Elevating pediatric urology care: The crucial role of nursing research in quality improvement.

This educational article highlights the critical role of pediatric urology nursing research in improving the care of children with urological conditions. It discusses the multifaceted nature of pediatric urology nursing, addresses challenges such as limited nurse scientists and resource constraints, and highlights the need to overcome barriers to increase research involvement. The authors emphasize the importance of prioritizing research areas, the promotion of collaboration, and the provision of adequate funding and academic time for pediatric nurses to contribute to evidence-based practice, to improve patient outcomes. Furthermore, it highlights the importance of research in advancing nursing practice, shaping protocols, and advocating for the rights and needs of children with urological conditions and their families.

Endourological Management of Ureteral Stricture in Patients with Renal Transplant: A Systematic Review of Literature.

Purpose: To analyze the utility and outcomes of available endourologic options to treat ureteral stricture after kidney transplantation (KT). Methods: A systematic review was carried out for all English language articles from 2000 to 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standards using EMBASE, MEDLINE, SCOPUS, Google scholar, and Cochrane library. The search term combination for the string was follows: [(Ureteral stricture) OR (ureter stenosis) OR (ureteral stenosis) OR (Stricture ureter) OR (Narrowing ureter) OR (Ureter restriction) OR (ureteral restriction) OR (ureteral narrowing) OR (ureteral obstruction) OR (ureter obstruction) OR (obstructing ureter) OR (obstructive ureter) OR (narrow ureter) OR (ureteral narrow)] AND [(kidney transplant) OR (transplanted kidney) OR (transplant) OR (transplantation)] AND [(management) OR (Robotic) OR (laser) OR (stent) OR (dilatation) OR (dilation) OR (endoscopic) OR (endourological) OR (Urologic) OR (laparoscopic) OR (surgery) OR (treatment)]. Case reports, review articles, animal and laboratory studies were excluded. Risk of bias assessment was conducted using the RoB 2 and ROBINS-I tools. Results: A total of 1102 relevant articles published from 2000 to 2023 were found. After screening of titles and abstracts, a total of 19 articles were included in our systematic review. Ureteral stent/nephrostomy placement, balloon dilatation (ureteroplasty) with or without laser was used as initial approaches whereas follow-up and success rate were analyzed among other parameters. Conclusions: The management of ureteral strictures after KT is challenging and selecting the most appropriate treatment is crucial for successful outcomes. Our review suggests that, an endourologic management is a safe option with good long-term outcomes, especially in short and early strictures.

Mobility and Sporting Activity After Renal Trauma: A Survey Regarding Best Clinical Practice During the Recovery Stage.

OBJECTIVE: To evaluate strategies that are followed after pediatric renal trauma during the recovery stage, with an emphasis on mobility and involvement in subsequent sporting activities. Renal trauma is the most common urogenital trauma in children. The American Association for the Surgery of Trauma (AAST) scale is most commonly used to stratify the severity of injury. There is no consensus in the existing literature with respect to the recovery stage following renal trauma. METHODS: A survey was constructed by the European Association of Urology (EAU) - Young Academic Urologists (YAU) Pediatric Urology Working Group and then made digitally available on SurveyMonkey. The survey consists of 15 questions exploring relevant factors and timing to start again with mobility and activity. RESULTS: In total 153 people responded, of whom 107 completed the entire survey. The presence of pain and severity of trauma were acknowledged as most important factors to commence mobilization, whereas presence of hematuria was identified as an additional factor for sporting activity. Regardless of severity of trauma a minimum of 90% of respondents recommend return to noncontact sports within 12weeks. For contact sports, a minimum of 33% of respondents advised >12weeks minimum before starting again. A small number of respondents would never allow sporting activities again. CONCLUSION: The time to allow sporting activity shows high variation among the respondents, some even restricting sporting activities completely. This survey highlights the need for a standardized protocol based on multicenter follow-up data.

