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Purpose: The purpose of this study was to characterize the relationship between a novel radiographic measurement on initial AP pelvis radiograph (termed "bladder shift," BS) to intraoperative blood loss (IBL) during acetabular surgical fixation. Methods: All adult patients receiving unilateral acetabular fixation (Level 1 academic trauma; 2008–18) were reviewed. AP pelvis radiographs were reviewed for visible bladder outlines and then measured to determine the percentage deformation toward the midline. Hemoglobin & hematocrit data were then used to calculate quantitative blood loss between pre- and post- operative blood counts for data analysis. Results: 371 patients with unilateral traumatic acetabular fractures requiring fixation were reviewed; 99 of these had visible bladder outlines, complete blood count and transfusion data (2008–2018; 66% associated patterns). Median bladder shift (BS) was 13.3%. Every 10% of bladder shift was associated with 123 mL greater IBL. Patients with full bladder shift to midline sustained a median 1.5L IBL (interquartile range [IQR] 0.8 to 1.6). Associated patterns had a threefold greater median BS (associated: 16.5% [15.4 to 45.9] vs. elementary: 5.6% [1.1 to 15.4], p < 0.05) and received intraoperative pRBC twice as frequently (57% vs. 24%, p < 0.01). Conclusions: Radiographic bladder shift is an easily available visual marker, in patients sustaining acetabular fractures, that may predict intraoperative hemorrhage and need for transfusions. [ABSTRACT FROM AUTHOR]

Risks of contralateral kidney abnormalities and chronic kidney disease necessitate follow-up for unilateral multicystic dysplastic kidneys (MCDK). A nationwide survey of senior UK pediatricians was conducted. Of the 60 responses obtained, 62% routinely perform a dimercaptosuccinic acid scan to confirm diagnosis. Eight percent routinely perform a cystogram to investigate contralateral vesicoureteric reflux. Sixty-two percent would routinely measure renal function (frequency ranging from once only to "every 2 years"). Twenty-five percent recalled MCDK nephrectomy being performed within the previous 5 years. Respondents voiced concerns that national guidance may result in an overcautious approach but could balance consensus and safe variation, and offer families choice and reassurance. The mean estimated cost of follow-up from birth to 18 years ranged from £258 to £3854. Results demonstrate significant variation in management, highlighting the need for a clear pathway to decrease unwanted variability and to ensure those at high risk of renal sequelae are recognized early, without undue investigatory burden. [ABSTRACT FROM AUTHOR]

Introduction. We present the first case of pediatric ileocystoplasty using a purely robotic approach in Spain. Case report. 12-year-old male with neurogenic bladder of low capacity and high pressures. After failure of conservative treatment, bladder augmentation with ileum patch was decided upon. Surgery was carried out using a purely robotic approach with 4 robotic and 2 accessory ports. Surgery duration was 380 minutes in total, without intraoperative complications. He was discharged 2 weeks after cystographic control. During 32-months follow-up, he has remained continent. Discussion. The minimal invasion, surgical precision and ergonomics made the robotic approach an optimal option for complex surgical techniques. Given the little availability of the robot and the low pediatric volume, its standardization is a challenge. Our accumulated experience is consistent with the current literature and shows promising surgical and esthetic results. We hope this case report will contribute to the divulgation and progressive introduction of robotic surgery in our daily lives. [ABSTRACT FROM AUTHOR]

Objective: In complex renal stone disease, few studies have shown that supine percutaneous nephrolithotomy (PCNL) is not inferior to prone PCNL. In our study, we evaluated the safety and efficacy of supine versus prone PCNL in patients with complex renal stone disease and patients with difficult anatomy. Methods: We prospectively analyzed 106 patients over 15 months from October 2022 to December 2023 and divided them as group S (Calcutta position supine arm) and group P (classical prone arm) by simple randomization. The measured data included body mass index (BMI), stone size, location of stone, number of punctures/access, tract length, bleeding, operative time, stone-free rate (SFR), length of hospital stay, and postoperative complications. Results: The operative time was 104.722 ± (34.48) versus 124.30 ± (22.67) minutes (group S vs. group P), which was significant (P = .01). The nephroscopy time was 89.722 ± 34.55 in group S vs. 92.212 ± 20.18 minutes, which was also significant (P = .01). The mean postoperative hospital stay was 3.889 ± 1.09 and 4.558 ± 1.33 days in supine and prone group (P = .021), respectively. Four patients in group S required re-look PCNL in comparison to 8 in group P. Overall SFR at 1 month was 76.92% and 68.51% (P .331), respectively in case of group S and P. Conclusion: The study revealed that supine position in Calcutta position is a viable alternative to classical prone position even in patients with complex renal stone and patients with difficult anatomy as major complications are less, SFR is higher, and need of auxiliary procedures are rare. [ABSTRACT FROM AUTHOR]

We developed a high‐resolution and noninvasive multichannel urodynamic system combined with a novel signal‐processing algorithm tailored to extract electromyographic (EMG) activity from the urinary bladder. We utilized a flexible noninvasive biopotential recording system to collect an array of EMG signals from the urinary bladder of human subjects. This study also presents the use of an existing artifact rejection methodology to autonomously extract an EMG signal from an environment prone to motion artifacts. [ABSTRACT FROM AUTHOR]

The objective: to determine tactical approaches to the selection of treatment methods and to evaluate the results of various types of urethroplasty in patients with urethral strictures and obliterations. Materials and methods. The results of 1362 surgical interventions in patients with strictures and obliterations of the urethra of various etiologies and complexity were analyzed from 2003 to 2020. The clinical data of the medical histories of 173 (12.7%) patients with long strictures and obliterations of the urethra were retrospectively evaluated. The age of the patients ranged from 13 to 85 years (average age - 44.6±1.2 years). For a detailed study of the results of surgical corrections of long strictures and obliterations of the urethra, patients were divided into two groups: group A - 50 (28.9%) patients who were operated on in 2003-2014 and group B - 123 (71.1%) patients who were operated on in 2015-2020. The localization and length of the stricture, the degree of spongiofibrosis were evaluated according to the results of ultrasonography and retrograde or micturition urethrocystography, as well as in some patients according to the data of spiral computed tomography in the angiomode. According to the types of surgical operations, the patients were divided into three groups: buccal plastic urethra, urethrourethral or urethro-prostatic anastomosis (UUA) and replacement plastic with a skin-fascial flap. The digital material was mathematically processed and the probability of difference was assessed using the Chi-square test for qualitative features and the t-test for quantitative features. Results. A retrospective analysis of the 18-year experience of surgical treatment of patients with urethral strictures and obliterations at the SI "Acad. O.F. Vozianov Institute of Urology NAMS of Ukraine" revealed a change in the percentage of various types of urethroplasty in the direction of methods with proven better results. During the analysis of the results of operations in 173 patients, an increased number of replacement and augmentation buccal plastics over the years and a decreased rate of urethro-urethral and urethro-prostatic anastomoses were found. This indicates an increase in the frequency of successful results in the second period of the study (accumulated experience) from 68.0% to 86.2%. Due to the change in the management of the treatment of patients with urethral strictures a probable improvement in the results of surgical treatment of patients with urethral strictures is determined by 2.9 times, accordingly, a probable decrease of treatment recurrences by 18.2% is also observed. Conclusions. The number of urethro-urethroanastomoses decreased by 20.0%, and the number of performed buccal urethral plastics increased by 91.6%. The obtained data correspond to the world research results. [ABSTRACT FROM AUTHOR]

