IntroductionAlthough cross-trigonal ureteral reimplantation (Cohen) is a commonly used technique in children, it represents a non-physiological transfer of the ureteral orifices and may prove challenging with regard to endoscopic ureteral operations in later life. In 1964, Mathisen described an alternative method of ureteral reimplantation with lateralization of the neohiatus, creating an orthotopic course of the submucosal ureter. We have evaluated success and complication rates of both techniques that were applied sequentially at our departments.MethodsForty-eight consecutive patients (83 ureters, 24 males/24 females) following Mathisen reimplantation were compared with 53 consecutive patients (98 ureters, 30 males/23 females) following Cohen reimplantation. Inclusion criteria were primary vesicoureteral reflux (VUR) and no previous intervention. Reflux grades (Mathisen 58 ureters/69.9% VUR >= III; Cohen 66 ureters/66.7% VUR >= III) and the occurence of other complicating factors (ureteroceles, megaureters, posterior urethral valves) in both groups were comparable.ResultsAfter Cohen's reimplantation there were no immediate complications requiring intervention; during follow-up (mean 28.2 months) three patients (5.6%) suffered febrile urinary tract infections (UTIs), of which one (1.8%) was diagnosed with a persisting VUR. Persistent hydronephroses (>= II SFU) were recorded in six patients (13.2%). After reimplantation using Mathisen's technique, two patients (4.1%) suffered significant intravesical bleeding; during follow-up (mean 23.06 months) four patients (8.3%) suffered febrile UTIs, and seven patients (14.5%) were diagnosed with persisting VUR after a mean follow-up of 10.8 months. The patients with persistent VUR had more commonly high-grade (IV and V) VUR initially, compared to the whole group. Two patients (4.1%) had persistent hydronephroses (>= II SFU). Mathisen's technique for ureteral reimplantation yielded a significantly (p = 0.0256 patients, p = 0.006 ureterorenal units) lower success rate (85.5% patients, 89.2% ureterorenal units) in comparison with Cohen's technique (98.2% patients, 99% ureterorenal units). Although there was no intervention for obstruction, persistent hydronephrosis was more common in the Cohen group (13.2% vs. 4.1%, n.s.).ConclusionsDespite the advantages of an orthotopic ureteral orifice close to the bladder neck, as achieved by Mathisen's reimplantation, cross-trigonal ureteral reimplantation proved more reliable for VUR correction. As regards optimizing the results, patient selection for either technique could prove essential. Nevertheless, as regards the difficulties with ectopic ureteral orifices in the Cohen technique in the long-term follow-up, the concept of anatomic, orthotopic ureteral reimplantation should be pursued and the technique should be further refined.

Objective. The aim of this study was to evaluate the clinical outcome after endoscopic therapy by injection of bulking agent in the treatment of occult vesicoureteral reflux (VUR) [no VUR on standard voiding cystourethrography (VCUG), but positive Tc-99m-2,3-dimercaptosuccinic acid (DMSA) scan] in females who have recurrent febrile urinary tract infections (UTIs). Material and methods. A case series was retrospectively identified of 24 females (mean age 15.5 years) with negative VCUG, but renal scars in one (n = 4) or both (n = 20) kidneys on DMSA scan. Endoscopic injection was performed bilaterally in 20 (83.3%) and unilaterally in four patients (16.7%). The incidence of postoperative UTIs was documented with a mean follow-up of 2.5 years (range 1-6 years). Results. The mean renal part function (DMSA scan) on the left and right sides was 53.5% (15-74%) and 47.3% (26-85%), respectively. Twenty-one out of 24 patients (87.5%) showed no evidence of any febrile UTIs postoperatively. One patient (4.2%) experienced a further febrile UTI 6 months after treatment. Two other patients (8.3%) had one questionable afebrile UTI, 4 and 3 years after therapy. Pressure flow electromyography confirmed a dysfunctional voiding pattern in 12 patients (50%) treated with pelvic floor therapy and behavioural interventions before endoscopic therapy. Conclusions. Injection of bulking agent seems to be a suitable treatment for occult VUR in females to prevent further febrile UTIs. Patients with occult VUR should undergo a careful evaluation of possible urodynamic disorders such as dysfunctional voiding. These findings should be studied in prospective trials before drawing any conclusions.

