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Rickard M, Lorenzo AJ, Richter J, Brownrigg N, Kim JK, Chua M, Goraya N, Khondker A, Yadav P, Keefe DT, Shinar S, Dos Santos J. Implementation of a standardized clinical pathway in a dedicated posterior urethral valves clinic: short-term outcomes. Pediatr Nephrol 2023; 38:3735-3744. [PMID: 37322171 DOI: 10.1007/s00467-023-06040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND To determine if the implementation of a posterior urethral valves (PUV) clinic and standardized management pathway improves the short-term kidney outcomes of infants with PUV. METHODS From 2016-2022, 50 consecutive patients were divided into groups after the implementation of the clinic (APUV, n = 29) and before (BPUV, n = 21) during a comparable timeframe. Assessed data included age at initial visit, timing and type of surgery, frequency of follow-up visits, medications, nadir creatinine, and development of CKD/kidney failure. Data are shown as median with interquartile range (IQR) and odds ratios (OR) with 95% confidence interval (CI). RESULTS APUV had higher rates of prenatal diagnoses (12/29 vs. 1/21; p = 0.0037), earlier initial surgical intervention (8 days; IQR 0, 105 vs. 33 days; IQR 4, 603; p < 0.0001), and higher rates of primary diversions (10/29 vs. 0/21; p = 0.0028). Standardized management led to earlier initiation of alpha blockers (326 days; IQR 6, 860 vs. 991; IQR 149, 1634; p = 0.0019) and anticholinergics (57 days; IQR 3, 860 vs. 1283 days; IQR 477, 1718; p < 0.0001). Nadir creatinine was reached at earlier ages in APUV (105 days; IQR 2, 303 vs. 164 days; IQR 21, 447; p = 0.0192 BPUV). One patient progressed to CKD5 in APUV compared to CKD3, CKD5 and one transplant in BPUV. CONCLUSION Implementing the PUV clinic with standardized treatment expedited postnatal management and resulted in a higher number of cases detected prenatally, a shift in primary treatment, younger ages at initial treatment, reduced time to nadir creatinine, and timely initiation of supportive medications. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mandy Rickard
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Juliane Richter
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Natasha Brownrigg
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Jin K Kim
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon, Philippines
| | - Noreen Goraya
- Department of Social Work, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Renal Sciences, Lucknow, India
| | - Daniel T Keefe
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Shiri Shinar
- Ontario Fetal Center, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Garriboli M, Clothier J, Selvaggio G, Harper L. Editorial: Posterior urethral valves: advances in diagnosis, management, and long-term follow up. Front Pediatr 2023; 11:1252048. [PMID: 37539010 PMCID: PMC10395328 DOI: 10.3389/fped.2023.1252048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Massimo Garriboli
- Paediatric Urology, Evelina London Children’s Hospital, London, United Kingdom
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, United Kingdom
| | - Joanna Clothier
- Paediatric Nephrology and Bladder Service, Evelina London Children’s Hospital, London, United Kingdom
| | - Giorgio Selvaggio
- Department of Paediatric Surgery, V. Buzzi Children’s Hospital, Milan, Italy
| | - Luke Harper
- Department of Paediatric Urology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Hofmann A, Ioannou A, Zöhrer PI, Rösch WH. Ureterocystoplasty in Boys with Valve Bladder Syndrome-Is This Method Still up to Date? CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040692. [PMID: 37189941 DOI: 10.3390/children10040692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023]
Abstract
Boys with valve bladder syndrome (PUV) require adequate treatment of the lower urinary tract to preserve renal function and improve long-term outcomes. In some patients, further surgery may be necessary to improve bladder capacity and function. Ureterocytoplasty (UCP) is usually carried out with a small segment of intestine or, alternatively, with a dilated ureter. Our aim was to evaluate the long-term outcomes after UCP in boys with PUV. UCP had been performed in 10 boys with PUV at our hospital (2004-2019). Pre- and postoperative data were evaluated in relation to kidney and bladder function, the SWRD score, additional surgery, complications, and long-term follow-up. The mean time between primary valve ablation and UCP was 3.5 years (SD ± 2.0). The median follow-up time was 64.5 months (IQR 36.0-97.25). The mean increase in age-adjusted bladder capacity was 25% (from 77% (SD ± 0.28) to 102% (SD ± 0.46)). Eight boys micturated spontaneously. Ultrasounds showed no severe hydronephrosis (grade 3-4). The SWRD score showed a median decrease from 4.5 (range 2-7) to 3.0 (range 1-5). No conversion of augmentation was required. UCP is a safe and effective approach to improve bladder capacity in boys with PUV. In addition, the possibility of micturating naturally is still maintained.
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Affiliation(s)
- Aybike Hofmann
- Department of Pediatric Urology in Cooperation with University Medical Center Regensburg, Hospital Barmherzige Brüder, Clinic St. Hedwig, 93049 Regensburg, Germany
| | - Alexandros Ioannou
- Department of Pediatric Urology in Cooperation with University Medical Center Regensburg, Hospital Barmherzige Brüder, Clinic St. Hedwig, 93049 Regensburg, Germany
- Department of Pediatric Surgery, Hospital Barmherzige Brüder, Clinic St. Hedwig, 93049 Regensburg, Germany
| | - Pirmin Irenaeus Zöhrer
- Department of Pediatric Urology in Cooperation with University Medical Center Regensburg, Hospital Barmherzige Brüder, Clinic St. Hedwig, 93049 Regensburg, Germany
| | - Wolfgang H Rösch
- Department of Pediatric Urology in Cooperation with University Medical Center Regensburg, Hospital Barmherzige Brüder, Clinic St. Hedwig, 93049 Regensburg, Germany
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Khondker A, Kim JK, Chua ME, Kwong JCC, Chan JYH, Yadav P, Richter J, Santos JD, Brownrigg N, Lorenzo AJ, Rickard M. The effect of primary urinary diversion on kidney function in posterior urethral valve: A matched comparison. Urology 2023; 172:170-173. [PMID: 36450318 DOI: 10.1016/j.urology.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine long-term kidney outcomes in boys with posterior urethral valve (PUV) undergoing either primary valve ablation or urinary diversion with matched baseline kidney function. METHODS After retrospective review of patients managed for PUV at our institution, propensity score matched analysis was conducted using nadir serum creatinine with logistic regression analysis. Nearest neighbor matching was used to allocate boys to primary urinary diversion and primary ablation groups. Primary outcomes included kidney function by creatinine or estimated glomerular filtration rate, chronic kidney disease, and end-stage renal disease. Comparative statistics by odds ratio (OR) and hazard ratios on survival analysis were calculated. RESULTS A total of 21 boys undergoing primary diversion were matched with 42 boys undergoing ablation using nadir serum creatinine and follow-up time with a median follow-up of 4.8 years. After matching, there was no significant difference in last follow-up kidney function by creatinine (P = .99) or estimated glomerular filtration rate (P = .98). Primary diversion was not associated with increased likelihood of developing chronic kidney disease stage 3 (OR 1.33; P = .31) or end-stage renal disease (OR 1.88; P = .35 and hazard ratios 1.85; P = .30) compared to primary ablation. CONCLUSIONS Our propensity matched study suggests that long-term kidney function and kidney outcomes are similar between primary ablation and primary diversion after adjusting for baseline kidney function in boys with PUV.
