Utility of urodynamics in the management of asymptomatic tethered cord in children.

Background: We have noted a recent increase in neurosurgical requests at our institution for urodynamics (UDS) prior to release of asymptomatic tethered cord. Our aim was to determine how preoperative UDS results are used in the clinical management of asymptomatic tethered cord.

Methods: A retrospective review was performed of 120 patients diagnosed with primary tethered cord from 2007 to 2010.

The current state of surgical practice for neonatal torsion: a survey of pediatric urologists.

Objective: The evaluation and treatment of perinatal testicular torsion is controversial. We performed a survey to assess practice patterns among pediatric urologists regarding treatment of perinatal torsion.

Methods: An internet survey was administered to members of two pediatric urology societies.

Outcome after discontinuing prophylactic antibiotics in children with persistent vesicoureteral reflux.

Purpose: Treatment for vesicoureteral reflux remains controversial. Lacking an evidence-based treatment protocol, we offered the option of terminating prophylactic antibiotics in otherwise healthy patients with persistent vesicoureteral reflux at age 5 years or greater. We report outcomes with respect to the urinary tract infection incidence and to whether surgical intervention was eventually done.

The management of ureteropelvic junction obstruction presenting with prenatal hydronephrosis.

The treatment of the newborn diagnosed with a ureteropelvic obstruction prenatally should follow a systematic approach. Although a majority of patients can be followed without surgical intervention, controversy exists concerning appropriate follow-up. Furthermore, a significant number of patients will manifest mild disease and thus deserve abbreviated follow-up.

Postnatal imaging of antenatal hydronephrosis.

Radiologic imaging of the newborn detected prenatally with hydronephrosis should follow a systematic approach. Upper and lower urinary tract imaging should be performed in most cases in order to determine the etiology and gauge the use of future imaging. An overview of renal ultrasound, voiding cystourethrography, renal scintigraphy, and magnetic resonance urography in the setting of antenatal hydronephrosis are discussed.

Prenatal intervention for lower urinary tract obstruction.

Hydronephrosis is one of the most common abnormalities detected on routine prenatal ultrasounds, being noted in up to 1% of fetuses. Rarely, severe hydronephrosis coexists with oligohydramnios, which portends a poor prognosis. We review the most recent literature on the results of prenatal intervention in this setting.

Antenatal hydronephrosis.

The diagnosis, workup, and management of prenatal hydronephrosis have undergone a swing from preemptive surgical treatment to a more conservative approach as the natural history of the differential diagnoses becomes more appreciated. We examine different radiologic tests for determining the diagnoses associated with antenatal hydronephrosis. A review of the more common differential diagnoses of prenatal hydronephrosis and current treatment options for ureteropelvic junction obstruction, vesicoureteral reflux, ureteroceles, ectopic ureters, and megaureters is undertaken.

Pediatric urodynamics: basic concepts for the neurosurgeon.

A great deal of information about overall bladder and urethral function can be obtained with the utilization of urodynamics. Urodynamics itself does not constitute a single test but more precisely the acquisition of multiple interconnected data combined to give an overall study of the storage and emptying phases of the bladder, function of the urethra, as well as the activity of the pelvic floor musculature. Urodynamic investigation represents one of the few reliable objective tests available to help guide therapy for the neurosurgeon.

End cutaneous ureterostomy for the management of severe hydronephrosis.

Purpose: Although rarely indicated, surgical treatment of severe megaureter can pose a formidable technical challenge, especially in the small infant. We present our experience and outcomes with end cutaneous ureterostomy as a temporizing adjunct to future ureteral reimplantation.

Materials And Methods: We performed a retrospective cohort study of patients who underwent end cutaneous ureterostomy between 1993 and 2005.

Incontinence following bladder neck reconstruction--is there a role for endoscopic management?

Purpose: Little has been reported concerning the efficacy of endoscopic injection of dextranomer/hyaluronic acid for the treatment of residual incontinence following bladder neck reconstruction. We present the experience of 2 institutions using endoscopic submucosal injection of dextranomer/hyaluronic acid to correct incontinence in patients who had previously undergone bladder neck reconstruction with or without concomitant enterocystoplasty.

Materials And Methods: A retrospective chart review was performed with patient demographics, indications for treatment and outcomes recorded.