; P1, from the start of filling to the first desire to void; and P2, from P1 to the end of filling or the start of voiding). The control group consisted of children with vesicoureteral reflux who had undergone video-urodynamic studies. Our study included 11 patients with spina bifida and 9 control participants. @*Results@#At baseline, patients with spina bifida exhibited lower values for the root mean square of successive differences in NN intervals, the percentage of successive R-R interval differences exceeding 50 msec relative to the total number of intervals, and high frequency (HF). In contrast, the low frequency (LF)/HF ratio was elevated in these patients (5.04 ± 4.75 vs. 0.67 ± 0.42, P = 0.014). During bladder filling, LF/HF values increased in the control group (P0, 0.67 ± 0.42; P1, 0.89 ± 0.34; P2, 1.21 ± 0.64; P = 0.018), while they declined in patients with spina bifida (P0, 5.04 ± 4.75; P1, 3.96 ± 4.35; P2, 3.26 ± 4.03; P < 0.001). The HF values were significantly elevated in children with spina bifida during bladder filling (P = 0.002). In the time domain, the standard deviations of all NN intervals were elevated only in the control group during bladder filling. Parasympathetic activity domains were reduced in the children with spina bifida at the initial assessment. @*Conclusions@#During the bladder filling phase, parasympathetic activity increased along with fixed sympathetic activity in the spina bifida group. In contrast, the control group exhibited a shift towards a sympathetic preponderance at the conclusion of bladder filling. These observations may be associated with the pathophysiology of neurogenic bladder in spina bifida.

An Analysis of Major Causes of Surgical Failure Using Bähren System in Intraoperative Venography During Varicocelectomy

Purpose@#In young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV). @*Materials and Methods@#We retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bähren system. @*Results@#One hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%). @*Conclusion@#Remnant collateral veins of the internal spermatic vein (ISV) (Bähren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bähren type 4) and is unidentifiable without venography.

An Analysis of Major Causes of Surgical Failure Using Bähren System in Intraoperative Venography During Varicocelectomy

Purpose@#In young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV). @*Materials and Methods@#We retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bähren system. @*Results@#One hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%). @*Conclusion@#Remnant collateral veins of the internal spermatic vein (ISV) (Bähren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bähren type 4) and is unidentifiable without venography.

Jejunogastric intussusception prone to misdiagnosis as gastric cancer / 영남의대학술지

The authors report a case of a 78-year-old female with a history of gastric surgery 35 years ago. She was initially misdiagnosed as gastric cancer bleeding and underwent an emergency laparotomy under the diagnosis of jejunogastric intussusception (JGI), 23 hours after the onset of symptoms. We also reviewed 116 JGI case reports and analyzed clinical features and outcomes. Compared to the past, diagnosis of JGI is easier with diagnostic examinations such as an endoscopy, computed tomography, and the upper gastrointestinal series. And a good prognosis can be expected with proper fluid resuscitation and surgical reduction, even if the symptoms persist more than 48 hours.

Clinical Features of and Antibiotic Resistance in Recurrent Urinary Tract Infection in Children with Vesicoureteral Reflux

Purpose@#This study aimed to investigate the clinical features of recurrent urinary tract infection (UTI) in children with vesicoureteral reflux (VUR) and to compare the causative uropathogen and antibiotic susceptibility between the first and recurrent UTI episodes. @*Methods@#We retrospectively reviewed the medical records of children with VUR who had recurrent UTI. Group 1 included patients in whom the same pathogen caused the first and recurrent UTI episodes. Group 2 included patients in whom different pathogens caused the first and recurrent UTI episodes. @*Results@#During a 13-year study period (2005–2018), 77 children with VUR experienced at least one episode of UTI. Among these, 47 patients (61.0%) had recurrent UTI. Of the children with recurrent UTI, 19 (40.4%) were in group 1 and 28 (59.6%) were in group 2. Escherichia coli was the most commonly isolated uropathogen (n=37; 39.4%) in both episodes of recurrent UTIs, followed by Klebsiella pneumoniae (n=18; 19.1%), Enterococcus faecalis (n=14; 14.9%), and Enterobacter aerogenes (n=7; 7.4%). Although the difference was not significant, the rate of resistance to the antibiotics ceftazidime, piperacillin/tazobactam, and trimethoprim-sulfamethoxazole increased in patients with the second episode of E. coli recurrence in group 1, and that to cefotaxime, ceftazidime, piperacillin/tazobactam, and meropenem increased in children with the second episode of E. aerogenes recurrence in group 1. @*Conclusions@#When selecting empirical antibiotics for recurrent UTI in children with VUR, it is important to consider that the pathogen and antimicrobial susceptibility of the previous UTI are not always the same in recurrent UTIs.

