PURPOSEWe sought to determine whether the alpha-adrenergic antagonist doxazosin could be used as primary therapy in children with voiding dysfunction.MATERIALS AND METHODSChildren were assigned to maintain a voiding diary and then randomly divided into a double-blind placebo controlled protocol (0.5 mg doxazosin or placebo). Duplicate uroflow studies with post-void residual evaluations and assessment of dysfunctional voiding scores were performed on initiation and completion of the study. At the conclusion parents were asked to rank the perceived improvement of the urinary incontinence (ie parental subjective perception of improvement).RESULTSNo significant differences between doxazosin (18) and placebo (20) treated patients were found in the number of incontinent days per week, severity of incontinent episodes or alterations in uroflow patterns. Although not significant, 2 findings suggested a beneficial effect of doxazosin over placebo. Specifically, doxazosin decreased the number of incontinent episodes weekly from a median of 18 to 4, while the number of incontinent episodes weekly in the placebo group remained essentially unchanged, decreasing from 15 to 14 (p = 0.13). Doxazosin also improved the dysfunctional voiding scores over placebo, for an improvement of -3 vs 0 points. Further substantiating a doxazosin effect over placebo was the subjective perception of the parents that doxazosin significantly improved urinary continence (p <0.02).CONCLUSIONSCompared to placebo, doxazosin did not demonstrate a significant objective benefit, but produced a significant subjective benefit in the treatment of urinary incontinence secondary to voiding dysfunction.

PURPOSE:Eosinophilic cystitis is a rare disorder, with fewer than 30 pediatric cases reported in the literature. We describe our experience with pediatric eosinophilic cystitis during a 20-year period.MATERIALS AND METHODS:Four children referred to our institution were subsequently diagnosed with eosinophilic cystitis between 1984 and 2004. A retrospective chart review was performed to assess clinical presentation, diagnosis, treatment and outcomes.RESULTS:Mean patient age at presentation was 10.8 years (range 5 to 18) and male-to-female ratio was 3:1. All 4 patients presented with irritative urinary symptoms, including 3 with dysuria and/or gross hematuria and 2 with urinary frequency, lower abdominal pain and/or a concomitant urinary tract infection. Allergic diseases (asthma, allergic rhinitis, etc) were present in 3 patients, and a formal allergen skin test was positive in 2 of those tested. A bladder mass mimicking malignancy was documented in 2 patients. Three patients had symptom resolution with conservative treatment, while 1 had development of an unremitting tumefactive process that eventually required partial cystectomy and bladder augmentation.CONCLUSIONS:Eosinophilic cystitis is a rare condition with a wide range of clinical manifestations. Children can present with a bladder mass mimicking sarcoma, underscoring the need for biopsy before diagnosis and treatment of a presumed oncological process. The condition usually follows a benign course, although unremitting progression remains a possibility.

PURPOSE:We review the use of split-thickness skin grafting in children with concealed penis.MATERIALS AND METHODS:Medical records were retrospectively reviewed for all patients younger than 20 years seen at our institution from 1995 to 2003 with a diagnosis of concealed penis. Patients were separated into "primary" and "secondary" groups based on the cause of concealment. Primary factors were prominent prepubic fat pad, dysgenetic dartos fascia or both. Secondary factors were post-circumcision phimosis and overzealous circumcision.RESULTS:A total of 26 patients 1 month to 19 years old were treated. In the primary group of 23 patients 11 underwent lysis of dartos fascia. Four of these 11 patients had insufficient skin, and split-thickness skin grafting was necessary to resurface the penile shaft. Five of the patients underwent excision of the fat pad only, and 2 underwent excision of the fat pad and lysis of fascia. Five patients are being observed. Of the 3 patients in the secondary group 1 underwent manual reduction of post-circumcision phimosis, 1 underwent scrotal flaps and 1 is being observed. Followup ranged from 2 weeks to 46 months (mean 13 months). Of 20 surgically repaired patients 19 (95%) had an excellent cosmetic result, were satisfied with penile length and reported no voiding complaints.CONCLUSIONS:The surgical approach for correcting concealed penis varies, depending on the cause. Of our 26 patients 4 (15%) had insufficient penile skin to resurface the penile shaft. In these select children split-thickness skin grafting provided a good cosmetic appearance and functional result.

