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Matthew D Timberlake, Craig A Peters
PURPOSE OF REVIEW: Although open ureteral reimplantation remains the gold standard for surgical correction of vesicoureteral reflux (VUR), robotic-assisted laparoscopic ureteral reimplantation (RALUR) holds promise and is becoming more widely utilized. The present article outlines primary operative techniques for RALUR, summarizes the current literature with respect to surgical outcomes and costs, and discusses early applications of RALUR to complex and reoperative cases. RECENT FINDINGS: Intravesical and extravesical techniques for RALUR have been described...
October 18, 2016: Current Opinion in Urology
Rohit Tejwani, Hsin-Hsiao S Wang, Jessica C Lloyd, Paul J Kokorowski, Caleb P Nelson, Jonathan C Routh
BACKGROUND: The advent of online task-distribution has opened a new avenue to efficiently gather community perspectives needed for utility estimation. Methodological consensus for estimating pediatric utilities is lacking, with disagreement over whom to sample, what perspective (patient vs. parent), and whether instrument-induced anchoring bias is significant. We sought to determine what methodological factors potentially impact utility estimates for vesicoureteral reflux (VUR). DESIGN: Cross-sectional surveys using a time-trade-off (TTO) instrument were conducted via Amazon's Mechanical Turk online interface; respondents were randomized to answer questions from child, parent, or dyad perspectives on the utility of a VUR health state and one of three "warm-up" scenarios (paralysis, common cold, none) prior to a VUR scenario...
October 13, 2016: Journal of Urology
Neslihan Karakurt, Nesrin Beşbaş, Ali Cansu Bozacı, Yelda Bilginer, Hasan Serkan Doğan, Serdar Tekgül
This study was performed to evaluate the role of postnatal ultrasonography (US) in predicting the final diagnosis and need of surgery of antenatal hydronephrosis patients. One hundred and twenty six renal units (RUs) of 76 patients with diagnosis of antenatal hydronephrosis (ANH) were studied. An early postnatal US no later than the first week of life was requested. Voiding cystourethrography (VCUG) and/or diuretic renogram (MAG3) was performed in children who had persistent or worsening hydronephrosis to make a certain diagnose of etiology...
November 2015: Turkish Journal of Pediatrics
F Soria, J E de la Cruz, E Morcillo, J Rioja, F M Sánchez-Margallo
Double-J ureteral stents disposal is associated with the appearance of side effects in up to 90% of the patients. The main causes of these symptoms are related to stent's design and the materials they are manufactured from. Vesicoureteral reflux and bladder trigone irritation are the etiopathogenic causes of ureteral stents associated morbidity. Due to this, and in order to improve patients' quality of life, stents that avoid reflux have been developed. Among anti-reflux designs, the first was a double-J stent the bladder tip of which is provided with a polymeric membrane that prevents retrograde flow of urine through its internal drainage channel...
October 2016: Archivos Españoles de Urología
Linda C Lee, Armando J Lorenzo, Martin A Koyle
Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25-40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution...
May 2016: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Pearl W Chang, Jennifer M Abidari, Mark W Shen, Tara L Greenhow, Michael Bendel-Stenzel, Heidi K Roman, Eric A Biondi, Alan R Schroeder
OBJECTIVES: To describe renal ultrasound (RUS) and voiding cystourethrogram (VCUG) findings and determine predictors of abnormal imaging in young infants with bacteremic urinary tract infection (UTI). METHODS: We used retrospective data from a multicenter sample of infants younger than 3 months with bacteremic UTI, defined as the same pathogenic organism in blood and urine. Infants were excluded if they had any major comorbidities, known urologic abnormalities at time of presentation, required intensive unit care, or had no imaging performed...
October 5, 2016: Hospital Pediatrics
Dimitri Papagiannopoulos, Ilina Rosoklija, Earl Cheng, Elizabeth Yerkes
Dextranomer/hyaluronic acid copolymer (Deflux) first received FDA approval in 2001 for endoscopic injection in children with grade II-IV vesicoureteral reflux (VUR). As experience has grown, Deflux has been used more liberally with encouraging results. We report three cases where Deflux was used in off-label fashion, resulting in delayed ureteral obstruction and loss of renal function (range 18-52 months post-operatively). We now place increased emphasis on the need for long-term follow-up after Deflux in both routine and complex cases, particularly in situations of off-label use...