Robot-Assisted Radical Prostatectomy in Renal Transplant Recipients: A Systematic Review.

Robot-assisted radical prostatectomy (RARP) has been shown to achieve excellent oncological outcomes with a low rate of complications in patients with prostate cancer. However, data on RARP in renal transplant recipients (RT) are dispersed. A literature search was conducted through April 2023 using PubMed/Medline, Embase and Web of Science databases. The primary aim was to evaluate the safety, oncologic and clinical outcomes of RARP in RT recipients. The secondary aim was to identify surgical technique modifications required to avoid iatrogenic damage to the transplanted kidney. A total of 18 studies comprising 186 patients met the inclusion criteria. Age at the time of treatment ranged 43-79 years. Biopsy results showed a high prevalence of low- and intermediate-risk disease. Operative time ranged between 108.3 and 400 mins, while estimated blood loss ranged from 30 to 630 mL. Length of hospital stay ranged from 3 to 6 days whereas duration of catheterization was between 5 and 18 days. Perioperative complication rate was 17.1%. Overall positive surgical margin rate was 24.19%, while biochemical recurrence was observed in 10.21% (19/186 patients). Modifications to the standard surgical technique were described in 13/18 studies. Modifications in port placement were described in 7/13 studies and performed in 19/88 (21.6%) patients. Surgical technique for the development of the Retzius space was reported in 13/18 studies. Data on lymphadenectomy were reported in 15/18 studies. Bilateral lymphadenectomy was described in 3/18 studies and performed in 4/89 (4.5%) patients; contralateral lymphadenectomy was reported in 7/18 studies and performed in 41/125 (32.8%) patients. RARP in RTRs can be considered relatively safe and feasible. Oncological results yielded significantly worse outcomes in terms of PSM and BCR rate compared to the data available in the published studies, with an overall complication rate highly variable among the studies included. On the other hand, low graft damage during the procedure was observed. Main criticisms came from different tumor screening protocols and scarce information about lymphadenectomy techniques and outcomes among the included studies.

A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV-V) vesicoureteral reflux.

INTRODUCTION: Traditionally, open ureteral reimplantation (OUR) has been the standard treatment for primary vesicoureteral reflux (VUR) requiring reimplantation. Robotic-assisted laparoscopic ureteral reimplantation (RALUR) is gaining popularity and high success rates have been reported. OBJECTIVE: In this multi-institutional study, we aimed to compare the perioperative and postoperative outcomes of OUR and RALUR for high-grade (IV + V) VUR in children. STUDY DESIGN: A retrospective evaluation was performed collecting data from 135 children (0-18 years) who underwent high grade VUR surgical correction at nine European institutions between 01/01/2009 and 01/12/2020, involving either open or robotic approaches. Institutional review board approval was obtained. Patients with lower grades of VUR (≤III), previous history of open or endoscopic ureteral surgery, neurogenic bladder, or refluxing megaureter in need of ureteral tapering were excluded. Pre-, peri- and post-operative data were statistically compared. RESULTS: Overall, 135 children who underwent either OUR (n = 68), or RALUR (n = 67) were included, and their clinic and demographic features were collected. The mean age of the open group was 11 months (interquartile range [IQR] 9.9-16.6 months), in the RALUR group it was 59 months (IQR 29-78mo) (p < 0.01); the open cohort had a weight of 11 kg (IQR 9.9-16.6 kg) while the RALUR group had 19 kg (IQR 13-25 kg) (p < 0.01). No significant differences were found for intraoperative (1.5 % vs 7.5 %, p = 0.09) or for postoperative complication rates (7.4 % vs 9 %, p = 0.15). Favorable outcomes were reported in the RALUR group: shorter time to stooling (1 vs 2 days), fewer indwelling urethral catheter days (1 vs 5 days), perioperative drain insertion time (1 vs 5 days) and a shorter length of hospital stay (2 vs 5 days) (p < 0.01). The success rate was 94.0 % and 98.5 % in the open and RALUR groups, respectively. The long-term clinical success rates from both groups was comparable:42 vs 23 months for open and RALUR, respectively. DISCUSSION: This study reported a large multicentric experience focusing on high grade VUR. Furthermore, this study compares favorably to OUR in a safety analysis. There was also a trend towards higher success rates with RALUR utilizing an extravesical approach which has not been previously reported. CONCLUSION: RALUR is an efficacious and safe platform to use during ureteral reimplantation for high grade VUR. The overall peri-operative and post-operative complication rates are at least equivalent to OUR, but it is associated with a faster functional recovery and time to discharge. Medium to long term success rates are also equivalent to OUR.

