Factores de riesgo asociados a anomalías congénitas renales y de vías urinarias / Risk factors associated with congenital renal and urinary tract anomalies

Introducción: Las anomalías congénitas renales y de las vías urinarias constituyen la principal causa de enfermedad renal crónica en la edad pediátrica. Su etiología es multifactorial. Intervienen factores maternos, genéticos y ambientales. En Cuba, las afecciones congénitas del riñón y las vías urinarias constituyen una latente preocupación y aunque se ha incrementado el diagnóstico prenatal de las mismas, el número de pacientes diagnosticados es alto. Objetivo: Contribuir al conocimiento de la comunidad científica en relación con los factores de riesgo asociados a las anomalías del desarrollo renal. Métodos: Se realizó una revisión sistemática de la literatura médica disponible en las bases de datos Ebsco, SciELO, Scopus, Pubmed, revistas de nefrología pediátrica, pediatría, genética y teratología; y en la red social académica: Researchgate. Se accedió, durante los últimos cinco años, a varios artículos publicados en español y en inglés. Se utilizaron los descriptores Congenital anomalies of the kidney and urinary tract, hydronephrosis, risk factors, prenatal diagnosis, congenital abnormalities. Conclusiones: La presencia de la diabetes, desde la etapa preconcepcional y durante las primeras semanas del embarazo, la obesidad, las dietas maternas bajas en proteínas, y las alteraciones de la fertilidad, se asocian a las anomalías del desarrollo renal. Existen factores de riesgo específicos para determinados tipos de defectos congénitos renales y de las vías urinarias. No se considera, que el consumo del ácido fólico tenga un papel protector sobre las alteraciones de la embriogénesis renal, por lo que se recomienda ser cauteloso con la dosis que se administra a las embarazadas.

Introduction: congenital renal and urinary tract anomalies are the main cause of chronic kidney disease in children. Its etiology is multifactorial. Maternal, genetic and environmental factors are involved. In Cuba, congenital renal and urinary tract affections constitute a latent concern, and although their prenatal diagnoses have increased, the number of diagnosed patients is high. Objective: to contribute to the knowledge of the scientific community in relation to the risk factors associated with renal developmental anomalies. Methods: a systematic review of the available medical literature was carried out in Ebsco, SciELO, Scopus and Pubmed databases, in pediatric nephrology, pediatrics, genetics, and teratology journals as well as in the academic social network: Researchgate. Several articles published in Spanish and English languages were accessed during the last five years. The used descriptors were congenital anomalies of the kidney and urinary tract, hydronephrosis, risk factors, prenatal diagnosis and congenital abnormalities. Conclusions: the presence of diabetes, from the preconceptional stage and during the first weeks of pregnancy, obesity, maternal diets low in protein, and fertility disorders, are associated with renal developmental anomalies. There are specific risk factors for certain types of kidney and urinary tract birth defects. It is not considered that the consumption of folic acid has a protective role on the alterations of renal embryogenesis, so it is recommended to be cautious with the dose administered to pregnant women.

Comparison of safety and effectiveness of active migration technique and in situ lithotripsy technique in the treatment of 1-2 cm upper ureteral calculi by flexible ure-teroscopy / 北京大学学报(医学版)

OBJECTIVE@#To compare the safety and effectiveness of active migration technique and in situ lithotripsy technique in the treatment of 1-2 cm upper ureteral calculi by retrograde flexible ureteroscopy.@*METHODS@#A total of 90 patients with 1-2 cm upper ureteral calculi treated in the urology department of Beijing Friendship Hospital from August 2018 to August 2020 were selected as the subjects. The patients were divided into two groups using random number table: 45 patients in group A were treated with in situ lithotripsy and 45 patients in group B were treated with active migration technique. The active migration technique was to reposition the stones in the renal calyces convenient for lithotripsy with the help of body position change, water flow scouring, laser impact or basket displacement, and then conduct laser lithotripsy and stone extraction. The data of the patients before and after operation were collected and statistically analyzed.@*RESULTS@#The age of the patients in group A was (51.6±14.1) years, including 34 males and 11 females. The stone diameter was (1.48±0.24) cm, and the stone density was (897.8±175.9) Hu. The stones were located on the left in 26 cases and on the right in 19 cases. There were 8 cases with no hydronephrosis, 20 cases with grade Ⅰ hydronephrosis, 11 cases with grade Ⅱ hydronephrosis, and 6 cases with grade Ⅲ hydronephrosis. The age of the patients in group B was (51.8±13.7) years, including 30 males and 15 females. The stone diameter was (1.52±0.22) cm, and the stone density was (964.6±214.2) Hu. The stones were located on the left in 22 cases and on the right in 23 cases. There were 10 cases with no hydronephrosis, 23 cases with grade Ⅰ hydronephrosis, 8 cases with grade Ⅱ hydronephrosis, and 4 cases with grade Ⅲ hydronephrosis. There was no significant diffe-rence in general parameters and stone indexes between the two groups. The operation time of group A was (67.1±16.9) min and the lithotripsy time was (38.0±13.2) min. The operation time of group B was (72.2±14.8) min and the lithotripsy time was (40.6±12.6) min. There was no significant difference between the two groups. Four weeks after operation, the stone-free rate in group A was 86.7%, and in group B was 97.8%. There was no significant difference between the two groups. In terms of complications, 25 cases of hematuria, 16 cases of pain, 10 cases of bladder spasm and 4 cases of mild fever occurred in group A. There were 22 cases of hematuria, 13 cases of pain, 12 cases of bladder spasm and 2 cases of mild fever in group B. There was no significant difference between the two groups.@*CONCLUSION@#Active migration technique is safe and effective in the treatment of 1-2 cm upper ureteral calculi.

