Holding Water: Congenital Anomalies of the Kidney and Urinary Tract, CKD, and the Ongoing Role of Excellence in Plumbing.

Congenital anomalies of the kidneys and urinary tracts can result in diminished natal kidney function, possibly through common embryologic pathway disruption or as a result of development taking place in the face of disordered 'post-renal' drainage. Impaired conduit and reservoir function present potential for an ongoing assault leading to further deterioration and progression of chronic kidney disease, a risk that extends to adults with these conditions, even after "correction". The drainage and storage aspects of the urinary system that can impact kidney function are reviewed with attention to correctable or manageable problems including: Bladder dysfunction wherein the low pressure storage of urine is compromised requiring the kidney to work against a pressure gradient, the classic post renal failure problem.

Intermittent testicular torsion in the pediatric patient: sonographic indicators of a difficult diagnosis.

Objective: The purpose of this study was to determine whether intermittent testicular torsion, defined as the sudden onset of unilateral scrotal pain of short duration with spontaneous resolution, has sonographic indicators that can be used to establish the diagnosis.

Materials And Methods: A retrospective search for pediatric patients presenting with suspected intermittent testicular torsion over a 2-year period was performed. The sonographic findings, medical records for clinical presentation, surgical outcomes, and comorbidities relevant to intermittent testicular torsion were reviewed.

Single-center experience with pediatric laparoscopic extravesical reimplantation: safe and effective in simple and complex anatomy.

Purpose: Minimally invasive approaches to the surgical management of vesicoureteric reflux (VUR) have become more prominent over the last 10 years with progress in both endoscopic and laparoscopic/robotic surgery. We hypothesized that laparoscopic extravesical detrussoraphy (LED) for the management of VUR in children with complex bladders and/or bilateral VUR was safe and effective.

Subjects And Methods: Under institutional review board approval we evaluated the charts of all patients seen at our institution over the last 8 years who had undergone LED for the management of VUR.

The impact of surgical approach and urinary diversion on patient outcomes in pediatric pyeloplasty.

Purpose: Recent comparisons of the impact of the surgical approach on pediatric pyeloplasty outcomes have generally incorporated a form of internal ureteral drainage. We hypothesized that the surgical approach does not affect outcomes in children who undergo unstented pyeloplasty and stenting offers no long-term benefit in those with pediatric pyeloplasty.

Materials And Methods: After receiving institutional review board approval we examined the records of all children who underwent initial pyeloplasty from December 2001 to December 2009.

A single-center experience with prone retroperitoneoscopic versus open renal surgery in children: an age- and procedure-matched comparison.

Purpose: We determined how surgical outcomes differ among children undergoing prone retroperitoneoscopic (RP) and open total and partial nephrectomies for benign renal disease.

Patients And Methods: A retrospective analysis was performed, using medical records of children who were undergoing benign renal surgery at a single institution from 2001 to 2010. Patients were divided into open or RP cohorts, then subdivided into those who were undergoing total or partial nephrectomies.

Ex-premature infant boys with hypospadias are similar in size to age-matched, ex-premature infant boys without hypospadias.

Objective: Studies have postulated that hypospadias, prematurity, and low birth weight are linked by defects in androgen signaling. To determine whether premature, hypospadiac boys are small and remain so, we compared their size at birth and at hypospadias repair to premature boys who underwent post-neonatal circumcision.

Methods: We identified premature boys admitted to Texas Children's Hospital who underwent either hypospadias repair or circumcision after 4 months of age.

Factors associated with delayed treatment of acute testicular torsion-do demographics or interhospital transfer matter?

Purpose: Testicular torsion is a true urological emergency. We determined whether a delay in treatment due to hospital transfer or socioeconomic factors would impact the orchiectomy rate in children with this condition.

Materials And Methods: We retrospectively evaluated the records of boys seen at a single institution emergency department who proceeded to surgery for a diagnosis of acute testicular torsion from 2003 to 2008.

Cross-sectional evaluation of parental decision making factors for vesicoureteral reflux management in children.

Purpose: Parental decision making in children with vesicoureteral reflux has potentially become more complex with the evolution of ethnic diversity in the United States, the Internet, the publication of contradictory clinical data and the emergence of minimally invasive surgery. We performed a cross-sectional study of parental management for pediatric vesicoureteral reflux.

Materials And Methods: We administered a 26-item questionnaire to parents of children with vesicoureteral reflux seen at Texas Children's Hospital urology offices or undergoing antireflux surgery at that institution.

Endoscopic treatment of symptomatic refluxing renal transplant ureteroneocystostomies in children.

To present a multi-center experience with the use of Dx/HA copolymer for treatment of symptomatic refluxing renal transplant UNC in children. A multi-center, retrospective chart review was performed. Eleven patients with a mean age of eight yr underwent renal transplantation with an anti-refluxing UNC.

Bladder injuries during laparoscopic orchiopexy: incidence and lessons learned.

Purpose: Laparoscopic orchiopexy is a safe operation. However, the bladder can be injured during creation of the transperitoneal tunnel for the cryptorchid testis. We reviewed our experience with this complication.

Experimental congenital vesicoureteral reflux in sheep is associated with reduced renal expression levels of aquaporin 1 and 2.

Purpose: Impaired concentrating capacity has been demonstrated in human refluxing kidneys and in kidneys of growing animals with experimental congenital vesicoureteral reflux. Aquaporin water channel proteins are the principal mediators of water homeostasis in the kidney. We examined the impact of experimental congenital vesicoureteral reflux on renal aquaporin protein expression.