Introduction Mixed gonadal dysgenesis (MGD) is a rare disorder of sexual development. The management of MGD is challenging since the disease significantly impacts a patient's growth, hormone balance, and gonadal development. This article used a large population and a long follow-up period for its analysis. Objectives This study aims to summarize the gender determination basis and analyze the long-term follow-up of mixed gonadal dysgenesis. Methods A total of 45 patients' clinical data were summarized and analyzed. Patients were divided by gender. Next, we followed up regarding the occurrence of complications after surgery, the patients' satisfaction with external genitalia appearance, the growth of the patients, counting the surgical pattern the incidence of surgical complications and the development of the patients' growth. All patients included in this study underwent chromosomal karyotype analysis, abdomen exploration, and pathological biopsy. After sex determination, 7 patients who were raised as female underwent clitoroplasty, and bilateral gonadectomy. 38 male patients underwent urethroplasty & thorn; one-sided gonadectomy. Results Patient follow-up started in the third month after surgery. Female patients reported no surgeryrelated complications, while 14 male patients showed surgery -related complications. Additionally, 20 male patients (60.6 %) had a lower height compared to normal peers, 12 of which (36.4 %) were lower than the second standard deviation of the height of normal peers. Conclusion The clinical manifestations of mixed gonadal dysgenesis are variable, and the management is complicated. Children's gonadal function, external genital conditions, psychological evaluation, and parents' wishes should be considered before sex determination. In China, most patients are raised as males with a high incidence of postoperative complications. We found that short stature is a common feature in male patients, thus their height and growth should be carefully supervised. Patients should pay attention to their sexual function and sexual potential during adulthood.

Background: Concomitant anterior urethral valves (AUVs) and posterior urethral valves (PUVs) is an extremely rare congenital urologic anomaly, which may be easily overlooked in the clinic. Objective: This study assessed the prognosis of children with concomitant PUVs and AUVs. Methods: The clinical data of inpatients with concomitant AUVs and PUVs in our hospital were collected from January 1983 to June 2022. The clinical manifestations, auxiliary inspection, and treatment were described in detail. Results: In total, 6 cases of concomitant AUVs and PUVs in boys were found in our hospital, with ages ranging from 3 months to 9 years; the main clinical manifestation was abnormal urination. Four patients exhibited concomitant AUVs and PUVs preoperatively and underwent simultaneous anterior and posterior urethral valvotomy. Follow-up studies showed that 3 patients' clinical symptoms substantially improved with well-maintained renal function. One patient died of renal failure. In the other 2 patients, PUVs were initially identified and excised, but their clinical symptoms did not show substantial improvement. Following voiding cystourethrography (VCUG), the AUVs were found and obstructions were then completely relieved. However, 2 patients died of renal failure. Conclusions: If urinary symptoms cannot be substantially relieved after posterior urethral valvotomy, VCUG and cystoscopy should be repeated to shorten the interval between anterior and posterior urethral valvotomies to improve patient prognosis.

目的 探讨女童陈旧骨盆骨折尿道外伤的治疗方法.方法 回顾性分析2015年4月至2023年4月北京儿童医院收治的10例陈旧骨盆骨折尿道外伤女童的临床资料.年龄(8.5±4.3)岁.7例合并尿道阴道瘘,1例合并膀胱阴道瘘;5例存在远端尿道闭锁或细小狭窄;5例合并阴道狭窄或部分闭锁.手术方式:经会阴尿道阴道瘘修补术1例,经耻骨尿道吻合术(端端吻合)2例,经耻骨尿道阴道瘘修补术+膀胱颈尿道吻合术1例,经耻骨尿道成形术(膀胱颈及尿道拖出)+尿道阴道瘘修补术+膀胱颈重建术4例,经耻骨尿道成形术+膀胱颈重建术1例,肠扩大膀胱阑尾代输出道可控性尿流改道术1例.术后观察排尿情况.每日使用尿垫数量＞1片为尿失禁,≤1片为控尿良好;主诉排尿费力,最大尿流率＜10ml/s为排尿困难.结果 本研究10例手术均顺利完成,术后无伤口感染、组织坏死等并发症.术后随访时间(52.0±26.2)个月.2例术后控尿良好,无排尿困难;7例出现并发症,其中2例因尿道狭窄致排尿困难,行尿道扩张后好转;5例尿道阴道瘘复发,其中3例再次行修补手术,再次手术后2例控尿良好,无排尿困难.1例尿流改道患者术后恢复良好.结论 女童陈旧骨盆骨折尿道外伤的处理较复杂,术后并发症发生率高,需根据年龄、病变严重程度和尿道、阴道条件选择合适的处理方式.