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Affiliation(s)
- Adree Khondker
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jin K Kim
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Jethro C C Kwong
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Justin Y H Chan
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Priyank Yadav
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Juliane Richter
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Natasha Brownrigg
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
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Voiding Dysfunction in Transitional Urology Patients: Common Issues and Management Strategies. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Oyinloye AO, Abubakar AM, Wabada S, Rikin CU. Experience with the use of mohan's valvotome for posterior urethral valve ablation at a centre in North-Eastern Nigeria. Afr J Paediatr Surg 2022; 19:144-148. [PMID: 35775514 PMCID: PMC9290366 DOI: 10.4103/ajps.ajps_188_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Posterior urethral valve (PUV) is the most common congenital cause of lower urinary tract obstruction in boys. Management has remained challenging in our region, with features of renal impairment evident in some patients at the time of presentation. Endoscopic valve ablation is the gold standard of treatment, but this is not readily available in our setting. Mohan's valvotome has been described as an alternative device for valve ablation. This study aimed to highlight the clinical presentation, management and early outcomes following valve ablation using Mohan's valvotome. METHODS A retrospective study of boys with PUVs managed between September 2014 and June 2018 was done. The demographic characteristics, clinical features, investigations, treatment and initial outcomes were reviewed. The main outcome measures were improved post-ablation urinary stream, serial serum creatinine values at presentation, 4-5 days of initial catheter drainage and at follow-up. RESULTS There were ten boys with the median age at presentation of 4 months (mean: 23.9 months; range 10 days to 7 years). Four patients presented after 1 year. All the patients had features of bladder outlet obstruction with associated fever in seven patients and urinary tract infections in six patients. Nine patients (90%) had suprapubic masses, while 2 had ballotable kidneys with co-existing urinary ascites in one patient. Valve ablation was achieved with Mohan's valvotome. There was a significant improvement in the urine stream in all patients. The median duration of follow-up was 7.5 months. Median serum creatinine was 0.95 mg/dl (mean 0.94 mg/d ± 0.38 mg/dl) at follow-up, compared to a median of 4.03 mg/dl at presentation (P = 0.01). CONCLUSION Initial drainage and definitive valve ablation with Mohan's valvotome is associated with improved serum creatinine and urinary stream.
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Affiliation(s)
- Adewale Olaotan Oyinloye
- Department of Surgery, Division of Pediatric Surgery, Federal Medical Center, Yola, Adamawa, Nigeria
| | - Auwal Mohammed Abubakar
- Department of Surgery, Division of Pediatric Surgery, Federal Medical Center, Yola, Adamawa, Nigeria
| | - Samuel Wabada
- Department of Surgery, Pediatric Surgery Unit, University of Maiduguri Teaching Hospital, Maiduguri, Borno, Nigeria
| | - Christopher Uruku Rikin
- Department of Surgery, Division of Pediatric Surgery, Federal Medical Center, Yola, Adamawa, Nigeria
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Babu R, Sai V. Bladder height width ratio on voiding cystourethrogram as a predictor of future valve bladder in children with posterior urethral valve. Pediatr Surg Int 2022; 38:935-939. [PMID: 35419631 DOI: 10.1007/s00383-022-05121-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND/AIMS Prompt and early treatment of valve bladder is known to improve renal outcome in patients with PUV. We hypothesized that bladder height width ratio (HWR) measurement on voiding cystourethrogram (VCUG) could predict development of valve bladder. METHODS All patients who underwent primary PUV ablation and evaluated later with urodynamics were included. Valve bladder was suspected when there were daytime wetting, persistent hydroureteronephrosis, and elevated detrusor pressures on urodynamics. VCUGs were analysed for HWR: maximum height/width of bladder. ROC curve analysis was performed to identify HWR that could predict development of urodynamic abnormality. RESULTS Between 2012 and 2017, 102 patients were studied: median age at valve ablation 25 days (3-125 days); follow-up 5 years (3-7 years). The ROC curve comparing post-ablation HWR with occurrence of valve bladder showed a cut-off of 1.45 (AUC 0.93). HWR cut-off of 1.45 had a sensitivity of 89% and specificity of 84% in predicting future valve bladder. Detrusor overactivity was noticed on urodynamics in 41/55 (74%) of those with HWR > 1.45 compared 5/47 (11%) in those with HWR < 1.45 (p = 0.001). CONCLUSION Bladder height width ratio on VCUG is a useful parameter to predict development of future valve bladder in children with PUV.