Maintenance biofeedback therapy for dysfunctional voiding: Does every child need it?

OBJECTIVES: The aim of the present study is to analyze the long-term clinical outcomes in children who were treated with biofeedback therapy (BF) for dysfunctional voiding (DV) and to determine the need for maintenance of BF due to clinical relapse. METHODS: Files of children with DV who underwent BF between 2013 and 2020 were retrospectively reviewed. Patients with neurological or anatomical problems were excluded. A total of 64 patients (52 girls, 12 boys) with a mean age of 8.89 ± 2.48 years who completed the initial BF sessions were included in the study. The demographic and clinical data, dysfunctional voiding symptom scores (DVSS), and uroflowmetry parameters were recorded before and after the initial BF sessions. Clinical success was regarded as the cessation of electromyography activity as well as concurrent resolution of lower urinary tract symptoms and improvement in uroflowmetry parameters. After the initial BF sessions, children who had initial success showed DV relapse at any time during follow-up received the maintenance BF sessions. Therefore, the patients with successful initial BF were divided into two groups: the group that needed maintenance BF, and the group which required no maintenance BF. RESULTS: Clinical success was achieved in 48 (75.0%) of 64 children following a median of 6 sessions (range 2-8). At the follow-up, 10 (20.8%) out of 48 patients showed symptom relapse at a median of 8 months (range 2-24 months). After a median of 3.5 maintenance BF sessions (range 1-6), clinical success was observed in all patients. Both groups showed a significant DVSS decrease after initial BF, however, those who needed maintenance had significantly higher DVSS (6.80 ± 2.53 vs. 3.61 ± 1.12, p < 0.001). At admission, DVSS <17.5 (odds ratio [OR]: 4.31, p = 0.025) and post-voiding residual volume as a percentage of estimated bladder capacity for age <28.9 (OR: 5.00, p = 0.009) were found as the predictive factors for initial BF success. The need for maintenance BF was 2.56-fold higher with a DVSS above 5.5 after initial BF sessions. CONCLUSIONS: Our results show that despite a clinical success rate of 75% after the initial BF, relapse can be seen within 2 years in approximately 20% of the patients. Nevertheless, maintenance of BF may provide clinical success in all patients. Relatively higher DVSS after initial BF can be used as a predictor of the need for maintenance BF.

Through the zipper or pants down: Does it change uroflowmetry parameters in healthy males?

OBJECTIVE: To evaluate if voiding through the zipper or voiding pants down would make any difference with regard to uroflowmetry parameters and postvoiding residual urine (PVR) volumes in healthy males with no lower urinary tract symptoms (LUTS). METHODS: Healthy males over 18 years of age with no LUTS were prospectively evaluated using a uroflowmetry test. Each individual was asked to void through the zipper (group 1) and pants down (group 2) at different times. The uroflowmetry test was repeated if the voided volume did not exceed 150 mL. Uroflowmetry results such as voided volume, maximum flow rate (Qmax), average flow rate (Qave), and duration of voiding were noted. PVR volume was assessed using ultrasonography. Electromyography was not used. Data are shown as mean ± standard deviation. For statistical analysis, a paired t test was used to analyze parametric parameters. RESULTS: A total of 44 males were enrolled. The median age of the individuals was 24 (range 18-44 years). There were no statistically significant differences between the two measurements in terms of voided volume (307 ± 121 mL vs 325 ± 145 mL, P = .365) and duration of voiding (25 ± 11 s vs 23.8 ± 11.6 s, P = .526). However, there were statistically significant differences in Qmax (26.6 ± 6.7 mL/s vs 30.0 ± 8.2 mL/s, P = .001), Qave (14.4 ± 3.6 mL/s vs 16.2 ± 5.1 mL/s, P = .009), and PVR volumes (23.9 ± 19.4 mL vs 3.9 ± 9.6 mL, P = .0001). CONCLUSION: Voiding pants down shows higher flow rates and lower PVR than voiding through the zipper in individuals with no LUTS. Future studies with a larger number of individuals (including those with LUTS) and a broader age range cohort are required for solid conclusions.

