Antegrade pressure measurement as a diagnostic tool in modern pediatric urology

The antegrade pressure measurement (APM) or perfusion pressure-flow test (Whitaker test) is a method of antegrade measurement of pressure in the upper urinary tract. In this study, we present the long-term follow-up results of APMs performed in our institution in the late 1980s and early 1990s to see whether the diagnostic decisions that were based on the outcomes of the test prove to be correct in the long term. We conducted a retrospective study by searching our hospital's electronic database. We found a total of 16 APMs performed between 1987 and 1995 (10 boys, six girls; mean age 61 months). In nine cases, action was undertaken immediately after the APM had been performed; in seven cases, this was a surgical procedure (re-implantation/re-calibration or pyeloplasty) after obstruction was demonstrated. In two cases (both postoperative after previous pyeloplasty), absence of obstruction was demonstrated and nephrostomy tubes were subsequently closed. In one case, this resulted in hydronephrosis that had to be treated with a new JJ stent. In all the seven cases in which no action was deemed necessary as a result of the outcome of the APM, long-term follow-up showed that intervention had indeed not been necessary. Although not often used anymore, the APM seems to be a safe and valuable diagnostic tool in the work up for possible urinary tract obstruction in children, especially in cases in which there is serious doubt concerning conservative watchful waitin

Bladder carcinoma in a 31-year-old female spina bifida patient with an auto-augmented bladder

We present the case of a 31-year-old spina bifida patient presenting with a poorly differentiated T3N1M0 bladder carcinoma with sarcomatoid differentiation in an auto-augmented bladder. She underwent a radical cystectomy and a bilateral lymph node dissection. However, only 10 months after the onset of her symptoms, she died after major lymphatic metastases had developed in the small pelvis. This case report is the first on an adult spina bifida patient developing bladder carcinoma after detrusorectomy. It shows that bladder cancer also occurs in patients who underwent detrusorectomy, despite the fact that the risk is supposedly lower than in patients who underwent enterocystoplasty. Moreover, tumour spread to adjacent organs could occur more rapidly in auto-augmented bladders because of the lack of muscle tissue. The latter could have serious implications on the prognosis of these patients

Electroejaculation in patients with spinal cord injuries : A 21-year, single-center experience

OBJECTIVES: To evaluate treatment results of electroejaculation in patients with spinal cord injuries and the additional value of repeated electroejaculation. METHODS: We carried out a retrospective chart analysis of all spinal cord injury patients treated with electroejaculation at University Medical Center Utrecht, Utrecht, the Netherlands, from January 1994 to January 2015. Data were collected on the patients' demographics and medical history. We evaluated sperm quality according to World Health Organization standards, pregnancy and delivery rates. RESULTS: A total of 230 electroejaculation procedures were carried out in 47 patients. In 227 of 230 electroejaculations (98.7%), an ejaculate could be obtained. In 169 of 230 (73.5%) electroejaculation procedures, it was possible to yield semen containing progressively motile spermatozoa. In 18 of 47 (38.3%) patients, no semen of sufficient quality could be yielded during the first electroejaculation. Repeated electroejaculation resulted in ejaculates containing progressively motile spermatozoa in seven of 18 (38.9%) of these men. Procreation was attempted through in vitro fertilization/intracytoplasmic sperm injection in 17 couples; of these, 14 of 17 (82.4%) couples achieved pregnancy. CONCLUSIONS: In the majority of spinal cord injury patients treated with electroejaculation, it is possible to obtain semen that can be used for assisted reproductive technologies. Repeated electroejaculation should be considered when the first procedure fails

Urinary considerations for adult patients with spinal dysraphism

The incidence of newborns with spinal dysraphism is diminishing worldwide, although survival of individuals with this condition into adulthood continues to improve. The number of adults with spinal dysraphism will, therefore, increase in the coming years, which will pose new challenges in patient management. Urological manifestations of spinal dysraphism can include increased risks of urinary incontinence, urinary tract infection, urinary calculi, sexual dysfunction, end-stage renal disease and iatrogenic metabolic disturbances; however, the severity and incidence of these symptoms varies substantially between patients. Owing to the presence of multiple comorbidities, treatment and follow-up protocols often have to be adapted to best suit the needs of specific patients. Authors describe bladder and kidney function and long-term complications of treatments initiated in childhood, as well as the potential for improvements in quality of life through better follow-up schedules and future development

