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1.
Medicine (Baltimore) ; 99(2): e18707, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914077

RESUMEN

Aim to illuminate the correlation between fetal hydronephrosis and postnatal urological abnormalities by a new classification system-"urinary tract dilation (UTD)" grade.Of 659 pregnancies screened by ultrasound, 34 cases were found with isolated fetal hydronephrosis, and enrolled in our study from 2017 to 2019. These 34 infants had been prospectively followed up to 6 months after birth by 3 times of urinary tract ultrasound. Hydronephrosis was graded in accordance with the UTD classification system.Among 34 infants with isolated fetal hydronephrosis. Twenty-four (70.6%) were classified as UTD A1 grade (mild hydronephrosis), and the other 10 (29.4%) were UTD A2-3 grade (moderate to severe hydronephrosis) by antenatal evaluation. After birth, all of the 24 infants (70.6%) with UTD A1 grade had normal ultrasonic findings of urinary tract; while the other 10 cases with UTD A2-3 grade had persistent abnormalities of urinary tract by postnatal assessment, sorted as UTD P1 grade (mild hydronephrosis) in 6 cases (17.6%), UTD P2 grade (moderate hydronephrosis) in 2 cases (5.9%) and UTD P3 grade (severe hydronephrosis) in 2 cases (5.9%). The most common postnatal urological abnormality of isolated fetal hydronephrosis was vesicoureteral reflux. During the follow-up period, 7 infants (20.6%) had urinary tract infection episodes and very few obtained positive cultures of the urine. Only 2 infants (5.9%) with the diagnosis of ureterovesical junction obstruction required surgery intervention, who were both classified as UTD P3 grade. None of the children with UTD P1 and P2 grades needed operation.The UTD classification system described the urinary tract both antenatally and postnatally, which could point out the correlation between fetal hydronephrosis and postnatal urological abnormalities. This new classification system is expected to be a good prognostic marker for fetal hydronephrosis.


Asunto(s)
Hidronefrosis/clasificación , Hidronefrosis/patología , Enfermedades Urológicas/etiología , Dilatación Patológica , Femenino , Edad Gestacional , Humanos , Hidronefrosis/complicaciones , Hidronefrosis/diagnóstico por imagen , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Ultrasonografía Prenatal , Sistema Urinario/diagnóstico por imagen , Infecciones Urinarias/etiología , Reflujo Vesicoureteral/etiología
2.
FP Essent ; 488: 25-34, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31894953

RESUMEN

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


Asunto(s)
Infecciones Urinarias , Reflujo Vesicoureteral , Profilaxis Antibiótica , Niño , Preescolar , Femenino , Fiebre , Humanos , Lactante , Masculino , Factores de Riesgo
4.
J Urol ; 203(1): 194-199, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31479395

RESUMEN

PURPOSE: In utero myelomeningocele closure is a valid alternative to postnatal repair with unclear benefits to bladder function. We compared bladder status in patients who underwent fetal myelomeningocele surgery versus postnatal repair. MATERIALS AND METHODS: We retrospectively reviewed our database, with group 1 consisting of in utero surgery and group 2 consisting of postnatal repair. Group 3 was a subgroup of group 2, including patients initially presenting at age less than 12 months. We recorded medical history, radiological investigation with renal ultrasonography, voiding cystourethrography, urodynamic evaluation and clinical outcome of the bladder pattern after treatment. RESULTS: We identified 88 patients in group 1, 86 in group 2 and 38 in group 3. The incidence of urinary tract infection was higher in the postnatal period (45% vs 20%). Hydronephrosis occurred in 20.7%, 22.6% and 28.9% of patients in groups 1, 2 and 3, respectively. Vesicoureteral reflux was diagnosed in 15% in all groups. Urodynamic data showed a higher prevalence of detrusor overactivity in group 1 and no difference in other urodynamic parameters. The high risk bladder pattern at initial evaluation occurred in 56%, 50% and 46% of patients in groups 1, 2 and 3, respectively. There was a trend to decrease the percentages of the high risk bladder pattern and to increase the normal pattern after treatment in all groups. CONCLUSIONS: In utero repair did not improve urological parameters compared to repair in the postnatal period.


