Combined low-dose antimuscarinics for refractory detrusor overactivity in children.

Introduction And Aims: Behavioral therapy and bowel management are the initial and mainstay treatments for overactive bladder (OAB). Antimuscarinic agents are initiated if these measures fail or symptoms are severe. This study reported the results of treatment with a high dosage of a single drug in children with refractory detrusor overactivity (DO).

Prospective randomized comparison between cold and warm ischemia in patients with renal insufficiency undergoing partial nephrectomy.

Objective: To compare between the effects of cold and warm ischemia on the risk of deterioration of renal insufficiency in patients with T1 renal tumor managed by partial nephrectomy.

Methods: This prospective randomized study was performed on 120 patients with chronic kidney disease, all having T1 renal tumors. Renal function was estimated by estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease formula.

Retrograde intrarenal surgery monotherapy versus shock wave lithotripsy for stones 10 to 20 mm in preschool children: a prospective, randomized study.

Purpose: We compared the outcome of retrograde intrarenal surgery monotherapy vs shock wave lithotripsy for stones 10 to 20 mm in preschool children.

Materials And Methods: This prospective study included 60 children with a mean ± SD age of 2.4 ± 1.

Effect of Botox injection at the bladder neck in boys with bladder dysfunction after valve ablation.

Objective: After posterior urethral valve ablation, some boys are still have a hostile bladder. We conducted a prospective randomized study to determine if Botox injection at the bladder neck will help improve vesical dysfunction in this subgroup of boys or not.

Patients And Methods: Twenty boys with history of posterior urethral valve ablation and severe bladder dysfunction with a mean age of 16 months were studied.

Factors that predict the spontaneous passage of ureteric stones in children.

Objective: To study the natural history of stone passage in children with ureterolithiasis and to define factors predictive of spontaneous passage.

Patients And Methods: In all, 72 children with ureteric stones were evaluated; patients with ureteric calculi of >10 mm were excluded, as were those with absolute indications for surgical stone removal. Stone size, location, side, presence of hydronephrosis, perinephric stranding and degree of the tissue-rim sign were estimated by unenhanced helical computed tomography (UHCT).

Ureteroscopy in infants and preschool age children: technique and preliminary results.

Introduction: We present our experience with the use of semirigid ureteroscopy for the treatment of ureteric stones in children less than or equal to 6 years of age.

Material And Methods: The records of 21 children (12 female, 9 male) with an average age of 4.7 years (range 8 months to 6 years) treated with semirigid ureteroscopy between June 2006 and July 2010 were reviewed.

Tamsulosin for the management of distal ureteral stones in children: a prospective randomized study.

Purpose: Based on efficacy demonstrated in the adult population, tamsulosin was evaluated with regard to facilitating ureteral stone expulsion in children presenting with distal ureteric calculi.

Patients And Methods: A prospective randomized controlled study involving 61 children with distal ureteric calculi <12 mm was performed. The children were randomly divided into two groups.

Percutaneous nephrolithotomy for the management of stones in anomalous kidneys in children.

Purpose: We report percutaneous nephrolithotomy for the management of stones in anomalous kidneys in children.

Materials & Methods: We performed PCNL on 6 children (one with bilateral stones), 3 boys and 3 girls with anomalous kidneys. Three had horseshoe kidneys, 2 malrotated kidneys, and one crossed fused ectopic kidney.

Z-plasty for sculpturing of the bifid scrotum in severe hypospadias associated with penoscrotal transposition.

Purpose: Bifid scrotum is usually associated with scrotal and perineal hypospadias. Conventional surgical repair involves rotation of two scrotal flaps, joining them in the midline, and vertical skin closure. Dimpling of skin can occur, resulting in suboptimal aesthetic results.

Penile advancement and lengthening for the management of post-circumcision traumatic short penis in adolescents.

Objectives: To report on the safety of combing suprapubic fat liposuction, penile suspensory ligament severing, and Z-plasty of penoscrotal webbing for penile lengthening in cases of post-circumcision traumatic short penis in adolescents.

Methods: This prospective study was conducted in 9 male patients with a mean age of 15.6 ± 1.

Early valve ablation can decrease the incidence of bladder dysfunction in boys with posterior urethral valves.

Purpose: Valve bladder syndrome represents the worst end of the posterior urethral valve spectrum. Recent data suggest that early valve ablation can provide the chance for the bladder to heal and improve dynamics. We tested the hypothesis that early valve ablation can decrease the incidence of bladder dysfunction in these boys.

Corporeal body grafting using buccal mucosa for posterior hypospadias with severe curvature.

Purpose: Severe penile curvature correction by corporeal body grafting has been successfully performed using various grafts and biomaterials. We present our initial experience with buccal mucosa as a free corporeal graft to correct severe penile curvature as part of a multistage approach to posterior hypospadias repair.

Materials And Methods: A total of 12 children with a mean age of 6.

Radiolucent renal stones in children: combined use of shock wave lithotripsy and dissolution therapy.

Objectives: To provide a noninvasive efficient modality for the treatment of radiolucent renal stones in children. Uric acid calculi comprise a significant proportion of urinary stones.

Methods: This study included 24 children (10 girls and 14 boys) with radiolucent renal stones.

Augmentation ureterocystoplasty in boys with valve bladder syndrome.

