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Objective·To explore the predictive value of diuretic renal scintigraphy parameters such as 20-minute residual rate (R20) for pyeloplasty in children with congenital unilateral ureteropelvic junction obstruction (UPJO).Methods·The clinical data and diuretic renal scintigraphy results of 110 children with congenital unilateral UPJO who were first treated at the Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from August 2018 to August 2023 were retrospectively analyzed. The imaging results and the progress of hydronephrosis were followed up after the first diuretic renal scintigraphy. According to the outcome event of pyeloplasty due to the progression of hydronephrosis, the children were divided into operation group and non-operation group. Age, gender, side of hydronephrosis, and baseline diuretic renal scintigraphy parameters including blood perfusion rate (BPR), differential renal function (DRF), time to peak (Tmax), time to half (T1/2) and R20 were compared between the two groups. Logistic regression was used to analyze the effect of various parameters on the progression of hydronephrosis. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of diuretic renal scintigraphy parameters for surgical intervention. Wilcoxon test was used to compare the examination parameters of two diuretic renal dynamic imaging.Results·During the follow-up, 60 children underwent pyeloplasty after progression, and the other 50 children did not progress. The differences in DRF, Tmax, T1/2 and R20 between the two groups of children at baseline were statistically significant (all P0.05).Conclusion·R20 plays an important role in the prediction of pyeloplasty in children with congenital unilateral UPJO. For children with R20≥90.08%, pyeloplasty should be performed as soon as possible to prevent further deterioration of renal function.

Introduction: Etiopathogenesis and the symptomatology of ureteropelvic junction obstruction (UPJO) in the pediatric population has not yet been definitely clarified, suggesting a multifactorial nature of the condition. The aim was to analyze the association between the number of Interstitial Cells of Cajal (ICCs), as well as P2X3 receptors in ureteropelvic junction (UPJ) and the pain response in pediatric patients with hydronephrosis. Methods: 50 patients with congenital hydronephrosis underwent open or laparoscopic pyeloplasty at one of two departments of pediatric surgery and urology in Poland. Patients were divided into two groups according to the pain symptoms before surgery. A total of 50 samples of UPJ were obtained intraoperatively and underwent histopathological and immunohistochemical (IHC) analysis. Quantitative assessment of ICCs was based on the number of CD117(+) cells of adequate morphology in the subepithelial layer and the muscularis propria. Expression of P2X3 receptors was evaluated as the intensity of IHC staining. Results: Patients with hydronephrosis and accompanying pain were on average 60 months older (77 vs. 17 months) than children with asymptomatic hydronephrosis (p = 0.017). Symptomatic children revealed higher numbers of ICCs in both the subepithelial layer and in the lamina muscularis propria. In particular, symptomatic patients aged 2 years or more exhibited significantly higher numbers of ICCs in the subepithelial layer. Significant differences in the distribution of ICCs between the subepithelial layer and the lamina muscularis propria were observed in both groups. Expression of P2X3 receptors was limited to the urothelium and the muscle layer and correlated between these structures. There was no relationship between pain response and the expression of P2X3 receptors. Conclusions: ICCs and P2X3 receptors may participate in the pathogenesis of UPJO and in the modulation of pain response to a dilatation of the pyelocaliceal system. Explanation of the role of ICCs and P2X3 receptors in propagation of ureteral peristaltic wave and the modulation of pain stimuli requires further studies. [ABSTRACT FROM AUTHOR]

Purpose: To determine if children with UPJO demonstrate a clinically significant change in somatic growth following pyeloplasty. Methods: We retrospectively evaluated the growth chart data of infants with SFU grade 3 or 4 congenital hydronephrosis at our institution from 2015 to 2022. Of those, 35 patients underwent pyeloplasty and 66 had no surgical intervention. Patients met criteria if they had SFU 3 or 4 hydronephrosis and MAG3 renal scan. If patients underwent surgery, height and weight percentiles were recorded from the pre-op and 6–16-month follow-up visits. In non-surgery patients, measurements were taken near the median age of surgery in the intervention group and 6–16 months later. Interval changes in group height and weight percentiles are compared for significant changes. Results: The surgery and non-surgery groups did not differ in terms of gender (71% vs 74% Male), starting age (296 vs 244 days), starting weight (58th vs 52nd percentile), or time between measurements (255 vs 260 days), though the surgery group had significantly less height in the pre-operative period (43rd vs 55th percentile, p = 0.050) and were more likely to have delayed drainage on renal scan (83% w/delay vs 35%). The surgery group showed a significant increase in height (18.9 percentiles; 95% CI 11–27) and weight (6.0 percentiles; 95% CI 0.50–12) after intervention. Conclusions: Patients with congenital hydronephrosis due to UPJO that underwent pyeloplasty showed a significant increase in weight and height at 6–16 months postoperatively compared to those that were managed with close observation. This suggests UPJO might lead to growth delay in infants. [ABSTRACT FROM AUTHOR]

ObjectivesThis research aims to analyze how exposure to fine particulate matter (PM2.5) and ambient heat during pregnancy increases the risk of congenital hydronephrosis (CH) in newborns.MethodsA case–control study was conducted to investigate the relationship between exposure to PM2.5 and ambient heat during pregnancy and the occurrence of CH in newborns. The study, which was conducted from 2015 to 2020, included 409 infants with CH as the case group and 409 infants without any abnormalities as the control group. Using spatial remote sensing technology, the exposure of each pregnant mother to PM2.5 concentration was meticulously mapped. Additionally, data on the ambient temperature of exposure for each participant were also collected. A logistics regression model was used to calculate the influence of exposure to PM2.5 and ambient heat on the occurrence of CH. Stratified analysis and interaction analysis were used to study the interaction between ambient heat exposure and PM2.5 on the occurrence of CH.ResultsAt the 6th week of gestation, exposure to PM2.5 may increase the risk of CH. For every 10 μg/m3 increase in PM2.5 exposure, the risk of CH increased by 2% (95%CI = 0.98, 1.05) at a p-value of >0.05, indicating that there was no significant relationship between the results. Exposure to intense heat at 6th and 7th weeks of gestation increased the risk of CH. Specifically, for every 1°C increase in heat exposure, the risk of CH in offspring increased by 21% (95%CI = 1.04, 1.41) during the 6th week and 13% during the 7th week (95%CI = 1.02, 1.24). At 5th and 6th weeks of gestation, the relative excess risk due to interaction (RERI) was greater than 0 at the 50th percentile (22.58°C), 75th percentile (27.25°C), and 90th percentile (29.13°C) of daily maximum temperature (Tmax) distribution, indicating that the risk of CH was higher when exposed to both ambient heat and PM2.5 at the same time compared to exposure to a single risk factor.ConclusionExposure to higher levels of PM2.5 and ambient heat during pregnancy increases the risk of CH in infants. There was a positive interaction between exposure to intense heat and high concentration of PM2.5 on the occurrence of CH.

