Fryl deficiency is associated with defective kidney development and function in mice.

FRY like transcription coactivator ( Fryl) gene located on chromosome 5 is a paralog of FRY microtubule binding protein ( Fry) in vertebrates. It encodes a protein with unknown functions. Fryl gene is conserved in various species ranging from eukaryotes to human. Although there are several reports on functions of Fry gene, functions of Fryl gene remain unclear. A mouse line containing null mutation in Fryl gene by gene trapping was produced in this study for the first time. The survival and growth of Fryl-/- mice were observed. Fryl gene expression levels in mouse tissues were determined and histopathologic analyses were conducted. Most Fryl-/- mice died soon after birth. Rare Fryl-/- survivors showed growth retardation with significantly lower body weight compared to their littermate controls. Although they could breed, more than half of Fryl-/- survivors died of hydronephrosis before age 1. No abnormal histopathologic lesion was apparent in full-term embryo or adult tissues except the kidney. Abnormal lining cell layer detachments from walls of collecting and convoluted tubules in kidneys were apparent in Fryl-/- neonates and full-term embryos. Fryl gene was expressed in renal tubular tissues including the glomeruli and convoluted and collecting tubules. This indicates that defects in tubular systems are associated with Fryl functions and death of Fryl-/- neonates. Fryl protein is required for normal development and functional maintenance of kidney in mice. This is the first report of in vivo Fryl gene functions. Impact statement FRY like transcription coactivator ( Fryl) gene is conserved in various species ranging from eukaryotes to human. It expresses a protein with unknown function. We generated a Fryl gene mutant mouse line and found that most homozygous mice died soon after their birth. Rare Fryl-/- survivors showed growth retardation with significantly lower body weight compared to their littermate controls. Although they could breed, more than half of Fryl-/- survivors died of hydronephrosis before age 1. Full-term mutant embryos showed abnormal collecting and convoluted tubules in kidneys where Fryl gene was expressed. Collectively, these results indicate that Fryl protein is required for normal development and functional maintenance of kidney in mice. To the best of our knowledge, this is the first report on in vivo Fryl gene functions.

Effect of hydronephrosis on survival in advanced stage cervical cancer.

BACKGROUND: Hydronephrosis is frequently encountered in advanced stage cervical cancers, and may be associated with mortality. In the present study, we aimed to demonstrate the effect of hydronephrosis on survival in patients with inoperable advanced stage cervical cancer. MATERIALS AND METHODS: The study data were acquired by retrospective analysis of the patient records belonging to 165 women with FIGO (International Federation of Gynecology and Obstetrics) stage-IIIB or more advanced cervical cancer, which were not surgical candidates. Parameters including patient age, pathological diagnosis, disease stage, pelvic sidewall extension, presence of hydronephrosis and administration of chemoradiation were analyzed. Further, the effects of these variables on survival were assessed. P values less than 0.05 were considered statistically significant. RESULTS: The distribution of the study patients according to disease stage was as follows: 131 (79.4%) had stage-IIIB, 18 (10.9%) had stage-IVB and 16 (% 9.7) patients had stage-IVA disease. Hydronephrosis was not evident in 91 (55.2%) of these patients, whereas 41 (24.8%) had unilateral and 33 (20%) patients had bilateral hydronephrosis. When compared to mean survival in patients who did not have hydronephrosis, survival was significantly shortened in patients who had bilateral and unilateral hydronephrosis (p<0.05). There was no significant survival difference between patients with unilateral and bilateral hydronephrosis (p>0.05). Although patient age, pathological type, pelvic involvement, and chemotherapy treatment rates were similar (p>0.05), radiotherapy requirement rate and disease stage were significantly different among the study groups (p<0.05). CONCLUSIONS: Hydronephrosis was found to be a significant predictor of poor survival in patients with advanced stage cervical cancer, irrespective of unilateral or bilateral involvement.While waiting for future studies with larger sample sizes, we believe that the FIGO stages in advanced cervical cancer could further be stratified into subgroups according to presence or absence of hydronephrosis.

Hydronephrosis in patients with cervical cancer: an assessment of morbidity and survival.

