Long-term urological complications after conservative local treatment (surgery and brachytherapy) in children with bladder-prostate rhabdomyosarcoma. A single team experience.

Background: Outcome of children with bladder-prostate rhabdomyosarcoma has improved with multimodal therapies, including surgery and/or radiotherapy for local treatment. Our aim was to report the long-term urological complications after a conservative approach combining conservative surgery and brachytherapy. Patients and methods: Eighty-six patients, free of disease, were retrospectively reviewed. Symptoms related to urinary tract obstruction, incontinence, infection and lithiasis were reported and graded according to CTCAE classification. Only symptomatic patients underwent urodynamic studies. Risk factors for complications were analyzed. Results: There were 76 males and 10 females. The median follow-up was 6.3 years (18 months-24 years). Complications occurred after a median follow up 5 years (0-21). Twenty-two patients had long-term urological complications. Urinary tract obstruction was found in 15 patients, urinary incontinence in 14 patients. Recurrent urinary tract infection and urinary lithiasis were found in 5 patients respectively. Beyond symptom, 3 etiologies were identified: bladder dysfunction in 15 patients, urethral stenosis in 6 and uretero-vesical junction stenosis in 5. Posterior bladder wall dissection used in large prostatic tumors, operation at age less than 2 years and partial prostatectomy were identified as risk factors for these complications. Conclusion: The conservative surgical approach combined with brachytherapy for BPRMS leads to long-term urological complications in 22% of patients free of their disease. Optimizing brachytherapy doses for young children and establishing a clear and long term follow-up protocol, could help to reduce these complications.

Urinary lithiasis: epidemiological, clinic and therapeutic aspects at CNHU-HKM / Cotonou, Republic of Benin

Objective: To report the epidemiological, clinical and therapeutic aspects of urinary lithiasis at the university clinic of urology - andrology of Centre National Universitaire Hubert Koutoukou MAGA of Cotonou. Patients and methods: This is a retrospective study of 117 cases of urolithiasis collected over 10 years, carried out at the university clinic of urology - andrology of Centre National Universitaire Hubert Koutoukou MAGA of Cotonou. The study parameters were age, sex, profession, clinical and para-clinical characteristics, topography of urolithiasis, the treatment used and the main complications. Frequency and average calculations allowed us to analyze our results. Results: The average age in our study was 44.5 years. The age group between 40-49 years old was the most represented with 27.4% of the cases. The sex ratio was 2. The most frequent clinical manifestation was dominated by low back pain in 85.5% of cases. Cytobacteriological examination of the urine was pathological in 27 patients or 20%. The most commonly used imaging test was ultrasound of the urinary tree (89.5%) followed by Euro-CT (56.4%). Creatinine levels were disturbed in 16.2% of patients and uremia in 13.7%. Over 85% of urolithiasis involved the upper urinary tract. The JJ catheter surge (29.9%) and percutaneous nephrolithotomy (24.8%) were the main techniques used for the treatment of urolithiasis at CNHUHKM of Cotonou. Conclusion: Urolithiasis remains a problem in our environment and requires an appropriate diagnosis with a view to effective and prompt management.

Frequency of Metabolic Abnormalities in Pakistani Children With Renal Stones

Objective: To determine the frequency of various metabolic abnormalities in children with urinary lithiasis. Methods: This cross-sectional study was conducted at the Armed Forces Institute of Urology, Rawalpindi, from 30 January 2017 to 1 February 2020. A total of 1355 children who were aged 4 to 14 years and who had renal stones were included, while those with urinary tract infections, posterior urethral valve, pelvi-ureteric junction obstruction, reflux disease, and chronic renal failure were excluded. Twenty-four-hour urine samples were analyzed for urinary uric acid, calcium, oxalate, citrate, and magnesium. Demographics and metabolic abnormalities—hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria, and hypomagnesuria—were noted and analyzed. Results: The study analysis included 1355 patients. Low urine volume was observed in 465 (34.3%) of the patients. Three hundred nine patients (22.8%) had metabolic abnormalities, the most common being hypocitraturia (184, 59.5%) followed by hypercalciuria (136, 44%) and hypomagnesuria (126, 40.8%). Mean age of presentation, disease duration, recurrent bilateral stones were found significantly different in those having metabolic abnormalities (7.81±2.25 versus 8.76±2.50 P < 0.001, 7.73±1.50 versus 8.43±1.54 P < 0.001, 19.4 versus 2.4% P < 0.001 respectively). No significant difference was found in frequency of abnormal urinary metabolic parameters between boys and girls (P > 0.05) or, upon data stratification, on the basis of disease duration, stone laterality, and recurrence. Conclusion: Metabolic abnormalities were found in 22.8% % of children presenting with urinary lithiasis. The most frequent abnormality observed was hypocitraturia followed by hypercalciuria and hypomagnesuria. Early identification helps manage such patients appropriately, mitigating long-term sequelae.

