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Chertin L, Neeman BB, Jaber J, Verhovsky G, Zisman A, Mamber A, Kafka I, Natsheh AE, Koulikov D, Shenfeld OZ, Chertin B, Koucherov S, Neheman A. Our experience with management of congenital urological pathologies in adulthood: What pediatric urologists should know and adult urologists adopt in pediatric practice experience. Curr Urol 2024; 18:7-11. [PMID: 38505161 PMCID: PMC10946651 DOI: 10.1097/cu9.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/19/2023] [Indexed: 03/21/2024] Open
Abstract
Purpose To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. Materials and methods We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. Results The study included 102 patients with a median age of 25 (interquartile range, 23-36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12-54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1-2). Conclusions Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.
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Affiliation(s)
- Leon Chertin
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
| | - Binyamin B. Neeman
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Jawdat Jaber
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Guy Verhovsky
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
| | - Ariel Mamber
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Ilan Kafka
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Ala Eddin Natsheh
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Dmitry Koulikov
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Ofer Z. Shenfeld
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Boris Chertin
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Stanislav Koucherov
- Department of Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel (Affiliated with the Faculty of Medicine, The Hebrew University, Jerusalem, Israel)
| | - Amos Neheman
- Department of Urology, Shamir Medical Center, Zerifin, Israel (Affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel)
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Wang J, Zhao Y, Chen Z, Geng H, Fang X. Ureterocele with duplex collecting systems and febrile urinary tract infection risk. Pediatr Surg Int 2023; 39:200. [PMID: 37191737 DOI: 10.1007/s00383-023-05442-w] [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] [Accepted: 03/10/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Ureterocele has been hypothesized to be the risk factor for febrile urinary tract infections (F-UTIs) in patients with duplex collecting systems, but this has not been proved, and our goal was to assess the relation between ureterocele with duplex collecting systems and F-UTIs. METHODS We included individual-participant data from patients seen for complicated duplex collecting systems from 2010 to 2020 retrospectively followed. Those with using continuous low-dose antibiotic prophylaxis and incompletely duplicated systems were removed from the study. The participants were divided into two cohorts according to patients with or without ureterocele. The primary endpoint of this study was recurrent F-UTIs. RESULTS We analyzed medical reports of 300 patients, of which 75% were female. Among the 300 patients, F-UTIs developed in 111/159 (69.8%) patients in the ureterocele group and in 69/141 (48.9%) patients in the no-ureterocele group. Univariate analysis found no discernible difference except in grade of hydronephrosis between ureterocele group and no-ureterocele group. Moreover, Cox proportional regression analysis revealed that patients of duplex system ureterocele might be intrinsically more prone to develop F-UTIs (adjusted hazard ratio 1.894; 95% CI 1.412-2.542; p < 0.001). CONCLUSION Among participants with duplex systems, the risk of recurrent F-UTIs in patients with ureterocele was higher than patients without it, and mini-invasive surgical correction should be considered at young age to reduce F-UTIs.
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Affiliation(s)
- Jinbin Wang
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Department of Pediatric Urology, Women and Children's Hospital, Qingdao University, Qingdao, People's Republic of China
| | - Yining Zhao
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, People's Republic of China
| | - Zhoutong Chen
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hongquan Geng
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaoliang Fang
- Department of Pediatric Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
- Department of Pediatric Urology, Shanghai Xinhua Hospital, No. 1665 Kongjiang Road, Shanghai, People's Republic of China.
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Morgan KE, Yeaman C, Ross SS, Michael J, Pohl HG, Casella DP, Sprague BM, Zee RS, Herndon CDA, Kern NG. Upper pole pathologies in duplex kidneys: an analysis of predictive factors for surgery and urinary tract infections from the Mid-Atlantic Pediatric Academic Consortium. J Pediatr Urol 2022; 18:803.e1-803.e6. [PMID: 35691790 DOI: 10.1016/j.jpurol.2022.05.019] [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: 02/28/2022] [Revised: 05/03/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE While there is significant data on the natural history and outcomes for prenatal hydronephrosis in simplex kidneys, duplex kidneys tend to be less studied. Management can be quite variable based on provider preference. We aimed to describe practice patterns from several tertiary academic institutions, identify clinical predictors for surgical intervention and urinary tract infection (UTI) for upper pole pathology, and demonstrate the natural history of lower pole vesicoureteral reflux (VUR). METHODS We conducted a retrospective review of patients from 4 Mid-Atlantic institutions between 2015 and 2020. Inclusion criteria included patients with a duplex kidney with upper pole pathology and/or lower pole VUR. The primary outcome was predictive factors for surgical intervention and UTI. The secondary outcome was to assess the natural history of lower pole VUR including resolution rates by grade. Linear regression identified clinical predictors for UTI events. Multivariate logistic regression identified predictors of surgical intervention, UTI, and lower pole VUR resolution. Descriptive statistics and regression modeling analyses were performed using SAS. RESULTS Two hundred forty-two patients were included with a total of 271 duplex renal units. Hydronephrosis grade (both SFU and UTD grading) and number of prior UTI events were statistically significant predictors for surgical intervention (p = 0.03/0.001 and p = 0.002 respectively). Ectopic ureter (p = 0.004), ureterocele (p = 0.02), and obstruction (p = 0.04) were the only pathologies predictive for surgery. Male gender and circumcision were significantly associated with decreased UTI risk (p = 0.03 and p = 0.01). On linear regression modeling, antibiotic prophylaxis after the first year of life was associated with decreased risk of further UTI events (p = 0.03); however, antibiotic prophylaxis within the first year of life did not decrease UTI risk (p = 0.14). For VUR outcomes, 65.0% of grades 1-3 VUR and 52.2% of grades 4-5 had resolution/improvement at mean time of 2.1 years. There were no predictive factors for resolution/improvement of VUR. CONCLUSIONS Hydronephrosis grade and UTI events were significant predictors for surgical intervention for upper pole pathology. Pathologies that were predictive for surgery included ectopic ureter, ureterocele and obstruction. Male gender, circumcision and antibiotic prophylaxis after the first year of life were associated with a decreased UTI risk. Roughly 58% of lower pole VUR spontaneously improved/resolved. Identification of these risk factors aids in standardization of care practices to reduce long-term UTI risk and inform counseling with families about possible need for surgical intervention and expectations for long term outcomes.