Asunto(s)
Feto/cirugía , Meningomielocele/cirugía , Complicaciones Posoperatorias/epidemiología , Femenino , Humanos , Hidronefrosis/epidemiología , Lactante , Recién Nacido , Masculino , Embarazo , Estudios Retrospectivos , Infecciones Urinarias/epidemiología , Reflujo Vesicoureteral/epidemiología
5.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(11): 1069-1072, 2019 Nov.
Artículo en Chino | MEDLINE | ID: mdl-31753086

RESUMEN

OBJECTIVE: To study the long-term prognosis of vesicoureteral reflux in children. METHODS: A retrospective analysis was performed for the clinical data of 138 children (218 ureters with reflux) who were diagnosed with vesicoureteral reflux for the first time from November 2005 to March 2017 and received medical treatment and regular follow-up. According to the initial grade of reflux, the ureters with reflux were divided into a low-grade group (141 ureters, grade I-III) and a high-grade group (77 ureters, grade IV-V), and the two groups were compared in terms of clinical data and follow-up results. RESULTS: Among the 138 children, there were 82 boys and 56 girls. Their age ranged from 31 days to 10 years at the time of confirmed diagnosis, with a median age of 8 months. The follow-up time ranged from 8 months to 7 years, with a median follow-up time of 1.4 years. At the time of confirmed diagnosis, the high-grade group had significantly higher levels of urinary N-acetyl-ß-D-glucosaminidase, urinary microalbumin and urinary immunoglobulin G than the low-grade group (P<0.05). Among the 218 ureters with reflux, 132 (60.6%) achieved a reduction in the grade of reflux (among which 74 achieved complete disappearance of reflux), 43 had no change in the grade of reflux, and 43 had an increase in the grade of reflux. Compared with the high-grade group, the low-grade group had a significantly higher complete remission rate (41.1% vs 19.5%, P=0.001) and a significantly shorter time to complete remission of reflux (P=0.002). CONCLUSIONS: Most children with vesicoureteral reflux can achieve a reduction in the grade of reflux or even complete disappearance of reflux during follow-up, and the children with low-grade reflux have better prognosis than those with high-grade reflux.


Asunto(s)
Reflujo Vesicoureteral , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Pronóstico , Estudios Retrospectivos
6.
Pan Afr Med J ; 33: 304, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692745

RESUMEN

Vesicoureteral reflux is very common in children, requiring a long follow-up period to reduce its progression toward chronic renal failure. This study aims to analyze the epidemiological diagnostic features, the management of vesicoureteral reflux and long term course of patients with this disease. We conducted a retrospective study of 42 patients with suspected vesicoureteral reflux hospitalized in the Department of Visceral Paediatric Surgery at the Hassan II University Hospital of Fez over a period of 6 years from January 2010 to December 2015. Mean age of patients at diagnosis was 3 years and 2 months. The boy is to girl sex ratio was 1.8. Vesicoureteral reflux was isolated in 81% of patients and secondary or associated in 19% of patients. The most common initial manifestation was urinary tract infection (90.4%). Renal function was impaired in 54.8% of children. The treatment was based on antibiotics against diagnosed UTI (90.4%), antibiotic prophylaxis in the case of recurrence and Cohen reimplantation (97.62%). Surgical indication readily concerned all patients with grades IV and V vesicoureteral reflux (73.9%) as well as patients with impaired kidneys and 26.1% of patients after medical treatment. Early and late postoperative course was in general satisfactory: disappearance of vesicoureteral reflux in 92.68% of cases. Upper urinary tract regressed except for 9.52% of patients; 95.23% of patients had complete recovery of renal function. There was a reduction in UTI recurrence (in 19.04% of cases after surgery). The majority of parents judged positively the clinical course of their children (54.76%) after surgery.


