Biomedical subjects

Antoine E Khoury

Publications and source records attributed to Antoine E Khoury.

At least 19 recordsLinked to original sources

PubMed2006

Symptom score for lower urinary tract dysfunction in pediatric urology.

Lower urinary tract dysfunction is a common component of virtually every pediatric urologist's practice. Although lower urinary tract dysfunction should be considered more of a social nuisance than a true medical condition, if left unchecked, real comorbidities may occur. A thorough history, physical examination, voiding diary, and noninvasive urodynamic studies, such as flow rate or flow rate with electromyography, generally are used to make an accurate diagnosis. Once the diagnosis is established, a wide range of therapies are available and their use may be based on the age of the child, duration of symptoms, etiology of the lower urinary tract dysfunction and associated urologic disease, and physician or family preferences. Symptom scoring systems have been devised to confirm diagnosis of lower urinary tract dysfunction, classify its severity, and serve as a monitoring instrument to determine response to treatment.

Child↗

PubMed2006

Outcome analysis of retroperitoneal laparoscopic heminephrectomy in children.

PURPOSE: Retroperitoneal laparoscopic heminephrectomy is a relatively new, well tolerated, minimally invasive alternative to open surgery for children with a nonfunctioning moiety in a duplex kidney. We collected data to assess outcomes in our experience with this procedure. MATERIALS AND METHODS: Data were retrospectively gathered on all patients operated on for retroperitoneal laparoscopic heminephrectomy at our institution between February 2001 and November 2004. Followup ultrasound was performed in all patients, and additional imaging was done only when clinically indicated. RESULTS: Retroperitoneal laparoscopic heminephrectomy was performed in 18 girls and 4 boys (18 upper and 5 lower pole moieties). Indications included ureterocele (12 patients), ectopic ureter (9) and vesicoureteral reflux (5). Mean age at surgery was 5 years (range 4 months to 18 years). Four patients required conversion to an open procedure due to inadequate exposure and were excluded from further review. Urine leaks developed postoperatively in 3 patients and were treated with Foley catheter drainage and/or stent placement. Two patients were noted to have large (more than 5 cm) asymptomatic retroperitoneal fluid collections on followup ultrasound. Functional loss of the remaining ipsilateral moiety was confirmed by DMSA scan in 2 children (ages 6 and 7 months). Doppler studies confirmed normal hilar blood flow in both cases. Clinical presentation for this subgroup included fever on postoperative day 3 in 1 patient and hypertension at 32 months postoperatively in 1. Mean followup was 33 months (range 3 to 56). CONCLUSIONS: Although retroperitoneal laparoscopic renal ablative surgery in children appears to be relatively safe and is associated with low morbidity, serious complications may occur with subtle or even late presentation.

Adolescent↗

PubMed2006

What are the most powerful determinants of endoscopic vesicoureteral reflux correction? Multivariate analysis of a single institution experience during 6 years.

PURPOSE: As the indications for endoscopic correction of vesicoureteral reflux continue to expand, the emergence of potential predictive variables has been noted. We used univariate and multivariate statistical analyses to find the most significant predictors of correction to improve patient selection. MATERIALS AND METHODS: A consecutive series of patients treated at a single institution was reviewed. Between August 1998 and August 2004, 232 children endoscopically injected with polydimethylsiloxane were identified, representing 351 refluxing units. A total of 23 variables were subjected to statistical analysis to detect predictors of reflux correction after injection. All identified patients with complete data and followup evaluations were included irrespective of anatomical variations, previous interventions or comorbidities. RESULTS: The overall success rate by patient and renal unit was 65% and 72%, respectively. In patients with a single system low grade (1-3) vesicoureteral reflux who did not previously undergo injection this success rate increased to 80%. Univariate analysis demonstrated that higher physician experience, low preoperative vesicoureteral reflux grade, absent renal scars and no previous injections were statistically significant predictors of vesicoureteral reflux correction (p <0.05). A history of febrile urinary tract infections and a duplex system did not attain significance (p = 0.069 and 0.076, respectively). On multivariate statistical evaluation only physician experience, preoperative vesicoureteral reflux grade and the number of previous injections remained significant. CONCLUSIONS: Multivariate analysis of our data showed the most important determinants of vesicoureteral reflux correction after endoscopic injection. Prospective validation will allow us to generate nomograms to better select and counsel patients who would benefit from vesicoureteral reflux treatment.

