Objective:Vesicoureteral reflux(VUR)index is a simple,validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children.The aim of this study was to evaluate and co...Objective:Vesicoureteral reflux(VUR)index is a simple,validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children.The aim of this study was to evaluate and compare the ureter diameter ratio(UDR)and VUR index(VURx)of patients treated with endoscopic injection(EI)and ureteroneocystostomy(UNC)methods in the pediatric age group due to primary VUR.Methods:Patients under the age of 18 years old who underwent EI and UNC with the diagnosis of primary VUR between January 2011 and September 2021 were determined as the participants.The UDR was assessed using voiding cystourethrography,and the VURx score was determined prior to treatment based on hospital records included in the study.Results:A total of 255 patients,60(23.5%)boys and 195(76.5%)girls,with a mean age of 76.5(range 13.0e204.0)months,were included in the study.EI was applied to 130(51.0%)patients and UNC was applied to 125(49.0%)patients due to primary VUR.The optimum cut-off for the distal UDR was obtained as 0.17 with sensitivity and specificity of 73.0%and 63.0%,respectively.The positive and negative predictive values were 66.0%and 70.0%,respectively.Conclusion:When the UDR and VURx score are evaluated together for the surgical treatment of primary VUR in the pediatric age group,it is thought that it may be useful in predicting the clinical course of the disease and evaluating surgical treatment options.展开更多
Vesicoureteral reflux(VUR)is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare.We recruited 35 primary VUR patients...Vesicoureteral reflux(VUR)is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare.We recruited 35 primary VUR patients with recurrent urinary tract infection(UTI)and 10 non-VUR patients with recurrent UTI.Contrast-enhanced voiding urosonography(ceVUS)was performed for VUR grading,and renal dynamic imaging was used for evaluating glomerular filtration rate(GFR,mL/min).Standardized GFR(sGFR),namely GFR/BSA(mL·min-1·m-2),was calculated based on the body surface area(BSA).Total sGFR(tsGFR,mL·min-1·m-2)was obtained from the sum of sGFR on the left and right sides of all the children.The risk of renal regurgitation was equal in the unilateral reflux group.The sGFR of children with grade Ⅳ(45.74±18.05mL·min-1·m-2)and grade V(49.67±23.63mL·min-1·m-2)reflux was significantly lower than that in children with grade Ⅱ(77.69±22.21 mL·min-1·m-2).The renal function compensation of contralateral non-reflux kidney increased in unilateral reflux group,which was higher than that in the control group and level Ⅱ,Ⅳ and Ⅴ of reflux group respectively.In VUR group of the same grade,sGFR decreased with the age at diagnosis.In unilateral grade V refux group,the tsGFR was lower than that in the unilateral grade I reflux group(133.51±48.21 vs.186.87+53.49mL·min-1·m-2).The patients with VUR of unilateral grade Ⅱ were significantly older than those with VUR of unilateral grades Ⅱ and Ⅳ.This study indicates that severe VUR is significantly associated with decreased renal function.Therefore,VUR should be diagnosed early and managed individually.展开更多
AIM To evaluate the risk profile of sulfur hexafluoride in voiding urosonography(VUS) based on a large cohort of children.METHODS Since 2011 sulfur hexafluoride(SH,SonoV ue?,Bracco,Italy) is the only ultrasound contra...AIM To evaluate the risk profile of sulfur hexafluoride in voiding urosonography(VUS) based on a large cohort of children.METHODS Since 2011 sulfur hexafluoride(SH,SonoV ue?,Bracco,Italy) is the only ultrasound contrast available in the European Union and its use in children has not been approved.Within a 4-year-period,531 children with suspected or proven vesicoureteral reflux(f/m = 478/53; mean age 4.9 years; 1 mo-25.2 years) following parental informed consent underwent VUS with administration of 2.6 ± 1.2 mL SH in a two-center study.A standardizedtelephone survey on adverse events was conducted three days later.RESULTS No acute adverse reactions were observed.The survey revealed subacute,mostly self-limited adverse events in 4.1%(22/531).The majority of observed adverse events(17/22) was not suspected to be caused by an allergic reaction: Five were related to catheter placement,three to reactivated urinary tract infections,five were associated with perineal disinfection before voiding urosonography or perineal dermatitis and four with a common cold.In five patients(0.9%) hints to a potential allergic cause were noted: Perineal urticaria was reported in three interviews and isolated,mild fever in two.These were minor self-limited adverse events with a subacute onset and no hospital admittance was necessary.Ninety-six point two percent of the parents would prefer future VUS examinations with use of SH.CONCLUSION No severe adverse events were observed and indications of self-limited minor allergic reactions related to intravesical administration of SH were reported in less than 1%.展开更多
