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This article, titled "Diagnostic insights and clinical outcomes of fetal urinary extravasation," presents a retrospective cohort study on cases of prenatal-diagnosed fetal urinary extravasation. The study identified seven cases out of approximately 1750 targeted scans for kidney and urinary tract anomalies, with a gender split of three males and four females. The cases had diverse pre- and postnatal clinical manifestations and outcomes, with some requiring surgical interventions and others being effectively managed conservatively. The article emphasizes the importance of prenatal diagnosis in revealing the underlying etiology and improving parental counseling regarding postnatal surgical intervention and renal outcome. [Extracted from the article]

Objectives: Evaluating the effectiveness and safety of repeated high-dose intradetrusor abobotulinumtoxin A (Dysport®) injections for the treatment of pediatric neurogenic bladders refractory to medications., Design: Retrospective interventional study., Participants: The cohort included 37 children (22 boys and 15 girls) of median age 9.2 years. Inclusion criteria were diagnosis of neurogenic bladder and failure to respond to medical treatment. Exclusion criteria were augmented bladder, insufficient data, and interval of > 11 months between video-urodynamic study and Dysport injection., Interventions: All participants were treated with an intra-detrusor injection of Dysport 30 IU/kg (up to 1000 IU) under general anesthesia. Repeated (second and third) injections were scheduled (6-12 months) in patients who demonstrated an improvement in cystometric parameters. All participants underwent video urodynamic testing before onset of treatment and 4-5 months after subsequent injection., Main Outcome Measures: Success of treatment was defined as a decrease in end filling pressure (EFP) to < 40 cm H 2 O and/or a 20% increase in maximal cystometric capacity (MCC). These parameters along with initial bladder features were evaluated for ability to predict treatment success., Results: No side effects of Dysport were observed or reported. The overall success rate was 62%. MCC increased by a median of 30% (IQR 200-300, p < 0.001), 37% (IQR 197-310, p = 0.001) and 45% (IQR 245-300, p = 0.025) after the first, second and third injections, respectively. Median EFP decreased from 45 cm H 2 O to 34 cm H 2 O (IQR 20-45, p = 0.029), 23 cm H 2 O (IQR 20-37, p = 0.004), and 20 cm H 2 O (IQR 12-32, p = 0.049) after the first, second, and third injections, respectively. No predicting factor of success of treatment were found; However, three of five cases of "end stage" bladder showed improvement., Conclusions: High-dose Dysport injection is safe and effective for the treatment of neurogenic bladder. Studies with larger cohort and a control group would further elucidate which bladders would benefit most. At present, we recommend treating also bladders with "end stage" features with botulinum toxin before considering augmentation., (© 2024 The Author(s). Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Objectives: To evaluate the effect of urethral catheterization on the accuracy of EMG uroflowmetry in children with non-neurogenic voiding disorders during pressure-flow (PF) studies compared to the non-invasive EMG uroflowmetry test., Methods: A retrospective study of children undergoing a urodynamic evaluation at our institution between 8/2018 and 7/2022 was employed. Urination curves and pelvic floor muscle activity were compared between PF studies and non-invasive EMG uroflowmetry test. The non-invasive test was selected as the standard benchmark., Results: 104 children were tested, with 34 children (33%) being able to urinate only in a non-invasive EMG uroflowmetry. The percentage of boys unable to urinate with a catheter was significantly higher than girls (54% vs. 13%, p-value < 0.001). In 70 children, a normal bell-shaped urination curve was found in 13 compared to 33 children in the PF studies and non-invasive uroflowmetry, respectively. PF studies demonstrated a specificity of 39% (95% CI 23-57) and a positive predictive value (PPV) of 61% (95% CI 53-67) in finding non-bell-shaped curves. Relaxation of pelvic muscles was found in 21 (30%) as opposed to 39 (55%) of children in invasive and non-invasive EMG uroflowmetry, respectively (p-value = 0.5)., Conclusion: The accuracy of PF studies in children, primarily in boys, compared to the non-invasive uroflowmetry, was poor. This may pose potential errors in diagnosis and subsequent treatment. We recommend completing a non-invasive EMG uroflowmetry in cases where the child refused to urinate, or pathology was found, requiring a modification in treatment., (© 2024. The Author(s).)

