Pedro Recabal

The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis.

OBJECTIVE To evaluate the effectiveness of the first postnatal ultrasound (US) in predicting the final postnatal diagnosis using a database of children followed prospectively for antenatal hydronephrosis, and to compare these findings with a systematic review of the literature. METHODS The study involved 1441 children who had their radiological evaluation between 3 and 60 days of life, including an US, performed at our institution in 1998-2006. Univariate and multivariate analyses were performed. A systematic review of articles on prenatal hydronephrosis resulted in 31 studies with 2202 patients who met the inclusion criteria for analysis. RESULTS 62.0% of renal units (RUs) had transient or non-obstructive hydronephrosis. Increasing degree of hydronephrosis correlated with increased risk of urological pathologies (from 29.6% RUs in the mild group to 96.3% RUs in the severe group). A systematic review of the literature indicated very poor quality data, but the findings appeared to be concordant with those from our patient population. CONCLUSION The findings from this study will help to quantify the incidence of postnatal pathology based upon the first postnatal US parameters. This information is useful for counseling and for determining which postnatal radiological tests will be necessary.

Risk Factors for Urinary Tract Infection After Renal Transplantation and its Impact on Graft Function in Children and Young Adults

PURPOSE Urinary tract infection will develop in 40% of children who undergo renal transplantation. Post-transplant urinary tract infection is associated with earlier graft loss in adults. However, the impact on graft function in the pediatric population is less well-known. Additionally the risk factors for post-transplant urinary tract infection in children have not been well elucidated. The purpose of this study was to assess the relationship between pre-transplant and post-transplant urinary tract infections on graft outcome, and the risk factors for post-transplant urinary tract infection. MATERIALS AND METHODS A total of 87 patients underwent renal transplantation between July 2001 and July 2006. Patient demographics, cause of renal failure, graft outcome, and presence of pre-transplant and post-transplant urinary tract infections were recorded. Graft outcome was based on last creatinine and nephrological assessment. RESULTS Median followup was 3.12 years. Of the patients 15% had pre-transplant and 32% had post-transplant urinary tract infections. Good graft function was seen in 60% of the patients and 21% had failed function. Graft function did not correlate with a history of pre-transplant or post-transplant urinary tract infection (p >0.2). Of transplanted patients with urological causes of renal failure 57% had post-transplant urinary tract infection, compared to only 20% of those with a medical etiology of renal failure (p <0.001). CONCLUSIONS In this study there was no correlation between a history of urinary tract infection (either before or after transplant) and decreased graft function. History of pre-transplant urinary tract infection was suggestive of urinary tract infection after transplant. Patients with urological causes of renal failure may be at increased risk for post-transplant urinary tract infection.

Variation in serum prostate-specific antigen levels in men with prostate cancer managed with active surveillance.

To describe fluctuations in prostate‐specific antigen (PSA) levels in men managed with active surveillance (AS) to determine if a single PSA increase is a consistent measure to use to trigger intervention.

MP52-09 INTRAOPERATIVE IDENTIFICATION OF NERVES USING A MYELIN-BINDING FLUOROPHORE: COMPARATIVE EFFICACY OF INTRAVENOUS VS. TOPICAL ADMINISTRATION

patients instead of the 5 mm instruments is common due to the shorter wrist lengths. We hypothesized that the use of 5 mm instruments for RAL pyeloplasty in infants with smaller working spaces will not affect the perioperative parameters and surgical outcomes in comparison to older children with larger working spaces. METHODS: We compared the perioperative parameters and surgical outcomes of RAL pyeloplasties performed by a single surgeon in infants and non-infant pediatric patients over a 2 year period using an 8.5 mm camera and 5 mm robotic instruments. Patient demographics, operative times, intraand postoperative complications, hospital pain medication usage, hospital length of stay, and treatment success rates were compared between the two groups. RESULTS: A total of 65 pediatric RAL pyeloplasties were included in the study (16 infants and 49 non-infant pyeloplasties). There were no significant differences in gender, laterality, proportion of re-do pyeloplasty, or preoperative hydronephrosis grade between the two groups. All procedures were performed without conversion to open surgery or significant perioperative complications. There were no differences in segmental operative times (total operative time, console time, port placement time, time for dissection to UPJO, and anastomosis time), hospital pain medication usage, and hospital length of stay between the two groups (p > 0.05 for all comparisons). The treatment success rates were 93.8% (15/16) and 100% (49/49), respectively (p 1⁄4 0.08). CONCLUSIONS: RAL pyeloplasty is a safe and effective surgical modality even in infants with comparable perioperative parameters and outcomes as those in older children. The use of 5 mm instruments in infants with smaller working spaces does not affect these parameters as well, while offering the potential for improved cosmesis.