Supervivencia de pacientes con cáncer de cérvix estadio clínico III y IV, sometidas a nefrostomía: Estudio descriptivo de centro único / Survival of patients with clinical stage III and IV cervical cancer undergoing nephrostomy: Descriptive study of a single center

Introducción: La cuarta parte de las mujeres con neoplasias ginecológicas cursa con obstrucción en la vía urinaria, secundaria a infiltración tumoral o compresión extrínseca de los uréteres. La nefrostomía es la alternativa clínica intervencionista para mejorar la nefropatía obstructiva y evitar el tratamiento de diálisis en un paciente oncológico con hidronefrosis. El presente estudio tiene el objetivo de determinar la supervivencia de pacientes con cáncer de cérvix portadoras de nefrostomía. Metodología: El presente estudio observacional se realizó en el Hospital Solón Espinosa Ayala "Solca-Núcleo de Quito" de enero-2014 a diciembre-2018. El cálculo muestral fue no probabilístico, se incluyeron casos de pacientes con cáncer de cérvix con nefrostomía. Las variables fueron: edad, su-pervivencia global, supervivencia con nefrostomía, tipo histológico de la neoplasia de cérvix, estadío, tratamiento oncológico luego de la nefrostomía, complicaciones y repuesta al tratamiento. Para el análisis se usó el método Kaplan Meier. Se analiza supervivencia según estadios funcionales ECOG . Resultados: Se incluyeron 96 casos en el estudio. La media de sobrevida luego de colocar la nefros-tomía fue de 277 días (9.2 meses), y la media de la sobrevida global fue de 462 días (15 meses). Las pacientes con ECOG-0 la supervivencia global fue de 625 días (20.8 meses), con ECOG 1, 2 y 3 fue de 437 días (14.5 meses) P= 0.013. Conclusión: Es este estudio las pacientes con cáncer de cérvix que tienen enfermedad localmente avanzada y metastásica con ECOG 0, son las más beneficiadas del procedimiento de nefrostomía con mejoría de la supervivencia. Las pacientes con enfermedad localmente avanzada y metastásica con ECOG 2 y 3, no mejoraron su sobrevida global con la colocación de nefrostomía, ya que a pesar de que recibieron tratamiento oncológico el 50% de ellas progresaron, pero evitaron el ingreso a programas de diálisis. La principal complicación luego de la colocación del catéter de nefrostomía fue la infección.

Introduction: A quarter of women with gynecological neoplasms present with obstruction in the urinary tract, secondary to tumor infiltration or extrinsic compression of the ureters. Nephrostomy is an interventional clinical alternative to improve obstructive nephropathy and avoid dialysis treatment in a cancer patient with hydronephrosis. The objective of this study was to determine the survival of patients with cervical cancer who underwent nephrostomy. Methodology: The present observational study was carried out at Solón Espinosa Ayala Hospital "Solca-Núcleo de Quito" from January 2014 to December 2018. The sample calculation was nonprobabilistic. Cases of patients with cervical cancer who underwent nephrostomy were included. The variables were age, overall survival, survival with nephrostomy, histological type of cervical neo-plasia, stage, oncological treatment after nephrostomy, complications, and response to treatment. For the analysis, the Kaplan­Meier method was used. Survival was analyzed according to ECOG func-tional stages. Results: Ninety-six cases were included in the study. The median survival after nephrostomy place-ment was 277 days (9.2 months), and the median overall survival was 462 days (15 months). Pa-tients with ECOG-0 had an overall survival of 625 days (20.8 months); those with ECOG 1, 2, and 3 had an overall survival of 437 days (14.5 months) (P= 0.013). Conclusion: In this study, patients with cervical cancer who had locally advanced and metastatic disease with ECOG 0 benefited the most from the nephrostomy procedure with improved survival. Patients with locally advanced and metastatic disease with ECOG scores of 2 and 3 did not improve their overall survival with nephrostomy placement. Fifty percent of them progressed despite receiving cancer treatment, but they avoided admission to dialysis programs. The main complication after placement of the nephrostomy catheter was an infection.

