Evaluating pediatric ureteropelvic junction obstruction: Dynamic magnetic resonance urography vs renal scintigraphy 99m-technetium mercaptoacetyltriglycine.

BACKGROUND: Ureteropelvic junction obstruction (UPJO) is a common congenital urinary tract disorder in children. It can be diagnosed as early as in utero due to the presence of hydronephrosis or later in life due to symptomatic occurrence. AIM: To evaluate the discrepancy between dynamic contrast-enhanced magnetic resonance urography (dMRU) and scintigraphy 99m-technetium mercaptoacetyltriglycine (MAG-3) for the functional evaluation of UPJO. METHODS: Between 2016 and 2020, 126 patients with UPJO underwent surgery at Robert Debré Hospital. Of these, 83 received a prenatal diagnosis, and 43 were diagnosed during childhood. Four of the 126 patients underwent surgery based on the clinical situation and postnatal ultrasound findings without undergoing functional imaging evaluation. Split renal function was evaluated preoperatively using scintigraphy MAG-3 (n = 28), dMRU (n = 53), or both (n = 40). In this study, we included patients who underwent surgery for UPJO and scintigraphy MAG-3 + dMRU but excluded those who underwent only scintigraphy MAG-3 or dMRU. The patients were divided into groups A (< 10% discrepancy) and B (> 10% discrepancy). We examined the discrepancy in split renal function between the two modalities and investigated the possible risk factors. RESULTS: The split renal function between the two kidneys was compared in 40 patients (28 boys and 12 girls) using scintigraphy MAG-3 and dMRU. Differential renal function, as determined using both modalities, showed a difference of < 10% in 31 children and > 10% in 9 children. Calculation of the relative renal function using dMRU revealed an excellent correlation coefficient with renal scintigraphy MAG-3 for both kidneys. CONCLUSION: Our findings demonstrated that dMRU is equivalent to scintigraphy MAG-3 for evaluating split renal function in patients with UPJO.

Isolated congenital inter-costal pulmonary hernia: a case report.

BACKGROUND: Intercostal lung herniation is a rare condition that may be congenital (20%) or acquired (80%). The isolated congenital form is exceptional, with one case reported in the literature. CASE PRESENTATION: We report a case of a 10-year-old French boy of Algeria origin, born with intermittent swelling of his right hemithorax. The swelling and pain gradually increased with age. A clinical examination revealed a localized swelling of his right hemithorax at the level of the midclavicular line and the fifth intercostal space. The swelling increased in size during respiratory movements and enlarged with Valsalva maneuvers. The intercostal lung hernia was treated by thoracoscopy. CONCLUSIONS: This is the second case of isolated congenital intercostal pulmonary hernia reported in the French and English literature. It is the first to be treated by thoracoscopy. Based on this case we performed a review of the diagnosis and therapeutic aspect of pulmonary hernias.

Reflective Practice About Retroperitoneal Laparoscopy in Comparison to Open Surgery for Ureteropelvic Junction Obstruction Repair in Children Less Than 1 Year of Age.

Introduction: The interest in laparoscopy in the treatment of ureteropelvic junction obstruction (UPJO) in children under 12 months of age remains controversial. The aim of this study is to evaluate feasibility and benefits of retroperitoneal laparoscopy (RL) compared to open surgery in this age group. Materials and Methods: Between January 2012 and May 2017, we performed 222 pyeloplasties: 144 by laparoscopy and 78 by open surgery. From 2012, the choice of operative technique was decided according to the laparoscopic experience of the surgeon; two surgeons operated laparoscopically on all children <12 months of age, while others operated using posterior lumbotomy (PL). The RL is standardized and performed by 3 trocars (5, 3, 3). Pre, per and postoperative parameters were analyzed retrospectively. Statistical tests: Pearson, Fisher, Student and Mann-Whitney. Results: During this 5-year period, 24 RL and 53 PL were included with a median follow-up of 27 months (5-63). In the LR group, postoperative drainage was performed by JJ (13 cases) and external stent (11 cases). No conversion has been listed in this group. In each group there was one failure that needed redo pyeloplasty. Duration of hospitalization and intravenous acetaminophen use were significantly lower in the RL group (2.8 vs. 2.3 days, p = 0.02, respectively) while operating time was significantly longer (163 vs. 85.8 min, p = 0.001). The postoperative complication rate was statistically identical in each group (urinary tract infection, wall hematoma, hematuria…). Conclusion: RL is feasible in children under 1 year of age in the hands of well-experienced surgeons with longer operative time but without added morbidity. Subject to the retrospective nature of our study, the RL seems to offer a benefit regarding duration of hospitalization and analgesics consumption.