Objective: The incidence of urethral injuries in children is rare due to the fact that the urethra is short, mobile and protected by the pubic bone. The management of urethral trauma in childhood remains controversial because of the limited expertise of most urologists. Material and Methods: We performed a literature review by searching the Medline database for articles published between 1975 and 2010 based on clinical relevance. Electronic searches were limited to the keywords ‘pediatric’, ‘urethral injury’, ‘trauma’ and ‘reconstruction’. Results: Retrograde urethrography is considered the gold standard for diagnosis of urethral injuries. The initial management should ensure drainage of the bladder either by suprapubic cystostomy or urethral realignment if possible: in complete anterior urethral disruption as well as in children with life-threatening pelvic and intra-abdominal injuries after posterior urethral injuries, a deferred repair after 3 months is necessary. Immediate primary suturing of disrupted and dislocated urethral ends should be avoided because of high complication rates. Primary repair, however, of the defect is possible in girls avoiding a 2-stage approach. Conclusion: The aim of therapy is minimizing remote damages such as urethrocutaneous fistulae, periurethral diverticulae, strictures, incontinence and impotence with different therapeutic management depending on classification of the injury and the presence of life-threatening injuries.

Objectives: We evaluated whether real-time 3D ultrasound (4D-US) together with clinical evaluation is an alternative to voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR) in children at postoperative follow-up. Material and Methods: We reviewed 178 children who underwent endoscopic therapy with dextranomer/hyaluronic acid copolymer in grade II or III VUR between 2002 and 2005. 4D-US was performed in all patients 1 day and 3, 9 and 18 months after endoscopic therapy. Only children with postoperative urinary tract infections (UTIs) and/or nonorthotopic position of the bulking agent were referred for VCUG. Results: In 93% of the ureteral units, the depot could be detected in the orthotopic position after 3, 9 and 18 months. None of these children developed UTIs in the postoperative follow-up. Twelve children demonstrated a shifting of the depot, indicating a possible therapy failure. Eight of these 12 patients (66.7%) presented a positive VCUG, and 50% of them sustained UTIs. Conclusions: 4D-US seems to be a sufficient protocol in the follow-up of children after endoscopic treatment of low-grade VUR. VCUG should be performed in cases of a shifted position of the depot; invasive investigations are unnecessary in asymptomatic children with orthotopic bulk.

Purpose HPV infection is the main risk factor for cervical carcinoma in 70 out of 100 cases. The aim of our prospective study was to investigate the epidemiology of human papilloma virus (HPV) and its colonization of the male genital tract in particular the inner layer of the foreskin. Material and Methods We examined anonymised foreskins of unselected 64 patients aged between 7 months and 13 years (mean 5.2) without any histories of sexual abuse or sexual activity. Indication for circumcision was phimosis. The presence of viral (HPV) nucleic acid (DNA) sequences in tissues could be demonstrated via in-situ hybridization (ISH) by using labelled DNA probes. For detection of HPV type 6 and 11 (low risk) as well as type 16 and 18 (high risk), the corresponding oligonucleotid probes were used and the process (ISH) was carried out according to the manufacturers protocol. Results The prevalence of low-risk HPV genotypes was 21.2 %, the prevalence of high-risk HPV DNA was 10.5 %. 82 % of the specimens showed inflammatory features, but no clinical apparent warts. Conclusions Our study revealed the occurrence of subclinical genital low and high risk HPV infections in boys which could be a reservoir for HPV-associated diseases in later life. Since it is proven that transfer results from sexual contact it is advisable to vaccinate not only girls but also boys before adolescence. HPV infection is the main risk factor for cervical carcinoma in 70 out of 100 cases. The aim of our prospective study was to investigate the epidemiology of human papilloma virus (HPV) and its colonization of the male genital tract in particular the inner layer of the foreskin. We examined anonymised foreskins of unselected 64 patients aged between 7 months and 13 years (mean 5.2) without any histories of sexual abuse or sexual activity. Indication for circumcision was phimosis. The presence of viral (HPV) nucleic acid (DNA) sequences in tissues could be demonstrated via in-situ hybridization (ISH) by using labelled DNA probes. For detection of HPV type 6 and 11 (low risk) as well as type 16 and 18 (high risk), the corresponding oligonucleotid probes were used and the process (ISH) was carried out according to the manufacturers protocol. The prevalence of low-risk HPV genotypes was 21.2 %, the prevalence of high-risk HPV DNA was 10.5 %. 82 % of the specimens showed inflammatory features, but no clinical apparent warts. Our study revealed the occurrence of subclinical genital low and high risk HPV infections in boys which could be a reservoir for HPV-associated diseases in later life. Since it is proven that transfer results from sexual contact it is advisable to vaccinate not only girls but also boys before adolescence.