Background: Robotics has been used safely and successfully in a variety of adult surgeries and is gradually gaining ground in pediatrics. While the benefits of robotic-assisted surgery in disease treatment are well recognized, its high cost has led to questions. To investigate whether robotic-assisted laparoscopic surgery (RALS) is cost-effective compared to conventional laparoscopic surgery (LS) in pediatric surgery, we attempted to construct a model to perform an analysis of these two surgical approaches using Python statistical analysis software. Methods: We selected four common complex pediatric surgical conditions (choledochal cyst, Hirschsprung's disease, vesicoureteral reflux, and congenital hydronephrosis) from three systems (pediatric hepatobiliary, gastroenterology, and urology). Models were constructed using Python statistical software to compare hospital costs and surgical outcomes for RALS and LS. In addition, we performed a preferred strategy analysis for both surgical modalities while assessing model uncertainty using one-way sensitivity analysis. Results: For the four diseases, the operative time decreased sequentially. The total inpatient costs of RALS were 10,816.72, 9145.44, 8414.29, 7973.58 dollars, respectively, yielding 1.789, 1.712, 1.749, 1.792 quality adjustment life years (QALYs) over two years post-operatively. The incremental cost of RALS relative to LS for each disease was 3523.44, 3200.20, 3049.79, 3043.66 dollars, respectively, with an incremental utility of 0.060, 0.054, 0.051, 0.050 QALYs. The incremental cost-effectiveness ratios (ICERs) for RALS for each of the four diseases were 58,724.01, 59,262.95, 59,799.79, 60,873.20 dollars/QALY, all less than 100,000 dollars/QALY. The cost of robot consumables was the main incremental cost of RALS and had the most significant impact on the model. Conclusion: For the four pediatric surgical conditions described above, RALS has higher inpatient costs than LS, but it has better postoperative outcomes, and all four RALS treatments are cost-effective. Children with complex diseases and long operative times appear to benefit more from RALS. [ABSTRACT FROM AUTHOR]

Introduction: Etiopathogenesis and the symptomatology of ureteropelvic junction obstruction (UPJO) in the pediatric population has not yet been definitely clarified, suggesting a multifactorial nature of the condition. The aim was to analyze the association between the number of Interstitial Cells of Cajal (ICCs), as well as P2X3 receptors in ureteropelvic junction (UPJ) and the pain response in pediatric patients with hydronephrosis. Methods: 50 patients with congenital hydronephrosis underwent open or laparoscopic pyeloplasty at one of two departments of pediatric surgery and urology in Poland. Patients were divided into two groups according to the pain symptoms before surgery. A total of 50 samples of UPJ were obtained intraoperatively and underwent histopathological and immunohistochemical (IHC) analysis. Quantitative assessment of ICCs was based on the number of CD117(+) cells of adequate morphology in the subepithelial layer and the muscularis propria. Expression of P2X3 receptors was evaluated as the intensity of IHC staining. Results: Patients with hydronephrosis and accompanying pain were on average 60 months older (77 vs. 17 months) than children with asymptomatic hydronephrosis (p = 0.017). Symptomatic children revealed higher numbers of ICCs in both the subepithelial layer and in the lamina muscularis propria. In particular, symptomatic patients aged 2 years or more exhibited significantly higher numbers of ICCs in the subepithelial layer. Significant differences in the distribution of ICCs between the subepithelial layer and the lamina muscularis propria were observed in both groups. Expression of P2X3 receptors was limited to the urothelium and the muscle layer and correlated between these structures. There was no relationship between pain response and the expression of P2X3 receptors. Conclusions: ICCs and P2X3 receptors may participate in the pathogenesis of UPJO and in the modulation of pain response to a dilatation of the pyelocaliceal system. Explanation of the role of ICCs and P2X3 receptors in propagation of ureteral peristaltic wave and the modulation of pain stimuli requires further studies.

