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AUA Highlights Pediatric Urology

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AUA Highlights 'Pediatric Urology' Mohamed El Sherbiny, MD. Montreal Children Hospital ... Reconstructive Urology. MANAGEMENT OF STRICTURES AFTER HYPOSPADIAS ... – PowerPoint PPT presentation

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Title: AUA Highlights Pediatric Urology


1
AUA Highlights Pediatric Urology
  • Mohamed El Sherbiny, MD
  • Montreal Children Hospital
  • McGill University Health Center

2
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

3
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

4
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

5
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

6
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

7
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

8
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

9
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)

10
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

11
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

12
Reconstructive Urology
13
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

14
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

15
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)

16
Risk factors and Etiology of Genito-Urinary
Anomalies
17
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

18
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

19
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.

20
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

21
Thank you
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