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Diabetes is a rapidly expanding epidemic projected to affect as many as 1 in 3 Americans by 2050. This disease is characterized by devastating complications brought about high glucose and metabolic derangement. The most common of these complications is diabetic bladder dysfunction (DBD) and estimates suggest that 50–80% of patients experience this disorder. Unfortunately, the Epidemiology of Diabetes Interventions and Complications Study suggests that strict glucose control does not decrease ones risk for incontinence, although it does decrease the risk of other complications such as retinopathy, nephropathy and neuropathy. Thus, there is a significant unmet need to better understand DBD in order to develop targeted therapies to alleviate patient suffering. Recently, the research community has come to understand that diabetes produces a systemic state of low-level inflammation known as meta-inflammation and attention has focused on a role for the sterile inflammation-inducing structure known as the NLRP3 inflammasome. In this review, we will examine the evidence that NLRP3 plays a central role in inducing DBD and driving its progression towards an underactive phenotype.

Non-dilated obstructive uropathy (NDOU) is a condition of renal insufficiency characterized by functional kidney failure and inability of collective system to dilate because of several causes, e.g. hypotension, severe oliguria or dehydration. TUR-syndrome is a complication of bladder resection possibly leading to this condition through electrolytic disequilibrium after fluids reabsorption. We present the case of a patient with solitary kidney suffering from this uropathy regardless of mild electrolytic disorders and small bladder perforations. Prompt diagnosis and management with ureteral stent or nephrostomy tube are imperative in this setting.

Malakoplakia (from Greek Malako “soft” + Plako “plaque”) is a rare inflammatory condition that presents as a papule, plaque, or ulceration that usually affects the genitourinary tract. The most frequently affected organ is the urinary bladder. This condition has features of granulomatous inflammation. The pathogenesis of the disease is not completely understood. It is often misdiagnosed as malignancy. In this case report, we present a case of urinary bladder malakoplakia which presented with obstructive uropathy and acute kidney injury (AKI).

Purpose of Review: The early recognition of urinary tract obstruction (UTO) is vital in order to prevent mortality and morbidity associated with an acute kidney injury (AKI) and progression to irreversible kidney damage. Urinary biomarkers such as neutrophil gelatinase–associated lipocalin (NGAL) have been recognised as an accurate tool in the timely diagnosis of AKI, but its role in the detection, prognosis and subsequent monitoring of a variety of obstructive uropathies has not yet been explored. We performed a systematic review of literature in accordance with Cochrane methodology from inception to August 2021. Recent Findings: Eleven studies were included in which urine and serum NGAL were measured (616 patients) presenting with multiple UTO aetiologies. Four investigated kidney stone disease (KSD) exclusively, whilst other studies identified other causes of UTO including pelviureteric junction obstruction (PUJO), retroperitoneal fibrosis (RPF) and ureteric strictures. Six studies monitored NGAL levels after surgical intervention to relieve the obstruction. Nine studies demonstrated a significant increase in both urine and serum NGAL levels in UTO, often in a more sensitive and timely manner than serum creatinine. Subclinical unilateral UTO could be recognised by urinary NGAL levels even in the absence of changes in serum creatinine. Following surgical intervention, a reduction in urinary and serum NGAL was seen in all but two studies. NGAL levels decreased acutely by 14% in 2 h and showed a long-term reduction of 78% in 6 months. Summary: Readily available but not yet widely accepted, NGAL has the potential to be a less invasive, low-cost diagnostic test for urinary tract obstructions as a whole. Not only can it be used as a marker of treatment success but also to monitor for obstruction recurrence or progression. Further research is required to acknowledge urinary biomarkers such as NGAL as a potential replacement to standard renal function monitoring tests in the context of obstructive uropathy. [ABSTRACT FROM AUTHOR]

