Ureteropelvic junction obstruction in the first three months of life: is sex a prognostic factor?

OBJECTIVE: Ureteropelvic junction obstruction (UPJO) is a blockage that occurs at the point where the renal pelvis (the part of the kidney where urine collects) meets the ureter (the tube that carries urine from the kidney to the bladder). This study compared outcomes between male and female patients with UPJO. PATIENTS AND METHODS: 402 UPJO patients diagnosed and treated before the age of three months were divided into two groups: males and females. The following information was extracted: age at diagnosis, age at surgery, the parenchymal thickness of the UPJ and contralateral sides (preoperatively and at 1 and 3 years postoperatively), pelvic diameter, and kidney function. RESULTS: There were 287 male and 115 female patients (a ratio of 2.5:1). The parenchymal thickness (PTs) at diagnosis and surgery were 5(4) mm and 5(3) mm in males, respectively. In females, these values were 5(3) mm and 6(5) mm, respectively. There was a significant decrease in male PT at the time of surgery compared to diagnosis (p<0.05). After the first postoperative year, PTs were 8(4) mm and 9(4) mm in males and females, respectively, and after the third postoperative year, PTs were 9(4) mm and 10(4.75) mm in males and females, respectively. CONCLUSIONS: Among patients diagnosed with UPJO during the first three months of life, males had a more severe disease course than females. Additionally, females experienced better clinical improvement during the long-term postoperative period.

Direct bilirubin to lymphocyte ratio can discriminate acute appendicitis and ovarian torsion: a comparative study.

OBJECTIVE: In this study, we aimed to determine whether a patient presenting to the emergency room with abdominal pain and for whom ultrasound access is challenging until an ultrasound is performed, is suffering from ovarian torsion or acute appendicitis. We sought to make this determination based on hematological indices and to investigate the diagnostic value of the direct bilirubin-to-lymphocyte ratio (DLR) in this context. PATIENTS AND METHODS: This study encompasses female patients who presented with abdominal pain to Çam and Sakura Training and Research Hospital between the years 2015 and 2023 and were diagnosed with either acute appendicitis or ovarian torsion. Patients' files were screened retrospectively. Key information, including patients' ages, the onset time of symptoms (duration of symptoms), and laboratory values, was meticulously recorded. The patients were divided into two groups: those with ovarian torsion (Group 1) and those with acute appendicitis (Group 2). RESULTS: The study comprised two distinct patient groups with a total of 159 patients: Group 1 (n=57), representing ovarian torsion, and Group 2 (n=102) representing acute appendicitis. No differences were found in terms of age, symptom duration, White Blood Cell (WBC) Count, Platelet (PLT), CRP (C-reactive protein), and Platelet-to-lymphocyte ratio (PLR) (p>0.05 for each comparison). Direct bilirubin (DB), indirect bilirubin (IB), and total bilirubin (TB) were higher in Group 2 than in Group 1 (p=0.011, p<0.001, p=0.044, respectively). Neutrophil-to-Lymphocyte Ratio (NLR) and Direct Bilirubin-to-Lymphocyte Ratio (DLR) were higher in Group 2 than in Group 1 (p=0.013, p=0.002, respectively). The NLR was analyzed with a cut-off value of 4.1 (AUC: 0.642; sensitivity 82%, specificity 52%). The PLR was analyzed with a cut-off value of 116 (AUC: 0.670; sensitivity 92%, specificity 42%). The DLR was analyzed with a cut-off value of 0.14 (AUC: 0.741; sensitivity 93%, specificity 55%). CONCLUSIONS: This research highlighted the potential of the DLR index in differentiating between ovarian torsion and acute appendicitis, revealing that DLR levels were notably higher in appendicitis patients.

Resultados a largo plazo de la cistoplastia de ampliación: una evaluación retrospectiva de 54 niños / Long-term outcomes of augmentation cystoplasty: A retrospective view of 54 children

