What is the Critical age for the Improvement of Parenchymal Thickness after Pyeloplasty?

PURPOSE: The most important point in cases of ureteropelvic junction obstruction (UPJO) is to decide on the need and timing of surgical treatment. Renal damage may become irreversible as the duration of the obstruction is prolonged. Worsening of hydronephrosis and decrease in renal parenchymal thickness after pyeloplasty may herald an irreversible renal damage. It is important to know at what age this damage begins. In this study, we aimed to determine the relationship between the age of the patients at the time of pyeloplasty performed for UPJO and parenchymal recovery. MATERIALS AND METHODS: In our study, 156 patients (mean age: 43.5 months) who underwent pyeloplasty with the diagnosis of UPJO between 2007 and 2019 were evaluated retrospectively. Demographic characteristics, ultrasonographic (USG) and nuclear renal scintigraphy findings, previous surgeries  â€‹of the patients  were recorded. RESULTS: Numerical variables were evaluated statistically, and the best cut-off point was determined. Parenchymal thickening was determined as the most important criterion in postoperative renal recovery which was more evident at early ages. Based on statistical assessments , the cut-off age for renal parenchymal recovery was determined as 38 months. While parenchymal recovery was inadequate after pyeloplasty performed in patients older than 38 months, the most significant improvement in renal functions was seen in children younger than 13 months of age. CONCLUSION: Pyeloplasty should be performed in patients with UPJO before development of severe renal damage. Statistically, the best parameter to evaluate the recovery after pyeloplasty is the change in parenchymal thickness. With advancing age, it is impossible to reverse the obstructive nephropathy.

Comparison of miniaturized percutaneous nephrolithotomy and retrograde intrarenal surgery: Which is more effective for 10-20 mm renal stones in children? / Comparación de nefrolitotomía percutánea mini y ureteroscopia flexible retrógrada intrarenal: ¿cual es más efectiva para litiasis de 10-20 mm en niños?

OBJECTIVE: To compare miniaturized percutaneous nephrolithotomy (mini-PNL) and retrograde intrarenal surgery (RIRS) in children with 10-20 mm renal stones. MATERIALS AND METHODS: Between 2015 and 2019, 63 pediatric patients aged under 16 years who under went mini-PNL and RIRS for the treatment of kidney stones sized 10-20 mm were analyzed retrospectively. The mini-PNL group (n=30) was defined as group 1 and the RIRS group (n=33) was defined as group 2. Peri-operative data including stone-free rate, operative time, fluoroscopy time, hospitalization time, number of anesthesia sessions, complication rates, and cost-effectiveness were analyzed. RESULTS: The mean age was 8.09±5.49 years in group 1 and 5.75±4.56 years in group 2. The stone free rate was not different at the first (80.0% vs. 57.6%) and third month (93.3% vs. 90.9%) follow-up in group 1 and group 2. The mean hospitalization, operative, and fluoroscopy times were statistically significantly longer in group 1. The mean number of anesthesia sessions for patients was 1.20±0.40 in group 1 and 2.15±0.44 in group 2 (p=0.00). Minor complication rates were not different and no major complications were observed in either group. The cost per patient was calculated as 365.97 Euros in group 1 and 698.64 Euros in group 2 (p=0.001). CONCLUSIONS: This study suggested that RIRS was an effective alternative treatment method for 10-20 mm kidney stones in children, with comparable stone-free and complication rates. RIRS has a shorter operative time, fluoroscopy time, hospital stay than mini-PNL, with a similar stone-free rate for 10-20 mm kidney stones in children. However, mini-PNL is cheaper and allowed a lower need for anesthesia sessions.

OBJETIVO: Comparar nefrolitotomia percutánea mini y ureteroscopia flexible retrógrada intrarenal para litiasis de 10-20 mm en niños. MATERIAL Y METODOS: Entre 2015 y 2019, analizamos retrospectivamente 63 pacientes pediátricos menoresde 16 años recibieron mini-nefrolitotomia percutanea y URs flexible para el tratamiento de litiasis renales de entre 10-20 mm. Grupo 1 (n=30) mini nefrolitotomía percutánea, grupo 2 (n= 33) URs flexible. Datos perioperatorios incluyendo la tasa libre de litiasis, tiempo quirúrgico,tiempo hospitalización, número de anestesias requeridas, tasa de complicaciones y coste-efectividad fueron analizados. RESULTADOS: La edad media fue de 8,09±5,49 año sen el grupo 1 y 5,75±4,56 en el grupo 2. La tasa libre de litiasis no fue diferente en el primer mes (80,0% vs.57,6%) y 3er mes (93,3% vs. 90,9%) entre el grupo 1 y grupo 2. La mediana de tiempo hospitalización, tiempo quirúrgico y tiempo exposición a fluoroscopia fueron mas largos en el grupo 1. La media de anestesias fue de 1,20±0,40 en el grupo 1 y 2,15±0,44 en el grupo 2 (p=0,00). La tasa de complicaciones menores no fue diferente y la de mayores tampoco. El coste por paciente se estableció en 365 euros en el grupo 1 y 698 euros en el grupo 2. CONCLUSIONES: Este estudio sugiere que la ureteroscopia flexible es un tratamiento efectivo como alternativa en niños con litiasis de 10-20 mm con unas tasa libres de litiasis y complicaciones parecidas. La URs flexible comporta un menor tiempo operatorio, fluoroscopia, estancia hospitalaria que la mini percutánea con tasa libre de litaisis similares. Por contra, la mini-percutanea es mas barata y comporta menos sesiones anestésicas.