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Affiliation(s)
- Ramesh Babu
- Pediatric Urology Unit, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India.
| | - Venkata Sai
- Departments of Pediatric Urology and Radiology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, 600116, India
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Gastaldi P, El-Khoury E, Haddad M, Mille E, Dariel A, Merrot T, Faure A. Preliminary experience in endoscopic section of posterior urethral valves using the Holmium: YAG laser. J Pediatr Urol 2022; 18:367.e1-367.e7. [PMID: 35477665 DOI: 10.1016/j.jpurol.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/09/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Refinements in endoscopic instrumentation, the widespread popularization of endourology and the minimal invasiveness of endoscopic approaches have led to evolving interest in expanding applications for their use and now include incision of posterior urethral valves (PUV). We aimed to report our paediatric experience of PUV incision with Holmium:YAG laser updating of the endoscopic technique, how we set parameters for the laser energy and provide some tips and tricks to increase the likelihood of completing treatment. METHODS A monocentric, prospective, continuous series of boys with PUV were treated endoscopically using a Holmium: YAG laser (1.2 J, 20 Hz, 800 μs). Feasibility was evaluated using operative time in minutes, spontaneous normal micturition after bladder catheter removal, and the duration of bladder catheterization in days in the absence of satisfactory micturition. Peri-operative complications were recorded. A VCUG was performed at 6 weeks postoperatively to exclude residual valves. RESULTS Since September 2018, 18 children with PUV were included. The median age at the time of endoscopic laser incision was 12 days (1 day-5 years). The median operative duration was 28 min (17-35). The urinary catheter was systematically removed on the first postoperative day. There were no intraoperative or anaesthesia-related complications. More specifically, no urethral injuries and no bleeding were recorded. No incomplete VUP incision was found on follow-up VCUG, and no endoscopic revision was necessary thus far, with a median follow-up of 44 months (6 months-60 months). DISCUSSION The use of the Holmium: YAG laser introduces new perspectives in the treatment of PUV. Its mechanism of action is considered a photothermic effect with a vapourization effect. The laser energy released by the Holmium: YAG source has a short tissue penetration distance and is strongly absorbed in an aqueous environment and therefore limits thermal tissue damage and favours early tissue re-epithelialization, reducing the risk of urethral stricture and decreasing postoperative oedema. The use of the laser in "incision" mode is the setting that most solicits the capacities of the laser (high energy, high frequency, and long pulse). The use of laser energy has the advantage of allowing tissue vapourization while ensuring maximal haemostasis and the possibility of introducing the laser fibre through the working channels of small, 6-Fr paediatric endoscopes. CONCLUSION In our experience, endoscopic PUV incision using the Holmium: YAG laser appears to be a safe and efficient technique.
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Affiliation(s)
- Pauline Gastaldi
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Eliane El-Khoury
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Mirna Haddad
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Eva Mille
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Anne Dariel
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Thierry Merrot
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France
| | - Alice Faure
- Aix-Marseille Université, APHM, CHU Hopital La Timone Enfants, Paediatric Surgery Department, 13385, Marseille, France.
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Ng NBH, Lau PYW. Hydroureteronephrosis in a male infant. Pediatr Neonatol 2021; 62:220-221. [PMID: 33500202 DOI: 10.1016/j.pedneo.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 10/27/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nicholas Beng Hui Ng
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
| | - Perry Yew Weng Lau
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
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Amesty MV, García-Vaz C, Espinosa L, Martínez-Urrutia MJ, López-Pereira P. Long-Term Renal Transplant Outcome in Patients With Posterior Urethral Valves. Prognostic Factors Related to Bladder Dysfunction Management. Front Pediatr 2021; 9:646923. [PMID: 34046373 PMCID: PMC8144517 DOI: 10.3389/fped.2021.646923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/12/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction: To obtain a successful renal transplant (RT) outcome in patients with posterior urethral valves (PUV), it is necessary to accomplish an adequate bladder dysfunction treatment. Our aim was to determine prognostic factors related to bladder dysfunction management in long-term RT outcome in patients with PUV. Methods: A retrospective review of patients with PUV who received a first RT after 1985 in our institution with at least 5 years of follow-up was performed. Variables analyzed included prenatal diagnosis, age of diagnosis, initial presentation and management, bladder dysfunction treatment, other surgical treatments, pre-transplant dialysis, age of transplantation, type of donor, immunosuppression regimen, vascular and urological complications, rejections episodes, and graft survival. Results: Fifty-one patients were included in the analysis. Prenatal diagnosis was done in 37.3%. Median age of diagnosis was 0.30 (0-88) months. Initial presentation was vesicoureteral reflux (VUR) in 78% and obstructive ureterohydronefrosis in 35.3%. Initial management was valve ablation (29.4%), pyelo-ureterostomy (64.7%), and vesicostomy (5.9%). In 33.3%, a type of bladder dysfunction treatment was performed: 21.6% bladder augmentation (BA), 15.7% Mitrofanoff procedure, 17.6% anticholinergic drugs, and 27.5% clean intermittent catheterization (CIC). Pre-transplant dialysis was received by 66.7%. Transplantation was performed at 6.28 ± 5.12 years, 62.7% were cadaveric and 37.3% living-donor grafts. Acute rejection episodes were found in 23.6%. Urological complications included recurrent urinary tract infections (UTIs) (31.4%); native kidneys VUR (31.4%); graft VUR (45.1%); and ureteral obstruction (2%). Vascular complications occurred in 3.9%. Mean graft survival was 11.1 ± 6.9 years. Analyzing the prognostic factor that influenced graft survival, patients with had CIC or a Mitrofanoff procedure had a significant better long-term graft survival after 10 years of follow-up (p < 0.05), despite of the existence of more recurrent UTIs in them. A better graft survival was also found in living-donor transplants (p < 0.05). No significant differences were observed in long-term graft survival regarding native kidneys or graft VUR, BA, immunosuppression regimen, or post-transplant UTIs. Conclusion: Optimal bladder dysfunction treatment, including CIC with or without a Mitrofanoff procedure, might result in better long-term graft survival in patients with PUV. These procedures were not related to a worse RT outcome in spite of being associated with more frequent UTIs.
