Analysis of Indications for Voiding Cystography in Children

In this study, we report the experience of our center with the prognosis of vesicoureteral reflux, depending on the indications for voiding cystography, during a 12-year period. Retrospective analysis included 4302 children who were analyzed according to the indication for voiding cystography: (1) a febrile urinary tract infection, (2) urinary tract malformations on ultrasonography and (3) lower urinary tract dysfunction. Vesicoureteral reflux was found in 917 patients (21.32%; 24.1% of girls and 17.9% of boys). In group (1), reflux was found in 437/1849 cases (23.63%), group (2) in 324/1388 cases (23.34%) and group (3) in 156/1065 cases (14.65%). A significantly lower prevalence of reflux and its lower degree was found in children from group (3) when compared to other groups (p < 0.01). VURs were confirmed in over 20% of children with urinary tract malformations on ultrasonography or after a febrile urinary tract infection, suggesting the need for voiding cystography in these children. Indications for this examination in children with lower urinary tract dysfunction should be limited.

Anatomical Findings of Renal and Urological Abnormalities in Cardiac Catheterization of Children with congenital heart diseases – A Single Center Experience

Background and aims: Congenital heart disease (CHD) is described as an abnormality in the heart structure or intra-thoracic great vessels that leads to functional problems. Since most of these disorders require medical and surgical interventions identifying concomitant disorders such as renal and urinary tract abnormalities is of great importance in the management of these patients. The present study aimed to investigate the relative frequency of abnormal kidney and urinary tract findings in abdominal cineangiography during cardiac catheterization of patients with CHD in Shahid Modarres Cardiovascular Medical and Research Center. Methods: The present study was performed prospectively on 545 patients aged < 18 years with CHD who underwent cardiac catheterization and concurrent abdominal cineangiography in Shahid Modarres Cardiovascular, Medical and Research Center, Tehran, Iran during a three-year period. The required data were extracted using a researcher-made questionnaire from patients’ electronic medical files. Results: Of a total of 545 patients in this study, 26 had both CHD and renal or urinary tract malformation. Patent ductus arteriosus was the most common CHD in patients with renal or urinary tract malformations (odds ratio: 1.2, 95%, CI: 2.25–11.63). In this study, the most common renal and urinary malformations among CHD patients was partial duplication of the kidney followed by Ureteropelvic Junction Obstruction.Conclusion: Since the prevalence of renal and urinary tract malformations is higher in CHD patients, performance of concurrent abdominal cineangiography during cardiac catheterization may lead to early diagnosis and treatment as well as better pre- and post-operative management of patients.

Primary enuresis

Worldwide, about 10% of children (aged 6-7 years old) suffer from bedwetting; in other words, this condition is widespread but the impact is often underestimated. The training of family doctors very rarely included guidance with specific recommendations, the frequent approach being the expectation of spontaneous resolution. The purpose of this paper is to provide the family doctor, who takes care of the child, with a guideline in the management of nocturnal enuresis. Materials and method. The systematic review of existing practice guides and literature, articles and studies published between 2001 and 2021 (PubMed, Cochrane, BMJ, Elsevier, JAMA Network, The Lancet, New England Journal of Medicine, Springer Nature, Wiley), on primary nocturnal enuresis, led to the creation of a material that was the basis of this article. Discussion and conclusions. The initial assessment should include history, physical examination and urinalysis. Se­ve­ral conditions associated with enuresis need to be identified, evaluated and treated: constipation, obstructive sleep apnea, diabetes, diabetes insipidus, chronic kidney disease and psychiatric disorders. Treatment begins with counseling the child and parents about effective behavioral changes. First-line treatment includes bedside alarm therapy and desmopressin. The choice of therapy is based on the age of the child, the patterns of emptying at night and the wishes of the child and family. The recommendation to a pediatrician expert in the field is indicated for children with primary enuresis refractory to standard and combination therapies, as well as for children with some secondary cau­ses of enuresis, including urinary tract malformations, recurrent urinary tract infections or neurological disorders.

Folic acid, periconceptional multivitamin supplementation and pregnancy: modern aspects

Folic acid (vitamin B9) is a water-soluble vitamin, essential for the growth and development of the blood and immune systems. Its deficiency is a significant risk factor for fetal neural tube defects. The widespread implementation of drugs and food supplements containing folic acid in preparation for pregnancy and in its first trimester has significantly reduced the incidence of fetal neural tube defects.According to current recommendations, taking 0.4 mg of folic acid per day is indicated within 6 months before conception and in the first trimester of pregnancy. Taking folic acid at a dosage of 4 mg is indicated for patients with a history of a fetal neural tube defect.There are also other risk factors for developing fetal neural tube defects. These include family history, obesity, malabsorption syndrome, folate cycle gene polymorphisms, smoking, drug use, diabetes mellitus (pre-gestational), and other chronic diseases. Determination of the required dosage of folic acid in these categories of patients still requires discussion and clinical trials. Also, folic acid intake is associated with a decreased risk of esophageal atresia, conotruncal heart disease, cleft palate, urinary tract malformations, and omphalocele, reduces the incidence of some behavioral anomalies, in particular, hyperactivity, the need for planning a pregnancy.

A rare case report of prune belly syndrome with malnutrition

ABSTRACT Prune belly syndrome (PBS) is a rare congenital malformation of unknown etiology characterized by a triad of deficient abdominal wall musculature, undescended testicles and urinary tract malformations. Most of the patients have pulmonary, cardiac, skeletal and gastrointestinal tract anomalies. Lack of abdominal muscles leads to constipation due to inability to perform Valsalva maneuver, which helps push the stool out of the rectum during the defecation. Additionally, frequent respiratory tract infections, persisting constipation and urinary tract infections lead to the development of malnutrition in children. We report this case to raise the awareness of low socioeconomic and low-resource medical settings that malnutrition could be existed or caused by PBS. We also encourage the expansion of pediatric surgery and family medicine training to increase the number of specialist (family medicine) to report and refer PBS in earlier phase, while working in rural areas and remote provinces.

The Mechanism of Prune Belly Syndrome Development: A Sonographic Sequential Assessment

Prune belly syndrome is a rare disorder characterized by the absence of anterior abdominal wall muscles, bilateral cryptorchidism, and urinary tract malformations. The aim of this case study was to illustrate the developmental sequelae of prune belly syndrome, acquired through a series of antenatal sonography. A 20-year-old woman visited a diagnostic medical sonography center for an obstetrical sonogram. Her fetus was diagnosed with megacystis at 15 weeks’ gestation. The mother returned for repeated appointment and to observe fetal changes during the development of prune belly syndrome. First, the megacystis, hydroureter, and hydronephrosis were noted followed by hazy ascitic and amniotic fluid. The hemodynamics were altered in the umbilical artery, middle cerebral artery, and ductus venosus. Subsequently, the pressure was neutralized, but it was observed after birth that the newborn had cryptorchidism, a distended abdomen with wrinkled wall, and absent right kidney. In conclusion, prune belly syndrome could be caused by megacystis due to bladder outlet obstruction in otherwise normal karyotype fetuses. Megacystis leads to hydroureter, hydronephrosis, and abdominal distention. The persistent abdominal distention gives rise to the underdevelopment of anterior abdominal wall muscles and cryptorchidism.