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Article: Management of High-Grade Penile Curvature Associated With Hypospadias in Children.

Moscardi, Paulo R M / Gosalbez, Rafael / Castellan, Miguel Alfedo

2017 Volume 5, Page(s) 189

Abstract: Penile curvature is a frequent feature associated with hypospadias with also a great variability of severity among each patient. While the low-grade curvature (<30°) can be relatively easily corrected by simple techniques like penile degloving and dorsal ...

Abstract	Penile curvature is a frequent feature associated with hypospadias with also a great variability of severity among each patient. While the low-grade curvature (<30°) can be relatively easily corrected by simple techniques like penile degloving and dorsal plication, severe cases often demand more complex maneuvers to manage it. A great number of surgical techniques have been developed to adequately correct curvatures greater than 30°; however, each one of them should be individualized to different patients and local conditions encountered. In this article, we will review the evaluation of the pediatric patient with penile curvature associated with hypospadias with a special attention to high-grade cases, their management, indications for surgical treatment, and several surgical options for their definitive treatment.
Language	English
Publishing date	2017-09-04
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2017.00189
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Article: Robotic Management of Urolithiasis in the Pediatric Population.

Ballesteros, Natalia / Snow, Zachary A / Moscardi, Paulo R M / Ransford, George A / Gomez, Pablo / Castellan, Miguel

Frontiers in pediatrics

2019 Volume 7, Page(s) 351

Abstract: A variety of surgical techniques exist for the management of urolithiasis. Minimally invasive techniques have replaced open surgery in the last few decades. For complex stone management, robotic-assisted laparoscopic surgery (RALS) has emerged as a safe ... ...

Abstract	A variety of surgical techniques exist for the management of urolithiasis. Minimally invasive techniques have replaced open surgery in the last few decades. For complex stone management, robotic-assisted laparoscopic surgery (RALS) has emerged as a safe and feasible alternative in adults. The literature for RALS for urolithiasis (RALS-UL) in the pediatric population is scarce. Herein, we present a review of the literature in both adult and pediatric patients as well as our experience using RALS-UL at our institutions. Special attention is given to the synchronous management of urolithiasis when surgery is performed for other conditions such as ureteropelvic junction obstruction (UPJO), and a supplemental video is provided.
Language	English
Publishing date	2019-08-22
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2019.00351
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Article: Staged ureteral reconstruction using the appendix in a complex pediatric patient.

Moscardi, Paulo Renato Marcelo / Blachman-Braun, Ruben / Labbie, Andrew / Castellan, Miguel

Urology case reports

2018 Volume 21, Page(s) 98–100

Language	English
Publishing date	2018-09-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2745459-9
ISSN	2214-4420
ISSN	2214-4420
DOI	10.1016/j.eucr.2018.08.016
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Article ; Online: Voiding Cystourethrogram in Children With Unilateral Multicystic Dysplastic Kidney: Is It Still necessary?

Blachman-Braun, Ruben / Camp, Michelle M / Becerra, Maria F / Guevara, Christian G / Velasquez, Maria C / Moscardi, Paulo R M / Ballesteros, Natalia / Gosalbez, Rafael / Labbie, Andrew S / Castellan, Miguel A / Restrepo, Ricardo / Alam, Alireza

Urology

2020 Volume 139, Page(s) 156–160

Abstract: Objective: To evaluate the value of the voiding cystourethrogram (VCUG) in children with multicystic dysplastic kidney (MCDK) who have a normal versus abnormal contralateral kidney and bladder ultrasound (US), and assess the risk of having ... ...

