Biomedical subjects

John W Brock

Publications and source records attributed to John W Brock.

At least 19 recordsLinked to original sources

PubMed2007

Subureteral injection of dextranomer/hyaluronic acid copolymer for persistent vesicoureteral reflux following ureteroneocystostomy.

PURPOSE: We sought to evaluate the use of subureteral dextranomer/hyaluronic acid copolymer injection for persistent vesicoureteral reflux following ureteroneocystostomy. MATERIALS AND METHODS: We performed a retrospective review of patients who had undergone dextranomer/hyaluronic acid injection between 2002 and 2005 for persistent vesicoureteral reflux following ureteroneocystostomy. Analysis included evaluation of patient demographics, reflux grades, voiding dysfunction, reflux resolution rates and operative complications. Success was defined as no reflux on voiding cystourethrogram at 1 to 6 months postoperatively. RESULTS: A total of 12 cases with 14 refluxing ureters were reviewed. Of the 12 patients treated 9 (10 ureters) had adequate followup. Mean followup was 10 months. Seven of 10 ureters (70%) demonstrated resolution of reflux after the initial injection. A second dextranomer/hyaluronic acid injection resulted in complete resolution in 2 of the 3 failed ureters (67%). Resolution in the remaining failed ureter could not be assessed due to insufficient patient followup. In children with adequate followup success was ultimately achieved in 9 of 9 ureters (100%) using up to 2 injections. A comparison of clinical factors between patients with success after the initial injection and those requiring 2 injections showed that the presence of persistent voiding dysfunction was the only parameter that was statistically significant. All patients tolerated the procedure without complications. CONCLUSIONS: Considering the difficulties inherent in repeat surgery and the high success rate of dextranomer/hyaluronic acid injection in this series, this treatment is an appealing and reasonable option for patients with persistent vesicoureteral reflux following open ureteroneocystostomy.

Child↗

PubMed2006

Prenatal exposure to 1,1-dichloro-2,2-bis (p-chlorophenyl)ethylene (p,p'-DDE) in relation to child growth.

OBJECTIVE: To examine the relation between prenatal 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p'-DDE) exposure (a metabolite of the insecticide DDT) and child growth during the first 7 years of life. Design Prospective cohort study. Participants 1,712 children born between 1959 and 1966 with measured p,p'-DDE concentrations in their mother's serum samples from pregnancy. Setting Multicenter US Collaborative Perinatal Project (CPP). RESULTS: The highest prenatal concentrations of p,p'-DDE (>or=60 microg/l), as compared with the lowest (<15 microg/l), were associated with decreased height at age 1 year [adjusted coefficient (SE) = -0.72 cm (0.37), n = 1,540], 4 years [-1.14 cm (0.56), n = 1,289], and 7 years [-2.19 (0.46), n = 1,371]. Among subjects in lower categories of exposure no association was observed. CONCLUSIONS: The findings suggest that high prenatal exposure to p,p'-DDE decreases height in children. Impaired growth may be a general indicator of toxicity and suggests that specific organ systems (e.g. endocrine) could be affected.

Adult↗

PubMed2006

Bladder tissue formation from cultured bladder urothelium.

Tissue recombination is a powerful method to evaluate the paracrine-signaling events that orchestrate the development of organs using the in vivo environment of a host rodent. Studies have reported the successful generation of primary cultures of rodent bladder urothelium, but none have reported their use to recapitulate bladder tissue with tissue recombination. We propose that primary cultured bladder urothelium, when recombined with inductive embryonic bladder mesenchyme, will form bladder tissue in a recombination model. Adult rat bladders were isolated and urothelium obtained. Sheets of bladder urothelium were re-suspended in collagen and maintained in tissue culture. After expansion (>20 passages), the urothelium was recombined with embryonic day-14 mouse bladder mesenchyme, then grafted beneath the renal capsule of immunocompromised mouse hosts. Grafts were harvested after 28 days. Control grafts were performed with bladder mesenchyme alone, cultured bladder urothelium alone, and collagen matrix alone. Final tissues were evaluated with staining and immunohistochemistry (H&E, Gomori's trichrome, broad-spectrum uroplakin, and smooth muscle actin alpha and gamma). Immunocytochemistry on cultured urothelium for broad-spectrum keratin, vimentin, and broad-spectrum uroplakin confirmed pure populations, void of mesenchymal contaminants. Staining of recombinant grafts demonstrated bladder tissue with mature urothelium and stromal differentiation. Control tissues were void of bladder tissue formation. We have successfully demonstrated that a chimeric bladder is formed from primary cultured bladder urothelium recombined with embryonic bladder mesenchyme. This is a powerful new tool for investigating the molecular mechanisms of bladder development and disease. Future applications may include the in vitro genetic manipulation of urothelium and examining those effects on growth and development in an in vivo environment.

