Treatment of vesicoureteric reflux in children

Aim. To study the efficacy of endoscopic correction of vesicoureteric reflux in children using bulk synthetic material.Material and methods. From 2016 to 2020, we studied the results of treatment of 63 children with vesicoureteric reflux. The children ranged in age from 6 months to 17 years. The degree of vesicoureteral reflux was as follows: grade I was observed in 2 (3.1%) patients, grade II in 16 (25.3%), grade III in 30 (47.6%), grade IV in 13 (21.98%), and grade V in 2 (3.1%). Among 63 patients with CKD, grade I was found in 26 (41.3%), grade II - in 16 (25.4%); grade III - in 13 (20.6%); grade V - in 2 (3.1%). - III stage - 13 (20,6%); IV stage - 8 (12,7%); IV stage - 4 (12,6%). - (12,7%), and there were no patients with V stage of CKD were absent. Unilateral vesicoureteric reflux was noted in 45 (71.4%) children, bilateral - in 18 (28.5%) children. Endoscopic intravesical correction of vesicoureteral reflux was performed by suburethral injection of “Dam+”.Results and discussion. Summarizing the results of our study, it should be noted that positive results were achieved concerning the relief of urinary tract infection, elimination of urine outflow from the upper urinary tract, improvement of renal function after PMR correction using “Dam+”. Positive results of VUR correction amounted to 75,01%.Conclusions. Endoscopic correction of VUR is one of the effective and low-traumatic methods of treatment. Application of the biocompatible synthetic material “Dam+” in the correction of vesicoureteric reflux contributes to positive results.

Voiding cystourethrography in children: spectrum of findings with clinical correlation

Background Voiding cystourethrography (VCUG) is a gold standard diagnostic tool in the detection of lower urinary tract structural abnormalities in children. Objective To study the spectrum of different urinary tract abnormalities that could be detected in pediatric patients who underwent VCUG. Methods A retrospective study was carried at pediatric radiology unit Ain Shams university hospitals, starting from March 2019 till September 2019. Spectrum of findings were quantified in relation to patients’ symptoms. The number of true acquisitions and fluoroscopic frames, as well as the time of examination, were used as an indicator for radiation dose exposure. Results Out of 134 patients who were included in our study and underwent VCUG, the majority was males (n = 85, 63.4%) and patients who had more than 24 months and less than 216 months with median (IQR) 72 (48-108)months being (n = 82, 61.2%). We found that half of the cases had abnormal VCUG findings (n = 67, 50%). The most common abnormality was vesicoureteric reflux (VUR) (n = 38, 28.4%) followed by bladder abnormalities (n = 14, 10.5%).The commonest presented complaint was urinary tract infection symptoms (n = 58, 43.3%). Infants below 24 months of age showed more abnormal findings than older children. Males showed more abnormal findings than females. High-grade VUR (IV-V) was more frequent than low grade. Both recurrent urinary tract infection (UTI) and bladder abnormalities were found to be strong predictors for VUR (p = 0.019 and 0.013, respectively). The median (IQR) of static films within patients who had abnormal VCUG findings was greater than the median (IQR) of static films within patients who had normal VCUG findings being 7.0 (7.0 – 8.0) versus 6.0 (5.0 – 7.0), respectively with a significant statistically difference (F = 6.571, p = 0.011). Conclusion VCUG can detect different lower urinary abnormalities in children. VUR is the commonest encountered finding during VCUG, especially among patients with recurrent UTI.

Compensatory renal hypertrophy in reflux nephropathy presenting as hypertensive emergency

ABSTRACT Hypertensive emergency in the paediatric population is not uncommon. However, due to its numerous etiologies, care should be taken in determining the approach of management. We report a case of a child who presented with double vision, giddiness and elevated blood pressure. Blood investigations were normal. Renal ultrasound and magnetic resonance imaging of the abdomen were performed which both showed findings suspicious of a large heterogeneous mass at the lower pole of the left kidney with dysplastic right kidney. A final diagnosis of bilateral vesicoureteric reflux with left compensatory hypertrophy was made based upon micturating cystourethrography findings and was later confirmed by 99mTc-dimercaptosuccinic acid (DMSA) study. The objective of this case is to share the importance of the appropriate choice of radiological examinations, not only in achieving an accurate diagnosis but to ensure that unnecessary investigations are avoided.

A 64-slice CT angiographic study of morphologic and morphometric analysis of healthy kidney donors

The kidneys are bilaterally paired organs and serve several essential functions required to maintain a normal human physiological function. The renal size was conventionally determined on x-ray or urography by measuring the renal length distance of first lumbar vertebrae to third or fourth lumbar vertebrae. Ectopic position of the kidney can be associated with ureteric stone, vesicoureteric reflux and can predispose to iatrogenic trauma during interventional radiological and laparoscopic procedures and any surgeries. Therefore, it is important to know the variations between individuals in the level of kidney relative to the spinal column. The study aimed to analyse the morphometric and morphologic measurements of the kidney using CT angiogram in kidney donors. In this study, the length and breadth of kidney and different level of location of kidney in 100 renal donors were analysed. The study was conducted in specialised scan centres located in Chennai. Out of 100 kidney donors, 61% of them were male & 39% of them were female. The right kidney length was found to be 10.59 ±1.14 cms, and left kidney length was found to be 10.72 ± 1.22 cms. This report will be useful for transplant surgeries, as well as clinicians and radiologist who perform various techniques.

Ten years institutional experience with study of prognostic factors affecting renal outcome in children with posterior urethral valves

Background: Evaluation of our 10 year’s experience and analyze the prognostic factors affecting renal outcome in children with posterior urethral valves (PUV).Methods: We retrospectively reviewed the medical records of 129 patients diagnosed and managed as posterior urethral valves from 2009 till 2019 in our institution age of presentation, signs and symptoms, anthropometry, surgical interventions, and biochemical investigations were recorded and data were analyzed on an excel spreadsheet.Results: Mean age of presentation was 3 years and mean follow up was 4 years. 99 underwent primary valve ablation and 30 patients underwent diversion as primary treatment, the most common presenting symptom was poor urinary stream (90), enuresis (88), and fever (60). Correlation of resolution of symptoms pre and postoperatively was statistically not significant. 26% patients developed chronic renal failure (CRF) and 8.5% patients progressed to end stage renal disease (ESRD). Correlation of mean nadir serum creatinine >1 mg/dl (p=0.030), presence of protenuria (p=0.020), bladder dysfunction (p=0.029), bilateral high grade vesicoureteric reflux (VUR) (p=0.019), hypertension (p=0.01) was statistically significant. Correlation of age of presentation (p=0.341), outcome for patients treated with diversion or valve ablation in relation to CRF (p=0.239), incontinence (p=0.209), malnutrition (p=0.194) was statistically insignificant.Conclusions: Nadir serum creatinine >1 mg/dl, presence of protenuria, bladder dysfunction, bilateral high grade VUR are significant prognostic factors affecting long term outcome in PUV. Early detection and timely management may lead to a better outcome in these patients.