Normal Voiding Pattern Research Articles

Evaluation of maximum voided volume in Korean children by use of a 48‐h frequency volume chart

Study Type - Diagnostic (validating cohort). Level of Evidence 2a. What's known on the subject? and What does the study add? The relationship between the maximum voided volume followed a linear curve. The formula presented, bladder capacity (mL) = 12 ×[age (years) + 11], is thought to be a reasonable one for Korean children. Korean children have a smaller bladder capacity than that reported in previous Western studies. • To develop practical guidelines for the prediction of normal bladder capacity in Korean children measured by a frequency volume chart (FVC), maximum voided volume (MVV) is an important factor in the diagnosis of children with abnormal voiding function. • In all, 298 children, aged 3-13 years, with no history of voiding disorders volunteered for the study. The MVV was determined in 219 subjects by use of a completely recorded FVC. • Linear regression analysis was used to define the exact relationship between age and bladder capacity. An approximate formula related age to bladder capacity as follows: bladder capacity (mL) = 12 ×[age (years) + 11]. • The relationship between the MVV measured by a FVC by age (3-13 years) of Korean children followed a linear curve. • When applied to normal voiding patterns, the formula presented appears to be a reasonable one for Korean children.

Editorial Comment

Lower urinary tract dysfunction with primary vesicoureteral reflux is recognized as a major risk factor for recurrent urinary tract infection, 1 Dias C.S. Silvia J.M. Diniz J.S. et al. Risk factors for recurrent urinary tract infections in a cohort of patients with primary vesicoureteral reflux. Pediatr Infect Dis J. 2010; 29: 2139-2144 Crossref Scopus (39) Google Scholar as well as for failure of open or endoscopic surgery. The authors outline their experience with endoscopic treatment of vesicoureteral reflux in a select group of children with symptoms of overactive bladder (OAB)—urgency or urge incontinence. All patients were toilet trained at diagnosis and had initially received a course of behavior modification, with anticholinergic medication in some cases, and 10% had failed previous dextranomer (Dx)/hyaluronic acid (HA) injection. Using the hydrodistension injection technique method, the overall success rate was commendable at 83%. The authors injected an 18% greater volume of Dx/HA in those children whose OAB symptoms were ongoing at endoscopic surgery and achieved a marginally greater (+8.7%) success rate, on early postoperative voiding cystourethrogram (VCUG) at 6-12 weeks, compared to those whose OAB symptoms had been eradicated preoperatively. After successful Dx/HA injection, the incidence of urinary tract infection was low, and 40% of the children with preoperative well-controlled OAB returned to normal voiding patterns. Is Endoscopic Injection Therapy a Reasonable Treatment Option for Low-grade Vesicoureteral Reflux in Association With Overactive Bladder?UrologyVol. 78Issue 3PreviewTo assess the clinical outcome of endoscopic injection in children with vesicoureteral reflux (VUR) and concomittant overactive bladder (OAB). Full-Text PDF ReplyUrologyVol. 78Issue 3PreviewWe agree that our study carries some limitations, including the lack of urodynamic data and objective criteria for categorizing the voiding symptoms and overactive bladder (OAB). Given our study's retrospective nature, our analysis was dependent on the information available from the chart review. Full-Text PDF

Is Endoscopic Injection Therapy a Reasonable Treatment Option for Low-grade Vesicoureteral Reflux in Association With Overactive Bladder?

