Congenital lower urinary tract obstruction (CLUTO) is a spectrum of fetal malformations caused by anatomical abnormalities of the urethra, characterized by high rates of perinatal complications and mortality. The 2024 joint guideline from the European Association of Urology (EAU) and the European Society for Paediatric Urology (ESPU) introduced systematic revisions to the comprehensive management of CLUTO. Key updates encompass advancements in prenatal and postnatal screening and precise diagnosis, refined fetal prognosis assessment, clearer indications and modality selection for prenatal intervention, optimization of postnatal treatment strategies, and the establishment of a lifelong follow-up framework within an integrated care pathway. This article elucidates these key updates by comparing the 2024 EAU/ESPU guideline with the 2022 European Rare Kidney Disease Reference Network (ERKNet) consensus. It also discusses ongoing controversies and future research directions. The aim is to provide clinicians with the latest evidence-based insights to inform practice, ultimately improving outcomes and quality of life for children with CLUTO.
Humans ; Urology ; Female ; Urethral Obstruction/therapy* ; Pregnancy ; Child ; Europe ; Prenatal Diagnosis ; Infant, Newborn ; Urethra/abnormalities*

Renal tubulointerstitial fibrosis is the common ending of progressive renal disease. It is worth developing new ways to stop the progress of renal fibrosis. Peroxisome proliferator-activated receptor-γ (PPARγ) agonists have been studied to treat diabetic nephropathy, cisplatin-induced acute renal injury, ischemia reperfusion injury and adriamycin nephropathy. In this study, unilateral ureteral obstruction (UUO) was used to establish a different renal fibrosis model. PPAR? agonist pioglitazone was administrated by oral gavage and saline was used as control. At 7th and 14th day after the operation, mice were sacrificed for fibrosis test and T lymphocytes subsets test. Unexpectedly, through MASSON staining, immunohistochemistry for α-SMA, and Western blotting for a-SMA and PDGFR-β, we found that pioglitazone failed to attenuate renal fibrosis in UUO mice. However, flow cytometry showed that pioglitazone down-regulated Th1 cells, and up-regulated Th2 cells, Th17 cells and Treg cells. But the Th17/Treg ratio had no significant change by pioglitazone. Real-time PCR results showed that TGF-β and MCP-1 had no significant changes, at the same time, CD4(+) T cells associated cytokines were partially regulated by pioglitazone pretreatment. Taken together, pioglitazone failed to suppress renal fibrosis progression caused by UUO.
Animals ; Chemokine CCL2 ; metabolism ; Fibrosis ; Kidney ; pathology ; Kidney Diseases ; drug therapy ; etiology ; Male ; Mice ; Mice, Inbred C57BL ; PPAR gamma ; agonists ; T-Lymphocyte Subsets ; drug effects ; Thiazolidinediones ; administration & dosage ; pharmacology ; therapeutic use ; Transforming Growth Factor beta ; metabolism ; Urethral Obstruction ; complications

PURPOSE: Limited studies have shown antifibrotic effects of pentoxifylline, captopril, simvastatin, and tamoxifen. No comparisons are available of the effects of these drugs on prevention of renal and bladder changes in partial urethral obstruction (PUO). MATERIALS AND METHODS: The rats were divided into six groups (n=7). The sham-operated rats (group I) only underwent laparotomy and did not receive any treatments. The PUO groups (group II-VI) received normal saline (PUO+NS), pentoxifylline (100 mg/kg/d; PUO+PEN), captopril (35 mg/kg/d; PUO+CAP), simvastatin (15 mg/kg/d; PUO+SIM), or tamoxifen (10 mg/kg/d; PUO+TAM) by gavage for 28 days. Then, the volume and/or length of the kidney components (tubules, vessels, and fibrous tissue) and the bladder components (epithelial and muscular layers, fibrous tissue, fibroblast and fibrocyte number) were quantitatively evaluated on the microscopic sections by use of stereological techniques. RESULTS: The volume of renal and bladder fibrosis was significantly ameliorated in the PUO+PEN group, followed by the PUO+CAP, PUO+SIM, and PUO+TAM groups. Also, the volume and length of the renal tubules and vessels and bladder layers were more significantly protected in the PUO+PEN group, followed by the PUO+CAP, PUO+SIM, and PUO+TAM groups. CONCLUSIONS: Treatment of PUO with PEN was more effective in the prevention of renal and bladder fibrosis and in the preservation of renal and bladder structures.
Angiotensin-Converting Enzyme Inhibitors/pharmacology ; Animals ; Captopril/*pharmacology ; Disease Models, Animal ; Estrogen Antagonists/pharmacology ; Free Radical Scavengers/pharmacology ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology ; Kidney/*drug effects/pathology ; Male ; Pentoxifylline/*pharmacology ; Rats ; Simvastatin/*pharmacology ; Tamoxifen/*pharmacology ; Urethral Obstruction/*drug therapy ; Urinary Bladder Neck Obstruction/*drug therapy

