Boysen, WR; Akhavan, A; Ko, J; Ellison, JS; Lendvay, TS; Huang, J; Garcia-Roig, M; Kirsch, A; Koh, CJ; Schulte, M; Noh, P; Monn, MF; Whittam, B; Kawal, T; Shukla, A; Srinivasan, A; Gundeti, MS. Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): Outcomes and complications. Journal of Pediatric Urology. 2018; 14(3):262.e1-262.e6.
Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a minimally invasive alternative to open surgery. We have previously reported retrospective outcomes from our study group, and herein provide an updated prospective analysis with a focus on success rate, surgical technique, and complications among surgeons who have overcome the initial learning curve. We reviewed our prospective database of children undergoing RALUR-EV by pediatric urologists at eight academic centers from 2015 to 2017. We report a radiographic success rate of 93.8% overall, and 94.1% among children with grades III-V VUR. We found that radiographic resolution of VUR following RALUR is on par with contemporary open series, and the incidence of ureteral complications is low. Consideration of RALUR is one of several viable options for management of VUR in children.
DeFoor, W; Reddy, P; Reed, M; VanderBrink, B; Jackson, E; Zhang, B; Denlinger, J; Noh, P; Minevich, E; Sheldon, C. Results of a prospective randomized control trial comparing hydrophilic to uncoated catheters in children with neurogenic bladder. Journal of Pediatric Urology. 2017; 13(4):373.e1-373.e5.
Children with neurogenic bladder (NGB) often require a lifetime of clean intermittent catheterization (CIC), typically using uncoated catheters (UCs). Hydrophilic catheters (HCs) have lower friction than UCs with reported less damage to the urethra. The purpose of this study is to compare outcomes between these catheters. In conclusion, we determined that HCs may decrease the risk of UTI in children with NGB. Urethral complications were low in both groups. This pleased most HC patients, but some found the slippery coating difficult to handle.
O'Brien, LL; Guo, Q; Bahrami-Samani, E; Park, JS; Hasso, SM; Lee, YJ; Fang, A; Kim, AD; Guo, J; Hong, TM; Peterson, KA; Lozanoff, S; Raviram, R; Ren, B; Fogelgren, B; Smith, AD; Valouev, A; McMahon, AP. Transcriptional regulatory control of mammalian nephron progenitors revealed by multi-factor cistromic analysis and genetic studies. PLoS Genetics. 2018; 14(1).
Low nephron endowment increases the risk of kidney disease. Since nephrons derive from nephron progenitor cells, an understanding of the regulatory programs governing nephron progenitors has important translational potential. Although several transcription factors are known to regulate nephron progenitors, their target interactions are largely unknown. This study mapped and intersected the genome-wide binding sites for four such factors, identifying a high-value set of putative enhancer elements linked to genes regulating nephron progenitor properties.
DeFoor, W; Jackson, E; Schulte, M; Alam, Z; Asplin, J. Calcium-to-Citrate Ratio Distinguishes Solitary and Recurrent Urinary Stone Forming Children. The Journal of Urology. 2017; 198(2):416-421.
The prevalence of urinary stone disease is increasing in children. We previously reported a high rate of urinary metabolic abnormalities, including hypercalciuria and hypocitraturia, in stone forming children. In this study we determined whether calcium-to-citrate ratio could help predict those at risk for recurrent stone formation. At the conclusion of our study, we found there are significant differences in urine calcium-to-citrate ratios between solitary and recurrent calcium stone forming children. Solitary stone formers trended higher compared to controls. These findings may allow more precise risk stratification and treatment to prevent recurrent stone episodes.
Reddy, PP; Strine, AC; Reddy, T; Noh, PH; DeFoor WR Jr; Minevich, E; Sheldon, CA; VanderBrink, BA. Triamcinolone injection for treatment of Mitrofanoff stomal stenosis: Optimizing results and reducing cost of care. Journal of Pediatric Urology. 2017; 13(4):375.e1-375.e5.
Stomal stenosis is the most common complication after the creation of a continent catheterizable channel (CCC), but is challenging to treat. Researchers performed a retrospective review of patients who had undergone a triamcinolone injection (40 mg/ml) for the treatment of stomal stenosis at the present institution. The primary outcome of success defined as a patient-reported or caregiver-reported return to ease with catheterization, and avoidance of stomal revision or indwelling catheter. The success rate for triamcinolone injection favorably compared with other options for the treatment of stomal stenosis. It surpassed the reported success rate of stomal dilation and approached that of stomal revision. In conclusion, we found that triamcinolone injection is an effective and well-tolerated option for the treatment of stomal stenosis in any cutaneous stoma, thereby avoiding the need for a more invasive and costly stomal revision.