BACKGROUND Crossed fused renal ectopia is a rare congenital anomaly of the ascent of the kidney. This anomaly may be observed as a solitary kidney during initial evaluation. A solitary kidney must be evaluated for ass...BACKGROUND Crossed fused renal ectopia is a rare congenital anomaly of the ascent of the kidney. This anomaly may be observed as a solitary kidney during initial evaluation. A solitary kidney must be evaluated for associated anomalies such as duplication,horseshoe kidney,or crossed renal ectopia.CASE SUMMARY An anomaly was observed in a 9-mo-old male child who was subsequently diagnosed with crossed fused renal ectopia and vesicoureteral reflux(VUR). In this condition,recurrent febrile urinary tract infection can be a serious problem,and can easily cause renal damage due to relatively short ureters and high pressure in the kidney.CONCLUSION To prevent urosepsis and preserve renal function,early diagnosis and proper management including surgical correction should be considered for the management of renal ectopia with VUR.展开更多
Background:Vesicoureteral reflux is the most common urinary congenital anomaly in children.Given the risk associated with radiation exposure there has been an increasing need for radiation-free method in the diagnosis...Background:Vesicoureteral reflux is the most common urinary congenital anomaly in children.Given the risk associated with radiation exposure there has been an increasing need for radiation-free method in the diagnosis and follow-up of the vesicoureteral reflux.The aim of our study is to compare conventional urosonography without contrast enhancement and x-ray voiding cystourethrography.Patients and Methods:Children with recurrent urinary tract infection with suspected vesicoureteral reflux were included to the study.Vesicoureteral reflux is demonstrated and graded by x-ray voiding cystourethrography.DMSA is used for the evaluation of renal scar.Conventional sonographic procedure was performed in all patients.Ureterovesical junction insertion angle was evaluated.The diameter and length of the ureterovesical junction were also measured.Results:268 children enrolled to the study.Vesicoureteral reflux was demonstrated in 62 children by x-ray voiding cystourethrography.Ureterovesical junction insertion angle measurement had a statistically significant relation for right and left vesicoureteral reflux presence(right:r:.646,p:.01 and left:r:.446,p:.01).Diagnosis sensitivity of vesicoureteral reflux with conventional ultrasonography is 95.10%and specificity is 81%(Youden’s index 76.1%)for the cutoff value of the ureterovesical junction insertion angle is 28.6 degrees.Positive predictive value is 87.2%,negative predictive value is 94.73%and diagnostic accuracy is 86.29%with conventional ultrasonography.Conclusions:Measurement of ureterovesical junction insertion angle,length and diameter by conventional urosonography is an easy accessible and cheap technique with high sensitivity and specificity for the diagnosis and followup of the vesicoureteral reflux without exposure to ionizing radiation.展开更多
Purpose: Partial resection of the distal ureter is commonly performed during reconstructive surgery in pediatric urology;particularly for correction of vesicoureteral reflux (VUR) and ureterovesical junction obstructi...Purpose: Partial resection of the distal ureter is commonly performed during reconstructive surgery in pediatric urology;particularly for correction of vesicoureteral reflux (VUR) and ureterovesical junction obstruction (UVJO). Many hospitals require pathologic examination of all excised tissues. We examined the pathologic findings in such specimens to evaluate the utility of this practice. Methods: We reviewed the findings on pathologic examination of distal ureteral segments excised during surgical correction of VUR and UVJO in children by a single surgeon over a 13-year period. Results: One hundred and ninety-one specimens from 126 patients were reviewed. None were found to have any significant pathologic findings that impacted therapy. Conclusion: Routine pathological examination of distal ureteral segments excised during surgical correction of VUR and UVJO is not warranted. This presents potential for cost and resource reduction in care of these patients.展开更多
Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outc...Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outcomes of unilateral periureteral injection technique(PIT),as well as bilateral PIT in high-grade VUR.Methods:In this prospective study,we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018.Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units,respectively.In the unilateral PIT,the subureteral injection site was only at the 5-or 7-o’clock position.However,in the bilateral PIT,the subureteral injection sites were at 5-and 7-o’clock position.Pre-and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery.Results:Seven patients had bilateral reflux.Overall,75(81.5%)ureters showed Grade IV VUR,while 17(18.5%)had primary Grade V VUR.The mean age of the subjects was 39.2 months.In unilateral PIT ureters,VUR was resolved in 23(92.0%)refluxing units.It was downgraded to Grade III in one ureter(4.0%)and to Grade II in another ureter(4.0%).In addition,in bilateral PIT cases,VUR was resolved in 60(89.6%)ureters;it downgraded to Grades II and III in 3(4.5%)and 4(6.0%)refluxing units,respectively.Conclusion:Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR.However,further studies are needed to confirm our results.展开更多
BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature tho...BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature though for what happens to such kidneys, in the long run, particularly those which are poorly functioning.AIM To assess the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with unilateral primary VUR.METHODS Children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and January 2017 were included in the study. Patients who had a follow up of less than five years were excluded. Preoperative evaluation consisted of a voiding cystourethrogram and Dimercaptosuccinic acid(DMSA) scan. In the follow-up period, patients underwent a diuretic scan at 6 weeks and 6 months.Follow up ultrasound was done for change in grade of hydronephrosis and retrovesical ureteric diameter. Subsequent follow up was done at 6 monthly intervals with evaluation for proteinuria and hypertension and any recurrent urinary tract infection(UTI). For assessment of cortical function, DMSA was repeated annually for 5 years after surgery. A paired-samples t-test was used to test the mean difference of DMSA between pre-post observations.RESULTS During this period, 36 children underwent ureteric reimplantation for unilateral primary VUR. After excluding those with insufficient follow-up, 31 were included in the analysis. Most of the patients were males(n = 26/31, 83.8%). Patient’s age(mean ± SD, range) was 5.21 ± 3.71, 1-18 years. The grades of VUR were grade Ⅱ(1patient), grade Ⅲ(8 patients), grade Ⅳ(10 patients), and grade Ⅴ(12 patients). The pre and postoperative DMSA was 24.064 ± 12.02 and 24.06 ± 10.93, which was almost the same(statistically equal, paired-samples t-test: P = 0.873). The median(range) follow-up duration was 82(60-120)mo. One patient had persistent reflux after surgery(preoperative: grade Ⅳ, postoperative: grade Ⅲ), and the very same patient developed recurrent UTI. The difference in the preoperative and postoperative DRF was less than 10% in 29 patients. In one patient, the DRF decreased by 17%(22% to 05%) while in another patient, the DRF increased by 12%(25% to 37%) after surgery. None of the patients had an increase in scarring after surgery. 15% of patients were hypertensive before surgery and all of them continued to be hypertensive after surgery while none developed hypertension after surgery. None of the patients had significant proteinuria(> 150 mg/d) during the follow-up period.CONCLUSION Children with unilateral primary VUR and poorly functioning kidney maintain the renal function over the long term in most cases. Hypertension and proteinuria do not progress over time in these patients.展开更多
A retrospective study for data record of 106 patients subjected to voiding cystourethrogram test (VCUG), sonography test, and dimercaptosuccinic acid (DMSA) scintigraphy take place at King Abdulaziz University, radiol...A retrospective study for data record of 106 patients subjected to voiding cystourethrogram test (VCUG), sonography test, and dimercaptosuccinic acid (DMSA) scintigraphy take place at King Abdulaziz University, radiology department to find out the possibilities of detecting vesicoureteral reflux (VUR) in infants and children. Hydronephrosis & Renal pelvis dilatation were the highest frequency reason for VUR scan study and represent 36% of the overall cases with 53% positive finding, while Recurrent UTI frequency was 22.6% with 83% positive finding, and patients who had history of VUR come at the third place with 15% frequency and 81% positive finding. VUR was found in 65 of 106 children representing 61%. Male children are more likely to diagnostic with VUR than female and they represented 69% while 31% for female. Among the children with VUR, 39 had high-grade reflux (grade IV or V), while 26 had low-grade reflux (grades I, II or III). When we classified VUR into low-grade and high-grade, we found the majority of children with high-grade VUR had an abnormal DMSA and represented 77.4%, while 13 children with low-grade VUR had normal study. These studies are agreed with the present study;most children with normal DMSA scan finding had low grade reflux. In this study, 48 of 65 children (74%) the DMSA scintigraphy shows abnormal findings during the period of UTI while the VCUG scan study shows VUR in 75% of the children during the period of UTI. Comparing results of ultrasound and VCUG scan, 59% of the ultrasound findings gave the same result as VCUG in detecting the VUR in children. Then we confirm it all with the urine culture results of the same children. We found the majority of children with VUR had abnormal US finding during the period of UTI and represented 83%.展开更多
