Opioid utilization is minimal after outpatient pediatric urologic surgery.

Introduction: There are no guidelines for opioid use after pediatric urologic surgery, and it is unknown to what extent prescriptions written for these patients may be contributing to the opioid epidemic in the United States. We sought to characterize opioid utilization in a prospective fashion following outpatient pediatric urologic surgery at our institution.

Materials And Methods: After obtainingapproval from the Institutional Review Board, we prospectively recruited pediatric patients undergoing outpatient urologic surgery.

Abdominoplasty in prune belly syndrome: Modifications in Monfort technique to address variable patterns of abdominal wall weakness.

Introduction: Abdominoplasty is an important component of the management of children with prune belly syndrome (PBS). While there are features of the abdominal defect in PBS which are common to all patients, there will be differences unique to each patient that should be taken into consideration in surgical planning. Specifically, we have come to realize that although the Monfort procedure assumes a symmetric pattern of abdominal wall laxity, this symmetry is rarely present.

Is routine voiding cystourethrogram necessary following double hit for primary vesicoureteral reflux?

Introduction And Objective: Current AUA guidelines recommend voiding cystourethrogram (VCUG) following endoscopic treatment of vesicoureteral reflux (VUR). We evaluated the clinical and radiographic outcomes of children undergoing Double HIT (hydrodistention implantation technique) for primary VUR to determine success rates and the necessity of postoperative VCUG.

Study Design: Children with a history of febrile urinary tract infection (fUTI) undergoing Double HIT for primary VUR between 2009 and 2012 were identified.

Vesicoureteral reflux index (VURx): a novel tool to predict primary reflux improvement and resolution in children less than 2 years of age.

Purpose: Surgical correction of vesicoureteral reflux (VUR) is influenced by recurrent urinary tract infection (UTI) risk and the likelihood of spontaneous resolution. We aimed to identify factors associated with VUR resolution in children less than 2 years of age and to design a simple scoring tool to predict improvement and resolution.

Materials And Methods: Children less than 2 years old with primary VUR were identified.

Early effect of American Academy of Pediatrics Urinary Tract Infection Guidelines on radiographic imaging and diagnosis of vesicoureteral reflux in the emergency room setting.

Purpose: In 2011 the AAP revised practice parameters on febrile urinary tract infection in infants and children 2 to 24 months old. New imaging recommendations invigorated the ongoing debate regarding the diagnosis and management of vesicoureteral reflux. We compared evaluations in these patients with febrile urinary tract infection before and after guideline publication.

Phantom urinary incontinence in children with bladder-bowel dysfunction.

Objective: To report a previously undescribed condition in which children present with the sensation of wetness because of presumed urinary incontinence when they are actually completely dry. We have termed this entity "phantom" urinary incontinence (PUI).

Materials And Methods: Twenty children referred to our pediatric urology clinic were diagnosed with PUI between 2009 and 2013.

Temporal pattern of vesicoureteral reflux on voiding cystourethrogram correlates with dynamic endoscopic hydrodistention grade of ureteral orifice.

Purpose: The double hydrodistention implantation technique uses ureteral hydrodistention to visualize injection site(s) and determine required bulking agent volume. Along with grade, early vesicoureteral reflux on voiding cystourethrogram provides prognostic information regarding spontaneous resolution of reflux. We hypothesized that reflux timing is predictive of endoscopic hydrodistention grade.

Emergency room visits and readmissions after pediatric urologic surgery.

Objective: Reducing readmissions has become a focal point to increase quality of care while reducing costs. We report all-cause unplanned return visits following urologic surgery in children at our institution.

Materials And Methods: Children undergoing urology procedures with returns within 30 days of surgery were identified.

Selective endoscopic treatment of the non-refluxing contralateral ureter prevents new contralateral vesicoureteral reflux.

