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Biomedical subjects

Pramod P Reddy

Publications and source records attributed to Pramod P Reddy.

10 recordsLinked to original sources
PubMed2007

Incontinence following bladder neck reconstruction--is there a role for endoscopic management?

PURPOSE: Little has been reported concerning the efficacy of endoscopic injection of dextranomer/hyaluronic acid for the treatment of residual incontinence following bladder neck reconstruction. We present the experience of 2 institutions using endoscopic submucosal injection of dextranomer/hyaluronic acid to correct incontinence in patients who had previously undergone bladder neck reconstruction with or without concomitant enterocystoplasty. MATERIALS AND METHODS: A retrospective chart review was performed with patient demographics, indications for treatment and outcomes recorded. All patients had adequate bladder capacity and compliance on maximized medical therapy before injection. Continence was defined as at least a 3-hour daytime dry interval, while improvement was defined as an increase in the daytime dry interval to at least 2 hours. RESULTS: A total of 14 patients (10 females and 4 males) underwent 21 injections. At a median followup of 17 months 10 patients had successful results (6 continent, 4 improved). CONCLUSIONS: Endoscopic injection of dextranomer/hyaluronic acid to correct incontinence following bladder neck reconstruction appears safe and can increase the daytime dry interval in more than 70% of carefully selected patients. Continued followup is necessary to evaluate the long-term effectiveness of this treatment.

Child↗
PubMed2005

Use of tolterodine in children with neurogenic detrusor overactivity: relationship between dose and urodynamic response.

PURPOSE: Three exploratory studies were conducted to investigate the pharmacokinetics (PK) and safety of tolterodine in children 1 month to 15 years old with neurogenic detrusor overactivity. We urodynamically evaluated the dose and concentration effects of tolterodine to establish safe and effective dosing regimens. MATERIALS AND METHODS: Three open-label, dose escalating studies were conducted in children with stable neurological disease and detrusor overactivity. In studies 1 (patient aged 1 month to 4 years) and 2 (5 to 10 years) patients received 0.03, 0.06 and 0.12 mg/kg tolterodine solution day twice daily for 4 weeks each. In study 3 (patient age 11 to 15 years) patients received 2, 4 and 6 mg tolterodine extended-release capsules once daily for 4 weeks each. PK was assessed after 8 weeks, urodynamic assessments were conducted after each 4-week dosing period and 3-day micturition diaries were completed. RESULTS: Patients in studies 1 (19) and 2 (15) showed some dose related increases in volume to first detrusor contraction and cystometric bladder capacity. In study 3 (11 patients) there were no obvious dose-response relationships. PK results from studies 1 and 2 suggest that there was no apparent effect of age (< or =10 y) on these parameters. In study 3 time of maximum observed serum concentration and apparent terminal half-life were delayed, which is consistent with the extended-release formulation. Tolterodine was well tolerated, and there was no apparent relationship between tolterodine dose and adverse events in any study. CONCLUSIONS: These results support the safety of age and body weight adjusted dosing regimens for further clinical evaluation of tolterodine in children with neurogenic detrusor overactivity.

Adolescent↗
PubMed2004

Pediatric ureteroscopy.

Endoscopic evaluation and management of the diverse conditions involving the upper urinary tract of children is now feasible and has been shown to be safe and efficacious. This modality should be considered an essential part of the armamentarium of any urologist involved in the care of children. Continued technological advances will allow the indications for pediatric ureteroscopy to evolve. The benefits of minimally invasive surgery that have been proved in adult patients can now be offered to pediatric patients. A thorough knowledge of available equipment and the anatomic and physiologic differences of pediatric patients will ensure a successful outcome with minimal morbidity.

Age Factors↗
PubMed2003

The management of childhood voiding dysfunction.

Wetting disorders in children can be frustrating for the patient, his parents and the physician caring for him. Although in most children the urinary incontinence will resolve with maturation, it is the persistent wetter that is brought in for management. There are two main categories of wetting disorders: those associated with neurological dysfunction of the lower urinary tract (neurogenic bladder) and those with normal neurological function (voiding dysfunction). This communication will be limited to the features, evaluation and management of voiding dysfunction.

Child, Preschool↗
PubMed2002

Outcomes analysis of 64 consecutive open pediatric renal and upper ureteral operations.

OBJECTIVES: To report a recent consecutive series of children undergoing open renal and upper ureteral surgery that was analyzed for outcomes, particularly morbidity and length of stay. METHODS: A total of 64 children underwent open renal or upper ureteral surgery using an upper abdominal retroperitoneal approach. RESULTS: The mean operation time was 206 minutes, with a mean estimated blood loss of 20 mL. The mean analgesic dosage during the in-house postoperative period was 2.9 doses. The mean length of stay was 21.3 hours. A single complication occurred. One patient had a postoperative temperature of 38.6 degrees C, which was attributed to a pulmonary causation. CONCLUSIONS: For now, open surgery remains the standard approach for pediatric renal and upper ureteral anomalies and diseases with an expected postoperative result and course similar to that of laparoscopically performed procedures.

Analgesics↗
PubMed2002

Bilateral single ureteral ectopia in a boy.

Bilateral single ureteral ectopia is exceedingly rare, with fewer than 80 cases reported. Fewer than 20 cases have been reported in males. We describe a recent patient with bilateral single ureteral ectopia with bilateral megaureter and ureteral orifices opening into the prostatic urethra.

Abnormalities, Multiple↗
PubMed2002

Extensive upper and mid ureteral loss in newborns: experience with reconstruction in 2 patients.

PURPOSE: We describe our experience with reconstruction of the ureter in 2 patients who sustained extensive upper and mid ureteral loss as newborns. MATERIALS AND METHODS: Two male patients, a 1-month-old and a neonate, sustained extensive ureteral loss due to candidal infection involving the retroperitoneum and ureter. The 1-month-old sustained a loss of the middle third of the ureter, and the neonate sustained a 3 cm. loss of the upper ureter. The first case was managed with a combination of renal mobilization and an extensive Boari flap, while the second was managed with renal mobilization and nephropexy with primary ureteropyelostomy. RESULTS: Both patients had a successful outcome with no evidence of anastomotic stenosis or obstruction. CONCLUSIONS: Extensive upper and middle third ureteral defects may be primarily bridged successfully in pediatric patients using the standard technique of renal mobilization combined with ureteropyelostomy and a Boari flap, respectively.

Abscess↗
PubMed2002

Management of common disorders of the inguinal canal and scrotum in childhood and adolescence.

Primary care physicians, including family practitioners and pediatricians, frequently are consulted about children and adolescents with disorders of the inguinal canal and scrotum and are asked about the proper course of management, even if only to confirm an opinion of the surgical specialist. The purpose of this communication is to review the management of these conditions, including undescended testis, hydrocele and hernia, varicocele, testicular torsion, testicular trauma, epididymo-orchitis and scrotal edema.

Adolescent↗
PubMed2002

The management of childhood urinary tract infections.

Urinary tract infections can result in significant morbidity and represent one of the most common urological conditions that the pediatrician and family practitioner encounter in the pediatric patient population. The prevalence of UTI in girls may be as high as 8.1%. UTIs also represent the most commonly identified serious bacterial infection in infants presenting with a febrile illness. Of febrile infants aged 2-3 months, 3-10% have a documented UTI. While the majority of the UTIs are not associated with any significant underlying conditions, the mere presence of a UTI is worrisome to most parents. An appropriate evaluation will determine which of these patients need referral. A brief summary is therefore presented to assist the primary care physician in the evaluation and management of childhood UTIs.

Anti-Bacterial Agents↗