September 26, 2016: Urology
Yuichiro Ikado, Daisuke Obinata, Taro Matsumoto, Yasutaka Murata, Koichiro Kano, Noboru Fukuda, Kenya Yamaguchi, Satoru Takahashi
PURPOSE: Autologous cells potentially provide an ideal injectable substance for management in vesicoureteral reflux (VUR). The aim of this study is to examine the effects of mature adipocyte-derived dedifferentiated fat (DFAT) cell transplantation on VUR in a rat bladder pressurization-induced VUR model. METHODS: To create VUR, Sprague-Dawley rats underwent urethral clamping and placement of cystostomy followed by intravesical pressurization. Rat DFAT cells (1 × 10(6) cells, DFAT group, n = 5) or saline (control group, n = 5) was then injected into the bilateral vesicoureteral junctions...
September 28, 2016: International Urology and Nephrology
Anthony J Schaeffer, Saul P Greenfield, Anastasia Ivanova, Gang Cui, J Michael Zerin, Jeanne S Chow, Alejandro Hoberman, Ranjiv I Mathews, Tej K Mattoo, Myra A Carpenter, Marva Moxey-Mims, Russell W Chesney, Caleb P Nelson
INTRODUCTION: Voiding cystourethrography (VCUG) is the modality of choice to diagnose vesicoureteral reflux (VUR). Although grading of VUR is essential for prognosis and clinical decision-making, the inter-observer reliability for grading has been shown to vary substantially. The Randomized Intervention for Children with VesicoUreteral Reflux (RIVUR) trial provides a large cohort of children with VUR to better understand the reliability of VCUG findings. OBJECTIVE: To determine the inter-observer consistency of the grade of VUR and other VCUG findings in a large cohort of children with VUR...
September 6, 2016: Journal of Pediatric Urology
Erkin Serdaroglu, Mahfuz Aydogan, Kadriye Ozdemir, Mustafa Bak
BACKGROUND: Urolithiasis (UL) is a common problem in pediatric nephrology practice. About 9-23% of all pediatric UL cases consist of patients under 1 years old. The aim of the present study was to determine etiologic causes, clinical features and short term prognosis of urolithiasis in the first two years of life. METHODS: Two-hundred children between 0-2 years of age (mean age 10.3±6.1 months) with urolithiasis were included to the study. All children were completely evaluated for urolithiasis etiology...
September 13, 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
Monika Miklaszewska, Przemysław Korohoda, Katarzyna Zachwieja, Michał Wolnicki, Małgorzata Mizerska-Wasiak, Dorota Drożdż, Jacek A Pietrzyk
Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development. Retrospective, observational study of medical data of 54 children treated in Pediatric Nephrology and Urology Clinics for five years was performed. The following data were analyzed: serum creatinine, eGFR, urine analysis, renal scintigraphy (RS), renal ultrasound, and urodynamics. Mean age of studied population: 12.3 years, median of eGFR at the beginning and at the end of survey was 110.25 and 116.5 mL/min/1...
2016: International Journal of Environmental Research and Public Health
Stanislaw Warchol, Grazyna Krzemien, Agnieszka Szmigielska, Przemyslaw Bombinski, Michal Brzewski, Teresa Dudek-Warchol
BACKGROUND: Endoscopic correction of vesicoureteral reflux (VUR) in children offers minimally invasive management and is widely used as a first-line procedure for all grades of reflux. However, there is debate about which tissue-augmenting substance is the best to use. The aim of this study was to evaluate the efficacy of two bulking substances, Deflux (Dx/HA) and Vantris (PPC), for endoscopic treatment of VUR in children. METHODS: From 2009 to 2012, 65 children (50 girls and 15 boys) aged 1...
August 2016: Journal of Pediatric Urology
Linda C Lee, Armando J Lorenzo, Rakan Odeh, Michelle Falkiner, Dawn-Ann Lebarron, Jeffrey Traubici, Erika Mann, Paul R Bowlin, Martin A Koyle
PURPOSE: VCUG involves radiation exposure and is invasive. Several guidelines, including the AAP guidelines in 2011, no longer recommend routine VCUG after the initial UTI in children. The recent trend in VCUG use remains largely unknown. In this study, we examined practice patterns of VCUG use and explore the impact of these guidelines within a single-payer system over the past 8 years. MATERIALS AND METHODS: All VCUGs performed at a large pediatric referral center between January 2008 and December 2015 were identified...