Preoperative hydronephrosis predicts adverse pathological features and postoperative survival in patients with high-grade upper tract urothelial carcinoma

ABSTRACT Purpose: Epidemiological studies reported conflicting results about preoperative hydronephrosis in upper tract urothelial carcinoma (UTUC). This study aimed to investigate the association between preoperative hydronephrosis and pathologic features and oncologic outcomes in patients with UTUC treated by radical nephroureterectomy (RNU). Materials and Methods: This was a retrospective, single-center cohort study of 377 patients treated by RNU without perioperative chemotherapy between January 2001 and December 2014. Logistic regression, Cox regression, and survival analyses were performed. Results: Among the 226 patients with high-grade UTUC, 132 (58%) had preoperative hydronephrosis. Multivariable logistic regression revealed that hydronephrosis was independently associated with advanced pT stage (P=0.017) and lymph node or lymphovascular invasion (P=0.002). Median follow-up was 36 months (interquartile range: 20-48 months). The 3- and 5-year overall survival (OS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P <0.001). The 3- and 5-year cancer-specific survival (CSS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P=0.001). Hydronephrosis was independently associated with OS and CSS (P=0.001 and P=0.004, respectively). Among the 151 patients with low-grade UTUC, hydronephrosis was not associated with pathologic features and postoperative survival. Conclusions: Preoperative hydronephrosis was significantly associated with adverse pathologic features and postoperative survival in patients with high-grade UTUC.

Diagnosis of hydronephrosis or ureteral obstruction using renal sonography among patients with cervical cancer

@#<p style="text-align: justify;"><strong>Background:</strong> Cervical cancer is the second most common malignancy among Filipino women. The recent 2018 FIGO guidelines recommend imaging in cases of grossly invasive disease to determine the presence of hydronephrosis, which would immediately classify the disease as at least stage IIIB. CT and MRI are state-of-the-art modalities that can provide such information; however, these are costly and may not be accessible in areas with limited resources. Sonography is a safe and inexpensive alternative in this regard.</p><p style="text-align: justify;"><strong>Objective:</strong> This study aimed to evaluate the diagnostic performance of renal sonography in identifying the presence of ureteral obstruction or hydronephrosis among patients with grossly invasive cervical cancer, with non-enhanced CT as the reference standard.</p><p style="text-align: justify;"><strong>Methods:</strong> A blinded, prospective study was conducted among patients diagnosed with grossly invasive cervical cancer from the Philippine General Hospital. Participants underwent same-day evaluation with both renal sonography and non-enhanced CT. The presence of either ureteral obstruction or hydronephrosis secondary to cervical cancer was independently determined. The sensitivity, specificity, positive predictive value, and negative predictive value of renal sonography were calculated, with non-enhanced CT as the reference standard.</p><p style="text-align: justify;"><strong>Results:</strong> A total of 127 participants were enrolled. The mean age was 46 years, with a range of 24 to 65 years. The majority had stage IIB (41.7%) and stage IIIB (52.0%) disease. On non-enhanced CT, 46 (36.2%) showed evidence of ureteral obstruction or hydronephrosis, while 81 (63.8%) had negative results. On renal sonography, 46 (36.2%) had positive results, and 81 (63.8%) had negative findings. The sensitivity, specificity, and positive and negative predictive values of sonography were 91.3%, 95.1%, 91.3%, and 95.1%, respectively. Among patients with stage IIIB disease, sonography was shown to have higher sensitivity and specificity of 92.1% and 96.4%, respectively. Meanwhile, among patients with stage IB to IIB disease, its sensitivity and specificity were 87.5% and 94.3%, respectively.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Renal sonography has high sensitivity and specificity in the diagnosis of ureteral obstruction or hydronephrosis in patients with grossly invasive cervical cancer. Its sensitivity is higher when used in patients with stage IIIB disease, compared with those having lower-stage tumors.</p>