Simple Summary: Bladder cancer (BCa) requires the investigation of alternative therapies. Prior to clinical testing, researchers require the use of animal models to thoroughly investigate their therapeutic efficacy. To appropriately mimic cancer response, the cancer must be developed and treated within the relevant organ. This creates an obstacle with BCa, as cancer presence and progression are difficult to evaluate due to its location. Therefore, non-invasive techniques have been developed that allow for visualization of the cancer from outside the bladder. These techniques include bioluminescence imaging (BLI), micro-ultrasound imaging (MUI), magnetic resonance imaging (MRI), and positron emission tomography (PET). This paper reviews these imaging techniques when used independently or in conjunction in an animal model where BCa is developed within the bladder. Bladder cancer (BCa) is the sixth most prevalent cancer in men and seventeenth most prevalent cancer in women worldwide. Current treatment paradigms have limited therapeutic impact, suggesting an urgent need for the investigation of novel therapies. To best emulate the progression of human BCa, a pre-clinical intravesical murine model is required in conjunction with existing non-invasive imaging modalities to detect and evaluate cancer progression. Non-invasive imaging modalities reduce the number of required experimental models while allowing for longitudinal studies of novel therapies to investigate long-term efficacy. In this review, we discuss the individual and multi-modal use of non-invasive imaging modalities; bioluminescence imaging (BLI), micro-ultrasound imaging (MUI), magnetic resonance imaging (MRI), and positron emission tomography (PET) in BCa evaluation. We also provide an update on the potential and the future directions of imaging modalities in relation to intravesical murine models of BCa. [ABSTRACT FROM AUTHOR]

Background: There is anecdotal evidence regarding the simultaneous occurrence of vesicoureteral reflux (VUR) and gastroesophageal reflux disease (GERD), which indicates the probability of pathophysiological commonality. Objectives: In the present study, we evaluated the concurrence of VUR and GERD in children candidates for the voiding cystourethrogram (VCUG) study. Methods: This cross-sectional study was conducted on 62 children between 1 and 14 years old referred to a tertiary referral teaching hospital for VCUG in 2019 - 2020. All subjects underwent ultrasound to assess GERD and VCUG to rule out VUR. Results: According to the ultrasound assessment, 14.5% of subjects were diagnosed with GERD: 8.3% in males and 18.4% in females. VURwas detected in 48.4% of children (50.0% in males and 47.4% in females) using VCUG. Overall, seven (23.3%) had concomitantVUR and GERD: 4.2% in boys and 15.8% in girls, indicating no difference between the two genders (P = 0.125). The prevalence of concurrent GERD and VUR was also independent of age. In the two groups with and without VUR, the prevalence of GERD was 23.3% and 6.2%, respectively, indicating a relative risk of 2 (95% confidence interval [CI]: 1.32 - 3.02, P = 0.001). Conclusions: Regarding the relationship between GERD and VUR, despite the deletion of physiologic GER cases, the pathophysiological overlap between the two phenomena could be considered. [ABSTRACT FROM AUTHOR]

Simple Summary: Early and accurate bladder cancer staging is important as it determines the mode of initial treatment. Non-muscle invasive bladder cancer (NMIBC) can be treated with transurethral resection whereas muscle invasive bladder cancer (MIBC) requires neoadjuvant chemotherapy with subsequent cystectomy as indicated. Our hybrid machine/deep learning model demonstrates improved accuracy of bladder cancer staging by CECT using a hybrid machine/deep learning model which will facilitate appropriate clinical management of the patients with bladder cancer, ultimately improving patient outcome. Accurate clinical staging of bladder cancer aids in optimizing the process of clinical decision-making, thereby tailoring the effective treatment and management of patients. While several radiomics approaches have been developed to facilitate the process of clinical diagnosis and staging of bladder cancer using grayscale computed tomography (CT) scans, the performances of these models have been low, with little validation and no clear consensus on specific imaging signatures. We propose a hybrid framework comprising pre-trained deep neural networks for feature extraction, in combination with statistical machine learning techniques for classification, which is capable of performing the following classification tasks: (1) bladder cancer tissue vs. normal tissue, (2) muscle-invasive bladder cancer (MIBC) vs. non-muscle-invasive bladder cancer (NMIBC), and (3) post-treatment changes (PTC) vs. MIBC. [ABSTRACT FROM AUTHOR]

Simple Summary: Node-RADS represents a five-item comprehensive score, based on both size and configuration criteria, to standardize the radiologic assessment of lymph node invasion. In bladder cancer patients, pelvic lymph node staging is of utmost importance in clinical decision-making. In the current study, we applied Node-RADS scoring for a pelvic lymph-node evaluation of bladder cancer patients. We concluded that the Node-RADS score exhibits a moderate-to-high overall accuracy for identification of lymph node invasion, with the possibility of setting different cut-off values according to specific clinical scenarios. However, these results need to be validated on larger cohorts before drawing definitive conclusions. Background: Current cross-sectional imaging modalities exhibit heterogenous diagnostic performances for the detection of a lymph node invasion (LNI) in bladder cancer (BCa) patients. Recently, the Node-RADS score was introduced to provide a standardized comprehensive evaluation of LNI, based on a five-item Likert scale accounting for both size and configuration criteria. In the current study, we hypothesized that the Node-RADS score accurately predicts the LNI and tested its diagnostic performance. Methods: We retrospectively reviewed BCa patients treated with radical cystectomy (RC) and bilateral extended pelvic lymph node dissection, from January 2019 to June 2022. Patients receiving preoperative systemic chemotherapy were excluded. A logistic regression analysis tested the correlation between the Node-RADS score and LNI both at patient and lymph-node level. The ROC curves and the AUC depicted the overall diagnostic performance. In addition, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for different cut-off values (>1, >2, >3, >4). Results: Overall, data from 49 patients were collected. Node-RADS assigned on CT scans images, was found to independently predict the LNI after an adjusted multivariable regression analysis, both at the patient (OR 3.36, 95%CI 1.68–9.40, p = 0.004) and lymph node (OR 5.18, 95%CI 3.39–8.64, p < 0.001) levels. Node-RADS exhibited an AUC of 0.87 and 0.91 at the patient and lymph node levels, respectively. With increasing Node-RADS cut-off values, the specificity and PPV increased from 57.1 to 97.1% and from 48.3 to 83.3%, respectively. Conversely, the sensitivity and NPV decreased from 100 to 35.7% and from 100 to 79.1%, respectively. Similar trends were recorded at the lymph node level. Potentially, Node-RADS > 2 could be considered as the best cut-off value due to balanced values at both the patient (77.1 and 78.6%, respectively) and lymph node levels (82.4 and 93.4%, respectively). Conclusions: The current study lays the foundation for the introduction of Node-RADS for the regional lymph-node evaluation in BCa patients. Interestingly, the Node-RADS score exhibited a moderate-to-high overall accuracy for the identification of LNI, with the possibility of setting different cut-off values according to specific clinical scenarios. However, these results need to be validated on larger cohorts before drawing definitive conclusions. [ABSTRACT FROM AUTHOR]

