Stories about: Urology

Quick Note: Defining the connection between UTIs and antibiotic resistance

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Urinary tract infections affect approximately 3 percent of children in the United States and account for more than 1 million visits to pediatricians’ offices every year.

Although antimicrobial prophylaxis has been proven effective in preventing recurrent UTI in children specifically with vesicoureteral reflux, there remains an increased antibiotic resistance in children treated with antibiotics.

A recent study titled “Antimicrobial Resistance and Urinary Tract Infection Recurrence” sought to further investigate the relationship of antibiotic use and antibiotic resistance among children with vesicoureteral reflux. The paper, published in Pediatrics by the American Academy of Pediatrics (AAP), shows that although resistance was more common among children on antibiotic prophylaxis, antibiotic resistance decreased the longer the children stayed on prophylaxis.

This surprising finding suggests that children who require extended prophylaxis may not be at as high a risk of resistant infection as commonly thought.

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Clinical Consult: Weighing the risks and benefits of Deflux for reflux

vesicoureteral reflux VUR deflux Dx/HA

It’s estimated that one in three children with recurrent urinary tract infections have vesicoureteral reflux (VUR), a urological condition where urine flows backwards from the bladder to the kidney.

Though the condition’s management has evolved, the question of which treatment is the preferred one — and specifically, whether urologists should continue to turn to endoscopic injections of dextranomer/hyaluronic acid copolymer (Dx/HA, aka Deflux) — remains a source of debate.

Boston Children’s Urologist-in-Chief, David Diamond, MD and colleagues Alan B. Retik, MD and Stuart B. Bauer, MD, researched Dx/HA use, and determined that due to its:

  1. high failure rate
  2. long-term complication rate
  3. high re-treatment rate
  4. high (and rising) cost

the risks of Dx/HA far outweigh its limited benefits in a majority of patients.

Read Boston Children’s “Caution in Employing Deflux for Reflux – The Thinking Behind Our Approach” white paper and find out why our urology experts say Dx/HA should not be considered as a preferred treatment option for children with VUR.

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Cancer treatment and fertility: Acting now to have children later

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(Sebastian Kaulitzki/Shutterstock)

With over 75 percent of children diagnosed with cancer surviving into adulthood, more and more parents ask questions about the quality of life survivors can expect in the future, including: Will my child be able to have children down the road?

They’re right to be concerned. The therapies that are so effective at saving children’s lives can themselves cause a host of problems that don’t manifest until years later. These late effects of cancer treatment include particularly harsh impacts on fertility.

“Cancer treatment impairs ovarian function by reducing the number of eggs in them,” says Elizabeth Ginsburg, MD, a fertility specialist at Brigham and Women’s Hospital who collaborates with Lisa Diller, MD, the chief medical officer of Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. “It’s as though it pushes the ovaries further down the age curve. So while a woman who has survived childhood cancer may be 20 years old, her ovaries act like they’re 35 or 40.”

Boys are not exempt from these concerns. “Boys are at the same relative risk for infertility due to treatment,” says Richard Yu, MD, PhD, who works on male infertility in the Boston Children’s Department of Urology. “The same chemotherapy and radiation treatments that affect the ovaries can also wipe out the sperm stem cells in the testes.” …Read More

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Challenging Cases: Minimally invasive renal preservation surgery

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Robotic assisted laparoscopic partial nephrectomy can be safely and effectively performed in pediatric patients for renal tumors while preserving renal function. Classically, cases such as the two described below have been managed with an open, invasive approach or by radical nephrectomy. These two cases, cared for in collaboration with specialists from Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, demonstrate the effectiveness of renal preservation using robotic assisted laparoscopic surgery applied for renal masses in two different pediatric patients. …Read More

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