Comparison of the microbiological milieu of patients randomized to either hydrophilic or conventional PVC catheters for clean intermittent catheterization.

Introduction: Control of bacteriuria is problematic in patients who perform clean intermittent catheterization for management of neurogenic bladder. This population is often burdened with multiple urinary tract infections (UTIs), placing them at increased risk of end-stage renal disease. Hydrophilic catheters are a potential way to improve smooth and clean insertion, reduce disruption of the urothelium, and reduce bacterial colonization.

Association of O-Antigen Serotype with the Magnitude of Initial Systemic Cytokine Responses and Persistence in the Urinary Tract.

Unlabelled: Urinary tract infection (UTI) is one of the most common ailments requiring both short-term and prophylactic antibiotic therapies. Progression of infection from the bladder to the kidney is associated with more severe clinical symptoms (e.g.

Is VCUG still indicated following the first episode of urinary tract infection in boys?

Objectives: To determine if voiding cystourethrogram (VCUG) following first episode of urinary tract infection (UTI) offers any incremental diagnostic advantage in boys if a comprehensive renal and bladder ultrasonogram (RBUS) revealed no abnormalities.

Methods: All boys less than 10 years of age whose first evaluation for UTI included RBUS and VCUG were retrospectively studied over a 10-year period. Those with a disorder of the urinary tract known before imaging were excluded.

Relationship among bacterial virulence, bladder dysfunction, vesicoureteral reflux and patterns of urinary tract infection in children.

Purpose: We hypothesized that virulence levels of Escherichia coli isolates causing pediatric urinary tract infections differ according to severity of infection and also among various uropathies known to contribute to pediatric urinary tract infections. We evaluated these relationships using in vitro cytokine interleukin-6 elicitation.

Materials And Methods: E.

The relationship between obesity and complications after neonatal circumcision.

Purpose: Penile adhesions with hidden penis and penile skin bridges are complications after neonatal circumcision that seem to develop more often in overweight children. They could possibly be avoided if there were neonatal parameters predicting circumcision complications. We hypothesized that penile adhesions with hidden penis and skin bridges may be predicted by the height and weight of a newborn.

In vitro analysis of the bactericidal activity of Escherichia coli Nissle 1917 against pediatric uropathogens.

Purpose: The usefulness of prophylactic antibiotics to prevent recurrent urinary tract infections in children was recently questioned. Some groups have attempted to use probiotics, most commonly lactobacillus, to prevent recurrent infections by altering the intestinal bacterial reservoir with variable results. Mutaflor® is a possible alternative probiotic in which the active agent is Nissle 1917.

Novel management of urinary tract infections.

Purpose Of Review: To highlight observations that have suggested the need for changing the conventional approach to the evaluation and management of urinary tract infections (UTIs) and vesicoureteral reflux in children and examine new alternative approaches to prevention of UTI and renal scarring based on research into host-pathogen interaction.

Recent Findings: Recent studies have questioned the traditional approach of using prophylactic antibiotics to prevent recurrence of UTI and development of renal scarring in children with vesicoureteral reflux. Ongoing research on host-pathogen interactions reveals a promising capability to analyze virulence factors in bacteria causing UTIs in children, identify highly virulent bacteria capable of causing pyelonephritis and renal injury, and to selectively target the gastrointestinal reservoirs of these bacteria for elimination using probiotics.

Pathogenesis of renal injury in the megabladder mouse: a genetic model of congenital obstructive nephropathy.

Congenital obstructive nephropathy (CON) is the most common cause of chronic renal failure in children often leading to end-stage renal disease. The megabladder (mgb) mouse exhibits signs of urinary tract obstruction in utero resulting in the development of hydroureteronephrosis and progressive renal failure after birth. This study examined the development of progressive renal injury in homozygous mgb mice (mgb-/-).

Effect of rectal distention on lower urinary tract function in children.

Purpose: We investigated the effect of rectal distention on lower urinary tract function.

Materials And Methods: Children were assigned to a constipation and lower urinary tract symptoms group or to a lower urinary tract symptoms only group. The definition of constipation was based on pediatric Rome III criteria.

Pathophysiology and management of urinary incontinence in case of distal penile epispadias.

Purpose: We evaluated boys with distal epispadias and urinary incontinence to determine the cause, and designed a simplified bladder neck reconstruction to restore urinary continence.