To assess the clinical outcome of endoscopic injection in children with vesicoureteral reflux (VUR) and concomittant overactive bladder (OAB). A total of 41 patients with VUR and OAB underwent endoscopic injection of dextranomer/hyaluronic acid. At surgery, 13 patients had been successfully treated for their OAB (urgency with or without wetting) with behavior modification with or without anticholinergic therapy, and 28 had persistent OAB despite treatment. Voiding cystourethrogram was obtained 6-12 weeks postoperatively, and patients were followed up clinically for 1-5 years. Negative voiding cystourethrogram findings after a single treatment were seen in 34 (82.9%) of 41 patients. The radiographic success rate in patients with well-controlled OAB was 76.9% (10 of 13) compared with 85.7% (24 of 28) of those with poorly controlled OAB. The overall clinical success rate, defined as no evidence of urinary tract infection in the setting of negative voiding cystourethrogram findings, reached 78.0% (32 of 41). After successful endoscopic treatment, an unanticipated return to normal voiding patterns without the need for postoperative anticholinergic therapy was seen in 4 of the children with well-controlled OAB (40.0%) and in 4 with poorly controlled OAB (16.7%). Our data suggest that endoscopic injection is a viable treatment option for VUR in those with OAB, with postoperative rates of resolution comparable to those found in patients without OAB. Furthermore, 40.0% of children with well-controlled OAB no longer required therapy for OAB after resolution of their VUR.

820 THE EFFECT OF HIGH VOIDED VOLUME ON VOIDING PATTERNS IN CHILDREN

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfunction, Enuresis1 Apr 2011820 THE EFFECT OF HIGH VOIDED VOLUME ON VOIDING PATTERNS IN CHILDREN Murat Dayanc, Yusuf Kibar, Hasan Cem Irkilata, Ahmet Ali Sancaktutar, Turgay Ebiloglu, Ahmet Gur, and Giray Ergin Murat DayancMurat Dayanc Ankara, Turkey More articles by this author , Yusuf KibarYusuf Kibar Ankara, Turkey More articles by this author , Hasan Cem IrkilataHasan Cem Irkilata Ankara, Turkey More articles by this author , Ahmet Ali SancaktutarAhmet Ali Sancaktutar Ankara, Turkey More articles by this author , Turgay EbilogluTurgay Ebiloglu Ankara, Turkey More articles by this author , Ahmet GurAhmet Gur Ankara, Turkey More articles by this author , and Giray ErginGiray Ergin Ankara, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.639AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Uroflowmetry is a common noninvasive screening method which is used for the patients with lower urinary tract dysfunction. Patients sometimes make higher volume of urine than their expected bladder capacities (EBC) because of delaying of urinate when they undergo this test. Our aim was to investigate the effect of high voided volume that is higher than the EBC on voiding patterns during uroflowmetry. METHODS Between January 2009-May 2010, a total of 191 patients with lower urinary tract dysfunction underwent two times uroflowmetry and 392 uroflowmetry results were evaluated. Patients's EBC, voided volume (VV) and voiding patterns during uroflowmetry were recorded. For EBC measurement; (age x 30)+30formula was used. Group-1 consisted of 35 patients whose VV was <50% of EBC, group-2 consisted of 82 patients whose VV was 50–100% of EBC, group-3 consisted of 35 patients whose VV was 100–125% of EBC, group 4 consisted of 39 patients whose VV was >125% of EBC, respectively. RESULTS The mean age of the patients was 7.7 years (ranges 5 to 14) and 46 of them were boys and 145 were girls. These are the percentages of normal, intermittent and plateau voiding patterns according to groups respectively: 78.6%, 12.9%, 7.1% in group-1; 83.5%, 5.5%, 1.8% in group-2; 59.2%, 8.5%, 2.8% in group-3; 37.2%, 5.1%, 2.6% in group-4. On the other hand, percentages of staccato pattern were 1.4%, 9.2%, 29.5%, 55.1% in groups, respectively. Differences between the groups were statistically significant.(Table) Groups n Voiding Patterns Patients number Normal% Staccato% Intermit.% Plato% Groups-1 35 78.6 1.4 12.9 7.1 Groups-2 82 83.5 9.1 5.5 1.8 Groups-3 35 59.2 29.2 8.5 2.6 Groups-4 39 37.2 55.1 5.1 2.6 P value = 0.215 (Group 1-2), 0.093 (Group 1-3), 0.0001 (Group1-4), 0.0001 (Group2-3), 0.0001 (Group2-4), 0.034 (Group3-4) CONCLUSIONS Abnormal voiding patterns are seen when the EBC is exceeded during uroflowmetry and so that the reliability of the test diminishes. Therefore, in case of exceeding the EBC, the test should be repeated with normal voided volume when uroflowmetry results are evaluated. Abnormal voiding pattern of children with VV higher than EBC may explain the pathophysiology of children with postponement. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e330-e331 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Murat Dayanc Ankara, Turkey More articles by this author Yusuf Kibar Ankara, Turkey More articles by this author Hasan Cem Irkilata Ankara, Turkey More articles by this author Ahmet Ali Sancaktutar Ankara, Turkey More articles by this author Turgay Ebiloglu Ankara, Turkey More articles by this author Ahmet Gur Ankara, Turkey More articles by this author Giray Ergin Ankara, Turkey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Picture of the Month—Quiz Case

