PubMed Health⌕ Search

Biomedical subjects

Piet Hoebeke

Publications and source records attributed to Piet Hoebeke.

At least 19 recordsLinked to original sources
PubMed2026

Genital surgery in children with differences of sex development (DSD): Strengths and concerns across diverging regulations in four European countries.

Differences of Sex Development (DSD) is a collective term for a heterogeneous group of rare congenital conditions characterized by atypical genetic, gonadal, or genital sexual development. The treatment of children with DSD, particularly the indications for and timing of surgical interventions, has been the subject of debate for decades. In recent years, social developments emphasizing children's rights to self-determination and bodily integrity, along with increasing societal acceptance of atypical sex characteristics, have encouraged a more cautious approach toward early genital surgery in children with DSD. In 2019, the European Parliament adopted a resolution urging Member States to enact legislation prohibiting elective genital surgical interventions on intersex infants and children. Since then, several countries have indeed implemented restrictive measures, including legal bans on early surgical procedures. In this paper, we share the experiences and insights gained in recent years as pediatric urologists working in four neighboring countries in multidisciplinary university centers specializing in DSD care and research. We focus on current approaches to the care of children with DSD, the evolution of relevant national policies over time, and the nature and impact of recently introduced restrictive regulations on early surgical interventions. By presenting perspectives from pediatric urologists across these four countries, we aim to contribute to ongoing discussions on the alignment and refinement of surgical treatment practices for children with DSD.

Humans↗
PubMed2006

Complicated postirradiation vesicovaginal fistula in young women: keep off or try reconstruction?

OBJECTIVE: Repairing postirradiation vesicovaginal fistula is challenging because the fistula is surrounded by poorly vascularised and fibrotic tissue. An additional problem occurs when intravaginal brachytherapy has caused fibrosis of the vagina. METHODS: A one-stage technique was used for reconstruction of the vagina and fistula repair in three patients. The omentum and the sigmoid were used to enhance vascularisation and to create a neovagina. RESULTS: At a mean follow-up of 11 mo all patients are continent and report satisfactory sexuality. CONCLUSION: Using the omentum and the sigmoid is a valuable technique to repair vesicovaginal fistula and to reconstruct the vagina in a one-stage procedure.

Adult↗
PubMed2006

The impact of attention deficit hyperactivity disorders on brainstem dysfunction in nocturnal enuresis.

PURPOSE: In a specialized university setting the prevalence of attention deficit hyperactivity disorder in general and particularly the inattentive subtype attention deficit hyperactivity disorder of the predominantly inattentive subtype is highly increased. We replicated previous research findings that enuresis is associated with a brainstem deficit and investigated the impact of attention deficit hyperactivity disorder on this brainstem deficit in enuresis. MATERIALS AND METHODS: Electromyography recorded startle eye blink modification with and without attentional modulation was used to measure brainstem functioning in 158 children between 6 and 12 years old. Performance in 3 enuresis groups, including children with enuresis, enuresis plus attention deficit hyperactivity disorder of the predominantly inattentive subtype and enuresis plus attention deficit hyperactivity disorder combined, respectively, was compared with that in normally developing controls and in children with attention deficit hyperactivity disorder subtypes without enuresis. RESULTS: In an automatic attentional task the enuresis groups showed decreased brainstem inhibition compared to that in the control and attention deficit hyperactivity disorder groups (p <0.006). In a controlled attentional task children with and without enuresis who had attention deficit hyperactivity disorder of the predominantly inattentive subtype were unable to show attentional modulation in all age groups (p <0.02). CONCLUSIONS: Startle eye blink modification research reveals a brainstem inhibition deficit in children with enuresis, which could explain why they are unable to remain dry at night. When additional attention is allocated to specific trials in the task, children with attention deficit hyperactivity disorder of the predominantly inattentive subtype fail to optimize sensory gating. With respect to enuresis, this could result in an identification problem of bladder signals, leading to an inadequate or absent arousal effect in attention deficit hyperactivity disorder of the predominantly inattentive subtype.

Attention Deficit Disorder with Hyperactivity↗
PubMed2006

Desmopressin resistant nocturnal polyuria secondary to increased nocturnal osmotic excretion.