Asunto(s)
Antibacterianos/administración & dosificación , Infecciones Urinarias/etiología , Reflujo Vesicoureteral/diagnóstico , Adolescente , Profilaxis Antibiótica/métodos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Recurrencia , Estudios Retrospectivos , Infecciones Urinarias/epidemiología , Infecciones Urinarias/terapia , Reflujo Vesicoureteral/fisiopatología , Reflujo Vesicoureteral/cirugía
7.
Turk J Pediatr ; 61(1): 71-78, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31559724

RESUMEN

Gültekin ND, Benzer M, Tekin-Neijmann S. Is there any relation between connective tissue growth factor and scar tissue in vesicoureteral reflux. Turk J Pediatr 2019; 61: 71-78. Vesicoureteral reflux (VUR) is the most common uropathy in childhood which leads to increased frequency of urinary tract infection (UTI) and renal scarring. Connective tissue growth factor (CTGF) plays an important role in the development of glomerular and tubulointerstitial fibrosis in progressive kidney diseases. The aim of this study was to investigate the relation between urinary CTGF and renal damage resulted from VUR. This cross sectional study included 70 patients with VUR and 62 healthy sex and age matched children. Urinary creatinine and CTGF (uCTGF) concentrations were analysed in all cases and CTGF to creatinine ratio were calculated. The records of radiologic evaluations of the patients including ultrasound, voiding cystouretrography and 99m-technetium dimercaptosuccinic acid (DMSA) scintigraphy were obtained retrospectively. The patient group was further divided into two groups according to the existence of renal cortical scarring in the DMSA scan. The study consisted of three groups; Group 1 (control group) 62 children, Group 2 (VUR positive, scar negative) 24 patient, Group 3 (VUR positive, scar positive) 46 patient (VUR+scar). The medians of uCTGF and uCTGF to creatinine ratio of the three groups were significantly different (p < 0.001). Pairwise group comparisons revealed that Group 1 had significantly lower uCTGF level and uCTGF/creatinine ratio, as compared to Groups 2 and 3 (p < 0.001 and p=0.002, respectively). There was no statistically significant difference between Groups 2 and 3 (p=0.052). uCTGF is significantly increased in children with VUR, independent on the presence of renal scarring. Increased uCTGF, even in the absence of the renal scarring, could be interpreted as development and a progression of glomerular and tubulointerstitial fibrosis in vesicoureteral reflux. Further experimental and clinical investigations are required to fully elucidate the mechanism of CTGF in vesicoureteral reflux.


Asunto(s)
Cicatriz/diagnóstico por imagen , Factor de Crecimiento del Tejido Conjuntivo/orina , Corteza Renal/diagnóstico por imagen , Reflujo Vesicoureteral/complicaciones , Estudios de Casos y Controles , Niño , Preescolar , Creatinina/orina , Estudios Transversales , Femenino , Humanos , Masculino , Cintigrafía , Estudios Retrospectivos , Urografía
8.
Urologiia ; (4): 85-90, 2019 Sep.
Artículo en Ruso | MEDLINE | ID: mdl-31535811

RESUMEN

AIM: To substantiate the expediency of immunomodulators and probiotics application pathogenetically in the comprehensive preoperative preparation in children with congenital uropathies (U). MATERIALS AND METHODS: The study includes 60 patients with various types of congenital uropathy (CU) (vesicoureteral reflux, hydronephrosis, obstructive ureterohydronephrosis), which were divided into 3 groups in accordance with the preoperative preparation complex. 1 group - 20 patients with VU, immunomodulating drug Kipferon was added to the therapy at the preoperative stage, group 2 - 20 patients with VU - with the addition of the biologically active additive (BAA) "Bifidum No791 BAG", 3 control group - 20 children with VU standard complex of preoperative preparation. The diagnosis of VU was established using a standard urological examination. The examination of the content of pro-(IL-8) and anti-inflammatory (IL-10) cytokines in the urine was performed before the start of treatment (1 point) and on the 3-5th day after surgery (2 point) for all patients using the method of enzyme-linked immunosorbent assay. RESULTS: Based on signs of systemic inflammation and urinary syndrome, initially patients of all groups (n=60) were in the latent phase of chronic obstructive pyelonephritis. After surgical correction pyelonephritis was diagnosed in all children at point 2, the most pronounced was in the control group. Manifestation of dysbiosis in the control group was more often by 20% than in group 2. The examination of the cytokine profile of urine showed an increasing the level of IL-8 (p<0.0001) at 2 points in all groups, the most significant was in the control group (p<0.002). An increasing the level of IL-10 (p<0.0001) was noted at point 2 in all groups, the most significant was in groups 1 and 2 (p<0.003). High values of the inflammation activity index were observed only at point 2 in the children of the control group (p<0.001). CONCLUSION: The using of immunomodulators and probiotics in the comprehensive preoperative preparation of children with obstructive uropathies reduces the risk, severity and duration of postoperative complications.