Abstract	Objective: To evaluate the value of the voiding cystourethrogram (VCUG) in children with multicystic dysplastic kidney (MCDK) who have a normal versus abnormal contralateral kidney and bladder ultrasound (US), and assess the risk of having vesicoureteral reflux (VUR) or urinary tract infection (UTI) based on the US results. Methods: A retrospective chart review including children with unilateral MCDK with postnatal US and VCUG available at our institution between January 2008 and September 2017 was performed. Analysis was done to find association between abnormal contralateral US and contralateral VUR and UTI. Results: One hundred and fifty-six children were analyzed; 118(75.6%) patients had a normal contralateral kidney US, while 38(24.4%) had abnormal US. The rate of severe contralateral VUR (grade IV and V) was 2 (1.7%) and 5 (13.2%) in children with normal and abnormal contralateral US, respectively. The risk analysis demonstrated a significant association between severe VUR on the contralateral kidney and an abnormal contralateral US (odds ratio = 7.73; 95%CI: 1.43-41.81; P = 0.018) and no significant association with UTI (odds ratio = 1.58; 95%CI: 0.50-4.94; P = 0.435). Conclusion: Our data suggests, the rate of severe contralateral VUR in children with unilateral MCDK and normal contralateral kidney is low. VCUG should be considered for infants with proven MCKD and alterations on the contralateral kidney on US. Following patients with MCDK and normal contralateral kidney without the use of VCUG is a reasonable approach, unless there is development of signs and symptoms of recurrent UTI or deterioration of the renal function. We found that abnormal contralateral kidney US was associated with severe VUR.
MeSH term(s)	Child ; Female ; Follow-Up Studies ; Humans ; Infant ; Kidney/diagnostic imaging ; Male ; Multicystic Dysplastic Kidney/complications ; Multicystic Dysplastic Kidney/diagnosis ; Multicystic Dysplastic Kidney/physiopathology ; Risk Assessment/methods ; Risk Factors ; Ultrasonography/methods ; Ureter/diagnostic imaging ; Urinary Bladder/diagnostic imaging ; Urinary Tract Infections/diagnosis ; Urinary Tract Infections/etiology ; Urinary Tract Infections/prevention & control ; Urodynamics ; Urography/methods ; Vesico-Ureteral Reflux/diagnosis ; Vesico-Ureteral Reflux/etiology
Language	English
Publishing date	2020-02-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	192062-5
ISSN	1527-9995 ; 0090-4295
ISSN (online)	1527-9995
ISSN	0090-4295
DOI	10.1016/j.urology.2020.02.005
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Article ; Online: Laparoscopic pyeloplasty as an alternative to nephrectomy in adults with poorly functioning kidneys due to ureteropelvic junction obstruction.

Nascimento, Bruno / Andrade, Hiury S / Miranda, Eduardo P / Barbosa, João Arthur Brunhara Alves / Moscardi, Paulo R / Arap, Marco A / Mitre, Anuar I / Srougi, Miguel / Srougi, Victor / Duarte, Ricardo J

International urology and nephrology

2020 Volume 53, Issue 2, Page(s) 269–273

Abstract: ... estimated using Tc-99 m DMSA renal scintigraphy.: Results: Among 121 LP performed in the study period ...

Abstract	Objectives: To evaluate outcomes of laparoscopic pyeloplasty (LP) in adults with poorly functioning kidney due to ureteropelvic junction obstruction (UPJO). Methods: A retrospective comparative analysis was performed between adult patients who underwent LP due to UPJO with differential renal function (DRF) ≤ 15% and DRF > 15%. LP success rate and complications were assessed. LP success was defined as symptoms improvement and DRF improvement or stabilization. DRF and estimated glomerular filtration rate (eGFR) were analyzed before and 12 months after surgery to evaluate renal function recovery. DRF was estimated using Tc-99 m DMSA renal scintigraphy. Results: Among 121 LP performed in the study period at our institution, 15 and 42 were included in the DRF ≤ 15% and DRF > 15% groups, respectively. At a median follow-up of 17.8 months, all patients with DRF ≤ 15% reported symptoms improvement. LP success rate was 86.7% and 90.5% (p = 0.65) for patients with DRF ≤ 15% and DRF > 15%, respectively. There were no complications in the DRF ≤ 15% group, while there were three complications recorded in the DRF > 15% group (Clavien 2 and 3b). In the DRF ≤ 15% group, mean pre-operative and post-operative DRF was 9.5% ± 3.6 and 10.5% ± 7.8 (p = 0.49), respectively. Median pre-operative and post-operative eGFR was 68.5 ml/min and 79.8 ml/min (p = 0.93), respectively. Two patients had DRF improvement after LP. Conclusions: LP in adult patients with UPJO and poor function kidneys is an effective and safe procedure. DRF recovery is seen in a minority of the patients; however, LP is an alternative to nephrectomy.
MeSH term(s)	Adult ; Female ; Glomerular Filtration Rate ; Humans ; Kidney/physiopathology ; Kidney Function Tests ; Kidney Pelvis/surgery ; Laparoscopy ; Male ; Middle Aged ; Nephrectomy/methods ; Postoperative Complications/epidemiology ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Ureteral Obstruction/physiopathology ; Ureteral Obstruction/surgery ; Young Adult
Language	English
Publishing date	2020-08-29
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article
ZDB-ID	204048-7
ISSN	1573-2584 ; 0301-1623 ; 0042-1162
ISSN (online)	1573-2584
ISSN	0301-1623 ; 0042-1162
DOI	10.1007/s11255-020-02626-4
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Article: Predictive factors for early discharge (≤24 hours) and re-admission following robotic-assisted laparoscopic pyeloplasty in children.