Child↗

PubMed2006

Endoscopic treatment of reflux: management pros and cons.

PURPOSE OF REVIEW: The goal of this review is to contrast the issues in favor of and against the use of endoscopic injection therapy in an attempt to highlight the current state of flux and draw attention to areas that merit further research. RECENT FINDINGS: Current publications have mostly addressed the expanding use of endoscopic injection therapy for vesicoureteral reflux treatment, generally reporting short-term success rates and endpoints. This growing body of literature is presented in the context of perceived benefits vs. disadvantages in comparison with other available treatment modalities. SUMMARY: The management of vesicoureteral reflux has changed dramatically in the past decade, mostly because of the increasing acceptance of endoscopic injection therapy as an adequate, minimally invasive, and effective form of therapy. Recent advances in the composition of injectable materials have allowed for easier placement with a perceived favorable safety profile. In particular, dextranomer/hyaluronic acid has become the injectable material of choice, with quick acceptance and widespread use soon after its introduction in different countries. As we critically evaluate the evolving treatment options, the presented literature helps draw attention to some of the challenges we face and the need for long-term and carefully planned prospective studies to support our interventions.

Endoscopy↗

PubMed2005

Use of buccal mucosa to simulate the coronal sulcus after traumatic penile amputation.

Traumatic penile amputation is a rare but catastrophic complication of newborn circumcision, usually involving a portion of, or the entire, glans penis. Emergent reimplantation is necessary to prevent glans loss. However, loss of the coronal sulcus might occur despite successful reimplantation, resulting in a cosmetically unacceptable appearance. We report such a case involving a newborn who suffered partial penile glans amputation and loss of the coronal sulcus after reimplantation, successfully treated with buccal mucosa grafting.

Amputation, Traumatic↗

PubMed2005

A novel approach to skin coverage for epispadias repair.

PURPOSE: Current techniques for epispadias repair have resulted in significant improvement in the reconstruction of the urethra, corpora and glans. The final challenging step is to enhance the cosmetic result by accomplishing skin coverage for the penis and subpubic area, creating a penopubic and penoscrotal angle without dorsal suture lines, and avoiding future dorsal tethering of the penis as a result of scar contraction. We report a novel technique for penile skin coverage in the patient with epispadias that results in a superior cosmetic outcome. MATERIALS AND METHODS: The technique involves creation of 2 flaps-a ventral preputial transverse island flap rotated dorsally to cover the dorsal aspect of the penile shaft, and an advancement flap from the patch of skin present between the penis and scrotum in epispadias, which is advanced distally to cover the ventral aspect of the penis. The 2 flaps are sewn to each other with 2 lateral suture lines. Thus, the dorsal and ventral aspects of the penis are covered with intact skin devoid of suture lines. RESULTS: This technique was used in 8 males 2 days to 15 years old. The epispadias was part of exstrophy in 5 patients and an isolated defect in 3. Both flaps healed well in 7 of 8 patients. In 1 exstrophy case a segment of the transverse island flap became ischemic and was discarded intraoperatively. Dorsal skin coverage in this patient was achieved using a laterally based flap from the inguinal area, which healed without problem. Followup was 6 to 33 months. No patient had development of skin tethering, curvature or recurrence of the dorsal chordee. The cosmetic appearance of the penis was subjectively superior to that of boys who underwent skin closure using reverse Byars flaps. CONCLUSIONS: The cosmetic appearance of the penis using this novel technique is superior because of the absence of the dorsal scar that may cause chordee, the development of penopubic and penoscrotal angles, which gives the penis a more normal appearance, and the absence of the redundant patch of skin between the shaft of the penis and the scrotum.

Adolescent↗

PubMed2005

Simplified mons plasty: a new technique to improve cosmesis in females with the exstrophy-epispadias complex.

