|PEDIATRIC UOROLOGY ABSTRACTS
|Year : 2015 | Volume
| Issue : 5 | Page : 55-60
Pediatric Urology Abstracts
|Date of Web Publication||20-Mar-2015|
|How to cite this article:|
. Pediatric Urology Abstracts. Urol Ann 2015;7, Suppl S1:55-60
Classic versus 12 O'clock incision of posterior urethral valve: A prospective randomized study
Ahmad Elderwy, Ahmed Shahat,
Ahmed Aref Al-Dessoukey 1 , Hamdan Al-Hazmi 2 , Khalid Fouda Neel 2 , Ahmed Abdelmoneim,
Department of Urology, Division of Pediatric Urology, Assiut and Beni Suef University Hospitals, Egypt, 2 Division of Urology, King Khalid Hospital, KSA
Purpose: Endoscopic management of PUV is the gold standard. Various incision techniques and instruments were studied. Our aim is to evaluate the efficacy and safety of two commonly used incision approaches.
Methods: Between September 2007 and September 2012, 68 consecutive patients with PUV were randomly treated with either classic incision at the 5, 7, and 12 o'clock positions (group I; 33 cases), or incision at the 12 o'clock position (group II; 35 cases). Primary ablation was performed using either diathermy hook (in 26 patients) or sickle-shaped cold knife (in 42 patients). Urethral catheter was removed 1-day postoperatively for all cases. Voiding cystourethrogram was done for all patients at 2 months follow-up. All patients with persistent dilatation of posterior urethra on follow-up underwent revision cystoscopy. Recovery of bladder and renal function as well as resolution of vesicoureteral reflux (VUR) and hydroureteronephrosis (HUN) within the 2 treatment groups were compared.
Results: The median age at presentation was 6 months (range, day 1 to 9 years). Median follow-up was 3 years (range, 1-6). No significant difference was present between the two groups at presentation regarding age, renal function, VUR and HUN. Mean operative time was 20 vs. 10 min for groups I and II respectively (P < 0.001). Although the use of electro-ablation was comparable, revision valve ablation was indicated for 4 cases in the classic incision arm (P = 0.035).At last follow-up, the median estimated glomerular filtration rates were 70 and 78 mL/min/1.73 m 2 for groups I and II respectively (P = 0.193). Complete toilet training was achieved in 55% of group I compared to 69% in group II (P = 0.234).
Conclusion: Both PUV incision techniques are fairly comparable. However, single incision at the 12 o'clock position provides a shorter ablation time with relatively less morbidity.
Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children
Hamdan H. Alhazmi, Hamzeh M. Farraj
Department of Surgery, Division of Urology, College of Medicine, King Khalid University Hospital, King Saud University,
Objectives: The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children.
Materials and Methods: We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2004 to 2012. We looked at the demographic data, age at surgery, indication, operative time, surgical complications, conversion to open surgery and operative complications.
Results: Thirty-five total and six partial nephrectomies (upper pole) were performed. The mean age was 84 months (7-175). Vesicoureteric reflux, pelviureteric junction obstruction, and multicystic dysplastickidney disease were the main underlying pathologies.The mean operative time was 158 min (60-280). There were no intraoperative complications (surgical andanesthetic), and no significant blood loss was observed. Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies. No majorpostoperative complications were noted. The mean hospital stay was 2.5 days (1-5). A drain was used in12 cases and was removed after a mean of 2 days.
Conclusions: Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively inchildren. Still, this procedure is more challenging and requires an excellent image of the retroperitonealspace, especially when partial nephrectomies are concerned.
Unilateral renal agenesis: Necessity of postnatal evaluation
Khalid Albedawi, Osama Sarhan, Badr Al Harbi, Abdulhakim Al Otay, Mustafa Al Ghanbar, Ziad Nakshabandi
Pediatric Urology Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
Introduction: Children with suspected prenatal unilateral renal agenesis (URA) will be subjected to further evaluation postnatally. Postnatal renal bladder ultrasound will help in establishing the diagnosis in most cases. Additional imaging modalities with dimercaptosuccinic acid scan (DMSA) and a voiding cystourethrogram (VCUG) will aid in confirming the diagnosis and evaluating associated vesicoureteral reflux (VUR). We assessed the value of these modalities on the long-term outcome.