Objective: To investigate the diagnostic value of urography combined with color Doppler in children with congenital hydronephrosis. Methods: A total of 88 children with congenital hydronephrosis treated in our hospital from November 2018 to November 2021 were selected as the study subjects. All children perfectintravenous pyelography and color Doppler ultrasonography, the pathological diagnostic result was used as the gold standard,and the diagnostic value of the two examination methods in children with congenital hydronephrosis was compared. Results: The results of color Doppler ultrasound showed that there were 10, 39 and 39 children with mild, moderate and severe hydronephrosis respectively. Compared with children with different degrees of illness, the peak systolic velocity (PSV） and minimum diastolic velocity (EDV） in the severe group were lower than those in the moderate and mild group, and the blood flow resistance index (RI） in the severe group was higher than those in the moderate and mild group (P＜0.05), but there was no significant difference in PSV, EDV and RI between mild group and moderate group (P＞0.05). Compared with pathological examination results, color Doppler ultrasonography has a high diagnostic performance for children with moderate and severe congenital hydronephrosis, with an accuracy of 90.91% and 93.18%, respectively, and the kappa values compared with pathological diagnosis were 0.795, 0.862, high concordance; but low diagnostic performance for mild hydronephrosis, with a kappa value of 0.629, the consistency is general.The diagnostic results of intravenous pyelography were mild hydronephrosis in 11 cases, moderate hydronephrosis in 37 cases, and severe hydronephrosis in 40 cases; it has high diagnostic efficiency for children with mild congenital hydronephrosis, with an accuracy of 96.59%, and the kappa value compared with pathological diagnosis was 0.824, which has a high consistency; but the diagnostic performance of moderate and severe hydronephrosis is low, and the kappa value distribution were 0.583 and 0.565, and the consistency is general. The diagnostic accuracy of color Doppler ultrasound combined with intravenous pyelography was 94.32%, which was significantly higher than that of the two methods alone (P＜0.05). Conclusion: Different degree of condition of children with congenital hydronephrosis with different ultrasonic signs, color Doppler ultrasound examination for medium and severe hydronephrosis in children with good diagnostic value,while intravenous pyelography is more effective in diagnosing children with mild hydronephrosis. The combination of the two can improve the diagnostic accuracy of congenital hydronephrosis. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic pyeloplasty is one of the most demanding laparoscopic surgical procedure. The reason is the necessity of precise tissue preparation, spatulation of the ureter, resection of the pelvis and suturing of the anastomosis of the pelvis and ureter with rigid laparoscopic instruments. Robotic systems provide us with significant help, their disadvantage is however, that they are not available at all workplaces. New to the market are robotic laparoscopic instruments that are more affordable, combining advantages of conventional laparoscopy and robotics. Case report: We present a robotic laparoscopic pyeloplasty in a 37-year-old patient with congenital hydronephrosis on the left side. The patient was primarily examined for renal colic, an acute non-contrast CT scan of the abdomen confirmed significant hydronephrosis, but no ureterolithiasis was found. The subsequent CT IVU examination confirmed a complex diagnosis of the collecting renal system: bilateral duplex pelvis, right ureter, left duplex ureter and hydronephrosis of the left lower moiety, likely caused by an aberrant vessel below the PU (pyeloureteral) junction. Dynamic renal scintigraphy showed cumulative retention of the radiopharmaceutical in the lower pole moietyof the left kidney, without response to diuretics in the monitored time with signs of obstruction in the PUJ (PU junction). The patient was indicated for laparoscopic pyeloplasty of the left lower moiety of the kidney. The operation was performed by a single surgeon with the assistance of Soloassist II robotic arm with voice control. For dissection, resection of the pelvis and spatulation of the ureter DEX scissors were used. To suture the posterior wall of the anastomosis of the ureter and pelvis we used Vycril 4.0 stitches, and for the anterior wall V-lock 4.0. To perform these continuous sutures we utilized the flexibility of the robotic DEX needleholder with seven degrees of freedom of movement. The ureteropelvic anastomosis was sutured over a DJ stent inserted retrogradely. The operation time was 140 minutes. The urinary catheter was removed on the 3rd postoperative day, the surgical drain a day after and the DJ-stent 6 weeks after the operation on an outpatient basis. Compared to the current robotic systems, both purchase and operating prices of the used robotised devices are many times lower. The purchase cost of the robotic laparoscopic system is 1.8 million Czech crowns (Kč) with the operating cost averaging 7,000 CZK per use of the instrument. While the purchase price for the Soloassist II robotic arm, depending on the equipment, is around 2 million Czech crowns (Kč). Conclusion: Robotic laparoscopy enables precision with the possibility of using seven degrees of freedom of movement, maintaining tactile feedback and ergonomics (comfort) of the surgeon during operation. After a short practice, even in the hands of a less experienced laparoscopist, these instruments can improve surgical results, can reduce perioperative complications and operative time. Low acquisition and operating costs ensure an interesting future for robotic laparoscopy. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to clarify the advantage of retroperitoneoscopy‐assisted dismembered pyeloplasty with single‐site plus one port (RPSPO) for pediatric congenital hydronephrosis in patients aged ≥7 years. Methods: We retrospectively compared a group of patients aged ≥7 years (study group) with patients aged <7 years (comparison group), who underwent RPSPO between August 2015 and August 2018, in terms of preoperative patient characteristics, intra‐ and perioperative results, and postoperative results. Results: The study group consisted of eight patients. The median body weight at surgery was 27 kg (20–38 kg). The median age at surgery was 102.5 m (87–139 m). The severity of hydronephrosis on the affected side graded by the Society for Fetal Urology grade was grade 3 in one case and grade 2 or less in all other cases. All patients underwent a 99mTc‐MAG3 renogram. Comparison between the two groups showed significant differences in body weight at surgery (p = 0.003), age (p < 0.001), and preoperative hydronephrosis grade (p = 0.007), but the median length of the skin incision was 20 mm in both groups, with no significant difference (p = 1.000). Redo pyeloplasty was not required in any patient in either group. Conclusion: RPSPO is an advantageous procedure for older children because it allows precise ureteropelvic neoanastomosis under direct vision and the same wound size as in younger children. [ABSTRACT FROM AUTHOR]

Currently, laparoscopic pyeloplasty is gaining popularity in pediatric urology due to less invasive compared to the open standard pyeloplasty. Nevertheless, there are basic “critical” remarks about this pyeloplasty technique in children, which involve some difficulties in comparing tissues and intracorporeal suturing due to the limited available space. In addition, a significant negative point of laparoscopic pyeloplasty is the duration of the operation, especially in the younger age group of children. Despite all the advantages associated with minimal invasiveness, there are alternative methods of surgical treatment, which show quite impressive results. In our practical work, we performed minimally invasive open pyeloplasty: with a miniature incision, in a child with ureteropelvic junction obstruction with a good result. In addition, this access provides a wide exposure of the ureteropelvic junction and easy tissue manipulation.