Simple Summary: Organs at risk (OARs) management (rectum and bladder) is evaluated in patients receiving post-prostatectomy radiation. The role of full bladder instruction and the use of the endorectal balloon is evaluated. The efficacy of this practice was based on daily image and dose delivery using high-quality iterative cone-beam CT (iCBCT). The analysis revealed that a minimal bladder contour can be generated and followed to ensure sufficient bladder sparing. An endorectal balloon is not needed for sufficient target coverage or OAR sparing. Purpose: Post-operative prostate cancer patients are treated with full bladder instruction and the use of an endorectal balloon (ERB). We reassessed the efficacy of this practice based on daily image guidance and dose delivery using high-quality iterative reconstructed cone-beam CT (iCBCT). Methods: Fractional dose delivery was calculated on daily iCBCT for 314 fractions from 14 post-operative prostate patients (8 with and 6 without ERB) treated with volumetric modulated radiotherapy (VMAT). All patients were positioned using novel iCBCT during image guidance. The bladder, rectal wall, femoral heads, and prostate bed clinical tumor volume (CTV) were contoured and verified on daily iCBCT. The dose-volume parameters of the contoured organs at risk (OAR) and CTV coverage were assessed for the clinical impact of daily bladder volume variations and the use of ERB. Minimum bladder volume was studied, and a straightforward bladder instruction was explored for easy clinical adoption. Results: A "minimum bladder" contour, the overlap between the original bladder contour and a 15 mm anterior and superior expansion from prostate bed PTV, was confirmed to be effective in identifying cases that might fail a bladder constraint of V65% <60%. The average difference between the maximum and minimum bladder volumes for each patient was 277.1 mL. The daily bladder volumes varied from 62.4 to 590.7 mL and ranged from 29 to 286% of the corresponding planning bladder volume. The bladder constraint of V65% <60% was met in almost all fractions (98%). CTVs (D90%, D95%, and D98%) remained well-covered regardless of the absolute bladder volume daily variation or the presence of the endorectal balloon. Patients with an endorectal balloon showed smaller variation but a higher average maximum rectal wall dose (D0.03mL: 104.3% of the prescription) compared to patients without (103.3%). Conclusions: A "minimum bladder" contour was determined that can be easily generated and followed to ensure sufficient bladder sparing. Further analysis and validation are needed to confirm the utility of the minimal bladder contour. Accurate dose delivery can be achieved for prostate bed target coverage and OAR sparing with or without the use of ERB. [ABSTRACT FROM AUTHOR]

The article discusses the diagnostic imaging tools for detecting vesicoureteral reflux (VUR) in pediatric patients. Other topics include the association between VUR and urinary tract infections (UTI), the International Reflux Study grading system used to measure VUR severity, and the imaging tests to diagnose and grade VUR like voiding cystourethrography (VCUG), radionuclide cystography, and contrast-enhanced voiding urosonography.

Aims: Posterior urethral valves (PUV) are the leading cause of end-stage renal disease in boys. The study aimed to look at the ongoing renal damage and profibrotic activity by measuring the levels of Interleukin-6 (IL-6), Transforming growth factor-β (TGF-β), E-cadherin, and Monocyte Chemoattractant Protein-1 (MCP-1) and observing trends in subsequent follow-ups and at the same time correlating them with the established parameters of disease progression. Materials and Methods: This prospective study included 36 consecutive patients of PUV, managed over a period of 18 months. IL-6, TGF-β, E-cadherin, and MCP-1 were measured in urine samples at the time of admission, pre-fulguration and 3 months' and 9 months' post fulguration. The observed values were correlated with the conventional parameters used in clinical practice. Results: All the biomarkers showed statistically significant trends when these values were compared on admission, postoptimization and 3 months' and 9 months' postfulguration. None of the biomarkers showed a significant correlation with renal function tests. E-Cadherin and TGF-β showed a positive and a negative correlation with ultrasonography (USG) kidney, ureter, and bladder (KUB) respectively. E-Cadherin showed a positive correlation, whereas IL-6 and TGFβ showed negative correlation respectively with micturating cystourethrogram (MCUG). IL-6 showed statistically a significant negative correlation with dimercapto succinic acid (DMSA). MCP-1 did not show any significant correlation with USG KUB, MCUG and DMSA. Conclusion: This study concludes that E-Cadherin, IL-6, TGF-β can be promising urinary biomarkers for early detection of the ongoing renal damage in patients of PUV following valve fulguration. MCP-1 may have more complex interactions, with inflammatory markers; which warrants further research. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 38-year-old asymptomatic man whose prenatal diagnosis of an umbilical cord cyst led to the incidental discovery of a patent urachus in the fetus. Topics discussed include the rarity of umbilical cord cysts, differentiation between true cysts and pseudocysts, and the challenges in prenatally diagnosing patent urachus, emphasizing the importance of postnatal evaluation even when no prenatal diagnosis is made.

Background: Untreated postoperative urinary retention (POUR) leads to bladder overdistension. Treatment of POUR involves urinary catheterization, which predisposes patients to catheter-associated urinary tract infections. The hospital's rate of POUR after lobectomy was 21%, exceeding the Society of Thoracic Surgeons' benchmark of 6.4%. Nurses observed that more patients were being catheterized after implementation of a newly revised urinary catheter protocol. Objective: To reduce the incidence of POUR by implementing a thoracic surgery–specific nurse-led voiding algorithm. Methods: Experts validated the voiding algorithm that standardized postoperative assessment. It was initiated after general thoracic surgery among 179 patients in a thoracic surgery stepdown unit of a large Magnet hospital. After obtaining verbal consent from patients, nurses collected demographic and clinical data and followed the algorithm, documenting voided amounts and bladder scan results. Descriptive statistics characterized the sample and the incidence of POUR. Associations were determined between demographic and clinical factors and POUR status by using the t test and χ2 test. Results: The POUR-positive group and the POUR-negative group were equivalent with regard to demographic and clinical factors, except more patients in the POUR–positive cohort had had a lobectomy (P =.05). The rate of POUR was 8%. Society of Thoracic Surgeons reports revealed a rapid and sustained reduction in the hospital's rates of POUR after lobectomy: from 21% to 3%. Conclusion: The use of this nurse-led voiding algorithm effectively reduced and sustained rates of POUR. [ABSTRACT FROM AUTHOR]

Purpose: Evaluation of male with primary bladder neck obstruction (PBNO) using MRI and MR voiding cystourethrography (MR-VCU) to study both anatomical aspects of bladder neck and urethral lumen. Methods: In this retrospective study 21 male patients (mean age 33 ± 14) with urodynamic diagnosis of PBNO and 5 healthy volunteers ((mean age 28 ± 2) as control group were enrolled. Both patients and control group underwent 1.5 T MRI. Sagittal and oblique coronal Turbo-Spin-Echo T2-weighted scans were performed. Only patients underwent MR voiding cystourethrography (MR-VCU) performed with T1-weighted spoiled 3D gradient-echo sagittal acquisitions. Bladder lumen was filled with contrast-material-enhanced urine. Blinded test by two radiologists was performed to evaluate causes of bladder outlet obstruction evaluating MR-VCU. Anatomical MRI features of both control group and patients were compared in consensus by senior radiologist and urologist using the analysis of variance (ANOVA) test. Results: MRI allowed evaluation of the bladder neck muscular structures. We found 4 groups of PBNO patients: 52% hypertrophy of posterior lip of bladder sphincter; 20% asymmetry of lateral portion of bladder sphincter; 14% bladder neck cyst; 14% showed normal aspect of bladder neck. Comparison between the control group and first and second PBNO groups was considered statistically significant (p < 0.05) with diagnostic accuracy of 87%. Only 13 patients (61%) were able to perform MR-VCU and radiologists always made the diagnosis of PBNO. Conclusion: MRI together with MR-VCU provides useful anatomical and functional information in the study of bladder neck and urethral lumen. These preliminary results suggest that MRI could substitute for standard cystourethrogram in patients with PBNO. [ABSTRACT FROM AUTHOR]

Background/Aim: The gold standard in the diagnosis of VUR (vesicoureteral reflux) is voiding cystouretrography (VCUG), but it is an invasive test with risk of radiation. The aim of the study was to determine the sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of ultrasound (US) in the diagnosis of VUR. Methods: 760 kidneys of 380 patients were examined in this cohort study. The patients were grouped by three age groups; 0-2, 3-5 and 6-17 years old. US reports included the data of anteroposterior renal pelvic diameter (APRPD), kidney parenchyma, kidney size, and the size of ureters. For all age groups, the sensitivity, specificity, PPV and NPV were evaluated separately in two circumstances; APRPD is accepted pathologic when >5 mm and >10 mm. Results: A correlation was found between VCUG and US results in all age groups (P<0.001). When pathologic APRPD was accepted as >5 mm, sensitivity, specifity and NPV of US were 86.99%, 60.26% and 88.13% respectively, regardless of age. In contrast, when pathologic APRPD was >10 mm, sensitivity, specifity and NPV were 79.45%, 79.91% and 71.17%, respectively. Sensitivity and NPV of US were found highest in group of 0-2 age. Conclusion: If US are performed by radiologists experienced in the pediatric urinary system US and if it includes other parameters with APRPD, it will guide for VCUG in the diagnosis of VUR. Thus, radiation exposure can be minimalized in clinical practice. [ABSTRACT FROM AUTHOR]