Urodynamically proven lower urinary tract dysfunction in children after COVID-19: A case series.

CASE: Since the declaration of COVID-19 as a pandemic, other unexpected symptoms related to the infection besides the respiratory system have been reported. Although a few case reports have revealed that adult patients with COVID-19 also complained of urinary frequency and nocturia, the exact pathophysiology is still unclear. In this case series, we present three children aged 14 to 17 years with urodynamically proven lower urinary tract dysfunction (LUTD) following COVID-19. OUTCOME: None of the patients had constipation or bowel disorder before the diagnosis of COVID-19. In addition, neurological examination and related imaging revealed no signs of etiological factors. The median time from diagnosis of COVID-19 infection to the onset of lower urinary tract symptoms was 3 months. Incomplete bladder emptying/urinary retention supported by increased bladder compliance, high post-micturition residual urine volumes, and absence of detrusor pressure increase during the voiding phase in the pressure flow study (acontractile detrusor in two patients and hypocontractile detrusor in one patient) were observed. CONCLUSION: We observed that LUTD (eg, incomplete bladder emptying, urinary retention) can be prominent some time after the diagnosis of COVID-19. Even though psychogenic or neurogenic causes may not be excluded completely, clinicians should be aware of a recent COVID-19 infection in children with sudden-onset LUTD.

Effects of systemic androgens on late-stage urethral wound healing: An animal study.

BACKGROUND: There are limited data regarding the effects of systemic androgens on late-stage urethral wound healing. OBJECTIVE: To evaluate the effects of systemic androgens on fibrosis and scar formation in late-stage urethral wound healing. MATERIALS AND METHODS: Forty-five male Sprague Dawley rats were divided into three groups. First group consisted of 15 rats that were castrated on 23 days of age and were given 5 mg/kg testosterone undecanoate with 1/25 ml cottonseed oil intraperitoneally at weekly intervals for 3 weeks (castrated and replaced with testosterone rats [CAS+T] group). The castrated rats (CAS) group included 15 castrated rats. The remaining 15 rats underwent sham surgery. CAS and sham groups also received 1/25 ml cottonseed oil intraperitoneally at weekly intervals for 3 weeks. Furthermore, all groups were divided into three subgroups after testosterone/placebo administration (urethroplasty performed after first, second, and third weeks) in accordance with the urethroplasty timing. All animals were sacrificed 6 weeks after urethroplasty. Serum testosterone level was measured, tissue samples were investigated using hematoxylin and eosin and Masson's trichrome. Alpha-SMA, Coll 1 and Coll 3 primary antibodies were applied for immunohistochemical examination. Expression of cytokines and growth factors, such as Bax, Bcl2, IL-10, IP-10, TNF-alpha, TGFb1, MMP9, Col-I, Col-III, TIMP-1, fibronectin, fibroblast growth factor 10, platelet-derived growth factor, alpha-SMA, were also evaluated in the tissues. RESULTS: The blood testosterone levels were significantly higher in CAS+T group at the time of urethroplasty compared with the levels in CAS group; however, this difference was not observed at the time of sacrification (p < 0.001 and 0.97, respectively). Histological analysis with hematoxylin and eosin and Masson's trichrome staining revealed a significantly higher fibrosis in the sham group compared with the others. Significantly lower fibrosis was detected in the CAS group in the pairwise comparison of the pathological fibrosis area between the CAS and CAS+T groups (p < 0.001). Furthermore, tissue collagen-1, collagen-3, and alpha-SMA expression levels were statistically different between CAS and CAS+T groups (p < 0.001, <0.05, and <0.001, respectively). The tissue levels of BAX, TIM-1, MMP-9, Coll-I, Coll-III, TGF-beta, TNF-alpha, and IL-10 mRNA expressions in the CAS+T group were different than the levels in CAS group (as <0.5-fold and >1.5-fold changes, respectively). The expressions of all these markers were significantly higher in the sham group. The subgroup analysis of CAS+T group (urethroplasty performed after first, second, and third weeks) revealed similar histopathological wound healing findings. DISCUSSION: Debate continues on the effects and benefits of androgen use regarding urethral healing. There are two main routes for administration as systemic or local. This study focuses on the late-stage histologic and biochemical effects of systemic androgens. CONCLUSION: Systemic androgens adversely affect wound healing and cause abnormal extracellular matrix as well as scar formation.