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Affiliation(s)
| | - Claudia García-Vaz
- Department of Preventive Medicine and Public Health, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Espinosa
- Department of Pediatric Nephrology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Pedro López-Pereira
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
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Valve Bladder Syndrome Associated with Posterior Urethral Valves: Natural History, Work-up, and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nasir AA, Oyinloye AO, Abdur-Rahman LO, Bamigbola KT, Abdulraheem NT, Adedoyin OT, Adeniran JO. Short-Term Outcomes of Treatment of Boys with Posterior Urethral Valves. Niger Med J 2020; 60:306-311. [PMID: 32180661 PMCID: PMC7053278 DOI: 10.4103/nmj.nmj_118_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 09/22/2019] [Accepted: 11/07/2019] [Indexed: 11/12/2022] Open
Abstract
Background: Posterior urethral valve (PUV) is a significant cause of morbidity and mortality among male children resulting in renal failure in 25%–30% before adolescence irrespective of initial treatment. This study aimed at evaluating the early outcomes of children managed for PUV. Materials and Methods: This was a prospective study of all children who were treated for PUV between 2012 and 2016 at a single referral institution. Information reviewed included demographic and clinical data, imaging findings, pre- and post-operative serum electrolytes, and postoperative renal outcomes. Results: Twenty-nine male children were managed for PUV at a median age of 6 months including 7 (24.1%) neonates. Two (6.9%) patients had antenatal diagnosis. Micturating cystourethrogram confirmed PUV in all patients. Fourteen (48.3%) patients had impaired renal function (IRF) at presentation and 8 (57%) had improved renal function (RF) after initial catheter drainage. The mean creatinine at presentation was 1.86 ± 1.69 mg/dl and the mean serum creatinine following initial catheter drainage was 0. 93 ± 0.49 mg/dl (P = 0.003). For those patients with normal RF, the mean creatinine at presentation was 0.81 ± 0.22 mg/dl versus 0.74 ± 0.21 mg/dl (P = 0.012), following initial catheter drainage. Children with IRF on admission had mean creatinine at presentation of 2.61 ± 2.00 mg/dl compared to 1.17 ± 0.53 mg/dl (P = 0.002) after initial catheter drainage. Valve ablation was achieved with Mohan's valvotome in 26 (96.3%) patients. All patients had good urine stream at a median follow-up of 5 months. Four (13.8%) patients developed IRF at follow-up. Renal outcomes of patients presenting before 1 year and those presenting after 1 year were similar. Two children died preoperative of urosepsis and one out of hospital death given an overall mortality of 10.3% (n = 3). Conclusion: There was significant improvement in RF after initial catheter drainage. The incidence of IRF at follow-up was 13.8%. Long-term follow-up is necessary to identify patients at risk of end-stage renal disease.
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Affiliation(s)
- Abdulrasheed A Nasir
- Department of Surgery, Division of Paediatric Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Adewale O Oyinloye
- Department of Surgery, Division of Paediatric Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lukman O Abdur-Rahman
- Department of Surgery, Division of Paediatric Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Nurudeen T Abdulraheem
- Department of Surgery, Division of Paediatric Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olanrewaju T Adedoyin
- Department of Paediatric, Division of Nephrology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - James O Adeniran
- Department of Surgery, Division of Paediatric Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Rocha NP, Bastos FM, Vieira ÉL, Prestes TR, Silveira KDD, Teixeira MM, Simões e Silva AC. The protective arm of the renin‐angiotensin system may counteract the intense inflammatory process in fetuses with posterior urethral valves. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rocha NP, Bastos FM, Vieira ÉLM, Prestes TRR, Silveira KDD, Teixeira MM, Simões E Silva AC. The protective arm of the renin-angiotensin system may counteract the intense inflammatory process in fetuses with posterior urethral valves. J Pediatr (Rio J) 2019. [PMID: 29534877 DOI: 10.1016/j.jped.2018.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Posterior urethral valve is the most common lower urinary tract obstruction in male children. A high percentage of patients with posterior urethral valve evolve to end-stage renal disease. Previous studies showed that cytokines, chemokines, and components of the renin-angiotensin system contribute to the renal damage in obstructive uropathies. The authors recently found that urine samples from fetuses with posterior urethral valve have increased levels of inflammatory molecules. The aim of this study was to measure renin-angiotensin system molecules and to investigate their correlation with previously detected inflammatory markers in the same urine samples of fetuses with posterior urethral valve. METHODS Urine samples from 24 fetuses with posterior urethral valve were collected and compared to those from 22 healthy male newborns at the same gestational age (controls). Renin-angiotensin system components levels were measured by enzyme-linked immunosorbent assay. RESULTS Fetuses with posterior urethral valve presented increased urinary levels of angiotensin (Ang) I, Ang-(1-7) and angiotensin-converting enzyme 2 in comparison with controls. ACE levels were significantly reduced and Ang II levels were similar in fetuses with posterior urethral valve in comparison with controls. CONCLUSIONS Increased urinary levels of angiotensin-converting enzyme 2 and of Ang-(1-7) in fetuses with posterior urethral valve could represent a regulatory response to the intense inflammatory process triggered by posterior urethral valve.
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Affiliation(s)
- Natalia P Rocha
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica (LIIM), Belo Horizonte, MG, Brazil
| | - Fernando M Bastos
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica (LIIM), Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Serviço de Medicina Fetal, Belo Horizonte, MG, Brazil
| | - Érica L M Vieira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica (LIIM), Belo Horizonte, MG, Brazil
| | - Thiago R R Prestes
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica (LIIM), Belo Horizonte, MG, Brazil
| | - Katia D da Silveira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica (LIIM), Belo Horizonte, MG, Brazil
| | - Mauro M Teixeira
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica (LIIM), Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Instituto de Ciências Biológicas, Departamento de Bioquímica e Imunologia, Laboratório de Imunofarmacologia, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica (LIIM), Belo Horizonte, MG, Brazil.
