Speciality
Spotlight

 




 

Urology

 

 


















Pediatric
Urology 

  

  • Kirsch AJ, Escala J, Duckett JW, et al [ Univ of Pennsylvania, Philadelphia]

    Surgical Management of the Nonpalpable Testis : The Children’s Hospital of Philadelphia Experience.

    J Urol 159: 1340-1343, 1998

        


    Between 1986 and 1994, 1,866 boys with undescended testes were treated at 1 center. 

         


    During surgery, 41% were found to be atrophic or absent. 21% were intra abdominal. 30% were in the inguinal canal and 9% in other locations, including pubic tubercle, upper scrotum, superficial inguinal pouch, and perineum.

         



    Conclusion
    : In 24% the undescended testes were nonpalpable.

    39% of these were distal to the external inguinal ring. 

    41% were arophic or absent, and 20% were intra-abdominal.

        


    The inguinal approach to orchiopexy with transperitoneal mobilization of the vas and vessels without transection is very successful in patients with intra-abdominal cryptorchid testes. 

        


    Laparoscopy seems reasonable, provided it is combined with laparoscopic
    orchiopexy.

         

  • Silveri M, Capitanucci ML, Mosiello G, et al [Bambino Gesu Children’s Hosp, Palidoro, Rome]

    Endoscopic Treatment for Urinary Incontinence in Children with a Congenital Neuropathic Bladder

    Br J Urol 82: 694-697, 1998

         



    Conclusion
    : Collagen injection does not result in continence in all patients with neurogenic bladder.

         


    The result depended on the type of Neurogenic bladder. Patients with low-pressure complaint bladders had better results. Information regarding abdominal leak point pressure would be useful in patient selection.

         

  • I. Knerr, Z. Nyul, J. Miller, W. Rosch, J. Dotsch, R. Repp, W. Weidner and W. Rascher (Departments of Paediatrics and Urology, Friedrich-Alexander University, Erlangen, and Departments of Paediatrics and Urology, Justus-Liebig University, Giessen, Germany)

    Increased Endothelin-1 and Decreased Adrenomedullin Gene Expression in the Stenotic Tissue of Congenital Pelvi-ureteric Junction Obstruction in Children

    BJU Intl. May 2001 Vol. 87 (7) Pg. 667-671

         


    Results : The amount of endothelin-1 mRNA in stenotic specimens was higher than in the controls, indicated by significantly lower threshold cycles (Ct values).

        


    Adrenomedullin gene expression in the obstructed junctions was significantly lower than in normal junctions.

        


    The above maybe involved in the pathogenesis of congenital hydronephrosis. 

         

  • V. J. Ferlise, M. K. Ankem and J. G. Barone (Division of Urology, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA)

    Use of Cyanoacrylate Tissue Adhesive Under a Diaper

    BJU Intl. May 2001 Vol. 87 (7) Pg. 672-673

         


    Objective : To study the effect of a cyanoacrylate in 25 non toilet trained children undergoing inguinal surgery.

        


    Results : Of the 52 incisions, 27 were closed with suture and 25 with cyanoacrylate adhesive. All patients were followed up at 2 weeks. There were no instances of infection or wound dehiscence in either group. The incisions were cosmetically identical at 3 months of follow-up.

        


    Conclusion : Cyanoacrylate adhesive is a safe and effective method of skin closure that can be used under a diaper.

        


    Discussion : These are a concern that cyanoacrylate tissue adhesive in areas constantly exposed to body fluids may cause weakening of the tissue bond. However, there were no cases of tissue separation and in 25 incisions, the tissue adhesive was still intact at 2 weeks follow-up visit.

        


    It is important to ensure that the tissue adhesive is totally dry before moving the child or placing of diaper over the child. 

        

  • P. Ferrara, C. M. D’Aleo, E. Tarquini, S. Salvatore and E. Salvaggio (Department of Paediatrics, Catholic University, Rome, and Bassini Hospital, Milan-Bicocca University, Cinisello Balsamo, Milan, Italy)


    Side-effects of Oral or Intravesical Oxybutynin Chloride in Children with Spina Bifida


    BJU Intl. May 2001 Vol. 87 (7) Pg. 674-677

        


    Introduction : The reported efficacy of oxybutynin in the treatment of the overactive bladder is almost 50%, but because of its systemic action it can cause various side-effects e.g. dry mouth, constipation, drowsiness and cognitive dysfunction.

         


    Intravesical administration is useful in neurological patients in whom clean intermittent catheterization is often routine. This therapeutic approach allows high concentrations of the drug to be delivered to the target tissue with the maximum pharmacological response and theoretically, the minimum of side- effects. 

         



    Patients and Methods
    : Patients were selected from 225 children with MMC and neurogenic bladder dysfunction referred to the Spina Bifida centre of the Catholic University of Rome from January 1993 to December 1998; all had undergone surgical repair within 24-48 h after birth. 

        


    All patients received oxybutynin either orally or intravesically at a mean dose of 0.1-0.2 mg/kg, for the intravesical preparation the tablets were crushed and the powder dissolved in water (sterile). 

         


    The suspension was instilled into an empty bladder through the urethral catheter and 10 mL syringe; this was undertaken 2-3 times per day.

         


    The patients were followed up with regular urodynamic studies.

               


    Results : Of the 67 patients on oral oxybutynin, 19 (28%) discontinued, comprising 11 (16%) because of side-effects and eight (12%) who changed to intravesical oxybutynin because there were clinical indications for starting CISC.

         


    Of the 34 using intravesical oxybutynin 6 (18%) stopped because of side- effects; two (6%) had cognitive effects, particularly attention deficit and difficulties in basic arithmetical operations. 3 children reported facial flushing, with associated drowsiness. The last patient reported several episodes of hallucinations.

          


    Conclusion : Intravesical installation of oxybutynin is safe and effective but particular attention to and a specific record of central side-effects should be maintained when intravesical oxybutynin is used in children with a dysfunctional bladder. These patients must be closely monitored for any complications.