Objectives: This research aims to analyze how exposure to fine particulate matter (PM 2. 5) and ambient heat during pregnancy increases the risk of congenital hydronephrosis (CH) in newborns., Methods: A case-control study was conducted to investigate the relationship between exposure to PM 2.5 and ambient heat during pregnancy and the occurrence of CH in newborns. The study, which was conducted from 2015 to 2020, included 409 infants with CH as the case group and 409 infants without any abnormalities as the control group. Using spatial remote sensing technology, the exposure of each pregnant mother to PM 2.5 concentration was meticulously mapped. Additionally, data on the ambient temperature of exposure for each participant were also collected. A logistics regression model was used to calculate the influence of exposure to PM 2.5 and ambient heat on the occurrence of CH. Stratified analysis and interaction analysis were used to study the interaction between ambient heat exposure and PM 2.5 on the occurrence of CH., Results: At the 6th week of gestation, exposure to PM 2.5 may increase the risk of CH. For every 10 μg/m 3 increase in PM 2.5 exposure, the risk of CH increased by 2% (95%CI = 0.98, 1.05) at a p- value of >0.05, indicating that there was no significant relationship between the results. Exposure to intense heat at 6th and 7th weeks of gestation increased the risk of CH. Specifically, for every 1°C increase in heat exposure, the risk of CH in offspring increased by 21% (95%CI = 1.04, 1.41) during the 6th week and 13% during the 7th week (95%CI = 1.02, 1.24). At 5th and 6th weeks of gestation, the relative excess risk due to interaction (RERI) was greater than 0 at the 50th percentile (22.58°C), 75th percentile (27.25°C), and 90th percentile (29.13°C) of daily maximum temperature (Tmax) distribution, indicating that the risk of CH was higher when exposed to both ambient heat and PM 2.5 at the same time compared to exposure to a single risk factor., Conclusion: Exposure to higher levels of PM 2.5 and ambient heat during pregnancy increases the risk of CH in infants. There was a positive interaction between exposure to intense heat and high concentration of PM 2.5 on the occurrence of CH., 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 © 2024 Huang, Zhong, Shen, Gu, Chen, Xu, Chen, Wu and Yang.)

Objective: The aim of our study is to examine the spontaneous resolution rates of congenital hydronephrosis from a recent perspective. Material and Methods: Sixty-nine pediatric patients (M/F=46/23) with congenital hydronephrosis were enrolled in this study. Results: The mean age at the first postnatal examination was 10.8±7.6 days, and the mean age at the time of the final examination was 9.5±3.2 months. Forty-eight patients' renal anteroposterior diameters (APD) (69.5%) improved while 8 (11.6%) patients' APDs worsened during the follow-up period. However, MAG3 of these 8 patients was normal. The remaining thirteen (18.9%) patients had congenital anomalies of the kidney and the urinary tract (8 vesicoureteral reflux, 5 cases of ureteropelvic junction obstruction). The mean baseline APD was 9.1±2.8 mm in the group with reduced APD, and 9.7±2.8 mm in the one with increased APD (p=0.461). The mean APD at the final visit was significantly lower in the group with reduced APD than that in the group with increased APD (5.1±1.8 mm vs 17.9±12.6 mm; p=0.001). The anteroposterior diameter of 26 (81.25%) patients with left-sided hydronephrosis and 10 (71.4%) patients with rightsided hydronephrosis regressed spontaneously. The rate of spontaneous resolution was relatively low in patients with bilateral hydronephrosis (n=13; 56.5%) compared to unilateral ones. Conclusion: Our study indicates that an initially mild hydronephrosis does not exclude a pathological course in cases of congenital hyronephrosis. Therefore, in such patients, routine ultrasonography should be done regularly. [ABSTRACT FROM AUTHOR]

Objectives: To determine a follow‐up plan for mild congenital hydronephrosis in Japanese individuals. Methods: Neonates at Kansai Medical University Hospital (Hirakata, Osaka, Japan) who were diagnosed with mild congenital hydronephrosis – defined as a Society for Fetal Urology grade 1 or 2 – at 1‐month old by abdominal ultrasonography between 2014 and 2016 were enrolled. These patients were encouraged to undergo repeated abdominal ultrasonography for 2 years every 3 months to investigate the course of congenital hydronephrosis. Results: Among 1009 neonates, congenital hydronephrosis was detected in 118 affected renal units of 100 (9.9%) patients. According to the definition of the Society for Fetal Urology, 118 affected renal units were graded as grade 1 in 87 (74%), grade 2 in 30 (25%), grade 3 in one (1%) and grade 4 in 0 units. Among them, 117 affected renal units of mild congenital hydronephrosis comprising grades 1 and 2 were subjected to ultrasonographic evaluation to monitor the natural course. The rates of resolution at 7, 10, 13, 16, 19, 22 and 25 months after birth in Society for Fetal Urology grades 1 and 2 cases were 60% and 8%, 77% and 19%, 90% and 32%, 92% and 40%, 95% and 52%, 96% and 56%, and 99% and 60%, respectively. Conclusions: Grade 1 congenital hydronephrosis does not need to be followed up, because it mostly shows spontaneous resolution by 2 years of follow up without any complications. However, ultrasonographic examinations at 1‐year intervals for grade 2 congenital hydronephrosis are recommended to determine the subsequent follow‐up plan of patients. [ABSTRACT FROM AUTHOR]

Introduction. Minimal invasive treatment for congenital hydronephrosis in children remains a controversial topic, both in defining the necessity and timing of operation using laparoscopic techniques in neonates and infants. Materials and methods. This study aims to analyze criteria used for surgery in a series of patients operated in a laparoscopic manner, for congenital hydronephrosis, at the Emergency Clinical Hospital for Children “Marie Curie” Bucharest, Department of Pediatric Surgery, between 2007-2015. Results. In our series, the most frequent found criteria for surgery were anterior-posterior diameter over 3 cm, followed by 50% reduced parenchymal thickness, decreased renal function under 40% and finally symptomatic criteria – urinary tract infections and flank colicky pain. Both pelvic dilatation and parenchymal thickness correlates with renal function, though reduced parenchymal thickness has a stronger correlation. Infants under 1 year and under 10 kg represented a significant proportion (17.5% and 22.5% respectively). Conclusions. Young age (under 1 year old) and low-weight (under 10 kilos) in children are not reasons to delay classical or laparoscopic surgical treatment for PUJO (pyelo-ureteric junction obstruction). Pyelectasis is not specific to PUJO. It does not always mean obstruction and does not always show a strong correlation with impaired renal function. Best in establishing therapeutic conduct are the magnitude of renal parenchymal restructuring, the degree of renal function impairment and clinical symptomatology. Laparoscopic treatment is an effective surgical approach, that meets all the major advantages of minimal invasive surgery, applicable to infants and small children, regardless of age and weight.