Traumatic lower urinary tract injuries are uncommon and mainly occur in patients with severe trauma and multiple abdominopelvic injuries. In the presence of other substantial injuries, bladder and urethral injuries may be overlooked and cause significant morbidity and mortality. Therefore, it is important that radiologists are familiar with mechanisms and injuries that are high risk for bladder and urethral trauma. We review the imaging findings associated with these injuries and the appropriate modalities and techniques to further evaluate the patient and accurately diagnose these injuries. Computed tomography cystography and conventional retrograde urethrography are effective tools in identifying injuries to the lower urinary tract and play a crucial role in patient care and prognosis. [ABSTRACT FROM AUTHOR]

Radiographic and ultrasonographic evaluations of the urinary bladder architecture following autologous composite colo-peritoneal pedicle graft, as alternative tissue for urinary bladder reconstruction, in the surgical repair of experimental urinary bladder defects were carried out in two dogs. Predetermined 2 × 4 cm dimension of urinary bladder defect was created on the dorsum of the urinary bladder, and was patched with harvested 3 × 5 cm composite coloperitoneal pedicle flap. All operations were aseptically and humanely conducted. The gross anatomical evaluation of the urinary bladder architecture was performed by ultrasonography and contrast radiography of the repaired urinary bladder. Post-surgical cystosonographic assessments on day 8 showed thickened urinary bladder wall at the point of the graft, which decreased markedly on day 21. Cystographic evaluation revealed gradual transition of the urinary bladder architecture at the point of graft with clear delineation and minimal blurring at week 2 post-operation, which gradually disappeared at weeks 10 and 14. The cystosonographic and cystographic evaluations demonstrated evidence of advanced healing and well-preserved urinary bladder architecture with no evidence of leaks. The imaging modalities are adequately diagnostic to assess urinary bladder repairs following its management with composite colo-peritoneal graft in dogs. [ABSTRACT FROM AUTHOR]

The article describes the case of a patient with level one trauma injuries and with allergy to iodinated contrast computed topography (CT). The patient demonstrated pelvic compression injury, pubic diastasis, sacral fracture, pelvic hematoma and probable partial extrusion of the urinary bladder. The patient underwent gadolinium-based CT cystography to evaluate for a bladder rupture

To evaluate the safety and efficacy of laparoscopic bladder muscle flap reconstruction in the treatment of extensive ureteral avulsion. Patients with full-length (re length > 20 cm) and upper ureteral (avulsion length > 10 cm) defects were eligible. All patients were treated with laparoscopic bladder muscle flap reconstruction. Peri-operative information and post-operative complications were recorded. The kidney function, urinary ultrasound or computed tomography (CT), sun-renal function tests emission computed tomography (ECT) and cystography after operation were recorded. Ten patients were included (7 with full-length and 3 with upper ureteral defects). Median age was 56 years and 70% of them were female. The average operation time and blood loss was 124 min and 92.2 ml. There was no treatment-related adverse effects including urinary leakage, renal colic, fever, etc. The median follow-up was 18.5 months (3–39 months). The surgery did not significantly alter the renal function and separation degree of the renal pelvis during long-term follow-up. Double J stents were removed in nine patients (90%) within six months after operation. Only one case was diagnosed with post-operative anastomotic stricture, and subsequently received laparoscopic ipsilateral nephrectomy one year after the reconstruction operation. All cases had normal voiding and pear-shaped cystography. Laparoscopic bladder flap repair is a safe and effective treatment approach together with several advantages for patients with full-length or upper ureteral avulsion. [ABSTRACT FROM AUTHOR]

Background: Removal of urinary catheters depends on accurate noninvasive measurements of bladder volume. Patients with acute kidney injury often have low bladder volumes/ascites, possibly causing measurement inaccuracy. Objective: To evaluate the accuracy of bladder volumes measured with bladder scanning and 2-dimensional ultrasound (US) compared with urinary catheterization among different types of clinicians. Methods: Prospective correlational descriptive study of 73 adult critical care patients with low urine output receiving hemodialysis or unable to void. Bladder volumes were independently measured by (1) a physician and an advanced practice registered nurse using US, (2) an advanced practice registered nurse and a bedside nurse using bladder scanning, and (3) urinary catheterization (cath). Bland-Altman and χ2 analyses were conducted. Results: Mean (SD) cath volume was 171.7 (269.7) mL (range, 0-1100 mL). Abdominal fluid was observed in 28% of patients. Bias was −1.3 mL for US vs cath and 3.3 mL for bladder scanning vs cath. For patients with abdominal fluid and cath volume less than 150 mL, decisions to not catheterize patients were accurate more often when based on US measurements (97%-100%) than when based on bladder scanning measurements (86%-89%; P =.02). In patients with cath volume of 300 mL or more, decisions to catheterize patients were accurate more often when based on bladder scanning measurements (94%-100%) than when based on horizontal US measurements (50%-56%; P =.001). Conclusions: Bladder volume can be measured accurately with bladder scanning or US, but abdominal fluid remains a confounding factor limiting accuracy of bladder scanning. [ABSTRACT FROM AUTHOR]

Vesicoureteral reflux can be defined as a congenital anomalies of the lower urinary tract characterize by a defect in the vesico-ureteric valve (which is a functional valve result from the oblique intramural passage of the lower 2.5 cm. of the ureters in wall of the bladder) resulting in retrograde passage of urine into one or both ureters up to the kidneys during voiding. From March 2014 to June 2016, 60 (38 males and 22 females) children with low-grade primary VUR (10 with G1, 16 had G2 and 34 had G3) who are seeking medical advice in the urological department of Alhilla teaching and Alsadiq teaching hospitals and private clinics were included in this study. All patients evaluated by thorough medical history, complete physical examination, send for urinalysis, PCV, and ultrasonography, and confirm the diagnosis by voiding cystography. No Foley catheter put for patients with G1 VUR, while Foley catheter put for eight patients with G2 VUR (50%) and for 20 patients with G3 reflux (58.8%). Patients are fallowed for at least 1 year for any breakthrough upper or lower urinary tract infection and for the grade of reflux by frequent urinalysis and ultrasonography for any new renal scaring while voiding cystography repeat every 6 months. Conservative treatment is the first option in the treatment of low grade VUR. The use of indwelling Foley catheter in the treatment of low grade VUR remain controversy regarding its role in decreasing the back pressure on the renal parenchyma and its increasing rate of UTI .however this study reveal that the incidence of UTI occur in 6.25% of cases treated with continuous prophylactic antibiotic (CPA) alone and occur in 25% of cases treated with CPA with Foley catheter placement. [ABSTRACT FROM AUTHOR]