PURPOSE: Hydronephrosis is a frequently observed but understudied complication in patients with cervical cancer. To better characterize hydronephrosis in cervical cancer patients, the current study sought (1) to describe hydronephrosis-associated morbidity and (2) to analyze the prognostic effect of hydronephrosis in patients with a broad range of cancer stages over time. METHODS: The Mayo Clinic Tumor Registry was interrogated for all invasive cervical cancer patients seen at the Mayo Clinic from 2008 through 2013 in Rochester, Minnesota; these patients' medical records were then reviewed in detail. RESULTS: Two hundred seventy-nine cervical cancer patients with a median age of 49 years and a range of cancer stages were included. Sixty-five patients (23 %) were diagnosed with hydronephrosis at some point during their disease course. In univariate analyses, hydronephrosis was associated with advanced cancer stage (p < 0.0001), squamous histology (p = 0.0079), and nonsurgical cancer treatment (p = 0.0039). In multivariate analyses, stage and tumor histology were associated with hydronephrosis. All but one patient underwent stent placement or urinary diversion; hydronephrosis-related morbidity included pain, urinary tract infections, nausea and vomiting, renal failure, and urinary tract bleeding. In landmark univariate survival analyses, hydronephrosis was associated with worse survival at all time points. In landmark multivariate analyses (adjusted for patient age, stage, cancer treatment, and tumor histology), hydronephrosis was associated with a trend toward worse survival over time (hazard ratios ranged from 1.47 to 4.69). CONCLUSION: Hydronephrosis in cervical cancer patients is associated with notable morbidity. It is also associated with trends toward worse survival-even if it occurs after the original cancer diagnosis.

[Comparative analysis of interuterine therapy of unilateral and bilateral fetal obstructive uropathy]. / Analiza pórownawcza wyników terapii wewnatrzmacicznej obustronnej i jednostronnej uropatii zaporowej.

OBJECTIVE: The goal of the work was a comparative analysis of intrauterine therapy among pregnant women with diagnosed fetal uropathy and unilateral hydronephrosis. METHODS: The study was conducted on a group of 98 pregnant women hospitalized at the Department of Gynecology Fertility and Fetal Therapy Polish Mother's Memorial Hospital between 2006-2012. The study group included 77 cases of fetal obstructive uropathy (79%) and 21 cases of unilateral hydronephrosis (21%). Both groups have been analyzed in terms of prognosis. Follow-up has been conducted and results have been statistically analyzed. RESULTS: In 11% of cases of obstructive uropathy therapy early complications were observed. The remaining 89% of the patients delivered at a later date, of which 54% after 34 weeks of pregnancy The average weight of a newborn was 2645g and Apgar score - 7.45. 73% of newborns were discharged home in good condition, with preserved diuresis. CONCLUSIONS: 1. The use of intrauterine therapy has a positive effect on fetal condition and newborn postnatal state. 2. Unilateral hydronephrosis group was characterized by a significantly longer duration of pregnancy higher birth weight, Apgar score, and greater survival of newborns. 3. In the group of obstructive uropathy survival improvement was achieved and dieresis was preserved Intrauterine interventions were associated with a low risk of complications.

Simple modification in Hautmann neobladder to carry out left ureteroileal anastmosis without mobilization of the ureter.

We describe a simple modification in Hautmann neobladder that involves an elongation of its left chimney to advance it through the pelvic mesocolon in order to reach the left ureter in its original place. This technique was carried out on 27 patients who had Hautmann pouch after radical cystectomy, and we reported the outcome and complications that occurred at the site of urteteroileal anastomosis in the first 3 years after surgery. The modification was applied easily without any perioperative complications that were related to this step in particular. During follow up of these cases, we lost three patients who died before the end of the third postoperative year. At a mean follow up of 41.3 ± 10.2 months, we have not detected any cases of stricture formation or ureteral recurrence at the sites of the ureteroileal anastmosis. There was only one patient who developed acute pyelonephritis (3.7%) as a result of reflux.

Urologic co-morbidities associated with sacrococcygeal teratoma and a rational plan for urologic surveillance.

