AUA Highlights Pediatric Urology

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AUA HighlightsPediatric Urology

• Mohamed El Sherbiny, MD
• Montreal Children Hospital
• McGill University Health Center

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Endoscopic treatment of VUR

• Which product? Macroplastique VS Deflux
• Moore and Bolduc
• What about the Long-Term follow up?
• Lee et al.,
• LONG TERM success rate after Deflux
• Kirsch
• LONG-TERM APPEARANCE OF Deflux

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Macroplastique VS Deflux Moore and Bolduc

• Prospective non-randomized study
• 2 groups of patients with VUR treated with
  Macroplastique OR Deflux
• Full correction
• For Macroplastique 119/131 ureters (91)
• For Deflux 39/52 ureters (75)
• Univariate and multivariate analyses
• ? the only significant difference in the success
  rate was the type of product

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Long-term success after Deflux Lee et al.,

• Retrospective study
• First 3-month VCUG
• Success rate 248/333 (75)
• 1-year follow up VCUG (patients with initial
  success)
• Success rate 132/182 (73)
• one year data total success rate
• 132/267 (50)
• LATE FAILURE may WARRANT CONTINUED FOLLOW-UP

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LONG-TERM APPEARANCE OF Deflux Cerwinka and
Kirsch

• Retrospective review
• 9 Patients with history of Deflux subsequent CT
  scans
• average 24 months after injection
• Appearance
• 10 ureters ? tissue density (HU range 19-22)
• 8 ureters ? calcific density (HU range
  126-262)
• Non-calcified blebs ? shorter time since
  injection
• To avoid inappropriate intervention for
  misdiagnosed ureteral stones
• History of endoscopic injection
• The absence of hydronephrosis
• known location of the calcified material outside
  the ureter

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TO CIRC OR NOT TO CIRC Nobre et al.

• A Prospective Randomized study
• Costs of circumcision Vs topical treatment
  Circumcision
• Economic Perspective
• Topical steroid therapy
• 50 success
• Mean cost of US 167 per case (including failure
  costs)
• Circumcision
• Mean cost of US 440 per case (plt0,001)
• Topical treatment of phimosis can spare 50 of
  costs even considering the necessity of rescue
  circumcision

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DEFINING SALVAGE AFTER TESTICULAR TORSION Makari
et al

• Retrospective review 11 boys
• Intraop. salvage Postop. follow-up visit or
  sonogram
• Mean follow-up 131 months
• 4/11 (36) had asymmetry or atrophy
• Importance in
• Preoperative counseling
• Expectations for surgical intervention
• Determining the interval for postoperative
  follow-up

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MALIGNANT POTENTIAL OF THE CRYPTORCHID TESTIS
Banks et al

• A META-ANALYSIS
• TC 4 times common with history of CO
• Laterality
• weakest ipsilateral to unlilaterally UDT OR1.5
• intermediate in contralateral to unilaterally UDT
  OR5.1
• highest in bilaterally undescended testes OR7.1

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Banks et al continue

• Regarding means of descent
• weakest for testes that descended spontaneously
  (OR1.3)
• intermediate for testes repositioned by treatment
  (OR4.3)
• greatest for those remaining undescended (OR6.2)
  
• Age of correction
• lowest for correction by 9 years (OR2.7)
• intermediate for correction at 10-14 years
  (OR4.5)
• highest for correction after 14 years of age
  (OR6.3)

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LYMPHATIC SPARING MICROSCOPIC RETROPERITONEAL
VARICOCELECTOMY Wong et al

• Retrospective Study
• A modification on the Palomo technique
• an operating microscope
• 3-4 lymphatics are preserved
• 20 boys with grade 3 left varicoceles
• A mean follow-up of 8 months.
• No hydroceles
• No recurrences
• No testicular atrophy

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Bladder Urine TGF-b1 in first 3 months of life
and UPJO El-Sherbiny et al

• Prospective study
• A total of 42 newborns were included
• Observation group 31
• Pyeloplasty group 11
• BU-TGFb1 in the first 3 months of life was
  significantly higher in the surgical group
• In predicting surgery, BU-TGF b1 was
• 82 sensitive
• 86 specific

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Reconstructive Urology
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MANAGEMENT OF STRICTURES AFTER HYPOSPADIAS
REPAIR Gargollo et al

• Retrospective study
• 40 patient treated with
• Cold Knife incision (n6) or
• Dilation (n36).
• 25 (60) success
• 15 (40) Failed
• A second CKU or dilation ? success rates 30
• Urethroplasty ? higher success 70

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VAGINOPLASTY USING AUTOLOGOUS BUCCAL MUCOSA Bush
et al,

• Retrospective Study
• Six females (mean age 14 years)
• Harvested unilateral or bilateral
• Mucosa grafts were stented 5-7 days
• Moderate introital stenosis in one patient
• 5/6 ? 3x8cm sounds
• 2 sex active patients report satisfactory
  intercourse

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MITROFANOFF CONTINENT CATHETERIZABLE CONDUITS TOP
DOWN OR BOTTOM UP? Berkowitz ,et al

• To compare the relative drainage efficiency of
  posterior and anterior conduits
• 54 patients with gt3 years follow-up
• Anteriorly (33), or posteriorly (21)
• Anterior conduits had an increased risk of
• UTI 12 (35) Vs. 2 (10) Plt0.01
• Bladder stone 16 (48) Vs. 6 (29)

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Risk factors and Etiology of Genito-Urinary
Anomalies
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Genetic origin of VUR in the French-Canadians
Yang and Anne-Marie Houle

• Screened the RET gene in a well characterized
  group of VUR patients and family members
• In order to maximize the genetic homogeneity, ?
  only french speaking families
• 70 families with at least one member affected by
  VUR
• The study demonstrates that the Ret mutation is
  associated with VUR and may be a genetic origin
  of this condition in the French-Canadians

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MATERNAL RISK FACTORS FOR CONGENITAL URINARY
ANOMALIES Shnorhavorian et al

• Large case control study
• Univariate analyses
• gt 2-fold higher in mothers with DM (OR 2.5)
• gt 5-fold higher in mothers with renal disease (OR
  5.4),
• gt 8-fold higher in mothers with DM with
  pre-existing hypertension (OR 8.7)
• Role prenatal counseling targeted screening with
  prenatal ultrasound

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MATERNAL BURDEN OF ORGANOCHLORO-COMPOUNDS
ASSOCIATED WITH UNDESCENDED TESTES Chen et al.

• Prospective study
• Serum samples from both mothers and their sons on
  the day of orchidopexy
• OCCs, eg PCBs
• Maternal levels of PCB were significantly higher
  in mothers of boys with UDT than in mothers of
  normal boys.

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MATERNAL EXPOSURE TO POLYBROMINATED BIPHENYLS AND
GU CONDITIONS IN MALE OFFSPRING DeCaro et al

• a cohort of individuals accidentally exposed to
  PBBs during 1973-74.
• the study documents an increased incidence of
  male GU conditions associated with PBB exposure

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Thank you