Resolution of Diabetes Insipidus After Pyeloplasty: A Case Report and Review of the Literature

Nephrogenic diabetes insipidus (NDI), a rare cause of polyuria and polydipsia in children, is usually managed with medications and careful monitoring of water intake. We present a child who was incidentally found to have right hydronephrosis secondary to ureteropelvic junction obstruction, and was subsequently also diagnosed with NDI. After being medically managed, he underwent open right pyeloplasty. His polydipsia abated within 1 month of surgery, and he has done well off of medications since that time. NDI resolution after correction of obstructive uropathy in adults has been reported, but this represents a novel case in pediatrics

Endoscopic Deflux\u3csup\u3e®\u3c/sup\u3e injection for pediatric transplant reflux: A feasible alternative to open ureteral reimplant

Objective: Pediatric renal transplantation is frequently performed using a freely refluxing vesicoureteral anastomosis. The resulting vesicoureteral reflux (VUR) may increase the morbidity of urinary tract infections (UTIs) that commonly occur in this setting, yet open surgical correction of the refluxing anastomosis can prove difficult. We report our experience using endoscopic injection of dextranomer/hyaluronic acid (Deflux®) to correct transplant VUR. Materials and methods: We retrospectively reviewed the charts of patients treated with endoscopic injection of Deflux (Q-Med, Uppsala, Sweden) for VUR into their renal allograft. Indications for inclusion in the study were renal allograft transplantation for primary end-stage renal disease, radiographically proven VUR into the allograft, normal voiding history, and at least one documented febrile UTI. Preoperative and postoperative images, including voiding cystourethrogram and allograft ultrasound, were compared. Location of the transplant orifice and volume of Deflux were recorded. Clinical outcomes, including documented UTI and changes in serum creatinine following treatment, were also assessed. Results: Eight patients were identified who were treated for transplant VUR, with a total of nine transplant ureters injected. Mean patient age at time of injection was 11.6 years (range: 7-19 years). Post-injection voiding cystourethrograms and allograft ultrasound were available for all patients. Following treatment, four ureters demonstrated resolution of VUR and one ureter demonstrated improvement to grade 1 VUR. The remaining four ureters demonstrated no change in VUR grade. No patients showed any change in their serum creatinine, and no episodes of transplant pyelonephritis have occurred during the follow-up period. Mean post-injection follow-up has been 17.3 months (range 9-26 months). Conclusion: Initial results demonstrate that endoscopic treatment with Deflux is feasible and may provide a less invasive alternative for treatment of transplant VUR. Further investigation with a larger group of patients and longer follow-up is needed. © 2008 Journal of Pediatric Urology Company

Resolution of Diabetes Insipidus After Pyeloplasty: A Case Report and Review of the Literature

Nephrogenic diabetes insipidus (NDI), a rare cause of polyuria and polydipsia in children, is usually managed with medications and careful monitoring of water intake. We present a child who was incidentally found to have right hydronephrosis secondary to ureteropelvic junction obstruction, and was subsequently also diagnosed with NDI. After being medically managed, he underwent open right pyeloplasty. His polydipsia abated within 1 month of surgery, and he has done well off of medications since that time. NDI resolution after correction of obstructive uropathy in adults has been reported, but this represents a novel case in pediatrics

Ultrasound screening of asymptomatic siblings of children with vesicoureteral reflux: A long-term followup study

Purpose: Siblings of patients with vesicoureteral reflux (VUR) are at greater risk of having reflux than the general population, and the role of screening in this group is widely accepted. While voiding cystourethrogram (VCUG) is the gold standard for diagnosis of VUR, ultrasound (US) is often used for screening select patients. We examine the outcomes of a conventional US screening program in older asymptomatic siblings. Materials and Methods: Between 1984 and 2003 asymptomatic siblings older than 5 years as well as children whose parents refused VCUG were screened with conventional US and urine studies. If US showed a discrepancy in renal size, renal scarring or hydronephrosis, or a change in the size of the renal pelvis during the study, then VCUG was performed. Additionally, any child with a normal US who subsequently had symptoms of urinary tract infection was then referred for VCUG. Chart review was performed and 117 siblings were identified who met these criteria (age range 2 months to 15 years). An attempt was made to contact all 117 siblings to obtain long-term followup data. Results: Of the 117 siblings 11 (9.4%) were referred for VCUG secondary to abnormal US findings (9) and development of urinary tract infection (2). VCUG was negative in the 2 symptomatic children, while 5 of the 9 (55.6%) with abnormal US were found to have VUR. Telephone contact was established with 85 of the 117 (72.6%) siblings or their parents (average followup 8.3 years, range 2 months to 19 years). All 85 siblings with available followup information had normal US, and none had had symptoms or complications of VUR since screening. Conclusions: Given the lower incidence and seemingly innocuous nature of VUR in older asymptomatic siblings of known patients with reflux, observation alone in this group is an acceptable form of management. If either parental or physician anxiety exists in this approach, then conventional US offers a reliable alternative to invasive VCUG screening in this population. Copyright © 2005 by American Urological Association