         

  • M. Horowitz, S. M. Shah, G. Ferzli, P. I. Syad and K. I. Glassberg (The Division of Paediatric Urology, State University of New York, Downstate Medical Center, Brooklyn, NY, and Department of Surgery, Staten Island University Hospital, Staten Island, NY, USA)

    Laparoscopic Partial Upper Role Nephrectomy in Infants and Children 

    BJU Intl. April 2001 Vol. 87(6) Pg. 514-516

         


    Conclusion : Transperitoneal laparoscopic partial nephrectomy is preferable to open partial nephrectomy because:

         


    (i) Magnification provided by laparoscopy provides excellent vision for the precise dissection of the parenchyma and distal ureter, avoiding injury to healthy tissue.

    (ii) There is minimal blood loss, scarring and fast recovery and when upper polar nephrectomy is needed, the laparoscopic technique is less damaging to the lower pole. 

         


    The specific advantages of laparoscopy make it clearly preferable to open surgery.

         

  • G. Andriani, A. Persico, S. Tursini, E. Ballone, D. Cirotti, and P. Lelli Chiesa (Department of Pediatric Surgery and Department of Gynecology, Spirito Santo Hospital, Pescara and Section of Pediatric Surgery and Laboratory of Biostatistics, University G. D’Annunzio, Chieti, Italy) 

    The Renal-Resistive Index From the Last 3 Months of Pregnancy to 6 Months Old 

    BJU Intl. April 2001 Vol. 87 (6) Pg. 562-564

         



    Subjects and methods
    : From September 1998 to October 1999, 93 subjects were enrolled 32 were fetuses in the last trimester of pregnancy (group 1, 64 RU) and 61 were children (122 RU), 30 aged 0-1 month (group 2, 60 RU), 20 aged 1-3 months (group 3, 40 RU) and 11 aged 3-6 months (group 4, 22 RU).

        


    All subjects underwent colour Doppler ultrasonography and the RI of the renal artery was measured for each kidney. 

        


    Results : The RI was very high in group 1 but decreased noticeably during the first 6 months of life, reaching values similar to those in adults after the third month. 

         


    The normal ranges for groups 1-4 were 0.67-0.88, 0.57-0.90, 0.60-0.84 and 0.65-0.75, respectively. There were no statistically significant differences between the left and right
    kidneys.

         

Reflux
Diseases

 

  •  M. L. Godley, D. Desai, C. K. Yeung, H. K. Dhillon, P. G. Duffy and P. G. Ransley (The Institute of Child Health and Great Ormond Street Hospital for Children, NHS Trust, London UK, and Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong)

    The Relationship Between Early Renal Status, and the Resolution of Vesico-Ureteric Reflux and Bladder Function at 16 Months

    BJU Intl. April 2001 Vol. 87(6) Pg. 457-462

        


    Conclusion : In children with moderate or severe VUR resolution at 16 months is associated with normal kidneys in a similar proportion of boys and girls. Resolution also correlated well with normal bladder function. Presentation in infancy with bilateral abnormal kidneys, associated with severe VUR in boys, is a poor prognostic sign for the early outcome of VUR and for bladder function.

        
  • F. Bonnin, H. Lottmann, L. Sauty, C. Garel, F. Archambaud, V. Baudouin, A. El Ghoneimi, C. Loirat, B. D. Bok and Y. Aigrain (Hopital Beaujon, Clichy, Hopital Robert Debre, Paris, and Hopital Kremlin Bicetre, Bicetre, France)

    Scintigraphic Screening for Renal Damage in Siblings of Children with Symptomatic Primary Vesico-Ureteric Reflux

    BJU Intl. April 2001 Vol. 87(6) Pg. 463-466

         


    Conclusion : The study confirms a significant overall incidence of VUR (26%) in the asymptomatic siblings of patients treated for primary VUR.

        


    From the results of the DMSA scan (only one sibling had a parenchymal defect), the systematic screening of asymptomatic siblings does not appear to be beneficial.

        
  • R. A. Mevorach, B. Cilento, S. Zahorian, C. Badgett, R. Walker, A. Atala, S. Iannello, and M. Meyer (University of Rochester, Rochester, NY, Children’s Hospital, Boston, MA and Old Dominion University, Norfolk, VA, Portsmouth Naval Hospital, Portsmouth, VA, USA)

    A Noninvasive Test for Vesico-Ureteric Reflux in Children 

    BJU Intl. April 2001 Vol. 87(6) Pg. 467-472

         


    Method : 54 children (49 girls and 5 boys, mean age 7.2 years ranging 4-14 years) previously evaluated as having VUR volunteered to participate; no child was symptomatic at the time of study.

        


    Refluxing units were known to be present in 45 and absent in 16 patients (confirmed on voiding cysto-urethrography).

         


    The device developed acquires electronically processed acoustic signals from the child during an observed urination. The signals are then analysed off line to determine the presence or absence of VUR. 

         


    The initial preparation for the test included:

        


    (i) A full bladder measured by ultrasonography.

    (ii) Localization of the pelvi-ureteric junction by ultrasonography to accurately place the sensors on the child’s back.

         


    The children are then positioned at a commode after placing the sensors. 

         


    The record was started and continued until voiding occurred. The children were tested with the recording and the analysis team unaware of the presence and/or degree of VUR.

        


    The first 47 studies were single kidney examinations and the remaining 7 included simultaneous monitoring of both kidneys.

         



    Results and conclusion
    : Interpretable results were obtained in 89%.

         


    The noninvasive test detected VUR in 35 of 37 refluxing units and verified no reflux in 16 of 17 units without VUR.

         


    Further refinements may allow this technology to be used in all children with suspected
    VUR.

       
  • M. L. Podesta, A. Ruarte, M. Herrera, R. Medel and R. Castera (The Urology Unit, Department of Surgery, Hospital de Ninos ‘Ricardo Gutierrez’ and Associated Hospital to the University of Buenos Aires, Buenos Aires, Argentina)

    Bladder Functional Outcome After Delayed Vesicostomy Closure and Antireflux Surgery in Young Infants with ‘Primary’ Vesico-Ureteric Reflux

    BJU Intl. April 2001 Vol. 87(6) Pg. 473-479

         


    Conclusion : The study shows that the bladder of young infants with primary VUR treated with temporary vesicostomy regained normal function after re-functionalization of the lower urinary tract.

        
  • J. M. Vega-P, and L. A. Pascual (Urology Section, Hospital Pediatrico de Mendoza, Argentina) 

    High-pressure Bladder: An Underlying Factor Mediating Renal Damage in the Absence of Reflux? 