Ransford, George A / Moscardi, Paulo / Blachman-Braun, Ruben / Ballesteros, Natalia / Guevara, Christian / Salvitti, Mariarita / Alam, Alireza / Kozakowski, Kristin / Gosalbez, Rafael / Labbie, Andrew / Castellan, Miguel

Canadian Urological Association journal = Journal de l'Association des urologues du Canada

2021 Volume 15, Issue 11, Page(s) E603–E607

Abstract: Introduction: Minimally invasive pyeloplasty (MIP) for correction of ureteropelvic junction obstruction in children has significantly improved the postoperative management of these patients. In this study, we sought to examine the factors associated ... ...

Abstract	Introduction: Minimally invasive pyeloplasty (MIP) for correction of ureteropelvic junction obstruction in children has significantly improved the postoperative management of these patients. In this study, we sought to examine the factors associated with early discharge (≤24 hours) in children who underwent robotic-assisted laparoscopic pyeloplasty (RALP). Methods: We performed a retrospective chart review of all children who underwent RALP from 2012-2018 in our center. Descriptive statistics and a non-adjusted risk analysis were performed to evaluate the factors associated with early discharge (≤24h), re-admission, and complications within the first 30 days after the procedure. Results: Eighty-nine patients out of 124 total pyeloplasties (72%) stayed ≤24 hours post-surgery. Of the variables analyzed, later cases were statistically associated with length of stay (LOS); the first 55 patients had a lower probability of being hospitalized for ≤24 hours (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.09-0.64, p=0.004). Conclusions: RALP for children is associated with a high rate of early recovery, short hospital stay, and low re-admission and complication rates. Although not statistically significant, patients with shorter operative room time also had a shorter LOS. An increased LOS was observed in the initial patients of our series, and this is most likely explained by the initial learning curve of the team for the procedure itself and the more conservative postoperative management.
Language	English
Publishing date	2021-05-17
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2431403-1
ISSN	1911-6470
ISSN	1911-6470
DOI	10.5489/cuaj.7062
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Article: Diagnostic accuracy of Onen's Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of obstructive hydronephrosis in children.

de Bessa, Jose / Rodrigues, Cicilia M / Chammas, Maria Cristina / Miranda, Eduardo P / Gomes, Cristiano M / Moscardi, Paulo R / Bessa, Marcia C / Molina, Carlos A / Tiraboschi, Ricardo B / Netto, Jose M / Denes, Francisco T

PeerJ

2018 Volume 6, Page(s) e4791

Abstract: Introduction: Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic ...

Abstract	Introduction: Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic Renal Scintigraphy (DRS) and Ultrasonography (US). Recent studies have suggested that new parameters of conventional and color Doppler ultrasonography (CDUS) may be useful in discriminating which kidneys are obstructed. The present study aims to assess the diagnostic accuracy of such parameters in the diagnosis of obstruction in children with UPJO. Methods: We evaluated 44 patients (33 boys) with a mean age of 6.53 ± 4.39 years diagnosed with unilateral high-grade hydronephrosis (SFU grades 3 and 4). All underwent DRS and index tests (conventional US and CDUS to evaluate ureteral jets frequency) within a maximum interval of two weeks. Hydronephrotic units were reclassified according to the alternative grading system (AGS) proposed by Onen et al. Obstruction in the DRS was defined as a differential renal function <40% on the affected side and/or features indicating poor drainage function like T1/2 >20 minutes after the administration of furosemide, and a plateau or ascending pattern of the excretion curve. Results: Nineteen hydronephrotic units (43.1%) were obstructed. Some degree of cortical atrophy-grades 3 (segmental) or 4 (diffuse)-was present in those obstructed units. AGS grades had 100% sensitivity, 76% of specificity and 86.4% of accuracy. The absence of ureteral jets had a sensitivity of 73.68%, a specificity of 100% with an accuracy of 88.6%. When we analyzed the two aspects together and considered obstructed the renal units classified as AGS grade 3 or 4 with no jets, sensitivity increased to 78.9%, accuracy to 92%, remaining with a maximum specificity of 100%. These features combined would allow us to avoid performing DRS in 61% of our patients, leaving more invasive tests to inconclusive cases. Conclusions: Although DRS remains the mainstay to distinguishing obstructive from non-obstructive kidneys, grade of hydronephrosis and frequency of ureteral jets, independently or in combination may be a reliable alternative in the mostly cases.This alternative approach has high accuracy, it is less invasive, easily reproducible and may play a role in the diagnosis of obstruction in pediatric population.
Language	English
Publishing date	2018-05-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2703241-3
ISSN	2167-8359
ISSN	2167-8359
DOI	10.7717/peerj.4791
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Article ; Online: Septic Shock Following Surgical Decompression of Obstructing Ureteral Stones: A Prospective Analysis.

