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Purpose: Antibiotic prophylaxis is given to children at risk for urinary tract infection. However, evidence concerning its effectiveness in grade I to III vesicoureteral reflux is lacking. The objective of this study was to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infection in young children with low grade vesicoureteral reflux., Materials and Methods: Children 1 month to 3 years old with grade I to III vesicoureteral reflux were assigned randomly to receive daily cotrimoxazole or no treatment, and followed for 18 months. A urinary tract infection constituted an exit criterion. Infection-free survival rates were calculated using the Kaplan-Meier method and compared using the log rank test., Results: A total of 225 children were enrolled in the study. Distribution of gender, age at inclusion and reflux grade were similar between the 2 groups. There was no significant difference in the occurrence of urinary tract infection between the 2 groups (17% vs 26%, p = 0.2). However, a significant association was found between treatment and patient gender (p = 0.017). Prophylaxis significantly reduced urinary tract infection in boys (p = 0.013), most notably in boys with grade III vesicoureteral reflux (p = 0.042)., Conclusions: These data suggest that antibiotic prophylaxis does not reduce the overall incidence of urinary tract infection in children with low grade vesicoureteral reflux. However, such a strategy may prevent further urinary tract infection in boys with grade III reflux.

Purpose: Total urogenital mobilization is deemed to preserve the urogenital sinus blood supply and avoid ischemic complications. We report our experience with this technique for cloacal repair., Materials and Methods: We retrospectively reviewed all consecutive cases of persistent cloaca managed by total urogenital mobilization via a posterior sagittal approach by a single pediatric urologist between 1998 and 2003. During this period 22 girls (12 with a common channel longer than 3 cm) underwent total urogenital mobilization for cloaca repair (1 redo) at a median age of 10 months (range 2 to 102). A total of 15 procedures (68%) could be completed by a perineal approach only. Four patients with a long common channel required additional maneuvers after mobilization to complete the reconstruction., Results: Urethral stenosis was observed in 2 patients after urethral separation from the vagina (1) and common channel retubularization (1). One child with a perineal hemangioma required a redo posterior sagittal anorectoplasty for complete vaginal and anal closure. In addition, 1 case of urethrovaginal fistula was diagnosed on cystovaginoscopy but was asymptomatic, and 1 child with a minor residual common channel underwent urethral revision to allow easier intermittent catheterization. With a median followup of 48 months (range 11 to 162) the latest examination involving endoscopy with anesthesia showed a good result in 17 patients, a tight introitus that might require further surgery in 3 and a minimal residual common channel of 0.5 cm in 2., Conclusions: Total urogenital mobilization is an effective technique for repairing short and long common channels, and a low surgical complication rate can be anticipated.

Purpose: We assessed the incidence of perinatal morbidity and evaluated the outcome in children with prenatally diagnosed renal tumors in a retrospective multicenter study., Materials and Methods: A review of the records of patients from 20 institutions identified 28 children with prenatally diagnosed renal tumors. Prenatal findings, clinical charts, and radiological, surgical and pathological reports were reviewed in this study., Results: There were 26 congenital mesoblastic nephromas and 2 Wilms tumors. One or more complications were identified in 20 of the 28 cases (71%) during the perinatal period. Polyhydramnios was observed in 11 fetuses (39%), 2 presented with hydrops fetalis and 7 presented in acute fetal distress requiring emergency cesarean section, of which 1 died in utero before delivery. Median gestational age of the 27 neonates born alive was 35 weeks (range 29 to 39), including 13 (46%) who were pre-term (less than 34 weeks of gestation). Complications at birth included hemodynamic instability in 3 newborns, of whom 2 underwent emergency surgery, respiratory distress syndrome in 8 (30%) and hypertension in 6 (22%). Surgical complications occurred in 7 patients (26%), including tumor rupture in 1 and intraoperative bleeding with postoperative death in 1. At a median followup of 42 months (range 2 to 105) 26 of the 27 children were in complete remission., Conclusions: Fetal renal tumors have an excellent oncological outcome but a high risk of perinatal complications. Prenatal diagnosis should allow planning the delivery at a pediatric tertiary care center to avoid a potentially life threatening condition in neonates in the first hours of life.