Villous adenoma of the renal pelvis: a common entity at an uncommon location

Villous adenoma is uncommonly seen in the urogenital tract and is even more rarely seen in the upper urinary tract and renal pelvis. Like colorectal adenomas, these neoplasms can transform into adenocarcinoma. The preoperative diagnosis is challenging due to their frequent association with hydronephrosis. Herein, we present the case of a villous adenoma of the renal pelvis in a 62-year-old man presenting with recurrent urinary tract infection. The computed tomography scan showed marked hydronephrosis but no suspicious mass in the right kidney. A laparoscopic right nephrectomy was performed. Gross examination revealed a dilated renal pelvis with an irregular exophytic lesion in the renal pelvis's upper surface. The histopathological examination showed slender, elongated villi with thin fibrovascular cores, consistent with villous adenoma morphology. Isolated villous adenomas have a favorable prognosis. However, the pathologist should undertake a search for an invasive component.

Hidronefrosis gigante: a propósito de dos casos con distintas etologías / Giant hydronephrosis: about two cases with different etologies

La hidronefrosis gigante se considera una entidad rara, caracterizada por la presencia de al menos 1 litro de líquido dentro del sistema pielocalicial, más frecuente en pacientes masculinos, generalmente asintomático. Se presenta el caso de una paciente femenina de 85 años de edad quien refiere desde hace 6 años dolor lumbar izquierdo y aumento de la circunferencia abdominal; en la TAC abdomino-pélvica contrastada se evidencia bolsa hidronefrótica izquierda gigante con corteza renal adelgazada que no concentra ni elimina el contraste. Se presenta el caso de paciente masculino de 85 años de edad quien refiere desde hace 5 años aumento de la circunferencia abdominal y la TAC abdomino-pélvica contrastada muestra importante dilatación del riñón y sistema colector derecho secundario a litiasis ureteral. A ambos pacientes se les practicó nefrectomía simple. Con respecto a la hidronefrosis gigante, la etiología más frecuente es la estenosis de la unión ureteropélvica seguido por la patología litiásica y tumoral; es importante considerar esta entidad como diagnóstico diferencial en caso de masas quísticas abdominales(AU)

Giant hydronephrosis is considered a rare entity, characterized by the presence of at least 1 liter of fluid within the pielocalicial system; is more frequent in males and often asymptomatic. We present an 85-year-old female patient who has a 6-year complain of left lumbar pain associated with increase in abdominal circumference. On CT scan, a giant left hydronephrotic pouch is evidenced, with a thinned renal wall that does not concentrate or eliminate contrast. We present a 61 year-old male who refers a 5-year asymptomatic increase in abdominal circumference. The CT scan reveals significant dilatation of the kidney and right collecting system secondary to ureteral lithiasis. Both patients undergo simple nephrectomy. The most frequent etiology of giant hydronephrosis is ureteropelvic junction stenosis followed by lithiasic and tumor pathology. It is important to consider this entity as a differential diagnosis in the case of abdominal cystic masses(AU)

Pionefrose unilateral em cão - relato de caso / Unilateral pyonephrosis in a dog - case report / Pionefrosis unilateral en perro - relato de caso

A pionefrose consiste em uma hidronefrose contaminada, associada à destruição do parênquima renal. Tem como causas o bloqueio ureteral ou uretral por urólitos, inflamação crônica, neoplasia e ureter ectópico, seguidos de contaminação. O diagnóstico é realizado através de exames de imagem, principalmente a ultrassonografia e também através de urinálise e urocultura. Em casos avançados o tratamento preconizado é a nefrectomia. O presente trabalho tem como objetivo relatar um caso de um cão com suspeita inicial de hidronefrose. O paciente passou por nefrectomia, no pós-operatório observou-se melhora do seu quadro clínico, porém permanecendo a anemia. O diagnóstico definitivo, realizado por exame histopatológico, revelou pionefrose, entretanto sua causa não foi estabelecida.(AU)

Pyonephrosis consists of a contaminated hydronephrosis associated with the destruction of the renal parenchyma. Its causes include ureter or urethra blockage by uroliths, chronic inflammation, neoplasm, and ectopic ureter, followed by contamination. The diagnosis is made through image exams, mainly ultrasound, and also through urinalysis and uroculture. In advanced cases, nephrectomy is the recommended treatment. The objective of this study is to report a case of a dog with initial suspicion of hydronephrosis. The patient underwent nephrectomy, and during the postoperative period, an improvement in the clinical scenario was observed, despite the persistent anemia. The definitive diagnosis, carried out by histopathological examination, revealed pyonephrosis; however, its cause was not established.(AU)

