RENAL GROWTH AND FUNCTION IN PATIENTS NEPHRECTOMIZED IN CHILDHOOD

Abstract Aperia, A., Broberger, O., Wikstad, I. and Wilton, P. (Department of Paediatrics and Paediatric Radiology, Karolinska Institute, St. Göran's Children's Hospital, Stockholm, Sweden). Renal growth and function in patients nephrectomized in childhood. Acta Paediatr Scand, 66:185, 1977.—Eight patients nephrectomized in childhood were studied with regard to growth and function of the remaining kidney. The age of the patients ranged between 8½ and 31 years and the follow-up period was from 1 to 20 years. In most of the patients, repeated renal size determinations were made on postoperative urograms. Normal values for kidney size in childhood are also presented. The structural hypertrophy continued for at least three years after nephrectomy and was most pronounced in patients nephrectomized before three years of age. When more than three years had passed after nephrectomy the remaining kidney was 35–65% larger than normal. Healthy young adults and children with a previous history of urinary tract infection served as controls for function studies. The balance between glomerular and tubular function was well preserved in nephrectomized patients. The renal surface area showed the same relation to GFR and to reabsorption of bicarbonate in nephrectomized patients as in controls. It is therefore concluded that the increase in kidney function following unilateral nephrectomy is, at least in early life, primarily due to structural enlargement.     

先天性肾积水患儿肾脏水通道蛋白表达与肾实质厚度和肾小球滤过率的相关性

目的：探讨先天性肾积水患儿肾脏水通道蛋白AQP1-4 的表达与肾实质厚度和肾小球滤过率（GFR）变化之间的关系。方法：利用Western blot检测AQP1-4蛋白在10例先天性肾积水患儿(年龄62.3±18.3个月)10个肾组织和6例来自肾母细胞瘤手术切除患儿的正常肾脏组织(年龄62.7±17.1个月)中的相对表达量。同时对患侧肾脏肾实质厚度和GFR进行评估。积水肾脏AQP1-4表达与GFR以及肾实质厚度之间进行Pearson相关分析检验。结果：肾积水组AQP1-4蛋白相对表达均明显低于正常组（P＜0.05）。B超测量术前积水侧肾脏肾实质厚度平均为4.59±2.25 mm。99mTc-DTPA 测定积水侧肾脏GFR较对侧肾脏明显下降（40±12 mL/min vs 105±20 mL/min, P＜0.05）。积水组肾脏中AQP1-4蛋白相对表达量与肾实质厚度之间呈正相关,与患侧肾脏GFR之间亦呈正相关。积水侧肾脏肾实质厚度与GFR之间呈正相关。结论：先天性积水患儿肾脏AQP1-4蛋白表达下降,其表达量与肾实质厚度和肾脏GFR的变化呈正相关。     

Unilateral multicystic dysplastic kidney: long term outcomes.

AIMS: To report the long term follow up of children with antenatally detected unilateral multicystic dysplastic kidney (MCDK) with documentation of complications, involution rate with time, and renal function at 10 years. METHODS: Data were retrieved from a prospective regional registry of patients with MCDK between 1985 and 2004. Children were followed using a common protocol of investigation with follow up ultrasound scans (USS) at 2 (165 patients), 5 (117 patients), and 10 years (43 patients). RESULTS: Serial USS showed that 33% of the MCDK kidneys had completely involuted at 2 years of age, 47% at 5 years, and 59% at 10 years. No patients developed hypertension, significant proteinuria, or malignancy, but two developed pelviureteric junction obstruction in the contralateral kidney. Twenty seven of 143 children (19%) had vesicoureteric reflux (VUR) (96% mild to moderate VUR) into the contralateral kidney with no difference in the incidence of urinary tract infections or renal scarring between those with or without VUR. The mean estimated glomerular filtration rate (GFR) was 86.4 ml/min/1.73 m2 (range 48-125) in 31 of 43 patients followed to 10 years. CONCLUSIONS: Conservative management of unilateral MCDK is justified with clinical review and infrequent USS but longer term follow up continues in the 41% still with renal remnants at 10 years and those with impaired GFR. It is suggested that the initial micturating cystogram is deferred unless abnormal USS features are present in the contralateral kidney or ureter.     

Renal scintigraphy in children with vesicoureteral reflux

Objective

To determine the incidence and pattern of abnormal scintigraphy findings in children with UTI and VUR.

