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Introduction Neonates with lower urinary tract obstruction (LUTO) experience high morbidity and mortality associated with the development of chronic kidney disease. The prenatal detection rate for LUTO is less than 50%, with late or missed diagnosis leading to delayed management and long-term sequelae in the remainder. We aimed to explore the trends in prenatal detection and management at a high-risk fetal center and determine if similar trends of postnatal presentations were noted for the same period. Methods Prenatal and postnatal LUTO databases from a tertiary fetal center and its associated pediatric center between 2009 and 2021 were reviewed, capturing maternal age, gestational age (GA) at diagnosis, and rates of termination of pregnancy (TOP). Time series analysis using autocorrelation was performed to investigate time trend changes for prenatally suspected and postnatally confirmed LUTO cases. Results A total of 161 fetuses with prenatally suspected LUTO were identified, including 78 terminations. No significant time trend was found when evaluating the correlation between time periods, prenatal suspicion, and postnatal confirmation of LUTO cases (Durbin–Watson [DW] = 1.99, p = 0.3641 and DW = 2.86, p = 0.9113, respectively). GA at referral was 20.0 weeks (interquartile range [IQR] 12, 35) and 22.0 weeks (IQR 13, 37) for TOP and continued pregnancies (p < 0.0001). GA at initial ultrasound was earlier in terminated fetuses compared to continued (20.0 [IQR 12, 35] weeks vs. 22.5 [IQR 13, 39] weeks, p < 0.0001). While prenatal LUTO suspicion remained consistently higher than postnatal presentations, the rates of postnatal presentations and terminations remained stable during the study years (p = 0.7913 and 0.2338), as were GA at TOP and maternal age at diagnosis (p = 0.1710 and 0.1921). Conclusion This study demonstrated that more severe cases of LUTO are referred earlier and are more likely to undergo TOP. No significant trend was detected between time and prenatally suspected or postnatally confirmed LUTO, highlighting the need for further studies to better delineate factors that can increase prenatal detection. [ABSTRACT FROM AUTHOR]

Introduction: A nomogram for predicting the diagnosis of lower urinary tract obstruction (LUTO) based on an antenatal ultrasound index generated from a Bayesian Meta‐regression analysis has been in development and noted with superior diagnostic accuracy compared to the keyhole sign (KHS). We aim to assess the accuracy of the nomogram in expanded diagnostic utilization to predict LUTO. Methodology: The validation of the nomogram for expanded diagnostic utilization was based on data from a prospective institutional antenatal clinic database between January 2020 and June 2022. Diagnostic accuracy indices were determined for confirmed postnatal diagnosis of LUTO or prune belly syndrome (PBS). Receiver operating characteristics (ROC) curves were generated to compare the area under the curve (AUC) of the nomogram versus KHS. Results: Based on 84 male fetuses with antenatal ultrasound of moderate‐severe hydronephrosis (PUV n = 15, PBS n = 4), the KHS had 26.3% (95%CI 9.1–51.2) sensitivity and 100% (95%CI 94.4%–100%) specificity, with 14 false‐negatives. The nomogram showed a 84.2 (95%CI 60.4%–96.6%) sensitivity and 95.4 (95%CI 87.1%–99%) specificity with three false‐positives. The nomogram also had a superior AUC compared to KHS (0.98 vs. 0.63). Conclusion: The nomogram can be used as a valuable tool to trigger further postnatal screening and provide individualized risk assessments to families during prenatal counseling. Key points: What's already known about the topic?When fetuses with LUTO do not exhibit all of the classic prenatal ultrasound features, the diagnosis is often missed, resulting in infants being born outside high‐risk fetal centers. There are serious implications including early presentation in the neonatal period with infections and urosepsis and already compromised kidney function What does this study add?This work reports a tool for the early, and accurate prediction of LUTO using fetal ultrasound features. This nomogram allows for personalized risk stratification based on individual ultrasound features, which will improve the long‐term outcomes of children with LUTO [ABSTRACT FROM AUTHOR]