La pionefrosis es una hidronefrosis contaminada, asociada con la destrucción del parénquima renal. Sus causas son el bloqueo ureteral o uretral por urolitos, inflamación crónica, neoplasia y uréter ectópico, seguido de contaminación. El diagnóstico se realiza mediante exámenes de imágenes, principalmente ultrasonografía y también mediante análisis de orina y urocultivo. En casos avanzados el tratamiento recomendado es la nefrectomía. Este artículo tiene como objetivo informar un caso de un perro con sospecha inicial de hidronefrosis. El paciente se sometió a nefrectomía; después de la operación, su estado clínico mejoró, pero la anemia permaneció. El diagnóstico definitivo realizado por el examen histopatológico reveló pionfrosis, sin embargo, su causa no se ha establecido.(AU)

Ureter circuncaval ­ diagnóstico pela tomografia computadorizada: relato de caso / Circuncaval ureter - diagnosis by computed tomography: case report

Contexto: O ureter circuncaval, também conhecido como pré-ureter ou ureter retrocaval, é uma rara anomalia congênita com a qual os pacientes raramente relatam sintomas até a terceira ou quarta décadas de vida. A anomalia envolve predominantemente o ureter direito. Um ureter retrocaval à esquerda é visto apenas com persistência da veia cardinal esquerda, com situs inversus completo ou duplicação da veia cava inferior. A compressão do ureter entre a veia cava inferior e as vértebras resulta em hidronefrose e ureteronefrose progressiva. Descrição do caso: Paciente do sexo masculino, 31 anos de idade, com dor lombar recorrente à direita há dois anos. Apresenta exame físico sem alterações evidentes, inclusive testes específicos para a coluna vertebral. Exame de tomografia computadorizada da coluna lombar realizada há 18 meses, sem alterações significativas. Discussão: O ureter circuncaval, na maioria dos casos, é assintomático. Os sintomas dependem do grau de obstrução ureteral ou da presença de complicações e consistem em dor no flanco ­ ocasionalmente a dor intermitente é a primeira queixa ­, infecções recorrentes do trato urinário, hematúria macroscópica ou microscópica. Deve ser levado em conta que o ureter retrocaval pode coexistir com outras anomalias congênitas ­ 20% dos pacientes com ureter retrocaval apresentam anomalias congênitas concomitantes. O procedimento cirúrgico geralmente consiste na divisão ureteral, ressecção do ureter estenótico e redundante com realocação e reanastomose ureteroureteral ou ureteropélvica. Conclusão: Relatamos um caso de ureter circuncaval que é uma rara anomalia congênita predominantemente

The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience

ABSTRACT Objetive Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age. Materials and Methods From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported. Results Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the first 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the final outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results. Conclusions This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.

Estudio Descriptivo Transversal: Factores de Riesgo de Infección del Tracto Urinario en Pacientes Hospitalizados Menores de 5 Años en el Hospital Humanitario Pablo Jaramillo, Cuenca 2014 ­ 2015 / Cross­Sectional Descriptive Study: Risk Factors of Urinary Tract infection in hospitalized Patients Under the age of 5 in hospital humanitario Pablo Jaramillo, Cuenca 2014 - 2015

INTRODUCCIÓN: La infección del tracto urinario es la colonización y multiplicación microbiana a lo largo de la vía urinaria, es causa frecuente de consulta pediátrica. Su presentación clínica puede ser inespecífica y representa un riesgo de lesión permanente renal mientras menor es la edad del pa-ciente. El objetivo de este estudio fue determinar la prevalencia de los factores de riesgo conocidos de Infección del tracto urinario en pacientes hospitalizados menores de 5 años y mayores a un mes. MATERIALES y MÉTODOS: Se realizó un estudio descriptivo transversal en 68 pacientes con diagnóstico de infección del tracto urinario (confirmado por urocultivo), en el departamento de Pediatría del Hospital Humanitario Pablo Jaramillo hospitalizados entre enero del 2014 a diciembre del 2015. Se midió la prevalencia de los factores de riesgo de Infección del tracto urinario. Los datos se recolec-taron en un formulario con información obtenida de las historias clínicas y analizadas en SPSS V 20. Se evaluaron las posibles asociaciones entre las variables con el Chi cuadrado. RESULTADOS: el 67.6 % de la población fue del sexo femenino y 32.4 % al grupo masculino. El grupo etario con mayor prevalencia de ITU fue el de menores de 12 meses (80.9 %), con predominio del sexo femenino en todos los grupos etarios. Entre los factores de riesgo estudiados, se encontró que el antecedente materno de infección urinaria representó el 13.3 %. El reflujo vesico-ureteral se presentó en el 7.2 % y la hidronefrosis en el 8.8%. La fimosis fue predominante en los menores de 12 meses (11.7% del total de la población de estudio). El uso prolongado del pañal correspondió al 36.7 %. El 5.9% de los pacientes con ITU presentaron estreñimiento asociado. CONCLUSIÓN: La ITU es una patología infecciosa frecuente en menores de cinco años, con diferente distribución por edades de acuerdo al sexo. El grupo etario más frecuentemente afectado son los menores de 12 meses de edad, con predominio del sexo femenino. El uso prolongado del pañal (ma-yor a 8 horas) se constituye como el factor de riesgo estudiado de mayor prevalencia, y se encontró asociación estadísticamente significativa entre este factor y la ITU.(au)