BACKGROUND: Sacrococcygeal teratoma (SCT) is one of the most common neonatal and fetal tumors. SCT pelvic mass effect and the need for aggressive surgical resection, create potential for urologic co-morbidity. We reviewed our experience with SCTs and propose a rational plan for urologic surveillance. METHODS: We retrospectively reviewed all patients with SCT evaluated at our institution from 2004 to 2011. We collected data on the need for reconstructive surgery related to the urologic co-morbidity, the time to detection of urologic co-morbidity, and length of follow-up. RESULTS: We identified 28 patients evaluated during the study period with a median follow-up of 3.1 year (range 0.14-13.4). The Altman classifications were--type I: 7 (25%), II: 15 (53.6%), and III: 6 (21.4%). Eighteen (64.3%) patients had an associated urologic co-morbidity: 12 (42.9%) patients had hydronephrosis, VUR--10 (35.7%), NGB--13 (46.4%), and 4 (14.3%) developed ≥CKD2. When comparing the patients according to Altman classification, there was a trend towards more urologic co-morbidity in patients with increasing pelvic involvement, P = 0.06. Eleven patients (39.3%) had delayed urologic evaluation and five (17.9%) required reconstructive urologic surgery. In comparing these groups, 4 of 11 (36.4%) undergoing delayed urologic evaluation progressed to reconstruction, as opposed to only one of 17 (5.7%) with urologic evaluation within first year of life (P-value = 0.06). CONCLUSION: Urologic co-morbidities are common in children with SCT and appear most common in patients with more pelvic tumor involvement (≥Altman II). A risk-adapted approach to urologic surveillance is proposed.

A precystectomy decision model to predict pathological upstaging and oncological outcomes in clinical stage T2 bladder cancer.

OBJECTIVES: To categorize patients with clinical stage T2 bladder cancer into risk groups based on their potential for pathological upstaging and eventual oncological outcomes at cystectomy. To pre-emptively identify such patients who will be upstaged and have poor outcomes after cystectomy, aiming to better determine the ideal candidates for neoadjuvant chemotherapy. PATIENTS AND METHODS: A retrospective review was conducted of 1964 patients who underwent radical cystectomy for bladder cancer with intent to cure at the University of Southern California between 1971 and 2008. Neoadjuvant chemotherapy-naïve patients with clinically organ-confined urothelial carcinoma invading bladder muscle (cT2N0M0) were included. Univariate analysis and multivariable decision tree modelling with cross-validation were employed to identify precystectomy variables that could predict pathological upstaging and poor oncological outcomes. RESULTS: A total of 948 patients met the inclusion criteria, of whom 512 (54%) patients were upstaged at cystectomy; upstaging was associated with a worse recurrence-free and overall survival (both P < 0.001). Age, presence of hydronephrosis, evidence of deep muscularis propria invasion and lymphovascular invasion on transurethral resection specimen, as well as tumour growth pattern and count, were significantly associated with upstaging. When these factors were included in a decision tree model, 70.6% of patients with hydronephrosis experienced upstaging and had the worst outcome (P < 0.001). In patients without hydronephrosis, tumour growth pattern was a second-tier discriminator (P < 0.001); in patients with non-papillary tumours, 71.7% of cases with evidence of deep muscularis propria involvement experienced upstaging compared to 53.8% of cases with no deep muscle involvement (P = 0.012), whereas, among patients with combined papillary and non-papillary features, 33% of cases aged ≤65 years were upstaged compared to 47% of cases aged >65 years (P = 0.036). The cross-validated decision tree resulted in three risk groups with significantly varying probabilities of recurrence-free and overall survival (both with overall P < 0.001). CONCLUSIONS: Hydronephrosis, tumour growth pattern, deep muscle involvement and age can collectively identify patients with cT2N0M0 bladder cancer who have varying risks of pathological upstaging. Such categorization using a visually intuitive model can facilitate clinical decision-making with respect to neoadjuvant therapy in these patients.

Influence of preoperative hydronephrosis on the outcome of urothelial carcinoma of the upper urinary tract after nephroureterectomy: the results from a multi-institutional French cohort.