Asunto(s)
Atención Perioperativa , Enfermedades Urológicas , Niño , Humanos , Hidronefrosis , Pielonefritis , Reflujo Vesicoureteral
9.
Urology ; 134: 221-224, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31494213

RESUMEN

Ureteral triplication is a rare congenital anomaly of urinary tract with wide spectrum of presentation. The presentation with incontinence has usually been taken as a sign of ureteral ectopia in these cases. However, ectopia cannot explain all cases with incontinence. We report a case of a 14-year-old girl with ureteral triplication with contralateral duplication and vesicoureteral reflux of the upper moiety on the triplicate side and dysplastic upper moiety on duplicated side, who had persistent incontinence following a left ureteroureterostomy and right heminephrectomy. The clinical features of this rare case and the management of this peculiar postoperative situation is discussed herewith.


Asunto(s)
Uréter/anomalías , Adolescente , Femenino , Humanos , Uréter/diagnóstico por imagen , Uréter/cirugía , Incontinencia Urinaria/etiología , Reflujo Vesicoureteral/etiología
12.
Curr Urol Rep ; 20(9): 49, 2019 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-31289951

RESUMEN

PURPOSE OF REVIEW: Endoscopic injection of bulking agents for the treatment of vesicoureteral reflux (VUR) has become a therapeutic alternative to antibiotic prophylaxis and ureteral reimplantation. Although considered as a safe and efficient procedure, several studies have reported cases of ureteral obstruction (UO) after endoscopic correction of VUR. This review article evaluates the present VUR literature to estimate the incidence of UO following endoscopic injection of different substances, while also discussing the impact of injection technique and implant volume. RECENT FINDINGS: Twenty-five publications were identified that provided detailed information on 64 females and 32 males (age range, 7 months-48 years) that developed UO after endoscopic treatment of VUR using dextranomer/hyaluronic acid (Dx/HA), polyacrylate polyalcohol (PP), polydimethylsiloxane (PDMS), calcium hydroxyapatite (CaHA), polytetrafluoroethylene (PTFE), or collagen. There was some variation in the reported incidence of UO among these materials: Dx/HA (0.5-6.1%), PP (1.1-1.6%), PDMS (2.5-10.0%), CaHA (1.0%), and PTFE (0.3%). Postoperative UO was described following subureteric transurethral injection (STING), intraureteric hydrodistension implantation technique (HIT), combined HIT/STING and double HIT. The injected volume ranged widely, also depending on the type of bulking agent: Dx/HA (0.3-3.0 mL), PP (0.3-1.2 mL), PDMS (1.0-2.2 mL), CaHA (0.4-0.6 mL), and PTFE (1.5-2.0 mL). The timing of UO varied from immediately after the procedure to 63 months. Over half of patients showed asymptomatic hydroureteronephrosis on follow-up imaging, whereas the remaining presented with symptoms of acute UO or fever. UO remains a rare complication after endoscopic correction of VUR, generally reported in less than 1% of treated cases, which appears to be independent of the injected substance, volume, and technique. However, long-term follow-up is recommended as asymptomatic or delayed UO can occur, potentially leading to deterioration of renal function.


Asunto(s)
Materiales Biocompatibles/efectos adversos , Endoscopía/efectos adversos , Obstrucción Ureteral/etiología , Reflujo Vesicoureteral/cirugía , Resinas Acrílicas/efectos adversos , Adolescente , Adulto , Niño , Preescolar , Colágeno/efectos adversos , Dextranos/efectos adversos , Dimetilpolisiloxanos/efectos adversos , Durapatita/efectos adversos , Femenino , Humanos , Ácido Hialurónico/efectos adversos , Lactante , Inyecciones , Masculino , Persona de Mediana Edad , Politetrafluoroetileno/efectos adversos , Resultado del Tratamiento , Adulto Joven
14.
J Laparoendosc Adv Surg Tech A ; 29(9): 1180-1184, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31355700