Background: Pediatric urolithiasis is relatively uncommon and is generally associated with predisposing anatomic or metabolic abnormalities. In the adult population, emergency department (ED) admissions have been associated with an increase in ambient temperature. The same association has not been evaluated in the pediatric population., Objectives: To analyze trends in ED admissions due to renal colic in a pediatric population (≤ 18 years old) and to assess the possible effect of climate on ED admissions., Methods: We conducted a retrospective, multicenter cohort study, based on a computerized database of all ED visits due to renal colic in pediatric patients. The study cohort presented with urolithiasis on imaging during their ED admission. Exact climate data was acquired through the Israeli Meteorological Service (IMS)., Results: Between January 2010 and December 2020, 609 patients, ≤ 18 years, were admitted to EDs in five medical centers with renal colic: 318 males (52%), 291 females (48%). The median age was 17 years (IQR 9-16). ED visits oscillated through the years, peaking in 2012 and 2018. A 6% downward trend in ED admissions was noted between 2010 and 2020. The number of ED admissions in the different seasons was 179 in autumn (30%), 134 in winter (22%), 152 in spring (25%), and 144 in summer (23%) (P = 0.8). Logistic regression multivariable analysis associated with ED visits did not find any correlation between climate parameters and ED admissions due to renal colic in the pediatric population., Conclusions: ED admissions oscillated during the period investigated and had a downward trend. Unlike in the adult population, rates of renal colic ED admissions in the pediatric population were not affected by seasonal changes or rise in maximum ambient temperature.

This study objective is to examine the intracavernosal pressure (ICP) in hypospadias boys with and without previous corporotomies. Retrospectively, the ICPs that were measured routinely as part of the artificial erection test in boys who underwent hypospadias repair were collected. The measurement (mmHg) included a slow manual saline instillation and a 21-gauge needle in the corpora cavernosa, which was connected to a pressure monitor. The full and rigid erections were defined according to the Erection Hardness Score by agreement between the two surgeons operating on the patient. Included were 61 boys with a median age of 15 months (IQR 8-27). Group A included 32 boys with coronal, subcoronal, or penile hypospadias. Group B included 29 boys with penoscrotal, scrotal, and perineal hypospadias. The median pressures at full erection for Groups A and B were 71.5 (IQR 59-79) and 62.5 (IQR 48-71) (p = 0.036), respectively, and at rigid erection were 283 (IQR 219-310) and 237 (IQR 182-278) (p = 0.032), respectively. In group B, median pressures at full erection for boys with and without previous corporotomies were 53.5 (IQR 45-65) and 69 (IQR 57-82), respectively (p = 0.001), and at rigid erection were 189.5 (IQR 113-263) and 264.5 (IQR 226-298), respectively (p = 0.003). In a comparison between group A boys to 18 boys in group B who did not have corporotomies, the median pressures at full erection were 71.5 (IQR 59-79) and 69 (IQR 57-82), respectively (p = 0.9), and at rigid erection were 283 (IQR 219-310) and 264 (IQR 226-298), respectively (p = 0.86). In conclusion, ICPs of artificial erections are lower in proximal hypospadias and in boys with previous corporotomies. The durability and the implications of these pressures require further research., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Many primary school children withhold urine and stool whilst at school for various reasons. Limited toilet access and the failure to provide safe, sanitary toilets are putting children at risk for toilet avoidance behavior., Objective: We aimed to examine personal hygiene, environmental conditions, the perception of these on children, and their toilet use in primary schools., Study Design: Children aged 6-12 and their parents were asked to complete a self-report questionnaire regarding toilet behavior and the perception of school toilet standards., Results: The main findings are listed below using the data from the questionnaire., Discussion: We found that 9% and 63% of the children avoided urination and defecating at school, respectively. Similar results were reported previously. The participants' perceptions regarding the environmental conditions of school toilets and conditions revealed that 34% of the children felt that the toilets were dirty or very dirty. Around one-third of them reported a lack of toilet paper sometimes or most of the time. These unsatisfying hygienic conditions of school toilets can be easily solved. Unfortunately, 46% of the children in our study experienced bullying in school toilets. These worrisome data are seldom reported in other studies. The urination habits of the girls, who mostly preferred to partially squat or stand may lead to dysfunctional voiding and incomplete bladder emptying. Our study was limited by the relatively small population, the subjectiveness of the self-reporting questionnaire, and the voiding and defecation habits of the investigated children during school hours. These hours do not necessarily reflect the children's habits after school hours and during the weekends. Despite these limitations, the discussed issues regarding personal hygiene and the environmental conditions in the sampled primary schools are extremely important., Conclusion: Nearly half of the school children had negative perceptions