Comparison of laparoscopic pyeloplasty vs. robot-assisted pyeloplasty for the management of ureteropelvic junction obstruction in children.

Background: Ureteropelvic junction obstruction (UPJO) is a commonly observed abnormality in pediatric urology. Minimally invasive approaches have gained popularity in recent years. Studies have demonstrated excellent results with both laparoscopic pyeloplasty (LAP) and robot-assisted pyeloplasty (RAP).

A Proteomics Signature of Mild Hypospadias: A Pilot Study.

Mild hypospadias is a birth congenital condition characterized by the relocation of the male urethral meatus from its typical anatomical position near the tip of the glans penis, to a lower ventral position up to the brim of the glans corona, which can also be accompanied by foreskin ventral deficiency. For the most part, a limited number of cases have known etiology. We have followed a high-throughput proteomics approach to study the proteome in mild hypospadias patients.

New frontiers on the molecular underpinnings of hypospadias according to severity.

Hypospadias, which is characterised by the displacement of the urethral meatus from its typical anatomical location in males, shows various degrees of severity. In this systematic review, we surveyed our current understanding of the genetics of isolated hypospadias in humans according to the severity of the condition. We found that sequencing and genotyping approaches were the preferred methods of study and that single nucleotide polymorphisms were the most common finding associated with hypospadias.

Severity-Dependent Profile of the Metabolome in Hypospadias.

Hypospadias, characterized by the displacement of the opening of the urethra at any point in the medial-ventral side of the penis, is classified upon severity as mild (Type I) and severe (Type II and Type III) hypospadias. Hypospadias' etiology is idiopathic in the majority of cases, and underlying causes seem of multifactorial origin. Studies regarding genetic variants support this notion.

Evaluation and Management of the Undescended Testis in Puerto Rico: A Single Surgeon's 10 Years of Experience.

Objective: Cryptorchidism is an abnormality of the male genitourinary tract in which one or both testes fail to descend into the scrotum. The American Urological Association (AUA) clinical guidelines for the evaluation and treatment of cryptorchidism were recently published. We reviewed our experience with the evaluation and management of our patients and examined our findings with respect to the AUA and European Association of Urology (EAU) guidelines.

Current Concepts in Pediatric Robotic Assisted Pyeloplasty.

Robotic surgery in pediatric urology has been gaining popularity since its introduction almost two decades ago. Robotic assisted pyeloplasty is the most common robotic procedure performed in pediatric urology. Advances in robotic technology, instrumentation, patient care and surgical expertise have allowed the correction of ureteropelvic junction (UPJ) obstruction in most patients using this minimally invasive technique.

Can regional anesthesia have an effect on surgical outcomes in patients undergoing distal hypospadia surgery?

Background: Caudal and penile blocks are the most popular regional anesthetic techniques used in infants and children undergoing urological surgery. A recent report has suggested that penile venous pooling resulting from caudal blocks could affect surgical outcomes after hypospadias operations.

Objective: The aim was to report our experience in patients with distal hypospadias undergoing repair with caudal versus penile block.

Age of the mother as a risk factor and timing of hypospadias repair according to severity.

Background & Objectives: Hypospadias is characterized by a displacement of the urethral opening in males that can change from the typical position within the glans penis to a subcoronal position (Type I), to anywhere along the ventral shaft (Type II), to penoscrotal, scrotal, or perineal positions (Type III). We and others have previously reported that age of the mother (≥ 40 years old) is a risk factor for having a child with hypospadias, but there is a scarcity of reports on whether such risk is higher for having a child with the mild (Type I) or the more severe forms (Types II and III). In addition, we aimed to assess the timing of hypospadias repair according to severity.

Concordance of Expert and Parental Opinion about Hypospadias Surgical Outcome Is Severity Dependent.

Introduction: Hypospadias is a male congenital condition where the opening of the urethral meatus is not located in the typical anatomical position. It has been a challenge for empirical studies to ascertain the level of concordance of opinion among parents and urologists with regard to surgical outcomes according to hypospadias severity.

Materials And Methods: Parents of children who had undergone hypospadias repair were recruited for this study (n = 104).

Multi-institutional Experience in Laparoendoscopic Single-site Surgery (LESS): For Major Extirpative and Reconstructive Procedures in Pediatric Urology.

Objective: To review peri-procedural outcomes from a large, multi-institutional series of pediatric urology patients treated with laparaendoscopic single-site surgery (LESS) for major extirpative and reconstructive procedures.

Materials And Methods: Consecutive LESS cases between January 2011 and May 2014 from three free-standing pediatric referral centers were reviewed. Data include age, sex, operative time, blood loss, length of stay, and complications according to the modified Clavien-Dindo classification.

Laparoscopic Single-Site Surgery in Pediatric Urology: Where Do We Stand Today?

Since the first description of the laparoendoscopic single-site surgery (LESS) in the pediatric urology population, various authors have shared their experiences and results. We aim to provide a review of current studies of LESS and share our experience with this modality. The current literature describes the use of LESS for most surgeries performed in the pediatric urology population with similar results to open and standard laparoscopic surgery.

Laparoscopy in the surgical management of the non-palpable testis.

Introduction: To demonstrate that laparoscopic intervention should be considered as the initial surgical approach in the management of the non-palpable testis (NPT).

Methods: From 2007 to 2011, 100 testicular units underwent same surgeon laparoscopic management for NPT. Diagnostic laparoscopy was performed in all NPT and intra-abdominal testes (IAT) were managed by laparoscopic orchiopexy if low, laparoscopic Fowler-Stephens technique if high, and laparoscopic orchiectomy if atrophic.