    BJU Intl. April 2001 Vol. 87 (6) Pg. 581-584

        


    Conclusion : Most children with renal scarring and no reflux had lower urinary tract dysfunction. Common findings include high storage and voiding pressures, and discoordinated voiding. 

         


    These findings suggest that abnormal bladder dynamics play a role in the development of renal scars that occur in the absence of
    reflux.

         

Undescended Testis

 

  • A. B. Belman and H. G. Rushton (Departments of Urology, Children’s National Medical Center and the George Washington University Washington, DC, USA)

    Is the Vanished Testis Always a Scrotal Event?

    BJU Intl. April 2001 Vol. 87(6) Pg. 480-483

        


    Conclusion : Perinatal testicular torsion occurs after descent but before fixation of the tunica vaginalis to the scrotal wall. These testes atrophy, leaving a remnant of tissue in the scrotum that can be identified on scrotal exploration in almost all cases. Therefore it is recommended that the evaluation of the child with solitary palpable testis start with scrotal exploration.

        


    Laparoscopy should be reserved for those in whom no tissue consistent with a testicular nubbin is found in the scrotum.

        


    Comments : This study implies that we rethink the policy of primary laparoscopy in “absent testis”.

        
  • L A. Baker, S. G.
    Docimo, I. Surer, C. Peters, L. Cisek, D. A. Diamond, A.
    Caldamone, M. Koyle, W. Strand, R. Moore, R.
    Mevorach, J. Brady, G. Jordan, M. Erhard, and I. Franco (Brady Urological Institute, The Johns Hopkins Hospital, Baltimore; Division of Urology, The Children’s Hospital, Boston, MA; Department of Urology, Rhode Island Hospital, Providence, RI; Division of Paediatric Urology, The Children’s Hospital in Denver, Denver, CO; Division of Paediatric Urology, Department of Urology, Children’s Medical Center, University of Texas South-western at Dallas, Dallas, TX; Division of Urology, Department of Surgery, St. Louis University Hospital, St. Louis, MO; Department of Urology, Portsmouth Naval Hospital, Naval Medical Center, Portsmouth, VA; Department of Urology, Eastern Virginia Medical School, Norfolk, VA; Nemours Children’s Clinic, Jacksonville, FL; Paediatric Urology, New York Medical College, Westchester County Medical Center, Valhalla, New York, USA)

    A Multi-institutional Analysis of Laparoscopic Orchidopexy

    BJU Intl. April 2001 Vol. 87(6) Pg. 484-489

         


    Conclusion : Laparoscopic orchidopexy for the intra-abdominal testis in both large and small series can be expected to have a success rate higher than that historically ascribed to open
    orchidopexy.

         


    Within this series, single stage F-S (Fowler Stephen) laparoscopic orchidopexy resulted in a significantly higher atrophy rate than the 2 stage repair. When considering both F-S approaches, the laparoscopic technique gave a higher success rate than the open method.

         


    Laparoscopic orchiopexy is, if not the procedure of choice, an acceptable and successful approach to the impalpable undescended testis.

         
  • B. Chang, L. S. Palmer and I. Franco (Long Island Jewish Medical Center/Schneider Children’s Hospital, New Hyde Park, NY and The Children’s Hospital at the Westchester Medical Center, Valhalla, NY, USA)

    Laparoscopic Orchidopexy: A Review of a Large Clinical Series

    BJU Intl. April 2001 Vol. 87(6) Pg. 490-493

         


    Conclusion : The high overall success rate in placing the testis into the scrotum through laparoscopic procedures is considerably better than that reported in other series to date. 

         


    Laparoscopic orchodopexy is an effective method for managing intra-abdominal testes in children. 

         


    Patients who had undergone previous surgery had a higher risk of developing testicular atrophy. The additional dissection around the vas almost inevitably leads to testicular atrophy.

         

Varicocele

 

  • R.
    Misseri, A. B. Gershbein, M. Horowitz and K. I. Glassberg (Division of Paediatric Urology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA) 

    The Adolescent Varicocele. II: The Incidence of Hydrocele and Delayed Recurrent Varicocele After Varicocelectomy in a Long-term Follow-up

    BJU Intl. April 2001 Vol. 87(6) Pg. 494-498

        


    Conclusion: Hydroceles are detected infrequently within 6 months of
    varicocelectomy, with most occurring after 6 months and even appearing after 3 years. 

         


    They occur significantly more often after a Palomo repair. More hydroceles develop after bilateral repair regardless of the technique used, but not significantly so. Because hydroceles often develop, a lymphatic-sparing procedure should be used, especially for bilateral repair. Recurrent varicoceles may appear as late as 76 months varicocelectomy in patients where none had been detected at a mean of 27 months after surgery.

        
  • E. J. Kass, B. R. Stork and B. W. Steinert (Division of Paediatric Urology, Department of Urology, William Beaumont Hospital, Royal Oak, Michigan)

    Varicocele in Adolescence Induces Left and Right Testicular Volume Loss

    BJU Intl. April 2001 Vol. 87(6) Pg. 499-501

         


    Conclusion : The presence of grade I varicocele in adolescence appears to have no effect on normal testicular growth. Some patients with grade II varicocele are at risk of left testicular volume loss with time and should have their testicular volume measured annually.

         


    Patients with grade III varicocele are at risk of bilateral testicular volume loss; a careful evaluation and early surgical intervention are recommended in this group of patients.

        
  • J. Oswald, I. Korner and M. Riccabona (Department of Paediatric Urology, Krankehaus Barmh, Schwestern, Linz, Austria, and Department of Urology, Universitatsklinikum Essen, Germany) 

    The Use of Isosulphan Blue to Identify Lymphatic Vessels in High Retroperitoneal Ligation of Adolescent Varicocele – Avoiding Postoperative Hydrocele

    BJU Intl. April 2001 Vol. 87(6) Pg. 502-504

         



    Patients and Methods
    : The results were assessed from 28 consecutive adolescent patients undergoing varicocelectomy. The lymphatic vessels were identified and preserved using vital dyes, to avoid postoperative hydrocele formation. 

         


    Results: In 24 of 28 patients, the identification and preservation of lymphatic vessels was feasible. Over a mean range follow-up of 14 months there were no postoperative hydroceles and no clinical recurrences.