BackgroundCongenital anomalies of the kidneys and urinary tracts (CAKUT) represent the most prevalent cause for renal failure in children. The RNA epigenetic modification N6-methyladenosine (m6A) methylation modulates gene expression and function post-transcriptionally, which has recently been revealed to be critical in organ development. However, it is uncertain whether m6A methylation plays a role in the pathogenesis of CAKUT. Thus, we aimed to explore the pattern of m6A methylation in CAKUT.MethodsUsing m6A-mRNA epitranscriptomic microarray, we investigated the m6A methylomic landscape in the ureter tissue of children with obstructive megaureter (M group) and primary vesicoureteral reflux (V group).ResultsA total of 228 mRNAs engaged in multiple function-relevant signaling pathways were substantially differential methylated between the “V” and “M” groups. Additionally, 215 RNA-binding proteins that recognize differentially methylated regions were predicted based on public databases. The M group showed significantly higher mRNA levels of m6A readers/writers (YTHDF1, YTHDF2, YTHDC1, YTHDC2 and WTAP) and significantly lower mRNA levels of m6A eraser (FTO) according to real-time PCR. To further investigate the differentially methylated genes, m6A methylome and transcriptome data were integrated to identified 298 hypermethylated mRNAs with differential expressions (265 upregulation and 33 downregulation) and 489 hypomethylated mRNAs with differential expressions (431 upregulation and 58 downregulation) in the M/V comparison.ConclusionThe current results highlight the pathogenesis of m6A methylation in obstructive and reflux uropathy.

Introduction: Lower urinary tract symptoms (LUTS) are highly prevalent in men and the incidence increases with aging. The pathophysiology of LUTS is multifactorial and is characterized by voiding and storage symptoms. Acharya Sushruta described 12 types of Mutraghata along with its management in the form of single drug or compound formulations. Clinical Finding & Diagnosis: This is a case of LUTS secondary to benign prostatic hyperplasia; the patient was a known case of urosepsis, obstructive uropathy, and presented with LUTS with a Foley urethral catheter in situ for refractory urinary retention. Interventions: Despite the poor prognosis of the complicated LUTS, conservative treatment was given as per the management principles of urinary disorders in Ayurveda which showed a great potential in the management of complicated LUTS. Conclusion: The bothersome urinary symptoms of the patient were improved along with improvement in the quality of life and better compliance was observed by the patient.

Ketamine induced uropathy (KIU) is a urological condition increasing in prevalence, with similar symptoms to UTI, OAB syndrome or interstitial cystitis/bladder pain syndrome. We present the case of an 18-year old male who established severe LUTS and acute kidney injury due to KIU, in a short time-span of 6 months. Since cessation of ketamine is the cornerstone of treating KIU, correct and early diagnosis is essential. Physicians should therefore consider KIU as a differential diagnosis in storage LUTS, especially in younger patients with therapy-resistant LUTS.

Introduction: Ketamine, a versatile anesthetic, has seen increased recreational use, leading to significant health issues, including ketamine-induced uropathy (KIU). KIU manifests with lower urinary tract symptoms (LUTS) and can involve the upper urinary tract. This study aims to provide a comprehensive overview of KIU, addressing its pathophysiology, diagnostic strategies, and treatment options; and to define/identify future research priorities., Methods: During the 2024 meeting of the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, a dedicated Proposal (P) convened to explore KIU. This initiative involved a thorough review of existing literature, expert presentations, and consensus-driven discussions. The methodology ensured a comprehensive exploration of KIU from both clinical and pre-clinical perspectives, leading to actionable research recommendations., Results: Understanding the mechanisms of KIU is crucial for developing effective treatment options targeting specific pathophysiological pathways. Key findings include bladder fibrosis driven by transforming growth factor-β1 (TGF-β1), elevated purinergic responses and upregulated P2X1 purinoceptor expression, decreased barrier function due to increased expression of antiproliferative factor (APF), and functional loss of the bladder through Cav1.2 channel blockade. Research indicates that fibrosis, typically considered irreversible, may be mitigated. However, the exact timing and extent of fibrosis initiation and its impact on long-term outcomes require further research. LUTS typically improve after ketamine cessation but relapse upon resumption, indicating a hypersensitivity mechanism involving elevated serum IgE levels. Advanced stages of KIU do not always correlate with LUTS severity, shedding light on potential systemic effects and the need for evaluating liver enzymes. Furthermore, psychological dependency on ketamine, due to its positive perceptive and mood-altering effects, complicates cessation efforts. Long-term management requires a holistic approach, integrating medical treatments and supportive measures to help patients navigate life with potentially irreversible complications., Conclusion: This comprehensive review spans from fundamental pathology to practical clinical management, addressing both urological and systemic complications, and bridging insights from animal models to human applications. Developing effective treatment strategies necessitates addressing both the physical and psychological aspects of ketamine dependency., (© 2024 Wiley Periodicals LLC.)