Background: Efficient and accurate methods are needed to automatically segmenting organs-at-risk (OAR) to accelerate the radiotherapy workflow and decrease the treatment wait time. We developed and evaluated the use of a fused model Dense V-Network for its ability to accurately segment pelvic OAR. Material and methods: We combined two network models, Dense Net and V-Net, to establish the Dense V-Network algorithm. For the training model, we adopted 100 kV computed tomography (CT) images of patients with cervical cancer, including 80 randomly selected as training sets, by which to adjust parameters of the automatic segmentation model, and the remaining 20 as test sets to evaluate the performance of the convolutional neural network model. Three representative parameters were used to evaluate the segmentation results quantitatively. Results: Clinical results revealed that Dice similarity coefficient values of the bladder, small intestine, rectum, femoral head and spinal cord were all above 0.87 mm; and Jaccard distance was within 2.3 mm. Except for the small intestine, the Hausdorff distance of other organs was less than 9.0 mm. Comparison of our approaches with those of the Atlas and other studies demonstrated that the Dense V-Network had more accurate and efficient performance and faster speed. Conclusions: The Dense V-Network algorithm can be used to automatically segment pelvic OARs accurately and efficiently, while shortening patients' waiting time and accelerating radiotherapy workflow. [ABSTRACT FROM AUTHOR]

Background: The accuracy of any radiation therapy delivery is limited by target organ translocation and distortion. Bladder filling is one of the recognised factors affecting prostate translocation and distortion. The purpose of our study was to evaluate the effect of bladder volume on prostate translocation and distortion by using detailed three-dimensional prostate delineation on MRI. Patients and methods: Fifteen healthy male volunteers were recruited in this prospective, institutional review board-approved study. Each volunteer underwent 4 different drinking preparations prior to imaging, with MR images acquired pre- and post-void. MR images were co-registered by using bony landmarks and three-dimensional contouring was performed in order to assess the degree of prostate translocation and distortion. According to changes in bladder or rectum distention, subdivisions were made into bladder and rectal groups. Studies with concomitant change in both bladder and rectal volume were excluded. Results: Forty studies were included in the bladder volume study group and 8 in the rectal volume study group. The differences in rectal volumes yielded higher levels of translocation (p < 0.01) and distortion (p = 0.02) than differences in bladder volume. Moderate correlation of prostate translocation with bladder filling was shown (r = 0.64, p < 0.01). There was no important prostate translocation when bladder volume change was < 2-fold (p < 0.01). Moderate correlation of prostate distortion with bladder filling was shown (r = 0.61, p < 0.01). Conclusions: Bladder volume has a minimal effect on prostate translocation and effect on prostate distortion is negligible. Prostate translocation may be minimalised if there is < 2-fold increase in the bladder volume. [ABSTRACT FROM AUTHOR]

Voiding cystourethrography (VCUG) demonstrates the anatomy of the urinary system and is used to detect the presence/absence of vesicoureteral reflux. It is the most important modality for urological fluoroscopic examination in children. For improved patient care, it is important to understand and perform VCUG appropriately. Therefore, an in-depth review of VCUG protocols and techniques has been presented herein. In addition, tips, tricks, and pitfalls associated with the technique have also been addressed. [ABSTRACT FROM AUTHOR]

Introduction: Urinary bladder rupture is a pathology more common in males and may occur in the context of various conditions: abdominal traumas, inflammatory diseases, iatrogenic injuries. One of its most severe complications is urohemoperitoneum, representing a surgical emergency characterized by severe abdominal pain, distension, and abdominal tenderness. Left untreated, it presents a high mortality and morbidity rate. Case Report: We present a 46-year-old man, diabetic, chronic alcohol consumer, who presented to the Emergency Department complaining of progressively worsening dyspnea at rest, progressive abdominal distension, associated with diffuse abdominal pain, dysuria, and oliguria for about a week. The patient reported an episode of acute urinary retention 8 days ago, for which urethral-vesical catheterization was performed. CT examination revealed significant intraperitoneal fluid accumulation, as well as images suggestive of clots on both flanks, more pronounced in the supravesical pelvic region, and cystography under CT control showed bladder rupture at the dome level. Subsequently, emergency surgical intervention was performed, and exploratory laparotomy revealed the presence of hematuric urine in the intraperitoneal cavity in large amounts - 10 liters, with features suggestive of an older bleeding. Viscerolysis was performed, a 4 cm defect was identified in the posterior bladder wall, excisional debridement of bladder defect margins and double-layer cystorrhaphy were performed, with placement of a Foley urethral-vesical catheter. Abundant abdominal lavage was performed. The patient was diagnosed with urohemoperitoneum due to spontaneous bladder rupture. Discussions : The therapeutic approach to bladder rupture complicated by urohemoperitoneum must be prompt and correct, clinically evaluated, biologically and through imaging examinations, which contribute to establishing and implementing therapeutic methods. CT examination and cystography played an essential role in diagnosis, abdominal CT providing detailed images of the abdominal region, allowing presumptive identification of urinary bladder rupture, as well as evaluation of urohemoperitoneum extension, and cystography confirming the diagnosis and providing information about the rupture location. Conclusions: Urohemoperitoneum is a potentially fatal complication, but when promptly treated with care and specific interventions, the patient can make a complete recovery. [ABSTRACT FROM AUTHOR]

An unusual CT urogram scan showing 'kissing' bilateral ureteroceles was seen for the first time and it was a visual delight. [ABSTRACT FROM AUTHOR]

Urinary bladder injuries are uncommon, accounting for just 1.6% of all abdominal trauma. The most common presenting symptoms are hematuria, abdominal pain and inability to void. Ascites is the most typical manifestation on CT. We hereby report a case of a 24-year-old male victim of a road traffic injury with an unusual presentation of pneumoperitoneum and "reversal" of FAST positive status as the presenting signs of bladder injury. Prior awareness of urinary bladder injury as the etiology of pneumoperitoneum can possibly decrease morbidity with consideration of minimal access surgery for management. Compared to pneumoperitoneum, "FAST reversal" in catheterized patients is quite peculiar and sufficiently specific per se to warrant a cystogram or thorough intraoperative bladder evaluation. [ABSTRACT FROM AUTHOR]

Background: We previously reported that the top‐down approach (TDA) for infants with febrile urinary tract infections (fUTI) could prevent recurrent fUTI (r‐fUTI) but produced a high number of false‐positives on acute‐phase 99mTc dimercaptosuccinic acid (DMSA) renal scintigraphy. Therefore we compared the ultrasonography‐oriented approach (USOA) with TDA from the viewpoint of prevention of r‐fUTI. Methods: The TDA was applied between July 2010 and February 2014 and the USOA was applied between March 2014 and April 2017 in infants with first fUTI. In the USOA group, voiding cystourethrography (VCUG) was performed in the case of abnormality on acute‐phase renal bladder ultrasonography (RBUS) or on chronic‐ phase DMSA, which were performed in all cases. The frequency of r‐fUTI was compared between the TDA group and USOA group retrospectively. Results: Seventy‐four infants (52 male) and 79 infants (60 male) received TDA or USOA, respectively. No significant differences were found between the TDA and USOA groups in male : female ratio, age in months at initial onset of fUTI, observation period, or number of cases of r‐fUTI (TDA group, n = 4; USOA group, n = 5). Seventy‐four DMSA scintigraphy and 25 VCUG were carried out in the USOA group, and 111 DMSA scintigraphy and 34 VCUG in the TDA group. Conclusions: Both USOA and TDA were valid for prevention of r‐fUTI, but USOA was superior to TDA with regard to the reduced number of patients undergoing VCUG and DMSA. [ABSTRACT FROM AUTHOR]