Objective: The objective of this study was to evaluate risk factors for new contralateral vesicoureteral reflux (NCVUR) and to investigate whether assessment of the non-refluxing contralateral ureter (NRCU) by hydrodistention and selective treatment can reduce the incidence of NCVUR.

Materials And Methods: From 2001 to 2007, 339 of 841 patients (40%) were treated for unilateral VUR by endoscopic injection. While in the first 267 patients the NRCU was only assessed by hydrodistention but not injected (observation group), NRCUs of the subsequent 72 patients were prophylactically treated if deemed at high risk for NCVUR (H2 or H3) (prophylaxis group).

Pediatric chronic orchalgia.

Introduction: Chronic orchalgia, defined as testicular pain lasting > 3 months and interfering with normal activities, is neglected in the pediatric literature. We describe our experience with the evaluation and treatment of pediatric chronic orchalgia patients.

Materials And Methods: Charts were screened to identify patients meeting the criteria for chronic orchalgia.

Intermediate to long-term follow-up indicates low risk of recurrence after Double HIT endoscopic treatment for primary vesico-ureteral reflux.

Purpose: Follow-up of patients undergoing dextranomer/hyaluronic acid injection for vesico-ureteral reflux (VUR) is controversial. The purpose of our study was to test the hypothesis that patients undergoing the double hydrodistention-implantation technique (Double HIT) have a higher clinical and radiographic success rate.

Materials And Methods: Patients undergoing Double HIT endoscopic injection for VUR were prospectively identified.

Is endoscopic injection therapy a reasonable treatment option for low-grade vesicoureteral reflux in association with overactive bladder?

Objective: To assess the clinical outcome of endoscopic injection in children with vesicoureteral reflux (VUR) and concomittant overactive bladder (OAB).

Methods: A total of 41 patients with VUR and OAB underwent endoscopic injection of dextranomer/hyaluronic acid. At surgery, 13 patients had been successfully treated for their OAB (urgency with or without wetting) with behavior modification with or without anticholinergic therapy, and 28 had persistent OAB despite treatment.

Clinical and radiographic results of endoscopic injection for vesicoureteral reflux: defining measures of success.

Objective: Criteria for success following endoscopic vesicoureteral reflux (VUR) surgery vary greatly. We sought to define outcomes based on radiographic and long-term clinical follow up.

Methods: We reviewed the charts and interviewed parents of children who underwent endoscopic treatment for primary VUR (grades I-IV).

Does compliance status predict clinical status in patients undergoing endoscopic management of vesico-ureteral reflux?

Objective: Previous studies of endoscopic management of vesico-ureteral reflux (VUR) have had non-compliance rates around 50%. We examined success rates of patients non-compliant with a delayed follow up protocol after endoscopic injection for VUR.

Materials And Methods: Patients undergoing Double HIT, dextranomer/hyaluronic acid copolymer endoscopic injection for VUR were enrolled in a 1-year, delayed voiding cysto-urethrogram (VCUG) study.

Radiologic features of implants after endoscopic treatment of vesicoureteral reflux in children.

Objective: Implants after endoscopic treatment of vesicoureteral reflux (VUR) in children will be more frequently detected on imaging studies and may lead to misinterpretation and unnecessary intervention. This article reviews the radiologic appearance of implants.

Conclusion: Radiologic findings of implants depend on the imaging technique, bulking agent, and time after injection.

Dynamic hydrodistention of the ureteral orifice: a novel grading system with high interobserver concordance and correlation with vesicoureteral reflux grade.

Purpose: We evaluated the usefulness and interobserver concordance of a novel grading system for dynamic ureteral hydrodistention.

Materials And Methods: Between May 1, 2002 and July 1, 2008 the hydrodistention grade in 697 ureters was prospectively assigned and recorded, including H0-no hydrodistention, H1-ureteral orifice open but tunnel not evident, H2-tunnel seen only and H3-extravesical ureter visualized. Specifically 489 refluxing ureters (vesicoureteral reflux group) were compared to 100 normal control ureters (normal control group).

