The transition of young adults with lifelong urological needs from pediatric to adult services: An international children's continence society position statement.

Introduction: Children with urinary tract disorders managed by teams, or individual pediatricians, urologists, nephrologists, gastroenterologists, neurologists, psychologists, and nurses at some point move from child-centered to adult-centered health systems. The actual physical change is referred to as the transfer whilst the process preceding this move constitutes transition of care. Our aims are twofold: to identify management and health-service problems related to children with congenital or acquired urological conditions who advance into adulthood and the clinical implications this has for long-term health and specialist care; and, to understand the issues facing both pediatric and adult-care clinicians and to develop a systems-approach model that meets the needs of young adults, their families and the clinicians working within adult services.

Destruction of the bladder by single dose Mitomycin C for low-stage transitional cell carcinoma (TCC)--avoidance, recognition, management and consent.

Objectives: To identify a cohort of patients under our care who have had significant and in some cases irreparable damage to their bladders after Mitomycin C (MMC) instillation. To highlight the importance of avoidance and recognition of bladder perforations during transurethral resection of bladder tumour (TURBT) and explore the issue of consent regarding MMC given the serious complications that may occur after its instillation.

Patients And Methods: Patients referred to our tertiary centre for a second opinion to manage their complications after a suspected MMC leak was identified from the departmental database between January 2000 and December 2010.

Examining long-term outcomes of bladder exstrophy: a 20-year follow-up.

Objective: To examine long-term quality-of-life, urinary continence and sexual function outcomes in patients diagnosed with bladder exstrophy (BE).

Patients And Methods: A total of 65 patients with BE and follow-up of at least 20 years were identified. After informed consent for inclusion in the study, the patients were asked to complete three validated questionnaires, the Short-Form 36 quality-of-life questionnaire (SF-36), the International Consultation on Incontinence Questionnaire (ICIQ) and the International Index of Erectile Function (IIEF), to assess quality of life, perceived urinary continence and sexual function.

Evaluation of retained testes in adolescent girls and women with complete androgen insensitivity syndrome.

Purpose: To evaluate the magnetic resonance (MR) imaging appearance of the testes in women with complete androgen insensitivity syndrome (CAIS), including any benign or malignant changes.

Materials And Methods: This was a retrospective review of the testicular MR images and histologic reports from 25 patients with CAIS who chose to retain their testes beyond age 16 years and who were imaged between January 2004 and December 2010. Ethical approval was obtained, and informed consent was obtained from each subject to review the medical records, images, and histologic slides and reports.

Persistent histological changes in the exstrophic bladder after primary closure-a cause for concern?

Purpose: We investigated bladder biopsies from patients with classic bladder exstrophy for the histological features and discuss the potential clinical significance of the findings.

Materials And Methods: Bladder tissues were collected from patients with bladder exstrophy between 2004 and 2011. These specimens were obtained at primary bladder closure (group 1, 29 patients), during secondary reconstructive procedures (group 2, 27) or during cystectomy for failed reconstruction (group 3, 15).

Adult care of children from pediatric urology: part 2.

Purpose: We describe the outcomes of undescended testes and sex development disorders in adolescence and young adulthood. We reviewed the requirements for the long-term care of children born with these and other major congenital anomalies of the genitourinary system.

Materials And Methods: The current English language literature was retrieved with a PubMed® search for articles on these subjects.

Genital prolapse in adult women with classical bladder exstrophy.

Introduction And Hypothesis: The aim of this paper is to study the incidence and risk factors for genital prolapse in adult women with bladder exstrophy and to describe the long-term outcome of the Gore-Tex wrap procedure for genital prolapse.

Methods: A retrospective observational study on adult women with classical bladder exstrophy in a tertiary referral centre for disorders of sex development, including complex urogenital anomalies. Medical notes were reviewed and a confidential postal questionnaire on urinary continence and symptoms of prolapse was carried out.

Adult care of children from pediatric urology.

Purpose: In this article we highlight the difference, from established adult urology, in required approach to the care of adolescents and young adults presenting with the long-term consequences of the major congenital anomalies of the genitourinary tract. We review some abnormalities of the kidneys, progressive renal failure and disorders of bladder function from which general conclusions can be drawn.

Materials And Methods: The published literature was reviewed and augmented with material from our institutional databases.

Animal models in urinary diversion.

We set out to critically assess the value of animal experimentation in urinary diversion through intestinal segments, as some authors question the effectiveness of animal research, criticising the methodological quality, lack of standardization, inadequate reporting and the few systematic reviews in this field. Based on a comprehensive MEDLINE literature search (MeSH database; search terms: urinary diversion, urinary reservoirs, continent, rat, dog, animal models) we retrieved and evaluated all full-length papers published in English, German, French, and Spanish languages from 1966 to 2011 reporting the use of animal models in the setting of urinary diversion. Studies were stratified according to the addressed research question.

The efferent segment in continent cutaneous urinary diversion: a comprehensive review of the literature.

Objective: To critically assess the biophysical properties and current status of outlet formation in heterotopic intestinal urinary diversion. As despite three decades of clinical experience with continent cutaneous urinary diversion through bowel segments, no consensus has been reached for the optimal efferent segment although its function largely determines patient satisfaction.