PURPOSE: We investigated the role of increased solute excretion in children with desmopressin resistant nocturnal enuresis and nocturnal polyuria. MATERIALS AND METHODS: A total of 42 children with monosymptomatic nocturnal enuresis and significant nocturnal polyuria with high nocturnal urinary osmolality (more than 850 mmol/l) were not responding to desmopressin. A 24-hour urinary concentration profile was obtained with measurement of urine volume, osmolality, osmotic excretion and creatinine. The control group consisted of 100 children without enuresis. RESULTS: Based on osmotic excretion patients were classified into 3 groups. Group 1 had 24-hour increased osmotic excretion, most likely secondary to a high renal osmotic load. This was probably diet related since 11 of these 12 patients were obese. Group 2 had increased osmotic excretion in the evening and night, probably due to a high renal osmotic load caused by the diet characteristics of the evening meal. Group 3 had deficient osmotic excretion during the day, secondary to extremely low fluid intake to compensate for small bladder capacity. CONCLUSIONS: Nocturnal polyuria with high urinary osmolality in our patients with desmopressin resistant monosymptomatic nocturnal enuresis is related to abnormal increased osmotic excretion. This may be explained by their fluid and diet habits, eg daytime fluid restriction, and high protein and salt intake.

Adolescent↗
PubMed2006

Desmopressin toxicity due to prolonged half-life in 18 patients with nocturnal enuresis.

PURPOSE: Desmopressin has been used extensively for primary nocturnal enuresis and it is associated with a low incidence of adverse effects. The only reported serious side effect is seizure or altered levels of consciousness resulting from water intoxication, which has been reported for the nasal spray. We describe 18 children with clinical symptoms of water intoxication due to the prolonged bioactivity of desmopressin nasal spray. MATERIALS AND METHODS: We evaluated 18 patients with clinical suspicion of prolonged desmopressin bioactivity during treatment with intranasal desmopressin for primary nocturnal enuresis. The control group consisted of 50 children with primary nocturnal enuresis and proven nocturnal polyuria who were treated with the same desmopressin regimen. RESULTS: All patients had prolonged maximal urinary concentration capacity and delayed restoration of daytime diluting capacity (p <0.01). Of the patients 15 had the characteristic clinical symptoms of water intoxication with vomiting, headache, decreased consciousness and hyponatremia. We suspect that these symptoms are secondary to prolonged desmopressin bioactivity. CONCLUSIONS: Prolonged desmopressin bioactivity may increase the risk of water intoxication.

Adolescent↗
PubMed2006

The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society.

PURPOSE: We updated the terminology in the field of pediatric lower urinary tract function. MATERIALS AND METHODS: Discussions were held of the board of the International Children's Continence Society and an extensive reviewing process was done involving all members of the International Children's Continence Society as well as other experts in the field. RESULTS AND CONCLUSIONS: New definitions and a standardized terminology are provided, taking into account changes in the adult sphere and new research results.

Adolescent↗
PubMed2006

The prevalence of ADHD in children with enuresis: comparison between a tertiary and non-tertiary care sample.

OBJECTIVE: The main aim of the current study was to determine reliable comorbidity rates of ADHD for enuretic children admitted either to non-tertiary care or to a specialized paediatric clinic, i.e. tertiary care, since previous research has failed to incorporate a possible setting effect in this comorbidity; and to use a multi-method multi-informant assessment of ADHD. MATERIAL AND METHODS: Eighty children, aged between 6 and 12 y, admitted to non-tertiary care with enuresis and 120 children referred to tertiary care were screened for the presence of ADHD using a multi-method (diagnostic interview, questionnaires) multi-informant (parents, teachers) assessment. RESULTS: Enuretic children from the tertiary care sample have a 3.4 times increased chance of having comorbid ADHD when compared to children with enuresis admitted to non-tertiary care, corresponding to a prevalence rate of 28% and 10%, respectively. Overall, the tertiary care sample was older, showed more daytime incontinence and revealed an increasing prevalence of ADHD with older age when compared with the non-tertiary care group. CONCLUSION: The prevalence rate of ADHD is increased in an enuretic population compared to community samples (3-5%). Moreover, enuretic children admitted to tertiary care show significantly higher comorbidity than non-tertiary care patients. The ADHD prevalence in the former group increases with older age, suggesting therapy resistance and a negative prognosis for enuresis in the case of comorbidity.

Academic Medical Centers↗
PubMed2006

A new fast-melting oral formulation of desmopressin: a pharmacodynamic study in children with primary nocturnal enuresis.

OBJECTIVE: To determine the pharmacodynamic properties of a new oral lyophilisate formulation of desmopressin (in single doses of 30, 60, 120, 240, 360 or 480 microg) in children with known primary nocturnal enuresis (PNE) and thus identify those dosages that could provide a duration of action corresponding to a typical length of night-time sleep in children with PNE; additional objectives were to determine the safety and tolerability of desmopressin in this population. PATIENTS AND METHODS: Children with PNE (mean three or more wet nights/week), aged 6-12 years, were randomized into a double-blind, placebo-controlled study. An overhydration technique was used before dosing to suppress endogenous vasopressin production and thereby ensure that any antidiuresis could be attributed to treatment. Dosing with desmopressin or placebo occurred when urinary production was >0.13 mL/min/kg. Urinary volume, osmolality and duration of urinary-concentrating action (above three threshold levels: 125, 200 and 400 mOsm/kg) were determined as endpoints. RESULTS: All 72 participants receiving desmopressin had a pharmacodynamic response to the drug, while there was no change in urinary output in the 12 placebo-treated patients. There was a clear relationship between desmopressin dose and duration of action and osmolality during action, although the three highest-dose groups had similar results. The mean duration of action of desmopressin at the lowest osmolality threshold level was 3.6-10.6 h, according to dose; for the highest threshold, the values were 1.3-8.6 h. CONCLUSION: Desmopressin, as the oral lyophilisate, causes a marked decrease in urinary output in hydrated children with PNE. A small dose range (120-240 microg) is likely to control diuresis for a period corresponding to a night's sleep (7-11 h) in most children with PNE. However, some patients might require a higher dose to obtain antidiuresis for the complete night.

Administration, Oral↗
PubMed2005

Behavioural problems and attention-deficit hyperactivity disorder in children with enuresis: a literature review.

Nearly all studies on the co-morbidity between enuresis and psychopathology in children suggest an increased prevalence of behavioural disorders in general and of attention-deficit hyperactivity disorder (ADHD) in particular. Depending strongly on characteristics of the study design, the extent to which this prevalence is increased fluctuates heavily. In the current literature review we found a lack of standardization in the definitions of both enuresis and psychopathology, which makes comparison of research findings difficult. A series of confounding factors that possibly bias study results is also covered. Psychopathology in enuresis seems to be associated with older age, male gender, low socio-economic status and admission to specialized (university) paediatric clinics. Research that fails to report or to control for these factors will not be able to make generalizations to the total population of enuretic children. It is highly important for paediatricians to be aware of the effect of these methodological factors in order to read critically and appreciate the co-morbidity studies on the one hand and to understand better the association between enuresis and psychopathology on the other hand. Future research would benefit from diagnoses based on international diagnostic classification systems made within a well-defined sample.

Age Factors↗
PubMed2005

Internalizing and externalizing problem behavior in children with nocturnal and diurnal enuresis: a five-factor model perspective.

OBJECTIVES: To describe personality traits, internalizing, and externalizing problems of 6- to 12-year-old children with nocturnal and diurnal enuresis, examining differences from healthy referents, and investigating the association between personality traits and problem behavior. METHODS: Eighty-five children with combined nocturnal and diurnal enuresis were compared with 56 children with nocturnal enuresis and 155 healthy children on personality characteristics and problem behavior. RESULTS: Post hoc analyses of multivariate analyses indicated that parents of children with combined nocturnal and diurnal enuresis reported on average lower conscientiousness and higher neuroticism scores in their children than parents of healthy children, although the magnitude of these differences was moderate. Considerable differences in mean scores were found for the Child Behavior Checklist (CBCL) total problem scale and moderate differences for internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) problems in children with nocturnal and diurnal enuresis compared with healthy referents. Regression analyses across enuretic and healthy groups demonstrated that personality trait and problem behavior scales share substantial variance. CONCLUSION: Moderate to substantially higher levels of problem behavior is demonstrated in children with nocturnal and diurnal enuresis, who also display slightly higher neuroticism and lower conscientiousness scores.

Child↗
PubMed2005

Sexual and physical health after sex reassignment surgery.

A long-term follow-up study of 55 transsexual patients (32 male-to-female and 23 female-to-male) post-sex reassignment surgery (SRS) was carried out to evaluate sexual and general health outcome. Relatively few and minor morbidities were observed in our group of patients, and they were mostly reversible with appropriate treatment. A trend toward more general health problems in male-to-females was seen, possibly explained by older age and smoking habits. Although all male-to-females, treated with estrogens continuously, had total testosterone levels within the normal female range because of estrogen effects on sex hormone binding globulin, only 32.1% reached normal free testosterone levels. After SRS, the transsexual person's expectations were met at an emotional and social level, but less so at the physical and sexual level even though a large number of transsexuals (80%) reported improvement of their sexuality. The female-to-males masturbated significantly more frequently than the male-to-females, and a trend to more sexual satisfaction, more sexual excitement, and more easily reaching orgasm was seen in the female-to-male group. The majority of participants reported a change in orgasmic feeling, toward more powerful and shorter for female-to-males and more intense, smoother, and longer in male-to-females. Over two-thirds of male-to-females reported the secretion of a vaginal fluid during sexual excitation, originating from the Cowper's glands, left in place during surgery. In female-to-males with erection prosthesis, sexual expectations were more realized (compared to those without), but pain during intercourse was more often reported.