Porosity in Microtomography and Determination of Hounsfield Units do not Predict Calculi Fragmentation in Extracorporeal Lithotripsy: Analysis of an In-vitro Study

Background: Extracorporeal Shock Wave Lithotripsy (SWL) remains one of the most popular methods for treating urinary lithiasis. Objective: To evaluate structural and microtomographic characteristics associated with urinary calculi fragmentation in an experimental model of SWL. Methods: Samples consisting of at least two calculi fragments obtained from patients were submitted to urological procedures. All calculi were analyzed by X-ray diffraction and a morphological evaluation (weight, length, width, and volume measurements) was conducted along with microtomographic and conventional tomographic assessments in vitro. Thereafter, each sample was submitted to SWL in a ballistic gelatin model. The fragments were separated, using a granulometric sieve, into specimens larger than 4 mm and 2 mm, which were subsequently weighed. Results: Altogether, 48 urinary calculi were analyzed and were composed of whewellite (54%), struvite (22%), apatite (11%), uric acid (7%), cystine (4%), and whitlockite (2%). The fragmentation rate was 77.5% and 69.6% for samples > 4 mm and > 2 mm in size, respectively. Factors associated with a reduction in the effectiveness of SWL were volume, dry mass, and width of the calculus. The radiodensity and porosity of the samples evaluated by microtomography were not associated with the fragmentation of calculi. Conclusion: The volume, dry mass, and width of urinary calculi were positively correlated with the number of fragments larger than 4 and 2 mm in size obtained post-SWL.

The use of an Artificial Neural Network (ANN) in the evaluation of the Extracorporeal Shockwave Lithotripsy (ESWL) as a treatment of choise for urinary lithiasis.

Purpose: Artificial Neural Networks (ANNs) are simplified computational models simulating the central nervous system. They are widely applied in medicine, since they substantially increase the sensitivity and specificity of the diagnosis, classification and the prognosis of a medical condition. In this study we constructed an artificial neural network to evaluate several parameters of extracorporeal shockwave lithotripsy (ESWL), such as the outcome and safety of the procedure. Materials and methods: Patients with urinary lithiasis suitable for ESWL treatment were enrolled. An artificial neural network (ANN) was designed and a unique algorithm was executed with the use of the well-known numerical computing environment, MATLAB. Medical data were collected from all patients and 12 nodes were used as inputs (sex, age, B.M.I. (Body Mass Index), stone location, stone size, comorbidity, previous ESWL sessions, analgesia, number of shockwaves, shockwave intensity, presence of a ureteral stent and hydronephrosis). Conventional statistical analysis was also performed. Results: 716 patients were finally included in our study. Univariate analysis revealed that diabetes and hydronephrosis were positively correlated to the ESWL complications. Regarding efficacy, univariate analysis revealed that stone location, stone size, the number and density of shockwaves delivered and the presence of a stent in the ureter were independent factors of the ESWL outcome. This was further confirmed when adjusted for sex and age in a multivariate analysis.The performance of the ANN (predictive/real values) at the end of the training state reached 98,72%. The four basic ratios (sensitivity, specificity, PPV, NPV) were calculated for both training and evaluation data sets. The performance of the ANN at the end of the evaluation state was 81,43%. Conclusions: Our ANN achieved high score in predicting the outcome and the side effects of the extracorporeal shockwave lithotripsy treatment for urinary stones. In fact, the accuracy of the network may further improve by using larger sets of data, different architecture in designing the model or using different set of input variables, making ANNs thus, a quite promising instrument for effective, precise and swift medical diagnosis.

P1833HOW DO WE DEFINE HYPERCALCIURIA IN 24 HR URINE?

Background and Aims Hypercalciuria can clinically present itself as gross hematuria, microscopic hematuria, dysuria or abdominal pain without urinary lithiasis. It is also one of main metabolic causes of urinary lithiasis in children. In Nelson pediatrics, hypercalciuria is defined by a 24 -hour urine for calcium excretion&gt;4mg/kg/day. A spot urine calcium creatinine ratio of &gt;0.2, is considered abnormal in older children and adolescents. Both of them are not a standardized detect in children. Fasting and postprandial spot urinary calcium creatinine ratios may not detect hypercalciuria so accurately, that a 24-hour urine is preferred. In addition, 24hr urine collection is frequently under- or over-collected, which leads to an inadequate sampling hard to pick up which one the more accurate calculating methodology for the hypercalciuria detection with 24hr urine is. In this study, we evaluated the comparisons of 24 hr urine calcium creatinine ratio(Ca/Cr), 24hr urine calcium excretion(mg/kg)(Ca/Kg) and CCCR in school aged children. 24-hour urine for calcium excretion&gt;4mg/kg/day 24-hour urine calcium creatinine ratio of &gt;0.2 Calcium creatinine clearance ratio(CCCR); (24-hour U-calcium/P-total calcium) / (24-hour U-creatinine/P-creatinine), as known as fractional excretion of calcium(FeCa) Method We enrolled 250 normal kidney function patients who’s age is 7 to 18 year, was able to collect 24 hr urine in a single hospital unit. We conducted 24 hr urine collection, serum calcium creatinine levels on the same day from January 2007 to December 2019. We analyze of each values. We used SPSS. 25.0 Results