Srougi, Victor / Moscardi, Paulo R / Marchini, Giovanni S / Berjeaut, Ricardo Haidar / Torricelli, Fabio C / Mesquita, Jose L B / Srougi, Miguel / Mazzucchi, Eduardo

Journal of endourology

2018 Volume 32, Issue 5, Page(s) 446–450

Abstract: Purpose: To investigate risk factors for septic shock and death in patients with obstructive pyelonephritis due to ureteral stone, who underwent urinary tract decompression.: Patients and methods: We prospectively enrolled patients who presented at ... ...

Abstract	Purpose: To investigate risk factors for septic shock and death in patients with obstructive pyelonephritis due to ureteral stone, who underwent urinary tract decompression. Patients and methods: We prospectively enrolled patients who presented at the emergency department of our institution with clinical signs of pyelonephritis, Systemic Inflammatory Response Syndrome (SIRS), and obstructive ureteral stone confirmed by computed tomography scan. Forty patients that underwent urinary tract decompression were included. Demographical, medical, and laboratorial characteristics were recorded; antibiotic regimen and time from presentation to decompression were compared between patients with septic complications. Results: Septic shock and death occurred in 6 (15%) and 2 (5%) patients, respectively. Gender, age, and comorbidities were not associated with septic complications. Urinary culture was negative in 40% of the cohort and the most prevalent pathogen was Escherichia coli. Administration of antibiotics other than third-generation cephalosporin was associated with septic shock (p = 0.02). There was no difference between groups regarding the time of antibiotics use (p = 0.63) and time from presentation to urinary tract decompression (p = 0.07). Patients with leukocyte count above 15.6 × 10 Conclusions: We failed to find an association between time of antibiotic use or delayed urinary tract decompression and occurrence of septic complications; antibiotic choice was determinant of prognosis. Elevated serum leukocytes could be used as a trigger to indicate prompt surgical intervention.
MeSH term(s)	Adult ; Anti-Bacterial Agents/therapeutic use ; Comorbidity ; Decompression, Surgical ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Prognosis ; Prospective Studies ; Pyelonephritis/complications ; Retrospective Studies ; Risk Factors ; Shock, Septic/epidemiology ; Shock, Septic/etiology ; Systemic Inflammatory Response Syndrome/complications ; Systemic Inflammatory Response Syndrome/drug therapy ; Systemic Inflammatory Response Syndrome/epidemiology ; Ureteral Calculi/complications ; Ureteral Calculi/surgery ; Ureteral Obstruction/complications ; Ureteral Obstruction/surgery ; Urinary Tract Infections/complications ; Urinary Tract Infections/drug therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2018-03-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	356931-7
ISSN	1557-900X ; 0892-7790
ISSN (online)	1557-900X
ISSN	0892-7790
DOI	10.1089/end.2017.0896
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Article ; Online: Diagnostic accuracy of Onen’s Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of obstructive hydronephrosis in children

Jose de Bessa Jr / Cicilia M. Rodrigues / Maria Cristina Chammas / Eduardo P. Miranda / Cristiano M. Gomes / Paulo R. Moscardi / Marcia C. Bessa / Carlos A. Molina / Ricardo B. Tiraboschi / Jose M. Netto / Francisco T. Denes

PeerJ, Vol 6, p e

2018 Volume 4791

Abstract: Introduction Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic ... ...