Methods

Data of 118 children who underwent micturating cystourethrography (MCU) and late Tc-99m dimercaptosuccinic acid (DMSA) scan were evaluated. Findings were categorized under the image appearance and relative kidney uptake (RKU) and related to the grade of VUR, sex and child’s age.

Results

MCU revealed VUR (78 unilateral and 40 bilateral) of grades I, II, III, IV and V in 2, 47, 35, 19 and 15 patients respectively. There were 52 children with normal and 66 with abnormal DMSA finding. Scarring rate was significantly associated with high grade VUR (p=0.0023) and male gender ( p=0.0412). Bilateral scarring was seen exclusively in children with bilateral VUR. No significant difference was found between renal scarring and child’s age in the same gender group. Poor kidney function was shown in 5 patients.

Conclusion

Renal scarring highly correlated with grade of VUR. A strategy to perform MCU only on patients with abnormal DMSA finding is proposed.     

RENAL TRANSPLANTATION IN CHILDREN

ABSTRACT: Henriksson, C., Andersen, H. J., Gustafsson Å. and Gelin, L.-E. (Department of Surgery I, Sahlgren's Hospital, Gothenburg, Sweden, and Department of Pediatrics, Odense Hospital, Odense, Denmark). Renal transplantation in children. Acta Paediatr Scand, 64: 833, 1975.–From July 1967 to September 1974, 26 kidney transplantations were carried out in 16 children aged 6 to 17 years, in Gothenburg. The average age at the primary transplantation was 12 years and average body weight 29.7 kg. Five patients had familial juvenile nephronophthisis, 5 chronic glomerulonephritis, 5 chronic pyelonephritis, and one bilateral Wilms's tumour. Four patients were predialytic. Fourteen grafts came from living related donors. The surgical technique was standard as was the immunosuppression with azathioprine and cortisone; exceptionally antilymphocyte globulin was used. Thirteen patients were alive in September 1974, observed 2–65 months, 8 with a normal serum creatinine, 3 with moderately elevated serum creatinine, and 2 on hemodialysis. The 6- and 12-month survivals of patients are 100% and 93% respectively. Normal growth and full rehabilitation in recipients of functioning grafts make renal transplantation justified as a therapeutic procedure in terminally uremic children.     

Multicystic dysplastic kidney and contralateral vesicoureteral reflux. Renal growth

BACKGROUND: To evaluate if vesicoureteral reflux (VUR) contralateral to the multicystic dysplastic kidney can interfere with the compensatory renal hypertrophy. METHODS: Twenty-seven patients (17 males, 10 females) with multicystic dysplastic kidney (MDK) (14 on the right, 13 on the left) have been treated at the Nephrology Unit of the Pediatric Department of the University of Verona from birth up to the second year of life. All these patients were diagnosed as having MDK by prenatal ultrasonography. Seven children (4 males and 3 females) had VUR (5 monolateral, 2 bilateral), diagnosed at the end of the first month of life. After diagnosis children underwent antibiotic prophylaxis with beta-lactam compounds at low doses. Four patients underwent a surgical correction of VUR associated with nephrectomy within the second year of life. The remaining 3 patients were treated with antibiotic prophylaxis; a progressive resolution or downgrading of reflux grade took place respectively in 1 and in 2 of them. Only 6 children with MDK underwent nephrectomy. Renal growth was studied by serial echographic measurements of the longitudinal renal lenght (performed at birth, at 6 months, and at 2 years of life). RESULTS: Renal length was 5.68+/-1.24 cm, 6.72+/-0.88 cm, 8.56+/-1.27 cm in children without VUR, respectively at birth, 6 months and 2 years of life. Renal length was 4.65+/-0.63 cm, 6.70+/-0.64 cm, 7.07+/-1.14 cm in children with VUR, respectively at birth, 6 months and 2 years of life. A statistically significant difference was observed between the two groups at birth (p<0.05) and at 2 years of life (p<0.01). CONCLUSIONS: The conclusion is that VUR contralateral to the MDK is associated with small kidneys and reduced renal growth both at birth and at 2 years of life.     

Unilateral multicystic dysplastic kidney: long term outcomes

Aims

To report the long term follow up of children with antenatally detected unilateral multicystic dysplastic kidney (MCDK) with documentation of complications, involution rate with time, and renal function at 10 years.

Methods

Data were retrieved from a prospective regional registry of patients with MCDK between 1985 and 2004. Children were followed using a common protocol of investigation with follow up ultrasound scans (USS) at 2 (165 patients), 5 (117 patients), and 10 years (43 patients).