Serum irisin is a novel biomarker for bladder cancer detection.

BACKGROUND: This study intended to investigate irisin levels in bladder cancer patients and healthy controls. OBJECTIVE: Our aim was to evaluate if serum irisin could be used as a diagnostic tool in bladder cancer and further, if it could differentiate muscle-invasive and non-muscle-invasive bladder cancer patients. METHODS: In this study, 90 primary bladder cancer patients in addition to 30 age-matched healthy individuals for the control group were prospectively included. Bladder cancer patients were divided into two subgroups as non-muscle-invasive (60 patients) and muscle-invasive (30 patients). Blood samples were obtained before the diagnosis of the disease. Serum irisin levels were measured using ELISA. Demographic data as well as tumor grade and stage were noted. RESULTS: Mean serum irisin level was significantly lower in the bladder cancer patients compared to the control group (4.53 ± 2.55 vs. 16.5 ± 5.67, p < 0.001). Also, serum irisin level was statistically lower in the muscle-invasive bladder cancer group compared to the non-muscle-invasive counterparts (3.19 ± 1.47 vs. 5.18 ± 2.73, p < 0.001). Serum irisin could differentiate bladder cancer patients from healthy individuals with a sensitivity of 86.2% and a specificity of 89.7% at a cut-off value of 8.689 (AUC = 0.859). Moreover, to discriminate between NMIBC and MIBC, the sensitivity was 75% and the specificity was 73.7% at a cut-off value of 3.97 (AUC = 0.732). CONCLUSION: Our results showed that serum irisin levels can be used for the diagnosis of bladder cancer. Also, it can help distinguish high-grade and stage tumor.

The association between the congenital heart diseases and congenital anomalies of the kidney and the urinary tract in nonsyndromic children.

Several congenital heart diseases (CHD) are present in children with congenital anomalies of the kidney and the urinary tract (CAKUT) in syndromic or nonsyndromic patterns. The purpose of this study was to identify nonsyndromic children with CAKUT who required echocardiographic evaluation and to find the prevalence of CHD in these patients. Retrospective chart review of nonsyndromic patients with CAKUT between 2012 and 2018 was conducted. Types of congenital anomalies of the kidney and urinary tract and echocardiogram reports of the patients, age, gender, prematurity, prenatal diagnosis of CAKUT, and family history were noted. Among 806 children with CAKUT, 135 patients underwent transthoracic echocardiographic evaluation and CHD was detected in 91 (11.2%). The most common type of CHD was secundum type atrial septal defect that was found in 73 (80.2%) patients. On the other hand, the most frequent types of congenital anomalies of the kidney and the urinary tract were isolated hydronephrosis and primary vesicoureteral reflux (61.4% and 12.8%, respectively). Our results showed that 75.8% of the patients with congenital heart diseases had isolated hydronephrosis. Finally, only 18 (2.2%) cases out of 806 patients that were evaluated via transthoracic echocardiography due to the clinical findings and family history had a CHD that required close (<6 months) follow-up. Congenital heart diseases that required close follow-up are rarely observed in nonsyndromic patients with CAKUT. Therefore, we suggest echocardiography should be performed in cases of clinical suspicion and family history rather than routinely in this patient group.