RESUMEN

Purpose: To compare the surgical outcomes of children submitted to robot-assisted reconstruction with or without drainage placement performed by a single surgeon in a tertiary referral center. Materials and Methods: Patients submitted to robot-assisted reconstruction, including pyeloplasty for ureteral pelvic junction obstruction, end-to-end anastomosis for retrocaval ureter, and reimplantation for vesical ureter reflux (VUR) from January 2016 to November 2018, were included. Patients with ureteral pelvic junction obstruction or retrocaval ureter were selected for surgery according to the presence of symptoms and/or evidence of obstruction on diagnostic imaging. The criteria for reimplantation included breakthrough urinary tract infections, progressive renal scarring, and persistent VUR despite watchful waiting. Results: Overall, 31 children composed the no drain placement (DP) group and 29 the DP group. Preoperative feature of the two groups were comparable. Overall, only 1 (3.3%) postoperative complication occurred in no DP group and 2 (6.9%) in the placement group (P = .512). Length of stay was 3 (interquartile range [IQR]: 3-4) and 4 (IQR: 4-4) days, respectively (P = .651). At last follow-up, overall success rate was 100% in the no DP group and 96.6% in the DP group (P = .297). Conclusions: Robot-assisted reconstruction represents a safe minimally invasive approach with optimal surgical outcomes for the treatment of upper urinary tract. Expert robotic surgeons could avoid drainage placement after surgery as this does not undermine perioperative outcomes and postoperative success rate. Our study, first in literature, proves the interest in assessing the safety of no drainage placement also in the pediatric field.


Asunto(s)
Drenaje/métodos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Centros de Atención Terciaria , Uréter/cirugía , Obstrucción Ureteral/cirugía , Reflujo Vesicoureteral/cirugía , Anastomosis Quirúrgica/métodos , Preescolar , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reimplantación/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Reflujo Vesicoureteral/etiología
15.
Hinyokika Kiyo ; 65(4): 123-126, 2019 Apr.
Artículo en Japonés | MEDLINE | ID: mdl-31247690

RESUMEN

We report a case of misdirection of a catheter for clean intermittent catheterization (CIC) into the ureter. A four-year-old girl with neurogenic bladder due to myelomeningocele had been managed with CIC by her parents for several years. From about a month before her visit, macroscopic hematuria appeared intermittently followed by abdominal pain and fever-up for a short time which ceased spontaneously. As cystography demonstrated bilateral vesicoureteral reflux, we performed endoscopic intraureteral injection of Deflux[TM] and during the operation we confirmed influx of bloody urine from the right ureteral orifice but not from the left one. As computed tomography revealed a tubular foreign body located in the upper portion of the right ureter, another endoscopic operation was performed and it was removed successfully. The removed foreign body was identified as a disposable catheter that was used for CIC.


Asunto(s)
Cateterismo Uretral Intermitente , Meningomielocele , Vejiga Urinaria Neurogénica , Reflujo Vesicoureteral , Preescolar , Femenino , Humanos , Cateterismo Uretral Intermitente/efectos adversos , Meningomielocele/terapia , Uréter , Vejiga Urinaria Neurogénica/terapia , Reflujo Vesicoureteral/etiología
16.
Saudi J Kidney Dis Transpl ; 30(3): 706-709, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31249237

RESUMEN

Diabetes mellitus (DM) is a common disease in Oman as in rest of Gulf Cooperation Council where metabolic syndrome is of high prevalence. DM is a foremost risk factor for urinary tract infections (UTIs). It is also linked to more complicated infections such as emphysematous pyelonephritis (EPN), emphysematous pyelitis (EP), renal/perirenal abscess, emphysematous cystitis, xanthogranulomatous pyelonephritis, and renal papillary necrosis. The diagnosis of these cases is frequently delayed because the clinical manifestations are generic and not different from the typical triad of upper UTI, which include fever, flank pain, and pyuria. A middle-aged female with DM and chronic kidney disease stage IV was admitted with recurrent UTI with extended-spectrum beta-lactamase-producing Escherichia coli. At presentation, she was afebrile, clinically stable, had no flank pain and there was no leukocytosis. Laboratory test for C- reactive protein done twice and was only mildly elevated at 7 and 11 mg/dL. A computed tomography scan of kidney-ureter-bladder (CT-KUB) was recommended and reported as "no KUB stone but small atrophic left kidney with dilatation of the pelvicalycial system and ureter and the presence of air in the collecting system suggestive of EP." Thus, commonly associated with DM, especially in females, debilitated immune-deficient individuals, and patients harboring obstructed urinary system with infective nidus. Air in the kidney is not always due to EPN. UTI with a gas-producing organism can ascend to the kidney in the presence of vesicoureteral reflux.