Results

Serial USS showed that 33% of the MCDK kidneys had completely involuted at 2 years of age, 47% at 5 years, and 59% at 10 years. No patients developed hypertension, significant proteinuria, or malignancy, but two developed pelviureteric junction obstruction in the contralateral kidney. Twenty seven of 143 children (19%) had vesicoureteric reflux (VUR) (96% mild to moderate VUR) into the contralateral kidney with no difference in the incidence of urinary tract infections or renal scarring between those with or without VUR. The mean estimated glomerular filtration rate (GFR) was 86.4 ml/min/1.73 m² (range 48–125) in 31 of 43 patients followed to 10 years.

Conclusions

Conservative management of unilateral MCDK is justified with clinical review and infrequent USS but longer term follow up continues in the 41% still with renal remnants at 10 years and those with impaired GFR. It is suggested that the initial micturating cystogram is deferred unless abnormal USS features are present in the contralateral kidney or ureter.     

RENAL FUNCTIONAL ADAPTATION IN THE REMNANT KIDNEY IN PATIENTS WITH RENAL AGENESIS AND IN PATIENTS NEPHRECTOMIZED IN CHILDHOOD

ABSTRACT. The renal response to volume expansion was determined in four patients with renal hypertrophy due to unilateral renal agenesis (URA) and in four patients with renal hypertrophy due to nephrectomy (Nz). Four healthy controls were also studied. The studies were performed during water diuresis and following i.v. infusion of isotonic saline solution. Conventional clearance techniques were used. GFR and PAH clearence were increased to about the same extent in Nz and in URA. Fractional Na⁺ excretion was highest in the Nz group and lowest in the control group. It was higher in the Nz group than in the URA group. Fractional water excretion (V/GFR) and free water clearance (C h ₂ o ) were also determined and the results indicate that the high fractional excretion of Na⁺ from the hypertrophied kidney can be attributed to reduced fractional re-absorption of filtrated Na⁺ both in the proximal and the distal tubules. The fractional Na⁺ reabsorption in the distal tubule appears to be higher in URA than in Nz. It is concluded that glomerular tubular balance for Na⁺ is more similar to that found in healthy controls if the stimulus to hypertrophy occurs prenatally than if it occurs postnatally.     

Renal failure in Wilms' tumor patients: A report from the National Wilms' Tumor Study Group

This report defines the incidence and determines the etiology of renal failure (RF) in patients undergoing treatment for Wilms' tumor (WT). The database of the National Wilms' Tumor Study (NWTS) was searched to identify all children reported to have developed chronic renal failure. There were 55 patients found to have RF. Of these, 39 patients had bilateral tumors, 15 with unilateral disease and one with a WT in a solitary kidney. The median interval from diagnosis to the onset of renal failure was 21 months. The incidence of RF in bilateral WT was 16.4% for NWTS-1 & -2, 9.9% for NWTS-3, and 3.8% for NWTS-4. The incidence of RF in unilateral WT remained stable. The most common etiologies of RF were: bilateral nephrectomy for persistent or recurrent tumor (24 pts), Drash syndrome (12 pts), progressive tumor in the remaining kidney (5 pts), radiation nephritis (6 pts), and other causes (5 pts). The etiology of renal failure was not reported in three children. Children with unilateral WT and a normal contralateral kidney have a very low incidence of RF, and this review does not support a recommendation for parenchymal sparing procedures in these patients. Children with bilateral WT are at risk for the development of RF, and parenchymal sparing procedures are warranted. © 1996 Wiley-Liss, Inc.     

RELATIONSHIP BETWEEN GLOMERULAR FILTRATION RATE AND RADIOLOGICAL APPEARANCE OF THE RENAL PARENCHYMA IN CHILDREN

Selective renal function studies with determination of the glomerular filtration rate (inulin clearance) have been carried out in more than 30 children aged 3 to 15 years. Most of the patients had a history of one or more urinary tract infections as well as pathological IVP-findings of varying degree. The selective studies were accomplished by means of external ureteral compression. Themethod proved to have an extremely good validity even in cases of severe ureteral reflux with dilatation of ureter and pelvis. No correlation could be found between radiological size of the kidney and glomerular filtration rate. In almost half of the patients with significant unilateral reduction of the renal parenchyma the glomerular filtration rate of this side was found to be more than 40% of the total glomerular filtration rate. In contrast the glomerular filtration rate of several of the kidneys estimated to be of normal size was significantly reduced. It is obvious from these findings that nephrectomy must never be carried out until selective renal function studies have been made. An additional finding was an apparently good correlation between the clinical and functional finding, i.e. the glomerular filtration rate appeared to be inversely correlated to the relapse frequency of the urinary tract infections. The fact that the. functional finding correlated well with the clinical finding but not with the radiological size of the kidney suggests various etiologies for the parenchymal reduction.     