Factors Associated with Operation Time of Laparoscopic Gastric Wedge Resection for Gastric Subepithelial Tumors

Purpose@#Gastric subepithelial tumor (GST) is a disease entity that includes all gastric subepithelial lesions. The oncologically safe surgical technique is complete resection with adequate resection margins. Most of the studies about laparoscopic gastric wedge rsection (LGWR) in GST focus on oncologic curability or surgical effectiveness. However, studies on the factors associated with the operation time are rare. Therefore, this study was conducted to analyze and compare the factors associated with the operation time of LGWR. @*Methods@#From 2010 to 2019, 145 consecutive patients undergoing LGWR were reviewed retrospectively. Clinical characteristics of GST and operation time were analyzed and compared. @*Results@#A total of 145 patients was enrolled and reviewed. There were 59 males (40.7%) and 86 females (59.3%) with a mean age of 53.6 years and mean body mass index (BMI) of 23.9 kg/m 2 . Mean tumor size was 2.9 cm and mean operation time was 66.0 minutes. In statistically, the mean operation time showed significant association with tumor size, BMI, longitudinal tumor location and tumor location between lesser and greater curvature. In multivariate analysis, tumor size, BMI and longitudinal classification of tumor location are statistically significant. @*Conclusion@#A shorter operation time is expected when there is a small tumor, low BMI and mid portion of the stomach GST. Preoperative evaluation for tumor size and body weight is important. In patients with large GST, obesity and both end stomach GST, we think that pre-operative preparation for long operation time should be considered.

Effects of tranilast on the epithelial-to-mesenchymal transition in peritoneal mesothelial cells

BACKGROUND: We investigated the effects of tranilast on epithelial-to-mesenchymal transition (EMT) in an animal model and on the EMT signaling pathway in human peritoneal mesothelial cells (HPMCs).METHODS: We performed in vitro studies (cytotoxicity, cell morphology, and western blot analyses) on HPMCs from human omenta, along with in vivo studies (peritoneal membrane function and morphometric and immunohistochemical analyses) on Sprague Dawley rats. Thirty-two rats were divided into three groups: control (C) group (peritoneal dialysis [PD] catheter but not infused with dialysate), PD group (4.25% glucose-containing dialysate), and PD + tranilast group (4.25% glucose-containing dialysate along with tranilast).RESULTS: In in vitro experiments, transforming growth factor-beta 1 (TGF-β1) increased α-smooth muscle actin and Snail expression and reduced E-cadherin expression in HPMCs. TGF-β1 also reduced cell contact, induced a fibroblastoid morphology, and increased phosphorylation of Akt, Smad2, and Smad3 in HPMCs. Tranilast significantly inhibited TGF-β1-induced EMT and attenuated these morphological changes in HPMCs. In in vivo studies, after 6 weeks of experimental PD, the peritoneal membrane was significantly thicker in the PD group than in the C group. Tranilast protected against PD-induced glucose mass transfer change and histopathological changes in rats.CONCLUSION: Tranilast prevented EMT both in HPMCs triggered with TGF-β1 and in rats with PD-induced peritoneal fibrosis. Thus, tranilast may be considered a therapeutic intervention that enables long-term PD by regulating TGF-β1 signaling pathways.