Patients and Methods: A retrospective review of the records of all patients with suspected prenatal diagnosis of URA between 2004 and 2013 was done. We included all patients who underwent postnatal evaluation with RBUS and DMSA for the confirmation of the diagnosis. We also included patients who underwent VCUG screening for (VUR). Long-term follow up assessed the contralateral renal growth, fate of VUR, and the ultimate renal function.
Results: A total of 46 children (26 males and 20 females) with a suspected URA were identified. Postnatal ultrasounds was sufficient in establishing the diagnosis in all patients. URA was detected on the left side in 32 patients. Furthermore, it detected contralateral hydronephrosis in 8 patients (17%), two of them were found to have VUR. DMSA scans confirmed the diagnosis of URA in all patients and showed renal scars in two kidneys (4%). VCUG was performed in 22 patients, of whom 3 were diagnosed with VUR. All of these patients had low-grade reflux and managed conservatively. After a mean follow up of 4 years, RBUS showed compensatory hypertrophy in 41 patients (89%) while 3 patients (6%) developed chronic kidney disease (CKD).
Conclusion: Prenatally suspected cases of URA should be promptly evaluated. Postnatal RBUS is found to be sufficient in establishing the diagnosis. Additional imaging studies should be limited to patients with contralateral renal abnormalities. Long-term follow up is highly indicated to assess for compensatory hypertrophy and identifying patients at risk of developing CKD.
Uronephrological outcomes of patients with neural tube defects
Does a spina bifida clinic make a difference?
Hamdan H. Al-Hazmi, Mahmoud S. Trbay, Abdulmonem B. Gomha, Ahmad A. Elderwy 1 ,
Amenah J. Khatab, Khalid F. Neel
Division of Urology, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia, 1 Department of Urology, Pediatric Urology Unit, Assiut University Hospital,
Objectives: To review the uronephrological outcomes of myelomeningocele (MMC) patients attending a Spina Bifida Clinic.
Methods: We retrospectively reviewed the medical records of all patients from the combined Spina Bifida Clinic, at King Khalid University Hospital, Riyadh, Saudi Arabia between 1999 and 2009 who had at least one year of follow-up with us. We examined their demographic data, uronephrological status at presentation, most recent follow-up, and the rate of surgical intervention.
Results : During the 10-year period, 188 patients were actively followed-up. The mean age at presentation was 5.3 years 3.6 SD. At their last follow-up, 109 patients (58%) were using clean intermittent catheterization, 44 (23%) had received Botox; injections, and 26 (14%) had undergone bladder reconstruction. Most (66%) patients were older than 3 years when they presented to us; this group had a significantly higher rate of surgical intervention (Botox; or reconstruction)compared with those who came to us earlier (P = 0.003 for patients receiving Botox; injections, and P = 0.025 for patients undergoing bladder reconstruction).
Conclusion: Our multidisciplinary Spina Bifida Clinic is an integral part of MCC management to reach a safe urological outcome. Early presentations to our clinic resulted in a lesser need for surgical intercession compared with those who presented at more than 3 years old.
Dissolution therapy versus shock wave lithotripsy for radiolucent renal stones in children: A prospective randomized study
Ahmad A. Elderwy, Adel Kurkar, Montaser Hussein 1 , Hazem Abozeid 2 , Hisham M. Hammodda, Abdel-Fatah Ibraheim
Departments of Pediatric Urology, 1 Pediatric Nephrology and 2 Radiology, Assiut University Hospital, Assiut University, Egypt
Purpose: Our aim is to prospectively evaluate the efficacy of dissolution therapy in comparison to the standard shock wave lithotripsy (SWL) as a noninvasive modality for the treatment of radiolucent renal stones in children.