Evaluation of subclinical cardiovascular risk and cardiac function in children with vesicoureteral reflux: a prospective study.

BACKGROUND: Vesicoureteral reflux is a prominent congenital anomaly of the kidney and the urinary tract. Further, renal scarring is known to be related to chronic inflammation. However, there have been limited studies to date regarding the cardiovascular consequences of vesicoureteral reflux. OBJECTIVE: The aim of this study is to evaluate the possible subclinical atherosclerosis and cardiovascular complications in children with vesicoureteral reflux. METHODS: Patients with vesicoureteral reflux and age matched healthy controls were prospectively included in this case-control study. Patients were divided into two groups concerning renal scarring status. To assess cardiac functions, carotid artery intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses were evaluated. RESULTS: There were 50 patients with vesicoureteral reflux; 26 patients without renal scarring and 24 patients with renal scarring, as well as 40 healthy controls. Myocardial performance indexes (Tei indexes) measured by tissue Doppler echocardiography from septum and left ventricle were significantly increased in study group (for all, p < 0.001). Also, intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses of the study groups were significantly higher than the control group (for all, p < 0.001). However, no statistical difference was observed between renal scarring (-) and renal scarring (+) groups. CONCLUSIONS: Results of our study showed early deterioration of cardiac systolic and diastolic functions in children with vesicoureteral reflux regardless of renal scarring. Also, diagnosis of vesicoureteral reflux is an important risk factor for subclinical atherosclerosis, independent of renal scarring, which should be considered in the follow-up of these patients.

Incidental ectopic adrenal cortical tissue: Retrospective analysis of 16 patients.

OBJECTIVE: To evaluate ectopic adrenal cortical tissue (EACT) and identify clinical, pathological and radiological aspects. STUDY DESIGN: Retrospective review of pathology reports in a single tertiary institution between 2010 and 2020 was conducted. Patients diagnosed with EACT were included for analysis. Demographic characteristics, accompanying pathologies and clinicopathological and radiological findings of these patients were analyzed. RESULTS: There was a total of 17 patients in the cohort. Fifteen were boys and 2 were adults (1 male). The mean diameter of the EACT nodule was 0.25 cm (range 0.2-0.5 cm). All EACTs were incidentally diagnosed. Seven EACTs were diagnosed during an inguinal hernia repair, 6 during orchidopexy, 1 during partial orchiectomy, 2 during orchiectomy and 1 during hysterectomy and bilateral salpingoophorectomy due to uterine prolapse. DISCUSSION: EACT is a rare entity that is mostly found incidentally during inguinoscrotal interventions. Radiological discrimination of EACT may not be easy and thus, not detected prior to surgery. Clinical significance of EACT is not very well understood, however it tends to be a benign pathology. Although it is more commonly found in children, adults may present with EACT, as well. CONCLUSION: A tiny yellowish nodule detected in the inguinoscrotal region should be suspected for EACT by pediatric urologists, surgeons, and pathologists.

Are urachal remnants really rare in children? An observational study.

