Management of lower urinary tract fibroepithelial polyps in children

Introduction Fibroepithelial polyps (FEP) of the lower urinary tract are relatively common in adults but rare in children, with fewer than 250 cases reported in the literature to date. Objective The aim of this study was to address the experience of FEP management in children. Study design A retrospective multicenter review was undertaken in children with defined FEP of the lower urinary tract managed between 2008 and 2018. The data at 18 pediatric surgery centers were collected. Their demographic, radiological, surgical, and pathological information were reviewed. Results A total of 33 children (26 boys; 7 girls) were treated for FEP of the lower urinary tract at 13 centers. The most common presentation was urinary outflow as hematuria (41%), acute urinary retention (25%), dysuria (19%), or urinary infections (28%). A prenatal diagnosis was made for three patients with hydronephrosis. Almost all of the children (94%) underwent ultrasound imaging of the urinary tract as the first diagnostic examination, 23 (70%) of them also either had an MRI (15%), cystourethrography (25%), computerized tomography (6%), or cystoscopy (45%). Two of these children (6%) had a biopsy prior to the surgery. The median preoperative delay was 7.52 (range: 1–48) months. Most of the patients were treated endoscopically, although four (12.1%) had open surgery and two (6.1%) had an additional incision for specimen extraction. The median hospital stay was 1.5 (range: 1–10) days. There were no recurrences and no complications after a median follow-up of 13 (range: 1–34) months. Discussion The main limitation of our study is the retrospective design, although it is the largest one for this pathology. Conclusion This series supports sonography as the most suitable diagnosis tool before endoscopy to confirm the diagnosis and to perform the resection for most FEP in children. This report confirms the recognized benign nature in the absence of recurrences

Evolution of urine metabolomic profiles in newborns

International audienceMetabolomics provides untargeted identification of all detectable low molecular-weight molecules by profiling without a priori the metabolic signatures of biological samples in connection to pathophysiological events. The goal of metabolomic studies is to identify relevant biomarkers or composite metabolic patterns associated with particular disease status. Urine is particularly suited for metabolomic analysis in newborns and children, due to its simple and non-invasive method of collection. Its biochemical composition is correlated to a number of factors such as genotype, gender, disease, nutritional state and age. The number of metabolomic studies in pediatrics is rising, but little is known concerning age-related changes in urine metabolic profiles and newborn metabolic maturation over time. The aim of this study was to investigate changes in urine metabolic profiles during the first four months of life using 1H-nuclear magneticresonance (NMR) spectroscopy combined with multivariate statistical analysis. Urine samples were collected from 91 newborns under 4 months old without nephrologic or urologic disease. The mean age was 68 days ± 24. The1H-NMR spectra were analyzed using Principal Component Analysis (PCA) and the effect of age on the urinary metabolite profile was observed even from this unsupervised analysis. Further analysis using Orthogonal Partial Least Squares (OPLS) methodology was performed and a model with good predictive power was calculated, allowing the identification of an age-related metabolic profile. We observed the most significant evolution between 2 and 3 months of life. Our results allow a deeper understanding of newborn metabolic maturation. They contribute to identifying potential confounding factors in the application of metabolomics in newborns

Evolution of urine metabolomic profiles in newborns

International audienceMetabolomics provides untargeted identification of all detectable low molecular-weight molecules by profiling without a priori the metabolic signatures of biological samples in connection to pathophysiological events. The goal of metabolomic studies is to identify relevant biomarkers or composite metabolic patterns associated with particular disease status. Urine is particularly suited for metabolomic analysis in newborns and children, due to its simple and non-invasive method of collection. Its biochemical composition is correlated to a number of factors such as genotype, gender, disease, nutritional state and age. The number of metabolomic studies in pediatrics is rising, but little is known concerning age-related changes in urine metabolic profiles and newborn metabolic maturation over time. The aim of this study was to investigate changes in urine metabolic profiles during the first four months of life using 1H-nuclear magneticresonance (NMR) spectroscopy combined with multivariate statistical analysis. Urine samples were collected from 91 newborns under 4 months old without nephrologic or urologic disease. The mean age was 68 days ± 24. The1H-NMR spectra were analyzed using Principal Component Analysis (PCA) and the effect of age on the urinary metabolite profile was observed even from this unsupervised analysis. Further analysis using Orthogonal Partial Least Squares (OPLS) methodology was performed and a model with good predictive power was calculated, allowing the identification of an age-related metabolic profile. We observed the most significant evolution between 2 and 3 months of life. Our results allow a deeper understanding of newborn metabolic maturation. They contribute to identifying potential confounding factors in the application of metabolomics in newborns

L’avenir de la chirurgie pédiatrique en France : la démographie des chirurgiens pédiatres en formation