Does the mechanism of injury in pediatric blunt trauma patients correlate with the severity of genitourinary organ injury?

Introduction: Blunt abdominal trauma can result in injury to genitourinary (GU) organs. Children may be more susceptible to some GU injuries due to anatomic differences compared to adults. Mechanism of injury (MOI) has been thought to relate to both the likelihood and severity of GU injury in children, although this has not definitively been proven. Our purpose was to determine if MOI has any correlation to the severity of GU injury in children treated at our institution. Materials and methods: We reviewed records of all pediatric blunt trauma patients presenting to our institution from January 2005-December 2010 using the LeBonheur Children\u27s Hospital Trauma Registry. All patients with GU injuries were included in this study. Data collected included demographic information, MOI, type and grade of GU injury, associated injuries, and clinical outcome. Continuous variables were tested with ANOVA and categorical variables were tested with chi-square test. Results: Records of 5151 children with blunt trauma were reviewed; 76 patients were found to have GU organ injury. There were 47 males (61.8%) and 29 females (38.2%). Categories of MOI included motor vehicle accident, sports injury, bicycle accident, all-terrain vehicle accident (ATV), pedestrian struck accident, falls, and animal injury. MOI did not have any statistically significant association with the severity of GU organ injury (p = 0.5159). In addition, there was no association between MOI and either gender or side of injury. There was a statistically significant association between MOI and patient age (p = 0.04); older pediatric patients were more likely to experience GU injury due to sports injury and ATV accidents, where as younger patients were more likely to experience GU injury due to pedestrian struck, bicycle accidents or animal bite. Conclusions: Although specific MOI would seem to relate to presence and severity of injury in children, MOI alone does not correlate with the severity of GU organ injury in our pediatric trauma population. Age of pediatric patients is associated with the type of MOI that results in GU organ injury. The possibility of GU injury should be considered in all symptomatic pediatric patients with clinically significant blunt trauma regardless of the exact MOI

Pediatric urolithiasis - Does body mass index influence stone presentation and treatment?

Purpose: Pediatric obesity is a major public health concern in the United States. We investigated the association of body mass index with presentation and outcome in children with urolithiasis. Materials and Methods: We identified all patients 2 to 18 years old at our institution with a radiographically confirmed first renal or ureteral stone between January 2003 and June 2008. Data abstracted included demographics, stone characteristics, treatment and metabolic evaluation. Patients were stratified into 3 body mass index categories, including lower (10th percentile or less for age), normal (10th to 85th percentile) and upper (85th percentile or greater) percentile body weight. Results: Of the children 62 boys (55.4%) and 50 girls (44.6%) were evaluable. Mean age at diagnosis was 11.8 years. Body mass index stratification showed lower percentile body weight in 11 patients (9.8%), normal percentile body weight in 55 (49.1%) and upper percentile body weight in 46 (41.1%). Mean stone diameter was 5.0 mm. Of the stones 31 (27.7%) were in the kidney or ureteropelvic junction and 81 (72.3%) were in the ureter. Surgery was done in 87 patients (78.9%) and stone clearance was accomplished by 1 (69.0%) or 2 (31.0%) procedures in all. Lower percentile body weight patients presented earlier than normal and upper percentile body weight patients (9.0 vs 12.2 and 12.0 years, respectively, p = 0.04). Neither stone size nor the number of procedures required for stone clearance differed significantly by body mass index. Conclusions: Upper percentile body weight was not associated with earlier stone development, larger stones or the need for multiple surgical procedures. In lower percentile body weight patients symptomatic renal stones developed significantly earlier than in normal or upper percentile body weight patients. Stone size and the surgical intervention rate were similar regardless of body mass index. Further research may identify potential factors predisposing children with lower percentile body weight to early stone development. © 2010 American Urological Association Education and Research, Inc