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Kajbafzadeh AM, Sabetkish S, Sabetkish N. Prognostic significance of maternal urinary carbohydrate antigen 19-9 for antenatal diagnosis of posterior urethral valve associated with fetal hydronephrosis. Int Urol Nephrol 2019; 51:909-915. [PMID: 30955138 DOI: 10.1007/s11255-019-02138-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/27/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the predictive role of maternal urinary CA 19-9 as a non-invasive marker for diagnosing antenatal posterior urethral valve (PUV). METHODS A total of 40 women in the third pregnancy trimester were enrolled. Case group (group A) consisted of 20 women with a diagnosis of antenatal PUV. Twenty women with similar gestational age, fetal sex, normal US, and no history of congenital anomalies were chosen as a control group (group B). Maternal urine samples were collected and urinary CA 19-9 was measured in both groups. The correlations between maternal urinary CA 19-9 and APD (measured during pregnancy and the initial evaluation of the newborn) were assessed. CA 19-9 level in first urine of neonates was also evaluated. RESULTS The mean ± SD of maternal urine CA 19-9 was higher in PUV group compared to the control group (131.6 ± 23.8 vs. 13 ± 2.7 U/mL). In addition, there was a significant correlation between maternal urinary CA 19-9 and the APD measured at the third trimester (p < 0.001) and the initial evaluation of fetus after birth according to SFU grading system (p < 0.001). However, no significant difference was found between gestational age and urinary CA 19-9 level (p = 0.34). There was also a significant correlation between the CA 19-9 level in first urine of neonates and CA 19-9 level of maternal urine (p < 0.001). CONCLUSIONS This is the first time that maternal urinary CA 19-9 has been applied as a noninvasive and practical diagnostic marker in antenatal PUV.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shabnam Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Lifelong Congenital Urology: The Challenges for Patients and Surgeons. Eur Urol 2019; 75:1001-1007. [PMID: 30935758 DOI: 10.1016/j.eururo.2019.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/13/2019] [Indexed: 11/22/2022]
Abstract
CONTEXT Patients born with complex congenital genitourinary anomalies (including bladder exstrophy, cloacal exstrophy, epispadias, neurogenic bladder, hypospadias and posterior urethral valves) often require major reconstructive surgery in childhood. These conditions, their treatment and sequelae require lifelong follow-up. This has created the need for adult urologists to provide care as these patients grow into adults. OBJECTIVE To evaluate current strategies for transition and provide a current position statement with examples of the challenges faced by patients and their health care teams as a result of these conditions and their treatment. EVIDENCE ACQUISITION Each of the authors was asked to provide a 500-word synthesis, based on current literature; to highlight the challenges faced in an area of their expertise. EVIDENCE SYNTHESIS The authors assembled in March 2018 to form a consensus based on the data gathered. The aforementioned sections were reviewed and following the consensus discussion the paper was formulated and reviewed. CONCLUSIONS Lifelong care of congenital problems is challenging and essential for many but not all. Expertise is needed to provide the best care for patients and make the best use of resources. Specialist centres appear to be the most effective and safe model. In the long term it would be ideal to establish an evidence base focused on the common long-term problems with these conditions to ensure excellent care with appropriate expertise. PATIENT SUMMARY Patients born with complex congenital anomalies of the genitourinary system require specialist care in childhood. Many will need lifelong care to manage their condition and the treatment of it. There is growing interest in this area of medicine and this consensus statement addresses the need for lifelong care in this group. The aim is to ensure that all patients that need care at any age are able to find what they need.
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McLeod DJ, Szymanski KM, Gong E, Granberg C, Reddy P, Sebastião Y, Fuchs M, Gargollo P, Whittam B, VanderBrink BA. Renal Replacement Therapy and Intermittent Catheterization Risk in Posterior Urethral Valves. Pediatrics 2019; 143:peds.2018-2656. [PMID: 30709926 DOI: 10.1542/peds.2018-2656] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Posterior urethral valves predispose children to renal replacement therapy (RRT) and bladder dysfunction. Researchers of single-institutional series were unable to refine risk stratification because of rarity of the disease. We aimed to identify clinical variables associated with the risk of RRT and clean intermittent catheterization (CIC) in a large multicenter cohort study. METHODS Children with posterior urethral valves born between 1995 and 2005 who were treated before 90 days of life at 5 children's hospitals were retrospectively reviewed. Outcomes included RRT and recommendation for CIC. Predictors and outcomes were assessed by using survival analysis. RESULTS A total of 274 patients were managed for a median of 6.3 years, and 42 progressed to RRT. On survival analysis, 16% progressed to RRT by 10 years of age. RRT varied by the serum nadir creatinine level in the first year of life (SNC1) (log-rank P < .001). After stratifying by the SNC1, the estimated risk of progressing to RRT by 10 years of age was 0%, 2%, 27%, and 100% for an SNC1 of <0.4, an SNC1 of 0.4 to 0.69, an SNC1 of 0.7 to 0.99, and an SNC1 of ≥1.0 mg/dL, respectively. CIC was recommended in 60 patients, which translated on survival analysis to a risk of 26% by 10 years of age. CONCLUSIONS Risk of RRT and CIC recommendation increased with age. The SNC1 strongly predicted need for RRT. These results allow for both improved family counseling and the potential for more appropriate screening and intervention strategies for those identified in higher-risk groups.
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Affiliation(s)
- Daryl J McLeod
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - Konrad M Szymanski
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Edward Gong
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Pramod Reddy
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Yuri Sebastião
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - Molly Fuchs
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Benjamin Whittam
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
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Vasconcelos MA, E Silva ACS, Gomes IR, Carvalho RA, Pinheiro SV, Colosimo EA, Yorgin P, Mak RH, Oliveira EA. A clinical predictive model of chronic kidney disease in children with posterior urethral valves. Pediatr Nephrol 2019; 34:283-294. [PMID: 30196383 DOI: 10.1007/s00467-018-4078-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/19/2018] [Accepted: 08/30/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posterior urethral valves (PUVs) are associated with severe consequences to the urinary tract and are a common cause of chronic kidney disease (CKD). The aim of this study was to develop clinical predictive model of CKD in a cohort of patients with PUVs. METHODS In this retrospective cohort study, 173 patients with PUVs were systematically followed up at a single tertiary unit. The primary endpoint was CKD ≥ stage 3. Survival analyses were performed by Cox regression proportional hazard models with time-fixed and time-dependent covariables. RESULTS Mean follow-up time was 83 months (SD, 70 months). Sixty-five children (37.6%) developed CKD stage ≥ 3. After adjustment by the time-dependent Cox model, baseline creatinine, nadir creatinine, hypertension, and proteinuria remained as predictors of the endpoint. After adjustment by time-fixed model, three variables were predictors of CKD ≥ stage 3: baseline creatinine, nadir creatinine, and proteinuria. The prognostic risk score was divided into three categories: low-risk (69 children, 39.9%), medium-risk (45, 26%), and high-risk (59, 34.1%). The probability of CKD ≥ stage 3 at 10 years age was estimated as 6%, 40%, and 70% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001). The main limitation was the preclusion of some relevant variables, especially bladder dysfunction, that might contribute to a more accurate prediction of renal outcome. CONCLUSION The model accurately predicts the risk of CKD in PUVs patients. This model could be clinically useful in applying timely intervention and in preventing the impairment of renal function.
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Affiliation(s)
- Mariana A Vasconcelos
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Ana Cristina Simões E Silva
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Izabella R Gomes
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Rafaela A Carvalho
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Sergio V Pinheiro
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | | | - Peter Yorgin
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
| | - Eduardo A Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil.
- Visiting Scholar, Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA.