Materials and Methods: A total of 87 children with radiolucent renal calculi were included. Age range was 0.5-13 years (median 2.5). Computed tomography scan was done to confirm stone density to be less than 500 Hounsfield units (HU). Stone length varied from 7 to 24 mm (median 12). The patients were randomly divided into 2 groups; the medical group (n = 48) received potassium sodium hydrogen citrate at a dosage of 1 mEq/kg/day for 1-3 months, and the SWL group (n = 39) treated using a Dornier Lithotripter S under general anesthesia. Complications were recorded for both groups. Subjects were defined as stone-free if imaging within 3 months showed no evidence of stones.
Results: The stone-free rate was 72.9% with dissolution therapy versus 82.1% after single session SWL (P = 0.314). One patient in each group had pyelonephritis episode during follow up (P = 0.698). Of the 13 patients with failed medical regimens, 3 were found to be noncompliant, and 5 took the medication sporadically.
Conclusions: Medical dissolution therapy is a well tolerated and effective treatment of radiolucent renal stones in children and eliminates the need for SWL in up to 73% of cases.
Outcome of augmentation cystoplasty patients in terms of preserving renal function and continent rate: KFSHRC experience
Shahbaz Mehmood, Ali Al-Sulihem Waleed Al Taweel
King Faisal Specialist Hospital, Riyadh, Saudi Arabia
Introduction and Aim: One of the main postoperative concerns of augmentation cystoplasty is to preserve renal function and continent rate. In present study, we want to investigate the overall results of augmentation cystoplasty and to know whether it preserve renal function and continence postoperatively.
Materials and Methods: We retrospectively reviewed 41 (22 male and 19 female) cases of neurogenic and non-neurogenic bladder dysfunction, underwent Augmentation Cystoplasty from 2004 to 2014 in adult Urology Department, KFSHRC Riyadh. Mean age of the patients 27.5 (Range 17-55) years. All patients' data, renal function test and urodynamic findings and preoperative treatment taken were documented. 40 Patients underwent open AC and 01 robotic assisted AC. 15 pts(36.58%) were with end stage renal disease and 26 (63.41%) were with normal creatinine. 37 patients (90.24%) were incontinent and 4 (9.76%) were continent preoperatively. 36 pts. (87.80%) underwent Ileocystoplasty, 1(2.44%) ureterocytoplasty, 2(4.88%) colocystoplast, 1 (2.44%) ureteroileocystoplasty, 1(2.44%) ileocolic catheterizable conduit. Outcome of the patients in terms of overall complications, success rate in terms of preserving renal function and continence rate were also noted.
Results: A total of 41 patients underwent AC with preoperative diagnosis of 22 pts (53.6%) with neurogenic bladder, posterior urethral valve 6 pts. (14.6%), bladder Extrophy 6 (14.6%), idiopathic overactive bladder 6 (14.6%), interstitial cystitis, Hinnman syndrome and schistosomiasis 01 pt. (2.43%) each. Median follow up period was 48 (range: 9-117) months. 36 pts. (87.80%) was dry after augmentation cystoplasty. Bladder stone was found in 5 (12.19%) of patients. Creatinine remained stable in more than 95% of pts. Mean pre op creatine was 73 and post op 78 and P-value was 0.1738.
Conclusion: AC is still a viable option in refractory bladder dysfunction patients. It preserves renal function and provide convenient method of voluntary and complete emptying. Preoperative diagnosis of urethral sphincter dysfunction is very important in order to proceed for additional procedure to make patient continent.
Stentless pyeloplasty in children: A prospective randomized study
Ahmad A. Elderwy, Adel Kurkar, Diaa Abdelhamed, Mohamed Taha
Division of Pediatric Urology, Department of Urology, Assiut University Hospitals, Assiut 71516, Egypt
Introduction and Objectives: Stented open pyeloplasty is widely used in pediatric urology practice. Our aim is to present our experience with stentless pyeloplasty in children.