PURPOSE: Long-term data suggest that a significant number of women with the exstrophy-epispadias complex (EEC) report dissatisfaction with the cosmetic appearance of the genitalia. We developed a new technique of mons plasty in an attempt to improve the overall cosmetic appearance of the external genitalia in females with EEC. MATERIALS AND METHODS: Nine consecutive females with a mean age of 6.4 years (range 2 days to 12.2 years) previously diagnosed with EEC underwent simplified mons plasty concomitantly with various other urological reconstructive procedures. Briefly, a simplified mons plasty was performed by approximating the bifid hemiclitoris and subsequently incising the lateral sulci between the labia majora and minora, which allowed the superomedial rotation of the labia majora and underlying peripubic adipose tissue, thus, recreating the mons. RESULTS: There were no perioperative complications. With a mean followup of 6 months (range 4 to 12) all patients had improved cosmesis with respect to a more prominent mons, more appropriately situated labia and adequately recessed introitus. CONCLUSIONS: Simplified mons plasty improves cosmesis in females with external genital abnormalities secondary to EEC. Although our followup is admittedly short, we believe that this technique should be considered in the armamentarium of the reconstructive surgeon during the operative treatment of this complex group of patients.

Abdominal Wall↗

PubMed2005

Prospective evaluation of remote, interactive videoconferencing to enhance urology resident education: the genitourinary teleteaching initiative.

PURPOSE: Changes in referral patterns and resource allocation into Centers of Excellence affect the educational experience of urology trainees by altering resident exposure to patients and clinicians, especially at sites where subspecialty deficiencies exist. Access to educators at Centers of Excellence using interactive videoconferencing technology may facilitate residency training objectives and enhance trainees' overall educational experience. We prospectively evaluated the implementation of this technology at tertiary care teaching centers to enhance urology resident education. MATERIALS AND METHODS: Using videoconferencing technology, urology residents at the University of Western Ontario (London, Canada) participated in a series of didactic, interactive pediatric urology teleteaching seminars. These were presented by an expert pediatric urologist from the Hospital for Sick Children, Toronto, Canada. Using a 5-point Likert scale (1-strongly disagree, 5-strongly agree), participants responded to statements pertaining to seminar content, technology and ease of use at the completion of each session. The results were subsequently tabulated and evaluated to determine the effectiveness and accessibility of the program in providing expert pediatric urological education to residents at a remote urology training program. RESULTS: The entire urology resident staff from postgraduate year 1 to 5 participated in the seminar program. The overall acceptance of this medium was high (mean score 4.5). The quality of presentation, as well as picture and sound quality, all received mean scores greater than 4. Participants indicated that their ability to interact with the presenter was not inhibited by using this medium. All participants agreed that they would use this technology in the future (mean score 4.5) and that the presentation would not be improved if the presenter were on-site. Due to preexisting technology at both centers, no direct cost was incurred throughout the study. CONCLUSIONS: Our experience suggests that interactive teleteaching using readily available, existing technology, is a cost-effective and accepted method of providing trainees with an appropriate educational experience. In centers where subspecialty deficiencies exist, this medium may provide residents with the necessary education requirements of their respective programs without the need for costly teacher (or student) travel. Continual improvements in technology as well as the addition of multiple sites will increased this medium's impact in the future.

Adult↗

PubMed2005

Aerosol transfer of bladder urothelial and smooth muscle cells onto demucosalized colonic segments for porcine bladder augmentation in vivo: a 6-week experimental study.