OBJECTIVES: Recent publications have assessed the prognostic significance of hydronephrosis in the outcome of upper tract urothelial carcinoma (UUT-UC). Our study sought to determine the prognostic impact of hydronephrosis on UUT-UC survival and its relationship to the clinicopathological features. MATERIALS AND METHODS: A retrospective, multi-institutional French study was conducted on 401 patients who underwent radical nephroureterectomy for non-metastatic UUT-UC. Hydronephrotic status was determined using preoperative imaging reports. Univariate and multivariate analyses were conducted to identify factors associated with survival. RESULTS: Preoperative hydronephrosis was present in 74 patients. Median follow-up was 26 months. Hydronephrosis was associated only with ureteral localisation (p < 0.001). No difference was observed in 5-year cancer-specific survival (CSS) between the hydronephrosis group (80.1 %) and the no hydronephrosis group (83.6 %) (p > 0.05). Only age (p = 0.02) and pT stage (p = 0.01) were independent predictors of CSS. Hydronephrosis was not a significant predictor of CSS in the univariate and multivariate analyses (p = 0.87 and p = 0.66). No significant difference was observed for 5-year metastasis-free survival (MFS) between the hydronephrosis group (69.8 % ± 6.6 %) and the no hydronephrosis group (80.5 % ± 3 %) (p = 0.052). Hydronephrosis was not a significant predictor of MFS in the univariate and multivariate analyses (p = 0.16 and p = 0.36). Multifocality (p = 0.02), pT stage (p < 0.001) and positive surgical margins (p = 0.02) were independent predictors of MFS. For the pelvic tumours subgroup, hydronephrosis was an independent predictor of MFS (p = 0.01) but not CSS (p = 0.86). CONCLUSION: Preoperative hydronephrosis was not associated with survival. However, among tumours presenting with hydronephrosis, pelvicalyceal tumours appear to have a worse prognosis than ureteral tumours.

Early risk factors for neonatal mortality in CAKUT: analysis of 524 affected newborns.

BACKGROUND: Congenital abnormalities of the kidney and urinary tract (CAKUT) are significant causes of morbidity. The aim of the study was to determine predictive factors of mortality in newborns with CAKUT. METHODS: All 29,653 consecutive newborns hospitalized in a tertiary neonatal unit between 1996 and 2006 were evaluated. The main outcome was neonatal mortality. The variables analyzed as risk factors were maternal age, first pregnancy, low birth weight (LBW), prematurity, oligohydramnios, and CAKUT associated with other malformations (Associated CAKUT). RESULTS: CAKUT was detected in 524 newborns, with an overall prevalence of 17.7 per 1,000 live births. A total of 325 (62%) cases were classified as urinary tract dilatation, 79 (15.1%) as renal cystic disease, and 120 (22.9%) as other subgroups. In the urinary tract dilatation subgroup, independent risk factors for early mortality were Associated CAKUT [odds ratio (OR) 20.7], prematurity (OR 4.5) LBW (OR 3.8), oligohydramnios (OR 3.0), and renal involvement (OR 3.0). In the renal cystic disease subgroup, two variables remained associated with neonatal mortality: LBW (OR 12.3) and Associated CAKUT (OR 21.4). CONCLUSION: The presence of extrarenal anomalies was a strong predictor of poor outcome in a larger series of infants with CAKUT.

Outcome of pregnancies complicated by oligohydramnios or anhydramnios of renal origin.

OBJECTIVE: To evaluate the outcome of fetuses with oligohydramnios due to kidney anomalies. METHODS: A retrospective study was performed of all pregnancies diagnosed with oligohydramnios and associated kidney anomalies during the period 2000-2008. Outcome included pregnancy outcome, mortality, and morbidity. Morbidity included renal function based on the glomerular filtration rate (GFR) during follow-up. RESULTS: A total of 71 pregnancies were evaluated; 36 fetuses presented on ultrasound with cystic dysplasia, 15 with polycystic kidney disease (PKD) and 20 with hydronephrosis. Twenty-three (32%) had associated anomalies. In 49 fetuses (69%), the diagnosis had been made before 24 weeks of gestational age (GA); 41 of those pregnancies were terminated. Twenty-five neonates were live born: 10 survived, 15 died. Prognostic factors for survival included GA at diagnosis (32.2 weeks for survivors vs 28.1 weeks for non-survivors; P = 0.02), diagnosis of hydronephrosis (7 in the survivors vs 4 in the non-survivors: P = 0.05), isolated anomaly (9 in the survivors vs 7 in the non-survivors: P = 0.04). Severity of oligohydramnios (1 case of anhydramnios in the survivors vs 7 in the non-survivors: P = 0.08) was not significant. The 1-year GFR was below 50 mL/min.1.73 m(2) in four of the ten survivors. CONCLUSION: The prognosis of early onset renal oligohydramnios is poor. Predictive determinants of survival are: GA at diagnosis, nature of renal anomaly (hydronephrosis vs other), and presence of associated anomalies.

