Objective To evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS)and minimally invasive percutaneous nephrolithotripsy (MPCNL)for the pediatric renal calculi (≥ 1.5 cm).Methods In the retrospective study,97 patients with renal calculi (≥ 1.5 cm) underwent operation which is conducted by the same operative team from March 2011 to March 2016.Among them,40 patients were treated with RIRS,including 29 male and 11 female patients.57 patients were treated with minimally invasive percutaneous nephrolithotripsy,including 45 males and 12 female patients.The mean stone size was (1.9 ± 0.4) cm (ranging 1.5-3.0 cm) in the RIRS group and (2.1 ± 0.5) cm(ranging 1.5-3.5 cm) in the MPCNL group.In RIRS group,3 stones were stag-horn calculi.The diameter in 44 stones was more than 1.5 cm.Among them,33 stones located in the renal pelvis and upper middle calyces.11 stones located in the lower calyces.Multiple stones were found in 30 cases and single stone was found in 10 cases.7 cases had the history of unilateral urolithiasis.3 cases had the positive results of urine culture before operation.In MPCNL group,7 stones were stag-horn calculi.The diameter in 60 stones was more than 1.5 cm.Among them,56 stones located in the renal pelvis and upper middle calyces.4 stones located in the lower calyces.Multiple stones were found in 41 cases and single stone was found in 16 cases.4 cases had the history of unilateral urolithiasis.2 cases had the positive results of urine culture before operation.The mean stone size in MPCNL was larger,but the difference was not statistically significant (P ＞ 0.05).No statistical significance was found between the two groups in sex,age,preoperative urine,positive culture,patients with renal staghorn calculi,percentage of multiple calculi,stones in lower calyx and operation history of the same side(P ＞ 0.05).The urine white blood cells between the two groups were statistically significant (P ＜0.01),but the urine white blood cells in RIRS before placing double J stent had no significant difference with those in MPCNL.Results In RIRS group,The mean operative time was(90.2 ± 17.8) minutes.The mean hemoglobin deficit was (7.9 ± 7.9)g/L.The complication rate was 7.5％ (3/40).The postoperative hospital stay was (5.0 ± 2.3) days.The hospitalization cost was (42 994.1 ± 9 747.8) yuan.Stone-free rates after one session was 72.5％ (29/40).After second procedure,stone-free rates were up to 90.0％ (36/40).In MPCNL group,the mean operative time was (77.8 ± 15.6) min.The mean hemoglobin deficit was (10.0 ± 7.1) g/L.The complication rate was 24.6％ (14/57).The postoperative hospital stay was (8.0 ±2.5) days.The hospitalization cost was (24 626.3 ± 6 324.7) yuan.The stone-free rate after one session was 82.5％ (47/57).After second procedure,stone-free rates were up to 94.7％ (54/57).In statistics,there was no significant difference in hemoglobin drop,the stone-free rate on one session and the final stone-free rates(P ＞ 0.05).But significant difference existed in operative time,complications rate,postoperative hospitalization time and hospitalization cost (P ＜ 0.05).Conclusion Both RIRS and MPCNL are feasible,safe and minimally invasive way to treat renal calculi(≥ 1.5 cm) in pediatric patients.The stone-free rates between the two groups are comparable.RIRS has an advantage in postoperative hospitalization time and postoperative complications.MPCNL takes the advantage of operation time,hospitalization cost and needn't routinely places the double-J ureteral stent.

Objective To observe the therapeutic effect of discontinuation pyeloplasty in children with hydronephrosis.Analyze the factors that affect the recovery of postoperative renal function.Methods A retrospective analysis was performed on 125 children with hydronephrosis caused by unilateral ureteropelvic junction obstruction from January 2014 to December 2015 in Hunan Children's Hospital.Preoperative and postoperative renal pelvis anteroposterior diameter,renal parenchymal thickness,segmental artery resistance index,glomerular filtration rate (GFR),blood urea nitrogen,serum creatinine and other indicators were observed.The measurement data were expressed as mean ± standard deviation (Mean ± SD),and paired t-test was used for inter-group comparison,and Chi-square test was used for inter-group comparison of counting data.Logistic regression analysis was performed on the factors such as sex,age,hydronephrosis location and hydronephrosis degree before operation,and the important factors affecting postoperative renal function recovery were screened out.Results Postoperative renal pelvis anteroposterior diameter (1.87 ± 1.02) cm,renal parenchyma thickness (6.34 ± 1.41) mm,segmental arterial resistance index (0.68 ± 0.05),GFR (40.54 ± 3.25) ml/min,blood urea nitrogen (2.18 ± 1.24) mmol/L and serum creatinine (27.54 ± 6.21) μg/ml and other indicators were better than preoperative,the difference were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis showed that the degree of hydronephrosis,age and level of renal function were the influencing factors of renal function recovery (P ＜ 0.05).The postoperative recoveryof renal function was not related to gender,location of hydronephrosis,surgical methods and other factors (P ＞ 0.05).Conclusions Pyeloplasty is good for children with hydronephrosis,it can improve the degree of patients with hydronephrosis,improve renal function recovery.Preoperative patients with age,degree of hydronephrosis and sub-renal function levels affect postoperative renal function recovery.