Animals↗

PubMed2006

High yield of urodynamics performed for refractory nonneurogenic dysfunctional voiding in the pediatric population.

PURPOSE: In the pediatric population urodynamic evaluation for nonneurological causes has been previously reported as a low yield endeavor when considering patients with a primary diagnosis of dysfunctional voiding. We evaluated the rate of clinically significant urodynamic findings that would drive therapeutic intervention for a spectrum of urological disorders in pediatric patients without neurological deficit in whom initial conventional management had failed. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients who had undergone urodynamics in the last 7 years. Patients with known neurological deficits were excluded. RESULTS: A total of 805 pediatric urodynamic evaluations were performed from December 1997 to July 2004 at our institution, including 89 in patients with no known neurological diagnosis and charts available for review. Of the urodynamic studies 33 (37.1%) were reported as normal and 56 patients (62.9%) had clinically significant discoveries. Storage phase abnormalities were the predominant finding in 37 patients (66.1%), including uninhibited detrusor contractions in 31 (55.4%). Emptying phase abnormalities were less common (19 patients or 33.9%). There was no difference in the percent of patients with positive urodynamics findings depending on sex. CONCLUSIONS: In our analysis evaluation of all recent urodynamics performed at a single institution revealed a high rate of pathological findings in patients with various nonneurological diagnoses.

Adolescent↗

PubMed2006

Hydrocele formation following laparoscopic varicocelectomy.

PURPOSE: Hydrocele is a known complication of varicocelectomy. We evaluated the incidence of hydrocele following laparoscopic varicocelectomy at our institution. MATERIALS AND METHODS: A total of 89 boys were treated with laparoscopic ligation of the spermatic vessels for clinically palpable varicoceles between January 2000 and December 2003. Charts were retrospectively reviewed. A total of 10 patients were excluded because they were lost to followup or presented with recurrent varicocele. Followup consisted of office visits with physical examinations at 1 and 12 months postoperatively. Patient charts were reviewed for perioperative variables, operative technique and complications. RESULTS: Only 1 of 79 patients (1.3%) had persistent varicocele with a mean of 20.7 months of followup. A total of 18 patients (22.8%) had development of hydrocele postoperatively, of whom 9 required hydrocelectomy. In addition, 2 of these 9 patients needed repeat hydrocelectomy. Of the 57 patients with greater than 6 months of followup 29.8% had development of hydrocele. A higher rate of hydrocele formation (31.1%) was also noted in patients who underwent ligation and division of the spermatic vessels rather than ligation alone (11.8%, p = 0.04). CONCLUSIONS: Our series demonstrates a high rate of hydrocele formation following laparoscopic varicocelectomy, particularly in patients with longer followup. The incidence of hydrocele after laparoscopic varicocelectomy may be underreported. However, there appears to be a statistically significant decrease in hydroceles when the internal spermatic vessels are simply ligated rather than ligated and divided. Despite its ease and low failure rate, the standard technique of laparoscopic varicocelectomy requires reexamination, potentially allowing modifications that may decrease hydrocele formation, such as salvaging lymphatics and avoiding division of the vessels.

Adolescent↗

PubMed2006

Prospective, longitudinal evaluation of health related quality of life in the pediatric spina bifida population undergoing reconstructive urological surgery.