Aims: Study on prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves. Materials and Methods: Antenatally diagnosed hydronephrosis patients were included. Postnatally, they were divided into two groups, posterior urethral valve (PUV) and non-PUV. The studied parameters were: Gestational age at detection, surgical intervention, ultrasound findings, cord blood and follow up plasma renin activity (PRA) values, vesico-ureteric reflux (VUR), renal scars, and glomerular filtration rate (GFR). Results: A total of 25 patients were included, 10 PUV and 15 non-PUV. All infants with PUV underwent primary valve incision. GFR was less than 60 ml/min/1.73 m 2 body surface area in 4 patients at last follow-up. Keyhole sign, oligoamnios, absent bladder cycling, and cortical cysts were not consistent findings on antenatal ultrasound in PUV. Cord blood PRA was significantly higher (P < 0.0001) in PUV compared to non-PUV patients. Gestational age at detection of hydronephrosis, cortical cysts, bladder wall thickness, and amniotic fluid index were not significantly correlated with GFR while PRA could differentiate between poor and better prognosis cases with PUV. Conclusions: Ultrasound was neither uniformly useful in diagnosing PUV antenatally, nor differentiating it from cases with non-PUV hydronephrosis. In congenital hydronephrosis, cord blood PRA was significantly higher in cases with PUV compared to non-PUV cases and fell significantly after valve ablation. Cord blood PRA could distinguish between poor and better prognosis cases with PUV.

30 patients with congenital hydronephrosis were divided into two groups according to the degree of morphological changes. The first group consisted of 12 men with age from 23 to 57 years; the second one – of 18 men with age from 21 to 61 years.We did morphometry studying of kidney structure main parameters and proved an important role of vessel malformation – it was the background for secondary morphological changes, which were more expressed in the second patient group. Intraparenchymal vessel Doppler sonography study correlated with congenital morphological changes.Therefore Doppler sonography confirmed an important role of vessel malformation in congenital hydronephrosis and secondary morphological changes development without the correlation between these processes and age of the patients.

Objective To evaluate the utility of hydroureter (HU) to identify high-grade vesico-ureteric reflux (VUR) in patients with high-grade postnatal hydronephrosis (PH). Patients and methods We retrospectively reviewed patients’ charts that had antenatal hydronephrosis from 2008 to 2014. Patients were excluded if they presented with febrile urinary tract infection (fUTI), neurogenic bladder, posterior urethral valve, multi-cystic dysplastic kidney, and multiple congenital malformations. We reviewed postnatal ultrasonography images and patients with Society of Fetal Urology (SFU) Grades 3 and 4 hydronephrosis with a renal pelvic antero-posterior diameter of ≥10 mm were included. The ureter was assessed and considered dilated if the ureteric diameter was  ≥4 mm. The voiding cystourethrogram (VCUG) studies, fUTI incidence, and surgical reports were reviewed. Results Of the 654 patients reviewed, we included 148 patients (164 renal units) of whom 113 (76.4%) were male and 35 (23.6%) female. SFU Grade 3 PH was identified in 49% of the renal units, with the remaining 51% being SFU Grade 4. HU was found in 50/164 renal units and was not detected in the remaining 114 units. VUR was diagnosed in four units (3.5%) without HU (low-grade VUR); whilst it was detected in 19 units (38%) with HU (72.7% were high-grade VUR) ( P  < 0.001). VUR was diagnosed on the contralateral side in four/105 patients with PH without HU and diagnosed in 10/43 patients with PH with HU ( P  < 0.001). During a median follow-up of 25.9 months, none of the renal units that had VUR without HU developed UTI or had surgeries. Conclusion Low-grade uncomplicated VUR was diagnosed in 3.5% of renal units without HU. Our results support limiting the use of VCUG to renal units with PH if associated with HU. [ABSTRACT FROM AUTHOR]

A 5 day old baby, with known left hydronephrosis which discovered by prenatal US presented with gastrointestinal tract obstruction. Laboratory work up demonstrated abnormal renal function and metabolic acidosis combined with hyperkalemia. Radiology tests showed bilateral hydronephrosis with huge left renal pelvis crossing the midline and causing deviation of the gut laterally. This acute presentation beside inability to receive oral feeding made us prefer immediate left renal drainage with pyelostomy in order to restore renal function, relieve the pressure effect of the huge renal pelvis and stabilize the baby. Dismembered pyeloplasty was done at age of 3 months.

Objective: To evaluate problems in diagnosis and management of congenital hydronephrosis. Material & methods: This study was retrospective. Data was collected from medical records of patients with congenital hydronephrosis, which were hospitalized or went to urologic outpatient clinic at Ciptomangunkusumo Hospital from January 1999 to December 2008 and Harapan Kita Maternal and Pediatric Hospital from January 2004 to December 2008. Data was analyzed with SPSS programme version 13.0. Statistical analysis was performed to find the relationship between age at diagnosis and kidney function (Mann-Whitney test) and between age at diagnosis and nephrectomy rate (Chi-Square test). Results: There were 15 patients who presented because of antenatal diagnosis. Of the 145 patients, we could collect antenatal history only from 63 patients. Obstetricians provided antenatal care in 56 out of 63 patients. Antenatal ultrasound was performed in only 59 out of 63 patients and only 44,07% (26 patients) with hydronephrosis was detected antenatally. Eleven out of 26 antenatally diagnosed patients came to our clinic at a later age. Three standard studies (postnatal ultrasound, voiding cystourethrogram, and renal scintigraphy) were performed only in 12 out of 145 patients (8,27%). Ultrasound was performed in 108 patients (74,5%), voiding cystourethrogram in 79 patients (54,5%), and renal scintigraphy in only 26 ptients (17,9%). The suggested management was conducted in 115 patients; operative management in 95 patients (82,61%) and conservative treatment in 20 patients (17,39%). The most common operative procedures were ureteroneocystostomy, pyeloplasty, nephrectomy, and posterior urethral valveablation. Mean serum creatinine in below 12 months old group and above 12 months old group was 0,78±0,93mg/dl dan 1,03±0,88 mg/dl respectively(p0,05). Nephrectomy was performed in 16 patients, with the most common indication was grade IV hydronephrosis with thin parenchyma in 11 patients (68,75%) and the most common etiology was UPJ obstruction in 10 patients (62,5%). We can only collect follow up data from 73 out of 115 managed patients (63,48%). Urinalysis, ultrasound/voiding cystourethrogram, and renal function studies were not routinely conducted during follow up. Conclusion: The management of congenital hydronephrosis in Indonesia needs improvements in antenatal care standards, particularly obstetric ultrasound, to improve early detection of congenital hydronephrosis. Better education for parents about the importance of follow up is needed, especially for antenatally diagnosed patients. A consensus regarding diagnostic tools used in managing congenital hydronephrosis must be established among urologists, pediatricians, and radiologists.