Purpose: We studied the inheritance pattern, clinical features and outcome in children with vesicoureteral reflux (VUR). Characteristics of known familial VUR cases were also compared with those of sporadic VUR. Mater...Purpose: We studied the inheritance pattern, clinical features and outcome in children with vesicoureteral reflux (VUR). Characteristics of known familial VUR cases were also compared with those of sporadic VUR. Material and Methods: 726 patients were treated for VUR between 1990-2004. The families were contacted by letter inquiring if other members of the family were affected. The phenotype of all cases (familial and non-familial) was characterized in terms of presenting symptoms, reflux grade, recurrent urinary tract infections, kidney damage, and the natural course of reflux. Results: The response rate was 79%. A total of 99 individuals (22%) reported relatives with VUR. Since some of the 99 index cases belonged to the same family, the total number of families was ultimately 66. The distribution of relatives with VUR was: 38 siblings, 20 parents (15 mothers), 19 cousins, 15 aunts/uncles and 12 grandparents. The phenotype of VUR did not differ between familial and non-familial cases. However, VUR among relatives was of milder grade than index and sporadic cases. Conclusions: The proportion of hereditary reflux in our material was lower than in other studies (22%). We found a strong overrepresentation of maternal transmission of reflux. Severity of the disease did not differ between familial and non-familial VUR.展开更多
Background Primary vesicoureteral reflux(VUR)is a common congenital anomaly of the kidney and urinary tract(CAKUT)in childhood.The present study identified the possible genetic contributions to primary VUR in children...Background Primary vesicoureteral reflux(VUR)is a common congenital anomaly of the kidney and urinary tract(CAKUT)in childhood.The present study identified the possible genetic contributions to primary VUR in children.Methods Patients with primary VUR were enrolled and analysed based on a national multi-center registration network(Chinese Children Genetic Kidney Disease Database,CCGKDD)that covered 23 different provinces/regions in China from 2014 to 2019.Genetic causes were sought using whole-exome sequencing(WES)or targeted-exome sequencing.Results A total of 379 unrelated patients(male:female 219:160)with primary VUR were recruited.Sixty-four(16.9%)children had extrarenal manifestations,and 165(43.5%)patients showed the coexistence of other CAKUT phenotypes.Eighty-eight patient(23.2%)exhibited impaired renal function at their last visit,and 18 of them(20.5%)developed ESRD at the median age of 7.0(IQR 0.9–11.4)years.A monogenic cause was identified in 28 patients(7.39%).These genes included PAX2(n=4),TNXB(n=3),GATA3(n=3),SLIT2(n=3),ROBO2(n=2),TBX18(n=2),and the other 11 genes(one gene for each patient).There was a significant difference in the rate of gene mutations between patients with or without extrarenal complications(14.1%vs.6%,P=0.035).The frequency of genetic abnormality was not statistically significant based on the coexistence of another CAKUT(9.6%vs.5.6%,P=0.139,Chi-square test)and the grade of reflux(9.4%vs.6.7%,P=0.429).Kaplan–Meier survival curve showed that the presence of genetic mutations did affect renal survival(Log-rank test,P=0.01).PAX2 mutation carriers(HR 5.1,95%CI 1.3–20.0;P=0.02)and TNXB mutation carriers(HR 20.3,95%CI 2.4–168.7;P=0.01)were associated with increased risk of progression to ESRD.Conclusions PAX2,TNXB,GATA3 and SLIT2 were the main underlying monogenic causes and accounted for up to 46.4%of monogenic VUR.Extrarenal complications and renal function were significantly related to the findings of genetic factors in children with primary VUR.Like other types of CAKUT,several genes may be responsible for isolated VUR.展开更多
Background:Urinary tract infection(UTI)is a prevalent bacterial infection affecting adults and pediatric populations,with distinct patterns observed in infants.This bibliometric analysis aims to provide a comprehensiv...Background:Urinary tract infection(UTI)is a prevalent bacterial infection affecting adults and pediatric populations,with distinct patterns observed in infants.This bibliometric analysis aims to provide a comprehensive overview of the research landscape in pediatric UTI from 1990 to 2022,exploring qualitative and quantitative research output,contributing authors,institutions,countries,collaborative links,and hotspot topics.Purpose:This study aims to evaluate the qualitative and quantitative research output and trends in UTI in the pediatric population through a bibliometric analysis.The analysis covers highly cited articles,contributing authors,institutes,countries,collaborative links,and future research prospects.Methods:A bibliometric analysis was conducted using the Web of Science platform with a search string focused on pediatric UTI articles published between January 1990 and December 2022.The analysis employed the Bibliometrix R-package software and VOSviewer for collaborative networks and keyword co-occurrence maps.Results:Out of 1399 published articles,81.7%were research articles.The annual growth rate of publications was 4.46%.The USA led in contributions,with the University of Pennsylvania being the most productive institution.The"Journal of Pediatric Urology"and"Pediatric"were prominent journals.Lorenzo AJ from the University of Toronto was the top author.Collaborative networks highlighted the significance of collaboration in pediatric UTI research.Conclusion:In conclusion,this bibliometric analysis provides a detailed snapshot of the research landscape in pediatric urinary tract infections.With 1399 articles analyzed,the study reveals a sustained interest and growth rate of 4.46%,emphasizing ongoing efforts to address pediatric UTI challenges.The USA dominates contributions,reflecting its pivotal role in advancing knowledge.The top institutions,journals,and authors are identified,with collaborative networks highlighted.Keyword co-occurrence networks unveil critical themes,notably"vesicoureteric reflux,""management,"and"diagnosis."展开更多