Methods: A comprehensive Medline literature search using the Medical Subject Headings database (search terms: continent urinary diversion followed by either efferent segment, nipple, Mitrofanoff, Yang-Monti, Benchekroun, tapered ileum, intussuscepted ileum, Kock pouch, T-valve, or Ghonheim) was conducted to identify all full-length original articles addressing the various principles and techniques of outlet formation as well as their outcomes and complications.

Obstructive ejaculatory duct calculi in a patient with bladder augmentation and myelomeningocele.

Symptomatic ejaculatory duct (ED) calculi, typically composed of uric acid, carbonate apatite and calcium phosphate, or calcium phosphate in the form of hydroxyapatite, are rare occurrences. We report a case of bilateral, large ED calculi in a patient with spina bifida myelomeningocele and an augmented neurogenic bladder. A 25-year-old Caucasian male, not compliant with his urological management, presented with abdominal pain, difficulty in self-catheterization, nausea and vomiting.

Pyospermia in an adult cohort with persistent lower urinary tract symptoms and a history of ablated posterior urethral valve.

Purpose: To assess for the presence of lower urinary tract symptoms and abnormal semen parameters in adults with a history of PUV.

Materials And Methods: The study involved 29 male patients, aged 17-51 (mean 21.5 years), with a history of PUV.

Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002).

The British Society of Gastroenterology (BSG) and the Association of Coloproctology for Great Britain and Ireland (ACPGBI) commissioned this update of the 2002 guidance. The aim, as before, is to provide guidance on the appropriateness, method and frequency of screening for people at moderate and high risk from colorectal cancer. This guidance provides some new recommendations for those with inflammatory bowel disease and for those at moderate risk resulting from a family history of colorectal cancer.

Risk of bladder tumours after childhood cancer: the British Childhood Cancer Survivor Study.

Objectives: To estimate the risk of a second primary tumour (SPT) of the bladder in a cohort of childhood cancer survivors, investigate factors associated with a bladder SPT developing, and compare the risk observed with that expected from the general population.

Patients And Methods: The analysis included 17981 individuals diagnosed with childhood cancer, between 1940 and 1991 in Britain, and surviving for ≥5 years. Ascertainment of a bladder SPT was primarily through the National Health Service Central Registers (NHSCR).

Anorectal malformations: what happens in adulthood?

Objective: To comprehensively evaluate the outcomes in adults who were born with anorectal malformations (ARMs), to assess the relationships between the major types of ARM and outcomes, and to examine the relationships between bowel and urinary function and sexual well-being, as advances in surgical treatment for ARMs have led to more patients surviving into adult life, and adult data on urinary and bowel function are scant, with even less known about the effect of diagnosis and treatment on sexual and reproductive function.

Patients And Methods: In all, 74 adult patients with a diagnosis of ARM confirmed by review of paediatric medical records completed a series of validated questionnaires on urinary and bowel function, body esteem, sexual well being, fertility and overall quality of life.

Results: There were high levels of urinary and bowel incontinence for both men and women.

Stabilization of renal deterioration caused by bladder volume dependent obstruction.

Purpose: Previously published data from our unit show the detrimental effect of excessive bladder filling at normal pressure on renal function in chronically dilated renal units. Synchronous cystometry and dynamic renography identified a critical volume of filling that prevents upper tract drainage. In this followup study we determined whether maintaining bladder volume below this critical level would halt renal deterioration.

Vaginal restoration in survivors of childhood rhabdomyosarcoma.

Childhood genital rhabdomyosarcoma is a devastating diagnosis. Treatment is usually rigorous, comprising extensive surgery often with adjuvant chemotherapy and radiotherapy. This management is, however, increasingly successful, and survival into adolescent and adult life is becoming more commonplace.

Routine surveillance cystoscopy for patients with augmentation and substitution cystoplasty for benign urological conditions: is it necessary?

Objective: To evaluate screening cystoscopy as the long-term follow up in patients with an enterocystoplasty for > or =10 years.

Patients And Methods: We performed a prospective analysis of 92 consecutive patients who attended our endoscopy suite for regular check cystoscopy as per standard follow-up. This is performed for all patients with cystoplasty performed at our institute after 10 years.

Epithelial-stromal tumor of seminal vesicle in a patient with chromophobe renal cell carcinoma and small lymphocytic lymphoma.

Biphasic tumors of the seminal vesicle are rare. We report a further case in a 61-year-old man of a seminal vesicle epithelial-stromal tumor with focally atypical epithelial and stromal cells, the latter displaying a smooth muscle immunophenotype. In addition, this was associated with 2 synchronous malignant neoplasms, chromophobe renal cell carcinoma and small lymphocytic lymphoma, both of which were detected incidentally after clinical presentation because of the seminal vesicle mass.

Comparison of biochemistry and diet in patients with enterocystoplasty who do and do not form stones.

Objective: To evaluate patients with a history of urinary stones in intestinal reservoirs and compare them with similar patients who have never formed stones.

Patients And Methods: One consequence of storing urine in an intestinal reservoir is urolithiasis, and there are several theories on its cause, all based on limited evidence. There are many factors predisposing to stone formation, and dietary and biochemical factors might be useful to distinguish those who form stones from those who do not.

Myelomeningocele: neglected aspects.

The commonest cause of neurogenic bladder in children is myelomeningocele. Survival of children is much improved in the Western world, but by 35 years old, about 50% will have died. In adults, the commonest causes of death are lung and heart diseases.