Factors affecting endoscopic treatment’s failure for primary vesicoureteral reflux in the paediatric population

Objective: The purpose of this study is to identify which factors could determine endoscopic therapy’s failure in the paediatric patients with primary vesicoureteral reflux (VUR). Methods: We reviewed data from patients who underwent endoscopic surgery for primary reflux. We performed a multivariate logistic regression analysis considering factors conditioning therapeutic failure. All the tests were performed considering significant values of p < 0.05. Statistical analysis was performed with the SPSS 19.0 program. Study sample was homogenised by just including patients with primary reflux and excluding both patients with secondary reflux and patients with functional lower urinary conditions. Results: A total of 96 patients were included for review. Median age at surgery was 28 months. The overall success rate of endoscopic surgery for vesicoureteral reflux was 57%. Female sex, age under 24 months at the time of surgical intervention and having suffered a urinary tract infection (UTI) despite antibiotic prophylaxis are statistically significant risk factors for therapy failure. Conclusions: Nonetheless, differences between series could explain these differences in success rates. The lack of standardisation of the definition of ‘success’, the heterogeneity of patients included, and variables such as the degree of reflux, the presence of dysfunctional voiding, age or follow-up make it difficult to compare the success rate between series. Therefore, homogenisation of study samples assessing the evolution of primary reflux and response to endoscopic therapy is warranted. Level of evidence: Not applicable

Initial Evaluation of Uroplakins UPIIIa and UPII in Selected Benign Urological Diseases

Background: Uroplakins (UPs) are glycoproteins that play a specific role in the structure and function of the urothelium. Disorders which affect the normal expression of UPs are associated with the pathogenesis of infections and neoplasms of the urinary tract, primary vesicoureteral reflux, hydronephrosis and renal dysfunction. The appearance of uroplakins in the urine and/or plasma may be of potential importance in the detection of urinary tract dysfunction. The aim of the present study was to investigate uroplakin IIIa (UPIIIa) and uroplakin II (UPII) expression in patients with selected urological diseases. Methods: Plasma and urine from patients with benign prostatic hyperplasia (BPH), urethral stricture (US), urinary tract infection (UTI) and urolithiasis were compared to healthy people without urological disorders. UPs concentrations were measured by the immunoenzymatic method. Results: In patients with BPH and UTI, concentrations of UPIIIa in urine and plasma, as well as UPII in urine, were statistically significantly higher than in the control groups. In the US group, only the plasma UPIIIa concentration differed significantly from the control. Conclusion: The conducted research shows that benign urological diseases may affect the state of the urothelium, as manifested by increased concentrations of both UPs in patients’ urine and plasma, especially in BPH and UTI.

Prediction of spontaneous resolution of primary vesicoureteral reflux in children

The retrospective study is based on a database of 871 patients who received conservative therapy for primary VUR. A one-way survival analysis was used to assess the factors influencing the likelihood of spontaneous resolution of VUR. Cox regression was performed for multivariate analysis. The construction of the predictive model was carried out using binary logistic regression. The developed prognostic model is highly reliable, its application can facilitate the adoption of an optimal treatment strategy.

Initial Evaluation of Uroplakins UPIIIa and UPII in Selected Benign Urological Diseases

BackgroundUroplakins (UPs) are glycoproteins that play a specific role in the structure and function of the urothelium. Disorders of normal expression of uroplakins are associated with the pathogenesis of infections and neoplasms of the urinary tract, primary vesicoureteral reflux, hydronephrosis and renal dysfunction. The appearance of uroplakins in the urine and/or plasma may be of potential importance in the detection of urinary tract dysfunction. The aim of the study was to investigate uroplakin IIIa (UPIIIa) and uroplakin II (UPII) expression in patients with selected urological diseases. Plasma and urine from patients with benign prostatic hyperplasia (BPH), urethral stricture (US), urinary tract infection (UTI) and urolithiasis, were compared to healthy people without urological disorders. MethodsA total 152 of human urine and plasma samples from normal and patients with selected benign urological diseases were analyzed. UPs concentration was measured by immunoenzymatic method. All calculations were done using the STATISTICA 13.3 (TIBCO software Inc.).ResultsIn patients with BPH and UTI, UPIIIa in urine and plasma also UPII in urine concentrations were statistically significantly higher than in the control groups. In the US group, only the plasma UPIIIa concentration differed significantly from the control. There were no significant differences between the concentrations of UPs compared to the controls in both the urine and plasma of patients with urolithiasis. ConclusionThe conducted research shows that benign urological diseases may affect the state of the urothelium, as manifested by an increased concentration of both UPs in patients’ urine and plasma, especially in BPH and UTI.

The Role of Radiographic Imaging in Diagnosis and Follow-up of Vesicoureteral Reflux: Review Article

Background: Primary vesicoureteral reflux is a basic influencing for urinary tract infections in children. The basic technique for the diagnosis of vesicoureteral reflux is voiding cystourethrography, accompanied with cystoscintigraphy. Voiding cystourethrography has the benefit of only minor irradiation. However it does no longer permit the morphological assessment of bladder and vesicoureteral reflux grading. Colored-Doppler cystosonography with echocontrast is a currently delivered technique for imaging vesicoureteral reflux. The purpose of our study is to explore the role of Radiographic Imaging in diagnosis and follow‐up of vesicoureteral reflux. Method: A systematic review was carried out, (including PubMed, Google Scholar, and EBSCO) of imaging modalities used to detect or evaluate vesicoureteral reflux disease. The found articles were screened by titles, and abstracts. No software will be utilized to analyze the data. The review was performed by the group members and each verified by at least two, to ensure the validity and minimize the mistakes. Results and Conclusion: Colour-Doppler cystosonography, due to the nonexistence of ionizing radiations, has great benefits, mainly in cases requiring continued or prolonged monitoring. In spite of practices stated in the literature, this procedure has a role in the diagnosis of vesicoureteral reflux. Our group chooses colour-Doppler cystosonography for the follow-up of medium-severe grade vesicoureteral reflux previously diagnosed by radiology and/or scintigraphy. Cystoscintigraphy is used only to confirm cases resulting negative at ultrasonography.