A PREVIOUSLY HEALTHY 6-YEAR-OLD BOY PREsented to the emergency department (ED) with 2 weeks of progressive right leg pain and a limp. He reported pain only when bearing weight or with extension of his right knee, although his parents noted he had been waking from sleep in pain. He denied a history of trauma and had not experienced joint swelling or erythema. He had not had fever, weight loss, or recent infections and confirmed normal voiding patterns. Our patient saw his pediatrician for this same concern 3 days before our evaluation and was found to have a minimally elevated erythrocyte sedimentation rate and normal lower extremity plain radiographs. In the ED, he was wellappearing and afebrile with normal vital signs for age. He held his right knee in mild flexion and refused to ambulate secondary to pain. The findings of a physical examination confirmed a full range of motion of the right hip and ankle. No joint instability, deformity, or swelling of his leg was noted, although he had mild swelling and tenderness over his right posterior iliac crest. Laboratory results were significant for C-reactive protein, 2.2 mg/L (to convert to nanomoles per liter, multiply by 9.524), erythrocyte sedimentation rate, 30 mm/h, and normal complete blood cell count with a normal manual differential cell count. Plain radiographs of the hip and right femur were obtained. (Figure 1) What is your diagnosis?

Non-neurogenic elimination disorders in children

Non-neurogenic elimination disorders cover a wide spectrum of lower urinary tract and bowel dysfunctions, observed in the absence of a neurological background or lower urinary tract malformation. We reviewed conditions responsible for incontinence during bladder filling with normal voiding patterns (such as overactive bladder, giggle incontinence, post-void dribbling), and dysfunctional voiding syndromes. Dysfunctional elimination syndrome usually includes detrusor-sphincter dyscoordination, small-capacity overactive bladder or decompensated large poorly contractile bladder, and large-volume post-micturition residuals, occasionally associated with bowel dysfunction. At the most severe end of the spectrum lies the non-neurogenic neurogenic bladder syndrome, characterized by the association of a severe impairment of the upper urinary tract with a dysfunctional elimination syndrome. It must be emphasized that if the term 'non-neurogenic' relates to the absence of a neurological lesion, it is however conceivable that these conditions actually do have an underlying neurological cause that remains to be identified.

Urodynamic Evaluation of Urinary Disturbances following Traumatic Brain Injury

Objectives: To identify the incidence and the type of voiding dysfunction by doing urodynamic studies (UDS) in head injury patients. The purpose of this paper is to present our findings and promote research in this field. Patients and Methods: A prospective study was conducted recruiting patients sustaining head injuries with positive CT scan findings. Clinical and radiological evaluation was done. Patients then underwent standardized UDS. The urodynamic findings were correlated with outcome and analyzed. Results: Three out of 11 patients (27.3%) had unstable bladder with multiple involuntary contractions in the filling phase. All of them had significant contusions in the right frontal region and 2 of them had subarachnoid hemorrhage. All of these patients had normal proprioception, voluntary detrusor contractions and nil post-void residue. Two out of the 3 patients had catheter in situ and 1 patient had complaints of frequency and urgency. At 1 year of follow-up, all 3 patients had a normal voiding pattern and the upper tracts were normal on ultrasound in all patients. Conclusions: Voiding dysfunction is a significant problem in patients with head injury. Bladder hyperreflexia is seen in patients with injuries above the pontine micturition center. The voiding abnormality has good prognosis and resolves spontaneously. Treatment in the acute phase may require anticholinergics for a few months.