PURPOSE: In a pilot study we developed a cell transfer technology for populating demucosalized colonic segments with bladder urothelium. This process was achieved through aerosol transfer of a single cell suspension consisting of bladder urothelial cells, smooth muscle cells and fibrin glue onto demucosalized colonic segments. We further evaluate this new concept in a controlled study. MATERIALS AND METHODS: The study was performed on 20 piglets (20 kg). In all animals 50% of the bladder with excised, and a 10 cm segment of the sigmoid was isolated. Animals were then equally divided into 5 groups of 1) colocystoplasty only, 2) demucosalized colocystoplasty, 3) demucosalized colocystoplasty plus covering of the demucosalized sigmoid with fibrin glue only, 4) aerosol application of fibrin glue with single cell suspension of urothelial cells only to the demucosalized colon, and 5) aerosol application of fibrin glue with urothelial and smooth muscle cells to the demucosalized colon. The 4 corners of the augmented segments were marked with 5-zero polypropylene sutures. Animals were sacrificed 6 weeks later and the surface area of the augmented segment was measured. Segments were submitted to histological and immunohistochemical analysis. RESULTS: The surface area of the augmented segments showed an increase in group 1 animals, stabilization in groups 4 and 5, and marked reduction in groups 2 and 3. On hematoxylin and eosin, and Masson trichrome staining all group 1 animals showed normal colonic epithelium of the augment. All animals in groups 2 and 3 showed excessive scarring with urothelial coverage only at the augment periphery, while the central augment area showed no epithelium. Segments from groups 4 and 5 showed confluent epithelial covering with no fibrosis. There was no evidence of colonic epithelial re-growth in any animal in groups 2 to 5. Cytokeratin 7 and uroplakin III staining demonstrated complete coverage of the augmented segment with urothelium only in groups 4 and 5. CONCLUSIONS: The addition of aerosolized cells of urological origin is a viable augmentation approach that appears to achieve the much sought after inhibition of intrinsic fibrosis and contraction of colonic segments when incorporated into the urinary tract without this cellular component. Moreover, this technique appears to provide a histologically normal, confluent urothelium, which sets the stage for prevention of the well-documented biochemical aberrations inherent in augments containing gastrointestinal epithelium. While successful in this model regardless of the incorporation of urological smooth muscle cells, chronic studies are now warranted to validate the short-term results as well as determine whether the urological mesenchymal population (smooth muscle) will be required to sustain the uroepithelial phenotype in the long term.

Aerosols↗

PubMed2005

A multicenter evaluation of technical preferences for primary hypospadias repair.

PURPOSE: Considerable controversy exists regarding the optimal surgical technique for the repair of mid shaft and proximal hypospadias. We sought to evaluate differences in surgical preferences among an international cohort of pediatric urologists. MATERIALS AND METHODS: An anonymous questionnaire containing relevant demographic data as well as choices of technique to repair 5 representative hypospadias cases was developed and administered. RESULTS: Of 121 pediatric urologists contacted 101 completed the survey, representing an 83% response rate. The majority were full-time academic pediatric urologists who performed 6 to 10 hypospadias surgeries monthly. A total of 92 respondents (confidence interval [CI) 0.84 to 0.96) preferred the tubularized incised urethral plate (TIP) technique for the repair of distal hypospadias. Similarly, 82 (CI 0.72 to 0.88) preferred TIP for the repair of mid shaft hypospadias. The 2 most common techniques for repair of proximal hypospadias without chordee, preferred by 43 correspondents each (CI 0.33 to 0.53), were TIP and transverse island flap (TVIF) onlay. For repair of moderate (30-degree to 40-degree) chordee dorsal plication was preferred by 82 respondents, while a ventral approach was preferred by 12. When moderate chordee was associated TVIF onlay was preferred by 35 (CI 0.26 to 0.45) and TIP by 24 respondents (CI 0.16 to 0.34). For severe chordee (greater than 50 degrees) 31 respondents preferred dorsal plication, while 68 chose some form of ventral repair. Among the respondents 37 approach proximal hypospadias associated with severe chordee using a staged procedure, while 40 use a single stage procedure using a TVIF tube (CI 0.30 to 0.50). Using Spearman's rank correlation coefficient, no significant correlations were identified between respondent practice demographics and choice of repair for each hypothetical hypospadias case. CONCLUSIONS: In this cohort of pediatric urologists we observed that the majority prefers TIP to repair distal and mid shaft hypospadiac defects. Significant variability exists for preferred technique for proximal hypospadias and chordee correction. These results support the need for prospective trials comparing techniques for the repair of proximal hypospadias.

Europe↗

PubMed2004

Efficacy of polydimethylsiloxane injection to the bladder neck and leaking diverting stoma for urinary continence.