OBJECTIVE: Congenital hydronephrosis is induced by congenital obstruction of uretero pelvic junction, bladder vesicoureteral reflux, posterior urethral valve, stricture of ureter end and ureterocyst, which is extremely apt to cause end-stage renal failure in children. It becomes significant to explore the expression profile and clinical significance of aquaporin-1 (AQP-1) and ET-1 (endothelin-1) in the urine of children with congenital hydronephrosis. PATIENTS AND METHODS: 80 cases of children with congenital hydronephrosis were selected to be the observation group and another 40 cases of children with other diseases were served as control group. Pre-operative morning urine, intra-operative renal pelvis urine and morning urine at the 7th day after the operation of all the children were collected for the detection of the level of ET-1, Cr level and AQP1 in the urine. Urine various indexes of different diseases stages in children of both groups were compared. RESULTS: There was no significant difference between children with mild and children in control group (p > 0.05). In the observation group, the AQP-1 level during the operation was significantly lower than that before operation, but it was significantly higher in post-operation than that during the operation, which was still lower than that in control group (p < 0.05). Urine ET-1 level in observation group and its positive rate were significantly higher than that in control group (p < 0.05). Serum stress indexes in each stage of the observation group were significantly higher than that in control group (p < 0.05). CONCLUSIONS: The expression levels of urine AQP-1 and ET-1 of children with congenital hydronephrosis were obviously increased. The AQP-1 level during the operation was lower than that before operation. This post-operation level was significantly higher than before the operation. The expression of AQP-1 and ET-1 could be used as important indexes for clinical diagnosis. [ABSTRACT FROM AUTHOR]

Diagnosing real urinary obstruction and surgical decision making for the operative correction of urinary obstruction, are still problematic in congenital hydronephrosis (CH). Compliance of the renal pelvis is one of the important defense mechanisms of renal parenchyma against urinary obstruction. We observed early loss of function in some cases of CH with low and moderate anteroposterior diameter of the renal pelvis (APDRP). To evaluate structural properties of the renal pelvic tissue of patients with CH and the relation of these structural properties with renal function and Anteroposterior diameter of the renal pelvis. Ureteropelvic junction (UPJ) excised during UPJ obstruction operations from 2013 to 2019 were evaluated histopathologically. The patients were divided into the two groups according to initial renal function, i.e. group with initial preoperative differential renal function (DRF) less than 35% and group with initial DRF greater than 35%. The percentage of collagen to whole tissue area were analyzed using image processing program. The relationship between DRF and tissue collagen ratio, SFU and APDRP was evaluated. There were 5 patients in the DRF <35% group and 16 patients in the DRF >35% group. However, APDRP's of the DRF <35% group were also significantly lower than the DRF >35% group. The collagen distribution in the muscle layer was more prominent in the DRF <35% group. Proportionally, percentage of collagen stained surface was significantly higher in DRF <35% group. There are numerous histopathological studies evaluating the cause of UPJ obstruction. Besides these studies that are oriented to etiology, there are many studies comparing the histopathological changes at UPJ with surgical outcome and prognosis. In the present study, we found that renal pelvis collagen ratio was significantly increased in patients with lower APDRP and with severe renal function loss. This increase in the collagen content in the renal pelvis have been shown to affect the compliance negatively and decrease APDRP, which leads to a faster loss of renal function. Thus, pelvic structural changes accompanying UPJ obstruction may aggravate urinary obstructive process. Increased renal pelvis collagen ratio negatively affects the expansion of the renal pelvis, which is one of the protective mechanisms of the renal parenchyma, and may be one of the triggering mechanisms of early loss of renal function. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction. Minimal invasive treatment for congenital hydronephrosis in children remains a controversial topic, both in defining the necessity and timing of operation using laparoscopic techniques in neonates and infants. Materials and methods. This study aims to analyze criteria used for surgery in a series of patients operated in a laparoscopic manner, for congenital hydronephrosis, at the Emergency Clinical Hospital for Children “Marie Curie” Bucharest, Department of Pediatric Surgery, between 2007-2015. Results. In our series, the most frequent found criteria for surgery were anterior-posterior diameter over 3 cm, followed by 50% reduced parenchymal thickness, decreased renal function under 40% and finally symptomatic criteria - urinary tract infections and flank colicky pain. Both pelvic dilatation and parenchymal thickness correlates with renal function, though reduced parenchymal thickness has a stronger correlation. Infants under 1 year and under 10 kg represented a significant proportion (17.5% and 22.5% respectively). Conclusions. Young age (under 1 year old) and low-weight (under 10 kilos) in children are not reasons to delay classical or laparoscopic surgical treatment for PUJO (pyelo-ureteric junction obstruction). Pyelectasis is not specific to PUJO. It does not always mean obstruction and does not always show a strong correlation with impaired renal function. Best in establishing therapeutic conduct are the magnitude of renal parenchymal restructuring, the degree of renal function impairment and clinical symptomatology. Laparoscopic treatment is an effective surgical approach, that meets all the major advantages of minimal invasive surgery, applicable to infants and small children, regardless of age and weight. [ABSTRACT FROM AUTHOR]