Objective: Children with valve bladder syndrome represent the worst end of the posterior urethral valve spectrum. When conservative measures fail to control recurrent infections, prevent deterioration of the upper tract (in the form of increasing hydronephrosis and or worsening of kidney function) and improve incontinence, augmentation cystoplasty is considered. In most of these boys, renal insufficiency precludes the use of intestine for augmenting the bladder.

Single-stage repair of bladder exstrophy in older children and children with failed previous repair.

Aim: Evaluation of cosmetic and functional outcome of single-stage exstrophy-epispadias complex repair in older children and those with previously failed repair.

Materials And Methods: This study comprised 15 children (12 boys and 3 girls) with classic bladder exstrophy and a mean age at repair of 8.6 months (range 2-24 months).

Partial penile disassembly for isolated epispadias repair.

Objectives: Isolated male epispadias defect is present in 10% of cases of epispadias-exstrophy complex. Surgical repair of epispadias malformation remains debatable as evident by the different techniques adopted. The current study presents our experience in partial penile disassembly for isolated epispadias repair.

The multistage use of buccal mucosa grafts for complex hypospadias: histological changes.

Purpose: We report our experience using buccal mucosa in the multistage repair of complex hypospadias, and the observed histological changes.

Materials And Methods: We evaluated 31 patients (14 adults and 17 children). A total of 19 patients presented after failed hypospadias repair with deficient ventral skin, 5 presented with scrotal hypospadias and 7 presented with perineal hypospadias.

Botulinum A toxin urethral sphincter injection in children with nonneurogenic neurogenic bladder.

Purpose: We evaluated botulinum-A toxin (Botox) injection into the urethral urinary sphincter in children with nonneurogenic neurogenic bladder to decrease urethral resistance and improve voiding. In these patients alpha-blocker medications had failed and injection was an alternative to unavailable biofeedback.

Materials And Methods: Prospective treatment was performed in 10 children 6 to 17 years old (mean age 8) with nonneurogenic neurogenic bladder using botulinum-A toxin (Botox).

Urodynamic predictors of upper tract deterioration in children with myelodysplasia.

The clinical and urodynamic data of 62 children with myelodysplasia without previous urological treatment were tested statistically for the ability to predict upper tract deterioration. This was done by comparing these data among 26 children with dilated upper tracts and 36 children with normal upper tracts. Vesicoureteric reflux had a strong positive correlation with upper tract dilation but the maximum cystometric capacity, detrusor instability, compliance, maximum urethral closure pressure and peak flow rate all had no predictive value.

Modified vascularized pedicled scrotal flap for complex hypospadias.

Surgical correction of complex hypospadias defects is a problem. A 1-stage technique using a scrotal septum pedicled skin flap was used in 7 patients with inadequate preputial skin and scarred ventral penile skin unsuitable for satisfactory repair. The results were satisfactory in 5 patients.

Perioperative antibiotic prophylaxis for transurethral resection of the prostate: is it justifiable?

The role of perioperative antimicrobial prophylaxis in transurethral resection of the prostate remains controversial. A total of 110 patients with preoperative sterile urine undergoing transurethral resection of the prostate was included in this open, prospective and randomized study to compare the prophylactic role of cefoperazone to no antibiotic prophylaxis. Patients were well matched between the 2 groups on all essential characteristics and risk factors at baseline.

The evolution of artificial sphincter cuff in growing animals.

An animal model was developed to simulate the effect of implantation of artificial sphincter cuff on the urethra in children. The study was conducted on 28 pigs, 15 castrated males, four uncastrated males and nine females, divided into four groups: control unoperated, and three operated groups. Group I contained young piglets (castrated males, uncastrated males and females), group II contained adult animals and group III contained sham operated animals.

Dynamics of the ureterovesical junction: its resistance to upper urinary tract outflow in pigs.

In pigs, upper urinary tract outflow resistance at the ureterovesical junction (UVJ) has been investigated before and after changes of capacity and compliance of the bladder with ureterovesical perfusion pressure (UV-PP) measurements and cystometry (PB). Changes of UV-PP approximately paralleled changes of PB during volume changes and compression of the bladder, and during detrusor activity. Exceptions were: detrusor activity in all bladders, being nondistended, during which UV-PP always increased more than PB; and low and high compliant, and small capacity bladders in which UV-PP may change more than PB under all conditions once these bladders are so far filled that they are distended.

Intravesical instillation of a calcium entry blocker and its effects on detrusor contractility: in vitro and vivo experiments.

The effects of intravesical instillation of a Ca2+ entry blocker (verapamil) on the contractility of the bladder detrusor muscle of the rabbit were investigated in vitro and in vivo. In in vitro experiments, using whole bladder preparations, spontaneous contractile activity and contraction induced by direct electric stimulation or acetylcholine were monitored. Both activities were inhibited in a time-dependent manner after the intravesical instillation of 7.

Dynamics of the ureterovesical junction: its fluid transport mechanism in the pig.

The peristaltic fluid transport mechanism of the ureterovesical junction was investigated with distal and juxtavesical ureteral perfusion pressure measurements. Elimination of the activity of the juxtavesical ureteral segment, juxtavesical or intravesical partial resection of the ureteral sheaths, and impediment of shortening of the muscular layers of the ureterovesical junction ureter segment, all reduced the effectiveness of ureterovesical junction peristalsis. From these findings and from the anatomy of the ureterovesical junction we concluded that peristaltic urine transport through the ureterovesical junction is effectuated by shortening and telescoping of the muscular layers of the ureterovesical junction ureter segment and its sheaths into each other and into the ureteric hiatus.