Urachal remnants are thought to have a low prevalence. However, recent studies indicate a higher rate. The aim of this study was to evaluate the prevalence of urachal remnants in children referred for imaging by abdominal/urinary/suprapubic ultrasonography in one calendar year. Files of children who underwent abdominal/urinary/suprapubic ultrasonography in one calendar year were retrospectively reviewed. Data regarding children ≤17 years that underwent ultrasonography of the ventral abdominal wall while being assessed for various reasons were collected. Anomalies detected, age, gender, reason for ultrasonography request, and diagnosis of the urachal remnant were noted. All ultrasonography assessments were performed by a single pediatric radiologist in a single institution. There were 4836 patients in the study (1919 boys). Median age of the whole cohort was 7 years. A total of 10 patients were found to have urachal remnants, which included eight urachal cysts (three boys) and two urachal diverticula (one boy).Conclusion: The prevalence of urachal remnants in our cohort was nearly 2 in every 1000 children. More specifically, the prevalence of urachal cysts was one in 600. What is Known: • Urachal remnants were believed to be rare. • Recent studies indicated a higher incidence than previous reports. What is New: • This study shows that urachal remnant may be observed in one every 500 children that undergo ultrasonography of the abdomen for various reasons. • Parental counselling and management of urachal remnants should be planned accordingly.

Renal, Bladder and Sexual Outcomes in Adult Men with History of Posterior Urethral Valves Treated in Childhood.

OBJECTIVE: To determine the adulthood outcomes of bladder, kidney, and sexual functions of posterior urethral valve (PUV) patients. MATERIALS AND METHODS: The records of patients who were treated for PUV between 1980, and 2001 and aged ≥18 years by the end of 2019 were retrospectively reviewed. Patients with complete adulthood data were included in the study. Renal, bladder, and sexual functions were assessed. Adulthood uroflowmetry results of 22 patients were also evaluated. RESULTS: Thirty-nine patients with complete adulthood data out of 89 were included. The median follow-up time was 22.7 years (15-33 years). Median age at initial surgery for PUV was 36 months (1-168 months), and median age at last follow-up was 26 years (18-46 years). Lower urinary tract dysfunction was noted in 15 (38%) patients. In 22 patients (56%) with uroflowmetric analyses, median values of Qmax, voided volume, and post voiding residual urine volume were 20.5 mL/sec (7-43 mL/sec), 389 mL (154-1750 mL), and 18.5 mL (range 0-190 mL), respectively. Nineteen patients (48.7%) had normal glomerular filtration rate, 2 patients (5.1%) had chronic kidney disease, and the remaining 18 patients (46.1%) had end stage renal disease, 14 (35.9%) of whom underwent renal transplantation. Thirty-two patients (82%) had sexual function evaluation, none of which reported erectile dysfunction. However, 4 patients (12.5%) reported slow ejaculation. Five patients fathered a child whereas infertility was observed in 2 patients. CONCLUSION: After 2 decades, glomerular filtration rate was normal almost in half of the PUV patients while lower urinary tract dysfunction was detected in 38%. Furthermore, erectile dysfunction was rare.

Fibroepithelial Polyp at the Bladder Neck Presenting with Gross Hematuria in a 5-Year-Old Boy.

Background: In any age group, gross hematuria is an alarming symptom. A variety of diseases, including urinary tract tumors, urinary tract infections, glomerulonephritis, urinary stone disease, and urinary trauma, can cause gross hematuria. Neoplasms of the urinary tract are definitely the most bothersome among the differential diagnoses. Fibroepithelial polyps (FEPs), in contrast, are mesodermal-originated rare and benign tumors that can be observed in the urinary tract. In this case report, we present a child with an FEP at the bladder neck that was referred because of gross hematuria. Case Presentation: A 5-year-old boy presented with intermittent gross hematuria for 2 weeks. Ultrasonography showed a 2 × 1 cm mucosal surface-borne polypoid lesion at the trigon. Patient underwent cystoscopic evaluation that revealed a polypoid mass located at the bladder neck; however, there were no signs of bladder outlet obstruction in the bladder. Transurethral resection revealed an FEP. Conclusion: Hematuria should be evaluated carefully not only in adults but also in children. FEPs in bladder can mimic bladder carcinoma clinically and radiologically. It should be kept in mind in the differential diagnosis of bladder lesions on imaging modalities in pediatric population.