          

PUJ
obstruction

 

  •  C. K. Yeung, Y. H. Tam, J. D. Y. Sihoe, K. H. Lee and K. W. Liu (Division of Paediatric Surgery, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong) 

    Retroperitoneoscopic Dismembered Pyeloplasty for Pelvi-Ureteric Junction Obstruction in Infants and Children 

    BJU Intl. April 2001 Vol. 87(6) Pg. 509-513

        



    Patients and Methods
    : Thirteen infants and children with PUJ obstruction underwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years). 

         


    9 patients presented with complications secondary to PUJ obstruction, including upper urinary tract infection, pyonephrosis and increasing hydronephrosis with impairment in renal function. The other 4 patients had recurrent loin pain. 

          


    The patient was placed in semi-prone or semilateral position. The retroperitoneal space was entered via a 1-cm incision over the mid-axillary line and further developed using a glove balloon. Video-retroperitoneoscopy was undertaken using a 5-mm laparoscope. 

         


    Dismembered pyeloplasty was carried out with the pelvi-ureteric anastomosis fashioned using fine polydioxanone sutures over a double-pigtail ureteric stent.

        


    Results : The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. Drainage was satisfactory in all 12 patients on follow-up.

        
  • P. A. Borzi (Department of Paediatric Surgery, Mater and Royal Children’s Hospitals, Brisbane, Australia)

    A Comparison of the Lateral and Posterior Retroperitoneoscopic Approach for Complete and Partial Nephroureterectomy in Children 

    BJU Intl. April 2001 Vol. 87(6) Pg. 517-520

         


    Conclusion : The posterior approach gives easy and quick access to the renal pedicle. It is preferable for complete nephrectomy alone and partial or polar excision. In children under 5 years, a near complete ureterectomy can be achieved. 

         


    The lateral approach creates more inferomedial space, gives better access to ectopic kidneys and allows complete ureterectomy in all cases. Care must be taken as peritoneal tears are more common.

        
  • P. H. O’Reilley, P. J. C. Brooman, S. Mak, M. Jones, C. Piccup, C. Atkanson, and A. J. Pollard (Departments of Urology and Nuclear Medicine, Stepping Hill Hospital, Stockport, UK)

    The Long-term Results of Anderson Hynes Pyeloplasty

    BJU Intl. March 2001 Vol. 87 (4) Pg. 287-289

        


    Introduction : There are few published data on the efficacy and durability of open pyeloplasty and its role as a gold standard has occasionally been questioned at endourology meetings.

         


    Results : In all, 41 evaluable patients were identified, 24 agreed to return for reassessment. The mean (range) time from surgery was 10.6 years. The results showed an improvement over the preoperative split renal function in 19 patients (79%) and an improvement in drainage in 23 (96%).

        


    Conclusion : The Anderson Hynes operation is an excellent procedure for treating pelvi-ureteric junction obstruction and produces a lasting improvement in function and drainage in most patients. It is the gold standard against which newer techniques should be
    compared.

         

Hypospadias

 

  •  A.
    Marte, G. Di Iorio, M. De Pasquale, A. M. Cotrufo and D. Di Meglio (Department of Paediatrics, Paediatric Surgery, 2nd University of Naples, Naples, Italy)

    Functional Evaluation of Tubularized-Incised Plate Repair of Midshaft-Proximal Hypospadias Using Uroflowmetry

    BJU Intl. April 2001 Vol. 87(6) Pg. 540-543

        



    Patients and methods
    : 21 patients were selected from those undergoing surgery from January 1996 to January 1998 at the authors’ institute.

        


    All patients had midshaft-proximal hypospadias and were treated using the Snodgrass technique. Patients were included if they were able to void volitionally and had no fistula. 

         


    The flow pattern, maximum (Qmax) and mean flow rate (Qave) were measured. The results were expressed as percentiles and compared with published values from normal children.

         


    The Qmax and Qave were considered normal if > 25th percentile, as equivocally obstructed when in the 5-25th percentile and obstructed if < 5th percentile. 

         


    Conclusion : The tubularized-incised plate repair provides satisfactory functional results for midshaft-proximal hypospadias; uroflowmetry is an important noninvasive tool to evaluate this technique. A long-term follow-up is needed to confirm these
    results.

         
  • J. M. Gatti, A. J. Kirsch, W. A. Troyer, M. R. Perez-Brayfield, E. A. Smith and H. C. Scherz (Division of Paediatric Urology, Emory University School of Medicine and Children’s Healthcare of Atlanta, and Division of Neonatology, Northside Hospital, Atlanta, GA, USA) 

    Increased Incidence of Hypospadias in Small-For-Gestational Age Infants in a Neonatal Intensive-Care Unit 

    BJU Intl. April 2001 Vol. 87 (6) Pg. 548-550

         


    Conclusion : The incidence of hypospadias in small-for-gestational age infants admitted to the NICU is > 10 times higher than that reported for the general population. There was a trend to lower fetal and placental weight in SGA infants with hypospadias than in the controls. 

         


    This finding merits further evaluation using a larger population database and suggests that factors resulting in SGA infants occur at a critical point early in development, affecting both somatic and urethral development.

        

Dysfunctional
voiding

 

  • P. Hoebeke, E. Van Laecke, C. Van Camp, A. Raes, and J. Van De Walle (Departments of Urology and Paediatrics, Paediatric Uro-Nephrologic Centre, Ghent University Hospital, Ghent, Belgium)

    One Thousand Video-Urodynamic Studies in Children with Non-Neurogenic Bladder Sphincter Dysfunction 

    BJU Intl. April 2001 Vol. 87 (6) Pg. 575-580

         


    Conclusion : These results from a large series provide a new insight into the epidemiology and pathophysiology of NNBSD (Non-Neurogenic Bladder Sphincter Dysfunction).

        


    The age distribution provides evidence against a dysfunctional voiding sequence. The risk of developing UTI in NNBSD is greater only in girls. In children with a lazy bladder the risk is also significantly higher, indicating that residual urine is a greater risk factor than detrusor instability. 

         


    Urge syndrome and dysfunctional voiding in girls carry the same risk for developing UTI, indicating that bladder instability is a high risk factor for UTI than detrusor sphincter discoordination. 

         


    All dysfunctions carry an equal risk for developing secondary reflux. Children with NNBSD have different primary diseases but all have a common risk of incontinence, UTI, reflux and
    obstipation.