Objectives. Congenital primary obstructive megaureter (POM) is caused by ureterovesical junction stenosis, reduced peristalsis, and the resulting dilatation. Even though ureteral re-implantation remains the current gold standard technique, retrograde dilatation is considered as an effective therapeutic alternative with good results and growing proponents - to the extent it has become the technique of choice in some healthcare facilities. The objective was to present an alternative approach for treatment purposes. Materials and methods. This is the case of a 5-month-old infant with POM and pyonephrosis requiring nephrostomy and intravenous antibiotic therapy. Endoscopic dilatation was carried out by means of a percutaneous drainage in an antegrade fashion and did not require cystoscopy. Results. The procedure was uneventful. During follow-up, ureterohydronephrosis decreased, while ureteral dilatation persisted to a lesser extent with an adequate peristalsis and absence of secondary VUR. The patient has had no symptoms after an 11-month follow-up. Conclusions. POM antegrade dilatation is an effective alternative in selected patients as it makes the pathology disappear. [ABSTRACT FROM AUTHOR]

Background: Obstructive uropathy (OU) is a common cause of end-stage renal disease (ESRD) in children. Children who escape the newborn period with mild-to-moderate chronic kidney disease (CKD) continue to be at increased risk. The predictive ability of clinically available markers throughout childhood is poorly defined.Methods: Patients with OU were identified in the Chronic Kidney Disease in Children Study. The primary outcome of interest was renal replacement therapy (RRT) (cases). Controls were age matched and defined as patients within the OU cohort who did not require RRT during study follow-up.Results: In total, 27 cases and 41 age-matched controls were identified. Median age at baseline and age at outcome measurement were 10 vs. 16 years, respectively. First available glomerular filtration rate (GFR) (36.9 vs. 53.5 mL/min per 1.73 m2), urine protein/creatinine (Cr) (0.40 vs. 0.22 mg/mg) and microalbumin/Cr (0.58 vs. 0.03 mg/mg), and serum CO2 (20 vs. 22 mmol/L) and hemoglobin (12.4 vs. 13.2 g/dL) differed significantly between cases and controls, respectively. GFR declined 3.07 mL/min per 1.73 m2/year faster in cases compared to that in controls (p < 0.0001). Urine protein/Cr and microalbumin/Cr increased by 0.16 and 0.11 per year more in cases compared to those in controls, respectively (p ≤ 0.001 for both). Serum phosphate increased by 0.11 mg/dL and serum albumin and hemoglobin decreased by 0.04 (g/dL) and 0.14 (g/dL) per year more for cases compared to those for controls, respectively (p < 0.05 for all).Conclusions: Age-specific baseline and longitudinal measures of readily available clinical measures predict progression to ESRD in children with mild-to-moderate CKD from OU. [ABSTRACT FROM AUTHOR]

Ketamine cystitis, also referred to as ketamine-induced uropathy, is a new clinical syndrome affecting primarily young to middle-aged ketamine abusers and has become a global phenomenon since its first reported series in 2007. A spectrum of urological destructions ranging from mild cystitis to severely contracted bladder, ureteric stricture, upper tract damage, and irreversible renal failure has been reported. This review considers the scope and burden of ketamine cystitis in the Chinese population in Asia, stating the current status of management pathway, and reviews our current understanding on the pathophysiology of ketamine-induced uropathy.

