Diagnosis of vesicoureteral re ux according to the 1999 and 2011 guidelines of the Subcommittee on Urinary Tract Infection of the American Academy of Pediatrics

Capone, M; Balestracci, Alejandro; Toledo, Ismael; Martin, Sarah E.

doi:10.5546/aap.2016.eng.129

Cited by 1 publication

(1 citation statement)

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“…In addition, the screening or diagnostic tests for both diseases also appear to be in decline due to recently released guidelines. The updated American Academy of Pediatrics (AAP) guidelines [3] on the diagnosis and management of urinary tract infections (UTIs) in febrile infants and young children has led to the delay of voiding cystourethrography (VCUG) until the second UTI, which has decreased the diagnostic incidence of VUR [4]. Similarly, in 2012, the U.S. Preventive Services Task Force recommended against prostate-specific antigen (PSA) screening for prostate cancer, as they concluded that the potential benefits of screening were not greater than the expected risks; however, the debate on PSA screening is still continuing [5].…”

Section: Introductionmentioning

confidence: 99%

Lessons learned over a decade of pediatric robotic ureteral reimplantation

Baek

Koh

2017

Investig Clin Urol

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The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR) has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR). However, higher-than-expected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer.

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Section: Introductionmentioning

confidence: 99%