Validation of the 7th AJCC/UICC staging system for gastric cancer and a proposal for a new TNM system based on a prognostic score: a retrospective multicenter study

PURPOSE: We validate the 7th American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system for gastric cancer and propose a new staging system that reflects the prognostic significances of each of T and N category. METHODS: Data from 5,957 patients who underwent curative gastrectomies from 2000 to 2007 at 4 university hospitals in Daegu Metropolitan city in Korea were analyzed for the validation of the 7th AJCC/UICC staging system for gastric cancer. The hazard ratios of the respective T and N categories were estimated and converted to weightings and summated to make prognostic score (P-score). Homogeneity and stage grouping were determined according to the P-scores. RESULTS: In the 7th AJCC/UICC staging system for gastric cancer, poor discrimination was noted between stages IIB and IIIA (P = 0.152). In addition, heterogeneity in stage IIB (P = 0.021) and a small gap in 5-year survival rates (1.7%) between stages IA and IB were noted. A new proposed staging system was generated on the basis of P-scores and demonstrated more discrimination between stages and more homogeneity within stages. The new staging system reflects the different prognostic impacts of N3a and N3b. CONCLUSION: Several controversial issues of the 7th AJCC/UICC staging system for gastric cancer were reconfirmed in the present analysis. The TNM system based on P-score appears to be more scientifically accurate than the 7th AJCC/UICC staging system for gastric cancer.

Factors Affecting Quality of Life Among Spinal Cord Injury Patients in Korea / 대한배뇨장애요실금학회지

PURPOSE: Complaints from spinal cord injury (SCI) patients are typically related to physical disability affecting activities of daily life. However, difficulties with voiding and defecation and/or sexual function can also be major concerns. The general population and even physicians are generally unaware of these complaints; therefore, this study focuses on surveying SCI patients regarding challenges that are faced in daily life. METHODS: A questionnaire was administered randomly and anonymously to SCI patients who visited the Korea Spinal Cord Injury Association and several rehabilitation hospitals in the Republic of Korea in 2013. All participants gave their consent prior to filling out the questionnaire. RESULTS: A total of 299 patients answered the questionnaire; the male to female ratio was 5.8:1 and common vectors for injury were motor vehicle accidents, industrial accidents, and falling down. Of the 169 patients who answered the ‘most troublesome’ and ‘wish would improve’ complaints questionnaire properly, urinary problems were most common, specifically incontinence and urinary tract infection. Among all patients, 67% were using clean intermittent catheterization, 63% were taking voiding-related medications, 83% had sexual desires, and among the 122 patients who did not have offspring, 27% had future plans for children. CONCLUSIONS: From this questionnaire, we discovered that SCI patients in the South Korea suffer not only from physical disability but also many other quality-of-life-related problems. When managing SCI patients, physicians should show greater concern and educate patients about problems related to voiding and sexual activity, rather than just physical disability.

Delayed redo pyeloplasty fails to recover lost renal function after failed pyeloplasty: Early sonographic changes that correlate with a loss of differential renal function

PURPOSE: To evaluate changes in differential renal function (DRF), as a functional outcome, in children who underwent redo pyeloplasty for management of failed pyeloplasty and to examine the factors that affect functional outcomes. MATERIALS AND METHODS: Between January 2002 and November 2010, a total of 18 patients who underwent redo pyeloplasty for persistent ureteropelvic junction obstruction after failed pyeloplasty were enrolled in this study. We assessed perioperative factors and evaluated changes in renal cortical thickness (RCT), renal function, and hydronephrosis by use of serial ultrasound and diuretic renography. RESULTS: The mean follow-up period was 44.83+/-28.86 months. After redo pyeloplasty, prevention of further functional deterioration was observed in only 12 of the 18 patients. After dividing the patients according to this observation, we discovered significant differences in both change in DRF (dDRF) and change in RCT (dRCT) (difference between before and after initial pyeloplasty) between the two groups (p<0.001). Additionally, we noted a significant positive correlation between dRCT and dDRF. All patients showed improvements in hydronephrosis grade and relief of symptoms compared with before redo pyeloplasty. CONCLUSIONS: Redo pyeloplasty should be considered in cases of failed pyeloplasty to preserve renal function and obtain relief from symptoms. If patients show severe deterioration of DRF or a decrease in RCT after initial pyeloplasty, preservation of DRF in these patients after redo pyeloplasty could be difficult. Therefore, redo pyeloplasty should be performed before severe deterioration of DRF or decrease in RCT.

