Konrad Szymanski | Indiana University (original) (raw)

Papers by Konrad Szymanski

Urology, 2013

Pediatric extrarenal malignant rhabdoid tumors (MRTs) are rare and aggressive (20% 5-year surviva... more Pediatric extrarenal malignant rhabdoid tumors (MRTs) are rare and aggressive (20% 5-year survival). Only 2 cases of bladder MRTs have been published. We report on a 9-year-old boy presenting with gross hematuria, palpable pelvic mass, and an obstructed, nonfunctional kidney. Evaluation was consistent with a 9.7 cm extrarenal MRT invading the bladder and prostate. He underwent a cystoprostatectomy, Indiana pouch continent urinary reservoir creation, and a left nephroureterectomy. A discrete 2.5 cm focus of renal MRT was found. To our knowledge, this is the first case of simultaneous perivesical and renal MRT. We review the current management of pediatric extrarenal MRTs.

The Journal of urology, 2014

Bladder stones are common after bladder augmentation, often resulting in numerous procedures for ... more Bladder stones are common after bladder augmentation, often resulting in numerous procedures for recurrence. We sought to determine whether surgical technique and stone fragmentation are significant predictors of bladder stone recurrence after bladder augmentation. We retrospectively reviewed 107 patients treated for first bladder stones at our institution. Patient demographics, details of surgeries, stone therapy and recurrence were reviewed. Kaplan-Meier survival and Cox proportional hazards analysis were used to determine predictors of time to first stone recurrence. Of 107 patients 55.1% were female and 79.4% had neuropathic bladder. Patients underwent augmentation at a median age of 8.0 years (range 2.4 to 22.8) and were followed for a median of 12.4 years (1.8 to 34). Segments used for augmentation included ileum (72.9% of cases), sigmoid (16.8%), cecum/ileocecum (9.4%) and other (ureter, stomach/ileum, 1.8%). Bladder neck procedures were performed in 63.6% of patients and cat...

The Journal of urology, Jan 3, 2015

We sought to evaluate HRB in children undergoing reconstruction for urinary and fecal incontinenc... more We sought to evaluate HRB in children undergoing reconstruction for urinary and fecal incontinence from a parental perspective. A HRB instrument was mailed to the parents or guardians of 300 consecutive patients who previously underwent reconstruction for urinary and/or fecal incontinence at our institution between 1997-2011. We assessed parent-reported HRB using the validated GCBI and their satisfaction with 6 supplemental questions. One-sample t-tests as well as exploratory univariate and multivariate linear regressions were performed for statistical analysis. The response rate was 40.0% at a mean elapsed time of 5.5 years (0.6 - 13.8 years) after reconstruction. SB was the most common primary diagnosis in 48 patients (56.5%). The mean total GCBI score and subscores for each domain were positive, indicating an improved HRB after reconstruction (all p<0.0001). Certain patients, possibly based on diagnosis and gender, may particularly benefit from reconstruction (p≤0.04). Parents...

The Journal of Urology, 2015

The purpose of this study was to assess long-term renal function, morbidities and mortality follo... more The purpose of this study was to assess long-term renal function, morbidities and mortality following primary gastrocystoplasty. We performed a retrospective review of all patients ≤ 21 years old who underwent primary gastrocystoplasty from 1984-2004. Patients who underwent secondary gastrocystoplasty, primary composite augmentation or had cloacal exstrophy were excluded. The primary outcome was progression to end-stage renal disease (ESRD). Secondary outcomes included mortality, bladder malignancy, hematuria dysuria syndrome (HDS), electrolyte abnormalities and surgical revisions. Of the 50 patients who underwent a gastrocystoplasty, 35 (60% male, median age 9.4 years) met inclusion criteria. Median follow up was 19 years (interquartile range 11-25 years). Of 35 patients, 15 (43%) had normal preoperative estimated glomerular filtration rate (eGFR), 5 (14%) had CKD stage 2, 10 (29%) stage 3 and 5/35 (14%) stage 4. Of those with CKD 3 or 4, 5/15 improved to a normal eGFR, 1/5 remained at stage 3 CKD and 9/15 developed ESRD. One patient with normal eGFR developed ESRD following an episode of septic shock from osteomyelitis. Seven (20%) patients died due to septic shock from a urinary tract infection (2), ventriculoperitoneal shunt infection (1), pneumonia (1), ESRD (1), complications of pregnancy (1), and unknown cause (1). There were no bladder malignancies; nine (24%) developed HDS. Eight (23%) had surgical revisions. The majority of patients had preserved or improved renal function after gastrocystoplasty. There were no deaths attributable to gastric augmentation and no bladder malignancies. Approximately one fourth of patients required surgical revision.