PURPOSE:We evaluate the outcome of ureterocystoplasty based on preoperative evaluations.MATERIALS AND METHODS:We reviewed preoperative ultrasound, voiding cystourethrography and preoperative/postoperative urodynamic studies (UDS) in 64 patients undergoing ureterocystoplasty.RESULTS:Augmentation was performed with the distal 5 to 8 cm of a single megaureter in 8 patients without and 16 with grade 4 to 5/5 reflux. Median gain or loss in capacity and compliance was +0.14-fold and -0.11-fold, respectively. Re-augmentation has occurred or is pending in 23 cases (92%). Augmentation was performed in 40 patients with either a complete single or double collecting system. In 9 patients without reflux the diameter of the augmenting system was directly related to success. None of 6 with a ureteral diameter of greater than 1.5 cm required re-augmentation (median increase in bladder capacity and compliance 6 and 50-fold, respectively). Ureterocystoplasty was inadequate in 3 patients with a ureteral diameter of less than 1.5 cm and re-augmentation was required. In 31 patients with reflux, preoperative UDS of the entire system was beneficial. If the system had either normal or mild noncompliance (greater than 20 ml/cm H2O) ureterocystoplasty improved compliance 1-fold (6 cases) and re-augmentation not required. If UDS showed moderately or severely noncompliant system (less than 20 ml/cm H2O, 26 cases) ureterocystoplasty increased capacity and compliance by 0.4-fold (40%) and 0.25-fold (25%), respectively. Re-augmentation has occurred or is pending in 21 of 26 cases (81%).CONCLUSIONS:Ureterocystoplasty with any single or double collecting system is warranted in patients without reflux and a ureteral width greater than 1.5 cm, and in patients with reflux and mild noncompliance (greater than 20 ml/cm H2O) on UDS.

You have accessJournal of UrologyDiscussed Poster, Saturday, May 8, 2004, 1:00 - 5:00 pm1 Apr 2004208: A Double-Blind, Placebo-Controlled Study of Alpha-Adrenergic Blockers (Doxazosin) for Treatment of Voiding Dysfunction in Children Stephen A. Kramer, Suzanne R. Rathbun, David Elkins, R. Jeffrey Karnes, and Douglas A. Husmann Stephen A. KramerStephen A. Kramer More articles by this author , Suzanne R. RathbunSuzanne R. Rathbun More articles by this author , David ElkinsDavid Elkins More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , and Douglas A. HusmannDouglas A. Husmann More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37470-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "208: A Double-Blind, Placebo-Controlled Study of Alpha-Adrenergic Blockers (Doxazosin) for Treatment of Voiding Dysfunction in Children." The Journal of Urology, 171(4S), p. 55 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 55 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Stephen A. Kramer More articles by this author Suzanne R. Rathbun More articles by this author David Elkins More articles by this author R. Jeffrey Karnes More articles by this author Douglas A. Husmann More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSE:Previous studies have suggested that increased p53 expression is associated with advanced stage and biologically aggressive (chemotherapy resistant) Wilms tumors. We decided to test the hypothesis that increased immunopositivity of p53 is associated with biological aggressiveness in patients with histologically favorable Wilms tumors.MATERIALS AND METHODS:We reviewed the charts of all patients with unilateral Wilms tumor treated at our institution between 1976 and 2001. Histological characteristics, tumor stage, clinical course and p53 expression as determined by immunohistochemical analysis were determined. All immunohistological evaluations were performed on tissue obtained before administration of chemotherapy.RESULTS:A total of 63 cases of unilateral histologically favorable Wilms tumor were assessed. Five cases (8%) were p53 positive. No significant relationship to p53 expression or stage at presentation was noted in 1 of 21 (5%) stage 1, 3 of 21 (14%) stage 2, 1 of 11 (9%) stage 3 and 0 of 10 stage 4 tumors positive for up-regulation of p53. Of the 5 patients with up-regulated p53 expression 1 (20%) had documented disease progression or relapse while on standard National Wilms Tumor Study chemotherapy. Of the 58 patients who were p53 negative 10 (17%) had disease progression or relapse while on standard National Wilms Tumor Study chemotherapy (p >0.3).CONCLUSION:In contrast to previously published studies, we found no correlation of p53 expression to either tumor stage at presentation (p >0.3) or prognosis (p >0.3) in individuals with histologically favorable Wilms tumor assessed for immunopositivity before administration of chemotherapy.