目的 探讨尿动力学(urodynamics,UDS)检查评估无神经系统及下尿路器质性病变的膀胱输尿管反流(vesicoureteral reflux,VUR)患儿下尿路功能障碍(lower urinary tract dysfunction,LUTD)的临床意义.方法 回顾性分析2017年1月至2021年12月首都医科大学附属北京儿童医院收治的106例VUR患儿UDS检查结果,按照有无LUTD将患儿分为有LUTD组(77例)和无LUTD组(29例),比较两组患儿膀胱容量、残余尿量(post voiding residual urine volume,PVR)以及最大尿流率等尿动力学指标.结果 有LUTD组残余尿量97.71±93.17 mL,明显高于无LUTD组11.81±9.17 mL(t=5.564,P=0.008);有 LUTD 组最大尿流率 8.82±5.01 mL/s,明显低于无 LUTD 组 15.04±7.75 mL/s(t=6.314,P=0.030).有LUTD组中,29例为低级别VUR(Ⅰ～Ⅲ级),48例为高级别VUR(Ⅳ～Ⅴ级).低级别VUR患儿中3例膀胱顺应性减低,高级别VUR患儿中19例顺应性减低,两者比较(x2=7.537,P=0.006)差异有统计学意义;低级别VUR患儿中7例PVR增加,高级别VUR患儿中23例PVR增加,两者比较(x2=4.298,t=0.038)差异有统计学意义.特发性逼尿肌过度活动(idiopathic detrusor overactivity disorder,IDOD)35例(35/77,45.5％),其中19例为低级别VUR,占低级别VUR总数的65.5％(19/29);逼尿肌括约肌协同失调(dysfunctional voiding,DV)33例,其中27例为高级别VUR,占高级别VUR总数的56.3％(27/48).结论 PVR增多、最大尿流率降低提示VUR患儿存在LUTD的可能.高级别VUR患儿中,PVR增加更为明显、且膀胱顺应性更差.IDOD在低级别VUR中常见,DV在高级别VUR中更为常见.

目的 探讨儿童肾盏憩室(calyceal diverticulum,CD)的临床特点、诊断及手术治疗方式.方法 回顾性分析2010年1月至2021年10月首都医科大学附属北京儿童医院泌尿外科与包头市第四医院小儿外科收治的7例肾盏憩室患儿临床资料,其中男5例,女2例;就诊年龄8个月至11岁,平均年龄3岁11个月.憩室位于左侧3例,右侧4例;肾上盏4例,肾中盏3例.憩室长径3～9cm,平均6.2 cm.产前超声发现肾脏囊性变3例,腹痛2例,无症状腹部包块1例,体检发现肾脏囊性病变合并高血压1例.3例术前经泌尿系超声检查确诊,4例术中确诊.7例均行手术治疗,其中开放肾盏憩室切除术2例,肾盏憩室剪裁+盏颈扩大术3例,开放和腹腔镜憩室壁翻瓣卷管输尿管端侧吻合术各1例.结果 7例均获随访,随访时间3个月至10年,患儿术后CD相关症状均消失,术前扩张的肾盏憩室均明显缩小,无一例复发;1例合并肾积水患儿术后积水明显减轻,但肾功能恢复较差,肾核素扫描显示分肾功能为20％,目前仍在随访中.结论 肾盏憩室易发生反复泌尿系感染、慢性腹痛、肉眼血尿、结石等,易误诊为单纯性肾囊肿,两者处理方式不同,需加以区分.应根据憩室位置、盏颈狭窄程度采取个体化治疗,包括肾盏憩室切除、盏颈扩大部分憩室切除、憩室壁翻瓣卷管输尿管端侧吻合术.如处理得当通常预后较好,少有复发.