文摘Objective:Vesicoureteral reflux(VUR)index is a simple,validated tool that reliably predicts significant improvement and spontaneous resolution of primary reflux in children.The aim of this study was to evaluate and compare the ureter diameter ratio(UDR)and VUR index(VURx)of patients treated with endoscopic injection(EI)and ureteroneocystostomy(UNC)methods in the pediatric age group due to primary VUR.Methods:Patients under the age of 18 years old who underwent EI and UNC with the diagnosis of primary VUR between January 2011 and September 2021 were determined as the participants.The UDR was assessed using voiding cystourethrography,and the VURx score was determined prior to treatment based on hospital records included in the study.Results:A total of 255 patients,60(23.5%)boys and 195(76.5%)girls,with a mean age of 76.5(range 13.0e204.0)months,were included in the study.EI was applied to 130(51.0%)patients and UNC was applied to 125(49.0%)patients due to primary VUR.The optimum cut-off for the distal UDR was obtained as 0.17 with sensitivity and specificity of 73.0%and 63.0%,respectively.The positive and negative predictive values were 66.0%and 70.0%,respectively.Conclusion:When the UDR and VURx score are evaluated together for the surgical treatment of primary VUR in the pediatric age group,it is thought that it may be useful in predicting the clinical course of the disease and evaluating surgical treatment options.
基金This project was supported by the National Natural Science Foundation of China(No.81873596).
文摘Vesicoureteral reflux(VUR)is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare.We recruited 35 primary VUR patients with recurrent urinary tract infection(UTI)and 10 non-VUR patients with recurrent UTI.Contrast-enhanced voiding urosonography(ceVUS)was performed for VUR grading,and renal dynamic imaging was used for evaluating glomerular filtration rate(GFR,mL/min).Standardized GFR(sGFR),namely GFR/BSA(mL·min-1·m-2),was calculated based on the body surface area(BSA).Total sGFR(tsGFR,mL·min-1·m-2)was obtained from the sum of sGFR on the left and right sides of all the children.The risk of renal regurgitation was equal in the unilateral reflux group.The sGFR of children with grade Ⅳ(45.74±18.05mL·min-1·m-2)and grade V(49.67±23.63mL·min-1·m-2)reflux was significantly lower than that in children with grade Ⅱ(77.69±22.21 mL·min-1·m-2).The renal function compensation of contralateral non-reflux kidney increased in unilateral reflux group,which was higher than that in the control group and level Ⅱ,Ⅳ and Ⅴ of reflux group respectively.In VUR group of the same grade,sGFR decreased with the age at diagnosis.In unilateral grade V refux group,the tsGFR was lower than that in the unilateral grade I reflux group(133.51±48.21 vs.186.87+53.49mL·min-1·m-2).The patients with VUR of unilateral grade Ⅱ were significantly older than those with VUR of unilateral grades Ⅱ and Ⅳ.This study indicates that severe VUR is significantly associated with decreased renal function.Therefore,VUR should be diagnosed early and managed individually.
文摘AIM To evaluate the risk profile of sulfur hexafluoride in voiding urosonography(VUS) based on a large cohort of children.METHODS Since 2011 sulfur hexafluoride(SH,SonoV ue?,Bracco,Italy) is the only ultrasound contrast available in the European Union and its use in children has not been approved.Within a 4-year-period,531 children with suspected or proven vesicoureteral reflux(f/m = 478/53; mean age 4.9 years; 1 mo-25.2 years) following parental informed consent underwent VUS with administration of 2.6 ± 1.2 mL SH in a two-center study.A standardizedtelephone survey on adverse events was conducted three days later.RESULTS No acute adverse reactions were observed.The survey revealed subacute,mostly self-limited adverse events in 4.1%(22/531).The majority of observed adverse events(17/22) was not suspected to be caused by an allergic reaction: Five were related to catheter placement,three to reactivated urinary tract infections,five were associated with perineal disinfection before voiding urosonography or perineal dermatitis and four with a common cold.In five patients(0.9%) hints to a potential allergic cause were noted: Perineal urticaria was reported in three interviews and isolated,mild fever in two.These were minor self-limited adverse events with a subacute onset and no hospital admittance was necessary.Ninety-six point two percent of the parents would prefer future VUS examinations with use of SH.CONCLUSION No severe adverse events were observed and indications of self-limited minor allergic reactions related to intravesical administration of SH were reported in less than 1%.
