The role of videourodynamic studies in diagnosis and management of vesicoureteral reflux

Objective: Increased incidence of lower urinary tract dysfunction (LUTD) has been reported in older children with vesicoureteral reflux (VUR), and its treatment affects patient outcome. The optimal initial imaging method is often difficult for clinicians to select in this patient group. The aim of the study was to investigate the value of videourodinamic studies (VUD) in the detection and management of VUR in children with recurrent urinary tract infections and lower urinary tract symptoms such as urge, urge incontinence, weak stream, and frequency. Material and Methods: The study included 117 children with 234 kidney-ureter units (KUUs). The clinical patient records of DMSA scintigraphy, voiding cystouretrography (VCUG), and VUD were reviewed retrospectively. Results: Vesicoureteral reflux was identified in 108 of 234 KUUs (46%). In 55% of refluxing KUUs, VUR was exhibited by both techniques while 25% of refluxing KUUs were exhibited by only VCUG, and 19% of refluxing KUU by only VUD. Bladder instability was detected in 55 of 74 (74%) patients with VUR, and in 34 of 43 (79%) patients without VUR. There was moderate concordance in the diagnosis of VUR by VUD and VCUG (?=0.55±0.05), but the difference in reflux detection rate between VUD and VCUG was not statistically significant (p=0.47). Conclusion: Our findings indicated that VUD and VCUG techniques exhibit equal reliability in the diagnosis of VUR, and VUD provides additional information concerning LUTD. Copyright © 2013 by Türkiye Klinikleri

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients