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Biomedical subjects

Christopher S Cooper

Publications and source records attributed to Christopher S Cooper.

At least 19 recordsLinked to original sources
PubMed2006

Frequency of wetting is predictive of response to anticholinergic treatment in children with overactive bladder.

OBJECTIVES: To examine the variables relative to the response of oxybutynin treatment in children with daytime urinary incontinence. METHODS: The records of patients seen for voiding problems between 1999 and 2003 were reviewed. Patients taking oxybutynin for 3 months or longer were included in the study. Patients with structural or neurologic bladder abnormalities and those taking oxybutynin at the initial visit were excluded. Age, sex, uroflowmetry findings, postvoid residual urine volume, duration and severity of symptoms before oxybutynin, urinary tract infection history, constipation, and the duration, dosage, and adverse effects of oxybutynin treatment were evaluated. Data were analyzed using Fisher's exact test for categorical variables, the two-sample t test or Wilcoxon rank-sum test for continuous and ordinal variables, and the linear mixed model analysis for uroflow data. RESULTS: Eighty-one patients met the inclusion criteria. After an average follow-up of 1.2 years, 31 (38.3%) were dry, 25 (30.9%) had experienced significant improvement, 19 (23.5%) had experienced slight improvement, and 6 (7.4%) were unchanged. No significant differences were detected between those who became dry and those with little to no improvement with respect to age, sex, duration of symptoms, follow-up, uroflow pattern, postvoid residual urine volume, or bladder capacity. Those children presenting with decreased frequency of wetting episodes were significantly more likely to obtain daytime continence. The most common side effects were constipation (18.5%), dry mouth (17.3%), and flushing (13.6%). CONCLUSIONS: Children with daytime incontinence presenting with the lowest frequency of wetting were most likely to achieve continence. The frequency of wetting should be considered a significant prognostic variable when assessing the results of therapeutic intervention trials.

Adolescent↗
PubMed2005

Kidneys with reflux nephropathy maintain relative renal function after ureteral reimplantation.

PURPOSE: In children with severe unilateral reflux nephropathy and diminished relative renal function (RRF) a dilemma exists between the choice of treatment with ureteral reimplantation or nephrectomy. Limited followup data are available regarding relative renal function or postoperative complications after ureteral reimplantation in kidneys with significant unilateral reflux nephropathy. MATERIALS AND METHODS: We retrospectively reviewed the records of 460 patients who underwent ureteral reimplantation between 1980 and 2002, and identified children with primary vesicoureteral reflux and severe unilateral reflux nephropathy (RRF 30% or less on renal scintigraphy). The postoperative outcomes were assessed for relative renal function and complications including hypertension, pyelonephritis or persistent reflux. RESULTS: A total of 18 girls and 14 boys with a mean preoperative relative renal function of 20.1 +/- 7.8% (range 2% to 30%) met the inclusion criteria. Reflux grade in the poorly functioning kidney was II in 4 children (13%), III in 14 (44%), IV in 11 (34%) and V in 3 (9%). Reflux was unilateral in 15 children (47%) and bilateral in 17 (53%). Mean followup from surgery was 3.7 years (range 0.3 to 12.9). In 28 children with both preoperative and postoperative renal scans, mean preoperative RRF was 20.3 +/- 7.4% and mean postoperative RRF was 20.5 +/- 8.6% with a mean time between renal scans of 2.3 years. No statistically significant change was noted from preoperative to postoperative relative renal function with a mean change of +0.2 +/- 3.7% (range -6.5% to +10%, p=0.82). Postoperative complications occurred in 7 of the 32 children (22%), including hypertension (1), pyelonephritis (3) and persistent reflux (4). Pyelonephritis occurred in 1 child with persistent reflux. No statistically significant difference existed in mean preoperative relative renal function between those with and without complications (24.6 +/- 8.9% vs 18.8 +/- 7.2%, p = 0.09). CONCLUSIONS: Children who underwent ureteral reimplantation in association with unilateral reflux nephropathy maintained stable relative renal function.

Adolescent↗
PubMed2004

Vesicoureteral reflux: who benefits from surgery?

Increased recognition of the association between urinary tract infections and reflux, sibling screening, and the evaluation of antenatal hydronephrosis have resulted in an increase in the diagnosis of reflux early in life. Although many children would sustain no untoward affects of their condition if reflux were left untreated, the disease can be severe and even life threatening. Although antireflux operations have been refined and improved, it remains difficult to determine which individuals truly benefit from these operations. A large prospective randomized placebo-antibiotic-operation study with long-term follow-up is needed, as is the development of nomograms, to assess the individual child's risk of adverse outcomes.

Child↗
PubMed2004

Vesicoureteral reflux: surgical approaches.

The treatment of vesicoureteral reflux has evolved over the past half-century from primarily surgical to nonoperative treatments. Although the benefits of surgical correction versus medical management are debated, the surgical techniques that have evolved are highly effective in correcting vesicoureteral reflux. Recently, the US Food and Drug Administration has approved an injectable implant of dextranomer/hyaluronic acid copolymer for use in children, making the endoscopic treatment of reflux a potential alternative to open surgical correction. This article reviews the different surgical techniques,postoperative management, and complications, as well as the various implants used in the endoscopic correction of vesicoureteral reflux and their outcomes.

Animals↗
PubMed2004

Long-term outcome analysis of Starr plication for primary obstructive megaureters.

PURPOSE: The Starr technique of tapering megaureters was first reported in 1979. Although this method of ureteral plication is well known, to our knowledge there are no clinical studies regarding outcomes. We report the first long-term outcome results with the Starr technique for primary obstructive megaureters. MATERIALS AND METHODS: Three girls and 10 boys with a total of 16 primary obstructive megaureters (3 bilateral) underwent reimplantation with Starr plication between 1988 and 2000. Baseline and followup renal function (average followup 6.2 years) was determined with renal scan and/or 24-hour urinary creatinine clearance. Average age at operation was 5.6 years (range 2 months to 13 years). All ureters were plicated using the Starr technique with interrupted polydioxanone sutures performed by a single surgeon (CEH). Reimplantation methods were the Hendren technique in 7 and Politano-Leadbetter in 9. RESULTS: No ureter demonstrated obstruction postoperatively. One ureter refluxed, which resolved with subureteral collagen injection. Seven patients had mean preoperative and postoperative creatinine clearance +/- SD 72.9 +/- 14.8 and 102.1 +/- 10.9 cc per minute, respectively (p <0.05). Six patients underwent preoperative and postoperative renal scans. Average preoperative relative renal function on renal scan in the kidney with a megaureter was 53.0% +/- 6.7% (range 37% to 84%). Long-term followup (average 4.1 years) renal scan revealed a relative function of 53.3% +/- 9.2% (range 37% to 100%). CONCLUSIONS: Our data demonstrate that Starr plication is a safe procedure that provides long-term stabilization of renal function in the management of primary obstructive megaureter.

Adolescent↗
PubMed2004

Improved uroflow parameters and post-void residual following biofeedback therapy in pediatric patients with dysfunctional voiding does not correspond to outcome.

PURPOSE: We evaluated pediatric patients who were treated with biofeedback for dysfunctional voiding with respect to clinical outcome and objective changes in uroflow parameters and post-void residual. MATERIALS AND METHODS: We retrospectively reviewed 81 patients treated for dysfunctional voiding and/or urinary tract infections with biofeedback. Conservative management had previously failed in all patients. Uroflow data and symptoms were reviewed, and clinical outcomes were recorded. For analysis, patients were stratified by symptoms of incontinence or presence of urinary tract infections. RESULTS: Of 73 patients with incontinence 22 (30%) became dry, 36 (49%) had improvement and 15 (21%) reported no change following biofeedback. In 39 (78%) of 50 patients with recurrent urinary tract infections resolved. Overall, there was a significant (p <0.002) increase in peak flow and average flow rate, and a significant decrease in post-void residual and post-void residual as a percent of predicted bladder capacity. There was no significant change in voided volume following biofeedback. Overall, there was no significant difference in uroflow parameters and post-void residual following biofeedback between patients with incontinence or infections, except for a higher maximum flow rate in patients who continued to have infections. CONCLUSIONS: Treatment of children with pelvic floor muscle biofeedback is associated with improved urinary continence and decreased urinary tract infections in the majority. It results in improvement in uroflow curves and parameters, and a decreased post-void residual. Posttreatment results of these parameters did not correlate with improvement in continence and urinary tract infections.

