Single port surgery in pediatric age: report of first 300 cases.

BACKGROUND: In recent years, evolution of surgery has led to laparoscopy and then to single port surgery. In pediatric age, few papers have been published about single port procedures; in particular, no one has described the use of the Octoport device (Frankenman International Ltd., Suzhou, China). We present our experience using a new device. METHODS: A retrospective analysis of first 300 cases was performed collecting the data of all patients treated with Octoport device from October 2017 to September 2021. Epidemiological data, diagnosis, operative times, and complications were analyzed. Postoperative pain was compared with standard laparoscopy. RESULTS: A total of 300 procedures were performed during the study period. The age range was 1-17 years. The conversion rate was 3.6% (11 patients) including both conversion to traditional laparoscopy and to laparotomy. Pain management was comparable to traditional laparoscopy. The complication rate was 3.6%, in one case leading to re-do surgery. All the cases in our Unit were successfully completed, with complications mainly related to the original pathology rather than to the technique itself. CONCLUSIONS: The learning curve for Octoport use proved to be functional as for standard laparoscopy. In this study, surgical indications for the use of single port laparoscopy were defined, discerning favorable and unfavorable procedures. A proven superiority of this technique over traditional laparoscopy is yet to be defined, but Octoport has proved to be a safe and easy tool to reduce invasiveness of procedures in pediatric surgery with better cosmetic results.

Renal shear wave velocity and estimated glomerular filtration rate in children with chronic kidney disease.

A shear wave velocity (SWV) value obtained by the acoustic radiation force impulse technique depends on tissue elasticity. We investigated the relationship between SWV values and the estimated glomerular filtration rate (eGFR) in children with chronic kidney disease. A total of 29 patients were enrolled in the study. There were 18 primary and 11 secondary cases of vesicoureteral reflux. eGFR was calculated using Schwartz's formulas (2012). Partial eGFR for each kidney was assessed by multiplying the eGFR by the percentage of renal function measured by means of renal (99m)Tc-dimercaptosuccinic acid scintigraphy. All ultrasound tests were done by a single qualified technician using a convex probe (frequency 4 MHz) on an S-2000 system. The mean SWV values of the two kidneys were significantly and negatively correlated with eGFR calculated with both univariate (cystatin C [Cys C] and multivariate (creatinine, Cys C, and nitrogen) equations. Of all the formulae, the strongest correlation was obtained with eGFR (Cys C). SWV of the renal cortex correlates with the eGFR of patients affected by malformative uropathies. Nevertheless, this technique needs standardization and validation.

Ureteral rupture after blunt abdominal trauma in a child with unknown horseshoe kidney.

More than 90% of renal injuries in children result from blunt abdominal trauma. A 10-year-old female had a blunt abdominal trauma with macro-hematuria. The computed tomography scan revealed the presence of a horseshoe kidney and a 3rd grade renal lesion and contrast leakage from the right ureter. The ureteral rupture was confirmed by cystoscopy and ascendant pyelography and than a double J-stent was implanted. The stent was removed one month later. Non-surgical management has become the standard of care for both ureteral and renal lesions in children. Non-surgical treatment is a safe procedure for renal trauma with ureteral rupture in children.

Acoustic radiation force impulse (ARFI) in the evaluation of the renal parenchymal stiffness in paediatric patients with vesicoureteral reflux: preliminary results.

OBJECTIVES: To prospectively evaluate acoustic radiation force impulse (ARFI) imaging of the kidneys in children with and without chronic renal disease. METHODS: Twenty-eight children (age range 9-16 years) with primary or secondary vesicoureteral reflux (≥ grade III) underwent scintigraphy and ultrasound with ARFI. Kidneys were divided-according to scintigraphy-into "affected" and "contralateral"; the results were compared with 16 age-matched healthy subjects. An ARFI value, expressed as speed (m/s) of wave propagation through the tissue, was calculated for each kidney through the mean of the values obtained at the upper, middle and lower third. The Wilcoxon test was used; P values <0.05 were considered statistically significant. RESULTS: The mean ARFI values obtained in the "affected" kidneys (5.70 ± 1.71 m/s) were significantly higher than those measured in both "contralateral" (4.09 ± 0.97, P < 0.0001) and "healthy" kidneys (3.13 ± 0.09, P < 0.0001). The difference between values in the "contralateral" kidneys and "healthy" ones was significant (P < 0.0001). The "affected" kidneys with secondary reflux had mean ARFI values (6.59 ± 1.45) significantly higher than those with primary reflux (5.35 ± 1.72). CONCLUSIONS: ARFI values decrease from kidneys with secondary vesicoureteral reflux to kidneys with primary reflux to unaffected kidneys contralateral to reflux to normal kidneys.

