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To describe a laparoscopic surgical technique for ureterocystoplasty in pediatric patients with the Mitrofanoff procedure.The procedure was performed in 4 patients (2 females and 2 males), 8-11 years old (average, 9.5 years), with a history of myelomeningocele and secondary neurogenic bladder. The patients were evaluated before the surgery with renal ultrasound, voiding cystourethrography, and renal scintigraphy. All subjects reported left hydronephrosis with severe dilatation of ureter and the collector system, left megaureter with grade V vesicoureteral reflux, and left functional exclusion, with right renal normal function. The urodynamic investigations revealed low bladder size and bladder leak point pressure (BLPP) above 40 cm H2O. The laparoscopic ureterocystoplasty augmentation procedure and the Mitrofanoff procedure with the proximal ureter were performed in these patients. Complications and outcomes were recorded and compared with those of the postoperative urodynamic test.The 2-4 years of follow-up of the patients and its urodynamic postoperative evaluation reported at least 75% of the capacity according to their age, compliance that varied between 15 to 20 mL/cm H2O, and a BLPP of less than 40 cm H2O. This last parameter is considered of low risk to damage the upper urinary tract. There was no leaking of urine by the stoma over the 4 hours of catheterization.Even though enterocystoplasty is the gold standard to increase the capacity of the neurogenic bladder, it has an elevated morbidity. So the use of a dilative ureter to increase bladder size and create a Mitrofanoff stoma in patients with neurogenic bladder, pop-off phenomenon, and renal ipsilateral atrophy could be considered by the laparoscopic approach.

Left tibial agenesis, polysyndactyly with talipes equinovarus deformity and Grade IV vesicoureteral reflux of the right kidney are described in a 40-day-old male and an unrelated 1-month-old male, is also reported with right tibial agenesis, polysyndactyly with talipes equinovarus deformity and right kidney agenesis and left Grade V vesicoureteral reflux. No other pathology was recorded. Follow up at 1 year and 3 years, respectively, revealed normal motor and mental development. As this combination has been unpublished before, we believe that this a new syndrome.

Since DX/HA was approved by the Food and Drug Administration in 2001 as an acceptable tissue-augmenting substance for subureteral injection, endoscopic treatment has become increasingly popular for treating vesicoureteral reflux (VUR). However, most paediatric urologists still continue to recommend ureteral reimplantation as the treatment of choice in the management of grade V VUR. The purpose of this study was to prospectively evaluate the effectiveness of endoscopic subureteral injection of DX/HA in the treatment of grade V reflux.During 2001-2009, 56 children (35 males, 21 females) with primary grade V VUR underwent endoscopic treatment using DX/HA. Their ages ranged from 4 months to 11 years. Forty-nine patients had unilateral grade V VUR, and seven had bilateral grade V (63 refluxing ureters including 17 duplex systems). Renal scarring on dimercaptosuccinic acid was observed in 39 kidneys (mild scarring 13, moderate scarring 14 and severe scarring 12). In all patients, endoscopic injection was made after inserting the needle within the wide ureteral orifice. Renal ultrasound and voiding cystourethrogram was performed 3 months after the endoscopic treatment. If VUR had not resolved, the patient was considered for further endoscopic treatment. After the VUR was resolved, children were followed with renal ultrasound at 1 year and every 2 years thereafter.The VUR completely resolved after first injection of DX/HA in 33 (52.4%) ureters and downgraded to grade I VUR in 7 (11.1%) ureters. 19 (30.2%) ureters required a second injection, and 4 (6.3%) ureters required a third injection to resolve VUR. No children in this series needed reimplantation of ureters or presented with ureteral obstruction during follow-up.Endoscopic treatment with DX/HA is effective in eradicating grade V primary reflux. This simple and minimally invasive treatment should be offered to all parents of children with grade V VUR as an alternative to ureteral reimplantation.

We encountered a patient with megaureter-megacystis syndrome showing a giant bladder and dilated ureters with marked reflux, which is very rare; to our knowledge, only 2 patients have been reported in Japan. The patient was a 4-year-old boy, who showed inborn polyposia and polyuria, and proteinuria at the age of 1 year. He visited the pediatric department in our hospital complaining of cold-like symptoms, stomachache and diarrhea. Urinary infection and kidney dysfunction were observed, and the patient was hospitalized for close examination. Bilateral pyelocaliceal hydronephrosis was detected by ultrasonography, and the patient was referred to our department. CT revealed bilateral hydronephrosis (right atrophic kidney), hydroureters and megacystis. Bilateral grade V vesicoureteral reflux, an increase in the bladder volume (> 300 ml), and urination without residual urine were noted by voiding cystourethrography. Uroflowmetry revealed that maximum flow rate was 21.6 ml/sec, voided volume was 110 ml, and residual volume was 24 ml. From these examinations, the patient was diagnosed as having megaureter-megacystis syndrome, and underwent antireflux operation of the bilateral ureters using Cohen's procedures.