Introduction: Surgical treatment is increasingly finding a place in the treatment of unilateral obstructive uropathy. This study was designed to investigate the recoverability of renal function following surgical treatment of adult patients with unilateral obstructive uropathy using Lasix 99mTc-diethylenetriaminepentaacetate renography (DTPA-R) for measurement of glomerular filtration rate (GFR) before and after surgery. Methods: This was a prospective study which included 29 (20 males and 9 females) consecutive adult patients with a diagnosis of unilateral renal obstruction and a normal contralateral kidney. The obstruction and malfunction of the contralateral kidney were confirmed with Lasix DTPA-R. For all the patients, surgical treatment of the unilateral kidney obstruction was performed, and post-surgical measurement of the function of the treated kidney was also applied using Lasix DTPA-R. Results: The mean age of the patients was 42.24 years. According to our results, the average of pre-operation GFR was 17.48 ± 9.10 ml/minute/1.73 m2 and post-operation GFR was 26.4 ± 11.2 ml/minute/1.73 m2. It is approved that the GFR increased 8.92 ± 6.30 ml/minute/1.73 m2 after surgery. The most increased rate of GFR was observed in the group with the impaired kidney with GFR > 20 ml/minute. It is approved that the rate of recovery in the patients with preoperational total GFR > 75 ml/minute and also 50 < GFR < 75 ml/minute was more than that in the other patients. Conclusion: Our findings demonstrated that in unilateral obstructive uropathy if the GFR of the impaired kidney is > 10 ml/minute/1.73 m2 or total GFR > 25 ml/minute/1.73 m2 the functional recovery of damaged kidney could be expected following the removal surgery.

Urinary tract abnormalities are the most frequently occurring developmental anomaly in children. Pelvicalyceal system duplication is one of them and signifies the existence of two urine diverting separate systems. This anomaly occurs in 10% of population, usually in girls, and is associated with complete or partial ureter duplication. The frequency of total ureter duplication, which in 20–40% of patients is found as bilateral, is 1:125 children (0.8% of the population). The most frequent malformation is asymptomatic, diagnosed coincidentally casually and does not require any treatment. In some patients with pelvicalyceal system duplication, vesicoureteral reflux (VUR) and ectopic ureter may coexist. Malposition of ureter’s orifice into the bladder predispose to urinary retention, development of hydronephrosis and urinary tract infection (UTI). Ectopic ureterocele is recognized in 6–20% of children with recurrent UTI. The reason why children are referred to the hospital is UTI or hydronephrosis revealed by ultrasound imaging. When the ultrasound image of pelvicalyceal system duplication is ambiguous, micturating cystourethrography (MCU) and scintigraphy become the primary diagnostic procedure, or urography – in more complicated cases. In the case of ectopic ureter, the danger of inappropriate catheterization, i.e. directly into its lumen, may occur. Though very rare, this may cause some diagnostic difficulties and lead to injury of the urinary tract. For this reason, we want to further discuss this complication following a diagnostic procedure on the example of two cases of pelvicalyceal system duplication with ectopic ureter.

Background: Urological pathologies of children are dominated by congenital malformations of the kidneys and urinary tract. Their management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. Patients and Methods: Data for aetiology, treatment, and results in children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. Results: A total of 214 patients with complete data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele, nephroblastoma, the posterior urethral valves, ureteropelvic junction obstructions, post-circumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations represented 81.3%, followed neoplastic pathologies (7.9%), traumatic pathologies (6.1%) and others (4.7%). The disorders of male genitalia were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The average age of the children urological pathologies at the time of consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%.

Ketamine consumption as a recreational drug is on an increasing trend. Chronic abuse of ketamine leads to ketamine-associated uropathy, commonly presenting with lower urinary tract symptoms and suprapubic pain. Upper tract involvement is observed in a portion of patients. Inflammatory picture and hypersensitive reaction are observed in the histopathology of ketamine cystitis specimen. Assessment with symptom score questionnaires, imaging assistance and endoscopic examination are essential in the evaluation of patients with ketamine-associated uropathy. While abstinence is the key to alleviate the detrimental impact from ketamine abuse, both medical and surgical options are available to relieve the complications. This review discussed the clinical presentation, pathology, assessment and management strategy of ketamine-associated uropathy. [ABSTRACT FROM AUTHOR]

The incidence of simple renal cysts varies in the literature, ranging from 10.7% to 23%. While the majority of cysts appear to be mostly asymptomatic, it has been documented that they may potentially be a cause of abdominal or flank pain, raised blood pressure, hematuria or obstructive uropathy. We present a case of 73 year old female with chronic right flank pain and recurring renal stone disease. Imaging revealed a large parapelvic right simple renal cyst which was drained successfully with the aid of ureteroscopic laser treatment. [ABSTRACT FROM AUTHOR]

