Could CA 19-9 be a useful biomarker in the diagnosis, prognosis, and prediction of adequate relief in lower urinary tract obstructions?

INTRODUCTION: posterior urethral valves represent an important cause of childhood chronic kidney disease. The identification of biomarkers that indicate early kidney damage and even adequate clearance could reduce how many patients head towards kidney failure. OBJECTIVE: this study evaluated how this easy-analysis biomarker (CA 19-9) could help identifying potential renal damage and adequate clearance in obstructive uropathies. METHODS: 46 female Wistar rats were divided into 5 groups, with different patterns of partial urinary tract obstruction: group control; group OIV: infravesical obstruction; group OIVd: infravesical obstruction with reversion, obstruction relief 7 postoperative days later; group OUu: unilateral ureteral obstruction; group OUb: bilateral ureteral obstruction. The CA 19-9s performance was compared to another biomarker: Ngal. Determination of basal CA 19-9 and Ngal in urine and blood and serum creatinine levels was performed in the rats prior to surgery (T0) and after 14 days (T1). Group OIVd underwent intermediate (Ti) collection before clearance. RESULTS: the urinary concentration of CA 19-9 increased in groups OIV, OIVd and OUb; elevation at T1 and Ti, reached statistical significance compared to the T0 value (p<0,05). Changes in urinary CA 19-9 were more expressive in infravesical obstruction groups (AUC 0.81). Obstruction relief in group OIVd promoted significant urinary CA 19-9 reduction (p<0,05) in the final evaluation. CONCLUSIONS: CA 19-9 urinary concentration increased in partial urinary tract obstruction. Its best performance was in the bladder neck obstruction group, in which the elevation was detected early (6 days after infravesical obstruction) and the CA19-9 urinary concentration declined after clearance.

Could CA 19-9 be a useful biomarker in the diagnosis, prognosis, and prediction of adequate relief in lower urinary tract obstructions? / O antígeno carboidrato CA 19-9 poderia ser um biomarcador útil no diagnóstico, prognóstico e acompanhamento da obstrução baixa do trato urinário?

ABSTRACT Introduction: posterior urethral valves represent an important cause of childhood chronic kidney disease. The identification of biomarkers that indicate early kidney damage and even adequate clearance could reduce how many patients head towards kidney failure. Objective: this study evaluated how this easy-analysis biomarker (CA 19-9) could help identifying potential renal damage and adequate clearance in obstructive uropathies. Methods: 46 female Wistar rats were divided into 5 groups, with different patterns of partial urinary tract obstruction: group control; group OIV: infravesical obstruction; group OIVd: infravesical obstruction with reversion, obstruction relief 7 postoperative days later; group OUu: unilateral ureteral obstruction; group OUb: bilateral ureteral obstruction. The CA 19-9s performance was compared to another biomarker: Ngal. Determination of basal CA 19-9 and Ngal in urine and blood and serum creatinine levels was performed in the rats prior to surgery (T0) and after 14 days (T1). Group OIVd underwent intermediate (Ti) collection before clearance. Results: the urinary concentration of CA 19-9 increased in groups OIV, OIVd and OUb; elevation at T1 and Ti, reached statistical significance compared to the T0 value (p<0,05). Changes in urinary CA 19-9 were more expressive in infravesical obstruction groups (AUC 0.81). Obstruction relief in group OIVd promoted significant urinary CA 19-9 reduction (p<0,05) in the final evaluation. Conclusions: CA 19-9 urinary concentration increased in partial urinary tract obstruction. Its best performance was in the bladder neck obstruction group, in which the elevation was detected early (6 days after infravesical obstruction) and the CA19-9 urinary concentration declined after clearance.

