Baturu M, et al. Investig Clin Urol. 2024 Sep;65(5):473-479. https://doi.org/10.4111/icu.20240200

Purpose: To evaluate the effectiveness of preoperative ultrasound (US) measurements in predicting pediatric vesicoureteral reflux (VUR) treatment outcomes. Methods: This prospective study enrolled 35 patients (53 renal units) aged 1–16 years who underwent subureteric injection therapy for primary VUR between July 2020 and June 2022. Preoperative ultrasound examinations measured the bladder wall thickness at the ureteral orifice, ureteral submucosal tunnel length, distal ureteral diameter, patient demographics, VUR grade, presenting complaints, bladder–bowel dysfunction, and renal scarring, and the impact of these variables on treatment success was analyzed. Results: Among the patients, 91.4% were female, with a mean age of 6.83 ± 3.84 years. A comparison between the treatment success and failure groups revealed no significant differences in the age, sex, VUR grade, laterality, bilaterality, presenting complaints, bladder–bowel dysfunction, bladder wall thickness, or distal ureteral diameter (p > 0.05). However, renal scarring occurred in 16 (38.1%) patients in the treatment success group and 10 (90.9%) in the treatment failure group (p = 0.002). The treatment failure group had shorter detrusor-to-ureteral orifice distances and smaller detrusor-ureteral orifice distance-to-distal ureteral diameter (D/U) ratios than that of the success group (p = 0.004 and p = 0.006, respectively). Patients with a detrusor-to-ureteral orifice distance < 7.4 mm had an 81.82% likelihood of treatment failure. Conclusion: Ultrasound measurements of the detrusor-to-ureteral orifice distance and D/U ratio proved reliable in predicting the success of endoscopic subureteric injection therapy for VUR.

Objective: To compare the safety and effectivity of micro percutaneous nephrolithotomy (MicroPNL) in adults and children. Material and methods: Twenty children and twenty adult patients underwent MicroPNL were evaluated prospective consecutively,between June 2016 and December 2017,who were not suitable for retrograde intrarenal surgery (RIRS).Demographic data,stone free rates,length of hospitalization,duration of the operation,fluoroscopy time,transfusion rates,requirement of double J (D-J) catheter implantation and complications were examined. Results: Seventeen patients with complete data in each group were evaluated within the scope of the study. Mean age was 40.76±14.96 (18-67) years in adults and 5.38±3.84 (10 months-14 years) years in children.There were no differences found between two groups for the mean operation time, fluoroscopy time,and length of hospitalization.Total success rate was noted 94.11% in each group (p=1).While no complications were seen in adults, three complications developed in the pediatric group (p=0.07). One patient in children group had steinstrasse.In addition,intraperitoneal fluid extravasation occurred in one pediatric patient during the operation.After paracentesis,postoperative period was observed uneventful.Also,one pediatric patient had high fever due to urinary tract infection.While there was no need for perioperative D-J catheter implantation in adults,D-J catheter was implanted in 6 (35.29%) pediatric patients, due to fragmented stone burden (p= 0.007) (Table 1). Conclusion: According to our results, micaroPNL is safe and effective treatment option in symptomatic renal stones smaller than 2 cm, especially in adults. Unfortunately,it needs more attention due to the risk of complications in pediatric population Cite this article as: Seckiner I, Baturu M, Bayrak O ¨ , Ecemis O, Sen H. Micropercutaneous nephrolithotomy results in adults and pediatric patients: Is it safe for children? Turk J Urol. 2021;47(4):293-298.

Importance: Vesicouterine fistula (VUF) is an uncommon complication that predominantly occurs after cesarean delivery. Current evidence regarding its diagnosis and management is limited and largely derived from small retrospective studies. Objective: The objective was to evaluate the etiological factors, clinical characteristics, diagnostic approaches, and surgical outcomes associated with VUF through a systematic review and proportional meta-analysis. Study Design: This systematic review and proportional meta-analysis was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed/MEDLINE and Web of Science databases identified studies published between 2006 and 2026. Studies including at least 8 patients with VUF and reporting clinical or surgical outcomes were eligible. Pooled prevalence estimates with 95% CIs were calculated using random-effects models. Results: Eight retrospective studies involving 447 patients were included. Cesarean delivery was the predominant etiological factor (pooled proportion, 95.3%), while a history of repeat cesarean delivery was identified in 78.4% of patients. Cyclic hematuria represented the most characteristic symptom. Cystoscopy was the most frequently used diagnostic modality. Surgical treatment demonstrated a pooled success rate of 97.1%, with low recurrence and postoperative complication rates of 4.3% and 5.6%, respectively. Open abdominal repair remained the most common surgical approach, although minimally invasive surgery was increasingly reported. Conclusions: Vesicouterine fistula has evolved into a predominantly cesarean delivery-related iatrogenic condition with diverse clinical manifestations. Surgical repair provides excellent outcomes with low recurrence when appropriate reconstructive principles are followed. Although the pooled surgical success rate of 97.1% is impressive, this estimate is derived entirely from retrospective observational studies, several of which are small case series. Minimally invasive surgery is a feasible option in selected patients, but comparative evidence is insufficient to determine whether it improves perioperative or long-term outcomes relative to open abdominal repair.