September 1, 2016: Journal of Urology
Derrick L Johnston, Aslam H Qureshi, Rhys W Irvine, Dana W Giel, David S Hains
The past 30 years have seen broad changes in the diagnosis and management of vesicoureteral reflux (VUR). Recently, a clinical debate has generated an open discussion in academic circles. New evidence has shifted treatment patterns away from widespread surgical management and recently brought into question some pharmacologic treatments. VUR is usually not hazardous by itself but is a significant risk factor for urinary tract infection (UTI) and less commonly, renal scarring and insufficiency. Given the costs and morbidity of UTI as well as the potential for significant renal injury, our approach remains conservative...
June 2016: Current Treatment Options in Pediatrics
E Kara, T Sakaci, E Ahbap, T Sahutoglu, Y Koc, T Basturk, M Sevinc, C Akgol, A O Kayalar, Z A Ucar, A Unsal, N Seyahi
BACKGROUND: The goal of this study was to evaluate posttransplant urinary tract infection (UTI) rates and graft outcome in kidney transplantation for end-stage renal disease (ESRD) due to vesicoureteral reflux (VUR)-related reflux nephropathy (RN) versus chronic glomerulonephritis (CGN). METHODS: A total of 62 patients with ESRD who underwent kidney transplantation for VUR-related RN (VUR-RN group, n = 31; mean ± standard deviation age, 34.1 ± 6.0 years; 58.1% female) or CGN (CGN group, n = 31; mean age, 34...
July 2016: Transplantation Proceedings
María Fernández-Ibieta
In Dysfunctional Voiding (DV), the patient contracts the external urethral sphincter or pelvic diaphragm (consisting of striated muscle) during voiding, contrary to normal physiological mechanism. In Flowmetry plus pelvic Electromyography (EMG), the perineal surface electrodes will show a persistent activity during voiding. The cause is believed to be the persistence of an immature bladder control. The overall prevalence of DV is estimated between 7 and 11% of girls of school age. Symptoms of DV comprises a range of symptoms, deriving from outlet obstruction, incomplete voiding and elevated Post Micturition Residual (PMR): from daytime urine leaks, nocturnal enuresis, Urinary Tract Infections (UTI), or Vesicoureteral reflux (VUR), to the final decompensation of upper urinary tract in extreme cases...
August 16, 2016: Current Pediatric Reviews
Daniel Herz, Molly Fuchs, Andrew Todd, Daryl McLeod, Jennifer Smith
BACKGROUND: Published reports of outcomes of robot assisted laparoscopic ureteral reimplantation (RALUR) show mixed results that, on average, are inferior to open ureteral reimplant. We present a retrospective analysis of a prospective series of children who had RALUR from 2013 to June 2015. We hypothesized that surgical outcomes are based on identifiable risk variables. We provide a critical analysis of the relationship between patient characteristics and several surgical and non-surgical outcomes...
July 26, 2016: Journal of Pediatric Urology
Jin-Wei Ai, Xian-Tao Zeng, Ying Liu, Yu Fu, Tong-Zu Liu, Bin Pei
Vesicoureteral reflex(VUR) is a common disease in children. Some studies indicated that the angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism associated with the renal scar in VUR, but not all researchers agreed with it. To clarify the effect of ACE I/D polymorphism on renal scar risk in children with VUR, we performed the present meta-analysis. PubMed, CNKI, CBM, and Embase databases were searched for studies that examined the relationship between ACE I/D polymorphism and renal scar risk in children with VUR...
2016: Scientific Reports
Mohd Ashraf, Virender Kumar, Rifat Ara Bano, Khursheed Ahmed Wani, Javed Ahmed, Kaisar Ahmed
INTRODUCTION: Definite paucity of data pertaining to spectrum of renal and urinary tract diseases in our state and in various parts of India forms the basis of this study. Available data has emphasized more on specific clinical syndromes and chronic renal diseases rather than over all spectrums of renal and urinary tract diseases, that too in adult population. AIM: The present study a retrospective analysis, forms one of the basic data of paediatric nephrology and urology related disorders in our state...
June 2016: Journal of Clinical and Diagnostic Research: JCDR
Michael Garcia-Roig, Angela M Arlen, Jonathan H Huang, Eleonora Filimon, Traci Leong, Andrew J Kirsch
INTRODUCTION: Urinary stasis in the setting of obstruction provides an opportunistic environment for bacterial multiplication and is a well-established risk factor for UTI. Vesicoureteral reflux (VUR) with delayed upper tract drainage (UTD) on VCUG has been reported to correlate with increased UTI risk. We sought to determine whether delayed UTD can be reliably classified, and whether it correlates with UTI incidence, VCUG, or endoscopic findings. METHODS: Children undergoing endoscopic surgery for primary VUR (2009-2012) were identified...
July 21, 2016: Journal of Pediatric Urology
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