A Pilot Trial Comparing the Effects of Onabotulinumtoxina and Standard Oxybutynin Therapy as First Line Treatment for the Poorly Compliant Pediatric Neurogenic Bladder

Research question Is it feasible to conduct a phase III RCT to compare OnabotulinumtoxinA injections to oxybutynin as primary therapy in pediatric neurogenic bladder? Methods Patients on a stable oxybutynin regimen were recruited for a pilot RCT and underwent randomization to either OnabotulinumtoxinA or continuation of oxybutynin. Primary outcomes included an a priori defined feasibility and acceptability assessment. Secondary outcomes included continence, urodynamic parameters, side effects and QOL. Results The study enrolled 8 subjects in the OnabotulinumtoxinA group and 6 in the oxybutynin group. The recruitment rate was 75 % and the dropout rate was 6.6 %. There were 2 minor protocol deviations. There were no side effects in the botulinum group compared to 66.7% in the oxybutynin group (p=0.02). The clinical and QOL outcomes were comparable. Conclusion It is feasible and safe to conduct a phase III trial to investigate the efficacy of primary OnabotulinumtoxinA compared to oxybutynin therapy

A Review of the Effect of Injected Dextranomer/Hyaluronic Acid Copolymer Volume on Reflux Correction Following Endoscopic Injection

The current literature suggests that multiple variables affect vesicoureteric reflux (VUR) resolution rates following dextranomer/hyaluronic acid copolymer (Dx/HA) injection. This article reviews the evidence pertaining to the effect of injected Dx/HA volume on success rates following endoscopic correction. Lack of prospective studies which use injected volume as a continuous variable coupled with a nonstandardized injection technique and endpoint hinders the ability to reach a definite conclusion

Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes

In this article, we present the current approach to hypospadias, a review of the classification, preoperative evaluation, and factors that enable decision-making during surgery. We will then discuss patient-reported outcomes, evaluating the patients\u27 and parents\u27 perspectives regarding hypospadias repair

Diagnostic Approach to Reflux in 2007

There is ongoing controversy regarding the association between vesicoureteric reflux (VUR), recurrent urinary tract infections (UTI), and renal damage. Despite this, routine work up for VUR is still recommended after febrile UTI in most children. The present article reviews the indications and imaging modalities available for VUR diagnosis. Alternative newer techniques like MR cystography and voiding urosonography are discussed. The increasing evidence of the role of DMSA scans in managing children with VUR is highlighted

Instituting robotic pediatric urologic surgery in the canadian healthcare system: Evaluating the feasibility and outcomes of robot-assisted pyeloplasty and ureteric reimplantation

Introduction: Robotic pediatric urologic surgery has gained widespread adoption over the last decade. This article describes our experience in instituting the first pediatric urologic robotic surgery program in Canada. We evaluated the feasibility and safety of instituting pediatric robot-assisted urologic surgery and report our early outcomes for robot-assisted pyeloplasty (RAP) and ureteric reimplantation (RUR). Methods: We prospectively evaluated all patients undergoing RAP and RUR by a single surgeon from June 2013 to March 2019. Demographic and clinical data were prospectively collected and included sex, age, and preoperative grade of hydronephrosis or reflux. Descriptive statistics were performed, and comparisons were made using Student’s t-tests where appropriate. Success was defined as resolution or significant improvement of hydronephrosis following RAP and absence of recurrent urinary tract infection (UTI) and/or persistent vesicoureteric reflux (VUR) following RUR. Complications were described using the Clavien-Dindo system. Results: A total of 52 RAPs and 24 RURs were performed with a minimum of six months followup. Forty-five RAP patients met criteria for success, while diagnostic imaging of success in the form of MAG-3 Lasix renograms was documented in the remaining seven for an overall success of 100%. Sixteen RUR patients met criteria for success and seven showed resolution of VUR on imaging following their first UTI, for an overall success rate of 96%. Operative times progressively improved from 204±35 minutes to 121±15 minutes in the RAP group and from 224±52 to 132±39 minutes in the RUR group. In the RAP cohort, one Clavien grade II and four Clavien grade III complications were noted, while three Clavien grade III complications were noted in the RUR cohort. Conclusions: Despite limited case volumes, robotic pediatric urologic surgery can be integrated into the Canadian healthcare system with success rates comparable to reported literature. However, compared to open surgery, RAP and especially RUR warrant further study to ensure lack of significant complications noted in our study