Conventional assessment of overactive bladder syndrome uses invasive pressure-measuring catheters to detect bladder contractions (urodynamics). We hypothesised that bladder shape changes detected and measured using transabdominal ultrasound scan could provide a non-invasive and clinically useful alternative investigation of bladder contractions. This feasibility study evaluated a novel transabdominal ultrasound scan bladder shape test during conventional urodynamics and physiological bladder filling. The aim was to initially evaluate and refine a non-invasive approach for detecting and quantifying bladder shape changes associated with involuntary bladder contractions. To develop measurement techniques and characterise bladder shape changes during bladder filling, healthy female volunteers (n=20) and women with overactive bladder symptoms who had previously undergone urodynamics (n=30) completed symptom questionnaires and bladder diaries. The bladder shape test protocol included consumption of 1 l water before undergoing serial transabdominal ultrasound scan imaging of the bladder during physiological bladder filling and during episodes of urgency. In a further group of women with overactive bladder (n=22), serial transabdominal ultrasound scan images were captured during urodynamics so that shape changes occurring with bladder contractions could be characterised. In both healthy volunteers and women with overactive bladder, the transverse view of the bladder provided the most reliable plane to characterise and measure bladder shape changes. A sphericity index derived from the ratio between maximum inscribed and minimum circumscribed ellipses (πac2(inner)/πac2(outer)) offered a reliable and reproducible measurement system. Of participants undergoing transabdominal ultrasound scan during urodynamics, there were significant measurable differences in sphericity index between patients with bladder contractions (n=12) and patients with acontractile bladders (p < 0.001). Bladder shape changes detected during physiological filling and urodynamics have provided preliminary evidence to support further research into bladder shape test as a non-invasive diagnostic tool to identify involuntary bladder contractions in patients with overactive bladder syndrome. [ABSTRACT FROM AUTHOR]

Injuries to the bladder are infrequent and commonly result from blunt, penetrating, or iatrogenic trauma. Bladder injuries may be missed as they often present concomitantly with other abdominal and pelvic injuries; however, early detection and treatment are essential as morbidity and mortality may be significant. Gross hematuria, especially in the setting of pelvic fractures, may be indicative of a bladder injury which can be confirmed with cystography. Extraperitoneal injuries are commonly managed conservatively with catheter drainage while intraperitoneal ruptures traditionally required surgical exploration and closure. Presented is a contemporary review which encapsulates the etiology, presentation, assessment, and management of bladder injuries. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to study the efficacy of hued lubricating jelly instillation proximal to the upper ureteral stone during intracorporial pneumatic lithotripsy using semi-rigid ureteroscope for the prevention of migration of the stone. Materials and Methods: We enrolled 60 subjects with ureteral stone in this prospective, controlled clinical trial. Alternate patients were assigned to the hued lubricating jelly instillation group A (n=30) and control group B (n=30). Ureteroscopy was performed according the standard protocol, using 7.5 F semi-rigid ureteroscope and stone fragmentation by pneumatic lithotripter. In the group A patients, a 5 Fr catheter was inserted into the ureter under fluoroscopy and 3-5 mL of hued lubricant jelly was dispensed above the stone. Retropulsion and the presence of residual fragments were evaluated with computed tomography of kidneys, ureters and bladder, X-ray and ultrasonography at 24 hours and at two weeks. The migrated stones were treated with shock wave lithotripsy. Any adverse event was reported and graded as per the modified Clavien classification system. Results: The two groups had comparable demographic and stone characteristics. There was a statistically significant difference in retropulsion rate between the lubricating jelly instillation group and control group (6.67% vs 26.67%, p=0.04). No statistically significant complications were noted amongst the two groups. All patients were stone-free at 2-week follow-up. Conclusion: Instillation of hued lubricating jelly proximal to ureteral calculi during pneumatic lithotripsy is an effective method of preventing retrograde stone migration. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to compare urodynamic changes after valve fulguration alone and valve fulguration with bladder neck incision (BNI). Settings and Design: A total of 81 patients with posterior urethral valve were treated at our center from July 2010 to July 2016. Patients were randomized into two groups using simple randomization. Forty patients underwent BNI in addition to valve fulguration (Group I), and the remaining 41 patients underwent conventional transurethral valve fulguration (Group II). Subjects and Methods: The exclusion criteria for both the groups were the presence of simultaneous urogenital anomalies, any neurological condition, history of any urethral manipulation, and urinary diversion. Urodynamic changes were compared in both groups postoperatively. All patients were evaluated throughout their follow-up, according to the following protocol: (a) Voiding cystourethrography at 6 weeks after surgery; (b) Renal function test and urine culture at 6 weeks and then 3 monthly; (c) Ultrasound kidney, ureter, and bladder region and urodynamics at 3 and 6 months after surgery and then yearly. Median follow-up period for Group I was 27.5 months (13–72 months) and 14 months (14.5–72 months) for Group II. Statistical Analysis Used: Statistical analysis was done using the Student's t-test for parametric data and Chi-square test for categorical variable. P ≤ 0.05 was considered as statistically significant. Results: The mean age was 7.26 years in Group I and 7.66 years in Group II at the end of follow-up. There was no statistically significant difference found regarding detrusor overactivity (P = 0.68), compliance (P = 0.052), end-filling pressure (P = 0.08), and max Pdet at Qmax (P = 0.08) in the both groups. However, there was a statistically significant difference regarding improvement of peak flow (P = 0.038) and postvoid residue (PVR) (P = 0.045) in Group I in comparison to Group II. Conclusions: Valve ablation with BNI gives statistically significant better urodynamics in voiding phase regarding flow and lesser PVR in comparison to valve ablation. [ABSTRACT FROM AUTHOR]

Introduction: There are a small number of reports in the literature describing bladder rupture during cystograms in children. We hypothesized that children undergoing cystograms may have their bladder overfilled during the test. We aimed to evaluate the current practice when performing cystograms in our institution, contrasting actual volume used to fill the bladder to the age-adjusted bladder capacity. Methods: We performed a retrospective review of all voiding cystourethrograms (VCUG) and radionuclide cystograms (RNC) performed at the Children's Hospital of Eastern Ontario from 2006-2013. Formulas used to estimate age-adjusted bladder capacity: 1) infants <1 year: capacity (mL) = (2.5 x age [months]) + 38 (Holmdahl et al, 1996); and 2) older children >1 year: capacity (mL) = (2 + age [years]) x 30 (Koff et al, 1983). Results: A total of 2411 cystograms were done (1387 VCUG; 1024 RNC) in 817 infants and 1594 children older than one year -- 1113 boys and 1298 girls. Generally, bladders tended to be overfilled with 32% more volume in mL than the expected age-adjusted bladder capacity -- VCUG 151 (122) mL vs. 120 (97) mL (p<0.001) and RNC 191 (97) mL vs. 151 (74) mL (p<0.001). Most importantly, infants had a striking overfilling rate of 64% and 38 % more volume than their expected age-adjusted bladder capacity for VCUG and RNC, respectively (p<0.001). Conclusions: Bladders were filled above the estimated age-adjusted capacity in mL at the following rates: 32% in the whole group and 64% in infants undergoing VCUG. It raises concern of possible bladder rupture in this age group. Furthermore, this may lead to overgrading and overdiagnosing of vesicoureteric reflux, as well as overestimation of post-void residual. Attention should be paid to filling to age-adjusted bladder capacity and allowing the child adequate time to void during performance of the cystogram. [ABSTRACT FROM AUTHOR]

Although Double-J stents have become very common in the urological practice and are effectively used for various reasons, several complications related to it, such as hematuria, infection, irritative symptoms, pain, perforation, encrustation, and migration, have been observed. The present study reports five case reports of stent encrustation due to forgotten stents. [ABSTRACT FROM AUTHOR]