Materials and Methods: Between June 2009 to July 2012, 46 children had open Anderson-Hynes dismembered pyeloplasty using 2.5-3 cm flank incision. The children were prospectively randomized to 2 groups: Stentless pyeloplasty (25 children) and stented pyeloplasty (21 children). Both groups were compared regards length of hospital stay, postoperative complications, success rates and number of surgical procedures needed to achieve success.
Results: Both groups were comparable regards age (median 6 months each), sex, pre-operative hydronephrosis (HN) and split renal function. Median drain removal time and hospital stay were 2 days and 3 days in the stentless and stented groups, respectively (P < 0.001). Resolution or minimal residual HN was noticed postoperatively after median time of 4 months (range: 2-12) for stentless group and after 4 months (range: 2-14) in the stented group (P = 0.568). Recurrent ureteropelvic junction obstruction developed in one patient in each group. Median number of surgical procedures needed to achieve success was 1 versus 2 for the stentless and stented groups, respectively (P < 0.001).
Conclusion: Open stentless pyeloplasty in children is feasible with shorter hospital stay and fewer surgical procedures.
Hourglass bladder post-ileocystoplasty: A case report
Hamdan H. Alhazmi
Department of Surgery, Division of Urology, College of Medicine and King Khalid University Hospital, King Saud University, Saudi Arabia
Narrowing of the anastomotic area between the bowel segment and urinary bladder is known as "hourglass bladder." This report describes a rare case of hourglass bladder deformity occurring post-ileocystoplasty in a 14-year-old male. Herein are described essential steps that should be taken during bladderaugmentation to avoid such complication, along with a discussion of the relevant literature.
Laparoscopic Pyeloplasty in infancy and early childhood early outcome experience from single institute
Sheikh Khalifa Medical City, UAE
Purpose: Early outcome of a series infancy and younger children with PUJ obstruction who underwent Laparoscopic transperitoneal pyeloplasty. Patient number 30 cases.
Methods: Laparoscopic Anderson- Hynes Pyeloplasty from December 2012 to December 2014. All children were confirmed on renal US and diuretic renogram preoperatively, and Post-operative investigated again with US and renogram.
Conclusion: Laparoscopic transperitoneal pyeloplasty in infancy is safe with high preliminary successful rate. Excellent cosmetic result and less surgical trauma.
Modified Urethral mobilization and advancement versus modified meatal advancement and glanuloplasty incorporated for anterior hypospadias repair: A prospective comparative study
Ahmad A. Elderwy, Ahmed Abdelmoneim,
Division of Pediatric Urology, Department of Urology, Assiut University Hospital, Egypt
Introduction and Objective: To evaluate the hypospadias repair created by modified Urethral mobilization and advancement (mUMA) versus modified Meatal Advancement and Glanuloplasty Incorporated (mMAGPI).
Materials and Methods: Between June 2007 and January 2013, 247 consecutive boys (median age, 4 years) were enrolled. Preoperative position of the hypospadic meatus was glandular in 18, coronal in 101, and in the distal shaft in 128 boys. Ventral penile curvature, hypoplastic distal urethra and flat/small glans were noted in 201, 33 and 29 patients respectively. mUMA (group I; n = 112) and mMAGPI (group II; n = 135) techniques were compared as regards cosmesis and complications.
Results: Both groups were comparable regarding patients' age and severity of hypospadias. After a median follow-up period of 2 years (range: 1-5), urethrocutaneous fistula/dehiscence was noted in 3 patients in group I versus 7 patients in group II (P = 0.355). No urethral stenosis was encountered. A cosmetically normal slit-like meatus was obtained by single procedure in 93.8% of patients in group I versus 81.5% in group II (P = 0. 004). Normal circumcised penis was achieved in 92% and 93.3% of patients in group I and II respectively (P = 0. 807).
Conclusions: There are no significant differences in complication rates between the two techniques, and the mUMA technique is usually of better cosmesis.