The basic Helix-Loop-Helix (bHLH) proteins represent a well-known class of transcriptional regulators. Many bHLH proteins act as heterodimers with members of a class of ubiquitous partners, the E proteins. A widely expressed class of inhibitory heterodimer partners—the Inhibitor of DNA-binding (ID) proteins—also exists. Genetic and molecular analyses in humans and in knockout mice implicate E proteins and ID proteins in a wide variety of diseases, belying the notion that they are non-specific partner proteins. Here, we explore relationships of E proteins and ID proteins to a variety of disease processes and highlight gaps in knowledge of disease mechanisms. [ABSTRACT FROM AUTHOR]

Early diagnosis of congenital hydronephrosis, sometimes even from intrauterine life, may lead to the establishment of a suitable therapeutic course to avoid the occurrence of complications. Congenital hydroronephrosis, especially bilateral, and it is possible complications, such as recurrent urinary infections, which, in the absence of treatment, may impair renal function such as acute renal failure. Good ultrasound monitoring of newborns at 24-48 and post-natal and at 3 months allows to improve the quality of life of these children before any possible complication. In the present paper the authors propose to establish the presence of possible congenital hydronephrosis in a group of newborns admitted to the Neonatology Clinic of Louis Turcanu Hospital during the period 01.01.2016-31.12.2017 and the therapeutic conduct of choice that will lead to the avoidance of possible complications. [ABSTRACT FROM AUTHOR]

Objectives: Our objectives were to: (1) delineate factors associated with surgery at <1 year and (2) determine if early intervention was associated with increased risk of readmission. Methods: We conducted a retrospective review of children age 0-18 years with a diagnosis of UPJ obstruction who underwent pyeloplasty from 1/1/1999 to 9/1/2009 using the PHIS database. Data collected included patient factors (race, gender, insurance type, APR-DRG severity of illness) and hospital factors (annual case volume, census region, academic status). Outcomes assessed were: age at surgery and hospital readmission within 1 year of surgery. Data were analyzed using logistic regression and Cox PH for multivariate analyses. Results: 4499 children met study criteria. Minority race (OR 1.55), male gender (OR 1.49), public insurance (OR 1.37), high severity of illness (OR 3.60), Southern region (OR 1.44), and low hospital volume (OR 1.37) were significant predictors of early surgery ( p < 0.05). Only early surgery (HR 2.42; 95 % CI 1.67-3.49 2.42) was associated with increased risk of readmission. Conclusions: In children with UPJ obstruction, age at surgery is associated with patient demographic and hospital factors. Early surgery is associated with higher rates of readmission, suggesting that variations in age at surgery may be associated with significant differences in outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The most common measurements of hydronephrosis are the anterior-posterior (AP) diameter and the Society for Fetal Urology (SFU) grading systems. To date, the inter-rater reliability (IRR) of these measures has not been compared in the postnatal period. The objectives of this study were to compare the IRR of the AP diameter and the SFU grading system in infants and to determine whether ultrasound findings other than pelvicalyceal dilation are associated with higher SFU grades. Methods: Initial postnatal ultrasounds of infants seen from February 1, 2011, to January 31, 2012, with a primary diagnosis of congenital hydronephrosis were included for review. Ultrasound images were de-identified and reviewed by four pediatric urologists. IRR was calculated using the intraclass correlation (ICC) measure. A paired t test was used to compare ICCs. Associations between SFU grade and other ultrasound findings were tested using Chi-square or Fisher's exact tests. Results: A total of 112 kidneys in 56 patients were reviewed. IRR of the SFU grading system was high (right kidney ICC = 0.83, left kidney ICC = 0.85); however, IRR of AP diameter measurement was higher (right kidney ICC = 00.97, left kidney ICC = 0.98; p < 0.001). Renal asymmetry ( p < 0.001), echogenicity ( p < 0.001), and parenchymal thinning ( p < 0.001) were significantly associated with SFU grade 4 hydronephrosis on bivariable and multivariable analysis. Conclusions: The SFU grading system is associated with excellent IRR, although the AP diameter appears to have higher IRR. Physicians may consider ultrasound findings that are not explicitly included in the SFU system when assigning hydronephrosis grade, which may lead to variability in use of this classification system. [ABSTRACT FROM AUTHOR]

Introduction. Congenital hydronephrosis, can be caused by intrinsic and / or extrinsic uretero-pelvic obstruction. Regardless of the type of obstruction, pyeloplasty remains the traditional surgical procedure for hydronephrosis in children, though procedures that aim to relocate the vascular pedicle, commonly known as "vascular hitch", were described for hydronephrosis associated with aberrant renal vessels. Because of the development of minimally invasive surgery, this surgical technique gained its maximum utility in laparoscopy. We describe our experience with laparoscopic technique of relocating the aberrant vessels, in children with PUJO. Materials and method. Between January 2007-February 2015, a total of 35 patients, were operated by a laparoscopic technique for hydronephrosis. In this group, we studied eight patients (five boys and three girls), with a mean age of 9.7 years (range 4e17), diagnosed with vascular compression of the pelviureteric junction, who underwent laparoscopic relocation of the aberrant vessels. Surgical indication was based on an intermittent lumbar pain associated with evidence of pelviureteric obstruction (ultrasound / urography / DTPA scintigraphy). Results. The laparoscopic surgical technique involved dissection and mobilization of the lower pole vessels, freeing the junction and suspension of the vascular pedicle on the anterior pelvic wall. None of the patients required ureteral stenting, but a lumbar drain was held in place for 48 hours. In a single case we practiced the suspension of the pelvis to the psoas muscle, in a girl who had a simultaneous pelvic bifidity, and developed a troublesome postoperative course, caused by inefficient drainage of the renal pelvis, so the final solution was a uretero-calycostomy and ureteral stenting. The main outcome variables measured were relief of pain, improvement of the value of the urinary tract distension on ultrasound and of the renal function on scintigraphy, performed 3 and 6 months after surgery. Average operating time was 110 minutes. All patients were discharged on the fourth postoperative day, except for one patient, who was hospitalized for 21 days. All of the patients remained free of symptoms after six months. They showed no obstruction signs on ultrasound, with improvement of the renal appearance. Conclusions. Vascular relocation procedures are simple, requiring less operative time than pyeloplasty. Their advantages are maintaining the integrity of the urinary tract, without anastomosis or ureteral stenting. Controversy remains regarding patency of the pelviureteric junction. [ABSTRACT FROM AUTHOR]