of school toilets. This should raise awareness and concern for school staff to consider and investigate potential facilities improvement in light of the impact observed here. Implementation of appropriate education and a better environment of toilet facilities and security is important for the children's well-being., Competing Interests: Conflicts of interest The authors declare that they have no conflicts of interest., (Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: Previous studies of pediatric urolithiasis have suggested possible associations between the relative proportions of calcium oxalate dihydrate (COD) and calcium oxalate monohydrate (COM) stones with age, gender, and ethnicity. This study aimed to investigate the composition and distribution of calcium oxalate (CaOx) stones according to these clinical factors and the metabolic correlates of the different subtypes in pediatric stone formers (PSFs). Patients and Methods: We retrospectively reviewed the database of all first-time stone formers between 2014 and 2019. Infrared spectrometry was used to determine stone composition. Stones were categorized by their highest relative component and reported as a percentage of occurrences in the cohort as a whole and by patient gender, age (divided into three age groups: 1-5, 6-12, and 13-18 years), and ethnicity. Clinical and metabolic correlates were analyzed. Results: Of 2479 consecutive stones submitted to our chemical stone laboratory, 220 first-time PSFs were identified. COD stones were the predominant subtype in the youngest group, and COM stones in the oldest group (odds ratio 0.39, 95% confidence interval: 0.18-0.86, p  = 0.036). In the intermediate-age group (6-12 years), COM stones were more prevalent in Arab boys, and COD stones in girls of either ethnicity. COD stones were associated with hypercalciuria ( p  < 0.0001), and COM stones with hyperoxaluria ( p  = 0.0024). Hypercalciuria and hypocitraturia were the most prevalent abnormalities at ages 1 to 5 and 13 to 18 years, respectively. Conclusions: Analysis of CaOx stone subtypes and their metabolic correlates in stone formers has significant clinical relevance, specifically in children. In the present study, COD stones and hypercalciuria were more common in younger children, and COM stones and hypocitraturia in adolescents. These findings suggest unique complex interactions driving stone formations in children that may guide a more practical, limited, and cost-effective approach to metabolic evaluations, choice of treatment, and preventive measures, particularly in first-time CaOx PSFs.

Xanthomonas hortorum pv. pelargonii is the causative agent of bacterial blight in geranium ornamental plants, the most threatening bacterial disease of this plant worldwide. Xanthomonas fragariae is the causative agent of angular leaf spot in strawberries, where it poses a significant threat to the strawberry industry. Both pathogens rely on the type III secretion system and the translocation of effector proteins into the plant cells for their pathogenicity. Effectidor is a freely available web server we have previously developed for the prediction of type III effectors in bacterial genomes. Following a complete genome sequencing and assembly of an Israeli isolate of Xanthomonas hortorum pv. pelargonii - strain 305, we used Effectidor to predict effector encoding genes both in this newly sequenced genome, and in X. fragariae strain Fap21, and validated its predictions experimentally. Four and two genes in X. hortorum and X. fragariae , respectively, contained an active translocation signal that allowed the translocation of the reporter AvrBs2 that induced the hypersensitive response in pepper leaves, and are thus considered validated novel effectors. These newly validated effectors are XopBB, XopBC, XopBD, XopBE, XopBF, and XopBG., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wagner, Ben-Meir, Teper and Pupko.)

Purpose: To examine the accuracy of cystography under general anesthesia in children with vesicoureteral reflux (VUR)., Materials and Methods: A prospective study of children who had VUR on cystography without general anesthesia (i.e., the gold-standard), and who are candidates for endoscopic VUR repair surgery. All children subsequently underwent a cystography under general anesthesia before injection using standardized method, which was compared to the gold-standard cystography. χ 2 and Mann-Whitney U tests were used to compare proportions and medians between groups., Results: Between 2017 and 2021, 126 renal units in 13 boys and 50 girls were included. Median age was 3.4 years (interquartile range [IQR] 1.5-6.5). Median time from cystography without to cystography with general anesthesia was 3.8 months (IQR 2.7-6). Of the 126 renal units, 96 had VUR on cystography without general anesthesia. On dichotomous analysis (no VUR vs. any VUR) sensitivity, specificity, negative and positive predictive values of cystography under general anesthesia were 47% (45/96), 87% (26/30), 34% (26/77) and 92% (45/49), respectively. Accuracy was 56.3%; Cohen's Kappa coefficient was 0.22, indicating poor agreement. In subgroup analysis, the sensitivity of cystography under general anesthesia was significantly lower in primary VUR (20% vs. 55% in secondary VUR, p = 0.01) and active VUR (14% vs. 52% in passive VUR, p = 0.008)., Conclusion: Cystography under general anesthesia was poorly correlated to cystography performed while the child was awake or lightly sedated. Clinical decision relying on this cystography is questionable., (© 2022 Wiley Periodicals LLC.)