Percutaneous nephrolithotomy in children: A preliminary report
Ahmad A. Elderwy, Mohamed Gadelmoula,
Mohamed A. Elgammal, Ehab Osama,
Hamdan Al-Hazmi 1 , H. Hammouda, Esam Osman, Medhat A. Abdullah, Khalid Fouda Neel 1
Department of Urology, Division of Pediatric Urology, Assiut University Hospitals, Assiut, Egypt, 1 Department of Surgery, Division of Urology, College of Medicine, King Saud University, Saudi Arabia
Objectives: To evaluate the safety and efficacy of percutaneous nephrolithotomy (PNL) for managing renal stones >1.5 cm in pediatric patients.
Methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24).
Results: The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively.
Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.
Posterior urethral valves: Metabolic consequences in a cohort of patients
Osama Sarhan 1,2 , Ziad Nakshabandi 2 , Abdulhakim Alotay 2 , Mustafa Alghanbar 2 , Amr El-Husseini 3
1 Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, KSA, 2 Division of Pediatric Urology Division, Urology and Nephrology Center, Mansoura University, Egypt, 3 Division of Nephrology, University of Kentucky, USA
Purpose: Despite the improvement in PUV diagnosis and management about one third of patients progress to renal failure. Children with posterior urethral valve might have abnormal calcium, phosphorus, vitamin D and parathyroid hormone levels which could affect their bone health.
Materials and Methods: We followed a cohort of 64 children with posterior urethral valve for a period of 3.64 2.50 years after their initial presentation and management. We compared their laboratory parameters including serum calcium, phosphorus, parathyroid hormone, 25 hydroxy Vitamin D levels and kidney function with 20 age, gender and race matched control group.
Results: Patients with posterior urethral valve have significantly lower estimated kidney function (P - 0.006) and Vitamin D levels (P - 0.001) and higher parathyroid hormone levels (P - 0.042). No significant differences in serum calcium, phosphorus, alkaline phosphatase, sodium, potassium, bicarbonate levels between 2 groups. There was strong correlation with the degree of vitamin D deficiency and hyperparathyroidism with the degree of kidney dysfunction. On a multivariate study only the kidney function was the significant risk factor for Vitamin D deficiency and hyperparathyroidism.
Conclusion: Abnormal kidney function, vitamin D deficiency and hyperparathyroidism are prevalent after posterior urethral valve management. Kidney function is the main determinant of vitamin D and parathyroid hormone levels. Efforts should be directed toward managing chronic kidney disease and controlling vitamin D deficiency and hyperparathyroidism in children after posterior urethral valve ablation.
Primary versus secondary ureteroscopy for pediatric ureteral stones
M. A. Elgammal, A. S. Safwat, Ahmad A. Elderwy, A. S. El-Azab, M. S. Abdelkader 1 , H. M. Hammoudaa
Department of Urology, Assiut University, Egypt, 1 Department of Urology, Qena University, Egypt
Purpose: To evaluate the outcome of primary versus secondary ureteroscopy for pediatric ureteral stones.
Methods: A retrospective chart review study that included 66 children aged less than 12 years, who were subdivided into two groups: Group A, which included 42 children who had undergone primary ureteroscopy without pre-stenting; and Group B, which included 24 children who had undergone ureteroscopy after ureteric stenting. Kidneys, ureters and bladder radiographs were done on the first postoperative day to assess the degree of stone clearance and stent position.
Results: Age, gender, stone location and stone size were not significantly different between both groups. In Group A, 31 (73.8%) children required ureteric dilation, 13 (31%) had a tight ureter that failed to respond to dilation, 25 (59.5%) displayed complete stone clearance, and of these, 13 (52%) needed postoperative stenting. One child experienced ureteric injury during stone disintegration and was stented for 2 weeks. Children in Group B experienced a 95.8% complete stone clearance rate, with no ureteric injury reported; postoperative stenting was performed in 3 (12.5%) children.
Conclusion: Secondary ureteroscopy is preferable over primary ureteroscopy in pediatric populations because of a significantly lower need for ureteric dilation, shorter procedure time and better stone clearance rate.
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