Pediatric Nephrology, 2012

Background Pre-transplant nephrectomy is performed to reduce risks to graft and recipient. The ai... more Background Pre-transplant nephrectomy is performed to reduce risks to graft and recipient. The aims of this study were to evaluate (1) indications, surgical approach, and morbidity of native nephrectomy and (2) the effects of kidney removal on clinical and biological parameters. Methods This study was designed as a single-center retrospective cohort study in which 49 consecutive patients with uni-or bilateral native nephrectomies were identified from a total of 126 consecutive graft recipients in our pediatric kidney transplantation database between 1992 and 2011. Demographic, clinical, and laboratory details were extracted from charts and electronic records, including operation reports and pre-and post-operative clinic notes. Results Of the 49 nephrectomized patients, 47% had anomalies of the kidneys and urinary tract, 22% had cystinosis, 12% had focal segmental glomerulosclerosis, and 6% had congenital nephrotic syndrome. Nephrectomy decisions were based on clinical judgment, taking physiological and psychosocial aspects into consideration. Nephrectomy was performed in patients with polyuria (>2.5 ml/kg/h) and/or large proteinuria (>40 mg/m 2 /h), recurrent urinary tract infection or (rarely) hypertension. Urine output decreased from (median) 3.79 to 2.32 ml/kg/h (−34%), and proteinuria from 157 to 100 mg/m 2 /h (−40%) after unilateral nephrectomy (p00.005). After bilateral nephrectomy, serum albumin, protein and fibrinogen concentrations normalized in 93, 73, and 55% of nephrectomized patients, respectively. Clinically relevant procedure-related complications (peritoneal laceration, hematoma) occurred in five patients. Conclusion In summary, we demonstrate quantitatively that native nephrectomy prior to transplantation improved serum protein levels and anticipated post-transplant fluid intake needs in select children, reducing the risk of graft hypoperfusion and its postulated consequences for graft outcome.

The Journal of Urology, 2011

Purpose: Measuring the health related quality of life of patients with prostate cancer in routine... more Purpose: Measuring the health related quality of life of patients with prostate cancer in routine clinical practice is hindered by the lack of instruments enabling efficient, real-time, point of care scoring of multiple health related quality of life domains. Thus, we developed an instrument for this purpose.

The Journal of Urology, 2010

The literature on minimally invasive nephrectomy in adults and children on peritoneal dialysis is... more The literature on minimally invasive nephrectomy in adults and children on peritoneal dialysis is sparse. Case reports suggest that the transperitoneal approach is effective. We present our experience with retroperitoneoscopic nephrectomy in children on peritoneal dialysis. Materials and Methods: At 11 consecutive retroperitoneoscopic nephrectomies a total of 14 kidneys were removed from 10 children with a mean age of 12 years. We used a 3-port lateral retroperitoneoscopic nephrectomy technique with active trainee participation. Preoperative and postoperative biochemistry results within 3 months of surgery were compared with the Wilcoxon signed rank test. Results: Three bilateral synchronous, 1 bilateral staged and 6 unilateral retroperitoneoscopic nephrectomies were done. Mean operative time was 174 minutes for unilateral and 458 minutes for bilateral nephrectomy, including 1 simultaneous peritoneal dialysis insertion and 1 umbilical hernia repair. No open conversion, blood transfusion or postoperative surgical complication was noted. Peritoneal dialysis was initiated at a median of 9 hours postoperatively and dialysate volume was titrated to target within a median of 60 hours. One patient with a small peritoneotomy needed temporary hemodialysis despite intraoperative airtight repair. After surgery median serum albumin increased from 30.0 to 34.3 gm/l. Conclusions: Retroperitoneoscopic nephrectomy for end stage renal disease is a safe, effective technique that preserves peritoneal integrity in children who require immediate postoperative peritoneal dialysis. Avoiding post-nephrectomy hemodialysis decreases patient morbidity, preserving vessels for future vascular access. Compared to the literature on laparoscopy in this setting, retroperitoneoscopic nephrectomy can be considered the ideal approach for minimally invasive nephrectomy in patients on peritoneal dialysis.

The Journal of Urology, 2012

LGHN ϭ low grade hydronephrosis PHN ϭ prenatal hydronephrosis UTI ϭ urinary tract infection VCUG ... more LGHN ϭ low grade hydronephrosis PHN ϭ prenatal hydronephrosis UTI ϭ urinary tract infection VCUG ϭ voiding cystourethrogram VUR ϭ vesicoureteral reflux

Journal of Pediatric Urology, 2014

Objective: Recent and historical studies suggest that bladder neck procedures (BNPs) without augm... more Objective: Recent and historical studies suggest that bladder neck procedures (BNPs) without augmentation are safe and effective. In select patients we have performed BNPs without concomitant augmentation. We sought to determine long-term outcomes of this approach and attempt to identify risk factors for bladder deterioration. Patients and methods: A retrospective chart review was conducted to identify patients who underwent a BNP without bladder augmentation and followed for at least 4 years. BNPs were only performed in patients with favorable preoperative urodynamics (UDS). The charts were analyzed for long-term outcomes with the primary endpoint of bladder augmentation. Results: Twenty-nine patients (21 females) with poor bladder outlet resistance underwent a BNP without augmentation (mean follow-up 8 years). Thirteen patients (45%) were augmented at an average of 2.6 years. No predictive UDS parameters were identified; however, exploratory analysis suggested detrusor pressure at 100 mL bladder volume prior to BNP (p Z 0.009) was predictive of delayed augmentation. Conclusion: We report a 45% augmentation rate after isolated BNP in patients with favorable preoperative UDS parameters. We recommend close observation of this patient population with serial UDS, routine ultrasounds, and appropriate preoperative counseling prior to undertaking this approach, as this represents a life-long risk to the upper tracts.

BMC Cancer, 2011

Background: Despite the recent publication of results from two randomized clinical trials, prosta... more Background: Despite the recent publication of results from two randomized clinical trials, prostate specific antigen (PSA) screening for prostate cancer remains a controversial issue. There is lack of agreement across studies that PSA screening significantly reduces prostate cancer mortality. In spite of these facts, the widespread use of PSA testing in the United States leads to overdetection and overtreatment of clinically indolent prostate cancer, and its associated harms of incontinence and impotence. Discussion: Given the inconclusive results from clinical trials and incongruent PSA screening guidelines, the decision to screen for prostate cancer with PSA testing is an uncertain one for patients and health care providers. Screening guidelines from some health organizations recommend an informed decision making (IDM) or shared decision making (SDM) approach for deciding on PSA screening. These approaches aim to empower patients to choose among the available options by making them active participants in the decision making process. By increasing involvement of patients in the clinical decision-making process, IDM/SDM places more of the responsibility for a complex decision on the patient. Research suggests, however, that patients are not wellinformed of the harms and benefits associated with prostate cancer screening and are also subject to an assortment of biases, emotion, fears, and irrational thought that interferes with making an informed decision. In response, the IDM/SDM approaches can be augmented with strategies from the philosophy of libertarian paternalism (LP) to improve decision making. LP uses the insights of behavioural economics to help people better make better choices. Some of the main strategies of LP applicable to PSA decision making are a default decision rule, framing of decision aids, and timing of the decision. In this paper, we propose that applying strategies from libertarian paternalism can help with PSA screening decision-making. Summary: Our proposal to augment IDM and SDM approaches with libertarian paternalism strategies is intended to guide patients toward a better decision about testing while maintaining personal freedom of choice. While PSA screening remains controversial and evidence conflicting, a libertarian-paternalism influenced approach to decision making can help prevent the overdiagnosis and overtreatment of prostate cancer.

Journal of Pediatric Urology, 2014

It is critical to differentiate between a multicystic dysplastic kidney (MCDK) and a kidney with ... more It is critical to differentiate between a multicystic dysplastic kidney (MCDK) and a kidney with severe hydronephrosis as the treatment varies significantly. We designed a study to compare renal ultrasound (RUS) to nuclear medicine (NM) scan in the diagnosis of MCDK, in order to determine if RUS can be used for the definitive diagnosis of MCKD without use of NM scan. We performed a retrospective review of children with MCDK, who underwent both a RUS and Tc-99m MAG3 or DMSA scan. We planned to calculate the positive predictive value of an RUS diagnosis of MCDK, using NM scan diagnosis of a nonfunctioning kidney as the gold standard. The diagnosis of MCDK was made by RUS in 91 patients, 84 of whom had a normal bladder US. NM confirmed the diagnosis of MCDK in all 84 of these patients (100%). We have demonstrated a high predictive value for RUS in the diagnosis of MCDK. Our data support that in healthy infants with RUS diagnosis of unilateral MCDK and normal bladder US, NM scan may be unnecessary to confirm the diagnosis.

Urology, 2013

Pediatric extrarenal malignant rhabdoid tumors (MRTs) are rare and aggressive (20% 5-year surviva... more Pediatric extrarenal malignant rhabdoid tumors (MRTs) are rare and aggressive (20% 5-year survival). Only 2 cases of bladder MRTs have been published. We report on a 9-year-old boy presenting with gross hematuria, palpable pelvic mass, and an obstructed, nonfunctional kidney. Evaluation was consistent with a 9.7 cm extrarenal MRT invading the bladder and prostate. He underwent a cystoprostatectomy, Indiana pouch continent urinary reservoir creation, and a left nephroureterectomy. A discrete 2.5 cm focus of renal MRT was found. To our knowledge, this is the first case of simultaneous perivesical and renal MRT. We review the current management of pediatric extrarenal MRTs.

The Journal of urology, 2014

Bladder stones are common after bladder augmentation, often resulting in numerous procedures for ... more Bladder stones are common after bladder augmentation, often resulting in numerous procedures for recurrence. We sought to determine whether surgical technique and stone fragmentation are significant predictors of bladder stone recurrence after bladder augmentation. We retrospectively reviewed 107 patients treated for first bladder stones at our institution. Patient demographics, details of surgeries, stone therapy and recurrence were reviewed. Kaplan-Meier survival and Cox proportional hazards analysis were used to determine predictors of time to first stone recurrence. Of 107 patients 55.1% were female and 79.4% had neuropathic bladder. Patients underwent augmentation at a median age of 8.0 years (range 2.4 to 22.8) and were followed for a median of 12.4 years (1.8 to 34). Segments used for augmentation included ileum (72.9% of cases), sigmoid (16.8%), cecum/ileocecum (9.4%) and other (ureter, stomach/ileum, 1.8%). Bladder neck procedures were performed in 63.6% of patients and cat...

The Journal of urology, Jan 3, 2015

We sought to evaluate HRB in children undergoing reconstruction for urinary and fecal incontinenc... more We sought to evaluate HRB in children undergoing reconstruction for urinary and fecal incontinence from a parental perspective. A HRB instrument was mailed to the parents or guardians of 300 consecutive patients who previously underwent reconstruction for urinary and/or fecal incontinence at our institution between 1997-2011. We assessed parent-reported HRB using the validated GCBI and their satisfaction with 6 supplemental questions. One-sample t-tests as well as exploratory univariate and multivariate linear regressions were performed for statistical analysis. The response rate was 40.0% at a mean elapsed time of 5.5 years (0.6 - 13.8 years) after reconstruction. SB was the most common primary diagnosis in 48 patients (56.5%). The mean total GCBI score and subscores for each domain were positive, indicating an improved HRB after reconstruction (all p<0.0001). Certain patients, possibly based on diagnosis and gender, may particularly benefit from reconstruction (p≤0.04). Parents...

The Journal of Urology, 2015

The purpose of this study was to assess long-term renal function, morbidities and mortality follo... more The purpose of this study was to assess long-term renal function, morbidities and mortality following primary gastrocystoplasty. We performed a retrospective review of all patients ≤ 21 years old who underwent primary gastrocystoplasty from 1984-2004. Patients who underwent secondary gastrocystoplasty, primary composite augmentation or had cloacal exstrophy were excluded. The primary outcome was progression to end-stage renal disease (ESRD). Secondary outcomes included mortality, bladder malignancy, hematuria dysuria syndrome (HDS), electrolyte abnormalities and surgical revisions. Of the 50 patients who underwent a gastrocystoplasty, 35 (60% male, median age 9.4 years) met inclusion criteria. Median follow up was 19 years (interquartile range 11-25 years). Of 35 patients, 15 (43%) had normal preoperative estimated glomerular filtration rate (eGFR), 5 (14%) had CKD stage 2, 10 (29%) stage 3 and 5/35 (14%) stage 4. Of those with CKD 3 or 4, 5/15 improved to a normal eGFR, 1/5 remained at stage 3 CKD and 9/15 developed ESRD. One patient with normal eGFR developed ESRD following an episode of septic shock from osteomyelitis. Seven (20%) patients died due to septic shock from a urinary tract infection (2), ventriculoperitoneal shunt infection (1), pneumonia (1), ESRD (1), complications of pregnancy (1), and unknown cause (1). There were no bladder malignancies; nine (24%) developed HDS. Eight (23%) had surgical revisions. The majority of patients had preserved or improved renal function after gastrocystoplasty. There were no deaths attributable to gastric augmentation and no bladder malignancies. Approximately one fourth of patients required surgical revision.

Pediatric Nephrology, 2012

Background Pre-transplant nephrectomy is performed to reduce risks to graft and recipient. The ai... more Background Pre-transplant nephrectomy is performed to reduce risks to graft and recipient. The aims of this study were to evaluate (1) indications, surgical approach, and morbidity of native nephrectomy and (2) the effects of kidney removal on clinical and biological parameters. Methods This study was designed as a single-center retrospective cohort study in which 49 consecutive patients with uni-or bilateral native nephrectomies were identified from a total of 126 consecutive graft recipients in our pediatric kidney transplantation database between 1992 and 2011. Demographic, clinical, and laboratory details were extracted from charts and electronic records, including operation reports and pre-and post-operative clinic notes. Results Of the 49 nephrectomized patients, 47% had anomalies of the kidneys and urinary tract, 22% had cystinosis, 12% had focal segmental glomerulosclerosis, and 6% had congenital nephrotic syndrome. Nephrectomy decisions were based on clinical judgment, taking physiological and psychosocial aspects into consideration. Nephrectomy was performed in patients with polyuria (>2.5 ml/kg/h) and/or large proteinuria (>40 mg/m 2 /h), recurrent urinary tract infection or (rarely) hypertension. Urine output decreased from (median) 3.79 to 2.32 ml/kg/h (−34%), and proteinuria from 157 to 100 mg/m 2 /h (−40%) after unilateral nephrectomy (p00.005). After bilateral nephrectomy, serum albumin, protein and fibrinogen concentrations normalized in 93, 73, and 55% of nephrectomized patients, respectively. Clinically relevant procedure-related complications (peritoneal laceration, hematoma) occurred in five patients. Conclusion In summary, we demonstrate quantitatively that native nephrectomy prior to transplantation improved serum protein levels and anticipated post-transplant fluid intake needs in select children, reducing the risk of graft hypoperfusion and its postulated consequences for graft outcome.

The Journal of Urology, 2011

Purpose: Measuring the health related quality of life of patients with prostate cancer in routine... more Purpose: Measuring the health related quality of life of patients with prostate cancer in routine clinical practice is hindered by the lack of instruments enabling efficient, real-time, point of care scoring of multiple health related quality of life domains. Thus, we developed an instrument for this purpose.

The Journal of Urology, 2010

The literature on minimally invasive nephrectomy in adults and children on peritoneal dialysis is... more The literature on minimally invasive nephrectomy in adults and children on peritoneal dialysis is sparse. Case reports suggest that the transperitoneal approach is effective. We present our experience with retroperitoneoscopic nephrectomy in children on peritoneal dialysis. Materials and Methods: At 11 consecutive retroperitoneoscopic nephrectomies a total of 14 kidneys were removed from 10 children with a mean age of 12 years. We used a 3-port lateral retroperitoneoscopic nephrectomy technique with active trainee participation. Preoperative and postoperative biochemistry results within 3 months of surgery were compared with the Wilcoxon signed rank test. Results: Three bilateral synchronous, 1 bilateral staged and 6 unilateral retroperitoneoscopic nephrectomies were done. Mean operative time was 174 minutes for unilateral and 458 minutes for bilateral nephrectomy, including 1 simultaneous peritoneal dialysis insertion and 1 umbilical hernia repair. No open conversion, blood transfusion or postoperative surgical complication was noted. Peritoneal dialysis was initiated at a median of 9 hours postoperatively and dialysate volume was titrated to target within a median of 60 hours. One patient with a small peritoneotomy needed temporary hemodialysis despite intraoperative airtight repair. After surgery median serum albumin increased from 30.0 to 34.3 gm/l. Conclusions: Retroperitoneoscopic nephrectomy for end stage renal disease is a safe, effective technique that preserves peritoneal integrity in children who require immediate postoperative peritoneal dialysis. Avoiding post-nephrectomy hemodialysis decreases patient morbidity, preserving vessels for future vascular access. Compared to the literature on laparoscopy in this setting, retroperitoneoscopic nephrectomy can be considered the ideal approach for minimally invasive nephrectomy in patients on peritoneal dialysis.

The Journal of Urology, 2012

LGHN ϭ low grade hydronephrosis PHN ϭ prenatal hydronephrosis UTI ϭ urinary tract infection VCUG ... more LGHN ϭ low grade hydronephrosis PHN ϭ prenatal hydronephrosis UTI ϭ urinary tract infection VCUG ϭ voiding cystourethrogram VUR ϭ vesicoureteral reflux

Journal of Pediatric Urology, 2014

Objective: Recent and historical studies suggest that bladder neck procedures (BNPs) without augm... more Objective: Recent and historical studies suggest that bladder neck procedures (BNPs) without augmentation are safe and effective. In select patients we have performed BNPs without concomitant augmentation. We sought to determine long-term outcomes of this approach and attempt to identify risk factors for bladder deterioration. Patients and methods: A retrospective chart review was conducted to identify patients who underwent a BNP without bladder augmentation and followed for at least 4 years. BNPs were only performed in patients with favorable preoperative urodynamics (UDS). The charts were analyzed for long-term outcomes with the primary endpoint of bladder augmentation. Results: Twenty-nine patients (21 females) with poor bladder outlet resistance underwent a BNP without augmentation (mean follow-up 8 years). Thirteen patients (45%) were augmented at an average of 2.6 years. No predictive UDS parameters were identified; however, exploratory analysis suggested detrusor pressure at 100 mL bladder volume prior to BNP (p Z 0.009) was predictive of delayed augmentation. Conclusion: We report a 45% augmentation rate after isolated BNP in patients with favorable preoperative UDS parameters. We recommend close observation of this patient population with serial UDS, routine ultrasounds, and appropriate preoperative counseling prior to undertaking this approach, as this represents a life-long risk to the upper tracts.

BMC Cancer, 2011

Background: Despite the recent publication of results from two randomized clinical trials, prosta... more Background: Despite the recent publication of results from two randomized clinical trials, prostate specific antigen (PSA) screening for prostate cancer remains a controversial issue. There is lack of agreement across studies that PSA screening significantly reduces prostate cancer mortality. In spite of these facts, the widespread use of PSA testing in the United States leads to overdetection and overtreatment of clinically indolent prostate cancer, and its associated harms of incontinence and impotence. Discussion: Given the inconclusive results from clinical trials and incongruent PSA screening guidelines, the decision to screen for prostate cancer with PSA testing is an uncertain one for patients and health care providers. Screening guidelines from some health organizations recommend an informed decision making (IDM) or shared decision making (SDM) approach for deciding on PSA screening. These approaches aim to empower patients to choose among the available options by making them active participants in the decision making process. By increasing involvement of patients in the clinical decision-making process, IDM/SDM places more of the responsibility for a complex decision on the patient. Research suggests, however, that patients are not wellinformed of the harms and benefits associated with prostate cancer screening and are also subject to an assortment of biases, emotion, fears, and irrational thought that interferes with making an informed decision. In response, the IDM/SDM approaches can be augmented with strategies from the philosophy of libertarian paternalism (LP) to improve decision making. LP uses the insights of behavioural economics to help people better make better choices. Some of the main strategies of LP applicable to PSA decision making are a default decision rule, framing of decision aids, and timing of the decision. In this paper, we propose that applying strategies from libertarian paternalism can help with PSA screening decision-making. Summary: Our proposal to augment IDM and SDM approaches with libertarian paternalism strategies is intended to guide patients toward a better decision about testing while maintaining personal freedom of choice. While PSA screening remains controversial and evidence conflicting, a libertarian-paternalism influenced approach to decision making can help prevent the overdiagnosis and overtreatment of prostate cancer.

Journal of Pediatric Urology, 2014

It is critical to differentiate between a multicystic dysplastic kidney (MCDK) and a kidney with ... more It is critical to differentiate between a multicystic dysplastic kidney (MCDK) and a kidney with severe hydronephrosis as the treatment varies significantly. We designed a study to compare renal ultrasound (RUS) to nuclear medicine (NM) scan in the diagnosis of MCDK, in order to determine if RUS can be used for the definitive diagnosis of MCKD without use of NM scan. We performed a retrospective review of children with MCDK, who underwent both a RUS and Tc-99m MAG3 or DMSA scan. We planned to calculate the positive predictive value of an RUS diagnosis of MCDK, using NM scan diagnosis of a nonfunctioning kidney as the gold standard. The diagnosis of MCDK was made by RUS in 91 patients, 84 of whom had a normal bladder US. NM confirmed the diagnosis of MCDK in all 84 of these patients (100%). We have demonstrated a high predictive value for RUS in the diagnosis of MCDK. Our data support that in healthy infants with RUS diagnosis of unilateral MCDK and normal bladder US, NM scan may be unnecessary to confirm the diagnosis.