CHILDREN OF FEMALE RENAL TRANSPLANT RECIPIENTS

Abstract. Rasmussen, P., Fasth, A., Ahlmén, J., Brynger, H., Iwarson, S. and Kjellmer, I. (Departments of Paediatrics I and II, Surgery I and Infectious diseases and Division of Nephrology, University of Göteborg, Göteborg, Sweden). Children of female renal transplant recipients. Acta Paediatr Scand, 70: 869, 1981.-Results of follow-up of 5 children, aged 4.5–9 years, who were born to kidney transplanted mothers are presented. Various immunological parameters were mainly within normal limits with the possible exception of 1 child who exhibited a granulocytopenia which normalized at about 5 years of age. Three children whose mothers were carriers of HBsAg during and after pregnancy have become antigen carriers and show slightly elevated levels of liver transferases. One child has a cardiac anomaly and signs of slight neurological dysfunction. In other respects the children are well and show normal psychomotor and somatic development. The rather sparse information from the literature regarding this group of children indicates a surprisingly low frequency of severe physical complications.     

Posterior urethral valves: incidence and progress of vesicoureteric reflux after primary fulguration

This is a prospective study of 20 cases of posterior urethral valves (PUV) presenting between the ages of 12 days and 5.5 years (median 15 months) in order to determine the incidence and progress of vesicoureteric reflux (VUR), hydronephrosis (HN), and renal functional status. The efficacy of fulguration as the sole modality of treatment for PUV was assessed in terms of improvement or disappearance of VUR over a 6-month follow-up period. VUR was present in 60% of the patients, being unilateral in 41.7%. Out of 19 renal units with VUR, reflux subsided in 31.5% by 3 months and 78.94% by 6 months. The blood urea and serum creatinine levels, which were raised in 50% of the patients at presentation, came down to normal by 6 months in all the cases. Improvement in glomerular filtration rates (GFR) was noted in all the children at each follow-up and was found to be statistically significant (p<0.01). HN was present in all the patients at presentation and was bilateral in 90%. It decreased significantly during the follow-up period, though its complete disappearance was seen only in one case. Vesicoureteric reflux dysplasia syndrome (VURD) was present in two cases. Our study showed that VUR disappeared in a majority of the cases by 6 months once adequate urethral patency was restored, although hydronephrosis persisted.     

INCREASED FRACTIONAL EXCRETION OF PHOSPHATE AND BETA2-MICROGLOBULIN IN UNILATERAL RENAL DISEASE

ABSTRACT. Following progressive nephron loss tubular reabsorption in the remaining nephrons will fall to preserve solute and electrolyte excretion. We have examined the fractional excretion (FE) of phosphate, sodium, beta₂-microglobulin (β²M)and tubular glucose reabsorption (T_glucose) in children with unilateral renal disease to find 1) the threshold for this response and 2) whether intrinsic renal mechanisms can elicit this response. Separate renal function studies were performed using unilateral ureteral compression. Total glomerular filtration rate (GFR) was 93.7 ± 2.99 ml/1.73(m²)^-1.min^-1, and 110.25 ± 5.40 in control children. GFR in the scarred kidney (SK) was 22.4 ± 2.46 and in the contralateral kidney (CIK) 67.2 ± 4.60 ml. 1.73 (m²)^-1. min^-1. The kidney area was reduced in proportion to GFR in SK. FE phosphate and β₂M were significantly higher in SK than in CIK (sign test), but absolute values for FE_phosphate and β₂M were not higher in SK than in control kidneys. FE_sodium and T_glucose were the same in SK and CIK. Conclusion: Following moderate unilateral reduction of GFR selective depression of tubular reabsorption can occur without extrarenal impulses.     