Appearance of dextranomer/hyaluronic Acid copolymer implants on computerized tomography after endoscopic treatment of vesicoureteral reflux in children.

Purpose: With the increasing popularity of endoscopic treatment for vesicoureteral reflux in children, dextranomer/hyaluronic acid copolymer implants are more frequently detected on computerized tomography, which may lead to misinterpretation and unnecessary intervention. The objective of this study was to characterize the long-term appearance of dextranomer/hyaluronic acid copolymer implants on computerized tomography.

Materials And Methods: We evaluated the hospital charts of 893 patients who had undergone dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux between July 2001 and November 2007 to identify those who underwent subsequent computerized tomography of the abdomen and pelvis.

Dynamic hydrodistention classification of the ureter and the double hit method to correct vesicoureteral reflux.

Objectives: The objective of this monograph is to familiarize the reader with dynamic hydrodistention classification of the ureter and Hydrodistention Implantation Technique (HIT) methodology for the endoscopic correction of vesicoureteral reflux (VUR). The indications, current success rates, complications, and potential future applications of these methods are reviewed.

Methods: Hydrodistention (HD) of the ureteral orifice and distal ureter permits visualization of the intraureteral submucosal injection site and assessment of the degree of ureteral coaptation.

Appearance of Deflux implants with magnetic resonance imaging after endoscopic treatment of vesicoureteral reflux in children.

Objective: With the increasing popularity of endoscopic treatment for vesicoureteral reflux (VUR) in children, dextranomer/hyaluronic acid copolymer (Deflux) implants are more frequently detected by magnetic resonance imaging (MRI). Such findings on MRI may be misinterpreted and lead to unnecessary intervention. The objective of this study was to characterize the appearance of Deflux implants on MRI.

Endoscopic injection of dextranomer hyaluronic acid copolymer for the treatment of vesicoureteral reflux in duplex ureters.

Purpose: Endoscopic injection of dextranomer hyaluronic acid copolymer (DxHA) has been increasingly utilized for the treatment of complex cases of vesicoureteral reflux (VUR). We present our 6-year experience with the use of DxHA for the treatment of VUR in duplex ureters.

Materials And Methods: Between July 2001 and April 2007, 52 children were identified retrospectively who had been treated by endoscopic injection of DxHA for VUR into duplex ureters.

Endoscopic treatment of vesicoureteral reflux using dextranomer hyaluronic acid copolymer.

Vesicoureteral reflux (VUR) is a common urinary tract anomaly. Treatment is performed to minimize the risk of febrile urinary UTIs that may result in renal scarring. The endoscopic use of dextranomer hyaluronic acid copolymer has been gaining popularity as an alternative to the traditional methods of open surgery and chronic antibiotic prophylaxis.

Endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid in children.

Purpose: The goal of this review is to present current indications, injectable agents, techniques, success rates, complications, and potential future applications of endoscopic treatment for vesicoureteral reflux (VUR) in children.

Materials And Methods: The endoscopic method currently achieving one of the highest success rates is the double hydrodistention-implantation technique (HIT). This method employs dextranomer/hyaluronic acid copolymer, which has been used in pediatric urology for over 10 years and may be at present the first choice injectable agent due to its safety and efficacy.

Incidence of urinary tract infections in children after successful ureteral reimplantation versus endoscopic dextranomer/hyaluronic acid implantation.

Purpose: Endoscopic implantation of dextranomer/hyaluronic acid has proved to be an effective minimally invasive technique for correcting vesicoureteral reflux in children. There is some evidence suggesting that in addition to being less invasive, successful dextranomer/hyaluronic acid implantation compared to successful antireflux surgery is associated with fewer febrile and nonfebrile urinary tract infections. We review the clinical outcomes of 2 groups of children cured of reflux with open surgery and dextranomer/hyaluronic acid implantation to determine if a difference in clinical outcomes exists.