Recurrence of childhood nephrogenic adenoma in urinary bladder developed four years after previous surgery despite intravesical sodium hyaluronate therapy.

Nephrogenic adenoma (NA) is a rarely seen benign metaplastic lesion of the urinary tract. Its etiology is uncertain, but induced by chronic inflammation, irritation, and trauma. NA is located in the urinary tract, most commonly in the bladder. NA usually presents with hematuria and lower urinary tract symptoms. In the literature it is mostly seen in adults but about 30 cases of NA's have been reported in children. Treatment of intravesical lesions consists of transurethral resection (TUR) and fulguration and rarely partial or total cystectomy may be required in ineffective TUR. Recurrence rate is high during long-term follow-up. The intravesical application of sodium hyaluronate produces a protective effect on the glycosaminoglycan layer and delays or prevents its recurrence. We report a case of recurrent NA of the bladder in a pediatric male patient who was presented four years after previous surgery despite intravesical sodium hyaluronate therapy.

Evaluation of the effects of sedation administered via three different routes on the procedure, child and parent satisfaction during cystometry.

PURPOSE: In this study, we retrospectively investigated case reports with and without midazolam administration via oral, intranasal and rectal before cystometry procedure. We aimed to compare the data to evaluate the effects of sedation before cystometry on the pediatric patients and parents' satisfaction. METHODS: A total of 124 ASA I-II pediatric cases aged 5-14 years were retrospectively investigated from the hospital records. One of the three administration routes was chosen; oral midazolam at a dose of 0.5 mg/kg and nasal or rectal midazolam at a dose of 0.3 mg/kg (maximum 15 mg). Heart rate, blood pressure, oxygen saturation, the Wisconsin Hospital of Children Sedation Scale (CHWSS) score and the Groningen Distress Rating Scale (GDRS) score were recorded. Cystometry measurement values, diagnoses of the cases and procedure durations were recorded from the urodynamic laboratory records. RESULTS: 80 female, 44 male cases were evaluated. The CHWSS score at the 10th and 20th minutes after the drug administeration was higher in the oral group than the others (p = 0.001). The duration between the administration of the drug and the start of the procedure was shorter in the nasal group (p = 0.01). Parents satisfaction for sedation was 77 % when comparison of the cystometry with and without sedation. Comparison of the cystometry results with or without sedation no significant difference was found between all parameters (p > 0.01). CONCLUSION: We believe that sedation with midazolam administered through all three routes is a safe, effective and convenient option during cystometry, especially in the young age group.

Is there an association between histopathological changes in the lower ureter and renal functions? Evaluation of patients who underwent ureteroneocystostomy for ureterovesical obstruction or vesicoureteral reflux.

BACKGROUND/AIM: We aimed to assess the relationship between the histological changes of the ureterovesical junction (UVJ) and renal functions. Therefore, we evaluated histological changes of the lower ureter and renal scintigraphy findings of patients for whom ureteroneocystostomy was performed because of vesicoureteral reflux (VUR) or ureterovesical junction obstruction (UVO). MATERIALS AND METHODS: UVJ specimens were obtained from 18 children. We investigated the changes in neuronal innervation, muscular morphology, extracellular matrix, and apoptosis rate with renal scintigraphy findings. RESULTS: Seven UVO and 11 VUR patients were treated. Alpha-actin expression in smooth muscle cells was found to be lower (P < 0.001) while neuronal defect was more prominent in the UVO group (P = 0.002). The renal functions decreased as the smooth muscle structural defect increased in the VUR group (P < 0.05). CONCLUSION: Neuronal tissue and muscle tissue were more defective in the UVO group. The decrease in neuronal fibers and muscle cells explains the pathogenesis of the obstructive group, but no difference was observed regarding the accumulation of collagen type 3 and cellular apoptosis between the VUR and UVO groups. In the VUR group, renal functions decreased while the smooth muscle defect at the distal end of the ureter increased.

Metanephric stromal tumor: a challenging diagnostic entity in children.

A case with a renal mass diagnosed as metanephric stromal tumor is presented. A 6-year-old boy presented with frequently recurring urinary tract infections. He had been followed up at different medical centers for the last 2 years with a 2 × 2 cm simple cyst localized in the inferior pole of the left kidney. At our center, ultrasonography revealed a heterogeneous mass in the left kidney with a central cystic component. The patient underwent operation for left renal mass, and heminephrectomy was performed. The 5 × 4 × 2.5 cm left heminephrectomy specimen showed a partially cystic mass composed of bland spindle cells distributed haphazardly, entrapping tubules and glomeruli and producing fine collarettes around some tubules. The cysts were lined with a 1-layered flat or cuboidal epithelium. Histopathologically, the tumor was diagnosed as metanephric stromal tumor. Metanephric stromal tumor is a rare renal neoplasm of childhood that can present as a cystic mass, and the solid component can go radiologically undetected because of the blurring infiltrative margins. By presenting this rare entity, the authors suggest that this should be included in the differential diagnosis, thereby helping to avoid complications and unnecessary treatment.