PURPOSE: Spina bifida, the most frequent permanently debilitating birth defect, results in major urological problems of voluntary bladder control and bowel function, which may impair quality of life. We prospectively assessed quality of life in patients with spina bifida using child and parent reports simultaneously. This study had 3 goals, that is to 1) document baseline health related quality of life in patients with spina bifida preoperatively, 2) study health related quality of life, reporting differences between parents and children, and 3) study changes in health related quality of life prospectively at preoperative and postoperative intervals. MATERIALS AND METHODS: Patients with spina bifida who were 2 to 18 years old and required reconstructive urological surgery in 2004 were included in the study. Demographic survey and the validated PedsQL 4.0 health related quality of life questionnaire were used preoperatively and postoperatively. A clinical outcomes data set was completed after the clinician saw the patient. PedsQL 4.0 subscales were scored using the algorithms provided. RESULTS: The response rate was 100%. Mean participant age was 10.3 years. Preoperatively child physical and psychosocial health and school functioning were significantly higher than parent reports (p <0.001). Overall health related quality of life in patients with spina bifida was lower than in healthy children (62.4 vs 85, p <0.001). Six weeks postoperatively significant differences in health related quality of life reporting between parents and children had lowered. Six months postoperatively child emotional and social functioning scores were higher than parent scores (p <0.001). No correlation was found between health related quality of life, and clinical and demographic factors due to insufficient sample size. CONCLUSIONS: Children with spina bifida recorded higher health related quality of life scores than parents/guardians. This health related quality of life study addresses concerns that impact daily quality of life in patients with spina bifida. Future health related quality of life studies in patients with spina bifida should use child self-reports.

Adolescent↗

PubMed2006

Breast cancer among Alaska Native women potentially exposed to environmental organochlorine chemicals.

OBJECTIVES: To determine if an increased rate of breast cancer in Alaska Native women is related to their consumption of a subsistence diet that may contain p,p'-dichlorodiphenylethylene (DDE) and polychlorinated biphenyls (PCBs). STUDY DESIGN: A retrospective case control design. METHODS: We analyzed banked serum collected between 1981 and 1987 from 126 Alaska Native women, including 63 case women who subsequently developed breast cancer and 63 age-matched control women who remained cancer-free. Serum was analyzed for DDT, DDE, 13 other chlorinated pesticides, and 28 PCB congeners. RESULTS: The geometric mean for p,p'-DDE levels among case women was 8.67 ppb (95% Confidence Interval 7.48, 10.04); among control women, the geometric mean was 7.36 ppb (6.53, 8.30). The geometric mean for total PCB levels among case women was 4.55 ppb (3.61, 5.74) and for control women, the geometric mean was 6.10 ppb (4.73, 7.86). Cancer status and total PCB levels varied across ethnicity (i.e., Eskimo, Aleut, and Indian) but DDE levels were uniform among these ethnic groups. Using conditional logistic regression analysis to adjust for potential confounders (e.g., ethnicity, family history of breast cancer, parity), we found an odds ratio of 1.43 (0.46, 4.47) for the highest tertile of DDE exposure and 0.42 (0.07, 2.38) for the highest tertile of total PCB exposure. CONCLUSIONS: Although the results are limited by small sample size and restricted risk factor information, our findings of higher DDE levels, but lower PCB levels among women with breast cancer are consistent with previous research. Our results confirm exposure to organochlorines among Alaska Native women but do not identify these exposures as a significant risk factor for breast cancer.

Alaska↗

PubMed2005

Urinary and amniotic fluid levels of phthalate monoesters in rats after the oral administration of di(2-ethylhexyl) phthalate and di-n-butyl phthalate.

