European Association of Urology and European Society for Paediatric Urology Guidelines on Paediatric Urinary Stone Disease

Context: Paediatric stone disease is an important clinically entity and management is often challenging. Although it is known that the condition is endemic in some geographic regions of the world, the global incidence is also increasing. Patient age and sex; the number, size, location, and composition of the stone; and the anatomy of the urinary tract are factors that need to be taken into consideration when choosing a treatment modality. Objective: To provide a general insight into the evaluation and management of urolithiasis in the paediatric population in the era of minimally invasive surgery. Evidence acquisition: A nonsystematic review of the literature on management of paediatric urolithiasis was conducted with the aim of presenting the most suitable treatment modality for different scenarios. Evidence synthesis: Because of high recurrence rates, open surgical intervention is not the first option for paediatric stone disease, except for very young patients with very large stones in association with congenital abnormalities. Minimally invasive surgeries have become the first option with the availability of appropriately sized instruments and accumulating experience. Extracorporeal shockwave lithotripsy (SWL) is noninvasive and can be carried out as an outpatient procedure under sedation, and is the initial choice for management of smaller stones. However, for larger stones, SWL has lower stone-free rates and higher retreatment rates, so minimally invasive endourology procedures such as percutaneous nephrolithotomy and retrograde intrarenal surgery are preferred treatment options. Conclusions: Contemporary surgical treatment for paediatric urolithiasis typically uses minimally invasive modalities. Open surgery is very rarely indicated. Patient summary: Cases of urinary stones in children are increasing. Minimally invasive surgery can achieve high stone-free rates with low complication rates. After stone removal, metabolic evaluation is strongly recommended so that medical treatment for any underlying metabolic abnormality can be given. Regular follow-up with imaging such as ultrasound is required because of the high recurrence rates

Two Cases of Bladder Adenocarcinoma After Augmentation Cystoplasty

To draw attention to the disregarded malignancy risk after ileocystoplasty, we present two cases of adenocarcinoma. The first case was metastatic at initial diagnosis. Despite chemotherapy, the condition progressed and the patient died at the 9th month. The second patient has received cystectomy followed by chemotherapy and radiotherapy. Although the second patient was an immunosuppressed renal transplant, she was disease-free at the 27th month. As the malignancy risk after bladder augmentation is a proven fact, until the discovery of a proper diagnostic method, we recommend doing routine annual cystoscopic biopsy starting after the 10th year of ileocystoplasty

Efficacy of Antibiotic Coated Clean Intermittent Catheterization in Children with Neurogenic Bladder

Aim: The primary goal of urologic management in children with neurogenic bladder is to reduce the risk of urinary tract infection (UTI) and associated renal injury. We aimed to evaluate the use of antibacterial-coated clean intermittent catheterization (CIC) catheters for neurogenic bladder patients in comparison with standard catheters.  Material and Methods: We performed a retrospective study of 144 neurogenic bladder patients aged 6-16 years old, who received CIC at two major centers between January 2007 and June 2016. Group 1 consisted of children used antibacterial coated (chitosan) catheter (n=55), group 2 of children used standard CIC without antibacterial (n=42) and group 3 of children used standard CIC returned into antibiotic coated CIC (n=29). Febrile urinary tract infection and asymptomatic bacteriuria were evaluated among patients with antibacterial coated or standard catheters. We also focused on a subgroup of patients with high risk of urinary tract infection (grade 3> vesicoureteral reflux, previously scar formation in renal scintigraphy).  Results: Totally 126 patients (89 female, 37 male) were involved in this study. The mean age of the study group was 9.6±2.6 years (range 6 to 16) and the mean follow-up 58±14 months (min: 22, max: 69). There was no significant difference between three groups for asymptomatic bacteriuria and febrile UTI frequencies. However, febrile UTI frequencies and de nova scar formation in renal scintigraphy were higher in previously defined subgroup of patients with high risk of urinary tract infection in group 2 than group1 and 3.  Discussion: Both antibiotic coated and standard CIC can be used in children with neurogenic bladder with similar complication rates. Patients with high risk of urinary tract infection (higher than grade 3 vesicoureteral reflux, dilated ureter, previously de nova scar formation in renal scintigraphy) will benefit from antibacterialcoated catheters rather than standard ones

Heavy Scarring in the Unilateral Refluxing Kidney May Sign of Contralateral Reflux After Reimplantation

Objective: The aim of this study was to investigate the role of heavy ipsilateral scarring in the development of the contralateral reflux after unilateral reimplantation. Materials and Methods: The study included 43 patients (24 male, 19 female) who had undergone unilateral reimplantation. Heavy scarring was defined as the presence of multiple central scars on renal scan and differential function of less than 30% with diffuse paraenchymal damage. Postoperative voiding cystourethrography was performed to evaluate febrile urinary tract infection or hydronephrosis during follow-up. The development of the contralateral reflux was compared based on the type of reimplantation, age, preoperative renal scar status, and reflux grade. Results: Contralateral reflux developed in 6 children. No significant relationship was found between the pre-operative grade, type of reimplantation, and incidence of the contralateral reflux. However, de novo contralateral reflux was significantly higher in children with heavy scarring on the ipsilateral kidney. Among the five children with heavy kidney scarring and aged 4 years or younger, contralateral reflux was found in three children. Reflux was resolved within 24.6±12.2 months on average although one child recovered with Dx/HA implantation. Conclusion: We found that the presence of heavy scarring in the ipsilateral kidney may play a role in the prediction of contralateral reflux development

Pediatric Multilocular Cystic Nephroma Extending into the Renal Pelvis and Ureter

Multilocular cystic nephroma (MCN) is a rare tumor at the most benign end of the spectrum of the multilocular cystic neplasms of kidney. Nephrectomy is curative for MCN. In this case-report, we present a 16-month-old girl with a 10x15 cm multilocular cystic renal tumor extending into the renal pelvis and proximal ureter on the right side demonstrated on magnetic resonance imaging. Nephrectomy was performed. The pathology was completely consistent with MCN

The Early Histological Effects of Intravesical Instillation of Platelet-Rich Plasma in Cystitis Models

Purpose: To evaluate the early histological effects of the intravesical instillation of platelet-rich plasma (PRP) in rabbit models of interstitial and hemorrhagic cystitis

Does Lower Urinary Tract Status Affect Renal Transplantation Outcomes in Children?

Background. Lower urinary tract dysfunction (LUTD), an important cause of end stage renal disease (ESRD) in children, can adversely affect renal graft survival. We compared renal transplant patients with LUTD as primary renal disease to those without LUTD