         




 

  

Speciality Spotlight

 

 
Urology
 

 

Pediatric Urology 
  

  • Kirsch AJ, Escala J, Duckett JW, et al [ Univ of Pennsylvania, Philadelphia]
    Surgical Management of the Nonpalpable Testis : The Children’s Hospital of Philadelphia Experience.
    J Urol 159: 1340-1343, 1998
        
    Between 1986 and 1994, 1,866 boys with undescended testes were treated at 1 center. 
         
    During surgery, 41% were found to be atrophic or absent. 21% were intra abdominal. 30% were in the inguinal canal and 9% in other locations, including pubic tubercle, upper scrotum, superficial inguinal pouch, and perineum.
         
    Conclusion : In 24% the undescended testes were nonpalpable.
    39% of these were distal to the external inguinal ring. 
    41% were arophic or absent, and 20% were intra-abdominal.
        
    The inguinal approach to orchiopexy with transperitoneal mobilization of the vas and vessels without transection is very successful in patients with intra-abdominal cryptorchid testes. 
        
    Laparoscopy seems reasonable, provided it is combined with laparoscopic orchiopexy.
         

  • Silveri M, Capitanucci ML, Mosiello G, et al [Bambino Gesu Children’s Hosp, Palidoro, Rome]
    Endoscopic Treatment for Urinary Incontinence in Children with a Congenital Neuropathic Bladder
    Br J Urol 82: 694-697, 1998
         
    Conclusion : Collagen injection does not result in continence in all patients with neurogenic bladder.
         
    The result depended on the type of Neurogenic bladder. Patients with low-pressure complaint bladders had better results. Information regarding abdominal leak point pressure would be useful in patient selection.
         

  • I. Knerr, Z. Nyul, J. Miller, W. Rosch, J. Dotsch, R. Repp, W. Weidner and W. Rascher (Departments of Paediatrics and Urology, Friedrich-Alexander University, Erlangen, and Departments of Paediatrics and Urology, Justus-Liebig University, Giessen, Germany)
    Increased Endothelin-1 and Decreased Adrenomedullin Gene Expression in the Stenotic Tissue of Congenital Pelvi-ureteric Junction Obstruction in Children
    BJU Intl. May 2001 Vol. 87 (7) Pg. 667-671
         
    Results : The amount of endothelin-1 mRNA in stenotic specimens was higher than in the controls, indicated by significantly lower threshold cycles (Ct values).
        
    Adrenomedullin gene expression in the obstructed junctions was significantly lower than in normal junctions.
        
    The above maybe involved in the pathogenesis of congenital hydronephrosis. 
         

  • V. J. Ferlise, M. K. Ankem and J. G. Barone (Division of Urology, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA)
    Use of Cyanoacrylate Tissue Adhesive Under a Diaper
    BJU Intl. May 2001 Vol. 87 (7) Pg. 672-673
         
    Objective : To study the effect of a cyanoacrylate in 25 non toilet trained children undergoing inguinal surgery.
        
    Results : Of the 52 incisions, 27 were closed with suture and 25 with cyanoacrylate adhesive. All patients were followed up at 2 weeks. There were no instances of infection or wound dehiscence in either group. The incisions were cosmetically identical at 3 months of follow-up.
        
    Conclusion : Cyanoacrylate adhesive is a safe and effective method of skin closure that can be used under a diaper.
        
    Discussion : These are a concern that cyanoacrylate tissue adhesive in areas constantly exposed to body fluids may cause weakening of the tissue bond. However, there were no cases of tissue separation and in 25 incisions, the tissue adhesive was still intact at 2 weeks follow-up visit.
        
    It is important to ensure that the tissue adhesive is totally dry before moving the child or placing of diaper over the child. 
        

  • P. Ferrara, C. M. D’Aleo, E. Tarquini, S. Salvatore and E. Salvaggio (Department of Paediatrics, Catholic University, Rome, and Bassini Hospital, Milan-Bicocca University, Cinisello Balsamo, Milan, Italy)
    Side-effects of Oral or Intravesical Oxybutynin Chloride in Children with Spina Bifida
    BJU Intl. May 2001 Vol. 87 (7) Pg. 674-677
        
    Introduction : The reported efficacy of oxybutynin in the treatment of the overactive bladder is almost 50%, but because of its systemic action it can cause various side-effects e.g. dry mouth, constipation, drowsiness and cognitive dysfunction.
         
    Intravesical administration is useful in neurological patients in whom clean intermittent catheterization is often routine. This therapeutic approach allows high concentrations of the drug to be delivered to the target tissue with the maximum pharmacological response and theoretically, the minimum of side- effects. 
         
    Patients and Methods : Patients were selected from 225 children with MMC and neurogenic bladder dysfunction referred to the Spina Bifida centre of the Catholic University of Rome from January 1993 to December 1998; all had undergone surgical repair within 24-48 h after birth. 
        
    All patients received oxybutynin either orally or intravesically at a mean dose of 0.1-0.2 mg/kg, for the intravesical preparation the tablets were crushed and the powder dissolved in water (sterile). 
         
    The suspension was instilled into an empty bladder through the urethral catheter and 10 mL syringe; this was undertaken 2-3 times per day.
         
    The patients were followed up with regular urodynamic studies.
               
    Results : Of the 67 patients on oral oxybutynin, 19 (28%) discontinued, comprising 11 (16%) because of side-effects and eight (12%) who changed to intravesical oxybutynin because there were clinical indications for starting CISC.
         
    Of the 34 using intravesical oxybutynin 6 (18%) stopped because of side- effects; two (6%) had cognitive effects, particularly attention deficit and difficulties in basic arithmetical operations. 3 children reported facial flushing, with associated drowsiness. The last patient reported several episodes of hallucinations.
          
    Conclusion : Intravesical installation of oxybutynin is safe and effective but particular attention to and a specific record of central side-effects should be maintained when intravesical oxybutynin is used in children with a dysfunctional bladder. These patients must be closely monitored for any complications.
         

  • M. Horowitz, S. M. Shah, G. Ferzli, P. I. Syad and K. I. Glassberg (The Division of Paediatric Urology, State University of New York, Downstate Medical Center, Brooklyn, NY, and Department of Surgery, Staten Island University Hospital, Staten Island, NY, USA)
    Laparoscopic Partial Upper Role Nephrectomy in Infants and Children 
    BJU Intl. April 2001 Vol. 87(6) Pg. 514-516
         
    Conclusion : Transperitoneal laparoscopic partial nephrectomy is preferable to open partial nephrectomy because:
         
    (i) Magnification provided by laparoscopy provides excellent vision for the precise dissection of the parenchyma and distal ureter, avoiding injury to healthy tissue.
    (ii) There is minimal blood loss, scarring and fast recovery and when upper polar nephrectomy is needed, the laparoscopic technique is less damaging to the lower pole. 
         
