Our study shows that passive dilation of the ureteral orifice in preparation for ureteroscopy is a straightforward, successful and beneficial technique in children, with no associated complications.

Purpose The management of the contralateral inguinal canal in children with clinical unilateral inguinal hernia is controversial. Our objective was to systematically review the literature regarding management of the contralateral inguinal canal. Methods We searched MEDLINE, EMBASE, and Cochrane databases (1940–2011) using ‘hernia’ and ‘inguinal’ and either ‘pediatric,’ ‘infant,’ or ‘child,’ to identify studies of pediatric (age≤21 yrs) patients with inguinal hernia. Among clinical unilateral hernia patients, we assessed the number of cases with contralateral patent processus (CPP) and incidence of subsequent clinical metachronous contralateral hernia (MCH). We evaluated three strategies for contralateral management: expectant management, laparoscopic evaluation or pre-operative ultrasound. Pooled estimates of MCH or CPP were generated with random effects by study when heterogeneity was found (I2>50%, or Cochrane’s Q p≥0.10). Results We identified 2,477 non-duplicated studies, 129 of which met our inclusion criteria and had sufficient information for quantitative analysis. The pooled incidence of MCH after open unilateral repair was 7.3% (95% CI 6.5%–8.1%). Laparoscopic examination identified CPP in 30% (95% CI 26%–34%). Lower age was associated with higher incidence of CPP (p<0.01). The incidence of MCH after a negative laparoscopic evaluation was 0.9% (95% CI 0.5%–1.3%). Significant heterogeneity was found in studies and pooled estimates should be interpreted with caution. Conclusions The literature suggests that laparoscopically identified CPP is a poor indicator of future contralateral hernia. Almost a third of patients will have a CPP, while less than one in 10 will develop MCH when managed expectantly. Performing contralateral hernia repair in patients with CPP results in overtreatment in roughly 2 out of 3 patients.

Runninghead: Long-term outcomes of catheterizable urinary channels

Study Type – Diagnostic (non‐consecutive)
Level of Evidence 3b OBJECTIVE To describe the clinical and magnetic resonance imaging (MRI) characteristics of vaginal and paraurethral leiomyomas. PATIENTS AND METHODS All patients with pathologically confirmed paraurethral and vaginal wall leiomyomas from January 2006 to August 2007 were reviewed. Patients with no preoperative MRI of the pelvis were excluded. RESULTS Five patients were identified; all had a firm, smooth, non‐tender, non‐fluctuant mass. MRI showed a well‐circumscribed shape, a homogeneous signal that was hypointense or isointense to muscle on T1‐ and hyperintense or isointense to muscle on T2‐weighted images, and uniform enhancement. In all cases, MRI excluded urethral diverticulae, and pathology showed leiomyoma, of which one had atypical features. CONCLUSION Paraurethral and vaginal wall leiomyomas can be identified before surgery with a reasonable degree of certainty, based on their clinical and MRI characteristics.

No abstract

Nephrolithiasis in the pediatric population is an important cause of morbidity worldwide. Presenting signs and symptoms are often considerably different from those in adults. Vague abdominal pain, hematuria, and urinary tract infection are more common in children than the classic colicky flank pain. Imaging of suspected cases should be undertaken with careful consideration of diagnostic accuracy and the potentially harmful effects of ionizing radiation. Because children with nephrolithiasis have a high chance of recurrent stone formation, a thorough risk assessment and metabolic evaluation should be performed. This review discusses the presentation, acute evaluation and risk assessment of nephrolithiasis in the pediatric population.

Purpose-Success rates of ureteral reimplantation for primary vesicoureteral reflux (VUR) are high. Few studies document the natural history of children with persistent VUR. We reviewed their clinical outcomes and long-term resolution.Materials and Methods-We performed a retrospective review of all children with persistent VUR (grade≥1) into the reimplanted ureter(s) on initial cystogram after reimplantation for primary VUR at our institution from January 1990 -December 2002. We evaluated subsequent cystograms (graded on the 3-point radionuclide cystogram scale), surgery, and urinary tract infection (UTI). We performed survival analyses of time to resolution of persistent (grade≥1) and clinically significant (grade≥2) VUR in patients with >1 postoperative cystogram.

Introduction Urolithiasis is associated with systemic medical conditions in adults, but associations have not been well studied in children. We investigated the association of urolithiasis with diabetes mellitus (DM), hypertension (HTN), and obesity among children with and without urolithiasis. Methods We performed a matched case-control study using the Pediatric Health Information System (PHIS) database. ICD-9 codes identified urolithiasis cases from 2004–2009. Four randomly selected controls were matched by age, hospital, patient care setting, and year of treatment. Diagnoses from all hospital encounters were ascertained for comorbid conditions. Univariate and multivariable conditional logistic regression were used to assess the associations of urolithiasis with DM, HTN, and obesity. Results We identified 9,843 urolithiasis cases and 39,047 controls. On univariate analysis, stone patients had significantly higher odds of obesity (OR 1.44, 95% CI 1.27–1.64) and HTN (OR 2.12, 95% CI 1.88–2.40) compared to controls. The odds of Type I DM was lower among cases compared to controls (OR 0.38, 95% CI 0.30–0.48). After adjusting for gender, race, insurance type, and number of visits using logistic regression, children with urolithiasis still had higher odds of obesity (AOR 1.30, 95% CI 1.12–1.51) and HTN (AOR 1.61, 95% CI 1.40–1.86) and lower odds of Type I DM (AOR 0.32, 95% CI 0.25–0.41) as compared to controls. Conclusions Among pediatric patients at freestanding children’s hospitals, urolithiasis is associated with higher odds of obesity and hypertension and a lower odds of Type I DM. These findings may be helpful in further elucidating the etiology of pediatric urolithiasis.