PURPOSE: Achieving urinary continence is a major goal in the treatment of patients with bladder exstrophy/epispadias, spinal dysraphism and other urological disorders. Endoscopic injection of bulking materials is an evolving, minimally invasive procedure that provides an attractive alternative to open bladder surgery to increase outlet resistance. We evaluated the efficacy of bladder outlet (bladder neck and diverting stoma) polydimethylsiloxane injection (BOMI) to achieve continence in children. MATERIALS AND METHODS: We retrospectively reviewed the continence status of 33 patients prior to and following BOMI for urinary incontinence. The variables evaluated as predictors of success were underlying disease, ambulatory status, voiding status, bladder capacity, type and time from previous bladder neck reconstruction, anticholinergic treatment, injection site, amount of polydimethylsiloxane used, detrusor leak point pressure and immediate or delayed clean intermittent catheterization. Improvement was considered a 2-fold increase in the dry interval or 4 hours between bladder emptying in patients on clean intermittent catheterization and a 2-fold decrease in the number of absorbent pads needed. RESULTS: Between 1998 and 2002, 25 male and 8 female patients 4 to 19 years old (mean age 12.4 +/- 3.9) underwent 42 BOMIs for incontinence. Mean followup was 13 +/- 9 months (range 3 to 42). Incontinence was via the urethra in 28 cases and via a diverting stoma in the remaining 5. Of the 28 patients with leakage via the urethra none were cured, 12 (42%) were improved and 16 (58%) had no change in continence status. However, 3 of the 5 inpatients (60%) with leakage via a diverting stoma were cured. No perioperative complications were recorded. Injecting to a diverting stoma was the only factor found to be predictive of success. Extrusion of polydimethylsiloxane during the procedure was the only factor predictive of failure (3 of 3 cases or 100%). New onset dilatation of the collecting system was noted in 2 patients and all had improved continence following injection. CONCLUSIONS: Injection to the bladder neck did not result in any cure and had a low improvement rate of 42%. BOMI is a good therapeutic option for patients with leakage from a diverting stoma. Although no perioperative complications were recorded, 2 patients had new dilatation of the upper tract on ultrasound. Hence, long-term followup is warranted.

Administration, Intravesical↗

PubMed2004

Outcome of small residual stone fragments following shock wave lithotripsy in children.

PURPOSE: We evaluate the outcome of small residual stone fragments (RF) following extra-corporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) in children. MATERIALS AND METHODS: The medical records of 39 boys and 44 girls (88 renal units) with urolithiasis who underwent ESWL were reviewed. Median patient age was 7 years. Average stone burden was 14 mm. Mean followup was 46 months. After the first ESWL 40 of the 88 (46%) renal units became stone-free and 18 (20%) had RF 5 mm or less. The remaining 30 (34%) units required further treatment using ESWL or ancillary surgical procedures that rendered 12 of them stone-free and 8 with RF. The 26 renal units with RF constitute our study subjects. Adverse outcomes such as growth of RF, symptomatic episodes or calculi recurrence in stone-free cases were recorded. RESULTS: Of the 26 renal units with RF 5 mm or less, 18 (69%) had an adverse clinical outcome (symptoms or RF growth) and 8 (31%) patients were asymptomatic and had no stone growth. Patients with RF had a significant increase in adverse clinical outcome compared to stone-free subjects, with an odds ratio of 3.9 (95% CI 1.5-9.6). The presence of metabolic disorders was associated with RF growth (odds ratio 11.4, 95% CI 1.5-79). CONCLUSIONS: Small RF after ESWL is clinically significant in children and increase the chance of adverse clinical outcome. These patients require close followup, particularly those with identifiable predisposing disorders.

Adolescent↗

PubMed2004

Intrascrotal lipoblastoma with a complex karyotype: a case report and review of the literature.

Lipoblastoma is a tumor of adipose tissue that usually occurs in young children. Most lipoblastomas occur on the extremities, trunk, and head and neck, and most have rearrangements of the 8q region. We describe a lipoblastoma in a 12-month-old boy who presented with a rapidly enlarging scrotal mass. Electron microscopy revealed features consistent with immature adipocytes, and cytogenetic analysis revealed the following karyotype: 57,XY,+4,+6,+7,der(8)t(8;12) (q22;q13), +der(8)t(8;12) (q22;q13), +9,+10,+12,-16,+17,+der(18)t(8;18)(q22;q23),+19,+20. Interestingly, the breakpoint on chromosome 12 (q13) is the same as that seen in lipoblastomas. To our knowledge, this is the first reported case of such a complex karyotype in lipoblastoma and adds to the expanding list of karyotypic abnormalities seen in such tumors.

Aneuploidy↗

PubMed2003

Subureteral polydimethylsiloxane injection versus extravesical reimplantation for primary low grade vesicoureteral reflux in children: a comparative study.