Pathological kidney trauma is a special entity. Congenital or acquired lesions may interfere with clinical presentation, radiological imaging, and the therapeutic approach., Objective: Our objective was to determine the clinical, radiological, and therapeutic features of this entity., Materials and Methods: The medical records of 37 observations were retrospectively collected from January 1992 to February 2022. All cases were explored by a kidney ultrasound and/or a computed tomography scan, and classified according to the American Association of Surgery of Trauma. Pre-existing renal abnormalities were found in 37 patients among 203 (18.2%). The most common underlying lesion were urolithiasis (37.8%) followed by pyelo-ureteral junction syndrome (32.4%). Surgical abstention was decided in 11 cases, four nephrectomies were performed as a matter of urgency, and seven nephrectomies were performed remotely. The cure of uropathy was performed after an average delay of 3 months., Conclusion: Kidneys with underlying pathology are habitually more susceptible to trauma. Contusions are often benign contrasting with a high nephrectomy rate., Competing Interests: All authors disclose any conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Fungal urinary tract infections due to Candida have increased significantly in recent years. Our research objective was to study Candida species in urine samples of patients with urinary tract infections (UTIs) associated with obstructive uropathy and to investigate the virulence factors of the isolated Candida. Methods: Patients were divided into two groups: Group I (cases): 50 patients with UTIs and obstructive uropathy. Group II (control): 50 patients with UTIs but with no functional or anatomical obstruction of their urinary tract. Clinical histories and physical examinations, together with laboratory investigations of urine samples were carried out in all patients in this study. Mid stream urine samples were examined microscopically and by fungal cell culture. The isolated Candida species were identified by analytical profile index (API). Candida Virulence factors were determined for the isolated Candida. The susceptibility to fluconazole was evaluated. Results: This study revealed an overall isolation rate of 27% of Candida species among all patient groups. The rate was 36% in cases, and 18% in controls, a difference found to be statistically significant (P<0.05). By API, C.albicans was detected in 44% of Candida species in cases, and in 33% in controls. While C.glabrata was detected in 28% of Candida species in cases, and in 22% in controls. C.tropicalis was detected in 17% of Candida species in cases, and in 22% in controls. Both C.krusei and C.kyfr were detected in 5.5% of Candida species in cases, and in 11% in controls. In terms of virulence factors the study showed that 11 out of 27 (40.5%) of Candida isolates were biofilm positive by tube adherence. Phospholipase activity was demonstrated in 12 out of 27 (44.5%) of Candida isolates. Secretory aspartic proteinase activity was demonstrated in 13 out of 27 (48%) of the Candida isolates. Conclusion: Candida is an important cause of UTIs and obstructive uropathy is a major predisposing factor. [ABSTRACT FROM AUTHOR]

Ketamine cystitis, also referred to as ketamine-induced uropathy, is a new clinical syndrome affecting primarily young to middle-aged ketamine abusers and has become a global phenomenon since its first reported series in 2007. A spectrum of urological destructions ranging from mild cystitis to severely contracted bladder, ureteric stricture, upper tract damage, and irreversible renal failure has been reported. This review considers the scope and burden of ketamine cystitis in the Chinese population in Asia, stating the current status of management pathway, and reviews our current understanding on the pathophysiology of ketamine-induced uropathy. [ABSTRACT FROM AUTHOR]

Objective: To determine and verify how anthropometric variables correlate to ureteric lengths and how well statistical models approximate the actual ureteric lengths. Materials and methods: In this work, 129 charts of endourological patients (71 females and 58 males) were studied retrospectively. Data were gathered from various research centers from North and South America. Continuous data were studied using descriptive statistics. Anthropometric variables (age, body surface area, body weight, obesity, and stature) were utilized as predictors of ureteric lengths. Linear regressions and correlations were used for studying relationships between the predictors and the outcome variables (ureteric lengths); P-value was set at 0.05. To assess how well statistical models were capable of predicting the actual ureteric lengths, percentages (or ratios of matched to mismatched results) were employed. Results: The results of the study show that anthropometric variables do not correlate well to ureteric lengths. Statistical models can partially estimate ureteric lengths. Out of the five anthropometric variables studied, three of them: body frame, stature, and weight, each with a P< 0.0001, were significant. Two of the variables: age (R² = 0.01; P = 0.20) and obesity (R² = 0.03; P = 0.06), were found to be poor estimators of ureteric lengths. None of the predictors reached the expected (match: above: below) ratio of 1:0:0 to qualify as reliable predictors of ureteric lengths. Conclusion: There is not sufficient evidence to conclude that anthropometric variables can reliably predict ureteric lengths. These variables appear to lack adequate specificity as they failed to reach the expected (match: above: below) ratio of 1:0:0. Consequently, selections of ureteral stents continue to remain a challenge. However, height (R² = 0.68) with the (match: above: below) ratio of 3:3:4 appears suited for use as estimator, but on the basis of decision rule. Additional research is recommended for stent improvements and ureteric length determinations. [ABSTRACT FROM AUTHOR]

