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Objective:Objectives To investigate the predictive value of color Doppler flow imaging (CDFI) for the proteinuria following pyeloplasty for congenital ureteropelvic junction obstruction (UPJO) in children.Methods:We identified a series of 206 children with a mean age of (20.0±28.8) months (1-132 months), consisted of 171 males and 35 females, diagnosed with congenital UPJO accepted pyeloplasty from January 2014 to September 2018, the preoperative mean urinary Albumin/Creatinine Ratio (ACR) was (17.3±160.1) mg/mmol and the mean β2-microglobulin/Creatinine Ratio (β2-MG/Cr) was (135.6±383.8) μg/mmol, ultrasound showed a mean renal pelvis dilatation of (3.1±1.5) cm and a mean cortical thickness of (0.3±0.1) cm, and classified as grade Ⅰ-Ⅴ according to the blood flow distribution in renal by CDFI, these children were divided into three groups of increased, decreased and unchanged blood flow according to the postoperative CDFI within 1 week, the postoperative urinary protein and renal function indexes within 1 week and 2 years were retrospectively analysed among groups.Results:Within 1 week postoperatively, an increased, decreased and unchanged blood flow occurred in 113 (54.9%), 31(15.0%), 62(30.1%) children, respectively. Urinary ACR in above mentioned groups was (112.3±400.7), (16.1±29.3), (32.7±48.4) mg/mmol, β2-MG/Cr was (887.4±6061.0), (50.2±62.7), (51.9±57.8)μg/mmol, there were significant differences among groups ( P<0.01). Contralateral hydronephrosis occurred in 21(18.6%), 4(12.9%), 8(12.9%) children, urinary N-Acetyl-β-D-glucosaminidase (NAG) was (7.5±5.2), (7.0±5.4)、(5.7±4.5) U/L, these indexes showed no significant differences among groups. There was a positive correlation between the increased blood flow level and the decreased renal pelvis dilatation (Spearman’s correlation coefficient 0.2, P<0.01), ACR (Spearman’s correlation coefficient 0.4, P<0.01) and β2-MG/Cr (Spearman’s correlation coefficient 0.3, P<0.01). After a follow up of 2 years, 67 children were diagnosed with proteinuria in this series, 51 cases of them with an increased blood flow, which had significantly higher percentage than children with a decreased (4 cases, 12.9%) or unchanged blood flow (12 cases, 19.3%). Logistic multivariate analysis indicated that early postoperative (within 1 week) increased blood flow ( OR=1.9, 95% CI 1.5-2.6), contralateral hydronephrosis ( OR=2.2, 95% CI 1.1-4.8) and urinary NAG ( OR=1.1, 95% CI 1.0-1.1) were predictive of proteinuria, the increased blood flow was independent predictor of proteinuria (Ⅰ level increased: OR=1.9, 95% CI 1.5-2.6). Conclusions:The CDFI reveals good predictive value for the postoperative proteinuria, an early marked increased blood flow postoperatively indicated risk of proteinuria in the long term.
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Objective@#To evaluate the safety and efficacy of tabularized urethral plate disassembly for epispadias repair in infant.@*Methods@#From January 2016 to September 2018, 10 boys aged between 18 to 36 months old with mishaft epispadias were included. The main complaint was that the urethral opening was found on the dorsal side of the penis. Preoperative cystography revealed that 3 of them had unilateral vesicoureteral reflux (Grade Ⅰ), and white blood cells in routine urinary in all 10 patients were negative. Physical examination: the penis is short and flat, the width is 17-25 mm, average is 20.7 mm, the penis curvature is 15°-30°, average is 21.5°, and the urethral opening located on the dorsal side of the penis. The anesthesia method was selected for tracheal intubation, intravenous anesthesia combined with caudal anesthesia, and the surgical position was supine position. The surgical method: one stage of tabularized urethral plate disassembly urethroplasty: during the operation, the penile curve was corrected by free urethral plate and penile degloving. Two of them were unsatisfied with the correction of the curvature, and the ventral tunica folded was applicate. To avoid urethral plate ischemia, attention should pay to blood supply protection. The two corpus cavernosum are separated in the root, and the urethra is completely displaced to the ventral side of the cavernous body. The ventral side of the urethral under glans is shaped into a fissured that conforms to the anatomy. The prognosis and surgical choice of the midshaft epispadias were discussed combined with literature.@*Result@#The operation time was 130-200 min with an average of 157 mins. Intraoperative hemorrhage 5-30 ml, average is 16 ml, 1 case of glans skin was black one day after surgery, with enhanced dressing change. After 1 month, the glans was local atrophy and scar formation. No skin incision infection case. After discharge from the hospital, the follow up through the internet and outpatients for 3-40 months, average is 21 months, 2 cases with urethral fistula, more surgery to repair the fistula successfully after 6 months. The penile curvature was corrected in 8 cases, and the residual curvature of 2 cases was about 10-15°, which was temporarily observed. Patients with unilateral vesicoureteral reflux preoperatively, they still suffered from vesicoureteral reflux in the 6-12 months regular review after surgery without any intervention due to white blood cell was negative in urine routine. All cases had urinary patency and no cases with urethral stricture.@*Conclusion@#Tubularized urethral plate disassembly is a effective and simple procedure that can correct the midshaft epispadias in infant.