文摘BACKGROUND Crossed fused renal ectopia is a rare congenital anomaly of the ascent of the kidney. This anomaly may be observed as a solitary kidney during initial evaluation. A solitary kidney must be evaluated for associated anomalies such as duplication,horseshoe kidney,or crossed renal ectopia.CASE SUMMARY An anomaly was observed in a 9-mo-old male child who was subsequently diagnosed with crossed fused renal ectopia and vesicoureteral reflux(VUR). In this condition,recurrent febrile urinary tract infection can be a serious problem,and can easily cause renal damage due to relatively short ureters and high pressure in the kidney.CONCLUSION To prevent urosepsis and preserve renal function,early diagnosis and proper management including surgical correction should be considered for the management of renal ectopia with VUR.
文摘Background:Vesicoureteral reflux is the most common urinary congenital anomaly in children.Given the risk associated with radiation exposure there has been an increasing need for radiation-free method in the diagnosis and follow-up of the vesicoureteral reflux.The aim of our study is to compare conventional urosonography without contrast enhancement and x-ray voiding cystourethrography.Patients and Methods:Children with recurrent urinary tract infection with suspected vesicoureteral reflux were included to the study.Vesicoureteral reflux is demonstrated and graded by x-ray voiding cystourethrography.DMSA is used for the evaluation of renal scar.Conventional sonographic procedure was performed in all patients.Ureterovesical junction insertion angle was evaluated.The diameter and length of the ureterovesical junction were also measured.Results:268 children enrolled to the study.Vesicoureteral reflux was demonstrated in 62 children by x-ray voiding cystourethrography.Ureterovesical junction insertion angle measurement had a statistically significant relation for right and left vesicoureteral reflux presence(right:r:.646,p:.01 and left:r:.446,p:.01).Diagnosis sensitivity of vesicoureteral reflux with conventional ultrasonography is 95.10%and specificity is 81%(Youden’s index 76.1%)for the cutoff value of the ureterovesical junction insertion angle is 28.6 degrees.Positive predictive value is 87.2%,negative predictive value is 94.73%and diagnostic accuracy is 86.29%with conventional ultrasonography.Conclusions:Measurement of ureterovesical junction insertion angle,length and diameter by conventional urosonography is an easy accessible and cheap technique with high sensitivity and specificity for the diagnosis and followup of the vesicoureteral reflux without exposure to ionizing radiation.
文摘Purpose: Partial resection of the distal ureter is commonly performed during reconstructive surgery in pediatric urology;particularly for correction of vesicoureteral reflux (VUR) and ureterovesical junction obstruction (UVJO). Many hospitals require pathologic examination of all excised tissues. We examined the pathologic findings in such specimens to evaluate the utility of this practice. Methods: We reviewed the findings on pathologic examination of distal ureteral segments excised during surgical correction of VUR and UVJO in children by a single surgeon over a 13-year period. Results: One hundred and ninety-one specimens from 126 patients were reviewed. None were found to have any significant pathologic findings that impacted therapy. Conclusion: Routine pathological examination of distal ureteral segments excised during surgical correction of VUR and UVJO is not warranted. This presents potential for cost and resource reduction in care of these patients.
文摘Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outcomes of unilateral periureteral injection technique(PIT),as well as bilateral PIT in high-grade VUR.Methods:In this prospective study,we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018.Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units,respectively.In the unilateral PIT,the subureteral injection site was only at the 5-or 7-o’clock position.However,in the bilateral PIT,the subureteral injection sites were at 5-and 7-o’clock position.Pre-and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery.Results:Seven patients had bilateral reflux.Overall,75(81.5%)ureters showed Grade IV VUR,while 17(18.5%)had primary Grade V VUR.The mean age of the subjects was 39.2 months.In unilateral PIT ureters,VUR was resolved in 23(92.0%)refluxing units.It was downgraded to Grade III in one ureter(4.0%)and to Grade II in another ureter(4.0%).In addition,in bilateral PIT cases,VUR was resolved in 60(89.6%)ureters;it downgraded to Grades II and III in 3(4.5%)and 4(6.0%)refluxing units,respectively.Conclusion:Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR.However,further studies are needed to confirm our results.