PURPOSE:It has been hypothesized that endoscopic decompression of the duplex extravesical ureterocele is necessary to prevent the complications of urinary tract infections and progressive hydronephrosis. This study was performed to test this premise. MATERIALS AND METHODS:Infants younger than 2 weeks with an extravesical ureterocele associated with a duplex upper pole moiety were assigned to immediate endoscopic puncture of the ureterocele followed by antibiotic prophylaxis or antibiotic prophylaxis with plans for delayed surgical intervention. Radiographic studies and catheterized urine cultures were obtained at ages 3 and 6 months and for fever greater than 38.5C. All patients included in this study were followed through 6 months of life. RESULTS:Of the patients 32 underwent endoscopic puncture of the ureterocele. Median patient age at endoscopy was 5 days (range 3 to 13). During the first 6 months of life complications developed in 4 (12%), including febrile urinary tract infections in 3 (9%) and with progressive hydronephrosis due to incomplete puncture of the ureterocele in 1 (3%). The remaining 40 patients were treated with antibiotic prophylaxis and delayed open surgery. Median time to open surgery was 3 months (range 2 to 6). During the first 6 months of life complications developed in 5 (13%), including 3 (8%) febrile urinary tract infections and progressive hydronephrosis in 2 (5%). No statistical difference was noted between the 2 treatment groups. CONCLUSIONS:In patients with extravesical duplex ureteroceles neonatal complications of urinary tract infection and progressive hydronephrosis are not significantly different between those treated with immediate endoscopic decompression versus delayed open surgical intervention.

Purpose: We present a modification of bladder neck reconstruction which resulted in improved continence and voiding compared to other techniques of bladder neck repairs in patients with exstrophy and complete incontinence.Materials and Methods: The series consisted of 10 patients with the exstrophy-epispadias complex and complete incontinence who previously had undergone multiple operations for bladder closure, bladder neck reconstruction and epispadias repair. This modification combines bladder neck lengthening and narrowing of the distal half of the urethra, and submucosal embedding of the proximal half of the neourethra in the trigonal area. All patients also underwent bladder augmentation with detubularized sigmoid colon concurrent with bladder neck reconstruction. Additionally the appendical Mitrofanoff principle was applied to 5 cases.Results: Of the 10 patients who underwent bladder neck reconstruction with sigmoid cystoplasty 8 are voiding voluntarily without catheterization and are dry for longer than 4 hours day and night. Only 2 patients are partially dry with stress nocturia incontinence and in both we performed a Mitrofanoff procedure as an adjunct to catheterization and to ensure voiding and continence.Conclusions: Our modified bladder neck reconstruction provides better overall voiding and continence rates than the other bladder neck/urethral reconstruction procedures in patients with exstrophy and complete incontinence.

No AccessJournal of UrologyPediatric Urology1 Dec 1998INGUINAL LIPOBLASTOMATOSIS IN A MALE INFANT SHANE T. RUSSELL, MATTHEW T. GETTMAN, CAROLA A. ARNDT, A.G. NASCIMENTO, and STEPHEN A. KRAMER SHANE T. RUSSELLSHANE T. RUSSELL More articles by this author , MATTHEW T. GETTMANMATTHEW T. GETTMAN More articles by this author , CAROLA A. ARNDTCAROLA A. ARNDT More articles by this author , A.G. NASCIMENTOA.G. NASCIMENTO More articles by this author , and STEPHEN A. KRAMERSTEPHEN A. KRAMER More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62297-3AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "INGUINAL LIPOBLASTOMATOSIS IN A MALE INFANT." The Journal of Urology, 160(6 Part 1), p. 2204 References 1 : Lipoblastomatosis: a tumor of fetal fat different from hibernoma. Amer. J. Path.1958; 34: 1149. Google Scholar 2 : Recurrent lipomatous tumors of the groin. Arch. Path.1926; 1: 381. Google Scholar 3 : Benign lipoblastomatosis. An analysis of 35 cases. Cancer1973; 32: 482. Google Scholar From the Departments of Laboratory Medicine and Pathology, Pediatrics and Urology, Mayo Clinic, Rochester, Minnesota© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 160Issue 6 Part 1December 1998Page: 2204 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information SHANE T. RUSSELL More articles by this author MATTHEW T. GETTMAN More articles by this author CAROLA A. ARNDT More articles by this author A.G. NASCIMENTO More articles by this author STEPHEN A. KRAMER More articles by this author Expand All Advertisement PDF downloadLoading ...

No AccessJournal of UrologyPediatric Urology Medal1 Sep 1997Panayotis P. Kelalis Stephen A. Kramer Stephen A. KramerStephen A. Kramer More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64409-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Panayotis P. Kelalis." The Journal of Urology, 158(3), pp. 1154–1155 Department of Urology; Mayo Clinic; Rochester, Minnesota.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 158Issue 3September 1997Page: 1154-1155 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Stephen A. Kramer More articles by this author Expand All Advertisement PDF DownloadLoading ...