    The specific advantages of laparoscopy make it clearly preferable to open surgery.
         

  • G. Andriani, A. Persico, S. Tursini, E. Ballone, D. Cirotti, and P. Lelli Chiesa (Department of Pediatric Surgery and Department of Gynecology, Spirito Santo Hospital, Pescara and Section of Pediatric Surgery and Laboratory of Biostatistics, University G. D’Annunzio, Chieti, Italy) 
    The Renal-Resistive Index From the Last 3 Months of Pregnancy to 6 Months Old 
    BJU Intl. April 2001 Vol. 87 (6) Pg. 562-564
         
    Subjects and methods : From September 1998 to October 1999, 93 subjects were enrolled 32 were fetuses in the last trimester of pregnancy (group 1, 64 RU) and 61 were children (122 RU), 30 aged 0-1 month (group 2, 60 RU), 20 aged 1-3 months (group 3, 40 RU) and 11 aged 3-6 months (group 4, 22 RU).
        
    All subjects underwent colour Doppler ultrasonography and the RI of the renal artery was measured for each kidney. 
        
    Results : The RI was very high in group 1 but decreased noticeably during the first 6 months of life, reaching values similar to those in adults after the third month. 
         
    The normal ranges for groups 1-4 were 0.67-0.88, 0.57-0.90, 0.60-0.84 and 0.65-0.75, respectively. There were no statistically significant differences between the left and right kidneys.
         

Reflux Diseases
 

  •  M. L. Godley, D. Desai, C. K. Yeung, H. K. Dhillon, P. G. Duffy and P. G. Ransley (The Institute of Child Health and Great Ormond Street Hospital for Children, NHS Trust, London UK, and Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong)
    The Relationship Between Early Renal Status, and the Resolution of Vesico-Ureteric Reflux and Bladder Function at 16 Months
    BJU Intl. April 2001 Vol. 87(6) Pg. 457-462
        
    Conclusion : In children with moderate or severe VUR resolution at 16 months is associated with normal kidneys in a similar proportion of boys and girls. Resolution also correlated well with normal bladder function. Presentation in infancy with bilateral abnormal kidneys, associated with severe VUR in boys, is a poor prognostic sign for the early outcome of VUR and for bladder function.
        
  • F. Bonnin, H. Lottmann, L. Sauty, C. Garel, F. Archambaud, V. Baudouin, A. El Ghoneimi, C. Loirat, B. D. Bok and Y. Aigrain (Hopital Beaujon, Clichy, Hopital Robert Debre, Paris, and Hopital Kremlin Bicetre, Bicetre, France)
    Scintigraphic Screening for Renal Damage in Siblings of Children with Symptomatic Primary Vesico-Ureteric Reflux
    BJU Intl. April 2001 Vol. 87(6) Pg. 463-466
         
    Conclusion : The study confirms a significant overall incidence of VUR (26%) in the asymptomatic siblings of patients treated for primary VUR.
        
    From the results of the DMSA scan (only one sibling had a parenchymal defect), the systematic screening of asymptomatic siblings does not appear to be beneficial.
        
  • R. A. Mevorach, B. Cilento, S. Zahorian, C. Badgett, R. Walker, A. Atala, S. Iannello, and M. Meyer (University of Rochester, Rochester, NY, Children’s Hospital, Boston, MA and Old Dominion University, Norfolk, VA, Portsmouth Naval Hospital, Portsmouth, VA, USA)
    A Noninvasive Test for Vesico-Ureteric Reflux in Children 
    BJU Intl. April 2001 Vol. 87(6) Pg. 467-472
         
    Method : 54 children (49 girls and 5 boys, mean age 7.2 years ranging 4-14 years) previously evaluated as having VUR volunteered to participate; no child was symptomatic at the time of study.
        
    Refluxing units were known to be present in 45 and absent in 16 patients (confirmed on voiding cysto-urethrography).
         
    The device developed acquires electronically processed acoustic signals from the child during an observed urination. The signals are then analysed off line to determine the presence or absence of VUR. 
         
    The initial preparation for the test included:
        
    (i) A full bladder measured by ultrasonography.
    (ii) Localization of the pelvi-ureteric junction by ultrasonography to accurately place the sensors on the child’s back.
         
    The children are then positioned at a commode after placing the sensors. 
         
    The record was started and continued until voiding occurred. The children were tested with the recording and the analysis team unaware of the presence and/or degree of VUR.
        
    The first 47 studies were single kidney examinations and the remaining 7 included simultaneous monitoring of both kidneys.
         
    Results and conclusion : Interpretable results were obtained in 89%.
         
    The noninvasive test detected VUR in 35 of 37 refluxing units and verified no reflux in 16 of 17 units without VUR.
         
    Further refinements may allow this technology to be used in all children with suspected VUR.
       
  • M. L. Podesta, A. Ruarte, M. Herrera, R. Medel and R. Castera (The Urology Unit, Department of Surgery, Hospital de Ninos ‘Ricardo Gutierrez’ and Associated Hospital to the University of Buenos Aires, Buenos Aires, Argentina)
    Bladder Functional Outcome After Delayed Vesicostomy Closure and Antireflux Surgery in Young Infants with ‘Primary’ Vesico-Ureteric Reflux
    BJU Intl. April 2001 Vol. 87(6) Pg. 473-479
         
    Conclusion : The study shows that the bladder of young infants with primary VUR treated with temporary vesicostomy regained normal function after re-functionalization of the lower urinary tract.
        
  • J. M. Vega-P, and L. A. Pascual (Urology Section, Hospital Pediatrico de Mendoza, Argentina) 
    High-pressure Bladder: An Underlying Factor Mediating Renal Damage in the Absence of Reflux? 
    BJU Intl. April 2001 Vol. 87 (6) Pg. 581-584
        
    Conclusion : Most children with renal scarring and no reflux had lower urinary tract dysfunction. Common findings include high storage and voiding pressures, and discoordinated voiding. 
         