Two studies were designed to examine amniotic fluid and maternal urine concentrations of the di(2-ethylhexyl) phthalate (DEHP) metabolite mono(2-ethylhexyl) phthalate (MEHP) and the di-n-butyl phthalate (DBP) metabolite monobutyl phthalate (MBP) after administration of DEHP and DBP during pregnancy. In the first study, pregnant Sprague-Dawley rats were administered 0, 11, 33, 100, or 300 mg DEHP/kg/day by oral gavage starting on gestational day (GD) 7. In the second study, DBP was administered by oral gavage to pregnant Sprague-Dawley rats at doses of 0, 100, or 250 mg/kg/day starting on GD 13. Maternal urine and amniotic fluid were collected and analyzed to determine the free and glucuronidated levels of MEHP and MBP. In urine, MEHP and MBP were mostly glucuronidated. By contrast, free MEHP and free MBP predominated in amniotic fluid. Statistically significant correlations were found between maternal DEHP dose and total maternal urinary MEHP (p=0.0117), and between maternal DEHP dose and total amniotic fluid MEHP levels (p=0.0021). Total maternal urinary MEHP and total amniotic fluid MEHP levels were correlated (Pearson correlation coefficient=0.968). Statistically significant differences were found in amniotic MBP levels between animals within the same DBP dose treatment group (p<0.0001) and between animals in different dose treatment groups (p<0.0001). Amniotic fluid MBP levels increased with increasing DBP doses, and high variability in maternal urinary levels of MBP between rats was observed. Although no firm conclusions could be drawn from the urinary MBP data, the MEHP results suggest that maternal urinary MEHP levels may be useful surrogate markers for fetal exposure to DEHP.

Administration, Oral↗

PubMed2005

Maternal serum levels of polychlorinated biphenyls and 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) and time to pregnancy.

Polychlorinated biphenyls (PCBs), once used widely in transformers and other applications, and 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE), the main metabolite of the pesticide 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (DDT), are hormonally active agents. Changes in menstrual cycle functioning associated with PCBs and DDE, and increased odds of spontaneous abortion associated with DDE, suggest that these compounds could affect fertility. The authors investigated the association between PCB and DDE exposure and time to pregnancy by using serum levels measured in 390 pregnant women in the Collaborative Perinatal Project enrolled at 12 study centers in the United States from 1959 to 1965. They estimated adjusted fecundability odds ratios by using Cox proportional hazards modeling for discrete time data. Compared with time to pregnancy for women in the lowest exposure category (PCBs < 1.24 microg/liter, DDE < 14 microg/liter), time to pregnancy increased for women in the highest exposure category in terms of both PCBs (fecundability odds ratio for PCBs > or = 5.00 microg/liter = 0.65, 95% confidence interval: 0.36, 1.18) and DDE (fecundability odds ratio for DDE > or = 60 microg/liter = 0.65, 95% confidence interval: 0.32, 1.31). Overall, time to pregnancy increased with increasing serum PCB levels but was less suggestive of an association with DDE. Both trends were imprecise and attenuated when expressed on a lipid basis. Overall, evidence of an association between PCB or DDE exposure and time to pregnancy was weak and inconclusive.

Adult↗

PubMed2005

In utero exposure to background levels of polychlorinated biphenyls and cognitive functioning among school-age children.

Polychlorinated biphenyls (PCBs) are ubiquitous environmental contaminants. In utero exposure to background levels of PCBs has been associated with intellectual impairment among children in most, but not all, studies. The authors evaluated prenatal PCB exposure in relation to cognitive test (intelligence quotient (IQ)) scores on the Wechsler Intelligence Scale for Children at age 7 years. Pregnant women were recruited from 12 US study centers from 1959 to 1965, and their children were followed until age 7 years (the Collaborative Perinatal Project). Third trimester serum was analyzed for PCBs in 1997-1999 for 732 women selected at random and for an additional 162 women whose children had either a low or a high IQ score. The PCB-IQ association was examined in multivariate models. Among those in the lowest exposure category (<1.25 microg of PCB/liter of serum), the fully adjusted mean IQ score was 93.6 (standard error: 1.8); among those in the highest category (> or =5 microg of PCB/liter), the mean IQ was 97.6 (standard error: 1.2); and overall the increase in IQ per unit increase in PCB level (microg/liter) was 0.22 (95% confidence interval: -0.28, 0.71). In these data, in utero exposure to background levels of PCBs was not associated with lower IQ at age 7 years.

Abnormalities, Drug-Induced↗

PubMed2005

Maternal serum level of the DDT metabolite DDE in relation to fetal loss in previous pregnancies.