Objectifs : Faire le recensement des internes et chefs de clinique des universités-assistants des hôpitaux (CCA) en formation en chirurgie pédiatrique et analyser les résultats en fonction des besoins de la spécialité. Matériel et méthodes : Les données concernant la démographie des chirurgiens pédiatres en formation ont été recueillies par un questionnaire adressé aux internes, CCA et coordonnateurs interrégionaux de la spécialité, de septembre 2009 à mars 2010. Les informations suivantes ont été recueillies : nom et prénom, sexe, année de validation du concours de l’internat ou des épreuves classantes nationales, orientation choisie en chirurgie pédiatrique, le centre hospitalier universitaire (CHU) de formation durant l’internat, lieu d’exercice. Résultats : Cinquante-trois internes sont inscrits en diplôme d’études spécialisées complémentaires (DESC) de chirurgie infantile avec une orientation urologique, viscérale, thoracique ou plastique et vingt-et-un en orthopédie pédiatrique. Par ailleurs treize internes en DESC d’orthopédie adulte vont s’orienter vers l’orthopédie pédiatrique. La répartition des internes sur le territoire montre des différences importantes entre les inter-régions. Il existe 55 postes de CCA en chirurgie pédiatrique. Conclusion : Cette étude devra servir de socle aux réflexions engagées par la Commission nationale de l’internat et du post-internat. Le nombre important d’internes formés chaque année montre l’attractivité de la chirurgie pédiatrique pour les chirurgiens en formation. Il nous alerte sur la nécessité d’adapter la formation des chirurgiens pédiatres aux capacités de formation de notre système de santé et aux besoins de santé de la population française

Early detection of ureteropelvic junction obstruction in neonates with prenatal diagnosis of renal pelvis dilatation using 1H NMR urinary metabolomics

International audienceAbstract Renal pelvis dilatation (RPD) is diagnosed in utero on prenatal ultrasonography (US) and can resolve spontaneously. However, isolated RPD can also reflect ureteropelvic junction obstruction (UPJO), which requires surgical treatment to prevent progressive renal deterioration. The diagnosis of UPJO can only be confirmed after birth with repeat US and renal isotope studies. 1 H Nuclear Magnetic Resonance spectroscopy (NMR) was performed on urine of newborns with prenatally diagnosed unilateral RPD and healthy controls to identify specific urinary biomarkers for UPJO. The original combination of EigenMS normalization and sparse partial-least-squares discriminant analysis improved selectivity and sensitivity. In total, 140 urine samples from newborns were processed and 100 metabolites were identified. Correlation network identified discriminant metabolites in lower concentrations in UPJO patients. Two main metabolic pathways appeared to be impaired in patients with UPJO i.e. amino acid and betaine metabolism. In this prospective study, metabolic profiling of urine samples by NMR clearly distinguishes patients who required surgery for UPJO from patients with transient dilatations and controls. This study will pave the way for the use of metabolomics for the diagnosis of prenatal hydronephrosis in clinical routine

Evolution of Newborns’ Urinary Metabolomic Profiles According to Age and Growth

International audienc

Thoracoscopy for Pediatric Thoracic Neurogenic Tumors—A European Multi-Center Study

Objectives: To assess the efficacy of thoracoscopy and the outcome for children with thoracic neurogenic tumors. Methods: We performed a retrospective review of 15 European centers between 2000 and 2020 with patients who underwent thoracoscopy for a neurogenic mediastinal tumor. We assessed preoperative data, complications, and outcomes. Results were expressed with the median and range values. Results: We identified 119 patients with a median age of 4 years old (3 months–17 years). The diameter was 5.7 cm (1.1–15). INRG stage was L1 n = 46, L2 n = 56, MS n = 5, M n = 12. Of 69 patients with image-defined risk factors (IDRF), 29 had only (T9–T12) locations. Twenty-three out of 34 patients with preoperative chemotherapy had an 18 mm (7–24) decrease in diameter. Seven out of 31 patients lost their IDRF after chemotherapy. Fourteen had a conversion to thoracotomy. The length of the hospital stay was 4 days (0–46). The main complications included chylothorax (n = 7) and pneumothorax (n = 5). Long-term complications included Horner’s syndrome (n = 5), back pain, and scoliosis (n = 5). Pathology was 53 neuroblastomas, 36 ganglioneuromas, and 30 ganglioneuroblastomas. Fourteen had a postoperative residue. With a median follow-up of 21 months (4–195), 9 patients had a recurrence, and 5 died of disease. Relapses were associated with tumor biology, histology, and the need for chemotherapy (p = 0.034, p = 0.04 and 0.020). Conclusion: Our results show that thoracoscopy is safe, with good outcomes for thoracic neurogenic tumors in selected cases. Surgical outcomes are related to the IDRFs, whereas oncologic outcomes are related to tumor histology and biology

Long-Term Functional Outcomes of an Anorectal Malformation French National Cohort

International audienceThe present study aimed to assess long-term functional outcomes of children with anorectal malformations (ARMs) across a network of expert centers in France