BACKGROUND: Urinary tract infection is the colonization and microbial replication along the urinary tract, it is a frequent cause for seeking medical attention. Its clinical presentation is often nonspecific and represents a risk of permanent kidney damage, which is higher as younger is the patient. The aim of this study was to determine the prevalence of known risk factors for urinary tract infection in hospita-lized patients under the age of 5 years and older than a month of age. METHODS: A descriptive cross-sectional study was carried out in 68 patients with diagnosis of urinary tract infection (confirmed by urine culture), hospitalized at the Pediatrics department of Hospital Humanitario Pablo Jaramillo from January 2014 to December 2015. We measured the prevalence of the known risk factors for urinary tract infection. Data was collected in a form with the information obtained from the medical records and analyzed in SPSS V 20. Possible associations between the variables was evaluated with the Chi square test. RESUlTS: 67.6% of the sample were women and 32.4% were men. The age group with the highest prevalence of UTI was the group under 12 months (80.9%), with a higher frequency in females in all age groups. Among the risk factors, the maternal background of urinary infection represented 13.3%. Vesico-ureteral reflux represented 7.2% and hydronephrosis 8.8%. Phimosis was predominant in children under 12 months (11.7% of the total sample). The prolonged use of the diaper corresponded to 36.7 %. 5.9% of the patients with UTI presented constipation. CONClUSION: UTIs are a frequent infectious disease in children under 5, with different distribution according to age and sex. The age group more frequently affected was the group under 12 months of age, and it was higher on women. Prolonged used of diaper (higher than 8 hours) was the most frequent risk factor in this study, and we found statistical significant association between this two variables.(au)

Características clínicas y evolución del reflujo vesicoureteral en la infancia / Clinical characteristics and outcome of childhood vesicoureteral reflux

Introducción. El objetivo fue evaluar las características clínicas y la evolución del reflujo vesicoureteral (RVU) según el sexo y grado de RVU.Población y métodos. Se incluyeron pacientes con RVU vistos durante el seguimiento de rutina entre enero de 2014 y enero de 2015. Se registraron las características demográficas, la evolución, los laboratorios y las imágenes.Resultados. Se seleccionó a 220 pacientes, cuya media de edad del diagnóstico era 3,17 ± 3,08 años; en ese momento, los varones eran menores que las niñas (2,00 ± 2,59 vs. 3,81 ± 3,15, p < 0,001). La infección urinaria fue la presentación más frecuente, seguida de hidronefrosis prenatal (HNP). El 22 % de los pacientes tuvo reflujo de grado 1-2; el 51 %, de grado 3; y el 27 %, de grado 4-5. En el reflujo de grado 4-5, las ecografías y gammagrafías con ácido dimercaptosuccínico (DMSA) marcado con 99mTc presentaron más anomalías, y se realizaron más cirugías (p < 0,001). En los varones, fueron más comunes el reflujo de grado 4-5 (43,6 % vs. 18,3 %) y las anomalías ecográficas (77 % vs. 54 %) y en la DMSA (77 % vs. 59 %) (p < 0,05). En las niñas, hubo mayores tasas de infección urinaria, disfunción de las vías urinarias inferiores y resolución espontánea (p < 0,05).Conclusiones. A pesar de la menor edad al momento del diagnóstico, la resolución espontánea fue menor en los varones, y estos presentaron HNP, reflujo grave y anomalías radiológicas más frecuentemente.

