Evaluation of renal oxygenation by near-infrared spectroscopy during endoscopic injection of bulking agents in children with vesicoureteral reflux.

BACKGROUND: Near infrared spectroscopy (NIRS) is the measuring of regional tissue oxygenation (rSO2) by interpreting oxyhemoglobin and deoxyhemoglobin signals that come back by transmitting near infrared light to tissues. The effect of endourological interventions on renal perfusion in children is largely unknown. AIMS: To evaluate the effects of endoscopic injection of bulking agents (EIBA) for vesicoureteral reflux (VUR) on renal oxygenation (RO) using renal NIRS monitoring, which shows renal perfusion and oxygenation changes. STUDY DESIGN: Case-control study. METHODS: Group I had bilateral inguinal surgery, Group II cystoscopy, and Group III, EIBA for VUR with 30 patients in each group. During the operation, vital signs, peripheral oxygen saturation, end-tidal carbon dioxide, and renal regional oxygen saturation index (rSO2) values by bilateral renal NIRS monitoring were recorded. NIRS values before induction (T0) to postoperative (Tend) were determined. A 20% or more reduction in renal rSO2 (%20↓rSO2) was considered significant. Group III was also evaluated as subgroup III-A (not having "%20↓rSO2") and subgroup III-B ("%20↓rSO2"). RESULTS: The rSO2 decrease was observed in the first 5 min for both sides in group III. The most significant drop was at T30 for the right kidney and a significant decrease in rSO2, 20% or more, was observed in 6 renal units of 4 patients having higher SFU grading and renal scar in group III. CONCLUSION: EIBA may transitionally impair renal oxygenation. Higher SFU grading and renal scar may increase the risk of renal hypoxia during EIBA.

An atypical complication after hypospadias repair: A combined dorsal and lateral subcoronal urethrocutaneous fistulas.

Urethrocutaneous fistula (UCF) is one of the most common complications of hypospadias repair (HR). We present an unusual combined lateral and dorsal subcoronal (CLDSC) UCFs. Dorsal UCF has not been reported in children yet. A 10-year-old patient was admitted with the complaint of CLDSC UCFs following HR. A long fistula tract from the urethral meatus to the dorsal fistula orifice was excised together with urethroplasty. The patient did well postoperatively. Dorsal penile UCF is an unusual complication; but if it occurs, total excision of the fistula tract together with urethroplasty could be considered to prevent further complications.