Pedro-José López

Balanitis xerotica obliterans in children and adolescents: A literature review and clinical series

OBJECTIVE Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease that is considered as male genital variant lichen sclerosis. The incidence varies greatly in different series; diagnosis is mostly clinical but histopathological confirmation is mandatory. Various treatments are described, but there is no consensus that one is the best. MATERIALS AND METHODS A literature review was made of BXO and lichen sclerosis in boys under 18 years of age, between 1995 and 2013, analyzing demographic dates, treatments and outcomes. In addition to that, we reviewed BXO cases treated in our centers in the last 10 years. RESULTS After literature review, only 13 articles matched the inclusion criteria. Analyzing those selected, the global incidence of BXO is nearly 35% among circumcised children. Described symptoms are diverse and the low index of clinical suspicion is highlighted. The main treatment is circumcision, with use of topical and intralesional steroids and immunosuppressive agents. CONCLUSION BXO is a condition more common than we believe and we must be vigilant to find greater number of diagnoses to avoid future complications. The main treatment for BXO is circumcision, but as topical or intralesional treatments are now available with potentially good outcomes, they may be considered as coadjuvants.

Outcome of tunnelled central venous catheters used for haemodialysis in children weighing less than 15 kg

PURPOSE Central venous catheters (CVC) are frequently used for haemodialysis (HD) in children. However, there is paucity of information on the outcomes of CVCs when used for HD in very young patients. Our objective is to report the success, safety and complication rates of CVCs used for HD in children weighing less than 15 kg. MATERIALS AND METHODS This is a single-center retrospective study of all patients with end-stage renal disease (ESRD) weighing <15kg, who underwent a tunneled CVC placement for HD, between July 2006 and June 2012 at our institution. Analysed data included clinical background, age and weight at initiation of HD, outcome of HD, CVC vein insertion site, reason for removal, and catheter survival (in days). RESULTS Thirty-one CVC were placed in 11 patients weighing <15 kg, 8 males and 3 females. The main causes of ESRD were renal dysplasia and congenital nephrotic syndrome. At the beginning of HD, mean age was 27.5 (range 5-60) months and mean weight was 10.4 kg (4.5-13 kg). The preferred insertion site was the right internal jugular vein (90%). Mean duration of HD was 312 days. Mechanical factors were the main reason for catheter removal (39%). Mean catheter survival was 110 days/catheter. CONCLUSIONS We believe our study provides relevant information and encouraging data to support the use of CVC for HD in this cohort of infants; however, further improvement in prevention of catheter thrombosis and management of infections needs to be achieved.

Evidence-based Treatment of Multicystic Dysplastic Kidney: A Systematic review

OBJECTIVES There is a lack of a standardised protocol for the investigation and non-operative management of paediatric multicystic dysplastic kidney (MCDK). Institutional protocols for non-operative management remain essentially ad hoc. The primary outcome of this systematic review is to establish the incidence of hypertension associated with an MCDK. The secondary outcome is to determine the malignancy risk associated with an MCDK. The tertiary outcome is to assess the rate of MCDK involution. Subsequent to these, an evidence-based algorithm for follow-up is described. METHODOLOGY A systematic review of all relevant studies published between 1968 and April 2017 was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified by specific inclusion and exclusion criteria, all of which included data relevant to the primary, secondary and tertiary outcomes. Hypertension was defined as systolic blood pressure greater than the 95th centile for gender, age and height centile. Subset analysis was performed for hypertension associated with an MCDK. RESULTS The primary outcome measure revealed a 3.2% (27/838) risk of developing hypertension associated with an MCDK. The secondary outcome measure noted a 0.07% malignancy risk (2/2820). The tertiary outcome measure established that 53.3% (1502/2820) had evidence of involution of the dysplastic kidney. A total of 44 cohort studies (2820 patients) were analysed. CONCLUSION Given the low risk of hypertension and malignancy, which is similar to the general population, the current conservative non-operative pathway is an appropriate management strategy. An algorithm to help support clinicians with ongoing management is proposed.

Intraoperative cystography pre- and post-endoscopic treatment for vesicoureteral reflux: Guaranteed success?

OBJECTIVE This study was designed to investigate whether post-endoscopic treatment (ET) intraoperative cystography is predictive of treatment outcome. PATIENTS AND METHODS Patients diagnosed with vesicoureteral reflux (VUR) and treated endoscopically with polyacrylate/polyalcohol copolymer or dextranomer hyaluronic acid were studied prospectively between August 2009 and April 2011. Slow infusion pre-ET cystography was performed under anesthesia. Post-ET cystography was performed only if the intraoperative pre-ET results demonstrated VUR. RESULTS Over a period of 20 months, 23 patients were studied (18 girls, five boys), with an average age of 41.9 months (range 13 months-11 years). Thirty-two renal units with reflux were treated: nine bilateral cases, seven right, and seven left. The distribution of reflux grades was as follows: two grade I, 10 grade II, 11 grade III, nine grade IV. All injected ureters demonstrated grade 0 hydrodistention after the procedure. Twelve of 23 of the pre-ET cystography results were negative for VUR, indicating that the sensitivity of this test is 47% compared with the preoperative voiding cystourethrography (VCUG) or nuclear cystogram. There were no procedure complications. CONCLUSION Of all patients (n = 23), nearly 60% did not demonstrate pre-ET VUR on intraoperative cystography. If a postoperative VCUG had been performed on all patients, more than half would have received unnecessary radiation. Therefore, this study demonstrates that post-ET cystography does not predict the success of ET of VUR intraoperative. Pre-ET cystography under general anesthesia before ureteral injection, has very low sensitivity, creating false-negatives that may complicate the interpretation of post-ET cystography. We suggest that intraoperative cystography before and after ET fails to show clinical utility and should not be used to predict the outcome of endoscopic VUR treatment.

Abdominal Pain - Urological Aspects

Abdominal pain is one of the most common symptoms in pediatric practice. Etiologies behind it are multiple; a number of urological conditions present themselves with abdominal pain which may be classified as follows: a. Obstructive b. Nonobstructive pathologies: infectious diseases, malignancies and gynecological conditions