Following homozygosity mapping in a single kindred, we identified nonsense and missense mutations in MYO5B, encoding type Vb myosin motor protein, in individuals with microvillus inclusion disease (MVID). MVID is characterized by lack of microvilli on the surface of enterocytes and occurrence of intracellular vacuolar structures containing microvilli. In addition, mislocalization of transferrin receptor in MVID enterocytes suggests that MYO5B deficiency causes defective trafficking of apical and basolateral proteins in MVID.

CONCLUSIONS To our knowledge this is the first study describing PSCA-distribution through different developmental stages of the prostate.The similarity in intensity and distribution in fetal and malignant specimens is obvious. One can hypothesize that potentially malignant changes in the prostatic epithelium may occur early during fetal life. Prenatal developmental alterations may therefore increase the likelihood of developing prostate cancer later in life. Hence, prostatic stem cells require further functional investigations to understand their role in different developmental stages of the prostate.

You have accessJournal of UrologyPodium 39, Tuesday, May 22, 2007, 10:00 am - 12:00 pm1 Apr 20071351: The Devloping Prostate: An Interaction of Androgens and Estrogens Andreas Lunacek, Christian Schwentner, Josef Oswald, Georg Bartsch, Barbara Schlenck, and Christian Radmayr Andreas LunacekAndreas Lunacek More articles by this author , Christian SchwentnerChristian Schwentner More articles by this author , Josef OswaldJosef Oswald More articles by this author , Georg BartschGeorg Bartsch More articles by this author , Barbara SchlenckBarbara Schlenck More articles by this author , and Christian RadmayrChristian Radmayr More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31565-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1351: The Devloping Prostate: An Interaction of Androgens and Estrogens." The Journal of Urology, 177(4S), p. 445 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 445 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Andreas Lunacek More articles by this author Christian Schwentner More articles by this author Josef Oswald More articles by this author Georg Bartsch More articles by this author Barbara Schlenck More articles by this author Christian Radmayr More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose Myoblast transplantation has been shown to augment damaged tissue. Moreover it could be used as an autologous bulking agent in refluxing vesicoureteral junctions in order to restore the damaged muscular integrity. But graft viability and the behaviour of the donor myoblasts at the ureterovesical junction have not been demonstrated yet. Material and methods Muscle biopsies from the back muscles of 5 pigs were obtained. Quality of the cells was evaluated by electrophysiological and immunohistochemical tests. Additionally they were labelled with a PKH fluorescent membrane dye to provide fluorescent marking of live cells. 5 weeks after muscle biopsies all animals underwent cell transplantation with 300 × 106 cells suspended in transplantation medium loaded into five 1-cc tuberculin syringes and injected into the ureterovesical junction. Animals were sacrificed 8 weeks later, the donor cells were identified using PKH26 labelling and fluorescence-activated cell-sorter analysis. Moreover histopathology and evaluation concerning tissue reaction at the donor site was also carried out. Results 2-3 intact autologous skeletal myoblast–derived skeletal muscle cells/visual field were found in all injected animals. However, immunohistochemistry demonstrated viability of transplanted myoblasts only at the borders of the bulking area wheras central widespread necrosis with red fluorescent cell detritus could be observed. We did not observe marked signs of an inflammatory response, even though a fibrotic scar was found at the site of injection. Conclusions These results highlight the inability of the vast majority of transplanted myoblasts to survive. Only a small portion of the cells survive when transplanted into a well vascularized area which is in favour of the assumption of an indirect impairment such as paracrine effects. Failure of myoblast transplantation in this animal study does not prove that the procedure itself is ineffective, but these results do caution against the application of in vivo myoblasts as a bulking agent. Myoblast transplantation has been shown to augment damaged tissue. Moreover it could be used as an autologous bulking agent in refluxing vesicoureteral junctions in order to restore the damaged muscular integrity. But graft viability and the behaviour of the donor myoblasts at the ureterovesical junction have not been demonstrated yet. Muscle biopsies from the back muscles of 5 pigs were obtained. Quality of the cells was evaluated by electrophysiological and immunohistochemical tests. Additionally they were labelled with a PKH fluorescent membrane dye to provide fluorescent marking of live cells. 5 weeks after muscle biopsies all animals underwent cell transplantation with 300 × 106 cells suspended in transplantation medium loaded into five 1-cc tuberculin syringes and injected into the ureterovesical junction. Animals were sacrificed 8 weeks later, the donor cells were identified using PKH26 labelling and fluorescence-activated cell-sorter analysis. Moreover histopathology and evaluation concerning tissue reaction at the donor site was also carried out. 2-3 intact autologous skeletal myoblast–derived skeletal muscle cells/visual field were found in all injected animals. However, immunohistochemistry demonstrated viability of transplanted myoblasts only at the borders of the bulking area wheras central widespread necrosis with red fluorescent cell detritus could be observed. We did not observe marked signs of an inflammatory response, even though a fibrotic scar was found at the site of injection. These results highlight the inability of the vast majority of transplanted myoblasts to survive. Only a small portion of the cells survive when transplanted into a well vascularized area which is in favour of the assumption of an indirect impairment such as paracrine effects. Failure of myoblast transplantation in this animal study does not prove that the procedure itself is ineffective, but these results do caution against the application of in vivo myoblasts as a bulking agent.

Backgrounds/Aims: A urinary copper (Cu) >25 mu mol/24 h following penicillamine had a reported specificity of 98.2% and sensitivity of 88.2% in diagnosing Wilson's disease (WD). We have re-evaluated this test. Ninety-eight subjects were studied at presentation.Methods: Thirty-eight (19 girls, 19 boys; median age 10.3 years; range 5-16 years) had an ultimate diagnosis of WD. Sixty (24 girls, 36 boys; median age 10.1, range 2.3-15 years) had other fiver disorders. Urinary Cu was estimated for 24 h before (basal Cu) and for 24 h whilst giving penicillamine 500 mg orally 12 hourly x2 (post-penicillamine Cu).Results: Both basal Cu and post-penicillamine Cu differed significantly between WD patients and controls (basal Cu: median 6.5 mu mol/24 h, range 0.9-109 mu mol/24 h, versus median: 0.8 mu mol/24 h, range 0.1-19.5, p < 0.0001; post-penicillamine Cu: median 36.9 mu mol/24 h, range 1.98-219 mu mol/24 h, versus median 12.35 mu mol/24 h, range 0.5-49.8 mu mol/24 h, p < 0.0001). A post-penicillamine Cu >25 mu mol/24 h was observed in 29/38 patients with WD and in 4/60 controls. 25/ 38 WD patients were symptomatic. Twenty-three of these and 6/13 asymptomatic siblings had a positive test. The test had a sensitivity of 76% (95% confidence interval 101, 59.8-88.6%) and a specificity of 93% (95% CI, 83.8-98.2%). Sensitivity was better in symptomatic patients (92%, [95% CI; 74-99%]) than asymptomatic (46%,195% CI; 19.2-74.9%]).Conclusions: This test is valuable in the diagnosis of WD with active liver disease, but is unreliable to exclude the diagnosis in asymptomatic siblings. (C) 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Purpose The interureteric muscle represents an essential part of an adequate antireflux mechanism. Biopsies from children operated on for vesicoureteric reflux were investigated using morphological and immunohistochemical methods to evaluate smooth muscle configuration, potential muscle dysplasia and connective tissue changes in that area. Material and methods Biopsies of the interureteric muscle were obtained from 22 ureterorenal units undergoing reflux surgery. Mean age of patients was 32 months, reflux grades III to V, respectively. Routine histological paraffin embedded sections were stained -actin to evaluate the presence,α with haematoxylin, eosin and smooth muscle allocation and morphological integrity of the interurerteric smooth muscle architecture. Indirect immunohistochemical methods were used to assess the extracellular matrix for collagen composition. Extracellular matrix involvement was assessed estimating transforming growth factor- s III (TGF-s3) expression. Results All biopsies showed different grades of muscle atrophy and degradation. In these smooth muscle tissue lacking regions, disordered fibre arrangement associated with a 2 to 3-fold increase in endomysial and perimysial connective tissue in particular collagen type III was observed. Increased mesenchymal cell proliferation in the degenerated tissue areas was associated with a significant TGF-s3 expression of the surrounding muscle cells and correlated with organized collagen deposition. Conclusions Extracellular matrix remodelling with interstitial fibrosis of the longitudinal muscle sheath of the ureterovesical junction may be mediated through upregulation of TGF-s3. Diminution or even complete loss of contractile elements of the interureteric muscle in children with congenital vesicoureteral reflux is obviously associated with an inadequate antireflux mechanism of the vesicoureteral junction.