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19
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Vieira ÉLM, Pessoa Rocha N, Macedo Bastos F, da Silveira KD, Pereira AK, Araújo Oliveira E, Marques de Miranda D, Simões E Silva AC. Posterior urethral valve in fetuses: evidence for the role of inflammatory molecules. Pediatr Nephrol 2017; 32:1391-1400. [PMID: 28229280 DOI: 10.1007/s00467-017-3614-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of this cross-sectional study was to investigate inflammatory biomarkers in urine samples of 24 fetuses with posterior urethral valve (PUV) collected at 22 ± 4 weeks of gestation and to compare the findings with measurements in urine samples of 22 male healthy preterm neonates at 23 ± 4 weeks (control group). METHODS Inflammatory biomarkers in urine were measured using a cytometric bead array [interleukin (IL)-2, IL-4, IL-6, IL-10, interferon (IFN)-γ, soluable tumor necrosis factor receptor (TNFR) 1, sTNFR2, monocyte chemoattractant protein-1/chemokine ligand 2 (MCP-1/CCL2), eotaxin/CCL11 and interferon gamma-induced protein/10/C-X-C motif chemokine 10 (IP-10/CXCL10)] and ELISA assays [TNF, IL-8/CXCL8 and transforming growth factor-beta (TGF-β)]. The Mann-Whitney test was used to compare medians. Markers of glomerular (creatinine) and tubular [beta 2 (β2)-microglobulin, uromodulin, osmolality] functions were correlated with inflammatory biomarkers (Spearman test). RESULTS An intense inflammatory profile was identified, with significantly increased concentrations of urinary IL-2, IL-4, IL-6, TNF, sTNFRI, sTNFRII, IFN-γ, MCP-1/CCL2, eotaxin/CCL11 and IL-8/CXCL8 in the PUV group compared to the controls. The same was observed for the anti-inflammatory cytokine IL-10 and for the fibrogenic mediator TGF-β. In the correlation analysis, β2-microglobulin positively correlated with the presence of MCP-1/CCL2, sTNFRI and eotaxin/CCL11 and negatively correlated with the presence of creatinine. CONCLUSIONS This study shows that inflammatory molecules are already increased in fetuses with PUV at the mean gestational age of 22 weeks, suggesting a physiopathological role for inflammation just after the embryological formation of the urethral membrane.
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Affiliation(s)
- Érica Leandro Marciano Vieira
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG), Avenida Alfredo Balena, 190, 2° andar, sala 281, 30.130-100, Belo Horizonte, MG, Brazil
| | - Natalia Pessoa Rocha
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG), Avenida Alfredo Balena, 190, 2° andar, sala 281, 30.130-100, Belo Horizonte, MG, Brazil
| | - Fernando Macedo Bastos
- Fetal Medicine Unit, Department of Gynecology and Obstetrics, UFMG, Belo Horizonte, MG, Brazil
| | - Kátia Daniela da Silveira
- National Institute of Science and Technology in Molecular Medicine (INCT-MM), Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Alamanda K Pereira
- Fetal Medicine Unit, Department of Gynecology and Obstetrics, UFMG, Belo Horizonte, MG, Brazil
| | - Eduardo Araújo Oliveira
- Fetal Medicine Unit, Department of Gynecology and Obstetrics, UFMG, Belo Horizonte, MG, Brazil.,Pediatric Nephrology Unit, Department of Pediatrics, UFMG, Belo Horizonte, MG, Brazil
| | - Débora Marques de Miranda
- National Institute of Science and Technology in Molecular Medicine (INCT-MM), Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil.,Pediatric Nephrology Unit, Department of Pediatrics, UFMG, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG), Avenida Alfredo Balena, 190, 2° andar, sala 281, 30.130-100, Belo Horizonte, MG, Brazil. .,Fetal Medicine Unit, Department of Gynecology and Obstetrics, UFMG, Belo Horizonte, MG, Brazil. .,Pediatric Nephrology Unit, Department of Pediatrics, UFMG, Belo Horizonte, MG, Brazil.
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Niyogi A, Lumpkins K, Robb A, McCarthy L. Cystometrogram appearance in PUV is reliably quantified by the shape,wall, reflux and diverticuli (SWRD) score, and presages the need for intervention. J Pediatr Urol 2017; 13:265.e1-265.e6. [PMID: 28159527 DOI: 10.1016/j.jpurol.2016.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 12/03/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Radiological bladder abnormalities in boys with posterior urethral valves (PUV) are well recognised; however, the assessment is subjective. The shape, wall, reflux and diverticuli (SWRD) score objectively assesses shape, wall, reflux and diverticuli in a simple way. This study was undertaken to demonstrate that the SWRD score is reliable, reproducible and correlates with bladder outcome and videourodynamic (VUD) assessment in boys with PUV. MATERIALS AND METHODS Three blinded assessors determined the SWRD scores of PUV bladders from cystometrograms taken during VUD from September 2012 to October 2013. The scores were correlated with clinical outcome and VUD pressure measurements. Data were given as median (interquartile range), non-parametric tests used as appropriate (Mann-Whitney U test, or Kruskall-Wallis) and P < 0.05 was taken as significant. RESULTS A total of 55 boys with PUV underwent VUD assessment, for which 52 cystometrograms were available. The SWRD score for non-operative management was 1.0 (0.1-1.9) vs 2.0 (1.0-3.3) for operative intervention, P = 0.018 (Summary Figure). The SWRD score for compliant bladders was 1.1 (0.6-2.0) vs hypercompliant 1.7 (0.5-2.8) vs non-compliant 3.3 (2.8-5.0), Kruskall-Wallis P = 0.011. The hostile detrusor overactivity (DO) bladders (Pdet >40 cmH2O) had a SWRD score of 2.0 (1.3-3.7) vs 1.0 (0.5-2.5) for low-pressure DO bladders, P < 0.05. DISCUSSION In this series of patients, increasingly distorted bladder shape was seen to be associated with poor bladder dynamics on VUD. Patients with poorly compliant bladders had a significantly higher SWRD score than normal or megacystis patients. Severe DO was also significantly associated with a high SWRD score. Therefore, the radiological appearance of a hostile bladder represented a marker for high intravesical pressure. VUR and bladder diverticuli may lead to spurious pressure measurements during VUD; however, the SWRD score provided an independent mechanism with which to objectively assess these patients, even in the presence of gross VUR. CONCLUSIONS The SWRD score is a simple and objective scoring system for the radiological abnormalities of PUV bladders. It correlates with clinical outcome and VUD assessment of compliance and DO, but is independent of pressure measurements and so not confounded by VUR acting as a 'pop-off' mechanism.