文摘BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature though for what happens to such kidneys, in the long run, particularly those which are poorly functioning.AIM To assess the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with unilateral primary VUR.METHODS Children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and January 2017 were included in the study. Patients who had a follow up of less than five years were excluded. Preoperative evaluation consisted of a voiding cystourethrogram and Dimercaptosuccinic acid(DMSA) scan. In the follow-up period, patients underwent a diuretic scan at 6 weeks and 6 months.Follow up ultrasound was done for change in grade of hydronephrosis and retrovesical ureteric diameter. Subsequent follow up was done at 6 monthly intervals with evaluation for proteinuria and hypertension and any recurrent urinary tract infection(UTI). For assessment of cortical function, DMSA was repeated annually for 5 years after surgery. A paired-samples t-test was used to test the mean difference of DMSA between pre-post observations.RESULTS During this period, 36 children underwent ureteric reimplantation for unilateral primary VUR. After excluding those with insufficient follow-up, 31 were included in the analysis. Most of the patients were males(n = 26/31, 83.8%). Patient’s age(mean ± SD, range) was 5.21 ± 3.71, 1-18 years. The grades of VUR were grade Ⅱ(1patient), grade Ⅲ(8 patients), grade Ⅳ(10 patients), and grade Ⅴ(12 patients). The pre and postoperative DMSA was 24.064 ± 12.02 and 24.06 ± 10.93, which was almost the same(statistically equal, paired-samples t-test: P = 0.873). The median(range) follow-up duration was 82(60-120)mo. One patient had persistent reflux after surgery(preoperative: grade Ⅳ, postoperative: grade Ⅲ), and the very same patient developed recurrent UTI. The difference in the preoperative and postoperative DRF was less than 10% in 29 patients. In one patient, the DRF decreased by 17%(22% to 05%) while in another patient, the DRF increased by 12%(25% to 37%) after surgery. None of the patients had an increase in scarring after surgery. 15% of patients were hypertensive before surgery and all of them continued to be hypertensive after surgery while none developed hypertension after surgery. None of the patients had significant proteinuria(> 150 mg/d) during the follow-up period.CONCLUSION Children with unilateral primary VUR and poorly functioning kidney maintain the renal function over the long term in most cases. Hypertension and proteinuria do not progress over time in these patients.
文摘A retrospective study for data record of 106 patients subjected to voiding cystourethrogram test (VCUG), sonography test, and dimercaptosuccinic acid (DMSA) scintigraphy take place at King Abdulaziz University, radiology department to find out the possibilities of detecting vesicoureteral reflux (VUR) in infants and children. Hydronephrosis & Renal pelvis dilatation were the highest frequency reason for VUR scan study and represent 36% of the overall cases with 53% positive finding, while Recurrent UTI frequency was 22.6% with 83% positive finding, and patients who had history of VUR come at the third place with 15% frequency and 81% positive finding. VUR was found in 65 of 106 children representing 61%. Male children are more likely to diagnostic with VUR than female and they represented 69% while 31% for female. Among the children with VUR, 39 had high-grade reflux (grade IV or V), while 26 had low-grade reflux (grades I, II or III). When we classified VUR into low-grade and high-grade, we found the majority of children with high-grade VUR had an abnormal DMSA and represented 77.4%, while 13 children with low-grade VUR had normal study. These studies are agreed with the present study;most children with normal DMSA scan finding had low grade reflux. In this study, 48 of 65 children (74%) the DMSA scintigraphy shows abnormal findings during the period of UTI while the VCUG scan study shows VUR in 75% of the children during the period of UTI. Comparing results of ultrasound and VCUG scan, 59% of the ultrasound findings gave the same result as VCUG in detecting the VUR in children. Then we confirm it all with the urine culture results of the same children. We found the majority of children with VUR had abnormal US finding during the period of UTI and represented 83%.
文摘Purpose: We studied the inheritance pattern, clinical features and outcome in children with vesicoureteral reflux (VUR). Characteristics of known familial VUR cases were also compared with those of sporadic VUR. Material and Methods: 726 patients were treated for VUR between 1990-2004. The families were contacted by letter inquiring if other members of the family were affected. The phenotype of all cases (familial and non-familial) was characterized in terms of presenting symptoms, reflux grade, recurrent urinary tract infections, kidney damage, and the natural course of reflux. Results: The response rate was 79%. A total of 99 individuals (22%) reported relatives with VUR. Since some of the 99 index cases belonged to the same family, the total number of families was ultimately 66. The distribution of relatives with VUR was: 38 siblings, 20 parents (15 mothers), 19 cousins, 15 aunts/uncles and 12 grandparents. The phenotype of VUR did not differ between familial and non-familial cases. However, VUR among relatives was of milder grade than index and sporadic cases. Conclusions: The proportion of hereditary reflux in our material was lower than in other studies (22%). We found a strong overrepresentation of maternal transmission of reflux. Severity of the disease did not differ between familial and non-familial VUR.