PURPOSE: We compare the outcome of extravesical ureteral reimplantation to endoscopic polydimethylsiloxane (Macroplastique, Uroplasty, Inc., Minneapolis, Minnesota) subureteral injection for primary low grade vesicoureteral reflux in children. MATERIALS AND METHODS: Between 1997 and 2000, 180 patients underwent polydimethylsiloxane injection (74, 108 ureters) or extravesical ureteral reimplantation (106, 166 ureters) for low grade vesicoureteral reflux. Low grade reflux was defined as grades I to III. Outcome analysis included success rates, de novo hydronephrosis, voiding efficiency, urinary tract infections and complications. RESULTS: Mean patient age at surgery for the injection and surgery groups was 60 and 77 months, and mean followup was 12 and 15 months, respectively. Of the patients who underwent single injection 80.6% were cured of reflux at 3 months and 91.6% were cured at last followup. Success rate after reimplantation was 95.8% at 3 months which improved to 98.8% 1 year later. The success rate was significantly different between the injection and reimplantation groups at 3 and 12 months (p <0.01). Postoperative complications in the reimplantation group included transient urinary retention after bilateral surgery in 2 patients (3.3%), suprapubic fluid collections in 2 and wound seroma in 1. No complications occurred in the polydimethylsiloxane group. CONCLUSIONS: Extravesical ureteral reimplantation has near perfect success with a low but definite complication rate. Polydimethylsiloxane offers high success rates for reflux in an ambulatory setting with no short-term complications. Currently, endoscopic polydimethylsiloxane injection is our preferred mode of therapy for low grade vesicoureteral reflux in children when surgical correction is indicated.

Adolescent↗

PubMed2003

Tubularized incised plate repair: functional outcome after intermediate followup.

PURPOSE: We describe the functional outcome following tubularized incised plate repair of hypospadias in toilet trained children after an intermediate followup. MATERIALS AND METHODS: Children were included in this study only if they were toilet trained and had flow rate data not less than 6 months after primary tubularized incised plate hypospadias repair or 2 months after any secondary procedure to correct complications. Uroflow data (peak flow, voided volume and post-void residuals) were analyzed and plotted on previously determined age-volume dependent nomograms. RESULTS: Of the 48 boys 39 required no secondary procedures, while 9 secondary fistula closures were performed in 2, meatotomy in 2 and dilation in 5. After either primary (26) or secondary (7) procedures 33 of the 48 patients (68.7%) had normal peak flow rate and 15 (31.3%) had low peak flow rate. Of the 48 patients 46 had post-void residual urine less than 10% of voided volume. CONCLUSIONS: Most children will void efficiently with no straining and no post-void residual (1/2) to 4 years after tubularized incised plate hypospadias repair. Of our patients 68.7% have normal peak flow rate. Intermediate followup of larger series and followup at puberty are recommended to resolve the debate concerning the long-term functional outcome of tubularized incised plate hypospadias repair.

Child, Preschool↗

PubMed2003

Natural history of neonatal reflux associated with prenatal hydronephrosis: long-term results of a prospective study.

PURPOSE: We have previously reported on patients with neonatal vesicoureteral reflux followed conservatively. The current study is a long-term followup of our prospective expectant management protocol for the overall cohort. MATERIALS AND METHODS: Between 1993 and 1998, 31 of 260 patients with prenatal hydronephrosis had vesicoureteral reflux and were followed prospectively. Outcome analysis was done on 25 patients, excluding 6 who underwent surgery, with the end point of complete resolution or improvement of reflux using our previously reported Kaplan-Meier survival curve, urinary tract infection, dysfunctional voiding, and changes in renal function or growth, somatic growth and hypertension. RESULTS: Of the 25 cases reflux was grades I to V in 7%, 20%, 34%, 16% and 23%, respectively. Reflux resolved in 13 patients (52%) and improved in 6 (24%). Grades I to V disease resolved in 100%, 77%, 53%, 28% and 40% of refluxing units, respectively. The improvement rate for grades III to V reflux was 13%, 14% and 30%, respectively. Breakthrough urinary tract infection occurred in 4 patients with grades IV and V reflux, and dysfunctional voiding developed in 5. Followup renal scans showed 19% and 17% decreased differential function in 2 units without new scars. There was no difference in renal length in patients with resolved versus persistent reflux or low versus high grade reflux. All patients had normal somatic growth at the 4-year followup and none had hypertension. CONCLUSIONS: Expectant management was effective in the majority of cases and associated with a low urinary tract infection rate. Neonatal vesicoureteral reflux resolved or improved in 76% of our patients by age 4 years without somatic growth retardation or hypertension. High grade reflux resolved or improved in 59% of the units and showed normal renal growth with expectant management.