RESUMO Introdução: a válvula de uretra posterior representa uma importante causa de doença renal crônica na infância. A identificação de biomarcadores que monitorem danos renais precoces e o sucesso da desobstrução do trato urinário podem reduzir o número de pacientes que evoluem para insuficiência renal. Objetivo: avaliar o desempenho do biomarcador antígeno carboidrato CA 19-9 nas obstruções parciais do trato urinário. Método: 46 ratas Wistar foram divididas em 5 grupos: grupo controle; grupo OIV: obstrução infravesical; grupo OIVd: obstrução infravesical com alívio da obstrução após 7 dias; grupo OUu: obstrução ureteral unilateral; grupo OUb: obstrução ureteral bilateral. O desempenho do CA 19-9 foi comparado a outro biomarcador, a Ngal. A dosagem de CA 19-9 e Ngal na urina e no sangue, e os níveis de creatinina sérica foram avaliados nas ratas antes da cirurgia (T0) e após 14 dias (T1). O grupo OIVd foi submetido a uma coleta intermediária (Ti). Resultados: a concentração urinária de CA19-9 aumentou nos grupos OIV, OIVd e OUb; a elevação em T1 e Ti alcançou significância estatística em relação ao valor de T0 (p<0,05). As alterações no CA 19-9 urinário foram mais expressivas nos grupos de obstrução infravesical (AUC 0,81). O alívio da obstrução no grupo OIVd promoveu redução do CA 19-9 urinário (p<0,05). Conclusões: a concentração urinária de CA19-9 aumentou na obstrução parcial do trato urinário. Seu melhor desempenho foi no grupo de obstrução infravesical, no qual a elevação foi detectada precocemente (6 dias de pós-operatório) com queda após a retirada do fator obstrutivo.

Vaginoplasty with Oxidized Cellulose in Mayer-Rokitansky-Küster-Hauser Syndrome.

Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) is the major cause of vaginal agenesis. Vaginoplasty with oxidized cellulose has been used by gynecologists as a surgical option in vaginal agenesis; however, it is not very widespread among pediatric surgeons. A case of MRKHS who underwent vaginoplasty with oxidized cellulose is reported here.

Anterior sagittal approach without splitting the rectal wall.

INTRODUCTION: The anterior sagittal transrectal approach (ASTRA) has already become popular to treat lesions in the proximal urethra such as trauma, duplicity and stenosis, prostatic utricle, urethral-vaginal fistulas and urogenital sinus anomalies. It provides much better exposure than the traditional perineal approach. Morbidity caused by this technique could be potentially decreased if the anterior sagittal access were to be made without sectioning the rectum. We report our initial experience using anterior approach without rectal sectioning for the treatment of three different types of pelvic disorders. PRESENTATION OF CASE: Anterior sagittal access without sectioning the rectal wall was carried out in three different clinical cases - a vaginoplasty in a female patient with congenital adrenal hyperplasia; to treat paradoxical urinary incontinence in a patient with proximal hypospadias (46XY karyotype) and another one with gonadal dysgenesis (46XO/XY karyotype). DISCUSSION: Several surgical techniques have been reported to repair congenital or acquired lesions in the posterior urethra with high morbidity and no guarantees of adequate and safe surgical exposition. ASTRA provides an excellent exposure, splitting only the anterior rectal wall. In this study, the anterior sagittal approach was applied without splitting the rectal wall to repair different posterior urethral anomalies, providing excellent exposure without compromising the fecal continence mechanism. CONCLUSION: The anterior sagittal approach without splitting the rectum is a feasible procedure which provides excellent exposure to the posterior urethra in most cases and leads to less morbidity as it avoids the splitting and suturing of the rectum anterior wall.

Evisceraçäo do intestino delgado através de perfuraçäo de prolapso retal em uma criança / Evisceration of the small intestine through the rectal prolapse perforation in children

The rectal prolapse is very common in children under 3 years old. Rectal mucosae herniated in to the anal canal. The ethiologic causes are diarrhea, intestinal parasitosis, obstipation and desnutrition. The effort during the defecation, prolonged diarrhea and obstipation are important contribucting factors. The treatment in the majority of cases is medical treating factors like desnutrition, diarrheia and parasitosis. The authors report a case of a 3-month-old child with chronic diarrhea, severe desnutrition and recurrent rectal prolapse with perforation hole. This is a rare complication and considerations are made regarding the management of the case

Aganglionose total do colon: apresentaçäo de quatro casos / Total aganglionosis of colon: presentation of four cases

Os autores apresentam quatro casos de aganglionose de todo o cólon em crianças, tecendo comentários sobre as dificuldades no estabelecimento do diagnóstico e sobre o tratamento cirúrgico utilizado aos pacientes.