OBJECTIVETo study the effect and mechanism of Coicis Semen oil (Kanglaite injection, KLT) on renal interstitial fibrosis induced by unilateral ureteral obstruction (UUO).

METHODFifty-four male SD rats were randomly divided into 3 groups, 6 in each group, the sham operated group, the model group, and the KLT group. Renal interstitial fibrosis model was established in rats by UUO. After administration of KLT (15 mL x kg(-1) x d(-1)) for 3, 7 and 14 days, the dynamic histological changes of renal interstitial tissues were observed and renal damage including tubular impairment and interstitial fibrosis were quantified on HE and Masson stained tissue sections. The expression of alpha-smooth muscle actin (alpha-SMA) and transforming growth factor-beta1 (TGF-beta1) were measured by immunohistochemistry staining sections. The protein expression of p-Smad2 and Smad7 were detected by Western blot respectively.

RESULTThe degree of tubular damage in KLT group was much lower than that in UUO group (P < 0.05). The expression of alpha-SMA and TGF-beta1 was decreased in both UUO group and KLT group, while it was significantly lower in KLT group at every time point. The protein expression of p-Smad2 was obviously decreased while the protein expressions of Smad7 was obviously increased in KLT group, compared with the UUO group (P < 0.05).

CONCLUSIONCoicis Semen oil could attenuate the tubulo-interstitial fibrosis, probable by intervening the TGF-beta/Smads signal transduction pathway of UUO rats.

Animals ; Coix ; Fibrosis ; Injections ; Kidney ; pathology ; Male ; Plant Oils ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Signal Transduction ; drug effects ; Smad2 Protein ; metabolism ; Transforming Growth Factor beta1 ; antagonists & inhibitors ; physiology ; Urethral Obstruction ; drug therapy ; pathology

OBJECTIVETo evaluate the endourethral surgery for the complicated urethra stenosis and urethratresia.

METHODSThe endourethral surgery, such as internal urethrotomy transurethral scar electrosectomy or transurethral scar plasmakinetic bipolar electrocautery (PKR) or transurethral laser cicatrectomy, were carried out in 46 cases suffering from the complicated urethra stenosis and urethratresia.

RESULTSThe curative rate in this series being achieved by once and twice or three times'operation were 80.43% (39/46) and 13.04% (6/46) respectively. Three cases of treatment failure were caused by long-segment stricture and urethratresia or severe malposition of the urethral proximal and distal to a narrow-caliber area or post-operation infection. Thirty-nine cases have been followed up for 6 to 84 months. Satisfactory voiding has been achieved in all patients.

CONCLUSIONEndoscopic surgery was believed to be a safe and efficient therapeutic choice for the complicated urethra stenosis and urethratresia. The success of the treatment depends on understanding the length of the stricture before operation, resecting completely the scar tissue with electric or PKR or laser technique during the process, preventing infection and managing appropriately the urethral catheterization after operation.

Adolescent ; Adult ; Aged ; Endoscopy ; Follow-Up Studies ; Humans ; Laser Therapy ; Male ; Middle Aged ; Retrospective Studies ; Urethra ; abnormalities ; surgery ; Urethral Obstruction ; surgery ; Urethral Stricture ; surgery ; Urogenital Surgical Procedures ; methods

OBJECTIVETo improve the understanding of acute obstructive anuria at upper urinary tract in order to cope properly with corresponding clinical problems.

METHODSThe clinical problems of acute obstructive anuria at upper urinary tract in 55 patients was summarized and analysed. Anuria, lumbago, edema and progressive increase of blood creatinine and ureal nitrogen were the main bases of diagnosis. B-typed ultrasonography and plain film of abdomen (KUB) were the first choice in examinations. The treatment principles lied in prompt removal of obstruction as well as effective prevention and treatment of infection to protect renal function to maximum extent.