基金This work was supported by the Grant NSFC-81800602 from National Natural Science Foundation of China(Dr.Jia-Lu Liu)the Grant 20184Y0176 from Shanghai Municipal Commission of Health and Family Planning Youth Research Program(Dr.Jia-Lu Liu)+2 种基金the Grant SHDC12016107 from Shanghai Shenkang Hospital Developmental Center(Dr.Hong Xu)the Grant NSFC-81670609 from National Natural Science Foundation of China(Dr.Hong Xu)the Grant 2018YFA0801102 from National Key Research and Development Project(Dr.Hong Xu).
文摘Background Primary vesicoureteral reflux(VUR)is a common congenital anomaly of the kidney and urinary tract(CAKUT)in childhood.The present study identified the possible genetic contributions to primary VUR in children.Methods Patients with primary VUR were enrolled and analysed based on a national multi-center registration network(Chinese Children Genetic Kidney Disease Database,CCGKDD)that covered 23 different provinces/regions in China from 2014 to 2019.Genetic causes were sought using whole-exome sequencing(WES)or targeted-exome sequencing.Results A total of 379 unrelated patients(male:female 219:160)with primary VUR were recruited.Sixty-four(16.9%)children had extrarenal manifestations,and 165(43.5%)patients showed the coexistence of other CAKUT phenotypes.Eighty-eight patient(23.2%)exhibited impaired renal function at their last visit,and 18 of them(20.5%)developed ESRD at the median age of 7.0(IQR 0.9–11.4)years.A monogenic cause was identified in 28 patients(7.39%).These genes included PAX2(n=4),TNXB(n=3),GATA3(n=3),SLIT2(n=3),ROBO2(n=2),TBX18(n=2),and the other 11 genes(one gene for each patient).There was a significant difference in the rate of gene mutations between patients with or without extrarenal complications(14.1%vs.6%,P=0.035).The frequency of genetic abnormality was not statistically significant based on the coexistence of another CAKUT(9.6%vs.5.6%,P=0.139,Chi-square test)and the grade of reflux(9.4%vs.6.7%,P=0.429).Kaplan–Meier survival curve showed that the presence of genetic mutations did affect renal survival(Log-rank test,P=0.01).PAX2 mutation carriers(HR 5.1,95%CI 1.3–20.0;P=0.02)and TNXB mutation carriers(HR 20.3,95%CI 2.4–168.7;P=0.01)were associated with increased risk of progression to ESRD.Conclusions PAX2,TNXB,GATA3 and SLIT2 were the main underlying monogenic causes and accounted for up to 46.4%of monogenic VUR.Extrarenal complications and renal function were significantly related to the findings of genetic factors in children with primary VUR.Like other types of CAKUT,several genes may be responsible for isolated VUR.
文摘Background:Urinary tract infection(UTI)is a prevalent bacterial infection affecting adults and pediatric populations,with distinct patterns observed in infants.This bibliometric analysis aims to provide a comprehensive overview of the research landscape in pediatric UTI from 1990 to 2022,exploring qualitative and quantitative research output,contributing authors,institutions,countries,collaborative links,and hotspot topics.Purpose:This study aims to evaluate the qualitative and quantitative research output and trends in UTI in the pediatric population through a bibliometric analysis.The analysis covers highly cited articles,contributing authors,institutes,countries,collaborative links,and future research prospects.Methods:A bibliometric analysis was conducted using the Web of Science platform with a search string focused on pediatric UTI articles published between January 1990 and December 2022.The analysis employed the Bibliometrix R-package software and VOSviewer for collaborative networks and keyword co-occurrence maps.Results:Out of 1399 published articles,81.7%were research articles.The annual growth rate of publications was 4.46%.The USA led in contributions,with the University of Pennsylvania being the most productive institution.The"Journal of Pediatric Urology"and"Pediatric"were prominent journals.Lorenzo AJ from the University of Toronto was the top author.Collaborative networks highlighted the significance of collaboration in pediatric UTI research.Conclusion:In conclusion,this bibliometric analysis provides a detailed snapshot of the research landscape in pediatric urinary tract infections.With 1399 articles analyzed,the study reveals a sustained interest and growth rate of 4.46%,emphasizing ongoing efforts to address pediatric UTI challenges.The USA dominates contributions,reflecting its pivotal role in advancing knowledge.The top institutions,journals,and authors are identified,with collaborative networks highlighted.Keyword co-occurrence networks unveil critical themes,notably"vesicoureteric reflux,""management,"and"diagnosis."