PurposeWe aimed to explore whether Nephroblastomatosis (Nbm) has an effect on the prognosis of Wilms tumor (WT), and compare the relapse-free survival (RFS) and overall survival (OS) after surgery of WT patients with or without Nbm.MethodsWe retrospectively analyzed the clinical data of children with WT admitted to our department from April 2010 to September 2021. The enrolled patients were divided into two groups according to whether they were combined with Nbm histologically or not, the Nbm group for patients accompany with Nbm and the non-Nbm group for pure WT. All patients underwent a standardized comprehensive treatment according to National Wilms Tumor Study 5. Clinical variables, pathological results, and the prognosis were collected during follow-up.ResultsA total of 345 patients were finally enrolled in this study, of which 299 patients in the non-Nbm group and 46 patients in the Nbm group. Univariate Cox analysis revealed that Nbm was not the risk factor of either OS or RFS. The difference of postoperative RFS (P = 0.66) and OS (P = 0.68) between two groups was not significant. Subgroup analysis revealed that the RFS and OS between the non-Nbm group and the Nbm group had no statistical difference under the condition of same stage (low grade and high grade), same histology (favorable histology and unfavorable histology), same surgical approach (nephrectomy and nephron-sparing surgery), with or without lymph node metastasis (P > 0.05).ConclusionAlthough Nbm had a strong correlation with the occurrence of WT, a combined Nbm did not increase the risk of metastasis and poor prognosis of WT. After complete surgical resection followed by standardized treatment, the long-term RFS and OS were not different from pure WT.IEC-C-006-A04-V.06 retrospectively registered.

目的 探讨儿童后肾腺瘤的临床特点、诊断及治疗方法.方法 以2008年6月至2021年12月首都医科大学附属北京儿童医院泌尿外科收治的8例确诊为后肾腺瘤的患儿为研究对象,收集其临床资料,针对临床特点、影像学检查、手术方式、病理结果及预后进行回顾性分析.结果 8例后肾腺瘤患儿中,男7例,女1例;年龄1岁4个月至10岁4个月,平均年龄5岁7个月;右侧7例,左侧1例;2例因腹痛、1例因腹胀、1例因红细胞增多症经超声检查发现肾脏占位而入院,其余4例均无明显症状.患儿均采取肿瘤切除术,术后恢复良好,随访时间11个月至9年2个月,平均5年7个月,未见肿瘤复发,1例红细胞增多症患儿术后3个月复查红细胞水平恢复至正常.结论 后肾腺瘤临床较罕见,临床表现及影像学检查诊断相对困难,术后病理及免疫组化检查可明确诊断.患儿预后相对较好,术后无需常规化疗,术后3年内应常规行腹部及盆腔影像学检查.

Introduction Current research on the posterior urethral valve (PUV) mainly focuses on the follow-up of bladder function after valve ablation. However, few studies exist on the changes in bladder function before and after valve ablation. Objectives To investigate the urodynamic changes before and after PUV ablation and determine the effect of operation on bladder function, in patients. Materials and methods The clinical records of 38 boys diagnosed with PUV and undergone urodynamic exams before and after valve ablation were retrospectively reviewed. In addition, differences in patients’ radiographic studies and urodynamic characteristics between pre- and post-operation were evaluated. Moreover, the urodynamic data was compared using the paired t-test and all the data was expressed as means ± SEM. Additionally, p values less than 0.05 were considered to be statistically significant. Results All the patients were diagnosed with PUV and the follow-up period after operation ranged between 9 and 114 months. The urodynamic exams were performed about 6 months after operation. The results revealed that bladder compliance improved from 8.49 ± 4.73 to 13.31 ± 6.78 ml/cmH 2 O while the maximum detrusor pressure decreased from 95.18 ± 37.59 to 50.71 ± 21.71 cmH 2 O, after valve ablation. Additionally, there were significant differences in the pre- and post-operation values of bladder compliance and maximum detrusor pressure ( p < 0.05). However, there were no significant differences in the pre- and post-operation values with regard to the residual urine volume, maximum bladder volume and maximum urinary flow rate ( p > 0.05). Conclusions The adequacy of the COPUM incision is necessary. But the study showed that endoscopic valve ablation couldn’t by itself completely improve the bladder function of patients diagnosed with PUV. However, it was able to improve bladder compliance and decrease maximum detrusor pressure to a certain extent. However, bladder compliance still couldn’t reach the normal level.

