AUA 2007 - Pediatrics: Trauma, Tumors, Stone Disease and Infection, Imaging

ANAHEIM, CA (UroToday.com) - Abstract 1201 compared the accuracy of ureteral jet frequency by color Doppler ultrasound in the child with hydronephrosis. The study showed that a ureteral jet frequency less than 25% of the time was found to be a good indicator of obstruction in children with unilateral hydronephrosis. Abstract 1202 evaluated the role of renal tubular enzymes in voided urine as a predictor of UPJO. The findings were promising, however, Dr. Richard Lee commented that the mode of collection and storage is critical in this type of assay and must be consistent with each collected specimen. Abstract 1203 utilized a Markov model and showed that a marker would greatly improve quality of life and overall cost in the diagnosis and management of UPJ disease. Abstract 1204 concluded that increased parenchymal thinning and function on nuclear renal studies is more important than the T1/2 . Despite a T1/2 greater than 20 minutes, 31% of patients maintained good renal function and never required surgery. The question truly remains…do we wait to loose function or try to beat the loss.

Abstract 1205 evaluated the variables affecting the short stay pyeloplasty. Increased pain scores and as needed morphine increased the length of stay while age, gender, OR time, and stents showed no difference. Abstract 1206 discussed a 4 year experience with laparoscopic pyeloplasty. They had favorable results and utilize it in children over 18 months of age. The criticism from many in the audience was the group’s use of 3-0 absorbable suture. The audience unanimously recommended smaller suture (5-0 or 6-0) as large suture might be associated with more a greater inflammatory response. Abstract 1207 evaluated the use of endopyelotomy with only a 44% success rate. Should we really be doing this procedure in children with these results? Abstract 1208 convincingly showed that renal folding for those extremely large hydronephrotic kidneys at pyeloplasty allow the UPJ to be in dependent position. The long term follow up is very promising. Abstract 1209 showed that prenatal diagnosis of duplex systems truly did not impact surgical management when necessary.

Abstract 1210 evaluated the role of observation with CT findings of high grade renal injury. Observation can be safely implemented even in high grade injuries, however, multiple sites of extravasation, lack of contrast in the ipsilateral ureter, or the development of persistent pain or fever should prompt stenting. Abstract 1211 continued on the renal trauma topic and also stated that conservative management of shattered kidneys with disrupted parenchymal fragments is possible. Major vascular injuries need prompt surgical intervention, nonetheless. The session ended with Abstract 1212 addressed resident experience in the presence of a fellow. It showed that although the number of index cases decreased, the total number did not change. Fellowship did not seem to negatively impact the residency in Nashville, TN.

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