Laparoscopic ureteric reimplantation of a single-system ectopic ureter in a girl: A rarity

A 14-year-old girl presented with continuous dribbling of urine along with normal voiding pattern since childhood. Cystourethroscopy showed absence of right ureteric opening, and vaginoscopy showed right ureter opening into vaginal vault. Radiological images showed small right kidney with normal excretory function with single-system ectopic ureter. Patient underwent laparoscopic transperitoneal extravesical ureteric reimplantation. At 3 months’ follow-up, intravenous urography (IVU) and micturating cystourethrogram (MCU) showed no obstruction and reflux.

Treatment of stress urinary incontinence with adipose tissue-derived stem cells.

Effective treatment for stress urinary incontinence (SUI) is lacking. This study investigated whether transplantation of adipose tissue-derived stem cells (ADSC) can treat SUI in a rat model. Rats were induced to develop SUI by postpartum vaginal balloon dilation and bilateral ovariectomy. ADSC were isolated from the peri-ovary fat, examined for stem cell properties, and labeled with thymidine analog BrdU or EdU. Ten rats received urethral injection of saline as a control. Twelve rats received urethral injection of EdU-labeled ADSC and six rats received intravenous injection of BrdU-labeled ADSC through the tail vein. Four weeks later, urinary voiding function was assessed by conscious cystometry. The rats were then killed and their urethras harvested for tracking of ADSC and quantification of elastin, collagen and smooth muscle contents. Cystometric analysis showed that eight out 10 rats in the control group had abnormal voiding, whereas four of 12 (33.3%) and two of six (33.3%) rats in the urethra-ADSC and tail vein-ADSC groups, respectively, had abnormal voiding. Histologic analysis showed that the ADSC-treated groups had significantly higher elastin content than the control group and, within the ADSC-treated groups, rats with normal voiding pattern also had significantly higher elastin content than rats with voiding dysfunction. ADSC-treated normal-voiding rats had significantly higher smooth muscle content than control or ADSC-treated rats with voiding dysfunction. Transplantation of ADSC via urethral or intravenous injection is effective in the treatment and/or prevention of SUI in a pre-clinical setting.

The Effect Of Higher Or Lower Voided Volume To Voiding Patterns

PURPOSE To evaluate voiding patterns in children with LUTD have voided volume in uroflowmetry (UF) higher or lower level than expected bladder capasity. MATERIAL AND METHODS Expected bladder capasity was estimated with formula [(age+2)x30ml.]. Voided volumes were assessed during UF which was performed under typical conditions in seperate rooms (MMS 5000 urodynamics system). A total of 60 children with were voided 10% less or more than expected bladder capasity. Their voiding patterns were examined. RESULTS There were not seen any differences in voiding patterns in 38 of 60 children when it was compared with previous voiding patterns which was voided with expected bladder capasity. There were seen staccato voiding pattern in 22 of 60 children had voided volume 10% more than expected bladder capasity who had normal voiding pattern before. Thirteen of these 22 children had (+) EMG activity and remaining 9 0f them had (-) EMG activity. CONCLUSIONS The abnormal voiding patterns in UF with 10% higher expected bladder capasity should be reevaluated with appropriate voided volume. The effect of voided volume higher than expected bladder capasity on EMG needs future investigations.

Urotherapy In Children: Quantitative Measurements Of Daytime Urinary Incontinence Pre- And Post Treatment