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Affiliation(s)
- Kathryn E Morgan
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Clinton Yeaman
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Sherry S Ross
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Jamie Michael
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Hans G Pohl
- Department of Surgery, Division of Pediatric Urology, Washington, DC, USA
| | - Daniel P Casella
- Department of Surgery, Division of Pediatric Urology, Washington, DC, USA
| | - Bruce M Sprague
- Department of Surgery, Division of Pediatric Urology, Washington, DC, USA
| | - Rebecca S Zee
- Department of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Nora G Kern
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
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Sepúlveda-González G, Villagomez-Martínez GE, Arroyo-Lemarroy T, Hinojosa-Lezama JM, Lizarraga-Cepeda E, Martinez-Portilla RJ. Fetal surgery for obstructive ureterocele using an ultrasound-guided needle laser ablation technique: a case series. J Matern Fetal Neonatal Med 2022; 35:9857-9863. [PMID: 35403539 DOI: 10.1080/14767058.2022.2061345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Obstructive ureterocele is an intravesical cystic dilation of the distal end of the ureter associated with anhidramnios and dilation of both renal pelvises. METHODS This is a case-series of prenatally diagnosed ureterocele. Cases were selected at a third level reference hospital in Monterrey Mexico between 2010 and 2018. Eligible patients for fetal therapy were selected when bilateral hydronephrosis and severe oligohydramnios were found before 26+0 weeks of gestation. The fetal intervention comprised an ultrasound-guided needle laser technique for ureterocele ablation. RESULTS There were six cases of prenatal diagnosed of ureterocele, two cases showed anhidramnios at 23 weeks of gestation and were considered obstructive ureterocele. For these two cases, fetal surgery was performed using laser ablation of the ureterocele through an ultrasound-guided needle. In both, the urinary tract was decompressed, and the volume of amniotic fluid improved allowing to carry both pregnancies until term, one of them vaginally and the other by cesarean section. In the postnatal follow-up of both cases, the first neonate died due to neonatal asphyxia at 48-hours, and the second neonate required removal of the abnormal collecting system. CONCLUSIONS The use of ultrasound-guided laser ablation for the decompression of obstructive ureterocele is a safe and feasible technique in extremely premature fetuses that could allow survival of the affected fetus until term. Patients receiving an early prenatal diagnosis of obstructive ureterocele may benefit from fetal therapy to reduce the risk of lung hypoplasia and stillbirth.Established factsPrenatal mortality of bilateral obstructive ureterocele is up to 45%.Only a few techniques have been described for the management of prenatally bilateral obstructive ureterocele; among them, the puncturing of the ureterocele which may require more than one intervention during fetal, laser by fetoscopy which may increase the risk of postoperative complications, and ultrasound-guided laser fulguration which seems to be effective and safe.Novel insightsThe present is the first description of a case series on ureteroceles comprising two ultrasound-guided laser therapy as an effective treatment for bilateral obstructive ureterocele requiring a single intervention.The use of ultrasound-guided laser in obstructive cases avoids fatality and lung hypoplasia due to severe oligohydramnios. Still, the neonatal prognosis of the affected side at two years of age remains unchanged.
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Affiliation(s)
- Gerardo Sepúlveda-González
- Medicina Perinatal Alta Especialidad, Hospital Christus Muguerza Alta Especialidad, Monterrey, NL, México.,Medicina y Cirugía Fetal Monterrey, San Pedro Garza García, NL, México
| | - Gabriel Edgar Villagomez-Martínez
- Medicina Perinatal Alta Especialidad, Hospital Christus Muguerza Alta Especialidad, Monterrey, NL, México.,Hospital Universitario "Dr. José E González", Universidad Autonoma de Nuevo León, Monterrey, NL, México
| | - Tayde Arroyo-Lemarroy
- Hospital Regional de Alta Especialidad Materno Infantil de Nuevo León, Guadalupe, NL, México
| | - Jose Miguel Hinojosa-Lezama
- Hospital Universitario "Dr. José E González", Universidad Autonoma de Nuevo León, Monterrey, NL, México.,Centro Médico Zambrano Hellion, TEC de Monterrey, Monterrey, NL, México
| | - Esteban Lizarraga-Cepeda
- Medicina Perinatal Alta Especialidad, Hospital Christus Muguerza Alta Especialidad, Monterrey, NL, México.,Medicina y Cirugía Fetal Monterrey, San Pedro Garza García, NL, México.,Hospital Regional de Alta Especialidad Materno Infantil de Nuevo León, Guadalupe, NL, México
| | - Raigam Jafet Martinez-Portilla
- Fetal Medicine Research Center, BCNatal. Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Clinical Research Division, National Institute of Perinatology, Mexico City, Mexico
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The value of the routine third trimester ultrasound scan in antenatal care. Eur J Obstet Gynecol Reprod Biol 2020; 245:51-55. [DOI: 10.1016/j.ejogrb.2019.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 11/22/2022]
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