Purpose: We evaluated the factors critical in achieving urinary continence in patients with the exstrophy-epispadias complex.Materials and Methods: A total of 51 patients with epispadias and 33 with classic bladder exstrophy underwent vesical neck reconstruction. Patient records were reviewed to identify factors associated with the achievement of continence, including timing of bladder closure and urethroplasty, effect of bladder capacity before and after vesical neck reconstruction, and effect of enterocystoplasty.Results: Complete urinary continence was achieved in 42 of the 51 patients with epispadias (82%) and in 23 of the 33 with exstrophy (70%). Delayed bladder closure did not affect the ability to gain continence but increased the likelihood of subsequent enterocystoplasty (12 of 19 patients, 63%) compared to early bladder closure (5 of 14 patients, 36%).Conclusions: Preliminary urethroplasty did not enhance urinary control or reduce the need for enterocystoplasty. Bladder capacity before vesical neck reconstruction did not predict the need for enterocystoplasty or ultimate continence status in individuals. Adequate bladder capacity after vesical neck reconstruction was an important determinant of urinary continence. Approximately half of the patients with bladder exstrophy (17 of 33) required augmentation cystoplasty to achieve urinary continence.

No AccessJournal of UrologyPediatric Urology: Editorial1 Feb 1996Editorial: The Role of Newer Modalities in the Diagnosis of Vesicoureteral Reflux Stephen A. Kramer Stephen A. KramerStephen A. Kramer More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)66498-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial: The Role of Newer Modalities in the Diagnosis of Vesicoureteral Reflux." The Journal of Urology, 155(2), pp. 683–684 References 1 : The significance of the adrenergic nerves in the etiology of vesicoureteral reflux. J. Urol.1986; 136: 232. part 2. Link, Google Scholar 2 : Pronounced detrusor hypercontractility in infants with gross bilateral reflux. J. Urol.1992; 148: 598. part 2. Link, Google Scholar 3 : In search of a marker for genetic susceptibility to reflux nephropathy. Clin. Nephrol.1980; 14: 217. Google Scholar 4 : The transmission of vesicoureteral reflux from parent to child. J. Urol.1992; 148: 1869. Link, Google Scholar 5 : The long-term results of prospective sibling reflux screening. J. Urol.1992; 148: 1739. Link, Google Scholar Department of Urology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byNoe H (2018) Editorial: Screening for Reflux--The Current StatusJournal of Urology, VOL. 156, NO. 5, (1808-1808), Online publication date: 1-Nov-1996. Volume 155Issue 2February 1996Page: 683-684 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.MetricsAuthor Information Stephen A. Kramer More articles by this author Expand All Advertisement PDF downloadLoading ...

We investigated how various types of augmentation cystoplasty alter the native bacteriostatic properties of urine, particularly urinary urea and pH, in the Sprague-Dawley rat. The augmentation cystoplasties studied included 1 cm.(2) and 2 cm.(2) patches of colon, ileum and stomach as well as myoperitoneal bladder flaps. Augmentations in order of decreasing incidence of bacteriuria and urinary pH are 2 cm.(2) ileal greater than 1 cm.(2) ileal greater than 2 cm.(2) colonic greater than 1 cm.(2) colonic greater than myoperitoneal greater than cystotomy alone greater than 1 cm.(2) gastric greater than 2 cm.(2) gastric. Urinary urea concentrations were similar between cystotomy alone, and myoperitoneal and gastric augments. In contrast, all colonic and ileal augments had significantly lower urea concentrations compared to the aforementioned groups. Our findings suggest that the type and size of augmentation directly affect urinary pH and urea nitrogen concentration, and the incidence of bacteriuria.

Purpose: Can antiandrogens cause cryptorchidism in an animal model with a strip-like gubernaculum? If so, what anatomical abnormalities are associated with cryptorchidism?Materials and Methods: Timed pregnant sows received the antiandrogen flutamide during defined gestational intervals. Fetal pigs were evaluated for the presence of testicular undescent and for morphological paratesticular abnormalities at 110 days of gestation (birth).Results: Of 180 testes 84 (47%) were undescended and 9 (5%) were in the abdominal cavity. No undescended testis (0 of 200 testes) was found in control animals (p <0.001). Epididymal anomalies were found in all intra-abdominal testes, which was significant when compared to the epididymal abnormalities found with inguinal undescended testes (0%) or descended testes (1%) (p <0.001), Alterations in gubernacular morphology, in particular failure of gubernacular regression, were also directly associated with cryptorchidism (p <0.001).Conclusions: Androgens partially control transabdominal and transinguinal descent of the porcine testis. In addition, antiandrogen induced cryptorchidism is associated with epididymal malformation and failure of gubernacular regression. It remains to be determined if these latter findings are only associated with or the cause of testicular undescent.