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Affiliation(s)
- A Niyogi
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B46NH, United Kingdom
| | - K Lumpkins
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B46NH, United Kingdom
| | - A Robb
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B46NH, United Kingdom
| | - L McCarthy
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B46NH, United Kingdom.
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Faure A, Panait N, Panuel M, Alessandrini P, D'Ercole C, Chaumoitre K, Merrot T. Predicting postnatal renal function of prenatally detected posterior urethral valves using fetal diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient determination. Prenat Diagn 2017; 37:666-672. [DOI: 10.1002/pd.5063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 03/29/2017] [Accepted: 04/21/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Alice Faure
- Aix-Marseille Université; Marseille France
- Paediatric Surgery Department; APHM, CHU Hopital Nord; Marseille France
| | - Nicoleta Panait
- Aix-Marseille Université; Marseille France
- Paediatric Surgery Department; APHM, CHU Hopital Nord; Marseille France
| | - Michel Panuel
- Aix-Marseille Université; Marseille France
- Medical Imaging Department; APHM, CHU Hopital Nord; Marseille France
| | - Pierre Alessandrini
- Aix-Marseille Université; Marseille France
- Paediatric Surgery Department; APHM, CHU Hopital Nord; Marseille France
| | - Claude D'Ercole
- Aix-Marseille Université; Marseille France
- Gynecologic & Obstetrical Department; APHM, CHU Hopital Nord; Marseille France
| | - Kathia Chaumoitre
- Aix-Marseille Université; Marseille France
- Medical Imaging Department; APHM, CHU Hopital Nord; Marseille France
| | - Thierry Merrot
- Aix-Marseille Université; Marseille France
- Paediatric Surgery Department; APHM, CHU Hopital Nord; Marseille France
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Andrés-Jensen L, Jørgensen FS, Thorup J, Flachs J, Madsen JL, Maroun LL, Nørgaard P, Vinicoff PG, Olsen BH, Cortes D. The outcome of antenatal ultrasound diagnosed anomalies of the kidney and urinary tract in a large Danish birth cohort. Arch Dis Child 2016; 101:819-24. [PMID: 27217581 DOI: 10.1136/archdischild-2015-309784] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/29/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Antenatal ultrasound diagnosed anomalies of the kidney and urinary tract (AUDAKUT) are reported in 0.3%-5% on prenatal ultrasound (US) and 0.3%-4.5% on postnatal US. The anterior-posterior diameter of the renal pelvis (APD) is an essential measurement. Series with low threshold values of APD prenatally and postnatally will include healthy infants. It is important to avoid follow-up of such infants. INTERVENTIONS In 2006, new Danish guidelines for AUDAKUT were introduced. AIM OF STUDY Investigations of incidences and type of AUDAKUT based on Danish guidelines, including long-term follow-up. DESIGN Cohort study. SETTING Copenhagen University Hospital Hvidovre and Copenhagen University Hospital Rigshospitalet, Denmark. PATIENTS Consecutive cases with AUDAKUT in the second and third trimesters, which were either terminated before 22 completed weeks of gestation or born in the 8-year period January 2006-December 2013. Patients were followed until June 2014. RESULTS 50 193 live born children and 24 terminated fetuses (0.05%) were included. The prevalence of AUDAKUT was only 0.39% prenatally, 0.29% at first postnatal US and 0.22% at the end of follow-up, including terminated cases. The greater the prenatal and postnatal APD, the higher risk of febrile urinary tract infection (fUTI) and surgical intervention, and lower probability of resolution. 25% of the identified patients had fUTI and/or surgery. CONCLUSIONS We recommend threshold values of APD at least 10 mm in the third trimester and in general at least 12 mm at first postnatal US for intensive follow-up. In this largest to date unselected birth cohort of AUDAKUT, the incidences of clinically significant AUDAKUT were in the lowest range of those previously published.
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Affiliation(s)
- Liv Andrés-Jensen
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Finn Stener Jørgensen
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Jorgen Thorup
- Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Julie Flachs
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Jan Lysgaard Madsen
- Department of Clinical Physiology and Nuclear Medicine, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Lisa Leth Maroun
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pernille Nørgaard
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Pablo Gustavo Vinicoff
- Department of Radiology and Ultrasound, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Beth Härstedt Olsen
- Department of Radiology and Ultrasound, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Dina Cortes
- Department of Paediatrics, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Faure A, Bouty A, Caruana G, Williams L, Burgess T, Wong MN, James PA, O'Brien M, Walker A, Bertram JF, Heloury Y. DNA copy number variants: A potentially useful predictor of early onset renal failure in boys with posterior urethral valves. J Pediatr Urol 2016; 12:227.e1-7. [PMID: 27160979 DOI: 10.1016/j.jpurol.2016.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/29/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Posterior urethral valves (PUV) are among the most common urological causes of chronic kidney disease (CKD) in childhood. Recently, genomic imbalances have been cited as potential risk factors for altered kidney function and have been associated with CKD. The phenotypic effects of a copy number variant (CNV) in boys with PUV are unknown. Here, it was hypothesised that the progression to early renal failure in PUV patients may be influenced by genetic aberrations. OBJECTIVE To assess the relationship between CNVs and renal outcomes. PATIENTS AND METHODS Between September 2012 and July 2015, 45 children with PUV were recruited to evaluate the presence of CNVs in their DNA. The patients' medical records were retrospectively reviewed. The criteria for outcomes of renal function included: assessments of the nadir serum creatinine in the first year of life, the estimated glomerular filtration rate at 1 and 5 years, and the requirement for renal replacement. RESULTS Thirteen CNVs were identified in 12 boys (29% of the cohort). Microarray analysis revealed two pathogenic CNVs (well-established CNVs known to be associated with genetic disease) and 11 of unknown significance (CNVs with insufficient current available evidence for unequivocal determination of clinical significance), including genes that have been previously implicated in kidney diseases and urogenital disorders. The median follow-up was 10.2 years (range 3-17.5) in the group of patients with CNV compared with 5.8 years (range 1-16.6) in those CNV-. The nadir creatinine values were significantly higher in boys with CNVs than in those without CNVs (57.5 μmol/L (range 23-215) and 28 μmol/L (range 18-155), respectively (P = 0.05) (Figure). Boys CNV+ had a worse prognosis, with a higher incidence of Stage-V CKD compared with the control group (33% with CNVs vs. 9% in CNV-, P = 0.06) at a median age of 22 months (range 8 months-16 years). Four (33%) patients CNV+ underwent renal transplantation. DISCUSSION The role of CNVs in the deterioration of renal function remains unknown. It can be hypothesised that CNVs could be a contributing factor or may serve as an accelerant for the progression to renal failure. CONCLUSION The CNVs >100 Kb were significantly associated with early onset renal failure in children with PUV. Prenatal detection of CNV could help to identify foetuses at high risk of severe renal impairment in cases of suspected PUV, especially in cases without oligohydramnios or severe pulmonary hypoplasia. These preliminary results should be confirmed in a larger cohort of patients.