Objective: To analyze the relationship between the expression of homeobox A13 (HOXA13), epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR) gene in prepuce tissue of children with congenital hypospadias, discuss the relationship and significance of HOXA13, EGF and EGFR genes in congenital hypospadias and to understand their role in the pathogenesis of hypospadias. Methods: 65 cases of hypospadias were selected as the experimental group and 42 cases of phimosis as the control group. Hematoxylin-eosin (HE) staining was used to observe the pathological characteristics of prepuce tissues in the two groups. Immunohistochemistry, real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) and Western blot were used to detect the expression of HOXA13, EGF and EGFR in the two groups. Results: ⑴ HE staining showed that the epidermis of hypospadias was composed of keratinized stratified flat epithelium and epidermis of penile skin. The prepuce of phimosis children showed only infiltration of inflammatory cells in the superficial layer of the inner prepuce, blood vessel congestion, no obvious appendage structure, mostly fibroblasts. ⑵ Immunohistochemistry: The positive expressions of HOXA13, EGF and EGFR in the control group were significantly higher than those in the experimental group (P<0.01). ⑶ qRT-PCR: The expression levels of HOXA13, EGF and EGFR in the control group were 53.447±33.471, 80.012±20.430, 75.012±14.339, and the expression levels of HOXA13, EGF and EGFR in the experimental group were 9.128±5.996, 45.521±18.242, 32.043±10.215, respectively. The expression of HOXA13, EGF and EGFR in the control group was significantly higher than that in the experimental group (P<0.01). ⑷ Western blot: The expression levels of HOXA13, EGF and EGFR in the experimental group were lower than those in the control group. Conclusions The expression of HO-XA13, EGF and EGFR in prepuce tissue of children with hypospadias is low, which may be related to hypospadias.

Objective:To investigate the characteristics of urinary stones composition in children and the differences in their distribution among different sexes and age groups.Methods:The clinical data of 592 children with urinary stones who underwent stone composition analysis using infrared spectroscopy at Hunan Children's Hospital from October 2015 to October 2019 were retrospectively analyzed. There were 430 males and 162 females.The median age was 4.0 (0.3 to 18.0) years old. The stone composition and the differences in its distribution in different sex and age groups were analyzed.Results:A total of 643 urinary stones were analyzed in 592 cases, with 419 (65.2%) single-component stones and 224 (34.8%) mixed-component stones. The main stone components were calcium oxalate in 361 cases (56.1%), ammonium hydrogen urate in 130 cases (20.0%), cystine in 56 cases (8.7%), calcium phosphate in 33 cases (5.1%), uric acids in 33 cases (5.1%), magnesium ammonium phosphate in 25 cases (3.9%), and xanthine in 5 cases (0.8%). The percentage of calcium oxalate stones was higher in women than in men [65.6% (118/180) vs. 52.5% (243/463), P<0.05]. The proportion of upper urinary tract stones was higher in girl than in boy[93.4%(168/180) vs. 73.2%(339/463), P<0.05]. The differences in the composition ratios of calcium oxalate stones, ammonium hydrogen urate, cystine, and magnesium ammonium phosphate stones in different age groups were statistically significant ( P<0.05), with the highest proportion of calcium oxalate stones (35.6%) at 6 to 10 years of age, ammonium hydrogen urate and cystine stones at 1 to 2 years of age (45.4% and 42.9%), and magnesium ammonium phosphate stones at 3 to 5, 6 to 10, and 11 to 18 years of age, the percentage of urinary stones in children was 24%. Conclusions:The main component of urinary stones in children is calcium oxalate, followed by ammonium hydrogen urate and cystine. Age and gender correlate with the distribution of stone components. Calcium oxalate stones are common in females and in children aged 6 to 10 years, ammonium hydrogen urate and cystine stones are common in children aged 1 to 2 years, and magnesium ammonium phosphate stones are more common in children aged 3 to 5 years, 6 to 10 years, and 11 to 18 years.

Objective:To investigate the association between preterm birth, low birth weight and the risk of hypospadias.Methods:According to the search strategy of Cochrance Collaborative Network, the China National Knowledge Internet (CNKI), VIP, Wanfang, Pubmed, Cochrance and Embase were searched from the establishment of the database to April 2022. The literature on the relationship between preterm birth, low birth weight and the risk of hypospadias was included. Meta analysis was conducted on the relationship between preterm birth, low birth weight and the risk of hypospadias.Results:A total of 13 articles were included, including cases from Asia, Europe, Australia and America. Newcastle-ottawa Scale was used for evaluation, and the scores were all above 6. There were 10 articles on the relationship between preterm birth and the risk of hypospadias, all of which were case-control studies. Heterogeneity test I2=46%, P=0.05. There were 3 521 cases in the case group and 95 816 cases in the control group. Compared with the control group, preterm birth was a risk factor for hypospadias ( OR: 2.13, 95% CI: 1.89-2.41), and the difference was statistically significant ( Z=12.21, P<0.01). There were 11 articles on the association between low birth weight and the risk of hypospadias, all of which were case-control studies. Heterogeneity test I2=47%, P=0.04. There were 2 460 cases in the case group and 94 260 cases in the control group. Compared with the control group, low birth weight was a risk factor for hypospadias ( OR: 3.29, 95% CI: 2.57-4.22), and the difference was statistically significant ( Z=9.40, P<0.01). Conclusions:Based on meta-analysis of published literature, preterm birth and low birth weight increase the risk of hypospadias.