PURPOSE To quantitatively assess the effectiveness of urotherapy for children with daytime urinary incontinence, according to the definitions of the International Children's Continence Society. MATERIAL AND METHODS We performed a retrospective review of 122 children (age: mean 9, range 5-14 yrs) treated in an outpatient program for lower urinary tract dysfunction. Exclusion criteria were neurologic abnormalities. Therapy is based on cure of daytime incontinence, regulate fluid intake and voiding frequency, and increase maximum voided volume once a normal voiding pattern was obtained. In 98/122 children (80%) daytime urinary incontinence was present as a predominant symptom and in 42/98 cases (43%) combined with a history of recurrent UTI's. Therapy was given by an experienced nurse practitioner and consisted of an individually adapted drinking and voiding schedule, pelvic floor relaxation, instructions on toilet behavior, biofeedback uroflowmetry and if necessary recommendations for regular defecation were made. All patients received a personal and monitoring booklet. Before and at the end of the training patients were evaluated for number and severity of daytime wet accidents per week. We used a scoring system to grade the severity of incontinence. RESULTS Using the ICCS definitions of treatment outcome, success rate was determined: of all children with daytime urinary incontinence 78% responded to the urotherapy: 38 children (42%) had a full response: they all became dry during daytime, 8 (9%) showed good response, 24 (27%) showed partial response, 20 (22%) had no response and in 8 cases objective data were missing after training. Additional benefit was evident in improvement of accompanying voiding symptoms, such as voiding frequency and flow pattern. CONCLUSIONS Urotherapy is successful for the treatment of daytime urinary incontinence in children, with a response of 78% of our cases with an intensive outpatient training protocol. Further study towards long-term efficacy will be performed.

Multipathogenetic Origin of a Pelvic Mass

A 69-yr-old woman presented with a bulky hypogastric mass and abdominal pain. Computed tomography scan showed a mass anterosuperior and contiguous to the bladder wall, with a hypodense content, a voluminous bladder stone, and bilateral hydroureteronephrosis. Intraoperatively, the supravesical mass had the appearance of an infected urachal cyst. An unsuspected high-grade noninvasive papillary transitional cell carcinoma (TCC) of the bladder thoroughly surrounding the bladder stone became evident during the cystolithotomy. Postoperative videourodynamic study showed a normal voiding pattern with bilateral grade 4 vesicoureteral reflux. Early cystectomy was performed for uncontrolled recurrent bladder cancer, and the final pathology indicated pT1G3N0 TCC.

Urodynamic findings and functional or anatomical obstructions in children who developed bladder diverticula after reimplantation of the ureter

To study the clinical and urodynamic parameters of children who developed bladder diverticula (BD) after ureteral reimplantation. We have reviewed records of 15 children who underwent ureteric reimplantation, possibly with diverticulectomy between January 1998 and October 2004, who postoperatively developed BD and compared the results with 25 patients, surgically treated for primary vesicoureteric reflux (VUR) without BD development after reimplantation. A total of 737 reimplantations was performed in 492 patients. Of the 15 patients and 25 controls we reviewed voiding history and free uroflowmetry, urodynamic parameters, findings on urethrocystoscopy, VCUG and signs of dysfunctional or anatomical obstruction. Of the fifteen patients with a postoperative diverticulum, one patient (7%) had an infravesical obstruction in combination with a normal voiding pattern, nine patients (60%) had severe dysfunctional voiding and two patients (13%) had both. Three patients had no infravesical obstruction nor dysfunctional voiding. Urodynamically the mean Pmax postoperatively was 96.8 (cm-H(2)O) in the obstructed patients (BD-group) (in controls 50.0 cm-H(2)O) and 95.6 (cm-H(2)O) for the dysfunctional voiders (in controls 61.8 cm-H(2)O). The difference between the Pmax values of BD-group and controls was significant on the 95% C.I. (P < 0.01). Dysfunctional voiding and infravesical obstruction in children appear to be important risk factors for acquired BD. Voiding pressures are significantly higher in patients that developed BD. Cognitive bladder training to normalize voiding pressures should be done before surgery if feasible. Special attention should be paid to the persistence of an infravesical obstruction.

A case of ectopic dysplastic kidney and ectopic ureter diagnosed by MRI

A 14-year-old girl with a solitary right kidney had continuous urinary incontinence. Four months previously she had undergone surgical resection of a vaginal septum associated with uterus didelphys, which was causing obstructed menstrual flow. She was toilet trained at the age of 2 years, had a normal voiding pattern, and had no history or family history of incontinence. Pelvic examination, abdominal and pelvic ultrasonography, renal scintigraphy, voiding cystourethrography, abdominal and pelvic MRI, fluoroscopic retrograde vaginography, vaginoscopy, cystourethroscopy after administration of indigo carmine, laparoscopy, and pathologic examination of the excised specimen. Ectopic ureter draining into the vagina associated with a contralateral dysplastic kidney. Laparoscopic nephrectomy of the left renal remnant and ligation of the left distal ureter.