Introduction. The aim of the study was to assess the clinical features and outcome parameters of children with vesicoureteral reflux (VUR) based on gender and VUR grade.Population and methods. Patients with VUR who were seen during routine follow-up visits at Ankara University Children's Hospital between January 2014-January 2015 were included in this retrospective study. Patient demographics, clinical course, laboratory investigations, imaging were noted.Results. Two hundred and twenty patients were recruited. Mean age at the time of diagnosis was 3,17 ± 3,08 years. Boys were diagnosed at younger ages as compared to girls (2.00 ± 2,59 vs. 3,81 ± 3.15, p < 0.001). Urinary tract infection (UTI) was the most common presentation. The second presentation form was antenatal hydronephrosis (AHN) which was more common in males (25.6 %, p < 0.001). Twenty-two percent of the patients had grade 1-2, 51 % grade 3 and 27 % grade 4-5 reflux. Patients with grade 4-5 reflux had more abnormal ultrasound (US) and Tech 99m dimercaptosuccinic acid scintigraphy (DMSA) findings and surgery was performed more frequently in this group (p < 0.001). In males, grade 4-5 reflux (43.6 % vs. 18.3 %), abnormal US (77 % vs. 54 %) and DMSA (77 % vs. 59 %) findings were more frequent (p < 0.05). In girls higher rates of UTIs, lower urinary tract dysfunction (LUTD) and spontaneous reflux resolution were seen (p < 0.05).Conclusions: Despite younger age at diagnosis, spontaneous resolution was found lower in boys and they had more frequent AHN, more severe reflux, and radiological abnormalities.

Advance in re-do pyeloplasty for the management of recurrent ureteropelvic junction obstruction after surgery / 北京大学学报(医学版)

Ureteropelvic junction obstruction (UPJO) is characterized by decreased flow of urine down the ureter and increased fluid pressure inside the kidney. Open pyeloplasty had been regarded as the standard management of UPJO for a long time. Laparoscopic pyeloplasty reports high success rates, for both retroperitoneal and transperitoneal approaches, which are comparable to those of open pyeloplasty. However, open and laparoscopic pyeloplasty have yielded disappointing failure rates of 2.5%-10%. The main causes for recurrent UPJO are severe peripelvic and periureteric fibrosis due to urinary extravasation, ureteral ischemia, and inadequate hemostasis. In addition, failing to diagnose lower pole crossing vessels before or during the primary procedure is also responsible for recurrent UPJO. In addition, poor preoperative split renal function, hydronephrosis, presence of renal stones, patient age, diabetes, prior endopyelotomy history, and retrograde pyelography history were considered as predictors of pyeloplasty failure. The failure is usually defined by persistent pain, persistent radiographic obstruction (infection or stones), continued decline in split renal function, or a combination of the above. And the failure of pye-loplasty often occurs in the first 2 years after the surgery. The available options for managing recurrent UPJO with a salvageable renal unit include endopyelotomy, re-do pyeloplasty, stent implantation, percutaneous nephrostomy, ureterocalicostomy, and nephrectomy. Re-do pyeloplasty has such merits as high successful rates and rare complications, compared with endopyelotomy or ureterocalicostomy. And some investigators think that re-do pyeloplasty should be regarded as the gold standard for secondary therapy if feasible. Open pyeloplasty can enlarge the operating field, facilitate the exposure of the ureteropelvic junction, reduce the difficulty of operation, and thus reduce the occurrence of complications. There are no significant differences among the success rates of re-do pyeloplasty under open approach, traditional laparoscopy and robot-assisted laparoscopy, according to previous reports. However, traditional laparoscopic and robot-assisted pyeloplasty give advantages of cosmetology, small trauma, less postoperative pain, speedy recovery and shorter hospitalization, fewer complications and lower recurrent rates. If the primary pyeloplasty is an open operation in retroperitoneal approach, the traditional laparoscopic and robotic operation with retroperitoneal approach should be considered for secondary repair. The cause of recurrent UPJO should be evaluated before surgery and identified intraoperatively to minimize the possibility of recurrence.