Aims: Study on prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves. Materials and Methods: Antenatally diagnosed hydronephrosis patients were included. Postnatally, they were divided into two groups, posterior urethral valve (PUV) and non-PUV. The studied parameters were: Gestational age at detection, surgical intervention, ultrasound findings, cord blood and follow up plasma renin activity (PRA) values, vesico-ureteric reflux (VUR), renal scars, and glomerular filtration rate (GFR). Results: A total of 25 patients were included, 10 PUV and 15 non-PUV. All infants with PUV underwent primary valve incision. GFR was less than 60 ml/min/1.73 m2 body surface area in 4 patients at last follow-up. Keyhole sign, oligoamnios, absent bladder cycling, and cortical cysts were not consistent findings on antenatal ultrasound in PUV. Cord blood PRA was significantly higher (P < 0.0001) in PUV compared to non-PUV patients. Gestational age at detection of hydronephrosis, cortical cysts, bladder wall thickness, and amniotic fluid index were not significantly correlated with GFR while PRA could differentiate between poor and better prognosis cases with PUV. Conclusions: Ultrasound was neither uniformly useful in diagnosing PUV antenatally, nor differentiating it from cases with non-PUV hydronephrosis. In congenital hydronephrosis, cord blood PRA was significantly higher in cases with PUV compared to non-PUV cases and fell significantly after valve ablation. Cord blood PRA could distinguish between poor and better prognosis cases with PUV. [ABSTRACT FROM AUTHOR]

The aim was to investigate the relationship between apparent diffusion coefficient (ADC) values measured by diffusion-weighted magnetic resonance imaging (DW MRI) and the split glomerular filtration rate (GFR) in infants with congenital hydronephrosis. Diffusionweighted imaging (DWI) (b = 0 and 700 seconds/mm2) was performed with a General Electric Company (GE) Signa 1.5T MR unit in 46 infants suffering single congenital hydronephrosis and in 30 healthy infants as normal control group. The ADCs were calculated with regions of interest (ROIs) positioned in the renal parenchyma. The 46 obstructed kidneys were classified into four groups according to the GFR level: renal dysfunction compensated group, renal dysfunction decompensated group, renal failure group, and uremia group. The renal ADCs in six groups (normal kidneys in control group, contralateral kidneys, and four groups of hydronephrotic kidneys) were compared statistically using analysis of variance (ANOVA), and the correlative relationship between ADCs and GFR was examined by Pearson's correlation test. There were statistically significant differences in renal ADCs among the six groups. The ADCs of hydronephrotic kidneys were lower than that of the normal kidneys. There was a moderate positive correlation between the ADCs of hydronephrotic kidneys and split GFR (r = 0.744). This study indicated that the ADCs of congenital hydronephrotic kidneys were lower than that of normal renal parenchyma, and there was a positive correlation between the ADCs and split renal GFR, which demonstrates that the ADCs can reflect the filtration function of hydronephrotic kidneys and may provide some reference to help clinical physician to explore a novel noninvasive approach to evaluate the single renal function. [ABSTRACT FROM AUTHOR]

The aim of this paper is to address the dilemmas of the paediatric surgeon when facing an isolated, unilateral, congenital hydronephrosis and discuss the strategic options for the management of this condition. Congenital hydronephrosis, the most commonly diagnosed uropathy in children, is usually a benign and self-resolving condition. Nonobstructive hydronephrosis does not require operative treatment, while timely treatment is imperative for obstructive hydronephrosis before significant renal damage ensues. Managing congenital hydronephrosis is a challenging task. Thirty-two children with unilateral, isolated hydronephrosis and nonobstructed renography curves were followed up for 3 years. On the initial evaluation according to the grade of hydronephrosis: 22.6% were grade I, 54.8% grade II and 22.6% grade III. After 12 months of follow-up: 30% were grade I, 51.5% grade II and 18.5% grade III, respectively. After the three-year follow-up, there were no hydroneproses greater than grade II. The mean value of the separate GFR of the affected kidney at initial evaluation was 42.83%, and 40.33% after three years. In three children the treatment was converted from conservative to surgical. Nonobstructive, congenital hydronephrosis is a benign condition not requiring any medical treatment, but aggressive observation is indicated. [ABSTRACT FROM AUTHOR]

Introductions. The widespread use of prenatal ultrasonography results in increased recognition of congenital hydronephrosis, a therapeutic and diagnostic challenge. This study was conducted to investigate the natural course of prenatal hydronephrosis and the accuracy of postnatal APD in determining the outcome. Materials and Methods. All newborns with prenatal hydronephrosis were followed up by ultrasonography after birth. Voiding cystoureterography, diethylene triaamine pentaacetic acid renal scintigraphy, and dimercaptosuccinic acid renal scintigraphy were done if indicated. The receiver operating characteristic curve was plotted to determine the best cutoff for the anterior-posterior pelvic diameter (APD) to distinguish surgical from spontaneously resolving group. Results. Of 178 neonates, 42 (23%) required surgery. The area under the curve for APD to predict the need for surgery was 0.925 with an APD cutoff of 15 mm. The diagnostic value of APD for determining the need for surgery was determined by sensitivity and specificity of 95.2% and 73.5%, respectively. Conclusions. Postnatal APD on ultrasonography has a valuable diagnostic accuracy for requiring surgery and provides a useful guide for parental counseling. [ABSTRACT FROM AUTHOR]