We retrospectively reviewed the records of 101 pediatric patients who underwent uncomplicated ureteral reimplantation and were treated with postoperative epidural catheters for pain management. A total of 50 pediatric patients treated without epidural anesthesia was used as the control group. Length of hospital stay, time to first bowel activity, doses of narcotics, incidence of postoperative fever and evidence of epidural catheter related morbidities were documented. The costs of postoperative epidural anesthesia versus standard analgesics were compared.There was no significant difference in length of hospital tay or return of bowel function between treatment groups. Total doses of narcotics given during the hospital stay were significantly less for the epidural group (p < 0.05). The children given epidural anesthesia also had a significant increase in the incidence of postoperative fever (p < 0.05) and 25% had catheter related problems that often resulted in early removal of the epidural catheter. The cost of pain management using an epidural catheter was significantly greater than that of the standard narcotic regimen ($708 versus $14, p < 0.001).Continuous epidural infusion provides satisfactory pain control after ureteroneocystostomy in children without delaying hospital discharge. This technique of pain management is associated with a significant increase in the incidence of postoperative fever and overall cost compared to standard methods of postoperative pain management.

Micropenis secondary to hypogonadotropic hypogonadism was induced in the Sprague-Dawley rat using long acting microspheres of the gonadotropic agonist leuprolide acetate. Following the induction of micropenis treatment was initiated with testosterone at day 7, 28, 56 or 84 of life. All treatment protocols resulted in improved phallic growth compared to the untreated animals with micropenis (p < 0.01). Treatment of animals with testosterone beginning on day 7 of life resulted in premature growth of the penis and the redevelopment of micropenis in adulthood. In contrast, delaying testosterone therapy until day 56 (pubertal) or 84 (early postpubertal) resulted in complete penile development. These findings suggest that early exposure of the penis to androgens in childhood may eventually result in a significant reduction of phallic size in adulthood.

Objectives. One of the major controversies regarding descent of the testes is whether androgenic regulation of the gubernaculum testes exists. To determine if antiandrogens can alter the development of the gubernaculum within the fetus, the following experiment was performed.Methods. Timed pregnant Sprague-Dawley rats were treated with either flutamide, dihydrotestosterone (DHT), or vehicle alone (controls) from gestational day (CD) 15 to 17. Fetal specimens were removed via cesarean section on GD 18 and 20. Serial coronal sections were obtained, and digital microscopy with computer-assisted reconstruction was used to ascertain the morphology of the three components of the gubernaculum, that is, the gubernacular cord and the mesenchymal and muscular components of the gubernacular bulb.Results. Flutamide significantly prevented and DHT significantly enhanced gubernacular cord regression compared with controls (P < 0.01). Flutamide also resulted in a significant inhibition of the gubernacular bulb outgrowth, with diminution of both the mesenchymal and muscular components of the gubernacular bulb.Conclusions. These data suggest that androgens play an active role in gubernacular cord regression and gubernacular outgrowth within the fetal rodent.

We followed 21 patients with congenital infundibulopelvic stenosis, a rare obstructive disorder of the intrarenal collecting system, for a median of 11 years (range 2 to 28 years). Of these patients 19 (90%) had evidence of bilateral renal disease. In particular, 10 patients had bilateral infundibular pelvic stenosis, 6 a contralateral cystic dysplastic kidney and 3 a congenitally absent kidney. Extended observations of the patients with this disorder revealed that end stage renal disease or renal insufficiency developed in 8 patients (37%), all with bilateral renal anomalies. Renal biopsies in patients with end stage renal failure revealed widespread areas of renal dysplasia proximal to the stenotic infundibulum with focal or global glomerulosclerosis of the glomeruli, which was not involved in the dysplastic process. These pathological findings are consistent with the presence of a renal hyperfiltration injury. Our data suggest that the prognosis of infundibulopelvic stenosis is dependent upon the extent of total renal mass involved with the disease process and the duration of followup.