Adult↗
PubMed2005

Attention-deficit/hyperactivity disorder (ADHD) as a risk factor for persistent nocturnal enuresis in children: a two-year follow-up study.

AIMS: A previous prevalence study indicated that the prevalence of ADHD is highly increased in enuretic children. In the current 2-y follow-up study we investigate the relationship between both disorders further. Our goal is to determine whether the ADHD diagnoses can be reconfirmed and whether children with ADHD are more at risk for difficult-to-cure enuresis. Moreover, we explore the effect of medical enuresis parameters on the course of the voiding problem. METHODS: Eighty-six children with enuresis were screened twice on the presence of ADHD with a 2-y interval. A multi-method, multi-informant assessment of ADHD was used, the child's medical file was consulted, and a parent questionnaire on the child's current voiding problems was completed. RESULTS: Although 73% of all children with a 2-y-old diagnosis of ADHD still meet the disorder's criteria, only 66% of all subtype diagnoses can be reconfirmed. The odds that a child with ADHD still has voiding problems after 2 y are 3.17 times higher than for a child without ADHD. Although a slightly increased number of prescribed therapies in the ADHD group was noticed, no other significant differences in enuresis treatment methods were found between the groups. The medical parameters were not associated with treatment outcome. CONCLUSION: Since 73% of ADHD diagnoses can be reconfirmed, the data suggest that the prevalence of the ADHD syndrome rather than reactive ADHD symptomatology is increased in enuretic children. Children with ADHD are at risk for persistent enuresis. Two-year-old medical enuresis parameters seem to have little effect on the current presence/absence of enuresis.

Analysis of Variance↗
PubMed2005

Sacral nerve stimulation: Interstim therapy.

Sacral nerve stimulation is a young but promising technique in the treatment of chronic voiding dysfunctions. Electrical stimulation of the S3 nerve--using a pacemaker device--is able to treat a wide range of pelvic floor dysfunctions. This article gives a brief review on the indications, mechanisms of action and possible complications of this technique. Furthermore, new evolutions in the domain of sacral nerve modulation are discussed.

Electric Stimulation Therapy↗
PubMed2004

Impact of sex reassignment surgery on lower urinary tract function.

OBJECTIVE: To investigate the effects of sex reassignment surgery (SRS) on lower urinary tract function. METHODS: A questionnaire concerning voiding habits and lower urinary tract symptoms after sex reassignment surgery, was given to 24 female-to-male transsexuals (FTM) and 31 male-to-female transsexuals (MTF), who respectively underwent phalloplasty and vaginoplasty. For this study only Dutch speaking patients were selected. Also, uro-flowmetry data from 92 FTM transsexuals were reviewed. RESULTS: In general, no change in voiding patterns was observed. Post-void dribbling was reported by 79% of the FTM transsexuals, and 16% of the MTF group reported some form of incontinence. The uro-flowmetry examination showed a mean, non-significant decrease of 2 ml/s in Q(max) in FTM patients. CONCLUSION: SRS can cause minor changes in urinary habits. Even if they do not result in patients seeking medical help, transsexuals should be warned about these eventual discomforts pre-operatively.

Female↗
PubMed2004

Pelvic floor spasms in children: an unknown condition responding well to pelvic floor therapy.

OBJECTIVE: During a study period of 4 years, 21 children are seen for night time pelvic pain. These children typical wake up in the middle of the night with severe lower abdominal or perineal pain. During day some of them suffer urge syndrome. During urodynamic investigation extremely high pelvic floor activity as recorded by high urethral pressure was observed in these children. We therefore started pelvic floor relaxation biofeedback in these children. METHODS: All children diagnosed with pelvic floor spasms underwent biofeedback pelvic floor relaxation therapy in order to learn them to counteract pelvic pain due to these spasms. In those girls in whom detrusor hyperactivity was seen on urodynamics concomitant anticholinergic treatment was given (oxybutynin). RESULTS: Between January 1998 and January 2002 symptomatic pelvic floor spasms were diagnosed in 21 children (19 girls/2 boys). Pelvic floor relaxation biofeedback was successful for treatment of this condition in 17 of 21 children. Mean duration of therapy was 3 months (12 weekly sessions) and on long term follow-up relapse was seen in 3 of 17 successfully treated children. 10 of 17 successfully treated children received anticholinergics. CONCLUSION: Pelvic floor spasms in children (which can be secondary to detrusor overactivity) respond well to pelvic floor relaxation therapy.

Biofeedback, Psychology↗