CLINICAL AND CYTOGENETIC STUDIES IN UNDESCENDED TESTES

Abstract. 168 boys aged 2.5–16.8 years with unilateral or bilateral undescended testes or anorchia were studied. Retention was severe (canalicular or intraabdominal) in 1/4 and moderate in 3/4 of the cases. In unilateral retention, the volume of the scrotal testis was usually normal throughout childhood whereas pubertal testicular growth was delayed. In unilateral anorchia, the scrotal testis showed compensatory hypertrophy. In all age groups examined, the mean volume of the undescended testes was abnormally small. Undescended testes were accompanied by abnormalities of the epididymis in 3.6% of cases, of the ductus deferens in 7.8% and of the spermatic vessels in 8.3%. In anorchia such abnormalities were found regularly. Inguinal hernia accompanied 62.8% of the undescended testes and was most frequent in severe cases. Patients aged 8.0–9.9 years with unilateral undescended testis had advanced bone age. Cytogenetic investigations of 167 patients revealed one case of Klinefelter's syndrome (47, XXY). Gonadotrophin treatment was tried in 50 patients and was successful in 12. Surgical results were satisfactory in 86.1% of the operated testes.     

Renal tubular acidosis type 4 in neonatal unilateral kidney diseases

Three neonates, two with unilateral renal vein thrombosis and one with unilateral dysplastic kidney, developed type 4 renal tubular acidosis, manifested by nonazotemic hyperkalemic metabolic acidosis with alkaline urine pH and reduced potassium excretion. Normal plasma concentrations of sodium, aldosterone, and renin activity, together with normal renal fractional excretion of sodium, supported the diagnosis of renal tubular acidosis type 4, subtype 5. Arginine HCl loading studies showed that despite their ability to bring the urine pH to less than 5.8, net acid excretion was inadequate relative to the corresponding plasma bicarbonate concentration. Treatment with oral bicarbonate resulted in sustained normalization of blood acid-base status and accelerated linear growth in the first two infants, in whom spontaneous recovery occurred by ages 8 and 15 months, respectively. At that time, the affected kidneys were extremely small with distorted collecting systems; the contralateral kidneys showed compensatory hypertrophy. In the third infant, persistent acidosis and growth failure resulted from medical noncompliance; the removal of the dysplastic kidney at 7 months of age was followed by the return to normal blood acid-base status and normalized tubular hydrogen and potassium excretion. We conclude that neonatal unilateral kidney disease can result in renal tubular subtype 5. Spontaneous recovery can be expected, presumably because of " autonephrectomy " of the affected kidney plus the compensatory hypertrophy of the contralateral kidney.     

The role of DMSA scans in evaluation of the correlation between urinary tract infection, vesicoureteric reflux, and renal scarring

The correlation between urinary tract infection (UTI), vesicoureteric reflux (VUR) and renal scarring was studied in 89 patients (177 renal units; 1 solitary kidney) during the period 1997–2000. There were 63 males and 26 females; ages ranged from neonates to 14 years. UTI was diagnosed on the basis of a positive urine culture, VUR was diagnosed and graded by micturating cystourethrogram (MCU), and renal scarring was assessed by technetium 99 m Tc-dimercaptosuccinic acid (DMSA) scan. Ultrasonography (US) was done to evaluate renal tract dilatation and other structural abnormalities. A follow up DMSA scan was performed approximately 6 months after the initial scan. VUR was present in 106 of the 171 renal units in which it was studied and absent in 65 units. The majority of the VUR was grade V. Renal scars were seen in 90 of 177 renal units at presentation and in 72 of the 163 renal units studied at follow-up. Some information was lacking in 31 patients; hence, the correlation between UTI, VUR, and renal scarring was done in 58 patients. The majority of the suspected scars at presentation were not seen at follow-up, but most of the established scars persisted. Only 2 renal units showed scars for the first time on follow-up. On US, approximately 50% of normal kidneys showed either suspicious or established scars on DMSA scan, and patients with bilateral abnormality on US showed renal scars. Renal scars were seen in 15 of 23 children without VUR, 17 of 18 with unilateral VUR, and 16 of 17 with bilateral VUR. Thus, there is a cause-and-effect relationship between UTI and renal scarring that is made worse by VUR. DMSA scans have been shown to be the most reliable method of assessing renal scarring, and an abnormal US scan showing upper-tract dilatation or a structural abnormality may have a predictive value in the detection of renal scarring. Accepted: 18 April 2001     

Ultrasound screening of older asymptomatic siblings of children with vesicoureteral reflux: Is it beneficial?

The purpose of this prospective study was to determine the prevalence of renal abnormalities in 88 older asymptomatic siblings of the children with vesicoureteral reflux (VUR), using ultransound (US) as a diagnostic method. The age of the siblings ranged from 5 to 15 years, the median age being 8.33 years. A midstream urine sample was taken for standard urinalysis and urine culture, and blood pressure was measured in all children. US examination did not reveal chronic inflammatory changes of the kidneys such as a small shrunken kidney, noticeable parenchymal thinning or parenchymal echogenicity changes; nor did it reveal a small kidney due to growth retardation or any dilatation of the renal tract to indicate reflux. No hypertension was found. The study failed to prove the benefit of US screening of older asymptomatic siblings. The results of the present study are discussed in relation to other techniques and investigations/screening for VUR.     