Adolescent↗
PubMed2004

Coping, commitment, and attitude: quantifying the everyday burden of enuresis on children and their families.

OBJECTIVE: To develop and evaluate a parent-completed questionnaire for use by clinicians as part of routine care to assess the burden of diurnal and nocturnal enuresis on children and their families. METHODS: The questionnaire consisted of items that measure the impact on the child and his/her parent, the child's coping ability and commitment to treatment, previous treatment success, family frustration and overall cohesion, and parental attitudes about enuresis and its treatment. Questionnaires (n = 208) were completed by parents during the child's scheduled office visit for enuresis at 5 specialty clinics across the United States. Traditional criteria were used to assess reliability and validity of the questionnaire, including analysis of variance. RESULTS: Success rates provide evidence that many of the items in the child scale (79%) and all items in the parent scale (100%) met stringent criteria. alpha values were.62 and.77, respectively. Statistically significant differences were observed for the scales across responses on all but 1 global item, the majority of parental attitude items, whether the child urinated at bedtime, and the number of pads used. These findings suggest that the child's coping ability and commitment and the family's overall cohesion and frustration with the problem influence parental perceptions about the impact of enuresis on the child and the family. CONCLUSIONS: Findings about the performance of the new measure were satisfactory and suggest that, after further refinement, it should prove as a useful tool for clinicians treating enuresis in children.

Adaptation, Psychological↗
PubMed2004

Laparoscopic upper pole heminephrectomy for ectopic ureter: initial experience.

OBJECTIVES: To determine the feasibility, clinical outcomes, and complications of laparoscopic upper pole heminephrectomy for ectopic ureter. The standard treatment for a duplex kidney with a poorly functioning upper pole moiety is an upper pole heminephrectomy. We review our technique and experience with laparoscopic upper pole heminephrectomy. A brief review of the literature is provided. METHODS: A retrospective review of clinical records from three patients who underwent laparoscopic upper pole heminephrectomy was performed. Two of the three patients presented with lifelong urinary incontinence and were diagnosed with an ectopic ureter associated with a poorly functioning upper pole moiety. The third patient presented with recurrent episodes of pyelonephritis and was found to have a duplex kidney with a poorly functioning upper pole segment draining into a ureterocele. RESULTS: All three patients underwent laparoscopic upper pole heminephrectomy through the transperitoneal approach. Mean operative time, including ureteral stent insertion, was 198 minutes. Two of the three patients were discharged within 24 hours of surgery. The third patient had a urinary leak secondary to a small amount of residual upper pole parenchyma which resolved with superselective renal arterial embolization. All three patients are well at 5.3 months follow-up. CONCLUSIONS: Laparoscopic upper pole heminephrectomy for ectopic ureter is safe and reproducible and offers the patient the typical postoperative benefits of laparoscopic surgery.

Adolescent↗
PubMed2003

Long-term efficacy of periurethral collagen injection for the treatment of urinary incontinence secondary to myelomeningocele.

PURPOSE: The reports of efficacy of periurethral collagen injection (Contigen, Bard, Covington, Georgia) for treatment of urinary incontinence in the myelomeningocele population are limited and variable. We reviewed the efficacy of periurethral collagen in patients with myelomeningocele to provide long-term followup data. MATERIALS AND METHODS: From 1994 to 1999, 19 children and 6 adults with myelomeningocele underwent periurethral injections of collagen with an average of 2 treatments per patient. Mean followup +/- SD from last injection in the pediatric and adult groups was 2.9 +/- 1.5 years and 4.7 +/- 2.6 years, respectively. Postoperative continence was defined as dry, improved or unchanged. RESULTS: No pediatric patients became dry, 7 (37%) improved and 12 (63%) were unchanged. A single adult was dry (17%), 4 (67%) improved and 1 remained unchanged. Transient improvement was noted in 8 of the 13 patients who reverted to an unchanged status. Response rate was 66% in nonambulatory patients versus 42% in ambulatory patients (p = 0.38). Of 12 patients who responded and 13 who did not 8 in each group required 2 or more treatments. The responding group percentage of predicted bladder capacity was 97.6% versus 89.5% in those who remained unchanged (p = 0.66). CONCLUSIONS: The initial transient improvement following collagen injection and the long-term improvement following repeat injections suggest that degradation of collagen decreased its efficacy. The long-term results of this minimally invasive technique are poor.