OBJECTIVES The aim of this study was to determine circulating levels of ELAM-1 in sera collected from patients with vesicoureteral reflux, and to investigate the relationship between circulating concentrations of ELAM-1 and reflux nephropathy. METHODS The serum levels of ELAM-1 were measured in 117 patients aged between 3 months and 13 years, with grade III to grade V vesicoureteral reflux, and 22 controls, by ELISA technique. Renal scarring was demonstrated in 46 of the 117 children on radionuclide scans. RESULTS The mean serum ELAM-1 levels were 54.23 +/- 20.11 ng/ml in controls and 77.79 +/- 34.50 ng/ml in children with vesicoureteral reflux (p < 0.05). The mean serum ELAM-1 levels in children with vesicoureteral reflux and renal scarring (104.48 +/- 34.53 ng/ml) were significantly higher than in children with VUR without renal scarring (60.51 +/- 20.85 ng/ml; p < 0.001). CONCLUSION These findings suggest that circulating ELAM-1 levels reflect increased tissue damage in children with vesicoureteral reflux, probably as a result of progressive localised inflammatory responses occurring in these patients.

Objectives Although endoscopic treatment provides a high rate of success in children with grades II–IV vesicoureteral reflux (VUR), its role in the management of grade V reflux has been questioned. In this study we reviewed our 21-yr experience of endoscopic treatment in children with grade V primary VUR. Methods We retrospectively reviewed the medical records of 132 children who underwent endoscopic treatment for primary grade V reflux from 1984 to 2004. VUR was unilateral in 39 patients and bilateral in 34, and 59 patients had ipsilateral grade V reflux with a lower grade of VUR on the contralateral side. Endoscopic treatment was performed in a total of 166 grade V ureters; polytetrafluoroethylene was used from 1984 to 2000 and dextranomer/hyaluronic acid from 2001 to 2004. Median follow-up was 12.2 yr and mean follow-up was 13.4 yr. Results VUR was completely resolved after first injection in 88 (53%) ureters and downgraded to grade I or II in 26 (15.7%). VUR resolved after a second and third injection in 36 (21.7%) and 10 (6%) of ureters, respectively. Endoscopic treatment failed to correct VUR in 6 (3.6%) ureters, requiring ureteral reimplantation in 5 and nephrectomy in 1. Thirteen patients developed urinary tract infections during the follow-up period, and on investigation 9 ureters (5.4%) had recurrence of VUR. No injection or morbidity related to tissue-augmenting substances was noted in any patient. Conclusion Endoscopic treatment should be the first-line of treatment in management of grade V vesicoureteral reflux.

Objective. To determine if urinary N-acetyl-beta-glucosaminidase (NAG) assays could be applied as a screening test for early detection of vesicoureteral reflux. Methods. Two hundred eighty-eight urine samples from children undergoing voiding cystourethrography (VCU) for a variety of urologic problems were assayed for N-acetylbeta-glucosaminidase using spectrophotofluorimeter techniques. Sample creatinine levels were also determined using an auto analyzer. The urinary NAG to creatinine ratio for each patient was then compared to their VCU results, which were interpreted independently of the assay values and graded according to the International Reflux Classification system. The NAG to creatinine ratios were then classified according to their grade of reflux, and the mean NAG levels, plus one standard deviation, were calculated for each as well as for the nonrefluxing controls. Statistical analysis was done with P values obtained by Student's t-test. Results. A total of two hundred thirty-two specimens were evaluable with ninety (38.8%) samples collected from refluxing patients and one hundred forty-tw o (61.2%) samples from nonrefluxers. The NAG levels standardized to urine creatinine revealed a mean value among refluxers of 15.514 μmol/g creatinine. This compared with a mean value of 14.611 μmol/g creatinine in the nonrefluxing group, with the difference being insignificant. When the mean NAG levels were compared for each grade of reflux to the nonrefluxing controls, only grade V had a significant elevation (44.561 μmol/g creatinine) above the nonrefluxers (P = 0.0001). Conclusions. With the exception of grade V vesicoureteral reflux, urinary NAG levels do not reliably detect the presence of reflux and therefore cannot be accurately applied as a screening test for detection of this common urologic problem.