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Affiliation(s)
- A Faure
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia.
| | - A Bouty
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - G Caruana
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | - L Williams
- Royal Children's Hospital, VCGS, Parkville, VIC 3052, Australia
| | - T Burgess
- Royal Children's Hospital, VCGS, Parkville, VIC 3052, Australia; Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC 3010, Australia
| | - M N Wong
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | - P A James
- Royal Children's Hospital, VCGS, Parkville, VIC 3052, Australia
| | - M O'Brien
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - A Walker
- Department of Paediatric Nephrology, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - J F Bertram
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | - Y Heloury
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia
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Fertility and sexual dysfunction issues in adults with genitourinary congenital anomalies. Curr Opin Urol 2016; 26:357-62. [PMID: 27139192 DOI: 10.1097/mou.0000000000000295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW As growing numbers of adolescents with a history of congenital genitourinary anomalies successfully enter adulthood, their spectrum of urologic concerns broadens to include sexual function and reproduction. RECENT FINDINGS In hypospadias repair, preoperative testosterone was found to reduce rates of postoperative complications of urethrocutaneous fistula formation and meatal stenosis. Following hypospadias correction, dissatisfaction with surgical outcomes has been observed to correlate with psychological outcomes, rather than objective measurements such as location of meatus degree of curvature. In women with a congenital absence of a vagina, sigmoid vaginoplasty and dilation yield similar sexual outcomes, however, vaginoplasty was associated with a 20% rate of reoperation. Ilioinguinal-to-dorsal neurorrhaphy for restoration of penile sensation in myelomeningocele has shown success in a small pilot study. Both sexual activity and paternity rates are higher in women, compared with men who are born with bladder exstrophy. SUMMARY The extent and complexity of issues related to sexual function and fertility in the population of patients with a history of genitourinary malformation requires a thoughtful approach to timely surgical management and consistent care through their transition from childhood to adulthood.
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Bagga HS, Lin S, Williams A, Schold J, Chertack N, Goldfarb D, Wood H. Trends in Renal Transplantation Rates in Patients with Congenital Urinary Tract Disorders. J Urol 2016; 195:1257-62. [PMID: 26926553 DOI: 10.1016/j.juro.2015.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Improved bladder and renal management benefit patients with congenital uropathy and congenital pediatric kidney disease. This may translate to delayed initial renal transplantation in these patients, and improved graft and patient survival. Our primary study purpose was to determine whether patients with congenital uropathy and congenital pediatric kidney disease have demonstrated later time to first transplantation and/or graft survival. MATERIALS AND METHODS SRTR (Scientific Registry of Transplant Recipients) was analyzed for first renal transplant and survival data in patients with congenital uropathy and congenital pediatric kidney disease from 1996 to 2012. Congenital uropathy included chronic pyelonephritis/reflux, prune belly syndrome and congenital obstructive uropathy. Congenital pediatric kidney disease included polycystic kidney disease, hypoplasia, dysplasia, dysgenesis, agenesis and familial nephropathy. RESULTS A total of 7,088 patients with congenital uropathy and 24,315 with congenital pediatric kidney disease received a first renal transplant from 1996 to 2012. A significant shift was seen in both groups toward older age at initial renal transplantation in those 18 through 64 years old. In the congenital uropathy group this effect was most facilitated by decreased renal transplantion in patients between 18 and 35 years old (38% in 1996 vs 26% in 2012). The congenital pediatric kidney disease group showed a substantial decrease in patients who were 35 to 49 years old (from 39% to 29%). At 10-year followup the congenital uropathy group showed better graft and patient survival than the congenital pediatric kidney disease group. However, aged matched comparison revealed comparable survival rates in the 2 groups. CONCLUSIONS Analysis of trends in the last 14 years demonstrated that patients with both lower and upper tract congenital anomalies experienced delayed time to the first renal transplant. Furthermore, patients had similar age matched graft and patient survival whether the primary source of renal demise was the congenital lower or upper tract. These findings may indicate that improved urological and nephrological care are promoting renal preservation in both groups.
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Affiliation(s)
- Herman S Bagga
- Department of Urology, Cleveland Clinic, Cleveland, Ohio.
| | - Songhua Lin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Alun Williams
- Transplant Unit, Department of Paediatric Urology, Nottingham Children's Hospital, Nottingham, United Kingdom
| | - Jesse Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Nathan Chertack
- Case Western Reserve University of Medicine, Cleveland, Ohio
| | - David Goldfarb
- Department of Urology, Cleveland Clinic, Cleveland, Ohio
| | - Hadley Wood
- Department of Urology, Cleveland Clinic, Cleveland, Ohio
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Abstract
This article summarizes the most recent literature regarding congenital lower urinary tract obstruction in the fetus and newborn. Lower urinary tract obstruction is a heterogeneous group of rare diagnoses that have significant potential for in utero mortality and long-term morbidity in survivors. The diagnosis and management of the most common causes are reviewed. In addition, the current state of prenatal intervention for congenital lower urinary tract obstruction is discussed.
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Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA.
| | - John W Brock
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA
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Re: Role of vesicostomy in the management of posterior urethral valve in sub-Sahara Africa. J Pediatr Urol 2014;10:62-6. J Pediatr Urol 2014; 10:790. [PMID: 24993420 DOI: 10.1016/j.jpurol.2014.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/24/2022]
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