Adult↗
PubMed2003

Comparison of relative renal function by renal scintigraphy and lateralized creatinine clearance in children with bilateral vesicoureteral reflux.

OBJECTIVES: To evaluate the relative renal function on preoperative and postoperative renal scintigraphy with lateralized creatinine clearance. Multiple factors affect renal blood flow and glomerular filtration that alter the relative renal function calculated by renal scintigraphy. The relative renal function according to renal scintigraphy in children with bilateral vesicoureteral reflux has not been compared with lateralized creatinine clearance. METHODS: We retrospectively reviewed the charts of 45 children treated surgically for bilateral vesicoureteral reflux. The average age at time of reimplantation was 5.3 years. Bilateral ureteral catheters were placed intraoperatively. Lateralized creatinine clearance was measured with 24-hour urine collections postoperatively from each catheter. Bladder catheterization was not performed during the renal scans. RESULTS: Thirty-six of 45 children had preoperative 1 to 3-minute relative renal function assessed by scintigraphy, 28 had a postoperative assessment, and 24 had both. Preoperative relative renal function ranged between 51% and 94% (mean 61.3%) in the higher functioning kidney. Postoperative renal function ranged from 47% to 90% (mean 60.5%) in the higher functioning kidney. A strong correlation existed between preoperative relative renal function and lateralized creatinine clearance (P <0.0001). Similarly, a significant correlation existed between the postoperative assessment and lateralized creatinine clearance (P <0.0003). No significant difference occurred between the preoperative and postoperative 1 to 3-minute relative renal function (P = 0.3552). CONCLUSIONS: The 1 to 3-minute relative renal function determined by renal scintigraphy accurately reflects the relative renal function determined by lateralized creatinine clearance. Bladder catheterization does not appear necessary for accurate determination of relative renal function by renal scan even in the presence of bilateral reflux.

Adolescent↗
PubMed2003

Laparoscopic upper-pole heminephrectomy for ectopic ureter: surgical technique.

A duplex kidney associated with a poorly functioning upper-pole segment is commonly associated with incontinence, voiding dysfunction, and urinary tract infections. A standard treatment option for this condition is upper-pole heminephrectomy. With the continued development of minimally invasive urology, this technique can now be safely performed laparoscopically. This report details step by step our technique of laparoscopic upper-pole heminephrectomy. Key points include placement of a catheter in the normal ureter at the start of the case, full mobilization of the upper-pole ureter away from the renal hilum, and precise identification of the vasculature supplying the upper pole. Laparoscopic upper-pole heminephrectomy for ectopic ureter is safe and reproducible and offers the patient the typical postoperative benefits of laparoscopic surgery.

Humans↗
PubMed2003

Effectiveness of lidocaine lubricant for discomfort during pediatric urethral catheterization.

PURPOSE: Many children with urinary tract infections and vesicoureteral reflux require catheterization. Catheterization can be a painful experience, and a desire to avoid this experience may affect patient care. We evaluated the effectiveness of lubricant containing lidocaine for minimizing patient pain and distress during catheterization. MATERIALS AND METHODS: We conducted a prospective, double-blind, placebo controlled trial. Twenty children (16 girls and 4 boys, mean age 7.7 years) had urethral lubricant with or without lidocaine placed within 10 minutes before urethral catheterization. In all children pre-procedure anxiety, and pain and distress during catheterization were recorded. Pre-procedure anxiety was measured using a visual analog scale, pain was measured with the Oucher Pain Scale and distress was recorded by 2 independent observers with a simple 7-point Likert-type scale. RESULTS: There were no significant group differences for age, number of previous catheterizations or pre-procedure anxiety. The group receiving lubricant with lidocaine had significantly lower pain (21 +/- 19.69 versus 65.5 +/- 26.29) and distress (2.65 +/- 1.97 versus 4.7 +/- 2.07) (p = 0.001 and 0.007, respectively). CONCLUSIONS: The use of lubricant with lidocaine significantly decreases pain with pediatric urethral catheterization and is recommended with pediatric catheterizations.