Asunto(s)
Complicaciones de la Diabetes/mortalidad , Enfisema/microbiología , Infecciones por Escherichia coli/microbiología , Pielitis/microbiología , Infecciones Urinarias/microbiología , Reflujo Vesicoureteral/complicaciones , Enfermedades Asintomáticas , Complicaciones de la Diabetes/diagnóstico , Enfisema/diagnóstico por imagen , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Pielitis/diagnóstico por imagen , Recurrencia , Factores de Riesgo , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico , Reflujo Vesicoureteral/diagnóstico
17.
Actas urol. esp ; 43(5): 262-268, jun. 2019. tab
Artículo en Español | IBECS | ID: ibc-181094

RESUMEN

Objetivo: Identificar los resultados de la aplicación de polidimetilsiloxano en el manejo endourológico de reflujo vesicoureteral (RVU) sintomático al injerto renal y determinar factores asociados a la persistencia de los síntomas y del reflujo vesicoureteral. Material y métodos: Se incluyó a 23 pacientes con el diagnóstico de RVU sintomático en injerto renal evaluados de enero del 2010 a agosto del año 2018 en la Unidad Médica de Alta Especialidad # 14 de Veracruz, quienes recibieron aplicación endourológica de polidimetilsiloxano. Se realizó el análisis descriptivo, cuando fue posible se determinaron medidas de riesgo relativo para fracaso clínico (FC) con odds ratio (OR). Resultados: Del total de pacientes, 18 (78,3%) presentaron éxito clínico (EC). Se observó una diferencia significativa en la edad promedio (EC 30,61 ± 9,7, FC 46,0 ± 11,46; U de Mann-Whitney, p = 0,037) y en el número de episodios de pielonefritis aguda al injerto previos a la aplicación de PDMS (EC 2,27 ± 1,27, FC 3,6 ± 0,89; U de Mann-Whitney, p = 0,019). El patógeno más frecuente identificado fue la Escherichia coli, con un 45,4%. La resolución del RVU se observó en el 47,8% de los casos. Hubo una disminución del grado de RVU en el 73,9% de los casos. Se determinó como factor protector para FC la disminución del grado de RVU (OR: 0,031, IC del 95%: 0,002-0,437, con p = 0,008). Conclusiones: La aplicación endourológica de PDMS mostro ser útil en el manejo de los pacientes con RVU sintomático en injerto renal, disminuyendo el grado de RVU y permitiendo el EC en la mayoría de los casos


Objective: To identify the results of polydimethylsiloxane application in the endourological management of symptomatic vesicoureteral reflux to the kidney graft and to determine the factors associated with persistent symptoms and with vesicoureteral reflux. Material and methods: We included 23 patients diagnosed with symptomatic VUR in kidney graft, evaluated from January 2010 to August 2018 in the High Specialty Medical Unit # 14 in Veracruz. These patients received endourological application of polydimethylsiloxane. The descriptive analysis was carried out, and, if possible, the relative risk measures for clinical failure (CF) were determined with odds ratio (OR). Results: 18 (78.3%) patients presented clinical success (CS). There was a significant difference in the mean age (CS 30.61 ± 9.7, CF 46.0 ± 11.46; U Mann Whitney, P = .037), and in the number of episodes of AGPN prior to the application of PDMS (CS 2.27 ± 1.27, CF 3.6 ± 0.89, U Mann Whitney, P = .019). The most frequently identified pathogen was E. Coli, with 45.4%. VUR resolution was observed in 47.8% of the cases. There was a decreased degree of VUR in 73.9% of cases. A lower degree of VUR was determined as a protective factor for CF (OR: 0.031, 95% CI: 0.002-0.437, with P = .008). Conclusions: The endourological application of PDMS proved to be useful in the management of patients with symptomatic VUR in kidney graft, as it decreased the VUR degree and allowed CS in most cases