Objective:To summarize the clinical characteristics, treatments and prognoses of pediatric iatrogenic ureteral injury and lower the incidence of iatrogenic ureteral injury and the loss of long-term renal function.Methods:A total of 19 cases of iatrogenic ureteral injury from January 2005 to December 2020 were reviewed.There were 14 boys and 5 girls with an average age of 6 years.The involved side was left (n=7) and right (n=12). The causes, classifications, clinical manifestations, diagnostic modalities, management principles and long-term follow-up outcomes were recorded.Results:Among them, ureteral injury was caused by retroperitoneal or pelvic tumor operation (n=13) and appendectomy, high ligation of hernia sac and radical operation of Hirschsprung's disease (n=2). Six cases were treated promptly, including ureteropelvic anastomosis (n=2), end-to-end ureteral anastomosis (n=3) and ureteral replantation (n=1). Delayed diagnosis was made in 13 cases and time of postoperative diagnosis ranged from 4 days to 3 years.Two cases of hernia sac underwent ureteral reimplantation while the remainders had nephrostomy.After (3-6) months, pelvic ureteral anastomosis (n=1), ureteral end-to-end anastomosis (n=3), ureteral reimplantation (n=1), Boair surgery (n=2), appendix replacing ureter (n=2) and self-healing (n=2) were performed.During a follow-up period of (8-242) months, no obvious hydronephrosis was present in 2 cases of ureteral injury from ligation of hernia sac.The other 11 cases had varying degrees of hydronephrosis and remained stable during follow-ups.Conclusions:Iatrogenic ureteral injury in children occurs frequently during retroperitoneal, pelvic and inguinal operations.If detected timely and treated properly, long-term renal function may be preserved.

Objective:To evaluate the application value of distal ureter diameter ratio as a predictive factor for breakthrough urinary tract infection (BT-UTI) in children with primary vesicoureteral reflux (VUR).Methods:From January 2018 to December 2020, retrospective review was performed for the clinical features of 102 VUR children.Clinical data were collected for identifying the predictors of BT-UTI.Demographics, VUR grade, laterality, distal ureter diameter and UDR were examined by univariate and multivariable analyses.Primary outcome was BT-UTI.Results:Among them, 31 children (30.3%) experienced BT-UTI events.Based upon multivariate analysis, gender, maximal grade of reflux and laterality were not the predictors of BT-UTI.Ureteral diameter ratio (UDR)( P=0.0417, OR=11.4, 95% CI: 1.259-141.919) and age ( P=0.0467, OR=0.975, 95% CI: 0.949-0.997) were among the strongest predictors of early febrile BT-UTI in VUR children. Conclusion:Children with elevated distal UDR are at an elevated risk for BT-UTI independent of reflux grade.As an objective measurement of VUR, UDR provides valuable prognostic information for risks of recurrent pyelonephritis and may assist with clinical decision-making.

Objective:To improve the preoperative diagnosis of paratesticular tumor in children and to formulate an optimal and individualized treatment protocol.Methods:A total of 27 children of paratesticular tumor undergoing operations were reviewed retrospectively.The average age was 7.4(0.3-14.5) years.Tumor was located at left (n=12), right (n=14) and bilateral (n=1). All of them received preoperative physical and ultrasonic examinations.The average time from a discovery of testicular mass to surgery was 4.5 months (1 week to 3 years). Eight children underwent high ligation of spermatic cord through an inguinal incision during tumor orchiectomy.One child underwent resection of testicular para testicular masses through an inguinal incision.And 18 cases underwent resection of testicular simple para testicular masses through a scrotal incision.Without lymph node or distant metastasis, 6 low-risk children of parathyroid rhabdomyosarcoma received a combination of vincristine, actinomycin D and cyclophosphamide.One case of leukemic metastasis continued postoperative chemotherapy.The remainders received no further postoperative treatment.Results:The pathological examinations revealed benign (n=17) and malignant (n=10) tumors.Benign tumors included epididymal cyst (n=10), adrenal residual tumor (n=1), epididymal leiomyoma (n=1), infantile fibrous hamartoma (n=1), epididymal fibrous pseudotumor (n=1), lipoblastoma (n=1), splenic gland fusion (n=1) and lymphangioma (n=1). Malignant tumors (n=10) included paratesticular rhabdomyosarcoma (embryonic type) (n=6), infantile melanotic neuroectodermal tumor (n=1), well-differentiated liposarcoma (n=1), leukemic metastasis (n=1) and ganglionic neuroblastoma metastasis (n=1). The preoperative clinical diagnosis was basically consistent with the pathology.During an average follow-up period of 70(5-137) months, only 1 child of metastatic ganglioblastoma was re-operated for tumor recurrence on left face at Month 6 postoperatively.Conclusions:For paratesticular tumors in children, it is necessary to make a comprehensive judgment based upon medical history, laboratory tests and imaging examinations to make a definite preoperative diagnosis to avoid a delayed treatment of malignant tumors.

