Embryology and Morphological (Mal)Development of UPJ

WOS: 000528862100001PubMed: 32318525Kidney parenchyma and collecting system arise from two different embryologic units as a result of a close interaction between them. Therefore, their congenital abnormalities are classified together under the same heading named CAKUT (congenital abnormalities of the kidney and urinary tract). the pathogenesis of CAKUT is thought to be multifactorial. Ureteropelvic junction obstruction (UPJO) is the most common and most investigated form of CAKUT. Despite years of experimental and clinical research, and the information gained on the embryogenesis of the kidney; its etiopathogenesis is still unclear. It involves both genetic and environmental factors. Failure in development of the renal pelvis, failure in the recanalization of ureteropelvic junction, abnormal pyeloureteral innervation, and impaired smooth muscle differentiation are the main proposed mechanisms for the occurrence of UPJO. There are also single gene mutations like AGTR2, BMP4, Id2 proposed in the etiopathogenesis of UPJO

Urinary incontinance in childhood

WOS: 000277931100023Most common cause of childhood incontinence is enuresis nocturna which is characterized with spontaneus resolution and physiologically normal voiding. Although most cases are not related to any structural or neurological abnormality, it is important to properly diagnose a child who presents with wetting. A thorough medical history will delineate the pattern of incontinence and additional investigations are indicated in only selected patients. If the physician can identify the voiding disorder and treat the cause not the symptom, will minimize the effects of the condition on the child's social development and also prevent the possible injuries to upper urinary tract. Therefore, this review will mostly focus on differential diagnosis of the causes of urinary incontinence. (Turk Arch Ped 2009; 44 Suppl: 90-3

Factors Influencing the Choice of Pediatric Surgery as a Medical Career Among Turkish Pediatric Surgeons and Residents

WOS: 000291330700026Objective: Each medical specialty has its own reasons to be selected as a career by medical doctors. The aim of this study was to identify the main reasons to select pediatric surgery as a medical career among Turkish pediatric surgeons and residents. Material and Methods: Data of this cross-sectional survey were collected from pediatric surgeons and residents, based on a self-administrated questionnaire during 23(rd) National Congress of Pediatric Surgery in September 2005. The questionnaire included demographic variables (sex, gender, academic affiliation) and 13 possible influence factors which were marked on a 7 point semantic differentiation scale (3= strong negative influence, 0= no influence, +3= strong positive influence). Results: Eigthy-seven pediatric surgeons and residents participated in the survey. Three strong positive reasons (opportunity to perform surgery, working with children, and expected emotional satisfaction), one moderate reason (ability to appraisal of own skills and aptitude), and two minor positive reasons (expected academic opportunities and a teacher as a role model) were identified to select pediatric surgery as a medical career. Conclusion: Our findings may be used for the early identification and support of doctors who will become pediatric surgeons in Turkey

A pilot study assessing average detrusor pressure garnered from area under a urodynamic curve: Evaluation of clinical outcomes

Introduction The management of neurogenic bladder mostly relies on urodynamic studies; however, several studies have shown low interobserver reproducibility. The aim of this study was to evaluate if a new objective cystometric parameter was superior to other cystometric measures. Patients and methods A new parameter (pressure adjusted area under curve ratio, PAUC) was formulated from the ratio of area under the cystometry curve to a DLPP-adjusted total area (A(T)). A(T) was figured from a rectangle designed on the cystometrogram curve with a fixed height of 200 cmH(2)O and a width defined by the filling phase (figure). Two different estimated pressure measures derived from this (upper mean static pressure, UMSP and theoretical end filling pressure TEFP) were then calculated. Medical records of myelomeningocele patients with ultrasonography and renal scintigraphy performed at the time of urodynamics (with an interval of >5 years) were reviewed. Hydronephrosis and new scars in scintigraphy were used as the outcome measures. Results The study group consisted of 115 subjects with a median age of 4 (0-23) years at the time of the first urodynamic study. The median follow-up was 6 (5-14) years. PAUC and its derivatives (UMSP and TEFP) had the best discriminative power in predicting high grade hydronephrosis (0.830, 95% CI:0.732-0.927, p 0.1 significantly correlated with urinary tract dilatation (p < 0.001) and new scar formation (p = 0.002). In the multivariate analysis, our three parameters and having scars at admission were the only independent risk factors for new scars (p = 0.001 and p = 0.002, respectively) and worsening in hydronephrosis (p < 0.001 and p = 0.001, respectively). Discussion Our results show that our three parameters derived from area under the urodynamic curve are more reliable than other urodynamic measures. Their major theoretical advantage is to incorporate all the pressure during filling phase giving a more accurate picture of what the intravesical pressure milieu is. Using these measures, we demonstrated their superiority in predicting clinical outcomes. Major limitations of this study are the retrospectively collected data and lack of longitudinal follow-up starting from infancy in each patient. Conclusion Our new parameters (PAUC, UMSP and TEFP) which incorporate the impact of entire filling phase pressure changes in the analysis, may be useful tools to identify those patients who are under the risk of kidney damage with neurogenic lower urinary tract dysfunction

Endoscopic Management of Vesicoureteral Reflux in Duplex Renal Collecting Systems

Aim: Standardization of an optimal treatment protocol for vesicoureteral reflux (VUR) correlated with duplex kidney systems remains controversial. In this study, we reviewed our experience in endoscopic subureteric injection to correct reflux in duplex systems with documented indications, in an aim to confirm its position as an alternative means of open surgery. Materials and Methods: The hospital records of complete renal duplex system patients who had experienced endoscopic subureteric injection for VUR between 2009 and 2018 were reviewed. The indications for the amelioration of VUR included breakthrough urinary tract infection (UTI) along with the presence of renal scarring. Results: A total of 24 patients (18 girls, 6 boys) with refluxing renal duplex systems were included in the study. The mean age at first injection was 46.4 +/- 28.8 months (5-160) and the mean duration of follow-up was 47.25 +/- 27.7 months. The success rate with the initial injection was 83.3% (20/24). The mean volume of material injected was 0.68 +/- 0.49 mL per duplex system. Conclusion: Management of reflux in duplex systems is still controversial with insufficient data. Our results suggest that endoscopic management should be considered as an alternative to open ureteral reimplantation in refluxing duplex renal collecting systems. Major open surgery and accompanying discomfort can be avoided by an endoscopic injection which can be performed as an outpatient procedure in most of the reflux patients with duplex system who have an indication for surgical management

Changing bulking agent may require change in injection volume for endoscopic treatment of vesicoureteral reflux

WOS: 000451852300017PubMed ID: 30325612Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new went

Changing bulking agent may require change in injection volume for endoscopic treatment of vesicoureteral reflux

ABSTRACT Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent