Papers by Santiago Weller
The Journal of urology/The journal of urology, May 1, 2024
International braz j urol
Journal of Pediatric Urology
The proactive management of spina bifida (SB), especially of its severe form, myelomeningocele (M... more The proactive management of spina bifida (SB), especially of its severe form, myelomeningocele (MMC), has contributed to decreasing chronic kidney disease (CKD). The objective of this study is to present the evolution of 5-year-old patient with MMC followed from birth with a proactive approach. This retrospective study included 55 cases with MMC of up to 5 years of age. All of them were admitted at birth and followed by a multidisciplinary group, with a proactive approach: CIC and anticholinergics. In the same group, the variables were compared within the first year and the within the fifth year of life. Chronic kidney disease (CKD) was defined by: alterations on renal DMSA scintigraphy; alterations in microalbuminuria/creatininuria ratio, proteinuria 24 hs and decrease in glomerular filtration rate (GFR) calculated with Schwartz bedside equation. Although overactivity, UTI and VUR decreased throughout the first 5 years (49, 9 and 12%), reduced cystometric capacity, DLPP >40 cm of water and end-filling pressure (Pdet) >20 cm of water increased (41, 27 and 61%). All patients at 5 years of age required CIC. Reduced cystometric capacity and VUR were more significant with abnormal DMSA (36%) at 5 years old ( p: 0.03). Proteinuria and CKD increased to 25% and 49%. Similarly, the need for enalapril increased from 10% to 27%. The microalbuminuria/creatininuria ratio was pathological in 27.3%. 48 patients (87%) remained unchanged on DMSA scan and the other 7 underwent modifications (4 new cases with altered DMSA) over time. Of the 32 normal DMSA cases without changes, 81% did not present proteinuria and 88% continued to respond favorably to oxybutynin. GFR <90 ml/min/1.72m 2 was found in only 3 cases with abnormal DMSA. There was a RR 1.91 (IC95% 1.15-3.16) greater of renal compromise in cases that were anticholinergic-resistant compared to non-refractory cases. Over time, some patients suffered loss of bladder wall compliance, despite the proactive approach. There is an association between abnormal renal DMSA, reduced bladder capacity, and VUR at 5 years of age. Although proteinuria, CKD and enalapril requirement increased over 5 years, almost 90% did not show changes in renal DMSA status. Over time, some patients suffered loss of bladder wall compliance. Hence, even if a proactive approach is followed since birth, it is essential to continue with the ongoing monitoring of the renal status and thus avoid greater renal deterioration.
Journal of Pediatric Urology, 2021
In 1954 Murray performed the first truly successful pediatric kidney transplant from one homozygo... more In 1954 Murray performed the first truly successful pediatric kidney transplant from one homozygous twin to another (Murray et al., 1958). In 1966 Kelly reported a kidney transplantation in a patient with dysfunctional bladder who had undergone ileal segment urinary diversion (Kelly et al., 1966). Until that time, patients with ESRD and untreatable dysfunctional urinary tract were excluded from renal transplant programs. At that time, it was believed that the renal allograft connected to a dysfunctional bladder would run the same risk as the native kidneys, that is, the result would be again renal insufficiency (Sheldon et al., 1994).
Urology, 2021
OBJECTIVE To analyze the outcomes of patients undergoing upper-pole heminephrectomy surgery and t... more OBJECTIVE To analyze the outcomes of patients undergoing upper-pole heminephrectomy surgery and to assess the different variables that may have an impact on outcome, specifically regarding morbidity and the need for further surgeries. METHODS A retrospective study of patients who underwent laparoscopic upper-pole heminephrectomy for a non-functional moiety between August 2007 to December 2019 was conducted at three centers. 130 patients met the inclusion criteria. A transperitoneal approach was used. The following variables were evaluated: a) preoperative: presentation, presence of ureterocele and history of ureterocele incision, hydronephrosis grade, presence of VUR, and DRF on renal scintigraphy; and b) postoperative outcomes: Doppler ultrasound, renal scintigraphy, complications, fUTI, LUTS, and need for further surgery. Findings were considered statistically significant at p <0.05. RESULTS Postoperative complications were observed in five patients (3.8%). Six patients (4.6 %) needed further surgeries after heminephrectomy. The presence of ureterocele and VUR was related with the need for further surgeries (OR 4.91 - p 0.0415) and the occurrence of postoperative fUTI (OR 2.81 -p 0.0376). A 13.9% incidence of LUTS was found with no difference between patients with ureterocele and those with an ectopic ureter. Renal scintigraphy showed a median decrease in DRF of 2.7%. No patient had complete loss of function. CONCLUSION Laparoscopic upper-pole heminephrectomy showed to be a feasible and safe procedure. In most patients this surgery will be the definitive procedure. Patients with both VUR and ureterocele will need special consideration. No significant loss of function in the remaining lower moiety was found.
Journal of Pediatric Urology, 2020
Journal of Pediatric Surgery, 2020
Journal of Pediatric Urology, 2017
Frontiers in Pediatrics, 2017
Renal Transplantation - Updates and Advances, 2012
Journal of Pediatric Surgery, 2015
ISRN Urology, 2012
When the neurogenic bladder is refractory to anticholinergics, botulinum toxin type A is used as ... more When the neurogenic bladder is refractory to anticholinergics, botulinum toxin type A is used as an alternative. The neurotoxin type A reduces bladder pressure and increases its capacity and wall compliance. Additionally, it contributes to improving urinary continence and quality of life. This novel therapy is ambulatory with a low incidence of adverse effects. Due to its transitory effect, it is necessary to repeat the injections in order to sustain its therapeutic effect. In these review article we talk about Mechanism of Action, Indications, effects, administration and presentations of the Botulinum Neurotoxin Type A in pediatric patients. Also, we make references to controversial issues surrounding its use. A bibliographic search was done selecting articles and revisions from Pubmed. The key words used were botulinum toxin A, neurogenic bladder, and children. The search was limited to patients younger than 18 years of age and reports written in English in the past ten years.
Pediatric Surgery International, 2010
To determine whether surgical procedures of the lower urinary tract in patients with uropathies a... more To determine whether surgical procedures of the lower urinary tract in patients with uropathies affect evolution of the graft in renal transplantation. 156 kidney transplantations were performed in 150 patients with end-stage renal failure due to urologic disorders. The patients were classified into three groups: A, patients who did not require surgery in the lower urinary tract; B, required surgery and preserved adequate bladder function, and C, required surgery due to vesical dysfunction. Graft survival rates at 1 year were 93.38% in group A, 95.45% in group B and 93% in group C. Rates at 5 years post-transplantation were 82.45, 79.85 and 86.58% for each group, respectively (not significant). Complications were vesicoureteral stenosis: 2 in group A, 3 in B and 1 in C; vesicoureteral reflux: 1 in group A, 1 in B and 10 in C; distal ureteral necrosis: 2 cases in group A, 2 in B and 1 in C; upper urinary tract infection: 12, 23.1 and 42.2% in each group, respectively. Children with reconstructed urinary tract may be good candidates for kidney transplantation despite the higher frequency of urinary infections. Thus, careful and strict post-surgical urologic follow-up is mandatory.
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Papers by Santiago Weller