Wilms tumor (WT) is the second most common solid tumor in pediatric population. Botryoid WT is an uncommon growth pattern of WT, which is characterized by tumor extension into collecting system. A case of a 27-month-old boy with botryoid WT and left-sided inferior vena cava is reported in this article to emphasize the importance of preoperative imaging in preoperative planning.

This study is to investigate the effect of valve ablation on bladder function in patients with posterior urethral valves. The clinical data of patients with posterior urethral valves who received urodynamic examination before and after valve ablation were retrospectively analyzed.The bladder compliance improved during urine storage after operation, and the maximum detrusor pressure decreased during micturition. The postoperative urinary system ultrasound showed that the residual urine volume of the group with significantly improved upper urinary tract hydrocephalus was significantly less than that of the group with no improvement. The bladder compliance was significantly higher than that of the group with no improvement, and the maximum urine flow rate was significantly higher than that of the group with no improvement (all P<0.05). Valve ablation has limited effect on improving bladder function in patients with PUV. Valve incision can help improve the maximum bladder volume, residual urine volume and maximum urinary flow rate. It has a certain effect on bladder compliance and maximum detrusor pressure.

Background At present, there is no specific research on the factors affecting the success rate of urethroplasty in patients with DSD. The purpose of this study is to explore the factors affecting the success of urethroplasty in DSD patients, and to provide some reference for the surgical treatment of DSD patients undergoing urethroplasty. Method We reviewed patients with DSD who underwent urethroplasty from January 2016 to December 2019 retrospectively. Patients were divided into four groups: the successful group, the urethrocutaneous fistula group, the urethral diverticulum group, and the urethral stricture group. Risk factors were determined from the following data included the DSD classification, the age of first operation, length of urethral defect, degree of hypospadias, cryptorchidism, micropenis, gonad type, hormone therapy before operation, transposition of penis and scrotum, surgical strategy, urethral covering material, and postoperative catheter removal time. We explored the difference of each factor between four groups through the comparative study of single factor and multifactor logistic regression analysis of related factors. Result 122 cases were enrolled in this group (n = 122), 12 cases were lost to follow-up. Median follow-up was 28 months (12-55 months).We found the success rate of operation decreased with longer urethral defect (B = - 0.473, P = 0.005). The success rate of operation was higher in staged operation and TPIT (TPIT = Transverse Preputial Island Tube operation)-related operation than primary operation (B = 1.238, P = 0.006) and TPIT-nonrelated operation (B = 2.293, P = 0.001). Although there was a significant difference between the age of the first operation and the occurrence of urethrocutaneous fistula (P = 0.006 < 0.05), there was no significant difference in logistic regression analysis (P = 0.161 > 0.05). The incidence of urethrocutaneous fistula was lower in TPIT-related operation than in TPIT-nonrelated operation (B = - 2.507, P = 0.000). The incidence of postoperative urethral diverticulum was lower in staged operation than in primary operation (B = - 1.737, P = 0.015). Conclusion For patients with disorder of sex development undergoing urethroplasty, the length of urethral defect is an independent risk factor affecting both the success rate of operation and the urethrocutaneous fistula. The age of the first operation has a statistically significant effect on the occurrence of postoperative urethrocutaneous fistula, but it is not an independent factor. Urethrocutaneous fistula is less found in TPIT-related operation in the study. Staged operation is an independent protective factor for postoperative urethral diverticulum compared with one-stage operation but isn't related to urethrocutaneous fistula.

Objective:To prospectively evaluate the diagnostic value of contrast-enhanced ultrasonography (CEUS) for renal function in children with unilateral ureteropelvic junction obstruction (UPJO) .Methods:The study protocol was approved by the local ethics committee and written informed consent obtained from parents or guardians. Ultrasonography, CEUS and radioisotopic renography were performed in 51 children. There were 42 boys and 9 girls with a mean age of (6. 75±4. 14) years. Slope of ascending curve (A) , time to peak (TTP) , peak intensity (PI) and area under the curve (AUC) were recorded during CEUS. And quantitative data were calculated by the QLAB system software (semiautomated border tracking, Philips Healthcare) . Sensitivity and specificity were determined for CEUS and compared with radioisotopic renography.Results:A total of 102 kidneys in 51 children were visualized by CEUS. Perfusion time-intensity curve (TIC) of renal cortix demonstrated an asymmetrical single-peak curve in all groups. It could be distinctly distinguished between experimental and control groups. Compared to control group, TTP became markedly prolonged while A declined sharply in experimental group ( P<0. 05) . No significant correlation existed between AUC, PI and differential renal function (DFR) . However, correlation coefficients between TTP, A and DFR remained significant ( P<0. 001) . Receiver operating characteristic (ROC) curve of DRF was plotted for TTP with an area under the ROC curve (AUROC) of 0. 86. For DFR <40% on CEUS, the values of sensitivity and specificity were 92. 86% and 76. 14%. Conclusions:This preliminary experience represents the first-ever report of evaluating the diagnostic value of CEUS for renal function in UPJO children. And CEUS is a highly sensitive, rapid, non-invasive and cost-effective diagnostic imaging modality for detecting and monitoring renal function.

