Objective: To evaluate the efficacy and complications of mini-percutaneous nephrolithotomy (PCNL) sur-gery using 14-20 Fr access sheaths in pediatric patients, as well as the results of postoperative stone analysis and metabolic urine analysis.Material and methods: We retrospectively evaluated the records of 206 pediatric patients (232 kidney units) who underwent mini-PCNL for kidney stones in our clinic between February 2011 and December 2018. We evaluated the demographic characteristics, complications, stone-free rates, and the results of chemical analysis and urinary metabolic analysis.Results: The age ranged from 9 months to 16 years. The mean age was 5.1±3.9 years, and the median age was 3.5 years. The median stone burden was 200 mm2 (min: 100; max: 1600). Kidney stones were most commonly located in the pelvis in 118 (50.9%) patients, followed by lower calyceal stones in 42 (18.1%) and multiple calyceal stones in 38 (16.4%) patients, respectively. While the success of mini-PCNL was 80.6% after the first session, this rate increased to 87.9% after auxiliary treatments. The total complication rate was 12.9% according to modified Clavien classification. A postoperative stone analysis showed that calcium oxalate had the highest frequency with 61.1% of patients, followed by cystine stone with 21.3% of patients. Metabolic urine analysis revealed no abnormalities in 42.8% of patients. The most common metabolic ab-normality was hyperoxaluria (32%), followed by hypercalcuria (19.6%).Conclusion: Mini-PCNL is a safe and effective procedure with reasonable complications for the treatment of pediatric kidney stones. All kinds of multidisciplinary efforts are required to remove kidney stones com-pletely in pediatric patients.
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Objective: Vesicoureteral reflux (VUR) is considered the most important predisposing factor for urinary tract infection (UTI). Renal damage due to
VUR, subsequently renal scarring and the possibility of reflux nephropathy warrant early detection of VUR. Our aim was to evaluate the value of
positioned instillation of contrast (PIC) cystography in the detection of VUR in children with recurrent UTI and a normal voiding cystourethrography
(VCUG).
Materials and Methods: PIC cystography was performed in each child with the indication of recurrent UTI with a normal VCUG between June 2015
and November 2017.
Results: Thirty-four children (32 girls, 2 boys) aged 7 to 17 years (median, 10 years), were examined. Twenty (58.8%) patients had normal ultrasound
and 12 patients (35.3%) had bilateral scars detected using 99mTc-dimercaptosuccinic acid (DMSA). Thirty-one (91.2%) patients were shown to
have VUR on PIC cystography. Nine (29%) patients had no renal scar with positive PIC and 3 (12%) patients had scars with negative PIC. Scars were
detected in 13 (72.2%) patients with grade I-II VUR, and 4 (30.8%) with grade III-IV VUR had no scars on DMSA. There was no significant difference
between the results of PIC and DMSA renal scan. Twenty-six patients (76.5%) with PIC-VUR underwent simultaneous endoscopic injections. During
the postoperative follow-up with an average of 12 months, 27 patients showed no evidence of febrile UTIs.
Conclusion: Based on our results, PIC cystogram seems to be a good alternative to invasive voiding cystourethrogram in screening children for VUR
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Objective: The purpose of this study was to identify diagnostic microRNAs (miRNAs) associated with congenital kidney
anomalies.
Methods: Twenty-five healthy pregnant women who were found to have fetal kidney anomaly in the second trimester of
their pregnancy at Department of Perinatology, were included in the study. Serum samples were taken from the pregnant
women at the moment of diagnosis in the antenatal 20th gestational week, whereas serum samples were taken from the
cord blood of babies during birth. There were 11 multicystic dysplastic kidney patients, 6 autosomal recessive polycystic
kidney patients, and 8 unilateral hypoplastic kidney patients. Expression of specific miRNAs was monitored using specific
primer assays in Real-Time PCR. The expression of the following miRNAs was quantified: miR-17, miR-192, miR-194,
miR-204, miR-215, and miR-216.
Results: mir-17 expression was significantly lower in children with congenital kidney anomalies than in the control
group. ROC curve analysis showed that the area under the curve was 0.700 for miR-17 in the prediction of congenital
kidney anomalies.
Conclusions: In children with congenital kidney anomalies, miR-17 expression was significantly different than in the
control group. Thus, this miRNA may be used in the antenatal early detection of these congenital kidney anomalies.
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Aim: To assess the usefulness of late dimercaptosuccinic acid (DMSA) renal scans in revealing high-grade vesicoureteral reflux
(VUR).
Material and Methods: Between July 2015 and December 2016, medical records of 112 patients who were admitted with febrile
urinary tract infections (fUTIs) were retrospectively reviewed. The demographic information of the patients, and follow-up imaging
[ultrasonography (USG), DMSA renal scans, and voiding cystourethrography] data were reviewed.
Results: Of the 112 patients, 82 patients (73.2%) were female, 30 were male (26.8%), and the mean age was 7.04 ± 3.94 years.
Recurrent fUTIs were detected in 65 patients (58%). Of the patients, 68 (60.7%) had abnormal urinary system USG, and 74 (66.1%)
had abnormal DMSA renal scans. Vesicoureteral reflux (VUR) was detected in 63 patients (56.3%). VUR was present in 49 (66.2%) of
74 patients with scarring in DMSA and detected in 14 (38.8%) of 38 patients with normal DMSA scans. Significant agreement (kappa:
0.274 / p=0.003) was found between DMSA and VUR results. The sensitivity, specificity and positive predictive values of late DMSA
renal scan to predict VUR were 77.8 %, 49 % and 63.2% respectively.
Conclusion: Abnormal late DMSA scans carry a higher sensitivity and positive predictive value for predicting high-grade VUR in
children with recurrent fUTIs. Late DMSA imaging seems a useful option in screening for high-grade VUR in children when the acute
interventions are limited.
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