OBJECTIVE To create a nomogram of the fetal growth of the human prostate corresponding to gestational age, and to investigate the relationship between the expansive growth of the fetal prostate and the maternal testosterone surge during pregnancy.MATERIALS AND METHODS In all, 27 fetal prostates at 11-40 weeks of gestation, and seven neonatal specimens at 1-20 weeks after birth, were analysed. Serial sections of prostates were immunostained and examined using light microscopy. After modular image acquisition the volumes were calculated using three-dimensional reconstruction. The prostate volumes were correlated with gestational age, and related to reference testosterone levels during pregnancy.RESULTS There was exponential growth of the fetal prostate with gestational age. The increasing volume of the prostate during the fetal period corresponded with maternal testosterone levels. In the second trimester there was a significant increase in prostate volume in relation to the bladder. In infants, macroscopically there was an inverse proportion between bladder size and prostate volume.CONCLUSIONS Starting from the second trimester there is distinct growth of the fetal prostate, obviously triggered by the maternal testosterone surge. In neonates there is an inversion of the dimensions between bladder and prostate. These results indicating exponential growth of the fetal prostate provide evidence of a gender-related transient infravesical obstruction in human fetuses.

You have accessJournal of UrologyModerated Poster 15, Sunday, May 20, 2007, 3:30 - 5:30 pm1 Apr 2007522: Quality of Life Assessment in Children Treated Endoscopically for Vesicoureteral Reflux Christian Schwentner, Josef Oswald, Andreas Lunacek, Alexandre E. Pelzer, Barbara Schlenck, Ilona Schwentner, Stefan Hofer, Georg Bartsch, and Christian Radmayr Christian SchwentnerChristian Schwentner More articles by this author , Josef OswaldJosef Oswald More articles by this author , Andreas LunacekAndreas Lunacek More articles by this author , Alexandre E. PelzerAlexandre E. Pelzer More articles by this author , Barbara SchlenckBarbara Schlenck More articles by this author , Ilona SchwentnerIlona Schwentner More articles by this author , Stefan HoferStefan Hofer More articles by this author , Georg BartschGeorg Bartsch More articles by this author , and Christian RadmayrChristian Radmayr More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30762-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "522: Quality of Life Assessment in Children Treated Endoscopically for Vesicoureteral Reflux." The Journal of Urology, 177(4S), p. 174 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 174 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Christian Schwentner More articles by this author Josef Oswald More articles by this author Andreas Lunacek More articles by this author Alexandre E. Pelzer More articles by this author Barbara Schlenck More articles by this author Ilona Schwentner More articles by this author Stefan Hofer More articles by this author Georg Bartsch More articles by this author Christian Radmayr More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyModerated Poster, Monday, May 23,2005, 8:00 - 10:00 am1 Apr 2005698: Growth Curves of the Fetal Prostate in Relation to Gestational Age and the Maternal Testosterone Surge Andreas Lunacek, Josef Oswald, Christian Schwentner, Barbara Schlenck, Helga Fritsch, Stefano Longato, Martina Deibl, Georg C. Bartsch, and Christian Radmayr Andreas LunacekAndreas Lunacek More articles by this author , Josef OswaldJosef Oswald More articles by this author , Christian SchwentnerChristian Schwentner More