RESULTSForty-three cases (78.2%) recovered normal renal function. Ten cases (18.2%) still had azotemia three months after treatment. Two cases gave up treatment.

CONCLUSIONSThe reason of tumor for anuria should be paid attention to. The first choice in treatments is ureteral intubation by cystoscope. Diuretic should be used cautiously.

Acute Disease ; Adult ; Aged ; Anuria ; etiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Urethral Obstruction ; complications ; therapy

PURPOSE: The aim of this study was to evaluate the effectiveness of external sphincter relaxant and biofeedback with electrical stimulation therapy (EST) in patients who did not respond well to antibiotics. MATERIALS AND METHODS: One hundred-five patients with a diagnosis of female urethral syndrome were entered in this study. Antibiotics were given as first-line therapy for about 3 months. In cases of recurrent or persistent urethral syndrome, antibiotic therapy combined with external sphincter relaxant or biofeedback with EST were performed. According to video-urodynamic analysis, 31 patients (29.5%) were external sphincter relaxant group who showed functional urethral obstruction and 41 patients (39.5%) were biofeedback with EST group who had severe pain or discomfort with irritative voiding symptoms. Subjective symptom was measured before and after therapy using the Bristol Female Lower Urinary Tract Symptoms questionnaire. RESULTS: Thirty-three patients (31.4%) of all patients (n=105) were terminated with antibiotic therapy alone and 7 (21.2%) patients were recurred. The symptom score changed 10.51 to 2.85. In antibiotics with external sphincter relaxant, the symptom score changed 12.39 to 3.96. In five (16.1%) of them symptoms were recurred and 3 of 5 patients underwent urethral dilatation. In antibiotics with biofeedback, average frequency changed from 12.2 to 7.7 times a day and nocturia changed 2.4 to 0.6 time a night. The symptom score improved from 15.22 to 4.69 and the overall satisfaction rate was 87.8% (41.5%: very satisfied, 46.3%: satisfied, 12.2%: no response). CONCLUSIONS: Biofeedback and external sphincter relaxant therapy as an alternative therapeutic option are effective and appropriate for the treatment of female urethral syndrome especially in patients who did not respond well to antibiotics. For the better outcomes, selection of the most appropriate therapeutic modality with the diagnostic work up is warranted.
Anti-Bacterial Agents* ; Biofeedback, Psychology ; Diagnosis ; Dilatation ; Electric Stimulation Therapy ; Female* ; Humans ; Lower Urinary Tract Symptoms ; Nocturia ; Surveys and Questionnaires ; Urethral Obstruction

PURPOSE: The aim of this presentation is to analyze the factors influencing on retrograde insertion of double-J catheter in urethral obstruction due to malignancy and to predict the possibility of stunting with double-J catheter. MATERIALS AND METHODS: A retrospective analysis of 43 patients who had underwent retrograde double-J catheter insertion for urethral obstruction secondary to pelvic malignancy, from January 1993 to April 1997, was performed to evaluate the success rates of double-J ureteral stenting according to the factors such as age, sex, presence or absence of flank pain, degree of hydronephrosis, renal function, stage of tumor, laterality of ureter, past history of radiotherapy, operation and chemotherapy. RESULTS: According to the degree of hydronephrosis, the success rate was 100, 73.7 and 50% in grade I II and III, respectively(p<0.05). According to the renal function, the success rate was 81.3% in the group with normal renal function and 45.5% in the group with abnormal venal function(p<0.05) According to the stage of disease, the success rate was 100, 70.7 and 58.3% in stage I, II and III, respectively. According to the absence or presence of flank pain, the success rate was 56.3% in the group with flank pain and 81.5% in the group without flank pain. According to the past history of radiotherapy, the success rate was 65.6% in the group treated with radiotherapy and 90.9% in the group not treated with radiotherapy. The age, sex, laterality of ureter, past history of operation and chemotherapy were not significantly correlated to the success rates. CONCLUSIONS: The factors influencing on double-J ureteral slanting were the degree of hydronephrosis, renal function, absence or presence of flank pain, stage of disease and past history of radiotherapy Further study will be needed to demonstrate the accurate timing of urethral stenting with doublets ureteral catheter.
Catheters* ; Drug Therapy ; Flank Pain ; Humans ; Hydronephrosis ; Radiotherapy ; Retrospective Studies ; Stents ; Ureter* ; Ureteral Obstruction* ; Urethral Obstruction ; Urinary Catheters