Gastric Pseudotumoral Lesion Caused by a Fish Bone Mimicking a Gastric Submucosal Tumor

Gastric complications following unintentional foreign body ingestion are extremely rare. Here, we report the case of a 59-year-old healthy woman who presented with nonspecific abdominal pain and an apparent gastric submucosal tumor that was incidentally detected by gastrofiberscopy. The patient underwent laparoscopic surgery, which revealed an intact gastric wall with no tumor invasion, deformity, or evidence of a gastric submucosal lesion. However, an impacted fish bone was found.

Down-regulation of survivin suppresses uro-plasminogen activator through transcription factor JunB

Survivin, a member of the inhibitors of apoptosis protein family, is expressed during development and in various human cancers. However, the clinical relevance of survivin in cancer is still a matter of debate. Genes induced by hepatocyte growth factor (HGF) were screened using cDNA microarray technology in the stomach cancer cell lines, NUGC3 and MKN28. The levels of JunB, survivin, and uro-plasminogen activator (uPA) were up-regulated in cells treated with HGF in a dose-dependent manner. HGF-induced up regulation of JunB, survivin, and uPA was inhibited by pre-treatment with a MEK inhibitor (PD 98059). HGF-induced up-regulation of uPA was repressed by survivin knockdown. HGF enhanced the binding activity of JunB to the survivin promoter in control cells, but not in the JunB-shRNA cells. Transfection with survivin-shRNA resulted in a decrement of cell proliferation, as determined with MTT assays. In an in vitro invasion assay, significantly fewer cells transfected with survivin shRNA than control cells were able to invade across a Matrigel membrane barrier. In conclusion, survivin appeared to play an important role in the up-regulation of uPA induced by HGF via JunB and might contribute to HGF-mediated tumor invasion and metastasis, which may serve as a promising target for gastric cancer therapy.

Erratum to: Clinical Outcomes according to Primary Treatment in Gastric Cancer Patients with Peritoneal Seeding

No abstract available.

Malignant Solitary Fibrous Tumor of Retroperitoneum Mimicking Gastric Submucosal Tumor / 대한소화기학회지

Solitary fibrous tumors (SFTs) are an uncommon neoplasm characterized by the proliferation of spindle cells. The diagnostic criteria of malignant solitary fibrous tumors (MSFTs) include high cellularity, high mitotic activity (4>10 HPF), pleomorphism, hemorrhage and necrosis. This tumor frequently involves the pleura and MSFTs of retroperitoneum mimicking gastric submucosal tumor are very rare. We report a rare case of MSFT that presented as a gastric submucosal tumor. A gastroscopic examination showed a large bulging mucosa in the gastric body. Abdominal computed tomography revealed a well-defined heterogeneous enhancing mass between the left hepatic lobe and gastric body. Surgical resection was performed and histologic features were consistent with a MSFT.

Evaluation of Prognostic Values according to the New TNM Classification in Gastric Cancer

PURPOSE: In 2010, the new UICC/AJCC TNM classification for gastric cancer was declared. The new classification for gastric cancer has several changes from the 6th classification. We evaluated the prognostic values and differences according to the new UICC/AJCC TNM classification. METHODS: From 2000 to 2004, 1,196 patients who underwent curative resection with D1+beta or more lymph node dissection and with 15 or more lymph nodes retrieved were studied retrospectively. We analyzed clinical characteristics and survival outcomes retrospectively from medical records. RESULTS: According to UICC/AJCC 7th TNM classification, the 5-year survival rate (5YSR) of each group for depth of invasion and node metastasis were significantly different. The 5YSR of stage II in 6th classification was 82.4% and the 5YSR of stage IIa and IIb in 7th classification were 92.2% and 82.9%. The 5YSR of stage IIIa and IIIb in 6th classification were 56.3% and 33.0%. The 5YSR of stage IIIa, IIIb and IIIc in 7th classification were 72.7%, 48.4% and 26.1%. In our Cox regression multivariate analysis, N stage of the 6th UICC/AJCC TNM classification was the main independent prognostic factor. CONCLUSION: N stage of the 6th UICC/AJCC TNM classification is a more reliable prognostic factor than N stage of the 7th UICC/AJCC TNM classification. Further study should be performed to confirm the appropriateness of N stage TNM classification for gastric cancer.