    These findings suggest that abnormal bladder dynamics play a role in the development of renal scars that occur in the absence of reflux.
         

Undescended Testis
 

  • A. B. Belman and H. G. Rushton (Departments of Urology, Children’s National Medical Center and the George Washington University Washington, DC, USA)
    Is the Vanished Testis Always a Scrotal Event?
    BJU Intl. April 2001 Vol. 87(6) Pg. 480-483
        
    Conclusion : Perinatal testicular torsion occurs after descent but before fixation of the tunica vaginalis to the scrotal wall. These testes atrophy, leaving a remnant of tissue in the scrotum that can be identified on scrotal exploration in almost all cases. Therefore it is recommended that the evaluation of the child with solitary palpable testis start with scrotal exploration.
        
    Laparoscopy should be reserved for those in whom no tissue consistent with a testicular nubbin is found in the scrotum.
        
    Comments : This study implies that we rethink the policy of primary laparoscopy in “absent testis”.
        
  • L A. Baker, S. G. Docimo, I. Surer, C. Peters, L. Cisek, D. A. Diamond, A. Caldamone, M. Koyle, W. Strand, R. Moore, R. Mevorach, J. Brady, G. Jordan, M. Erhard, and I. Franco (Brady Urological Institute, The Johns Hopkins Hospital, Baltimore; Division of Urology, The Children’s Hospital, Boston, MA; Department of Urology, Rhode Island Hospital, Providence, RI; Division of Paediatric Urology, The Children’s Hospital in Denver, Denver, CO; Division of Paediatric Urology, Department of Urology, Children’s Medical Center, University of Texas South-western at Dallas, Dallas, TX; Division of Urology, Department of Surgery, St. Louis University Hospital, St. Louis, MO; Department of Urology, Portsmouth Naval Hospital, Naval Medical Center, Portsmouth, VA; Department of Urology, Eastern Virginia Medical School, Norfolk, VA; Nemours Children’s Clinic, Jacksonville, FL; Paediatric Urology, New York Medical College, Westchester County Medical Center, Valhalla, New York, USA)
    A Multi-institutional Analysis of Laparoscopic Orchidopexy
    BJU Intl. April 2001 Vol. 87(6) Pg. 484-489
         
    Conclusion : Laparoscopic orchidopexy for the intra-abdominal testis in both large and small series can be expected to have a success rate higher than that historically ascribed to open orchidopexy.
         
    Within this series, single stage F-S (Fowler Stephen) laparoscopic orchidopexy resulted in a significantly higher atrophy rate than the 2 stage repair. When considering both F-S approaches, the laparoscopic technique gave a higher success rate than the open method.
         
    Laparoscopic orchiopexy is, if not the procedure of choice, an acceptable and successful approach to the impalpable undescended testis.
         
  • B. Chang, L. S. Palmer and I. Franco (Long Island Jewish Medical Center/Schneider Children’s Hospital, New Hyde Park, NY and The Children’s Hospital at the Westchester Medical Center, Valhalla, NY, USA)
    Laparoscopic Orchidopexy: A Review of a Large Clinical Series
    BJU Intl. April 2001 Vol. 87(6) Pg. 490-493
         
    Conclusion : The high overall success rate in placing the testis into the scrotum through laparoscopic procedures is considerably better than that reported in other series to date. 
         
    Laparoscopic orchodopexy is an effective method for managing intra-abdominal testes in children. 
         
    Patients who had undergone previous surgery had a higher risk of developing testicular atrophy. The additional dissection around the vas almost inevitably leads to testicular atrophy.
         

Varicocele
 

  • R. Misseri, A. B. Gershbein, M. Horowitz and K. I. Glassberg (Division of Paediatric Urology, State University of New York, Downstate Medical Center, Brooklyn, New York, USA) 
    The Adolescent Varicocele. II: The Incidence of Hydrocele and Delayed Recurrent Varicocele After Varicocelectomy in a Long-term Follow-up
    BJU Intl. April 2001 Vol. 87(6) Pg. 494-498
        
    Conclusion: Hydroceles are detected infrequently within 6 months of varicocelectomy, with most occurring after 6 months and even appearing after 3 years. 
         
    They occur significantly more often after a Palomo repair. More hydroceles develop after bilateral repair regardless of the technique used, but not significantly so. Because hydroceles often develop, a lymphatic-sparing procedure should be used, especially for bilateral repair. Recurrent varicoceles may appear as late as 76 months varicocelectomy in patients where none had been detected at a mean of 27 months after surgery.
        
  • E. J. Kass, B. R. Stork and B. W. Steinert (Division of Paediatric Urology, Department of Urology, William Beaumont Hospital, Royal Oak, Michigan)
    Varicocele in Adolescence Induces Left and Right Testicular Volume Loss
    BJU Intl. April 2001 Vol. 87(6) Pg. 499-501
         
    Conclusion : The presence of grade I varicocele in adolescence appears to have no effect on normal testicular growth. Some patients with grade II varicocele are at risk of left testicular volume loss with time and should have their testicular volume measured annually.
         
    Patients with grade III varicocele are at risk of bilateral testicular volume loss; a careful evaluation and early surgical intervention are recommended in this group of patients.
        
  • J. Oswald, I. Korner and M. Riccabona (Department of Paediatric Urology, Krankehaus Barmh, Schwestern, Linz, Austria, and Department of Urology, Universitatsklinikum Essen, Germany) 
    The Use of Isosulphan Blue to Identify Lymphatic Vessels in High Retroperitoneal Ligation of Adolescent Varicocele – Avoiding Postoperative Hydrocele
    BJU Intl. April 2001 Vol. 87(6) Pg. 502-504
         
    Patients and Methods : The results were assessed from 28 consecutive adolescent patients undergoing varicocelectomy. The lymphatic vessels were identified and preserved using vital dyes, to avoid postoperative hydrocele formation. 
         
    Results: In 24 of 28 patients, the identification and preservation of lymphatic vessels was feasible. Over a mean range follow-up of 14 months there were no postoperative hydroceles and no clinical recurrences.
          

PUJ obstruction
 

  •  C. K. Yeung, Y. H. Tam, J. D. Y. Sihoe, K. H. Lee and K. W. Liu (Division of Paediatric Surgery, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong) 
    Retroperitoneoscopic Dismembered Pyeloplasty for Pelvi-Ureteric Junction Obstruction in Infants and Children 
    BJU Intl. April 2001 Vol. 87(6) Pg. 509-513
        
    Patients and Methods : Thirteen infants and children with PUJ obstruction underwent retroperitoneoscopic dismembered pyeloplasty (mean age at operation 2.7 years). 
         