MP97-17 A COMPARISON OF INTRAPERITONEAL ONLAY MESH REPAIR VS. MINIMALLY INVASIVE SUTURE REPAIR OF INGUINAL HERNIAS DURING ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

advantages of LESS-RP, such as lower postoperative pain and its cosmetic excellence, have been pointed out. However, LESS-RP is recognized to be a technically challenging procedure even for experts, especially in suturing and dissection. To overcome these challenges, we introduce transurethral-assisted transumbilical laparoendoscopic single-site radical prostatectomy (TU-LESS-RP) . With the technology, many operational equipments can be used through natural orifice to lower the operation difficulty and shorten the operation time. This study is to evaluate the feasibility and advantages of transurethral-assisted technology in LESS-RP for PCa patients. METHODS: From Jan. 2014 to Dec.2015, 118 patients underwent RP in our center, including 11 patients were performed by LESSRP (a single-port with four channels was inserted into the 2.5 cm periumbilical incision), and 107 were performed by TU-LESS-RP (homemade transurethral port were used, Suction and dissociation devices were inserted into transurethral port to assist the surgical operator). All data referring to patient demographics, pathology, and perioperative outcomes were recorded and analyzed. RESULTS: All the operations were successfully accomplished. No conversion into conventional laparoscopic or open surgery was performed. Compared with LESS-RP, TU-LESS-RP is easier to identify the neck of bladder, avoid the injury of rectum, make anastomosis quickly, expose the anatomic structures clearly, and so on. Consequently, with this technology we make the LESS-RP easy to master and shorten the operation and anastomosis time significantly. Meanwhile, we got satisfied cosmetic and continent results for patients. According to our data, TULESS-RP has more significant advantage than LESS-RP in following aspects: the mean operating time (135 min vs 215 min), the median estimated blood loss (108 ml vs 466 ml), the length of stay (9 d vs 16.5 d), and indwelling catheter time (7.5 d vs 14.5 d). All these patients had satisfied continent and cosmetic effects. For patients experienced lymph nodes dissection, the operating time was 36 min, the average lymph nodes was 10.6, and two patients with positive results (3/9 and 2/12). CONCLUSIONS: LESS-RP is technically challenging although with advantage of less invasive and more cosmetic effects even for experts. To solve these problems, TU-LESS-RP has been developed in our institution, and it has been proved more feasible and safer for localized PCa patients. The technology could minimize the interference between the laparoscopic equipments, shorten the operating time, decrease the risk and complications. TU-LESS-RP for localized PCa patients has just begun, and the number of cases experienced is still small. Being cosmetically highly favorable, this procedure will likely be further developed as a less invasive surgery in the future.

URINARY TRACT INFECTION AFTER RENAL TRANSPLANTATION IS NOT ASSOCIATED WITH POOR GRAFT OUTCOME IN CHILDREN

rate of UTI in all patients was 15.4% (95% CI: 9.2-21.4%) and in patients with antenatal hydronephrosis was 4.3% (95% CI: 0.2-8.4%). Among WKHVXEVHWRISDWLHQWVGLDJQRVHGDQWHQDWDOO\��QRVLJQLoFDQWGLI IHUHQFHLQ� infection rate was noted based on the level of obstruction, sex, grade of obstruction, circumcision status, or method of management. CONCLUSIONS: Many patients with hydronephrosis undergo surveillance. Our results demonstrate a low incidence of UTI in patients QRWPDLQWDLQHGRQDQWLELRWLFV��%DVHGRQWKHDERYH�oQGLQJV��ZHF RQFOXGH� that antibiotic prophylaxis in children with Grade III or IV hydronephrosis in the absence of VUR is not warranted.