Urinary excretion of glycosaminoglycans in patients with isolated nocturnal enuresis or combined with diurnal incontinence

OBJECTIVE: To determine variations in the amount of glycosaminoglycans (GAGs) excreted by patients with nocturnal enuresis and/or diurnal incontinence. PATIENTS, SUBJECTS AND METHODS: The study included 27 patients (aged 5-15 years) with nocturnal enuresis and/or diurnal incontinence, and 27 healthy age-matched children. Their urinary GAG excretion was assessed over 24 h using the sodium tetraborate-carbazole method. RESULTS: Patients with nocturnal enuresis and/or diurnal incontinence had higher mean values of urinary GAG excretion than age-matched controls. There were significant differences in GAG excretion between those with nocturnal enuresis and diurnal incontinence and those with nocturnal enuresis alone. CONCLUSIONS: GAG excretion in patients with nocturnal enuresis and/or diurnal incontinence was significantly higher than in normal children, suggesting that measuring urinary GAGs may be useful in evaluating physiopathological conditions of the bladder wall, and hence in monitoring potential damage in the bladder mucosa

Contrast enhanced Gray-scale and Color-Doppler Voiding Urosonography vs. Voiding Cystourethrography in the diagnosis and grading of vesicoureteral reflux.JCU2001;29:65-71/IF=0.596

Purpose. The purpose of this study was to compare contrast-enhanced gray-scale voiding urosonography (CE-VUS) and contrast-enhanced color Doppler voiding urosonography (CE-CDVUS) with voiding cystourethrography (VCUG) to verify whether the use of color Doppler imaging improves the diagnosis and grading of vesicoureteral reflux (VUR). Methods. ln 74 patients, CE-VUS and CE-CDVUS were compared with VCUG, which was used as the gold standard. SHU 508 A (Levovist) was used as the echo-enhancing contrast agent. VUR was diagnosed if hyperechoic dots or color signals were visualized in the ureter on sonograms. VUR grading was based on morphologic and dynamic findings on CE-VUS and morphologic and color findings on CE-CDVUS. VCUG was performed conventionally, and grading by VCUG was in accordance with the international system of radiographic VUR grading. Patients who voided during 1 examination only (either CE-VUS and CE-CDVUS or VCUG) were excluded from the study. Agreement between the results of CE-VUS and VCUG and between those of CE-CDVUS and VCUG in diagnosing VUR was calculated by rc statistics. CE-VUS and CECDVUS were compared for diagnostic accuracy by the McNemar test. Results. The agreement between CE-VUS and Correspondence to: A. L. Valentini @ 2001 John Wiley & Sons, Inc. VOL. 29, NO, 2, FEBRUARY 2OO1 VCUG in predicting VUR was 90% (rc score,0.77; p < 0.001). The agreement between CE-CDVUS and VCUG was 96% (rc score, 0.91; p < 0.001). CE-CDVUS showed a significantly higher diagnostic accuracy than did CEVUS (96% versus 90% of cases correctly classified; McNemar X2 = 4; p < 0.05). This was mainly related to the lower number of false-negative results for grade I and grade ll VUR when CE-CDVUS was used. Conclusions. The use of color Doppler imaging significantly improves the accuracy of contrast voiding urosonography in the detection and grading of VUR

Cryptorchidism associated with myelomeningocele

Objective: The authors studied 75 male infants with meningomyelocele (MMC) to analyse the association with cryptorchidism. Methods: All infants were diagnosed at birth and surgically corrected after 24\u201348 h. Testes were classified undescended in accordance with Kaplan. The associated malformations, the exact levels of the lesion (surgical report) and the presence of hydrocephalus and the cremasteric reflex have each been assessed. Results: In these patients a higher incidence of cryptorchidism (14.8%) was found than in the normal population. Lesion level (L2\u2013L3) and absence of cremasteric reflex was higher in children with associated cryptorchidism. Infants with MMC and undescended testes showed no increased incidence of hydrocephalus and sexual hormone levels remained within the normal range. These results suggest that the cremaster muscle could be a major factor involved in testis descent through the inguinal canal. Conclusions: The authors propose that spinal cord lesion, as well as neurologic dysfunction, is of major importance in the pathophysiology of cryptorchidism in spina bifida