Hydronephrosis is a common renal disease in children which can lead to a series of complications, and ultrasonography is a basic examination usually performed on suspected hydronephrosis patients. If we can use deep learning approaches to judge and grade the disease in the ultrasonic examination stage, we can save a lot of manpower, medical resources, money, and help the suffered patients. For the semantic segmentation of kidney ultrasound image, we designed an Attention-based Pyramid Scene Parsing Network (A-PSPNet), the core of which is the basic feature extraction network combining Convolutional Block Attention Module (CBAM) and pyramid analysis module. Experiments were carried out on a hydronephrosis dataset containing 1850 annotated ultrasound images, including the arrangement of attention units, statistical computing power, and comparison of the effectiveness between the benchmark and our proposed method. Our constructed model achieved better segmentation performance than benchmarks with only little extra overhead, which validated the lightweight and effectiveness of the model.

Background: Contrast-enhanced ultrasonography (CEUS) is a new potential modality for the quantitative evaluation of the microvascular perfusion of renal parenchyma.Objective: To prospectively evaluate the diagnostic value of CEUS in assessing renal function in patients with ureteropelvic junction obstruction (UPJO).Methods: The study protocol was approved by the ethics committee of Beijing Children’s Hospital (Beijing,China), and written informed consent was obtained from the patients’ parents or guardians. Ultrasonography (US), CEUS, and radioisotope renography were performed in 51 children (42 boys, 9 girls; mean age, 6.75 ± 4.14 years) with unilateral UPJO. The slope of the ascending curve (A), time to peak (TTP), peak intensity (PI), and area under the curve (AUC) were recorded during CEUS; the quantitative data were calculated by the QLAB system (semiautomated border tracking, Philips Healthcare) software. Sensitivity and specificity values were determined for CEUS and compared with radioisotope renography.Results: A total of 102 kidneys in 51 patients were depicted by CEUS and the perfusion time-intensity curve (TIC).CEUS depicted 102 kidneys in 51 patients, in whom the perfusion time-intensity curve（TIC）was determined. The TIC of renal cortical perfusion in all groups showed an asymmetrical single-peak curve, which could be clearly distinguished between the experimental group and the control group. Compared to the control group, the TTP was markedly prolonged but A was significantly decreased in the experimental group (P < 0.05). There was no significant correlation between AUC, PI and DFR，but the correlation coefficient between TTP, A and DFR remained significant (p<0.001).The receiver operating characteristic （ROC）curve drawn to differentiate the differential renal function (DRF) using the TTP value provided an area under the ROC curve (AUROC) of 0.86. The diagnostic performance of contrast-enhanced US was better than that of US, as the sensitivity and specificity values were 92.86% and 76.14%, respectively.Conclusions: This preliminary experience represents the first report of evaluating the diagnostic value of CEUS in assessing renal function in children with UPJO. CEUS is a highly sensitive, rapid, and diagnostic imaging modality for detecting and monitoring renal function noninvasively.

Hydronephrosis may lead to many potential diseases, and the diagnosis of hydronephrosis is time-consuming and laborious. To assist physicians in hydronephrosis diagnosis and treatment planning, an accurate and automatic kidney segmentation method is highly required in clinical practice. In recent years, deep convolutional neural networks such as Unet plays a key role in the field of image segmentation, but Unet itself cannot adjust the receptive field actively, which may result in poor attention to the characteristics of the segmented target. We propose an encoder-decoder network with weighted skip connections and the idea of hierarchical equal resolution that can manually control the receptive field. We evaluated our method by comparing it with various classical networks using a dataset of 1850 annotated images. The MPA of the model is 94.12 and the MIoU is 89.49, which outperformed other classical networks we compared to.