Clinical Outcomes according to Primary Treatment in Gastric Cancer Patients with Peritoneal Seeding

PURPOSE: Peritoneal seeding of gastric cancer is known to have a poor prognosis. With the diagnosis of peritoneal seeding, there is no effective treatment modality. Gastrectomy with chemotherapy or primary chemotherapy is basically one of major options for this condition. This study was conducted to compare the clinical outcomes of these treatments and to identify the better way to improve the prognosis of patients with peritoneal seeding. MATERIALS AND METHODS: Between 2001 and 2007, gastric cancer patients with peritoneal seeding by preoperative or intraoperative diagnosis were reviewed retrospectively. The enrolled patients were divided as primary gastrectomy and primary chemotherapy group. Clinicopathologic characteristics and clinical outcomes of groups were analyzed and compared. RESULTS: Fifty-four patients were enrolled. 21 patients belonged to the group of primary gastrectomy and 33 patients were to the primary chemotherapy group. Among 33 patients of the primary chemotherapy group, 17 patients were received only chemotherapy and 16 patients were received gastrectomy due to the good responses of primary chemotherapy. The 3 years survival rates were 14% in primary gastrectomy group, 55% in patients who received gastrectomy after primary chemotherapy, and 0% in patients with primary chemotherapy only. CONCLUSIONS: Although this study had many limitations, some valuable information was produced. In terms of survival benefits for the gastric cancer patients with peritoneal seeding, primary gastrectomy and additional gastrectomy after primary chemotherapy revealed the better clinical outcomes. But, prospective randomized clinical study and multi-center study are should be performed to decide proper treatment for gastric cancer patients with peritoneal seeding.

Inflammatory Pseudotumor of Splenic Hilar Node Mimicking Gastric Submucosal Tumor

Inflammatory pseudotumor (IPT) is an uncommon clinical condition characterized by proliferation of spindle cells, inflammatory cells, and small vessels. IPT has been reported in various anatomical sites, including the orbit, lung, liver, spleen, and so on. IPT of the lymph node is very rare. We recently experienced a 65-year-old woman diagnosed with IPT of the lymph node in the splenic hilar, or distal supra-pancreatic area, mimicking gastric submucosal tumor. The tumor was removed without event using the laparoscopic method. This lesion in the splenic hilum is extremely rare and has not been cited in the current literature. We describe such a rare case of IPT with a review of the literature.

Microbiological Contamination of Laboratory Mice and Rats in Korea from 2007 to 2008 / 한국실험동물학회지

In order to assess the microbiological contamination of laboratory mice and rats in Korea over the 2-year period from 2007 to 2008, we monitored animals housed in mouse and rat facilities equipped with barrier systems. In a barrier animal facility in Korea, the most important viruses in the identified pathogen were the mouse hepatitis virus (MHV) and Pasteurella (Pa.) pneumotropica, and Staphylococcus aureus was identified as the most common bacterial pathogen in Korea. The most commonly detected parasite in the identified pathogen was Trichomonas spp. in the mouse facilities and Entamoeba spp. in the rat facilities. In many cases, these pathogen-contaminated animals were genetically modified animals obtained from the university. Currently, consistent with the increased transfer of genetically modified animals between domestic and foreign animal facilities, the Pa. pneumotropica and parasites infection rates were shown to have increased as compared to those of the 2004-2006 period. Indeed, the MHV infection rate has been maintained at almost 20% in Korean animal facilities over the past 10 years. These results showed that effective quarantine programs for contaminated genetically engineered mutant mice and the monitoring of regular or irregular MHV monitoring in animal colonies should help to reduce pathogen contamination in Korean animal facilities.