The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis.

The evaluation and management of fetuses/children with antenatal hydronephrosis (ANH) poses a significant dilemma for the practitioner. Which patients require evaluation, intervention or observation? Though the literature is quite extensive, it is plagued with bias and conflicting data, creating much confusion as to the optimal care of patients with ANH. In this article, we summarized the literature and proposed recommendations for the evaluation and management of ANH.

Tumor in bladder reservoir after gastrocystoplasty.

Purpose: To our knowledge the risk of malignancy in patients with previous bladder augmentation with stomach is unknown. We report 3 cases of gastric adenocarcinoma and 1 of transitional cell carcinoma after augmentation cystoplasty with stomach with long-term followup.

Materials And Methods: Between August 1989 and August 2002, 119 patients underwent augmentation cystoplasty with stomach at our 2 institutions (University of Miami School of Medicine, and Seattle Children's Hospital and Regional Medical Center).

Severe congenital midureteral dilatation.

Congenital midureteral stricture is an uncommon cause of prenatal hydronephrosis, and it is generally associated with proximal hydroureteronephrosis . We report a unique case of a congenital severe midureteral dilatation associated with mild proximal ureteral dilatation and normal distal ureteral diameter. The dilated midureter was excised, and an open end-to-end ureteroureterostomy was performed.

Salvage extravesical ureteral reimplantation after failed endoscopic surgery for vesicoureteral reflux.

Purpose: Open intravesical ureteral reimplantation has been reported to be uncomplicated following dextranomer/hyaluronic acid implantation. However, there are no known reports regarding extravesical ureteral reimplantation following dextranomer/hyaluronic acid failure. We reviewed our experience with extravesical ureteral reimplantation after dextranomer/hyaluronic acid failure.

Segmental multicystic dysplasia and ureteropelvic junction obstruction in a nonduplicated kidney.

A 2-month-old child presented for evaluation of prenatal hydronephrosis. Imaging studies were consistent with a right duplex system with a dysplastic, nonfunctioning upper pole and lower pole ureteropelvic junction obstruction. We proceeded with removal of the upper pole and pyeloplasty and were surprised to find a single collecting system with a cystic, dysplastic upper pole segment and the absence of an upper pole pelvis or ureter.

New contralateral vesicoureteral reflux following dextranomer/hyaluronic Acid implantation: incidence and identification of a high risk group.

Purpose: To our knowledge the incidence of NCVUR following the endoscopic treatment of VUR with Dx/HA has not been reported previously. We evaluated the outcomes in a group of patients to determine the incidence, and to attempt to identify risk factors.

Materials And Methods: A total of 126 children with primary unilateral VUR underwent unilateral Dx/HA implantation at our institutions.

The treatment of catheterizable stomal incontinence with endoscopic implantation of dextranomer/hyaluronic acid.

Purpose: The creation of a catheterizable stoma has revolutionized the management of complex bladder reconstruction. Unfortunately, urinary incontinence per catheterizable stoma is seen in some patients. We present our experience with the use of submucosal implantation of dextranomer/hyaluronic acid in patients with catheterizable stomas with urinary incontinence.

Adolescent urology.

The area of adolescent urology encompasses a period of development that coincides with puberty. Disorders seen during this time either carry over from childhood (eg, hydronephrosis, enuresis, voiding dysfunction) or are early manifestations of urologic problems seen more commonly in adulthood (eg, urolithiasis, varicoceles). This article focuses on several areas of urology common to the adolescent.

Endoscopic treatment with dextranomer/hyaluronic acid for complex cases of vesicoureteral reflux.

Purpose: The surgical correction of primary vesicoureteral reflux (VUR) is highly successful. This success decreases in more complex cases and often involves reoperation and increased morbidity. We present our experience with the use of subureteral injection of dextranomer/hyaluronic acid (Dx/HA) in complex cases of vesicoureteral reflux in which open surgery would have been indicated.

Monoamniotic twin discordant for bilateral renal agenesis with normal pulmonary function.

A 22-year-old G4P3 woman with a twin pregnancy underwent an uncomplicated delivery at 35 weeks of gestation of normal-appearing twin boys. One of the boys returned 24 hours later with no voiding since birth. He was doing well with no respiratory difficulties and normal physical examination findings.

Renal transit time with MR urography in children.

Purpose: To prospectively evaluate use of dynamic contrast material-enhanced magnetic resonance (MR) urography for measurement of renal transit time (RTT) of a contrast agent through the kidney and collecting system so as to identify obstructive uropathy in children.

Materials And Methods: One hundred twenty-six children suspected of having hydronephrosis were hydrated prior to undergoing both conventional and dynamic contrast-enhanced MR urography of the kidneys and urinary tract. A three-dimensional sequence was used to track passage of contrast agent through the kidneys.

The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter.

Purpose: With the advent of tissue bulking agents, in particular dextranomer/hyaluronic acid copolymer (Dx/HA), for endoscopic implantation for vesicoureteral reflux (VUR), there has been a major shift in the surgical paradigm throughout Europe, and more recently, in the United States. We describe a modification of the technique used for implantation that has significantly improved our results.

Materials And Methods: Between October 2001 and October 2003, 285 children 7 months to 15 years old (mean age 4.

A prospective study comparing ultrasound, nuclear scintigraphy and dynamic contrast enhanced magnetic resonance imaging in the evaluation of hydronephrosis.

Purpose: A combination of nuclear medicine, ultrasound and voiding cystourethrography is typically used to investigate hydronephrosis in children. A major problem is the lack of an accepted gold standard to assess obstruction. In some cases the anatomy is unclear.