Clinical features of hydronephrosis induced by retroperitoneal fibrosis: 17 cases reports / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical features and outcome of hydronephrosis induced by retroperitoneal fibrosis (RPF), and to evaluate the effect of corticosteroid based therapy combined with surgical intervention of ureteral obstruction.@*METHODS@#A total of 17 RPF patients with hydronephrosis hospitalized in Peking University International Hospital from May 2016 to December 2019 were analyzed retrospectively.@*RESULTS@#The median age was 56 (53, 65) years, the male to female ratio was 2.4 : 1, and the disease duration was 4.00 (0.83, 8.00) months. The initial symptoms included back pain (9 cases), abdominal pain (6 cases), oliguria (2 cases) and lower limb edema (3 cases). Eight patients presented left hydronephrosis, 1 right hydronephrosis and 8 bilateral hydronephrosis. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were both elevated in 13 patients (76.5%, n=17). Immunoglobin (Ig) G4 increased in 5 cases (29.4%, n=17). IgG, IgE and IgA increased in 4 cases (30.8%, n=13), 4 cases (30.8%, n=13) and 1 case (7.7%, n=13), respectively. Among 12 patients who underwent biopsy, 3 patients were diagnosed with IgG4-relate disease. The level of IgG4 in the tissues varied, 6 cases expressed less than 10 per high power field (HPF) or no expression (50.0%). Only 2 cases expressed 10-30/HPF (16.7%), and 4 cases revealed more than 30/HPF (33.3%). Among the 17 patients with ureteral obstruction, no urinary drainage procedure was needed in 4 patients who had mild ureteral obstruction, whereas, ureteral stenting was carried out in the other 13 cases before drug treatment. Time was too short to evaluate the effect of urinary drainage procedures in 4 patients. For the rest, ureterolysis had to be performed in 3 cases after failed ureteral stent insertion. Successful drain removal was accomplished in all of these 9 patients and the mean time to drain removal was (6.7±3.0) months. In addition, 10 patients had complete medical records after an average follow-up time of 5 (3-13) months. Levels of ESR, CRP, IgG4, IgG, IgE, IgA were 54.0 (36.3, 98.5) mm/h, 26.8 (8.7, 53.0) mg/L, 1.34 (0.55, 3.36) g/L, 16.3 (13.0, 21.1) g/L, 40.5 (31.4, 203.0) IU/mL, 2.51 (1.82, 3.25) g/L at baseline, which all decreased predominantly after treatment. ESR, CRP, IgG4, IgG, IgE and IgA dropped by 38.5 (23.5, 54.3) mm/h (P < 0.01), 23.0 (5.5, 52.0) mg/L (P < 0.05), 0.92 (0.40, 2.85) g/L (P < 0.01), 6.5 (1.7, 9.1) g/L (P < 0.05), 23.7 (4.8, 162.0) IU/mL (P < 0.05) and 0.77 (0.32, 1.26) g/L (P < 0.05), respectively. Size of mass measured by CT/MRI imaging became smaller significantly and hydronephrosis relieved.@*CONCLUSION@#Onset of RPF is insidious and lack of specific initial symptoms. Corticosteroid based therapy combined with surgical intervention of relieving obstruction is effective.

Fibrosis retroperitoneal como causa de uropatía obstructiva. Reporte de caso / Retroperitoneal fibrosis as a cause of obstructive uropathy. Case report

Resumen La fibrosis retroperitoneal es una patología rara, en la mayoría de los casos idiopática, aunque se ha asociado a medicamentos, neoplasias y otras enfermedades de tejido conectivo. Histopatológicamente se evidencia inflamación y depósito de tejido fibrótico en el retroperitoneo y se caracteriza por cubrir los uréteres provocando lesión renal aguda obstructiva siendo ésta, la manifestación más frecuente; el diagnóstico definitivo se obtiene únicamente con biopsia y la base del tratamiento es la corticoterapia, aunque en casos severos y en resistencia a los corticoides se han usado otras terapias como los inmunomuladores. En ocasiones son necesarias las intervenciones quirúrgicas para el manejo de las complicaciones. Se presenta el caso de un hombre de 50 años que ingresó al servicio de urgencias del Hospital San José por dolor abdominal, los paraclínicos demostraron elevación de los azoados y en las imágenes diagnósticas hidronefrosis izquierda con componente de tejido blando interaortocava y periaórtico, se realizó biopsia retroperitoneal y se hizo diagnóstico de fibrosis retroperitoneal idiopática, se instauraron nefrostomías bilaterales y se inició manejo con corticoide.

Abstract Retroperitoneal fibrosis is a rare, in most cases idiopathic, pathology, although it has been associated with medications, neoplasms and other connective tissue diseases. In terms of histopathology, inflammation and deposits of fibrotic tissue in the retroperitoneum are observed and, characteristically, this covers the urethra, provoking acute obstructive kidney damage, the most frequent manifestation of the disease. The definitive diagnosis is obtained solely via biopsy, and the basis of treatment is corticotherapy, although in severe cases, and where resistance to corticosteroids exists, other treatments have been used, such as immunomodulators. Occasionally, surgical interventions are necessary to manage complications. The case of a 50-year-old man who came to the Hospital emergency service due to abdominal pain is presented. Paraclinical studies showed azotemia, and diagnostic images showed left hydronephrosis with a component of interaortocaval and periaortic soft tissue. A retroperitoneal biopsy was conducted, and a diagnosis of idiopathic retroperitoneal fibrosis was made. Bilateral nephrostomies were put in place and treatment with corticosteroids was initiated.

Ureteropelvic junction obstruction caused by metastatic cholangiocarcinoma

ABSTRACT We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient's known cholangiocarcinoma.