[Urothelial tumors in children]. / Tumeurs urothéliales de l'enfant.

Urothelial tumors are very rare in children (to date, only about 150 cases have been reported worlwide). Only 20% occur before the age of ten. The aim of this study is to specify the clinicopathologic features of urothelial tumor in young patients, which require a slightly different approach to treatment. On the basis of the WHO/ISUP (World Health Organisation/International Society of Urological Pathology) consensus classification report, these lesions are usually low-grade lesions, non invasive, and rarely recurrent. The sex ratio is three boys to one girl. These tumors are located preferentially in the low urinary tract, especially in the bladder. The main symptom is the macroscopic hematuria, which requires ultrasound examination in all cases. Cystoscopy is indicated in case of lesion of the bladder wall, or in case of persistent or recurrent hematuria, to obtain definitive diagnosis and biopsies. The tumors are mainly located on the posterior or lateral bladder wall above the trigone or near the ureteral orifices. Treatment is based on the transurethral resection of the lesion. The subsequent monitoring is sparsely codified, due to the exceptional occurrence of these tumors in the paediatric age group. These patients are likely to have better outcome than older patients, but it is due to the predominance of noninvasive papillary urothelial tumors. Tumor recurrences are not uncommon. In case of invasive, high-grade urothelial carcinomas, metastases or even lethal outcome may occur in rare cases.

Posterior urethral valves and vesicoureteral reflux: can prenatal ultrasonography distinguish between these two conditions in male fetuses?

OBJECTIVE: The objective of the study was to evaluate prenatal sonographic signs that distinguish male fetuses with posterior urethral valves (PUV) from those with vesicoureteral reflux (VUR). METHODS: Prenatal data were retrospectively retrieved from all consecutive women delivering between 2003 and 2012 of a male newborn with a postnatal diagnosis of PUV or VUR. Prenatal parameters included fetal bladder characteristics, identification of a dilated posterior urethra, and change in shape and size in the fetal renal pelvis or ureter. RESULTS: One hundred thirty-six women gave birth to a male newborn with a postnatal diagnosis of PUV (n = 49) or VUR (n = 87). The presence of posterior urethral dilatation [21 (42.9%) fetuses versus 0 (0%), p = 0.000], a thickened fetal bladder wall [37 (75.5%) vs 4 (4.6%), p = 0.000], and anhydramnios [14 (28.6%) vs 0, p = 0.000] were strongly associated with the postnatal diagnosis of PUV. Change in shape and size in the fetal renal pelvis or ureter was observed in 15 (17.2%) of 87 children with VUR versus 1 (2.0%) out of 49 with PUV (p = 0.010). CONCLUSIONS: Prenatal ultrasound may differentiate with reasonable accuracy male fetuses with a postnatal diagnosis of PUV from those with VUR. © 2016 John Wiley & Sons, Ltd.

[Urinary tract infection in children]. / Infections urinaires de l'enfant.

Urinary tract infection in children. The care of a child suspected of urinary infection (UI) goes through 4 stages. The diagnosis of UI is based on the presence of bacteriuria > 105 / mL, the collection of urine through a bas is unreliable and source of false positives. Localization diagnosis (acute pyelonephritis or cystitis) is based on clinical and biological signs (leukocytosis and inflammation). Etiological diagnosis is based on renal ultrasonography looking for obstructive uropathy, stones and bladder dysfunction; the search for a vesico-ureteral reflux with retrograd cystography is not systematic at first infection. The treatment of acute pyelonephritis is initiated usually intravenously for a period of 3 or 4 days. Oral antibiotics is then possible.

Infections urinaires de l'enfant. La prise en charge d'un enfant suspect d'infection urinaire passe par quatre étapes. Le diagnostic positif d'infection urinaire est posé en présence d'une bactériurie supérieure à 105 germes/mL ; le recueil des urines sur poche est peu fiable et source de faux positifs. Le diagnostic de localisation (pyélonéphrite aiguë ou cystite) repose sur des signes cliniques et biologiques (hyperleucocytose et syndrome inflammatoire). Le diagnostic causal repose sur l'interrogatoire et l'échographie rénale à la recherche d'une uropathie obstructive, d'une lithiase et d'un dysfonctionnement vésical. La recherche d'un reflux vésico-urétéral par cystographie rétrograde dès la première pyélonéphrite aiguë n'est pas systématique. Le traitement de la pyélonéphrite aiguë est initié le plus souvent par voie intraveineuse pour une durée de 2 à 3 jours ; le relais est ensuite pris par un traitement oral.

Long-term bladder function after ureterocele decompression in children.