INTRODUCTION:Laparoscopic pyeloplasty (LP) has been widely used in the treatment of pediatric ureteropelvic junction obstruction (UPJO). However, no prior reports with a large pediatric series have focused on the analysis of complications and impact factors of the outcomes. We hypothesized there were risk factors of higher Clavien grade postoperative complications. OBJECTIVE:To analyze the characteristics of complications and risk factors of high Clavien grade postoperative complications. PATIENTS AND METHODS:All children with UPJO treated with primary transperitoneal LP between July 2016 and July 2018 were retrospectively reviewed. The Clavien complication grades in groups with different weight, intraoperative complication (drainage methods), anteroposterior pelvic diameters (APPD), side, gender, title of surgeon, preoperative presentation and obstruction reason were compared. RESULTS:Of the 279 children, intraoperative complications in which the placement of double-J stents was not accomplished and conversion to open surgery (Satava grade II) occurred in 17 (6.09%) and 2 (0.72%) patients, respectively. A total of 270 patients (277 kidneys) were included in the analysis of postoperative complications. Postoperative complications occurred in 51 (18.89%) patients. The most frequent postoperative incident was febrile UTI in 27 patients. Of the 13 patients who required reoperations, 6 patients had kidney restenosis and were considered as failure of surgery. All complications with an exact onset time occurred within 10 months after surgery. In the univariate and multivariate analysis, weight <10 kg and having intraoperative complication with nephrostomy tube were risk factors of higher Clavien postoperative complication grade (P＜0.05). DISCUSSION:Patients who were <10 kg in weight and having intraoperative complication with nephrostomy tube had a greater risk of a higher Clavien grade postoperative complication. To reduce high Clavien grade postoperative complications, asymptomatic patients under 10 kg in weight and having intraoperative complication with nephrostomy tube need close monitoring. In the 26 patients who had an exact time of the postoperative complications, the longest time we found was 10 months. Thus, we recommend the follow-up time required to observe postoperative complications in patients should be at least 10 months after surgery. CONCLUSIONS:LP has been proven to be safe and effective in children with a low rate of complications. Weight <10 kg and having intraoperative complications with nephrostomy tube were risk factors of higher Clavien grade postoperative complications. Children with low weight and intraoperative complications need more attention in terms of the occurrence of complications.

Objective To investigate the timing and scheme of surgical treatment for the concomitant ureteropelvic junction obstruction(UPJO) and congenital abnormalities of the kidney.Methods The clinical data of 155 patients with concomitant UPJO and congenital abnormalities of the kidney from January 2006 to January 2016 was retrospectively analyzed.There were 107 males and 48 females,who aged 6 months to 16 years and 6 months.The average time was 5 years and 9 months old when they received operation.There were 8 cases less than 1 year old.There were 93 cases of UPJO on the left side,54 cases on the right side,and 8 cases on both sides.There were 33 cases with duplication of kidney,19 cases with solitary kidney,and 6 cases with renal dysplasia,6 cases with renal ectopia,12 cases with polycystic kidney disease,and 41 cases with dysplasia;2 cases with renal malrotation.There were 100 cases with symptoms such as fever,abdominal pain,vomiting.5 cases had received Anderson-Hynes pyeloplasty in other hospitals,2 cases received nephrectomy with symptoms did not relieve.4 cases were treated with nephrostomy in other hospital.Children with the repeated clinical symptoms,or renal function decreased significantly,or hydronephrosis progressive to the anteroposterior diameter of more than 30 mm received surgical treatment.Results There were 140 cases received Anderson-Hynes pyeloplasty,and 8 cases received nephrectomy with 5 cases were UPJO side and 3 cases were only abnormalities of the kidney without UPJO.All patients received IVP or ultrasonography postoperative 3-6 months,which showed hydronephrosis improved or no obvious change,and 4 cases were improved obviously.The IVP results showed that 5 patients with renal dysplasia together with UPJO had the renal function improved.There were 128 cases followed up for 12 to 106 months,with an average of 64.5 months.All patients had no clinical symptoms.83 cases were reexamined by IVP or ultrasonography,and hydronephrosis was getting better or no change.Conclusions The patients with concomitant UPJO and congenital abnormalities of the kidney don't need surgery in advance.The best choice for those patients is Anderson-Hynes pyeloplasty.The indication of nephrectomy should be considered carefully.