Emerging viruses impose global threats to animal and human populations and may bear novel genes with limited homology to known sequences, necessitating the development of novel approaches to infer and test protein functions. This challenge is dramatically evident in tilapia lake virus (TiLV), an emerging "orthomyxo-like" virus that threatens the global tilapia aquaculture and food security of millions of people. The majority of TiLV proteins have no homology to known sequences, impeding functionality assessments. Using a novel bioinformatics approach, we predicted that TiLV's Protein 4 encodes the nucleoprotein, a factor essential for viral RNA replication. Multiple methodologies revealed the expected properties of orthomyxoviral nucleoproteins. A modified yeast three-hybrid assay detected Protein 4-RNA interactions, which were independent of the RNA sequence, and identified specific positively charged residues involved. Protein 4-RNA interactions were uncovered by R-DeeP and XRNAX methodologies. Immunoelectron microscopy found that multiple Protein 4 copies localized along enriched ribonucleoproteins. TiLV RNA from cells and virions coimmunoprecipitated with Protein 4. Immunofluorescence microscopy detected Protein 4 in the cytoplasm and nuclei, and nuclear Protein 4 increased upon CRM1 inhibition, suggesting CRM1-dependent nuclear export of TiLV RNA. Together, these data reveal TiLV's nucleoprotein and highlight the ability to infer protein functionality, including novel RNA-binding proteins, in emerging pathogens. These are important in light of the expected discovery of many unknown viruses and the zoonotic potential of such pathogens. IMPORTANCE Tilapia is an important source of dietary protein, especially in developing countries. Massive losses of tilapia were identified worldwide, risking the food security of millions of people. Tilapia lake virus (TiLV) is an emerging pathogen responsible for these disease outbreaks. TiLV's genome encodes 10 major proteins, 9 of which show no homology to other known viral or cellular proteins, hindering functionality assessment of these proteins. Here, we describe a novel bioinformatics approach to infer the functionality of TiLV proteins, which predicted Protein 4 as the nucleoprotein, a factor essential for viral RNA replication. We provided experimental support for this prediction by applying multiple molecular, biochemical, and imaging approaches. Overall, we illustrate a strategy for functional analyses in viral discovery. The strategy is important in light of the expected discovery of many unknown viruses and the zoonotic potential of such pathogens.

Objectives: To examine correlations of the modified Bosniak categories assigned by radiologists to histological results and inter-rater reliability, focusing on intermediate-risk lesions., Materials and Methods: The data of pediatric patients who underwent surgery for intermediate-risk complex renal cyst at a tertiary medical center in 2006-2019 were collected retrospectively. Four pediatric radiologists from 2 different medical centers reviewed the available imaging scans, and assigned each to one of the four modified Bosniak classification categories. Binary cohorts of the Bosniak categories (I-II vs III-IV) were compared to the histological results. Diagnostic accuracy (benign- vs intermediate-risk lesion) was calculated for each radiologist and for each imaging modality. Krippendorff's α test was used to measure inter-rater reliability., Results: The cohort included seven children, each with 1 complex cyst that was rated as intermediate-risk on pathological study. The median age was 1.5 years (IQR 1, 11.9). A correct classification was made in 41/56 imaging readings (sensitivity 73.2%). Applying Krippendorff's test to the binary Bosniak cohorts yielded poor inter-rater agreement (α = 0.08)., Conclusion: Implementation of the modified Bosniak classification in children caused a disconcerting underestimation of intermediate risk. There was a low inter-rater consistency for the categories intended to guide decisions regarding surgery or conservative management. The findings suggest that clinicians should be cautious using the modified Bosniak system for children., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Degradation of intracellular proteins in Gram-negative bacteria regulates various cellular processes and serves as a quality control mechanism by eliminating damaged proteins. To understand what causes the proteolytic machinery of the cell to degrade some proteins while sparing others, we employed a quantitative pulsed-SILAC (stable isotope labeling with amino acids in cell culture) method followed by mass spectrometry analysis to determine the half-lives for the proteome of exponentially growing Escherichia coli , under standard conditions. We developed a likelihood-based statistical test to find actively degraded proteins and identified dozens of fast-degrading novel proteins. Finally, we used structural, physicochemical, and protein-protein interaction network descriptors to train a machine learning classifier to discriminate fast-degrading proteins from the rest of the proteome, achieving an area under the receiver operating characteristic curve (AUC) of 0.72. IMPORTANCE Bacteria use protein degradation to control proliferation, dispose of misfolded proteins, and adapt to physiological and environmental shifts, but the factors that dictate which proteins are prone to degradation are mostly unknown. In this study, we have used a combined computational-experimental approach to explore protein degradation in E. coli We discovered that the proteome of E. coli is composed of three protein populations that are distinct in terms of stability and functionality, and we show that fast-degrading proteins can be identified using a combination of various protein properties. Our findings expand the understanding of protein degradation in bacteria and have implications for protein engineering. Moreover, as rapidly degraded proteins may play an important role in pathogenesis, our findings may help to identify new potential antibacterial drug targets., (Copyright © 2021 Nagar et al.)