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Objective To evaluate the safety and efficacy of tabularized urethral plate disassembly for epispadias repair in infant.Methods From January 2016 to September 2018,10 boys aged between 18 to 36 months old with mishaft epispadias were included.The main complaint was that the urethral opening was found on the dorsal side of the penis.Preoperative cystography revealed that 3 of them had unilateral vesicoureteral reflux (Grade Ⅰ),and white blood cells in routine urinary in all 10 patients were negative.Physical examination:the penis is short and flat,the width is 17-25 mm,average is 20.7 mm,the penis curvature is 15°-30°,average is 21.5°,and the urethral opening located on the dorsal side of the penis.The anesthesia method was selected for tracheal intubation,intravenous anesthesia combined with caudal anesthesia,and the surgical position was supine position.The surgical method:one stage of tabularized urethral plate disassembly urethroplasty:during the operation,the penile curve was corrected by free urethral plate and penile degloving.Two of them were unsatisfied with the correction of the curvature,and the ventral tunica folded was applicate.To avoid urethral plate ischemia,attention should pay to blood supply protection.The two corpus cavernosum are separated in the root,and the urethra is completely displaced to the ventral side of the cavernous body.The ventral side of the urethral under glans is shaped into a fissured that conforms to the anatomy.The prognosis and surgical choice of the midshaft epispadias were discussed combined with literature.Result The operation time was 130-200 min with an average of 157 mins.Intraoperative hemorrhage 5-30 ml,average is 16 ml,1 case of glans skin was black one day after surgery,with enhanced dressing change.After 1 month,the glans was local atrophy and scar formation.No skin incision infection case.After discharge from the hospital,the follow up through the internet and outpatients for 3-40 months,average is 21 months,2 cases with urethral fistula,more surgery to repair the fistula successfully after 6 months.The penile curvature was corrected in 8 cases,and the residual curvature of 2 cases was about 10-15°,which was temporarily observed.Patients with unilateral vesicoureteral reflux preoperatively,they still suffered from vesicoureteral reflux in the 6-12 months regular review after surgery without any intervention due to white blood cell was negative in urine routine.All cases had urinary patency and no cases with urethral stricture.Conclusion Tubularized urethral plate disassembly is a effective and simple procedure that can correct the midshaft epispadias in infant.
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Objective To discuss the treatment effect with Mitrofanoff procedure in lower urinary tract of pediatric patients.Methods 9 patients conducted Mitrofanoff procedure from January 2014 to January 2018 in our center were analyzed retrospectively.There were 2 boys and 7 girls,age from 4 to 14 years old (7.3 years old in average).1 child was diagnosed as bladder exstrophy,4 children were neurogenic bladder,2 children were bladder tumor and the other 2 were urethral trauma.All patients were conducted Mitrofanoff procedure under general anesthesia,used appendix as the conduit,3 patients used their original bladder as reservoir,bladder augmentation was employed in 4 patients and ileal neobladder was employed in 2 patients to construct reservoir.The distal of appendix was inserted into submucosal of reservoior and the proximal end was connected to the umbilical or lower abdominal wall.Results The operations were all successfully completed without sever complications,the time spent was 176-210 min,190 min in average,hemorrhage amount 20-35 ml.Patients were followed up 15 to 50 months,the bladder capacity is 80 to 120 ml.Hydronephrosis was improved compared with pre-operative condition.4 children diagnosed with neurogenic bladder still suffered vesical ureteral reflux.All patients can conduct clean intermittent catheterization without difficulty.There was no leakage of urine from the stoma,while 2 patients showed leakage of urine from urethra when exercising,so we closed the bladder neck 6 month later.Conclusion Mitrofanoff procedure can be implied in children with end-staged lower urinary tract dysfunction due to nerogenic bladder,bladder tumor,bladder exstrophy,which makes intermittent catheterization become more convenient.
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Objective To investigate the clinical and pathological characteristics,diagnosis,differential diagnosis,treatment and prognosis of giant neurofibroma of penis in the child.Methods The clinical data including general data,imaging data,treatment methods,pathological characteristics of a case with giant neurofibroma of penis in a child were analyzed retrospectively and the relevant literature was reviewed.Results Gross appearance of the penile shaft neurofibroma was about 9 cm × 11 cm × 15 cm,with local ulceration.Computerized tomography scan revealed a giant mass in the penile shaft,about 9.0 cm × 10.0 cm × 13.4 cm.Partial excision of the penis was performed.Postoperative appearance of the residual penile shaft was about 2 cm long.The HE staining showed spindle cells with the red dye cytoplasm,spindle or elliptic nuclei and arranged in wavy partly.Positive immunostaining was presented with S-100 protein and Vimentin.The pathologic examination revealed a neurofibroma.There was no evidence of recurrence and the penis of the boy had normal sensation and erection by follow-up in 2 years.Conclusions Neurofibroma of penis in the child is extremely rare and the differential diagnosis of soft-tissue tumors of penis should be considered.The operative method should be individualized,the treatment goal is the complete resection;however,this goal must be weighed against detriment to functioning and the cosmetics of the involved organ.