Use of 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (DDT) continues in about 25 countries. This use has been justified partly by the belief that it has no adverse consequences on human health. Evidence has been increasing, however, for adverse reproductive effects of DDT, but additional data are needed. Pregnant women who enrolled in the Collaborative Perinatal Project (United States, 1959-1965) were asked about their previous pregnancy history; blood samples were drawn and the serum frozen. In 1997-1999, the sera of 1717 of these women who had previous pregnancies were analyzed for 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE), the major breakdown product of DDT. The odds of previous fetal loss was examined in relation to DDE level in logistic regression models. Compared with women whose DDE level was <15 microg/L, the adjusted odds ratios of fetal loss according to category of DDE were as follows: 15-29 microg/L, 1.1; 30-44 microg/L, 1.4; 45-59 microg/L, 1.6; and 60+ microg/L, 1.2. The adjusted odds ratio per 60 microg/L increase was 1.4 (95% confidence interval 1.1-1.6). The results were consistent with an adverse effect of DDE on fetal loss, but were inconclusive owing to the possibility that previous pregnancies ending in fetal loss decreased serum DDE levels less than did those carried to term.

Abortion, Spontaneous↗

PubMed2005

Simplified technique for laparoscopic extravesical ureteral reimplantation in the porcine model.

BACKGROUND AND PURPOSE: Laparoscopic intravesical and standard Lich-Gregoir repair have been reported but are technically challenging. Herein, we present our experience with a simplified laparoscopic reimplantation of the ureter to correct vesicoureteral reflux (VUR). MATERIALS AND METHODS: Bilateral VUR was created cystoscopically in six minipigs, as confirmed by a static cystogram 6 weeks later. The laparoscopic extravesical correction of VUR was performed utilizing a full-thickness cystotomy. The ureter was transposed inside the bladder, and a full-thickness bladder closure was performed. No attempt was made to cover the ureter with urothelium. No stents or catheters were utilized postoperatively. Three months after reimplantation, the animals were evaluated with serology, a static cystogram, an intravenous urogram (IVU), and gross pathologic and histopathologic examination. RESULTS: The postoperative cystograms confirmed no reflux in all the reimplanted ureters and residual grade 1 to 3 reflux in the non-reimplanted ureters. All pigs voided normally and were completely continent. Cystoscopic evaluation revealed complete epithelialization over the reimplanted ureter. One surgical complication occurred: the ureter was incorporated into the bladder closure and became obstructed. The IVU in all other pigs demonstrated patent ureters with prompt function. CONCLUSIONS: Laparoscopic reimplantation of the ureter utilizing this modified Lich-Gregoir approach corrected reflux in all animals. The full-thickness bladder incision and intravesical transposition of the ureter greatly simplifies the laparoscopic procedure. This laboratory experience encourages further clinical evaluation in the pediatric population with VUR.

Animals↗

PubMed2005

Polychlorinated biphenyls and menstrual cycle characteristics.

BACKGROUND: Experimental studies in nonhuman primates provide evidence that low-level exposure to persistent organochlorine pollutants such as polychlorinated biphenyls (PCBs) may affect aspects of their menstrual cycle, including cycle length, regularity, and bleeding duration. Few studies have examined these associations in humans. METHODS: We used data from 2314 pregnant women who participated in the Collaborative Perinatal Project, a cohort study that enrolled pregnant women in the 1960s in 12 centers in the United States. Information about usual (prepregnancy) menstrual cycle length, regularity, bleeding duration, and dysmenorrhea was collected at enrollment, and 11 PCBs and p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) were measured in stored blood samples collected during the third trimester of pregnancy. We used multivariate linear and logistic regression to examine the association between organochlorine levels and menstrual cycles, adjusting for demographic factors, cholesterol, and triglycerides. RESULTS: Total PCBs were positively associated with increasing menstrual cycle length (adjusted difference across 5 categories of PCB exposure = 0.7 days, trend-test P value = 0.02). Irregular cycles were slightly more frequent among those in the 2 highest categories of PCB exposure (odds ratio for highest category = 1.5; 95% confidence interval = 0.70-3.3), and there also was some evidence of an association with DDE. The strengths of these associations increased with various exclusions made to decrease potential misclassification of the outcome and the exposures. There was little evidence for associations between DDE or PCBs and bleeding duration, heavy bleeding, or dysmenorrhea. CONCLUSIONS: This study supports experimental studies in monkeys showing an effect of low-dose PCB exposure on menstrual function.