Anesthetics, Local↗
PubMed2003

Bimanual digital rectal examination for the evaluation of the nonpalpable testis.

PURPOSE: In the evaluation and treatment of the nonpalpable testis open surgical exploration and laparoscopy are methods used to differentiate abdominal, infrainguinal (below the internal ring) and atrophic or absent testes. We sought to evaluate the use of bimanual digital rectal examination as an additional tool to localize the nonpalpable testis. MATERIALS AND METHODS: Forty-one consecutive patients with 45 nonpalpable testes were evaluated in a prospective fashion. Bimanual digital rectal examination was performed with the patients under general anesthesia just before diagnostic laparoscopy or open inguinal exploration. Palpability, location, length and contralateral testicular length were recorded. RESULTS: Twenty-five gonads or spermatic cords (56%) were palpable using the bimanual technique. All positive examinations were confirmed laparoscopically or by open exploration, and the majority of gonads were intra-abdominal (17 of 25, 68%). Seventeen normal appearing gonads underwent orchiopexy and 8 were removed secondary to atrophy, dysgenesis or poor position. Twenty testes (44%) were not palpated using this method. Of these gonads 10 normal appearing testes were found at exploration and underwent orchiopexy. Of the 10 remaining gonads 6 atrophic testes were removed, and 4 hemosiderin laden remnants were thought to represent "vanished testes." Overall, 26 gonads or remnants were intra-abdominal, 10 were "peeping" or canalicular and 9 were infrainguinal. The overall specificity was 100%, with a sensitivity of 60%. The positive predictive value was 100%. CONCLUSIONS: Bimanual digital rectal examination is a valuable tool in the evaluation of the nonpalpable testis, and identified the presence and position of the testis in the majority of our cases. Although sensitivity is low, when the testis is palpated by this method, diagnostic laparoscopy to localize the testis may be avoided.

Algorithms↗
PubMed2003

Do public schools teach voiding dysfunction? Results of an elementary school teacher survey.

PURPOSE: Dysfunctional voiding in children may partly be learned, and constitutes a significant percentage of pediatric urological referrals. Half of a child's waking hours are spent at school, suggesting a significant potential impact on learned toileting behaviors. Nonetheless, data on teacher perception and practice regarding pediatric voiding are lacking. MATERIALS AND METHODS: A total of 1,000, 21-question surveys were mailed to randomly selected Iowa public elementary school teachers, of which 467 were returned and analyzed. RESULTS: Eighty percent of respondents reported set times for student bathroom breaks. More than half requested all children go to the bathroom at the set times. One-third asked a child requesting a break in the middle of class to wait. Thirty-five percent and 48%, respectively, reported the boys and girls bathrooms were always sanitary. Forty-seven percent and 36% believed bathroom sanitation was progressively worse during the day for boys and girls bathrooms, respectively. Forty-two percent and 34% noticed bullying and lack of supervision, respectively, in the boys bathrooms. Seventeen percent, 16% and 15% suspect an underlying health problem in children who urinate more frequently than normal, or wet or defecate in their pants, respectively. More experienced teachers are significantly more likely to report these suspicions to the school nurse. Only 18% of respondents reported receiving information about abnormal voiding or stooling. Only 8% were aware of specialists trained to treat children with these problems. CONCLUSIONS: Teachers report suboptimal toileting conditions for many children at public schools. These conditions appear to become significantly worse following kindergarten. Teachers have the potential to have a significant impact on dysfunctional voiding but are infrequently informed regarding these issues.