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Trasplante de Riñón , Reflujo Vesicoureteral/tratamiento farmacológico , Dimetilpolisiloxanos/uso terapéutico , Epidemiología Descriptiva , Escherichia coli Uropatógena/patogenicidad
18.
J Med Case Rep ; 13(1): 128, 2019 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-31053166

RESUMEN

BACKGROUND: A bilateral duplex collecting system is an unusual renal tract abnormality. Vesicoureteral reflux may be associated. We describe a rare case of bilateral duplex collecting system with bilateral vesicoureteral reflux in which the refluxing ureter on the left side drains the upper pole moiety contrary to what is often found. CASE PRESENTATION: A 24-year-old married Arab woman presented with ascending left-sided flank pain during micturition. She complained of recurrent urinary tract infections. A physical examination and laboratory tests were normal. Voiding cystourethrography and computed tomography scan detected bilateral duplex collecting system, grade IV vesicoureteral reflux on the left side, and grade I vesicoureteral reflux on the right. She underwent left heminephrectomy and dextranomer/hyaluronic acid injections on the right side. After a year of follow-up, a clinical examination and imaging findings were unremarkable. CONCLUSIONS: A bilateral duplex collecting system with refluxing upper pole moiety ureter is a very rare entity. The diagnosis should be suspected when exploring any flank pain with recurrent urinary tract infections to avoid subsequent renal impairment. Furthermore, this case shows how some common symptoms may lead to finding an unexpected urinary tract abnormality.


Asunto(s)
Cistografía , Dextranos/uso terapéutico , Ácido Hialurónico/uso terapéutico , Túbulos Renales Colectores/fisiopatología , Nefrectomía/métodos , Tomografía Computarizada por Rayos X , Reflujo Vesicoureteral/fisiopatología , Femenino , Dolor en el Flanco , Humanos , Riñón/anomalías , Túbulos Renales Colectores/diagnóstico por imagen , Resultado del Tratamiento , Uréter/anomalías , Infecciones Urinarias , Micción , Reflujo Vesicoureteral/diagnóstico por imagen , Reflujo Vesicoureteral/tratamiento farmacológico , Adulto Joven
19.
Urology ; 128: 77, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31101310
20.
J Korean Med Sci ; 34(21): e156, 2019 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-31144480

RESUMEN

BACKGROUND: Few studies have reported on breakthrough urinary tract infection (UTI) associated with the susceptibility of index UTI to prophylactic antibiotics in children with primary vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). We assessed the impact of the susceptibility of index UTI to prophylactic antibiotics in breakthrough UTIs in children with primary VUR receiving CAP. METHODS: We retrospectively reviewed the medical records of 81 children with primary VUR who were diagnosed after febrile or symptomatic UTI and subsequently received trimethoprim-sulfamethoxazole (TMP-SMX) as CAP between January 2010 and December 2013. We allocated children to a susceptible group or a resistant group based on the susceptibility of index UTI to TMP-SMX. We evaluated patient demographics and clinical outcomes after CAP according to the susceptibility of index UTI to TMP-SMX. Multivariate analysis was used to identify the predictive factors for breakthrough UTI. RESULTS: Of the 81 children, 42 were classified into the susceptible group and 39 into the resistant group. The proportion of breakthrough UTI was 31.0% (13/42) in the susceptible group and 53.8% (21/39) in the resistant group (P = 0.037). Progression of renal scarring was observed in 0% of children in the susceptible group and 15% in the resistant group (P = 0.053). Multivariate analysis showed that TMP-SMX resistance and initial renal scarring were significant predictors of breakthrough UTI. CONCLUSION: Susceptibility of index UTI to prophylactic antibiotics is a risk factor of breakthrough UTI and is associated with poor clinical outcomes in children with primary VUR receiving CAP.


Asunto(s)
Antiinfecciosos Urinarios/uso terapéutico , Profilaxis Antibiótica/métodos , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/prevención & control , Reflujo Vesicoureteral/tratamiento farmacológico , Antibacterianos/uso terapéutico , Bacterias/clasificación , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Combinación de Medicamentos , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Infecciones Urinarias/microbiología
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