Paediatric unilateral giant hydroureteronephrosis from idiopathic ureterovesical stricture: a case report.

A congenital type of ureterovesical junction obstruction may be present in the fetus or at any stage during childhood, more commonly associated with urinary tract infections and other secondary causes. We present the case of a 6-year-old boy who suffered from colic and side pain, which was worsening monthly. He suffered from a giant hydroureteronephrosis resulting from idiopathic ureterovesical junction obstruction, with no clinical or laboratory signs of urinary tract infection or other secondary causes of obstruction. Indications for surgery were a decrease in kidney function (<40%) at scintigraphy, severe hydronephrosis (>30 mm), and the coexistence of symptoms (colic pain). After surgery, kidney function returned to almost completely normal. Unexpectedly an obstruction may become symptomatic late in infancy, especially in patients with normal prenatal ultrasound screening and postnatal life, as was the case for our patient in whom the only clinical sign was pain at flank.

Renal involvement in children with vesicoureteral reflux: are prenatal detection and surgical approaches preventive?

OBJECTIVE: Surgical correction of vesicoureteral reflux (VUR) and prolonged administration of antibiotics seem to lead to similar renal outcomes. However, it is not known whether prenatal recognition and the position of VUR modify the outcome in different ways. The purpose of this study was to investigate the effects of prenatal detection and different treatment methods on the outcome of unilateral refluxing renal units. PATIENTS AND METHODS: This retrospective study enrolled 119 children (mean age 2.8+/-3.5 years) with primary VUR. Kidney growth and renal function were measured with ultrasound and scintigraphy, respectively. To compare the ultrasound readings among patients of different ages the comparative-length index or index was calculated, as a percentage of the ratio of unilateral and the sum of bilateral renal length. RESULTS: In unilateral refluxing renal units there was a reduction in both index and function, whereas not-refluxing was increased. In the follow-up, unilateral refluxing renal units had a worse index, whereas not-refluxing was better. Unexpectedly, surgical therapy of the left-refluxing renal unit led to a reduction in the index, whereas its function always stayed low in diagnosis but stable. The outcome of severely refluxing renal units was similar after both interventions. Prenatal and postnatal diagnosis did not seem to modify the renal result. CONCLUSIONS: Surgery showed similar renal outcomes to medical treatment. A kidney growth defect from high-grade VUR was detected in the diagnosis. Therefore, a congenitally damaged kidney does not ameliorate after each treatment. Finally, prenatal detection of VUR does not seem to modify the outcome of the kidney significantly.

Prenatal diagnosis of a rare form of congenital mid-ureteral stricture: a case report and literature revisited.

BACKGROUND: Congenital mid-ureteral stricture is a rare malformation of the ureter leading to prenatal and neonatal hydronephrosis. Site characterization of the narrowing is important to optimize the surgical approach to the newborn affected by hydronephrosis. CASE PRESENTATION: We report a female EM with a rare form of hydronephrosis, (i.e. mid-ureteral stricture) which was detected early during pregnancy by imaging techniques. During fetal life both conventional fetal Ultrasound and maternal Magnetic Resonance Imaging (MRI) were used to diagnose the obstruction. Magnetic Resonance pyelography and retrograde Ureteropyelography were performed after delivery and before surgical correction and confirmed the finding.Furthermore, we revisited the literature using online MEDLINE and EMBASE databases. The literature reported only a few cases of prenatal diagnosis of early onset mid-ureteral stricture. CONCLUSION: Mid-ureteral stricture is a rare cause of prenatal hydronephrosis. The diagnosis should not be delayed in order to apply the appropriate surgical approach. As a result, we showed the usefulness of fetal MRI and postnatal Magnetic Resonance pyelography, in the event that radionuclide renography with Tc-MAG3 was less informative, to allow the detection of the site of ureteral narrowing. Intrasurgical retrograde ureteropyelography confirmed these findings.