Abstract	Introduction Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic Renal Scintigraphy (DRS) and Ultrasonography (US). Recent studies have suggested that new parameters of conventional and color Doppler ultrasonography (CDUS) may be useful in discriminating which kidneys are obstructed. The present study aims to assess the diagnostic accuracy of such parameters in the diagnosis of obstruction in children with UPJO. Methods We evaluated 44 patients (33 boys) with a mean age of 6.53 ± 4.39 years diagnosed with unilateral high-grade hydronephrosis (SFU grades 3 and 4). All underwent DRS and index tests (conventional US and CDUS to evaluate ureteral jets frequency) within a maximum interval of two weeks. Hydronephrotic units were reclassified according to the alternative grading system (AGS) proposed by Onen et al. Obstruction in the DRS was defined as a differential renal function <40% on the affected side and/or features indicating poor drainage function like T1/2 >20 minutes after the administration of furosemide, and a plateau or ascending pattern of the excretion curve. Results Nineteen hydronephrotic units (43.1%) were obstructed. Some degree of cortical atrophy—grades 3 (segmental) or 4 (diffuse)—was present in those obstructed units. AGS grades had 100% sensitivity, 76% of specificity and 86.4% of accuracy. The absence of ureteral jets had a sensitivity of 73.68%, a specificity of 100% with an accuracy of 88.6%. When we analyzed the two aspects together and considered obstructed the renal units classified as AGS grade 3 or 4 with no jets, sensitivity increased to 78.9%, accuracy to 92%, remaining with a maximum specificity of 100%. These features combined would allow us to avoid performing DRS in 61% of our patients, leaving more invasive tests to inconclusive cases. Conclusions Although DRS remains the mainstay to ...
Keywords	Hydronephrosis ; Urinary tract obstruction ; Doppler ultrasound ; Diuretic renogram ; Children ; Diagnostic test ; Medicine ; R ; Biology (General) ; QH301-705.5
Subject code	610
Language	English
Publishing date	2018-05-01T00:00:00Z
Publisher	PeerJ Inc.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Retroperitoneoscopic pyelolithotomy: a good alternative treatment for renal pelvic calculi in children.

Cezarino, Bruno Nicolino / Park, Rubens / Moscardi, Paulo Renato Marcelo / Lopes, Roberto Iglesias / Denes, Francisco T / Srougi, Miguel

International braz j urol : official journal of the Brazilian Society of Urology

2016 Volume 42, Issue 6, Page(s) 1248

Abstract: Introduction: Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with na increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to ... ...

Abstract	Introduction: Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with na increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to 50% of children affected. Other factors associated with litiasis are infection, dietary factors, and anatomic malformations of urinary tract. Standard treatment procedures for pediatric population are similar to adult population. Extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nepfrolithotomy (PCNL), as well as laparoscopic and retroperitoneoscopic approaches can be indicated in selected cases. The advantages of laparoscopic or retroperitoneoscopic approaches are shorter mean operation time, no trauma of renal parenchyma, lower bleeding risk, and higher stone-free rates, especially in pelvic calculi with extrarenal pelvis, where the stone is removed intact. Patient and methods: A 10 year-old girl presented with right abdominal flank pain, macroscopic hematuria,with previous history of urinary infections.. Further investigation showed an 1,5 centimeter calculi in right kidney pelvis. A previous ureterorenoscopy was tried with no success, and a double J catheter was placed. After discussing options, a retroperitoneoscopic pielolithotomy was performed. Results: The procedure occurred with no complications, and the calculi was completely removed. The foley catheter was removed in first postoperative day and she was discharged 2 days after surgery. Double J stent was removed after 2 weeks. Conclusions: Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population.
MeSH term(s)	Child ; Feasibility Studies ; Female ; Humans ; Kidney Calculi/surgery ; Kidney Pelvis/surgery ; Laparoscopy/methods ; Nephrostomy, Percutaneous/methods ; Operative Time ; Treatment Outcome
Language	English
Publishing date	2016-11
Publishing country	Brazil
Document type	Case Reports ; Journal Article ; Video-Audio Media
ZDB-ID	2206649-4
ISSN	1677-6119 ; 1677-5538
ISSN (online)	1677-6119
ISSN	1677-5538
DOI	10.1590/S1677-5538.IBJU.2015.0242
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