As far as we know this is the first report on bulking agent injection into intravesical ectopic ejaculatory orifices reported in the English literature. During a follow-up period of 23 months, the child was free of episodes of epididymo-orchitis. Deflux injection in this rare anomaly of intravesical refluxing ducts had prevented irreversible damage to the testes from recurrent EO. Thus, it may be a better option than vasectomy when antibiotic treatment fails., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Anterior urethral anomalies (AUA) which present as anterior urethral valve, stenosis or atresia, are a rare cause for congenital urinary tract obstruction. We present our AUA prenatal diagnosis case series., Methods: Fetuses presenting with prenatal findings suggestive for AUA according to postnatal reported clinical and imaging signs (urinary tract dilatation, dilated bladder, enlarged edematous fetal penis, dilatation of the fetal urethra and diverticula) were followed prospectively., Results: Six fetuses were diagnosed with AUA. Diagnosis was confirmed upon examination of the neonate or the abortus. All cases presented with variable degrees of urinary tract dilatation. Four fetuses who presented with additional congenital anomalies of the kidneys and urinary tract (CAKUT) developed intra-uterine or early postnatal renal failure, while two isolated AUA cases have a normal renal outcome., Conclusions: AUA is a rare diagnosis. However, high index of suspicion and careful sonographic assessment of the male fetal urethra in cases referred for urinary tract dilatation may enable appropriate parent counseling, optimal prenatal surveillance and timed postnatal urological intervention. As in other lower urinary tract obstructions, future renal function seems to correlate with associated CAKUT, therefore close follow up throughout pregnancy and meticulous sonographic assessment is recommended., (© 2019 John Wiley & Sons, Ltd.)

Background: Guidelines for bladder augmentation (BA) in kidney transplantation (KT) recipients are not well-defined. In our center, simultaneous BA with KT (BA-KT) is performed. We assessed transplantation outcomes of this unique extensive procedure., Methods: A case-control single center retrospective study. Transplantation outcomes were compared with those of KT recipients who did not need BA., Results: Compared with 22 patients who underwent KT only, for 9 who underwent BA-KT, surgical complications and the need for revision in the early posttransplantation period were similar; early graft function was better: estimated glomerular filtration rate, 96.5 ± 17.1 versus 79.4 ± 16.6 mL/min at 0 to 6 months (P = 0.02); posttransplantation clean intermittent catheterization was more often needed: by 78% (7/9) versus 13% (3/22); and asymptomatic bacteriuria was more common: 100% versus 9% during the first 6 months (P < 0.001), 55% versus 9% (P = 0.02) and 66.6% versus 9% during the first and second years, respectively (P = 0.004). Urinary tract infection (UTI) incidence was also higher: 100% versus 23% during the first 6 months and 44% versus 9% during the second year posttransplantation. Graft function deteriorated significantly in the BA-KT group by the fifth posttransplantation year: estimated glomerular filtration rate was 47.7 ± 39.7 mL/min versus 69 ± 21.3 mL/min, with only 6 (66%) of 9 functioning grafts versus 100% in the KT only group. Causes of graft loss were noncompliance with drug therapy in 2 patients and recurrent UTIs in 2 patients., Conclusions: Excellent short-term outcome for simultaneous BA-KT is threatened by graft loss due to a high prevalence of UTIs and patient noncompliance with the demanding complex posttransplantation therapy.

Objective: To assess the postpubertal outcome of ventral penile curvature repaired in infancy in terms of recurrence and aesthetics., Materials and Methods: Postpubertal patients treated for hypospadias and ventral penile curvature in infancy at a tertiary medical center were invited to undergo assessment of the quality of the repair. Findings were compared between patients with a straight penis after skin release and patients who required dorsal plication., Results: The cohort included 27 patients of mean age 16.5 years who were reported with straight penis after surgery. Postpubertal curvature was found in 6 of 14 patients (43%) successfully treated by skin release and 10 of 13 patients (77%) who underwent dorsal plication (P = .087). Significant curvature (≥30 degrees) was found in 1 of 14 patients in the skin-release group and 4 of 13 in the dorsal plication group (P = .16). Rates of redo urethroplasty were 2 of 14 (14%) and 5 of 10 (50%), respectively. Patient satisfaction with the appearance of the penis did not differ significantly., Conclusion: Ventral penile curvature repaired in infancy often recurs after puberty. The need for dorsal plication has a trend-level association with recurrence of penile curvature in puberty. It might also be related to the degree of postpubertal penile curvature and the need for redo urethroplasty. Procedure type does not affect patient satisfaction with the postpubertal appearance of the penis., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To report the characteristics, treatment, and short-term outcome of neonatal post-circumcision bleeding, and to identify predictors of surgical treatment., Materials and Methods: The medical records of 90 consecutive neonates who presented to the emergency room with post-circumcision bleeding between 2009 and 2014 were reviewed. Circumcisions were performed using the traditional Mogen shield device. The study end point was surgical intervention for hemostasis. Predictors of surgical treatment were evaluated., Results: An estimated total of 28,383 circumcisions were performed during the study period; thus, the post-circumcision bleeding rate was 0.32%. Initial treatment included compressive dressing in 15 infants (17%) and hemostatic dressing in 47 infants (52%); 28 infants (31%) did not require treatment upon arrival to the emergency room. Two infants (2%) received blood transfusion. Surgical treatment was required in 11 infants (12%); 10 of 43 infants (23%) with active bleeding on arrival to the emergency room required surgery compared to 1 of 47 infants (2%) without active bleeding (P = .003). Similarly, 3 of 7 infants (43%) referred from other hospitals required surgery compared to 8 of 83 infants (10%) referred from the community (P = .037). Abnormal blood tests at presentation were not associated with surgical treatment. At 1 month of follow-up, 2 infants were admitted for recurrent bleeding. Coagulation abnormalities were found in 4 infants., Conclusion: Surgical treatment was required in 12% of infants presenting to the emergency room with post-circumcision bleeding. The rate of surgical intervention was significantly higher in infants with active bleeding at presentation and in those referred from other hospitals. Physicians should consider admitting infants presenting with active post-circumcision bleeding, whereas infants without active bleeding may be observed and discharged., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To describe the incidence of missed diagnosis and delayed presentation in children with testicular torsion, and to identify associated risk factors., Materials and Methods: The medical records of all children over 1 month of age diagnosed with testicular torsion between 2008 and 2014 were reviewed. Data pertaining to patient characteristics and treatment outcome were collected. Orchiectomy was categorized as caused by either delayed presentation or missed diagnosis. Logistic regression analyses were used to evaluate the association between patient characteristics and treatment outcome., Results: The study cohort included 100 children, 40 of whom underwent orchiectomy. Twenty-eight patients arrived with delayed presentation, and 12 were incorrectly diagnosed. On univariable logistic regression analyses, young age, long duration of pain, and prior community clinic examination were significantly associated with orchiectomy. Similarly, these variables were associated with delayed presentation and missed diagnosis when compared with the orchiopexy group. On multivariable analysis, young age and long duration of pain remained significant predictors of orchiectomy. Doppler ultrasound was performed in 70 patients; 7 of 70 ultrasounds were incorrectly diagnosed. Young age was associated with missed sonographic diagnosis, whereas ultrasound performer (senior radiologist vs resident) and time of the day were not., Conclusion: Missed diagnosis may account for up to 12% of orchiectomy cases. Younger age and prior community clinic examination increase the risk of incorrect diagnosis. Doppler ultrasound should be used with discretion and its results interpreted cautiously., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To characterize patients who develop late obstruction after subureteral injection of bulking agent for the treatment of pediatric vesicoureteral reflux (VUR)., Methods: We retrospectively evaluated the medical records of all patients who underwent endoscopic injection for the correction of VUR during 2008-2015 in 2 centers in Israel: Bnai-Zion Medical Center, Haifa, and Schneider Children's Medical Center, Petah Tikva. Nine patients who developed late-onset obstruction were included in the study, and their data were reviewed and analyzed., Results: Three boys and 6 girls with mean age of 3 years were included in the study. All patients had moderate-to-high grade VUR. Following injection, all children had a radiographic evidence showing resolution of the reflux. During follow-up, patients were diagnosed with late obstruction in a mean time of 13.4 months. All patients underwent open re-implantation., Conclusion: Late-onset obstruction may develop in patients treated with subureteral injection for VUR. Patients with high grade reflux and dilated ureters are at risk of late obstruction. Long-term follow-up with ultrasound is mandatory following endoscopic treatment of VUR., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Studies in the past have shown that children with spinal dysraphism have highly prevalent latex allergy. These children have a spectrum of congenital spinal anomalies, caused by defects in neural tube closure, with an incidence of 1 in 1000 births. Proposed risk factors for latex allergy include multiple surgeries since birth, including an insertion of a ventriculoperitoneal shunt, elevated IgE titers, repeat multiple catheterizations, and atopy. In the 1990 s, studies published in the United States and Europe showed a latex allergy prevalence of over 70% in these patients. On the other hand, studies published years later in other countries showed a declining prevalence of no more than 17%., Objective: Our goal was to prospectively assess the prevalence of latex allergy in children with spinal dysraphism in our non-latex free environment center compared with a control group., Study Design: The study group included 58 children with spinal dysraphism attending our center between 2010 and 2013. Findings were compared to 65 children referred for evaluation of allergic diseases. The parents completed questionnaires assessing personal and familial history of allergic diseases. All children were tested for blood latex IgE-specific antibodies (IMMULITE 2000)., Results: The mean age was 120.9 (67.6) months in the study group and 129.5 (68.5) months in the control group (p = 0.27). The corresponding median number of surgical procedures was 2 (range 0-10) and 0 (range 0-4), and mean duration of clean intermittent catheterization was 52 (72.2) months in the study group. Positive IgE antibodies and clinical allergic reactions were low with very similar prevalence in both groups (Figure)., Discussion: Our results show