PURPOSE: There is limited knowledge of long-term bladder function after ureterocele decompression. We studied bladder function in patients who underwent surgery in childhood for duplex system ureteroceles. MATERIALS AND METHODS: Toilet trained children treated for duplex system ureteroceles between 1990 and 2010 were included in study. We evaluated voiding dysfunction by the valid DVSS questionnaire and noninvasive studies, including uroflowmetry, electromyogram and post-void residual urine measurement. Urodynamics were done only in patients with abnormal DVSS or abnormal noninvasive studies. Patients were divided into group 1-ureterocele decompression (endoscopic incision), upper pole partial nephrectomy and ureteropelvic anastomosis, and group 2-primary or secondary bladder surgery (ureterocelectomy, ureterovesical reimplantation and bladder floor reconstruction). RESULTS: Of 62 operated patients 17 were lost to followup and 45 were fully studied at a mean followup of 9.5 years (range 3 to 20). Initial surgery was done at mean age of 5.1 months (range 6 days to 48 months). In the 33 group 1 patients, of whom 70% underwent endoscopic incision, the mean DVSS score was 1.5 (range 0 to 6), 7 patients (22%) had abnormal uroflowmetry or significant post-void residual urine and none had abnormal DVSS results. In the 12 patients in group 2 the mean DVSS score was 4 (range 0 to 11), 8 patients (66%) had abnormal uroflowmetry and significant post-void residual urine, and 3 had abnormal DVSS findings (p = 0.036). All group 2 patients underwent bladder surgery after decompression, including endoscopic incision in 2 and upper pole partial nephrectomy in 1. Only 1 child needed clean intermittent catheterization at age 3 years for hypocontractile megacystis and repeat febrile urinary tract infections. CONCLUSIONS: Ureterocele decompression alone in early childhood does not lead to major bladder dysfunction at long-term evaluation. Even if secondary bladder surgery is needed, significant bladder dysfunction is rare.

[Surgical treatment of high-type imperforate anus: role of laparoscopy]. / Traitement chirurgical des malformations anorectales hautes du nouveau-né: l'apport de la laparoscopie.

Two anomalies must be corrected in high-type imperforate anus: first, the rectal end is located above the puborectalis muscle, and there is a fistula between the rectum and the urinary tract (male) or the vagina (female). The standard approach is posterior sagittal anorectoplasty, as described by De Vries and Peña, which requires midline section of the muscle complex. Georgeson first reported laparoscopically assisted anorectal pull-through in 2000. This approach offers many advantages, such as division of the fistula under direct visual control, better visualization of the anatomical components of the pelvic floor, and especially avoidance of muscle section. Long-term follow-up will be needed to assess continence outcomes.

[Renal transplantation in children with lower urinary tract dysfunction]. / Transplantation rénale chez l'enfant porteur d'une anomalie du bas appareil urinaire.

Lower urinary tract dysfunction can lead to renal failure, owing to chronic infection and hypertension resulting from incomplete bladder drainage. These complications can recur after grafting. We compared the outcome of renal transplantation between patients with lower urinary tract dysfunction (group A) and upper urinary tract dysfunction (group B). One hundred twenty-seven kidney transplants were performed in 118 children in our institution between November 1988 and October 2005. Thirty-four patients had urinary tract anomalies (17 in group A, 17 in group B). The disorders in group A included posterior urethral valves (11 cases), neurogenic bladder (4 cases), bladder extrophy (1 case), and the Prune-Belly syndrome (1 case). We reviewed infectious and surgical complications, patient and graft survival, and graft function based on serum creatinine levels at 1, 5 and 10 years. Statistical analysis was based on the Mann-Whitney test. In group A, 5 patients had augmented bladder, 2 had incontinent urinary conduit, and 1 was transplanted on a pre-existing cutaneous ureterostomy. In nine cases, transplantation was performed on the native bladder, with no preparation. Seven complications were noted in group A, consisting of recurrent pyelonephritis (2 cases), renal abscess (1 case), upper urinary tract dilation (3 cases), lithiasis (1 case) and urinary tract incrustation by Corynebacterium in the ureterocutaneous conduit (1 case). Three complications occurred in group B, consisting of acute pyelonephritis (2 cases) and urinary tract infection with prostatitis and epididymitis (1 case). Complications tended to be more frequent in group A, but the difference was not significant (p=0.246). Mean graft survival is 5.29 years in group A and 5.97 years in group B (p=0.76). There was no difference between the two groups as regards the serum creatinine level at 1 year (p=0.77 ; Mann-Whitney test), 5 years (p=0.81) or at the end of follow-up (p=0.75). These results suggest that renal transplantation is similarly feasible in children with upper and lower urinary tract dysfunction. Indeed, we found no significant difference between the groups in terms of patient survival or graft survival and function.