Prognostic significance of hydronephrosis in bladder cancer treated by radical cystectomy.

OBJECTIVES: Hydronephrosis is a common finding in patients with bladder cancer. This study aims at an analysis of the association between hydronephrosis, pathologic characteristics of bladder cancer and cancer-specific survival rate after radical cystectomy. METHODS: Clinical data of 241 patients who underwent radical cystectomy between 1990 and 2007 for invasive bladder cancer were analyzed retrospectively. The significance of the relation between the clinical and pathological findings were determined by the chi(2) test. The Kaplan-Meier test was used for the estimation of disease-specific survival obtained according to hydronephrosis, and the differences were examined by the log-rank test. Multivariate analysis was performed by the Cox regression model. RESULTS: Of 241 patients, 39 (16.2%) had unilateral and 13 (5.4%) bilateral hydronephrosis. Five-year cancer-specific survival rates were reported as 63.4% in non-hydronephrotic and 11.57% in hydronephrotic patients (log-rank test, p < 0.001). The presence of hydronephrosis was associated with advanced pT stage, higher tumor grade and lymph node metastases (p < 0.001, p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that hydronephrosis is an important factor directly affecting cancer-specific survival (0.0264). CONCLUSIONS: The presence of hydronephrosis prior to radical cystectomy is a significant prognostic parameter, associated with poor cancer-specific survival and advanced disease stage.

Prognostic factors in malignant ureteric obstruction.

OBJECTIVE: To validate a model to stratify patients with obstructive nephropathy due to malignant ureteric obstruction, associated with a poor prognosis, into different prognostic groups, as a recent report identified low serum albumin, degree of hydronephrosis and number of events related to metastatic disease as prognostic indicators before palliative decompression. PATIENTS AND METHODS: We retrospectively review the charts to identify all patients who had a nephrostomy tube inserted for malignant ureteric obstruction. Laboratory and clinical factors that might influence prognosis were reviewed to attempt to externally validate the previously identified factors and model for risk stratification. RESULTS: The median (range) age of the 49 patients identified was 71 (36-91) years, and the median survival was 174 (14-602) days. Tumours were of urological origin in 66% of patients. Patients with prostate cancer had nephrostomy tubes indwelling for a mean of 279 days, vs 190 days (P = 0.07) for patients with tumours not of prostatic origin. A serum albumin level of >30 g/L (P ≤ 0.001), serum sodium <135 mmol/L (P = 0.019) and three or more events related to dissemination of cancer (P = 0.04) were factors associated with a significantly shorter mean survival. Complications related to the nephrostomy tube were experienced by 39% of patients. The model proved useful in stratifying these patients into different risk groups (P = 0.002). CONCLUSION: Consistent with a previous report we showed that a low serum albumin level and events related to metastatic disease were indicative of a poor prognosis. We also found that a low serum sodium level might be associated with a worse prognosis. We externally validated a model for stratifying patients into different prognostic groups. Palliative decompression is associated with significant morbidity.

Female ROMK null mice manifest more severe Bartter II phenotype on renal function and higher PGE2 production.