Objective. To explore whether it is safe to change from transecting excision and primary anastomosis (tEPA) towards nontransecting excision and primary anastomosis (ntEPA) in the treatment of short bulbar urethral strictures and to evaluate whether surgical outcomes are not negatively affected after introduction of ntEPA. Materials and Methods. Two-hundred patients with short bulbar strictures were treated by tEPA (n=112) or ntEPA (n=88) between 2001 and 2017 in a single institution. Failure rate and other surgical outcomes (complications, operation time, hospital stay, catheterization time, and extravasation at first cystography) were calculated for both groups. Potentially predictive factors for failure (including ntEPA) were analyzed using Cox regression analysis. Results. Median follow-up for the entire cohort was 76 months, 118 months, and 32 months for, respectively, tEPA and ntEPA (p<0.001). Nineteen (9.5%) patients suffered a failure, 13 (11.6%) with tEPA and 6 (6.8%) with ntEPA (p=0.333). High-grade (grade ≥3) complication rate was low (1%) and not higher with ntEPA. Median operation time, hospital stay, and catheterization time with tEPA and ntEPA were, respectively, 98 and 87 minutes, 3 and 2 days, and 14 and 9 days. None of these outcomes were negatively affected by the use of ntEPA. Diabetes and previous urethroplasty were significant predictors for failure (Hazard ratio resp. 0.165 and 0.355), whereas ntEPA was not. Conclusions. Introduction of ntEPA did not negatively affect short-term failure rate, high-grade complication rate, operation time, catheterization time, and hospital stay in the treatment of short bulbar strictures. Diabetes and previous urethroplasty are predictive factors for failure. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether grade 4-5 vesicoureteral reflux (VUR) can be predicted from renal ultrasound (RUS) findings and perform voiding cystourethrograms (VCUGs) only on high-risk patients.Methods: The RUS and VCUG images of infants with prenatally detected hydronephrosis admitted to our institution between 2003 and 2013 were re-evaluated. The UTI episodes were collected retrospectively from patient journals. Patients with complex urinary tract anomalies were excluded.Results: One hundred eighty, 44 female and 136 male, patients (352 renal units (RU)), 23 (30 RU) of them having grade 4-5 VUR, were included. The median age of the patients at the time of the RUS was 1.3 (0.1-3.0) months and the median follow-up time was 2.0 (0.1-11.2) years.In multivariate analysis, a visible ureter (OR 12.72; CI 5.33-32.04, p < 0.001) and shorter renal length (OR 2.67; CR 1.50-4.86, p < 0.001) in RUS predicted grade 4-5 VUR while a visible ureter predicted UTIs (OR 5.75; CI 2.59-12.66, p < 0.001).A three-grade risk score for high-grade VUR was developed based on the RUS findings and the patients were categorized into low-, intermediate-, and high-risk groups. The incidence of grade 4-5 VUR was 2.9% in the low-risk, 12.2% in the intermediate-risk, and 52.2% in the high-risk group. The sensitivity and specificity for detecting grade 4-5 VUR were 79 and 82%, respectively.Conclusions: In patients with antenatally detected hydronephrosis, a visible ureter and reduced renal length in RUS are significant risk factors for high-grade VUR. A RUS-based risk scoring would probably reduce the proportion of unnecessary VCUGs. [ABSTRACT FROM AUTHOR]

Introduction: A "Negative" ureteroscopy (URS) is defined as a URS in which no stone is found during the procedure. It may occur when the stone has already been passed spontaneously or when it is located outside the collecting system. The aim of the study was to outline risk factors for Negative-URS. Materials and Methods: We retrospectively analyzed the possible risk factors for Negative-URS from a database of 341 URS cases. In every case where presumptive ureteral stone was not found, a formal nephroscopy as well as a whole collecting system revision was completed. The Negative-URS group was compared with the non-Negative-URS group, in terms of patient and stone characteristics. Results: The database of 341 URS cases included 448 different stone instances, of which 17 (3.8%) were negative and 431 (96.2%) were therapeutic. There was no statistical significant difference between the two groups concerning age, body mass index, stone location in the ureter, stone laterality, and whether the patient was prestented. The stepwise multiple logistic regression revealed three important risk factors, namely CT stone surface area (p < 0.0001), radiopacity of the stone at kidney, ureter, and bladder radiograph (KUB; p = 0.0004), and gender (p = 0.0011) with an area under the curve of 0.91. Women were found to have more possibilities to have a negative procedure by four- to sevenfold than men depending on the model. A nonradio-opaque stone at KUB is more likely to be correlated with a Negative-URS by 9.5- to 11-fold more than a radiopaque stone at KUB. For each increase of 1 U in CT stone surface area, there is an increase of 10%–12% to be non-negative. Conclusions: Female gender, a nonradio-opaque stone at KUB, and a smaller stone surface were statistically significantly different in the Negative-URS population. [ABSTRACT FROM AUTHOR]

We conducted a retrospective chart review of 27 patients--7 men and 20 women, aged 47 to 94 years (mean: 71.3)--with symptomatic epiphora secondary to dacryostenosis who had undergone thulium:YAG (Tm:YAG) laser dacryocystorhinostomy (DCR). Among them, dacryostenosis had been documented in 35 eyes by dacryocystography. The Tm:YAG procedure involved the administration of local anesthesia, after which a 600-µm laser fiber was inserted into the lacrimal canaliculi and then into the nasolacrimal duct. Under endoscopic visualization, the DCR was performed anterior and inferior to the middle turbinate, which created an opening. Silicone stents were then inserted and tied intranasally. In the immediate postoperative period, all 27 patients noted initial improvement. During a follow- up of 22 days to 25 months (mean: 11.3 mo), 24 of the 27 patients (89%) remained symptom-free, while the remaining 3 patients (11%) experienced a treatment failure and required revision surgery. To the best of our knowledge, only two articles on thulium laser therapy for DCR have been previously published, both approximately 25 years ago; both involved the use of a thulium along with holmium and chromium in cadavers. As far as we know, our case series is the largest in the English-language literature that has documented the use of the thulium in laser therapy for DCR, and it is the only in vivo study. We found that DCR with the Tm:YAG laser was an effective and affordable option for patients with symptomatic epiphora secondary to lacrimal obstruction. [ABSTRACT FROM AUTHOR]

Ureterocolic fistulae are a rare phenomenon and are most commonly seen secondary to obstructive ureteric calculi. These are usually diagnosed on barium enema or intravenous urography. Most of the times, more than one investigation is needed to confirm the findings. We present a case of iatrogenically-induced ureterocolic fistula, diagnosed on renogram and direct radionuclide cystography. This case showcases the possibility of using a renogram study as a diagnostic tool for a suspected ureterocolic fistula. A renogram study also enables to asess the renal function, which is essential in deciding the management. [ABSTRACT FROM AUTHOR]

Renal scintigraphy is a useful tool in diagnosis and management of various nephro-urological conditions. Tc-99m dimercaptosuccinic acid renal scintigraphy (Tc-99m-DMSA), Tc-99m mercaptoacetyltriglycine (Tc-99m-MAG3) or Tc-99m diethylenetriaminepentaacetic acid (Tc-99m-DTPA) dynamic renal scintigraphy, and Radionuclide micturating cystography are the common scans used in children with kidney diseases. These studies are minimally invasive, easily available, and offer both anatomic details and functional information required for thorough evaluation. At the same time, it is essential to have appropriate knowledge to interpret these studies and be aware of their limitations and pitfalls. The advent of Positron emission tomography-computed tomography/magnetic resonance imaging (PETCT/MRI) has broadened the scope of nuclear medicine. This article focuses on the technique, interpretation, indication and recent practice guidelines of renal scintigraphy in children with kidney diseases. [ABSTRACT FROM AUTHOR]