INTRODUCTION: This meta-analysis aimed to determine the comparative effectiveness of timed alarm device-assisted urotherapy vs. standard urotherapy alone in managing pediatric daytime urinary incontinence (pDUI). METHODS: A systematic literature search was performed in December 2021, with an update search in July 2022. Comparative studies assessing the pDUI treatment effectiveness of timed alarm device-assisted urotherapy vs. urotherapy alone were identified and evaluated according to Cochrane collaboration recommendations. The assessed outcome includes pDUI complete response and adherence rates. Relative risk (RR) with 95% confidence intervals (CI) was extrapolated. A random-effects model was used to pool effect estimates. Heterogeneity was assessed with sensitivity and subgroup analysis performed according to study design and comparative group characteristics. GRADE criteria were used to assess evidence certainty. (PROSPERO CRD42022299173). RESULTS: Four studies (three randomized controlled trials [RCTs] and one retrospective cohort) with 635 cases were included. The pooled effect estimates of pDUI complete response showed no differences between intervention groups (RR 1.20, 95% CI 0.81, 1.76). Pooled effect estimates for treatment adherence were generated from two studies, which showed significantly better adherence for the timed-alarm device group (RR 2.97, 95% CI 1.46, 6.06). Significant interstudy heterogeneity was noted; the source is likely from the study design and comparator device characteristics. The quality of evidence was assessed to be of very low certainty. CONCLUSIONS: Based on very low certainty evidence, timed alarm device-assisted urotherapy does not seem to have the advantage of complete treatment response over standard urotherapy alone in managing pDUI; however, a timed-alarm device is likely able to improve urotherapy treatment adherence. [ABSTRACT FROM AUTHOR]

Objective: To determine long-term kidney outcomes in boys with posterior urethral valve (PUV) undergoing either primary valve ablation or urinary diversion with matched baseline kidney function.Methods: After retrospective review of patients managed for PUV at our institution, propensity score matched analysis was conducted using nadir serum creatinine with logistic regression analysis. Nearest neighbor matching was used to allocate boys to primary urinary diversion and primary ablation groups. Primary outcomes included kidney function by creatinine or estimated glomerular filtration rate (eGFR), chronic kidney disease (CKD), and end-stage renal disease (ESRD). Comparative statistics by odds ratio (OR) and hazard ratios (HR) on survival analysis were calculated.Results: A total of 21 boys undergoing primary diversion were matched with 42 boys undergoing ablation using nadir serum creatinine and follow-up time with a median follow-up of 4.8 years. After matching, there was no significant difference in last follow-up kidney function by creatinine (p=0.99) or eGFR (p=0.98). Primary diversion was not associated with increased likelihood of developing CKD stage 3 (OR 1.33; p=0.31) or ESRD (OR 1.88; p=0.35 and HR 1.85; p=0.30) compared to primary ablation.Conclusions: Our propensity matched study suggests that long-term kidney function and kidney outcomes are similar between primary ablation and primary diversion after adjusting for baseline kidney function in boys with PUV. [ABSTRACT FROM AUTHOR]

Introduction: Refractory bladder and bowel dysfunction (BBD) significantly affects the health and quality of life of children and their caregivers, emphasizing the need for effective and minimally invasive treatments. This study aims to present the inaugural Canadian experience using sacral neuromodulation (SNM ) as a therapeutic option for children with refractory BBD., Methods: Patients <18 years old with refractory BBD were prospectively followed from 2018 to the present. Preoperative evaluation included spinal MRI and video urodynamics. Two-stage SNM implantation was executed with a minimum two-week stage 1 trial. Functional outcomes and complication rates were measured following validated questionnaires., Results: Six patients completed staged implantation at a median age of 10.8 years (range 8.2-18). The median baseline Dysfunctional Voiding Scoring System (DVSS) score was 12.5 (10-22). At six months of followup, only one patient required adjunct bladder medication. Median DVSS at one-year followup was 5.5 (0-7). Symptomatic resolution was noted in three patients at six months, sustained over one year. Early surgical complications were reported in one (infection) and late complications in three (lead fracture, battery depletion, non-traumatic malfunction), requiring reimplantation at a median of 37.5 (1-49) months. Post-SNM reimplantation, oral medication and rectal therapy decreased, and DVSS scores improved by 30% (0-63.6) at six months., Conclusions: SNM is feasible and offers promising results for refractory pediatric BBD in Canada. The significant improvement of symptoms highlights the treatment's potential, which must be balanced against the high need for revision detected at three years, possibly related to patients' growth and high activity level.