Adolescent↗

PubMed2005

Maternal levels of polychlorinated biphenyls in relation to preterm and small-for-gestational-age birth.

BACKGROUND: In developed countries, polychlorinated biphenyls (PCBs) are ubiquitous contaminants of the environment, including foods. Within the range of the resulting low-level exposure, associations of PCBs with lower birth weight have been observed in several studies. METHODS: To examine further the association of PCBs with birth outcomes, we measured serum levels in 1034 pregnant women who were enrolled in the U.S. Collaborative Perinatal Project in 1959 to 1965 before PCB manufacturing was banned. RESULTS: The multivariate-adjusted odds ratio for preterm birth among those with PCB levels of >/=4 microg/L of total PCBs, compared with those with <2 microg/L, was 1.1 (95% confidence interval = 0.6-2.2); for the same exposure contrast, the odds ratio for delivering an infant who was small-for-gestational-age at birth was 1.6 (0.7-3.7). Birth weight and length of gestation were essentially unrelated to PCB level. CONCLUSIONS: In these data, maternal levels of PCBs during pregnancy were essentially unrelated to preterm birth, birth weight, or length of gestation. An association of PCBs with small-for-gestational-age birth was observed, but the results were inconclusive and occurred in the absence of an overall decrease in birth weight.

Adult↗

PubMed2005

Pediatric urological causes of hypertension.

PURPOSE: We reviewed the association of hypertension with several common pediatric urological conditions. MATERIALS AND METHODS: We comprehensively reviewed the published literature linking hypertension with urinary tract infection, renal scarring, vesicoureteral reflux, multicystic dysplastic kidney, ureteropelvic junction obstruction and posterior urethral valves. RESULTS: Hypertension is a recognized sequela of several common pediatric urological conditions. It is thought to be a direct consequence of renal damage or scarring often resulting from vesicoureteral reflux and/or febrile urinary tract infection. Multicystic dysplastic kidney has rarely been shown to cause hypertension when examined in large series rather than as isolated case reports. Ureteropelvic junction obstruction and posterior urethral valves have been linked to hypertension, although to our knowledge no series to date has specifically examined this relationship and smaller retrospective reviews seldom describe associated hypertension. CONCLUSIONS: Several pediatric urological conditions are known to cause hypertension. However, methodological flaws in the literature, including a lack of standardized blood pressure followup, highly variable patient populations and poor control of concomitant urological abnormalities, greatly limit the ability to establish a causative link between any 1 specific condition and hypertension. Early diagnosis, the prevention of infection, close clinical followup and early intervention remain the primary means of preventing pediatric urological causes of hypertension.

Adolescent↗

PubMed2005

Stromal hyperplasia in male bladders upon loss of transforming growth factor-beta signaling in fibroblasts.

PURPOSE: Rapid bladder growth associated, partial urethral obstruction and embryonic bladder development entail stromal-epithelial interactions involving signaling by the cytokine transforming growth factor-beta (TGF-beta). However, to our knowledge the role of TGF-beta in bladder stromal hyperplasia and hypertrophy is not understood. MATERIALS AND METHODS: In an effort to understand the specific role of TGF-beta signaling in bladder stroma a fibroblast specific conditional knockout mouse of the type II TGF-beta receptor gene, Tgfbr2(/spko), was generated using Cre-lox methodology. Bladders from 18, 7 to 8-week-old mice were harvested for histological and immunohistochemical analysis. RESULTS: Bladders from homozygous Tgfbr2(/spko), male mice showed marked hypertrophy in the lamina propria and smooth muscle layers in the absence of visible or functional bladder obstruction by age 8 weeks. However, age matched female mice of the same genotype maintained bladder architecture similar to that in wild-type littermate male and female controls. Immunohistochemistry for the phosphorylated form of Smad2 indicated a general loss in TGF-beta signaling in the lamina propria of bladders of male and female Tgfbr2(/spko), mice, and yet pronounced alpha-smooth muscle actin expression was noted in male Tgfbr2(/spko), bladders, which is a marker for myofibroblasts. CONCLUSIONS: A sex disparity was observed in the Tgfbr2(/spko), mouse model lacking TGF-beta signaling in fibroblasts. Deletion of TGF-beta in males leads to a hypertrophied lamina propria and muscularis externa with myofibroblast differentiation and proliferation. Female homozygous Tgfbr2(/spko), bladders appeared the same as those of wild-type male and female controls. This model suggests a role for stromal TGF-beta signaling with estrogens and androgens in bladder fibrosis.