    9 patients presented with complications secondary to PUJ obstruction, including upper urinary tract infection, pyonephrosis and increasing hydronephrosis with impairment in renal function. The other 4 patients had recurrent loin pain. 
          
    The patient was placed in semi-prone or semilateral position. The retroperitoneal space was entered via a 1-cm incision over the mid-axillary line and further developed using a glove balloon. Video-retroperitoneoscopy was undertaken using a 5-mm laparoscope. 
         
    Dismembered pyeloplasty was carried out with the pelvi-ureteric anastomosis fashioned using fine polydioxanone sutures over a double-pigtail ureteric stent.
        
    Results : The retroperitoneoscopic dismembered pyeloplasty was successful in 12 patients, while one with previous percutaneous nephrostomy drainage for pyonephrosis required open conversion because of difficulties in developing the retroperitoneal space. Drainage was satisfactory in all 12 patients on follow-up.
        
  • P. A. Borzi (Department of Paediatric Surgery, Mater and Royal Children’s Hospitals, Brisbane, Australia)
    A Comparison of the Lateral and Posterior Retroperitoneoscopic Approach for Complete and Partial Nephroureterectomy in Children 
    BJU Intl. April 2001 Vol. 87(6) Pg. 517-520
         
    Conclusion : The posterior approach gives easy and quick access to the renal pedicle. It is preferable for complete nephrectomy alone and partial or polar excision. In children under 5 years, a near complete ureterectomy can be achieved. 
         
    The lateral approach creates more inferomedial space, gives better access to ectopic kidneys and allows complete ureterectomy in all cases. Care must be taken as peritoneal tears are more common.
        
  • P. H. O’Reilley, P. J. C. Brooman, S. Mak, M. Jones, C. Piccup, C. Atkanson, and A. J. Pollard (Departments of Urology and Nuclear Medicine, Stepping Hill Hospital, Stockport, UK)
    The Long-term Results of Anderson Hynes Pyeloplasty
    BJU Intl. March 2001 Vol. 87 (4) Pg. 287-289
        
    Introduction : There are few published data on the efficacy and durability of open pyeloplasty and its role as a gold standard has occasionally been questioned at endourology meetings.
         
    Results : In all, 41 evaluable patients were identified, 24 agreed to return for reassessment. The mean (range) time from surgery was 10.6 years. The results showed an improvement over the preoperative split renal function in 19 patients (79%) and an improvement in drainage in 23 (96%).
        
    Conclusion : The Anderson Hynes operation is an excellent procedure for treating pelvi-ureteric junction obstruction and produces a lasting improvement in function and drainage in most patients. It is the gold standard against which newer techniques should be compared.
         

Hypospadias
 

  •  A. Marte, G. Di Iorio, M. De Pasquale, A. M. Cotrufo and D. Di Meglio (Department of Paediatrics, Paediatric Surgery, 2nd University of Naples, Naples, Italy)
    Functional Evaluation of Tubularized-Incised Plate Repair of Midshaft-Proximal Hypospadias Using Uroflowmetry
    BJU Intl. April 2001 Vol. 87(6) Pg. 540-543
        
    Patients and methods : 21 patients were selected from those undergoing surgery from January 1996 to January 1998 at the authors’ institute.
        
    All patients had midshaft-proximal hypospadias and were treated using the Snodgrass technique. Patients were included if they were able to void volitionally and had no fistula. 
         
    The flow pattern, maximum (Qmax) and mean flow rate (Qave) were measured. The results were expressed as percentiles and compared with published values from normal children.
         
    The Qmax and Qave were considered normal if > 25th percentile, as equivocally obstructed when in the 5-25th percentile and obstructed if < 5th percentile. 
         
    Conclusion : The tubularized-incised plate repair provides satisfactory functional results for midshaft-proximal hypospadias; uroflowmetry is an important noninvasive tool to evaluate this technique. A long-term follow-up is needed to confirm these results.
         
  • J. M. Gatti, A. J. Kirsch, W. A. Troyer, M. R. Perez-Brayfield, E. A. Smith and H. C. Scherz (Division of Paediatric Urology, Emory University School of Medicine and Children’s Healthcare of Atlanta, and Division of Neonatology, Northside Hospital, Atlanta, GA, USA) 
    Increased Incidence of Hypospadias in Small-For-Gestational Age Infants in a Neonatal Intensive-Care Unit 
    BJU Intl. April 2001 Vol. 87 (6) Pg. 548-550
         
    Conclusion : The incidence of hypospadias in small-for-gestational age infants admitted to the NICU is > 10 times higher than that reported for the general population. There was a trend to lower fetal and placental weight in SGA infants with hypospadias than in the controls. 
         
    This finding merits further evaluation using a larger population database and suggests that factors resulting in SGA infants occur at a critical point early in development, affecting both somatic and urethral development.
        

Dysfunctional voiding
 

  • P. Hoebeke, E. Van Laecke, C. Van Camp, A. Raes, and J. Van De Walle (Departments of Urology and Paediatrics, Paediatric Uro-Nephrologic Centre, Ghent University Hospital, Ghent, Belgium)
    One Thousand Video-Urodynamic Studies in Children with Non-Neurogenic Bladder Sphincter Dysfunction 
    BJU Intl. April 2001 Vol. 87 (6) Pg. 575-580
         
    Conclusion : These results from a large series provide a new insight into the epidemiology and pathophysiology of NNBSD (Non-Neurogenic Bladder Sphincter Dysfunction).
        
    The age distribution provides evidence against a dysfunctional voiding sequence. The risk of developing UTI in NNBSD is greater only in girls. In children with a lazy bladder the risk is also significantly higher, indicating that residual urine is a greater risk factor than detrusor instability. 
         
    Urge syndrome and dysfunctional voiding in girls carry the same risk for developing UTI, indicating that bladder instability is a high risk factor for UTI than detrusor sphincter discoordination. 
         
    All dysfunctions carry an equal risk for developing secondary reflux. Children with NNBSD have different primary diseases but all have a common risk of incontinence, UTI, reflux and obstipation.
         

 

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