considerable lower latex allergy and sensitization than studies published in the United States and Europe in the past, despite the fact that our center utilizes minimal avoidance measures for latex allergy. Study limitations include the relatively small number of patients in our single-center study. Moreover, our control group could not include normal volunteering healthy children due to institutional review board refusal., Conclusions: Children with spinal dysraphism in our center have a low prevalence of latex allergy. Possible explanations include low latex protein content gloves and catheters used worldwide, including our center, lower number of surgeries, or a disease associated propensity for latex sensitization with a geographically variable genetic association. More studies are needed to validate our conclusion that using minimal avoidance measures, without maintaining a strict latex free environment, seems sufficient to prevent clinical latex allergy, at least in the Mediterranean region., (Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Objective: To define prenatal sonographic predictors of ureteropelvic junction obstruction requiring postnatal pyeloplasty, in fetuses with isolated hydronephrosis., Methods: Retrospective data on prenatal sonographic parameters were compared between patients who had been diagnosed prenatally with hydronephrosis and either underwent postnatal pyeloplasty for ureteropelvic junction obstruction (n = 39) or were treated conservatively (n = 30)., Results: Significant differences between the surgically and conservatively treated patients were found for mean anterior-posterior renal diameter (22.8 ± 8.6 vs 14.2 ± 5.9 mm, respectively, p < 0.0001) and parenchymal thickness (5.9 ± 2.8 vs 8.1 ± 2.6 mm, p = 0.009). Anterior-posterior diameter >14 mm was the best single predictor of the need for surgery (area under the ROC curve, 0.817), with sensitivity 77%, specificity 69%, positive predictive value (PPV) 77% and negative predictive value (NPV) 69% (β = 1.17, 95%CI = 1.07-1.28, p < 0.001). Mean ratio of anterior-posterior diameter to parenchymal thickness was significantly higher in the postnatal pyeloplasty group (5.4 ± 4.5 vs 2.1 ± 1.4, p = 0.0001). A ratio >2.1 had a sensitivity of 87% and specificity of 65% for the need for surgery (area under the curve 0.822, PPV 79%, NPV 77%; β = 1.92, 95%CI = 1.16-3.17, p < 0.001)., Conclusion: In cases of prenatal isolated hydronephrosis, the pelvic anterior-posterior diameter and parenchymal thickness may predict the need for postnatal pyeloplasty. A ratio of >2.1 of pelvic anterior-posterior diameter to parenchymal thickness suggests ureteropelvic junction obstruction and supports the use of more intensive prenatal and postnatal surveillance., (© 2014 John Wiley & Sons, Ltd.)

Objective: To describe the causes and outcome of urinary retention in children and assess its prevalence by gender and age., Methods: The medical records of all children (aged <18 years) who presented to the emergency room with acute urinary retention from 2000 to 2012 were reviewed. Patients with postoperative urinary retention, a known neurologic disorder, and neonates were excluded. Data were collected on patient demographics and cause, treatment, and outcome of the urinary retention. Findings were evaluated and compared by age and gender., Results: The study group comprised 42 boys (75%) and 14 girls (25%). Median follow-up time was 25 months. Causes of urinary retention were mechanical obstruction in 14 patients (25%), infection or inflammation in 10 (18%), fecal impaction in 7 (13%), neurologic disorders in 6 (11%), gynecologic disorders in 4 (7%), and behavioral processes in 3 patients (5%); 12 patients (21%) were idiopathic. All patients with mechanical obstruction were boys, of whom 5 had a pelvic tumor. Age distribution was bimodal: 29% of the events occurred between ages 3 and 5 years, and 32%, between ages 10 and 13 years. Fifteen children underwent surgery. Three children required continuous catheterization during follow-up., Conclusion: Urinary retention in children is characterized by a variable etiology and bimodal age distribution. The high rate of severe underlying disease is noteworthy and should alert physicians to the importance of a prompt, comprehensive, primary evaluation of this patient population in a hospital setting to initiate appropriate treatment and avoid complications., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Protein phosphatase magnesium dependent 1A (PPM1A) has been implicated in fibrosis and skin wounding. We generated PPM1A knockout mice to study the role of PPM1A in the wound healing-inflammation-angiogenesis cross talk. The role of PPM1A in these processes was studied using the ocular alkali burn model system. In the injured cornea the absence of PPM1A led to enhanced inflammatory response, stromal keratocyte transactivation, fibrosis, increased p38 mitogen-activated protein kinase phosphorylation, elevated expression of transforming growth factor-β-related genes (including Acta2, TGF-β, Col1, MMP9, and VEGF) and subsequently to neovascularization. Augmented angiogenesis in the absence of PPM1A is a general process occurring in vivo in PPM1A knockout mice upon subcutaneous Matrigel injection and ex vivo in aortic ring Matrigel cultures. Using primary keratocyte cultures and various experimental approaches, we found that phospho-p38 is a favored PPM1A substrate and that by its dephosphorylation PPM1A participates in the regulation of the transforming growth factor-β signaling cascade, the hallmark of inflammation and the angiogenic process. On the whole, the studies presented here position PPM1A as a new player in the wound healing-inflammation-angiogenesis axis in mouse, reveal its crucial role in homeostasis on injury, and highlight its potential as a therapeutic mediator in pathologic conditions, such as inflammation and angiogenesis disorders, including cancer.