articles by this author , Barbara SchlenckBarbara Schlenck More articles by this author , Helga FritschHelga Fritsch More articles by this author , Stefano LongatoStefano Longato More articles by this author , Martina DeiblMartina Deibl More articles by this author , Georg C. BartschGeorg C. Bartsch More articles by this author , and Christian RadmayrChristian Radmayr More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35930-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "698: Growth Curves of the Fetal Prostate in Relation to Gestational Age and the Maternal Testosterone Surge." The Journal of Urology, 173(4S), pp. 190–191 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 190-191 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Andreas Lunacek More articles by this author Josef Oswald More articles by this author Christian Schwentner More articles by this author Barbara Schlenck More articles by this author Helga Fritsch More articles by this author Stefano Longato More articles by this author Martina Deibl More articles by this author Georg C. Bartsch More articles by this author Christian Radmayr More articles by this author Expand All Advertisement PDF downloadLoading ...

Patients with Wilson's disease (WD), Indian childhood cirrhosis (ICC), and idiopathic copper toxicosis (ICT) develop severe liver disease morphologically characterized by ballooning of hepatocytes, inflammation, cytoskeletal alterations, and Mallory body (MB) formation, finally leading to mostly micronodular cirrhosis. The pathogenesis of MBs in copper toxicosis is still unresolved. Immunohistochemical analysis of MBs in different types of copper intoxication revealed that keratin, p62, and ubiquitin are integral components. Thus MBs associated with copper intoxication resemble those present in alcoholic steatohepatitis (ASH) and nonalcoholic steatohepatitis (NASH). p62 is a multifunctional immediate early gene product that, on the one hand, is involved in stress-induced cell signaling (particularly that of oxidative stress) by acting as an adapter protein linking receptor-interacting protein (RIP) with the atypical protein kinase C. On the other hand, p62 binds with high affinity to polyubiquitin and ubiquitinated proteins. In conclusion, p62 accumulation in WD, ICC, and ICT and deposition in MBs indicates a central role of protein misfolding induced by oxidative stress in copper-induced liver toxicity. By sequestering potentially harmful misfolded ubiquitinated proteins as inert cytoplasmic inclusion bodies (e.g., as MBs), p62 may be a major player in an important cellular rescue mechanism in oxidative hepatocyte injury.

OBJECTIVE. The purpose of this article is to review the incidence and sonographic appearance of cerebrospinal fluid leakage after lumbar puncture in the neonatal period. Thirty-three neonates underwent spinal sonography after diagnostic lumbar puncture. A total of 21 of these patients showed cerebrospinal fluid leakage into the epidural space extending from the level of the cauda equina to the lumbar (n = 9), the thoracic (n = 8), or the cervical (n = 4) region. In eight patients, the subarachnoid space was markedly compressed by the epidural fluid collection.CONCLUSION. Cerebrospinal fluid leakage into the epidural space is a frequent complication of lumbar puncture in neonates and has a characteristic appearance on sonograms. Leakage after lumbar puncture must be differentiated from cerebrospinal fluid leakage due to perinatal meningeal injury. If cerebrospinal fluid leakage at the puncture site compresses the subarachnoid space, sonography assists in the performance of subsequent lumbar puncture.