Background: Duplex collecting system (DCS) is a common anomaly in childhood and may be consist of different anatomical variations. Diagnosis and treatment has not yet been standardized. In this study, our aim is to present the interventional procedures applied to our patients with DCS in the light of the literature. Material and Methods: Patients with signs and symptoms related to DCS between January 2011 and August 2018 were evaluated retrospectively. Demographic characteristics, diagnostic methods and interventional procedures were recorded. Results: The most common finding was urinary tract infection in 13 patients (mean age is 5 years). Diagnosis was made by the cystourethrography, intravenous urography and magnetic resonance urography studies in cases with suspected US. Upper-pole partial nephrectomy was performed in two patients, ureterocele puncture in 4, subureteric injection for vesicouretric reflux in 4. Only cystoscopy was done in two patients, and ureterolithotony required in one. Ureteroneocystostomy was performed in 4 patients, two of whom had previously undergone ureterocele puncture and two of which had previously been subureteric injection. There was no loss of function except one case. Conclusions: In addition to aggressive methods, endoscopic minimally invasive procedures are increasingly used in the management of DCS. The interventional procedure is selected according to the type of the anomaly and specific to the patient. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the impact of couch translational shifts on dose–volume histogram (DVH) and radiobiological parameters [tumour control probability (TCP), equivalent uniform dose (EUD) and normal tissue complication probability (NTCP)] of volumetric modulated arc therapy (VMAT) plans and to develop a simple and swift method to predict the same online, on a daily basis. Methods: In total, ten prostate patients treated with VMAT technology were selected for this study. The plans were generated using Eclipse TPS and delivered using Clinac ix LINAC equipped with a Millennium 120 multileaf collimator. In order to find the effect of systematic translational couch shifts on the DVH and radiobiological parameters, errors were introduced in the clinically accepted base plan with an increment of 1 mm and up to 5 mm from the iso-centre in both positive and negative directions of each of the three axis, x [right–left (R-L)], y [superior–inferior (S-I)] and z [anterior–posterior (A-P)]. The percentages of difference in these parameters (∆D, ∆TCP, ∆EUD and ∆NTCP) were analyzed between the base plan and the error introduced plans. DVHs of the base plan and the error plans were imported into the MATLAB software (R2013a) and an in-house MATLAB code was generated to find the best curve fitted polynomial functions for each point on the DVH, there by generating predicted DVH for planning target volume (PTV), clinical target volume (CTV) and organs at risks (OARs). Functions f(x, vj), f(y, vj) and f(z, vj) were found to represent the variation in the dose when there are couch translation shifts in R-L, S-I and A-P directions, respectively. The validation of this method was done by introducing daily couch shifts and comparing the treatment planning system (TPS) generated DVHs and radiobiological parameters with MATLAB code predicted parameters. Results: It was noted that the variations in the dose to the CTV, due to both systematic and random shifts, were very small. For CTV and PTV, the maximum variations in both DVH and radiobiological parameters were observed in the S-I direction than in the A-P or R-L directions. ∆V70 Gy and ∆V60 Gy of the bladder varied more due to S-I shift whereas, ∆V40 Gy, ∆EUD and ∆NTCP varied due to A-P shifts. All the parameters in rectum were most affected by the A-P shifts than the shifts in other two directions. The maximum percentage of deviation between the TPS calculated and MATLAB predicted DVHs of plans were calculated for targets and OARs and were found to be less than 0·5%. Conclusion: The variations in the parameters depend upon the direction and magnitude of the shift. The DVH curves generated by the TPS and predicted by the MATLAB showed good correlation. [ABSTRACT FROM AUTHOR]

Background: By now, two-dimensional contrast-enhanced voiding urosonography (ceVUS) has become a well-established method for the diagnosis and treatment monitoring of vesicoureteral reflux in children, particularly after the recent approval for this application in children in the USA and in Europe. The introduction of three-dimensional static (3D) and real-time (4D) techniques with ultrasound contrast agents opens up new diagnostic opportunities for this imaging modality. Objective: To analyze whether 3D and 4D ceVUS is a superior technique compared to standard 2D ceVUS in diagnosing vesicoureteral reflux in children. Material and methods: The study included 150 patients (mean age 3.7 years) who underwent 2D and 3D/4D ceVUS for the diagnosis and grading of vesicoureteral reflux. Results: 2D ceVUS and 3D/4D ceVUS diagnosed the same number of vesicoureteral refluxes, however, there was a statistically significant difference in grading between the two methods. Performing 3D/4D ceVUS resulted in changing the initial grade compared to 2D ceVUS in 19 out of 107 refluxing units (17.76%) diagnosed. The 4D technique enabled a more conspicuous visualization of vesicoureteral reflux than the 3D technique. Conclusions: 2D ceVUS and 3D/4D ceVUS diagnosed the same number of vesicoureteral refluxes, however, there was a statistically significant difference in grading between the two methods. Thus 3D/4D ceVUS appears at least a valid, if not even a more conspicuous technique compared to 2D ceVUS. [ABSTRACT FROM AUTHOR]

Aim: To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy. Materials and Methods: Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status. Results: At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one. Conclusions: The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction. [ABSTRACT FROM AUTHOR]

The prolapse of the pelvic organs is a pathologic condition that results from the deterioration of the support system of the pelvic organs. This system consists of pelvis structures which are organized on three levels of support whose deterioration cause apical and/or anterior and/or posterior compartment prolapse. The purpose of this article is to present the implications of different risk factors in the pathophysiology of pelvic floor disorders (PFD) on 103 women with symptomatic POP who have been operated with the surgical technique developed by Saba Nahedd. Our 103 cases have been examined and operated between 2013 and 2018. We have enrolled women aged between 31 and 81 years with symptomatic uterine prolapse grade I-IV and/or cystocele per magna and/or rectocele. All the 103 were preoperatively investigated through clinical examination, blood and urine test, colposcopy, cervical cytology (Pap Test), fractionated curettage, ultrasound and cystography. For all of the patients has been applied the surgical technique of attaching the uterine isthmus to the sheath of the rectus abdominis muscle using an isthmus strip. The results showed that surgical intervention in the pelvic area, traumatic deliveries with forceps application and menopause are associated with an increased risk of apical prolapse stage II, cystocele per magna and rectocele. Our study showed that conjunctive tissue is the central part of the integral theory developed by Petros who showed that destruction of the conjunctive tissues in the pelvic fascia and ligaments is responsible for the PFD. [ABSTRACT FROM AUTHOR]

Objective: To evaluate if follow-up cystography alters clinical management in patients after treatment of traumatic bladder ruptures.Methods: Patients with uncomplicated blunt trauma bladder ruptures between 2000 and 2014 were identified in our institutional trauma registry. Primary management strategies consisted of either cystorrhaphy or catheter drainage. Primary outcome analyzed was occurrence of positive follow-up cystogram. Secondary outcomes were use of follow-up cystography and time to negative cystogram.Results: One hundred forty patients were identified with a median follow-up of 6.2 months (interquartile range [IQR] 3.0-32.4). Eighty-two patients (58.6%) had extraperitoneal (EP) ruptures, 49 had intraperitoneal (IP) ruptures (35.0%), and 9 had combined EP/IP rupture (6.4%). Fifty-six EP patients were managed with catheter drainage, whereas all other patients underwent cystorrhaphy. Thirty-five cystorrhaphy patients (42%) had no imaging before catheter removal. Forty-nine patients (58%) had cystograms at a median of 15.0 days (IQR 10.0-22.0) after cystorrhaphy, with only 1 patient having a persistent leak. Forty-six catheter drainage EP patients (82%) had negative cystograms at a median of 19.0 days (IQR 15.0-33.0). Of the 10 patients with persistent extravasation, 7 required operations for related complications, whereas 3 had negative imaging at a median of 38.0 days (IQR 25.8-66.8), with a mean of 2.8 cystograms before a negative study.Conclusion: Follow-up cystography after cystorrhaphy for uncomplicated blunt trauma-associated bladder ruptures rarely, if ever, provides unanticipated clinical information. For catheter drainage EP patients, cystography remains clinically valuable, as at least 18% of patients will have signs of continued extravasation. The optimal timing of cystography and catheter removal remains unknown. [ABSTRACT FROM AUTHOR]