Introducción y objetivos: A lo largo de los años los médicos que se ocupan de los trastornos urológicos pediátricos han recurrido a la ampliación vesical (AV), un procedimiento quirúrgico altamente desafiante desarrollado para preservar las funciones renales en diversos casos de anomalías urinarias congénitas. Este estudio tiene como objetivo revelar los resultados de la AV a muy largo plazo en una amplia muestra de pacientes pediátricos, así como el papel de la enfermedad subyacente en el pronóstico renal tras la AV.Materiales y métodosSe realizó un estudio transversal retrospectivo en 54 niños con anomalías urinarias congénitas que fueron sometidos a una AV. Se evaluó la técnica de ampliación utilizada, la localización de la implantación del uréter, las complicaciones y los hallazgos ecográficos. Se recogieron datos sobre los niveles de creatinina sérica en los registros preoperatorios y posteriores a la AV anuales.ResultadosDe los 54 niños 33 (61,1%) eran varones. Los diagnósticos fueron disrafismo espinal (DE) (n=13), válvula uretral posterior (VUP) (n=8), extrofia vesical (n=32) y traumatismo (n=1). La duración media del seguimiento fue de 18 (3-31) años. Las comparaciones de los niveles de creatinina sérica entre los grupos revelaron que, a pesar de que no existían diferencias significativas entre el grupo de extrofia vesical y el de VUP en el periodo preoperatorio ni en el primer año postoperatorio, los casos con VUP presentaban niveles de creatinina sérica significativamente más altos en los siguientes años posteriores a la cirugía. Además, en comparación con el grupo de DE, los sujetos con VUP tenían niveles significativamente más altos en el segundo (p=0,035) y décimo año (p=0,006) del postoperator. (AU)

Introduction and objectives: Throughout the years, clinicians dealing with pediatric urology disorders have resorted to bladder augmentation (BA), a demanding surgical procedure, to preserve renal functions in sundry congenital urinary tract defects. This study aimed to reveal the very long-term outcomes of BA in a large sample of pediatric patients and the role of underlying disease on renal prognosis after BA.Materials and methodsA retrospective cross-sectional study was conducted on 54 children with congenital urinary defects who underwent BA. The utilized augmentation technique, the location of ureter implantation, complications, and ultrasonography findings were analyzed. Data on serum creatinine levels were collected from preoperative records and anniversaries following BA.ResultsAmong 54 children, 33 (61.1%) were boys. Diagnoses were spinal dysraphism (SD) (n=13), posterior urethral valve (PUV) (n=8), bladder exstrophy (n=32) and trauma (n=1). The median follow-up duration was 18 (3-31) years. The comparisons of serum creatinine levels between groups revealed that, despite no meaningful difference was present between bladder exstrophy and PUV group in the preoperative period and postoperative 1st year, cases with PUV had significantly higher levels of serum creatinine levels in the following postoperative years. Therewithal compared with the SD group, subjects with PUV had significantly higher levels at the postoperative 2nd year (P=.035) and 10th year (P=.006).ConclusionsIn our study, significantly long-term follow-up outcomes could facilitate the pre- and postoperative approach for enterocystoplasty in children. According to our results, it is noteworthy that kidney functions are at high risk of worsening in subjects with PUV and underwent BA. (AU)

Long-term outcomes of augmentation cystoplasty: A retrospective view of 54 children.

INTRODUCTION AND OBJECTIVES: Throughout the years, clinicians dealing with pediatric urology disorders have resorted to bladder augmentation (BA), a demanding surgical procedure, to preserve renal functions in sundry congenital urinary tract defects. This study aimed to reveal the very long-term outcomes of BA in a large sample of pediatric patients and the role of underlying disease on renal prognosis after BA. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted on 54 children with congenital urinary defects who underwent BA. The utilized augmentation technique, the location of ureter implantation, complications, and ultrasonography findings were analyzed. Data on serum creatinine levels were collected from preoperative records and anniversaries following BA. RESULTS: Among 54 children, 33 (61.1%) were boys. Diagnoses were spinal dysraphism (SD) (n = 13), posterior urethral valve (PUV) (n = 8), bladder exstrophy (n = 32) and trauma (n = 1). The median follow-up duration was 18 (3-31) years. The comparisons of serum creatinine levels between groups revealed that, despite no meaningful difference was present between bladder exstrophy and PUV group in the preoperative period and postoperative 1st year, cases with PUV had significantly higher levels of serum creatinine levels in the following postoperative years. Therewithal compared with the SD group, subjects with PUV had significantly higher levels at the postoperative 2nd year (P = .035) and 10th year (P = .006). CONCLUSIONS: In our study, significantly long-term follow-up outcomes could facilitate the pre- and postoperative approach for enterocystoplasty in children. According to our results, it is noteworthy that kidney functions are at high risk of worsening in subjects with PUV and underwent BA.