Child↗
PubMed2003

Bladder pressure at the onset of vesicoureteral reflux determined by nuclear cystometrogram.

PURPOSE: Reflux grade predicts resolution and influences followup and treatment. Bladder pressure at the onset of reflux may reflect the ureterovesical junction competence. By combining simultaneous cystometry with nuclear cystography (nuclear cystometrogram) we determined bladder pressure at the onset of reflux. MATERIALS AND METHODS: Nuclear cystometrograms were performed in 40 children to determine bladder pressure at the onset of reflux, reflux volume and bladder capacity at the onset of reflux. The effect of bladder pressure and capacity at the onset of reflux was assessed with a reflux pressure volume index. RESULTS: A weak inverse correlation existed between bladder pressure at the onset of reflux and a normalized volume of reflux (r = -0.32, p = 0.018). A stronger correlation existed between reflux pressure and bladder volume at reflux (r = 0.47, p = 0.0002). An inverse correlation of the reflux pressure-volume index and reflux volume was significant (r = -0.49, p = 0.0002) as was the correlation between bladder volume at reflux and amount of reflux (r = -0.47, p = 0.0003). The reflux pressure-volume index for patients with persistent reflux at followup (median 1.89) was significantly smaller than that for those without reflux (median = 8.71, p = 0.02). A difference existed in normalized bladder volume at reflux between resolved and persistent reflux (p = 0.003). No difference was detected with respect to reflux volume and resolution (p = 0.738). CONCLUSIONS: A nuclear cystometrogram is no more invasive than a standard cystogram and permits determination of bladder pressure at the onset of reflux. Factors such as reflux pressure and bladder volume at reflux provide additional characterization of the ureterovesical junction and may help determine the prognosis for reflux resolution.

Administration, Intravesical↗
PubMed2003

Polyethylene glycol 3350 for constipation in children with dysfunctional elimination.

PURPOSE: Children with daytime wetting often have constipation, and treatment of constipation helps children become dry. Polyethylene glycol 3350 (Miralax, Braintree Laboratories, Braintree, Massachusetts) is a nonaddictive, tasteless powder that can be mixed with any liquid for treatment of constipation. MATERIALS AND METHODS: We review our use of polyethylene glycol 3350 in 35 girls and 11 boys with dysfunctional elimination. Noninvasive urodynamic studies and post-void residual measurement were performed before and during treatment. RESULTS: A significant increase in frequency of bowel movements occurred while taking polyethylene glycol 3350 (p = 0.0001). Average final dose was 0.63 gm/kg. The only reported adverse effect was diarrhea (9 patients). Of the children 18 became dry, 26 had decreased wetting and 2 had no improvement. Voided volume increased (146 vs 210 ml, p <0.0001) and post-void residual decreased significantly (92 vs 48 ml, p <0.0001) while on polyethylene glycol 3350. Ten children were still considered constipated including both patients who experienced no change in wetting. Average final dose in this group (0.69 gm/kg) did not differ significantly from those in whom constipation resolved (0.61 gm/kg). Patients in whom constipation resolved had a significantly lower post-void residual than those who remained constipated (11.8% vs 30.6%, p <0.01) and were significantly more likely to become dry or improved (p = 0.045). CONCLUSIONS: The efficacy, compliance and lack of significant side effects make polyethylene glycol 3350 an ideal substance for treatment of constipation in children with dysfunctional elimination. Persistent constipation was associated with decreased resolution of voiding symptoms and significantly increased post-void residuals.

Biofeedback, Psychology↗
PubMed2002

Antenatal hydronephrosis: evaluation and outcome.

We present a comprehensive and current review of the etiology, evaluation, treatment, and outcome of antenatal hydronephrosis. When a diagnosis of antenatal hydronephrosis is made, many questions regarding pregnancy, prenatal care, intervention, and what may be expected after birth are raised. Debate and controversy exist on the diagnosis and subsequent evaluation and management of the child with antenatal hydronephrosis. A review of the literature and our own experience with antenatal hydronephrosis are presented in order to guide the physician who is caring for mother and child.

Algorithms↗