Endoscopic subureteric injection of tissue-augmenting substances has become an alternative to long-term antibiotic prophylaxis and open surgery, in the treatment of children with vesicoureteric reflux (VUR). Successful elimination of reflux in about 80% of patients after a single injection (and in 90% after a repeat) has been achieved using non-degradable substances. young girl with grade III VUR and breakthrough infections would definitely need to undergo antireflux procedure. Endoscopic treatment would be an ideal procedure as it is a one-day surgery, with over 80% success rate, low morbidity and no long-term complications. Moreover, this form of surgery is appealing to, as well as the choice of the majority of parents.

The article discusses some important issues that urologic healthcare workers should consider when preparing to study for the certification examination. Topics discussed include obstructive uropathy as a major section on the certification examination at all levels, pediatric and congenital anomalies, and the importance of understanding medications used to treat incontinence.

Background: Urological pathologies of children are dominated by congenital malformations of the kidneys and urinary tract. Their management is often surgical. The objective of this survey was to study etiological and therapeutic aspects of urological presentations in children. Patients and Methods: Data for aetiology, treatment, and results in children hospitalized at the Paediatric Surgery service of National Teaching Hospital (CNHU) in Cotonou were retrospectively analyzed from January 1999 to December 2008. Results: A total of 214 patients with complete data were evaluated. Urological pathologies represented 4.8% of the hospitalizations in paediatric surgery, with an incidence of 21 cases per year. The mean age was 4.9 ± 3.2 years (age 1 week to 14 years). The male to female ratio was 14:14. Cryptorchidism, hydrocele, nephroblastoma, the posterior urethral valves, ureteropelvic junction obstructions, postcircumcision haemorrhage and hypospadias were the most frequent pathologies. Congenital urological malformations represented 81.3%, followed neoplastic pathologies (7.9%), traumatic pathologies (6.1%) and others (4.7%). The disorders of male genitalia were more frequent and constituted 68.2% of the cases. The anomalies of the urinary tract were 30.8% and intersex disorders were 0.9%. The average age of the children urological pathologies at the time of consultation was 8.85 ± 4.6 years. The treatment was often surgical with a mortality of 2.8%. [ABSTRACT FROM AUTHOR]

Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0-21%, new renal damage in 9-12%, and recurrent reflux in 17-47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment. [ABSTRACT FROM AUTHOR]

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The optimal management of vesicoureteral reflux (VUR) is quite controversial. For many years, only antibiotic prophylaxis and open surgery were considered possible options. Since the first descriptions in the early 1980s, endoscopic treatment (ET) has gained popularity and is now considered a valid alternative both to open surgery and antibiotic prophylaxis. Many surgical antireflux techniques have been described in the past 50 years. The general principle of reflux surgery, usually defined as ureteric reimplantation, is elongation of the submucosal ureteral tunnel with creation of a flap-valve mechanism. The antireflux operation can also be carried out laparoscopically, either extravesically or intravesically (pneumovesicum). Open surgery is associated with a high success rate (>95%) regardless of the technique adopted. However, because it is invasive, it is limited to selected cases. Laparoscopic technique is less invasive, but the mean operative time is much longer and results depend significantly on the learning curve. ET involves injecting material endoscopically into the submucosal space under the ureteric orifice. It is associated with a good success rate (about 80% after one injection). Advantages of this minimally invasive treatment include repeatability and the fact that postoperative complications are rare. With a second injection, after few months if needed, the success rate of ET approaches that of open surgery. Our 20-year experience in ET is described in detail in this paper, as this technique has changed the management algorithm for VUR dramatically. [ABSTRACT FROM AUTHOR]