Animals↗

PubMed2005

Pediatric ureteroscopic stone management.

PURPOSE: We reviewed our experience of 5 years using ureteroscopy with laser lithotripsy to treat stone disease in prepubertal children. MATERIALS AND METHODS: A retrospective review was performed of all ureteroscopic procedures performed in prepubertal children. RESULTS: A total of 33 ureteroscopic procedures were performed in 29 prepubertal children (15 males and 14 females) 5 to 144 months old (mean age 94 months, including 3 patients 24 months or younger). Stones were located in the renal pelvis in 1 case (3%), proximal ureter in 3 (9%), mid ureter in 5 (15%) and distal ureter in 24 (73%). Stone size ranged from 3 to 14 mm (mean 6). Eight patients required balloon dilation of the ureteral orifice. Followup ranged from 1 to 66 months (mean 11). Stone-free rate after initial ureteroscopy and laser lithotripsy was 88%, with all distal and mid ureteral stones (3 to 9 mm, mean 5) successfully treated. Three patients with proximal ureteral stones 7 to 14 mm in diameter (mean 10.3) required a secondary procedure (repeat ureteroscopy in 2 and shock wave lithotripsy in 1) to become stone-free. One patient with cystinuria and a renal pelvic stone measuring 14 mm required shock wave lithotripsy and percutaneous nephrostolithotomy. There were no major complications of ureteroscopy but there was 1 case of extravasation at the ureterovesical junction after balloon dilation that was managed with stent placement. CONCLUSIONS: Although more patients and longer followup are needed, ureteroscopy with laser lithotripsy is an excellent first line treatment for children with stones in whom conservative therapy fails, especially those with distal and mid ureteral stones. Patients with a stone burden of 10 mm or greater, especially in the proximal ureter, likely will require a secondary procedure to become stone-free.

Child↗

PubMed2004

Bowel vaginoplasty in children: a retrospective review.

BACKGROUND/PURPOSE: There are numerous congenital genitourinary conditions that result in vaginal agenesis or atresia. Reconstruction presents a challenge to the surgeon who wishes long-term functional and cosmetic results with low morbidity. Historically, reconstruction has involved the use of skin grafts and nonoperative methods with less than ideal results. The preference of the authors is to use intestinal segments for creating the neovagina and herein review their experience with this procedure. METHODS: The authors identified 10 children who underwent vaginal construction with intestinal segments from 1996 to the present. Patient charts were reviewed for etiology, procedure performed, operative and postoperative complications, and follow-up. RESULTS: Average age at surgery was 10.9 years (1 to 29 years). Of the 10 children, 3 required vaginal construction for cloacal extrophy, and 7 had vaginal atresia of various etiology. Sigmoid colon was utilized in 6 cases, ileum in 2, and, in 2 patients with high imperforate anus, their mucous fistula segment was used to create the vagina. Mean follow-up was 24 months. Complications included a right ureteral injury necessitating placement of an indwelling ureteral stent and a girl presenting with cyclic pelvic pain who required reanastomosis of the neovagina to the uterus for an obstructed cervical os. CONCLUSIONS: Intestinal segments can be used successfully for creation of a neovagina with exceptional cosmetic results and an acceptable complication rate. In appropriate patients, the mucous fistula can be used to create the vagina obviating the need for a bowel anastomosis.

Abnormalities, Multiple↗