AUTOANTIBODIES TO TAMM-HORSFALL GLYCOPROTEIN IN CHILDREN WITH RENAL DAMAGE ASSOCIATED WITH URINARY TRACT INFECTIONS

Abstract. Fasth, A., Bjure, J., Hellström, M., Jacobsson, B. and Jodal, U. (Departments of Pediatrics, Clinical Immunology, Pediatric Clinical Physiology and Pediatric Radiology). Autoantibodies to Tamm-Horsfall glycoprotein in children with renal damage associated with urinary tract infections. Acta Paediatr Scand, 69: 709, 1980.—Autoantibodies to the Tamm-Horsfall (TH) protein were analyzed in sera from 116 patients with pyelonephritis. The increases in antibody levels were limited in 23 patients with radiological detected renal damage during 31 attacks of acute pyelonephritis. 8 children with abnormally low total and/or unilateral ⁵¹Cr EDTA clearance had significantly lower IgG antibody levels to TH protein, than 14 children with normal clearance rate. All 61 children with renal damage had significantly low IgG, IgA and IgM antibody levels to TH protein 6 months after last infection as compared to the reference group. For IgG antibodies, the mean was well below –2 S.D. 12 children with increased serum creatinine had significantly lower IgG antibody levels than those with normal creatinine. No correlation was found between antibody levels and vesico-ureteric reflux. In contrast, 55 children with no renal damage still had significantly increased IgG and IgA antibody levels to TH protein 6 months after the infection. The mechanism for the low antibody levels was discussed and it was concluded that patients with urinary tract infection and low IgG antibody levels to TH protein were at risk for renal damage and should be radiologically examined.     

RENAL FUNCTION DURING HYDROPENIA AND WATER DIURESIS IN CHILDREN WITH RECURRENT URINARY TRACT INFECTIONS

The glomerular filtration rate (GFR), urinary concentrating and diluting capacity and sodium excretion have been determined in 17 children with previous histories of urinary tract infection confirmed by urine cultures. There were no signs or symptoms of infection at the time of the study. Renal function was found to be normal in patients with normal intravenous pyelographies (IVPs). In the patients with renal parenchymal changes a wide variety of functional changes could be found. Reduction of the glomerular filtration rate was the predominant lesion. The GFR could however not be predicted by the IVP-appearance. Most of the patients were able to increase the GFR during water diuresis. The glomerular-tubular balance for sodium was reset in 3 of the patients as manifested by an increased C_Na/C_In. The concentrating capacity was also reduced in those 3 patients, indicating an impairment of the sodium reabsorption in the loop of Henle. All the patients were able to dilute the urine normally during water diuresis, but 5 of the patients were unable to increase their diluting capacity during the transition from hydropenia to water diuresis. It is noteworthy that only those patients were unable to increase the GFR significantly during the transition from hydropenia to water diuresis.     

Transvesicoscopic cross-trigonal ureteroneocystostomy in children: a single-center experience

PurposeTo evaluate the safety and efficacy of transvesicoscopic ureteric reimplantation in children.Patients and methodsSeventeen ureteric units in 11 patients underwent a transvesicoscopic ‘Cohen’ ureteroneocystostomy in 2003–2007 and the results were retrospectively analyzed. There were four boys and seven girls. All patients had vesicoureteric reflux (VUR), except for one with paraostial diverticula. Six patients underwent bilateral and five unilateral transvesicoscopic reimplantation (a total of 17 units).ResultsThe procedure was successfully completed in all patients. Mean operation time was 217 min in unilateral cases and 306 min in bilateral cases without perioperative complications, except for pneumoperitoneum development in two cases. In the early postoperative period, two patients developed macroscopic hematuria. Mean hospital stay was 3.8 days (3–5 days), except for one patient who suffered from urinary tract infection and needed longer hospitalization. Mean follow-up period was 4.5 years (3–7 years). One patient with bilateral VUR had passive unilateral grade I VUR on postoperative cystogram, giving a success rate of 91% (94% of ureters). This patient was followed conservatively. One patient had recurrent urinary tract infections without reflux.ConclusionTransvesicoscopic cross-trigonal ureteroneocystostomy can be safely performed with a high success rate in children.