Over an 8-year period (January 1996 to December 2003), a total of 171 patients below the age of 15 years were diagnosed with chronic renal failure. The mean incidence rate of CRF in Kuwaiti children was found to be 38.2 per million children per year, with a peak incidence of 55 per million children per year. While the mean age at diagnosis was 33±12 months (range: 1 month to 15 years), the male:female ratio was 2.7:1. Etiological factors for chronic renal failure included congenital urological malformation (61.9%), chronic glomerulopathies (5.2%), hereditary nephropathies (21%), multi-system disease (0.5%), chronic pyelonephritis (without VUR) (4.6%), tumors (0.6%), ischemic renal disease (1.1%) and unknown etiology (1.7%). Thirty percent of patients reached end-stage renal disease within a mean of 18 months following diagnosis. The overall mortality before reaching ESRD was reported to be 4%. Kuwait has one of the highest incidence and prevalence rates of CRF in children. It is likely that genetic and hereditary factors are the cause of these high rates. [ABSTRACT FROM AUTHOR]

Aim: To determine the long-term results of ureterocele repair, bearing in mind the relative rarity of the malformation, its very polymorphic appearance and the diversity of treatments.Materials and Methods: Long-term results were assessed by postoperative follow-up of 126 children with 131 ureteroceles between 1970–2000.Results: With a mean follow-up of 72 months, only 64.2% of children were cured after a one-stage procedure. According to the anatomical type, favourable results were obtained in 81.6% of cases with a single ureter and 57.9% of cases with a duplicated ureter. Treatment success rates for single or duplicated ureters were 73% in the case of intravesical implantation and only 53.9% (34/63 children) in ectopic forms. According to the technique, cure rates were 67.6% after distal incision in 34 children, 61.9% after total nephrectomy or upper pole nephrectomy in 42 children, 50% after ureterocele repair and ureterovesical reimplantation in 20 patients, 75% after total resection of the pathological ureter, parietal reconstruction and ipsilateral and/or contralateral reimplantation in another 20 patients.Conclusions: A one-stage procedure is only able to cure 2/3 of patients. In view of the tendency to progressive regression of often monstrous distensions during the neonatal period, first-line treatment should consist of a distal incision, followed, in the case of recurrent infections, by partial or total nephrectomy, while reserving the intravesical approach to cases with recurrent pyelonephritis. When this surgery is performed on older children or adolescents, the ureteroceles will be smaller with a lower risk of sphincter damage. [Copyright &y& Elsevier]

Abstract Background: The activation of the renin–angiotensin system in various renal disorders is well established. Congenital urological abnormalities, such as obstruction and reflux, are common causes of renal failure in children contributing to approximately 25% of chronic renal failure in this age group. While the outlook relates to the severity of initial renal damage, there is considerable heterogeneity in renal parenchymal destruction among individuals and the reasons for this heterogeneity are not fully understood. A polymorphism within intron 16 of the angiostensin-converting enzyme (ACE) gene has been shown to influence the activity of the renin–angiotensin system, thus, it may also have an impact on the expression of renal disorders. We have determined the incidence of this ID polymorphism of the ACE gene in 47 Kuwaiti children with different urological abnormalities leading to variable degrees of renal impairment and in 48 healthy control subjects with a similar ethnic background. Methods: Blood samples were collected from the patients (n=47) and controls (n=48), total genomic DNA extracted and the ACE genotypes were determined using a polymerase chain reaction-based method. Results: The DD genotype was detected in 27/47 (57%) cases compared with 25/48 (52%) controls (P=0.439). The heterozygous genotype ID was found in 14/47 (29%) cases compared with 22/48 (46%) controls (P=0.0138). The homozygous II genotype was detected in 6/47 (13%) cases compared with 1/48 (2%) controls (P=0.0247). The D allele of ACE gene was detected in 41/47 (87%) uropathy cases when individuals with homozygous DD and heterozygous ID genotypes were considered collectively. The incidence of parenchymal damage was considerably higher in uropathy cases with DD genotype (62%) compared with those having ID (26%) and II (12%) genotypes. Conclusions: Our data suggest an association of D allele of the ACE gene insertion/deletion polymorphism and congenital urological abnormalities, which result in parenchymal damage in Kuwaiti Arab children. [ABSTRACT FROM AUTHOR]