ROMK null mice with a high survival rate and varying severity of hydronephrosis provide a good model to study type II Bartter syndrome pathophysiology (26). During the development of such a colony, we found that more male than female null mice survived, 58.7% vs. 33.3%. To investigate the possible mechanism of this difference, we compared the survival rates, renal functions, degree of hydronephrosis, as well as PGE(2) and TXB(2) production between male and female ROMK wild-type and null mice. We observed that female ROMK Bartter's mice exhibited lower GFR (0.37 vs. 0.54 ml.min(-1).100 g BW(-1), P < 0.05) and higher fractional Na(+) excretion (0.66% vs. 0.48%, P < 0.05) than male Bartter's. No significant differences in acid-base parameters, urinary K(+) excretion, and plasma electrolyte concentrations were observed between sexes. In addition, we assessed the liquid retention rate in the kidney to evaluate the extent of hydronephrosis and observed that 67% of male and 90% of female ROMK null mice were hydronephrotic mice. Urinary PGE(2) excretion was higher in both sexes of ROMK null mice: 1.35 vs. 1.10 ng/24 h in males and 2.90 vs. 0.87 ng/24 h in females. TXB(2) excretion was higher in female mice in both wild-type and ROMK null mice. The increments of urinary PGE(2) and TXB(2) were significantly higher in female null mice than males, 233.33% vs. 22.74% of PGE(2) and 85.67% vs. 20.36% of TXB(2). These data demonstrate a more severe Bartter phenotype in female ROMK null mice, and higher PGE(2) and TXB(2) production may be one of the mechanisms of this manifestation.

Outcome of isolated antenatal hydronephrosis: a prospective cohort study.

The purpose of this study was to report the outcome of infants with antenatal hydronephrosis. Between May 1999 and June 2006, all patients diagnosed with isolated fetal renal pelvic dilatation (RPD) were prospectively followed. The events of interest were: presence of uropathy, need for surgical intervention, RPD resolution, urinary tract infection (UTI), and hypertension. RPD was classified as mild (5-9.9 mm), moderate (10-14.9 mm) or severe (>or=15 mm). A total of 192 patients was included in the analysis; 114 were assigned to the group of non-significant findings (59.4%) and 78 to the group of significant uropathy (40.6%). Of 89 patients with mild dilatation, 16 (18%) presented uropathy. Median follow-up time was 24 months. Twenty-seven patients (15%) required surgical intervention. During follow-up, UTI occurred in 27 (14%) children. Of 89 patients with mild dilatation, seven (7.8%) presented UTI during follow-up. Renal function, blood pressure, and somatic growth were within normal range at last visit. The majority of patients with mild fetal RPD have no significant findings during infancy. Nevertheless, our prospective study has shown that 18% of these patients presented uropathy and 7.8% had UTI during a medium-term follow-up time. Our findings suggested that, in contrast to patients with moderate/severe RPD, infants with mild RPD do not require invasive diagnostic procedures but need strict clinical surveillance for UTI and progression of RPD.

Prognostic factors in fetal hydronephrosis: a multivariate analysis.

With the increasing use of obstetric echography fetal hydronephrosis has been reported more frequently. The purpose of this study was to identify prognostic factors associated with adverse outcome, such as renal failure and death, in fetal hydronephrosis. One hundred and forty-eight children with fetal hydronephrosis were admitted, submitted to a systematic protocol, and prospectively followed. Prognostic factors associated with fetal echography and clinical and laboratory findings on admission were studied. The median follow-up was 39 months. The analysis was conducted in two steps. In a univariate analysis, variables associated with adverse outcome were identified by the Kaplan-Meier method. The variables that were significantly associated with adverse outcome were then included in a multivariate analysis. This analysis, using the multivariate Cox's model, was performed to identify variables that were independently associated with a worse prognosis. Only variables that remained independently associated with adverse outcome were included in the final model. After final adjustment by Cox's multivariate model, three variables were identified as independent predictors of adverse outcome: oligohydramnios, prematurity, and glomerular filtration rate lower than 20 ml/min. Thus, in the presence of oligohydramnios, prematurity, and abnormal renal function, the medical team must plan appropriate follow-up for infants at health centers prepared to investigate and treat uropathies in newborns.

[Results of ureterocystoneostomy for inner urinary diversion in locally advanced prostate carcinoma]. / Ergebnisse der Ureterozystoneostomie zur inneren Harnableitung beim lokal fortgeschrittenen Prostatakarzinom.