Objective: To review the characteristics and treatment outcome of testicular torsion in infants, aged 1 month to 1 year, and compare them with those seen in neonates., Methods: The study group included 30 patients aged younger than 1 year who were treated for testicular torsion at a tertiary pediatric medical center between 1993 and 2012. Medical records were retrospectively reviewed for clinical characteristics and treatment outcome. Findings were compared between patients who presented before age 1 month (neonate group, n = 17) or later (infant group, n = 13)., Results: The common clinical presentation in the neonate group was a solid, nontender scrotal mass apparent in 13 of 17 patients (76%). In the infant group, 11 of 13 patients (85%) presented with restlessness and 12 of 13 (92%) with a tender scrotal or inguinal mass. Torsion of an undescended testis was significantly more prevalent in infants, 7 of 13 (54%), than neonates, 1 of 17 (6%; P = .009). Although extravaginal torsion was documented in 5 of 6 neonates (83%), 8 of 9 infants (89%) had an intravaginal torsion (P = .011). Orchiectomy was performed in 14 of 17 neonates (82%) and 6 of 13 infants (46%; P = .056). Of the 29 patients with follow-up data, testicular salvage was documented in 1 of 17 neonates (6%) and 2 of 12 infants (17%), at a minimum follow-up of 5 months (P = .55)., Conclusion: Testicular torsion in the first year of life is a diverse condition. Although neonatal torsions were predominantly extravaginal, infantile torsions were mostly intravaginal, involving undescendent testes in more than half of the cases. Despite fewer orchiectomies performed on the infant group, testicular salvage rates in both groups were similarly low., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Oocyte maturation in mammals is a multiple-stage process that generates fertilizable oocytes. Ovarian oocytes are arrested at prophase of the first meiotic division characterized by the presence of a germinal vesicle. Towards ovulation, the oocytes resume meiosis and proceed to the second metaphase in a process known as maturation; they undergo nuclear and cytoplasmic changes that are accompanied by translation and degradation of mRNA. Protein phosphatase 1A, magnesium dependent, alpha isoform (PPM1A), which belongs to the metal-dependent serine/threonine protein phosphatase family, is highly conserved during evolution. PPM1A plays a significant role in many cellular functions such as cell cycle progression, apoptosis and cellular differentiation. It works through diverse signaling pathways, including p38 MAP kinase JNK and transforming growth factor beta (TGF-β). Herein we report that PPM1A is expressed in mouse oocytes and that its mRNA level rises during oocyte maturation. Using quantitative real-time polymerase chain reaction (qPCR) and western blot analysis, we found that PPM1A mRNA is synthesized at the beginning of the maturation process and remains elevated in the mature oocytes, promoting the accumulation of PPM1A protein. Since PPM1A function is mainly affected by its level, we propose that it might have an important role in oocyte maturation.

Purpose: We histologically investigated the cause of failed endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid injections in children., Materials and Methods: A total of 192 children underwent dextranomer/hyaluronic acid injection at our institution between January 2008 and September 2010. The study population consisted of 13 children (22 ureters) with vesicoureteral reflux who underwent ureteroneocystostomy following failed endoscopic injections (1 to 2) of dextranomer/hyaluronic acid. In all cases the dextranomer/hyaluronic acid was implanted in the mucosa of the mid to distal ureteral tunnel following hydrodistention of the ureter. The medical records were reviewed, and specimens of the archived distal ureters removed during surgery were examined histologically., Results: Mean patient age was 4.1 years. Mean dose of dextranomer/hyaluronic acid was 0.9 ml (both treatments) and mean lag between treatments was 13.4 months. Indications for open surgery were recurrent urinary tract infections and/or residual or aggravated reflux grade IV or higher. Histological study revealed that the dextranomer/hyaluronic acid was malpositioned in 21 of 22 ureters, residing in the muscle fibers in 2, adventitia in 14 and periureteral space in 5., Conclusions: This is the first known study to provide a histologically proved cause of failure of endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid injections in children. Malpositioning of the material outside the submucosal ureter was identified in a high percentage of cases. Larger studies are needed to corroborate these findings., (Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)