Body Height↗

PubMed2003

Aerosol transfer of bladder urothelial and smooth muscle cells onto demucosalized colonic segments: a pilot study.

PURPOSE: We developed a cell transfer technology for covering demucosalized colonic segments with bladder urothelium. This covering would be achieved through aerosol spraying of single cell suspension of bladder urothelial and smooth muscle cells with fibrin glue onto the demucosalized colonic segments. MATERIALS AND METHODS: In 6 piglets (20 kg.) a 4 cm.2 area of bladder was excised. Single cell suspension of bladder urothelial and smooth muscle cells was prepared. A segment of detubularized sigmoid colon was isolated on its vascular pedicle and demucosalized. The single cell suspensions were combined with an equal volume of fibrin glue and sprayed over the raw submucosal surface of the sigmoid segment. The sigmoid segment was retubularized and sutured to the posterior peritoneum. Animals were sacrificed 4 weeks later, and the segment was submitted to histological and immunohistochemical analysis. RESULTS: Sigmoid segments appeared grossly intact with no reduction in surface area. Hematoxylin and eosin architecture revealed an intact urothelial layer. Deep to this layer was a randomly aligned but distinctly segregated layer of smooth muscle cells. The urological new smooth muscle layer stained positive for calponin and the urothelial layer was cytokeratin-7 and uroplakin III positive. CONCLUSIONS: Separation, cell suspension and aerosol delivery of bladder urothelial and smooth muscle cells in fibrin glue can successfully transfer these urological cell populations to a new host tissue commonly used in urological reconstruction. In vivo co-culture of bladder smooth muscle and urothelial cells results in coverage of a large area of demucosalized gut providing new potential for transfer and reconstitution of urologically functionally appropriate tissue to the bladder itself.

Aerosols↗

PubMed2003

Long-term evaluation of metabolic profile and bone mineral density after ileocystoplasty in children.

PURPOSE: We evaluated the long-term effects of ileocystoplasty on linear growth, serum electrolytes, acid-base profile and bone mineral density (BMD) in a group of neurologically intact children with a mean followup of 8.9 years. MATERIALS AND METHODS: Between 1988 and 1997, 9 girls and 16 boys with a mean age of 6 years (range 1 month to 14 years) underwent ileocystoplasty for etiologies other than myelomeningocele and neuropathic bladder. Indications for ileocystoplasty were small noncompliant bladder secondary to bladder exstrophy in 12 cases, bladder outlet obstruction in 10 and post-partial cystectomy for rhabdomyosarcoma in 3. All patients underwent clinical evaluation, supine height measurement, serum electrolytes, arterial blood gases and BMD measurement using a fan beam dual energy absorpitometry scan. BMD was measured at L1-L4 and corrected for age and sex. RESULTS: Followup ranged from 4 to 13 years (mean 8.9). Serum creatinine was normal in 20 of the 25 patients. All patients had normal supine height measurement with a mean of 45th (+/- 9) centile on growth charts. Serum electrolytes, calcium, phosphorus and arterial blood gases were normal in all patients. Mean BMD corrected for age and sex was 89 (+/- 10)%. BMD was normal in 17 of 25 (68%) patients. Mild reduction in bone density between 1 and 2 standard deviations below the age/sex mean was documented in 3 (12%) patients and the remaining 5 (20%) showed marked osteopenia of 2 or more standard deviations. Of the latter 5 patients 2 had increased serum creatinine, 1 had a history of radiotherapy for pelvic rhabdomyosarcoma and 2 had cloacal exstrophy and short bowel, all of which might have contributed to the osteopenia. CONCLUSIONS: Ileocystoplasty for children with normal kidney function is not associated with alterations in serum electrolytes or arterial blood gases in the long term. However, 32% of patients showed variable degrees of reduction in BMD. Although marked reduction in BMD was associated with cofactors, 12% of patients had evidence of mild osteopenia in absence of those cofactors. We recommend routine preoperative and longitudinal followup BMD measurements for children undergoing intestinal bladder augmentation.

Adolescent↗