Ureterneoimplantation (unilateral in 6 cases) was performed as palliative urinary diversion in 8 patients (age 64-81 years) due to locally advanced prostate cancer and bilateral ureteral obstruction (serum creatinine 2.1 to 9.8 mg. per dl.) between 1991 and 1995. In these cases the application of a double-J-catheter had failed or a percutaneous nephrostomy was refused. Postoperative time of survival (237 days, 2 patients still living for 20 and 21 months after therapy), mortality (1 of 8 patients), morbidity and time to hospital discharge (26 days) are compared to the results of the published retrospective investigations concerning percutaneous nephrostomy. The opportunity of a natural micturition without external urinary diversion could be gained for a longer period of time (5 and 20 months) in 2 of 3 patients. The other patients with in situ double-j-catheters were drained sufficiently by a suprapubic cystostomy (serum creatinine postoperatively 1.3 to 2.0 mg. per dl.). Bilateral ureterocystoneostomy being more invasive than unilateral diversion showed no benefits and was no more performed since 1991. Uretemeoimplantation with comparable postoperative results to percutaneus nephrostomy seems to be a sufficient therapeutic possibility in patients with natural micturition, repeated catheter complications, refusal or failure of alternative urinary diversion.

Fatores prognósticos do óbito, da insuficiência renal e da obstruçäo uretral na hidronefrose fetal: uma análise multivariada / Prognostic factors associated with death, renal insufficiency and urethral obstruction in fetal hydronephrosis: a multivariate analysis

O achado de hidronefrose é frequentemente observado no trato urinário fetal. Com a utilizaçäo crescente da ultra-sonografia obstétrica, a incidência desse diagnóstico tem se tornado ainda mais frequente. Para que os pacientes afetados por essa alteraçäo sejam abordados de forma adequada é necessário um conhecimento do curso clínico e do prognóstico da hidronefrose fetal. O presente estudo foi realizado com o objetivo de identificar fatores prognósticos associados ao óbito e à insuficiência renal, denominados em conjunto como eventos adversos, na hidronefrose fetal. Fatores associados à presença de obstruçäo uretral, sabidamente a uropatia com pior prognóstico, também foram identificados. Em um período de 13 anos 148 crianças foram admitidas no estudo e submetidas a um protocolo previamente estabelecido. Fatores prognósticos relacionados às condiçöes maternas, ao ultra-som fetal, ao exame clínico no pós-natal e aos exames laboratoriais na admissäo foram sistematicamente obtidos. Esses fatores prognósticos foram determinados antes do diagnóstico definitivo da alteraçäo urológica associada à hidronefrose. Os pacientes foram seguidos periodicamente com uma mediana de acompanhamento de 36 meses. As variáveis associadas aos eventos adversos foram inicialmente identificadas, utilizando-se a estimativa de sobrevida de Kaplan-Meier. Os fatores associados aos eventos adversos nessa análise univariada foram incluídos na análise multivariada, objetivando identificar variáveis preditivas de mau prognóstico, controlando-se outros fatores. A análise multivariada utilizada foi uma análise de sobrevida, empregando o modelo de regressäo de Cox. Após o ajustamento final pelo modelo multivariado de Cox, três variáveis demonstraram estar conjuntamente associadas aos eventos adversos no período de observaçäo: oligoidrâmnio, prematuridade e taxa de filtraçäo glomerular abaixo de 20 ml/min. Para identificaçäo dos fatores associados à presença de obstruçäo uretral, as variáveis foram, inicialmente, submetidas a uma análise univariada, utilizando-se o teste do qui-quadrado. As variáveis significativamente associadas à obstruçäo uretral na univariada análise foram incluídas na análise multivariada. Esta análise foi realizada utilizando-se o modelo de regressäo logística. Duas variáveis permaneceram associadas à obstruçäo uretral neste modelo: oligoidrâmnio e megabexiga na ecografia pré-natal...

Hidronefrose fetal: abordagem pós-natal e seguimento / Fetal hydronephrosis: postnatal management and follow up

Objetivo: O achado de hidronefrose fetal tem sido observado cada vez com maior freqüência, e é provável que, com a melhoria dos equipamentos ecográficos, essa observaçäo seja crescente. Neste presente estudo, apresentamos uma avaliaçäo de crianças portadoras de hidronefrose fetal, com o objetivo de analisar as causas mais freqüentes de hidronefrose fetal e a evoluçäo a longo prazo. Métodos: Em um período de 13 anos, 148 crianças foram admitidas no estudo e submetidas a um protocolo previamente estabelecido: na admissäo, era iniciada a quimioprofilaxia e procedida a avaliaçäo de imagens do trato urinário, consistindo de realizaçäo de uretrocistografia miccional e ultra-som. Os estudos seqüenciais foram determinados pelos achados nessa avaliaçäo inicial...

