This Month in Pediatric Urology

Article Outline

• Urinary Tract Infection and Prenatal Renal Pelvic Dilatation
• Laparoscopic Malone Antegrade Continence Enema
• Outcome of Prenatally Detected Posterior Urethral Valves
• Copyright

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Urinary Tract Infection and Prenatal Renal Pelvic Dilatation 

Hydronephrosis is the most common anomaly detected by prenatal sonography. Many recommend antibiotic prophylaxis for the initial postnatal management of prenatally detected hydronephrosis based on the assumption that there is an increased risk of urinary tract infection (UTI). Coehlo et al (page 284) from Brazil assessed the risk of febrile infection in 192 patients with prenatally detected isolated renal pelvic dilatation. Significant uropathy was diagnosed postnatally in 78 (41%) patients, including ureteropelvic junction obstruction in 55, vesicoureteral reflux in 16 and megaureter in 7. UTI occurred in 27 (14%) patients, with the highest incidence in the first 2 years of life. Factors associated with increased risk for UTI were female gender and the presence of uropathy, despite the routine use of antibiotic prophylaxis.

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Laparoscopic Malone Antegrade Continence Enema 

The Malone antegrade continence enema has profoundly impacted the management of severe constipation and fecal soiling in many children with neuropathic conditions and/or imperforate anus. This technique typically involves some form of cecoplication, implantation or intussusception of the appendico-cecal junction to ensure continence of the catheterizable stoma. Nanigian and Kurzrock (page 299) from Sacramento, California describe a simplified laparoscopic approach without cecoplication in a series of 22 patients. Mean operative time was only 65 minutes. All but 1 patient were discharged from the hospital the day after surgery, all stomas were continent and there was no stomal stenosis at a mean followup of 24 months.

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Outcome of Prenatally Detected Posterior Urethral Valves 

The timing of intervention for boys with a posterior urethral valve has been greatly impacted by early detection with prenatal sonography. Sarhan et al (page 307) from Paris, France report their experience at a single center with 65 patients with a posterior urethral valve detected prenatally, of whom all but 2 were treated with primary valve ablation. At a median followup of 6.8 years renal failure developed in 11 (17%) children. Statistically significant predictors of final renal outcome included gestational age at diagnosis before 24 weeks (45% had renal failure) and the presence of oligohydramnios (54% had renal failure), while renal parenchymal changes on sonography were not predictive (24% had renal failure). Continence was achieved in 42 of 55 (76%) toilet-trained children.