Materials And Methods: Six boys with epispadias of the glans or distal penile shaft whose incontinence persisted after successful single stage epispadias repair were evaluated with cystoscopy and urodynamics after failed attempts at toilet training. Surgical management--simplified bladder neck reconstruction--involved suprapubic excision of an identified deformity of the roof of the bladder neck and posterior urethra, followed by reapproximation of the remaining normal bladder neck and posterior urethral tissues.

Requirements for accurately diagnosing chronic partial upper urinary tract obstruction in children with hydronephrosis.

Successful management of hydronephrosis in the newborn requires early accurate diagnosis to identify or exclude ureteropelvic junction obstruction. However, the presence of hydronephrosis does not define obstruction and displays unique behavior in the newborn. The hydronephrotic kidney usually has nearly normal differential renal function at birth, has not been subjected to progressive dilation and except for pelvocaliectasis does not often show signs of high-grade obstruction.

Nocturnal bladder emptying for reversing urinary tract deterioration due to neurogenic bladder.

Although daytime clean intermittent catheterization with urotropic medications is often sufficient therapy to relieve urinary retention and elevated intravesical pressures, neglecting the bladder affected by neuropathy or other significant pathologies during sleeping hours can lead to overdistension of the bladder and its deleterious consequences. The effect of this seemingly inconsequential clean intermittent catheterization interlude for some patients on an ideal daytime-only management protocol can lead to a syndrome of nighttime overdistension of the bladder, which can result in recurrent urinary tract infections, worsened incontinence, decreased bladder compliance and capacity, and progressive hydroureteronephrosis and renal insufficiency. Fortunately, nocturnal bladder emptying has emerged as a specific antidote for the syndrome of nighttime overdistension of the bladder, and because nocturnal bladder emptying can reverse or prevent bladder and upper tract deterioration, it is suggested that conventional therapies performed only during the daytime may have been inadequate for certain subgroups of patients who require a new therapeutic paradigm for their optimal management.

Nocturnal bladder emptying: a simple technique for reversing urinary tract deterioration in children with neurogenic bladder.

Purpose: In this preliminary study we sought to determine the effect of instituting nocturnal bladder emptying (NBE) in children with neurogenic (NGB) or nonneurogenic neurogenic bladder (NNGNGB) in whom urinary tract deterioration developed despite optimal daytime clean intermittent catheterization (CIC) and urotropic medications. We hypothesize that a syndrome of nocturnal overdistention of the bladder (SNOB) can cause urinary tract deterioration through increased nighttime storage pressures manifested by recurrent urinary tract infection (UTI), worsening incontinence, hydronephrosis and/or decreasing bladder compliance and capacity, and may be reversed by NBE.

Materials And Methods: A total of 19 children with NGB (17) or NNGNGB (2) who displayed urinary tract deterioration while on CIC and urotropic medications were started on NBE.

A novel technique for ureteral catheterization and/or retrograde ureteroscopy after cross-trigonal ureteral reimplantation.

Purpose: A criticism of the Cohen cross-trigonal reimplantation is the potential difficulty of retrograde access to the ureter. With the advent of modern endourological equipment, we devised a novel technique that obviates the aforementioned difficulty and permits even retrograde ureteroscopy.

Materials And Methods: Cystoscopy is performed and a curved tip vascular access catheter is directed towards the ureteral orifice.

"The beneficial and protective effects of hydronephrosis".

Hydronephrosis is generally considered a pathologic process, and especially in infancy is widely viewed as caused by obstruction, potentially injurious to the kidney and in need of expeditious surgical treatment. However a number of clinical and experimental studies suggest exactly the opposite: that hydronephrosis is not pathological but actually a compensating mechanism designed to protect the kidney from high pressures and renal damage. Furthermore, because hydronephrosis in the infant involves an already compliant and distensible renal pelvis it appears to be uniquely beneficial.

The valve bladder syndrome: pathophysiology and treatment with nocturnal bladder emptying.

Purpose: We determine the etiology and treat the specific pathophysiology of the valve bladder syndrome.

Materials And Methods: Defined as persisting or progressive severe hydroureteronephrosis without residual or recurrent obstruction, the valve bladder syndrome developed in 18 boys who underwent successful ablation of the posterior urethral valve. Serial radiographic, renal function, renographic, urodynamic and perfusion studies were performed for a mean time of 11 years.