Diagnóstico prenatal de hidronefrosis y seguimiento postnatal en la ciudad de Cali entre 1987 y 1995

Se presenta la revisión retrospectiva de 90 pacientes con hidronefrosis prenatal captados en el Hospital Universitario del Valle Evaristo García, Clínica Rafael Uribe Uribe del instituto de Seguros Sociales, Hospital Infantil Club Noel y en los consultorios particulares de tres nefrólogos pediatras de la ciudadde Cali entre el 1o. de enero de 1987 y el 30 de junio de 1995. Se revisaron las historias clínicas y los estudios imagenológicos durante el período prenatal y el seguimiento postnatal. Resultados: se estudiaron 90 pacientes con 127 unidades renales comprometidas. El promedio de edad materna es de 28 años y el 50 por ciento de ellas son primigestantes. La edad media en que se hizo el diagnóstico fue a las 30 mas o menos 5 semanas de gestación (20-40 semanas). Hubo predominio del sexo masculino en el 78 por ciento de los casos. Los diagnósticos prenatales más frecuentes fueron hidronefrosis unilateral (58 por ciento), hidronefrosis bilateral (26 por ciento) y riñón displásico multiquístico (14 por ciento). Luego de la evaluación postnatal con ecografía y cistouretrografía miccional cíclica, y estudios complementarios cuando se consideró necesario, los diagnósticos finales fueron hidronefrosis no obstructiva (43 por ciento), reflujo vesicoureteral (22 por ciento), hidronefrosis obstructiva (13 por ciento), riñón displásico multiquístico (8 por ciento), doble sistema colector (5 por ciento), otros (megauréter, secuencia de Potter, ectopia renal cruzada, ureterocele y divertículo paraureteral) (6 por ciento) y valvas de uretra posterior (3 por ciento). Los pacientes fueron discutidos en la Clínica de Nefro-Urología para definir conducta. Veintinueve pacientes (32 por ciento) requirieron corrección quirúrgica (12 pieloplastias, 11 reimplantes ureterales, tres polectomías, una fulguración de valvas, una vesicostomía y una nefrectomía). La función renal de los pacientes con hidronefrosis obstructiva se normalizó después de la cirugía. En el 23.3 por ciento de los casos (21 pacientes) se presentó infección urinaria en la fase inicial del estudio. En 70 pacientes se evaluó la función renal en el momento de entrada al estudio, siendo normal en el 96 por ciento; estaba disminuida en los dos pacientes con valvas de uretra posterior y en un paciente con reflujo vésico-ureteral grado IV bilateral.

Surgery for recurrent rectal adenocarcinoma in the presence of hydronephrosis.

From January 1974 to December 1989, 16 patients with locally recurrent rectal adenocarcinoma and hydronephrosis underwent exploratory celiotomy with curative intent. There were eight males and eight females. The median age was 61 years. Primary rectal adenocarcinomas were treated with abdominoperineal resection in 12 patients and low anterior resection in 4 patients. Four patients underwent adjuvant radiotherapy, one patient adjuvant chemotherapy, and one patient combination therapy. The median disease-free interval between resection of the primary tumor and recurrence was 18 months. Hydronephrosis was unilateral in seven patients (44%), and bilateral in nine patients (56%). Preoperative evaluation indicated that all 16 patients had local pelvic-perineal recurrence or pelvic recurrence alone. Resection was not possible in any of these 16 patients for the following reasons: 5 patients (31%) had pelvic sidewall involvement and carcinomatosis; 3 patients (19%) pelvic sidewall involvement alone; 2 patients (13%) pelvic sidewall involvement and sacral fixation; and 2 patients (13%) had sacral fixation alone. In the remaining four patients, there was pelvic sidewall involvement by tumor and/or synchronous hepatic metastases, carcinomatosis, or sacral fixation. The median survival after exploratory celiotomy was 8 months in the 16 patients who died of their disease. Unilateral and bilateral hydronephrosis appears to be a contraindication for potentially curative surgical resection in recurrent rectal adenocarcinoma.