Secondary endoscopic pyelotomy in children with failed pyeloplasty

To assess the results of secondary endopyelotomies (SEP) that were performed in our center in children who had earlier failed pyeloplasty. Eleven secondary endopyelotomies were done between 2005 and 2010 in 10 patients (5 boys and 5 girls, mean age 6.8 years), with a follow-up time of >6 months. The primary procedure was an open/laparoscopic pyeloplasty (n = 10) or a ureterocalicostomy (n = 1). In all cases, endopyelotomy was done by means of a monopolar electrocautery hook using the standard pediatric resectoscope. In 10 patients, SEP was done percutaneously, and in 1 patient it was done in a retrograde fashion. The mean operation time was 69 minutes. After a mean follow-up of 20 months, 70% of patients were free of complaints (n = 7), which was defined as a resolution of complaints, resolution of hydronephrosis, and improvement of renal wash-out curve and function. In 4 renal units, reintervention had to be considered; in one of these, a re-pyeloplasty has already been performed. The mean postoperative hospital stay was 2.8 days. No intraoperative complications occurred. In 1 patient, postoperative leakage around the nephrostomy drain occurred but resolved spontaneously. SEP is a fairly safe method to treat recurrent ureteropelvic junction-stenosis after failed pyeloplasty in children. However, because it seems to be less affective than the open redo pyeloplasty, it cannot be considered as a gold standard procedure and as such should be thoroughly discussed with the patient and parent

Upper and Lower Urinary Tract Outcomes in Adult Myelomeningocele Patients: A Systematic Review

<div><h3>Background</h3><p>The introduction of sophisticated treatment of bladder dysfunction and hydrocephalus allows the majority of SB patients to survive into adulthood. However, no systematic review on urological outcome in adult SB patients is available and no follow-up schemes exist.</p> <h3>Objectives</h3><p>To systematically summarize the evidence on outcome of urinary tract functioning in adult SB patients.</p> <h3>Methods</h3><p>A literature search in PubMed and Embase databases was done. Only papers published in the last 25 years describing patients with open SB with a mean age >18 years were included. We focused on finding differences in the treatment strategies, e.g., clean intermittent catheterization and antimuscarinic drugs versus early urinary diversion, with regard to long-term renal and bladder outcomes.</p> <h3>Results</h3><p>A total of 13 articles and 5 meeting abstracts on urinary tract status of adult SB patients were found describing a total of 1564 patients with a mean age of 26.1 years (range 3–74 years, with a few patients <18 years). All were retrospective cohort studies with relatively small and heterogeneous samples with inconsistent reporting of outcome; this precluded the pooling of data and meta-analysis. Total continence was achieved in 449/1192 (37.7%; range 8–85%) patients. Neurological level of the lesion and hydrocephalus were associated with incontinence. Renal function was studied in 1128 adult patients. In 290/1128 (25.7%; range 3–81.8%) patients some degree of renal damage was found and end-stage renal disease was seen in 12/958 (1.3%) patients. Detrusor-sphincter dyssynergy and detrusor-overactivity acted as adverse prognostic factors for the development of renal damage.</p> <h3>Conclusions</h3><p>These findings should outline follow-up schedules for SB patients, which do not yet exist. Since renal and bladder deterioration continues beyond adolescence, follow-up of these individuals is needed. We recommend standardization in reporting the outcome of urinary tract function in adult SB patients.</p> </div

Survival in spina bifida patients.

<p>If ‘survival into adulthood’ is given, the exact ages were not specified in the article.</p>*<p>Patients treated before 1975.</p>†<p>Patients treated after 1975.</p>‡<p>Two different papers, same study.</p><p>N/A = not available</p

Renal function adult studies (MMC patients) in chronological order.

<p>AMD = antimuscarinic drugs; CKD = chronic kidney disease; N/A = not available; DOA = Detrusor overactivity; DSD = detrusor sphincter dyssynergia; ESRD = end-stage renal disease; GFR = glomerular filtration rate; LPP = leak point pressure; Mixed: occult and open SB; VUR = vesico-ureteral reflux; rUTIs = recurrent urinary tract infections; N.S. = not significant.</p>a<p>in 12/193 patients renal function was unknown;</p>b<p>no reference values of renal function;</p>c<p>no urodynamic data available;</p>e<p> <b>exemption; only median age is stated, whereas in all other studies, mean age is given.</b></p>f<p>other denominator; only studies with known CKD’s are taken into account for this figure (see Results-section for more details).</p

Diagnostic accuracy of Tc-99m DMSA scintigraphy and renal ultrasonography for detecting renal scarring and relative function in patients with spinal dysraphism

Aims To study additional benefits of performing Tc-99m dimercaptosuccinic acid (Tc-99m-DMSA) scintigraphy as part of the follow-up of adults with spinal dysraphism (SD), compared with ultrasonography, with regard to finding renal scarring and difference in split renal function. Methods Between January 2011 and April 2013 every patient visiting our specialized outpatient clinic for adults with SD was invited to undergo both renal ultrasonography and Tc-99m-DMSA scintigraphy. Outcomes of both modalities were compared, with focus on renal scarring. The relation between renal scarring and hypertension was also assessed. Results In total, 122 patients (with 242 renal units) underwent both renal scintigraphy and ultrasonography. More scars were seen on DMSA scintigraphy than on ultrasonography: 45.9% vs. 10.3% of renal units;