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OBJECTIVE: To determine whether graft survival for patients with congenital anomalies of the kidney and urinary tract (CAKUT) is impaired compared to non-CAKUT counterparts. METHODS: The United States Renal Data System (USRDS) is a national data system that has collected information about end stage renal disease (ESRD) and renal transplantation since 1995. We identified 10,635 first-time renal transplant patients with ESRD attributed to a CAKUT diagnosis transplanted between 1995 and 2018, with follow-up of 7.9 ± 5.8 years. We matched 1:1 with non-CAKUT transplant recipients, using age at transplant, sex, race, year of transplant, and donor-type. We compared renal transplant death-censored graft survival between CAKUT vs non-CAKUT controls, with further stratification for age at transplant and lower urinary tract malformations (LUTM) vs upper urinary tract malformations (UUTM). RESULTS: Graft survival was better in CAKUT patients with a 5-year survival of 83.3% vs 79.3% (P< .001), and CAKUT status infers a hazard ratio of 0.878 for graft failure on multivariable analysis with Cox regression. Favorability of CAKUT status persisted when stratifying for both pediatric (80.3 vs 77.6% P< .001) and adult (84.5 vs 81.4% P< .001) age groups. Looking within the CAKUT population: comparison of LUTM to UUTM yielded no difference, implying that LUTM is not a risk factor for graft failure. Examining pediatric LUTM alone, graft survival was not better than matched non-CAKUT counterparts with 5-year graft survival of 69%-75% for LUTM adolescents. CONCLUSION: Renal transplant graft survival is better overall in CAKUT patients as opposed to non-CAKUT counterparts. Pediatric LUTM patients have similar graft survival to controls.

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INTRODUCTION AND OBJECTIVE: Vesicoureteral reflux (VUR) has been associated with the development and progression of reflux nephropathy (RN). Management of VUR has become more conservative over time as therapies have not been reliably proven to prevent renal scarring. We sought to examine the incidence of end stage renal disease (ESRD) due to RN over recent decades in the United States. STUDY DESIGN: The United States Renal Data System (USRDS) is a national data system that collects information about chronic kidney disease and ESRD. Since 1995, the USRDS has mandated that all dialysis centers enroll and submit data on new-onset ESRD patients. Of the over 2.5 million patients enrolled since 1996, 7314 were enrolled with a diagnosis code for RN as the primary cause of ESRD. We examined the trends seen in this patient population from 1996 to 2014 and used US census data to calculate incidence. RESULTS: The incidence of patients with new-onset ESRD attributed primarily to RN saw a steady decrease over time: from 1.9 per million in 1996 to 0.6 per million in the US population in 2014 (exp(B) = 0.941, p < 0.001). 58.8% of the patients were female, 87.4% white. The mean age at the time of ESRD onset was 47 years (IQR 30-65) and this did not significantly vary over the period (P > 0.05). When comparing pediatric new-onset ESRD to adult-onset, a non-significant trend (p = 0.093) was seen with a decrease in incidence of adult ESRD, but a relatively stable incidence of pediatric ESRD (mean age 12, incidence 0.2-0.6 cases per million US children/year). 44.5% of patients received renal transplantation at a mean age of 36 years, 18.9 months (IQR 5-40) after ESRD diagnosis. The mean age of mortality was 62 years old (IQR 50-76), and 5-year survival after RN ESRD diagnosis was 65.8%. DISCUSSION: As with any public database study, our findings may be limited by disease coding or reporting practices. Medical and surgical management trends practiced since the 1960s may have contributed to a decrease in the incidence of ESRD primarily attributed to RN in the United States between 1996 and 2014. Our findings may also reflect changes in diagnostic practices. CONCLUSIONS: ESRD attributed primarily to RN has gradually decreased in incidence in the United States between 1996 and 2014, but the age of ESRD onset has been unchanged.

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INTRODUCTION: Antegrade continence enema (ACE) is a well described treatment for pediatric patients with neurogenic bowel refractory to medical and retrograde management. ACE can be carried out either by catheterizable channel with enteric conduit or a cecostomy tube appliance. For those patients who have issues with pain or leakage around the cecostomy appliance or wish to be appliance free, we present our initial results and description of a novel technique of laparoscopic conversion of cecostomy to catheterizable ACE which uses the existing tract and requires no enteric conduit. METHODS: A single institution, retrospective chart review was carried out for 2014-2017 to identify patients undergoing ACE conversion. Preoperative parameters included age, sex, weight, neurogenic bowel etiology and time from initial cecostomy. Perioperative data included length of surgery, length of hospitalization and postoperative complications (via Clavien-Dindo scale). Postoperative follow up, ancillary procedures pertinent to the ACE and status at time of submission are also presented. RESULTS: Six patients were identified (mean age 14.1 +/- 4.3 years) with median follow up of 36 months (range 18-65). Neurogenic bowel etiology was spina bifida in five and spinal cord injury in one; all patients had concurrent neurogenic bladder with preexisting appendicovesicostomy. Mean operative time was 168 +/- 37 min (range 122-228) and mean length of hospital stay was 2 days (range 1-4). Success rate is 83% (5/6 continue to catheterize ACE channel), with one patient opting back for appliance through same tract. One patient has required operative revision for stomal stenosis. CONCLUSION: To our knowledge, this is the first report describing robotic-assisted laparoscopic conversion of cecostomy tube to a catheterizable ACE. The surgical technique we describe is simple and safe with minimal morbidity to the patient. It does not require an enteral conduit, and may represent a valid treatment in patients without the option of using the appendix.

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Page kidney refers to the occurrence of hypertension secondary to renal compression and is usually associated with a subcapsular or perinephric hematoma. It generally occurs weeks to months after the initial injury. We report on a case of Page kidney occurring acutely after Grade IV blunt renal trauma in a pediatric patient with a solitary kidney following a tobogganing accident. The child was initially managed conservatively and discharged after six days bed-rest. He re-presented post-injury Day 12 with recurrent hematuria, anemia, hypertension, and renal failure that required eventual, and successful, surgical exploration.

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OBJECTIVE: The purpose of this study is to assess the prognostic significance of a cystic vesico-allantoic communication discovered on prenatal ultrasound in terms of its effect on the developing urinary tract. METHODS: Multi-institution review of prenatal screening ultrasound was performed between 2004 and 2015 to identify cases of in utero communication between the fetal urinary bladder and a cystic dilatation of the umbilical cord. Gestational age at diagnosis, perinatal evolution, and eventual urinary tract outcome are described and compared with existing literature. RESULTS: Five cases of cystic vesico-allantoic communication were identified on second-trimester screening ultrasound. Serial ultrasounds showed an increase in the size of the umbilical cystic component with gestational age, followed by its eventual rupture prior to delivery. All neonates had urinary leakage through the inferior portion of the umbilicus with bladder prolapse ranging from patent urachus to partial bladder exstrophy. CONCLUSIONS: An isolated prenatal ultrasound finding of an hourglass communication between the fetal bladder and a cyst of the umbilical cord should be considered predictive of a spectrum from patent urachus to bladder exstrophy. Given the significant ramications on the developing urinary tract, the prenatal finding of vesico-allantoic cyst warrants referral to a high-risk obstetrical center with urologic consultation.

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