Antibiotic Prophylaxis for Children with Primary Vesicoureteral Reflux: Where Do We Stand Today?

The main goal of the management of vesicoureteral reflux (VUR) is prevention of recurrent urinary tract infections (UTIs), and thereby prevention of renal parenchymal damage possibly ensuing from these infections. Long-term antibiotic prophylaxis is common practice in the management of children with VUR, as recommended in 1997 in the guidelines of the American Urological Association. We performed a systematic review to ascertain whether antibiotics can be safely discontinued in children with VUR and whether prophylaxis is effective in the prevention of recurrent UTIs and renal damage in these patients. Several uncontrolled studies indicate that antibiotic prophylaxis can be discontinued in a subset of patients, that is, school-aged children with low-grade VUR, normal voiding patterns, kidneys without hydronephrosis or scars, and normal anatomy of the urogenital system. Furthermore, a few recent randomized controlled trials suggest that antibiotic prophylaxis offers no advantage over intermittent antibiotic therapy of UTIs in terms of prevention of recurrent UTIs or new renal damage.

Normal voiding patterns assessed by means of a frequency–volume chart

Voiding dysfunction is one of the commonest problems among the elderly. This study aimed to elucidate the mechanisms behind the diurnal and nocturnal urine output patterns in young and elderly male volunteers. Of particular interest was bladder reservoir function during the day and night. Young males (n=25; median age 25.0 years; range 22-32 years) and elderly males (n=18; median age 61.1 years; range 55-73 years) were included in the study. Their voiding habits were assessed from a 3-day frequency-volume chart (FVC) detailing all fluid intake and urine output. Data on voided volume, voiding frequency, maximum voided volume (MVV) and average voided volume (AVV) were obtained from the FVC. The young males' average fluid intake was significantly higher than that of the elderly males. On average the elderly males had a slightly higher voiding frequency than the young males, although this was not statistically significant. There was no difference between the two groups regarding their AVVs at night (including the first morning void). The MVVs of the young and elderly males were significantly different, whereas the ratio between voided volume and MVV did not differ between the groups. The main finding was that young and elderly males void with equal average volumes of urine at night (first morning void inclusive), whereas the elderly void with smaller volumes than the young during the day-time. The elderly thus seem to have the capacity to adjust their AVV to night-time urine output size.

934 P2X 3 RECEPTOR-EXPRESSION IN FETAL AND INFANT BLADDERS - THE BASIS FOR A NEW THERAPEUTIC CONCEPT FOR OVERACTIVE BLADDERS IN CHILDREN

Introduction. The urothelium plays an active role in the regulation of urinary bladder function due to its sensorial properties. P2X3 receptors are critical components of this sensory pathway. They convey afferent information creating central nervous pain perception. We report the expressional time course of P2X3-receptors from fetal life to adulthood to rule out their possible implications in various bladder pathologies. Material and methods. Fetal, neonatal, and adult bladder specimens were obtained and immunostained with anti-P2X3 antibodies. A computer assisted microscope evaluated the intensity, extension, and tissue distribution. results. P2X3-receptors are widely abundant in the suburothelial space containing the nerve plexuses. These suburothelial nerve fibers expressing P2X3 were demonstrated in fetal as well as infant bladder tissue. However, the overall P2X3 expression was less intense in fetuses when compared to infants. In contrast to previously described adult specimens, we found a higher density of P2X3 receptors in infants and fetuses. Conclusions. This is the first study investigating the expressional time course of P2X3 receptors during human fetal development as well as in infancy. The disproportionately strong expression of P2X3-receptors in infants may explain the process of reflective bladder emptying in non-toilet trained children. However, P2X3 is less abundant in adults with a normal voiding pattern. Correspondingly, overexpression or deregulation of the P2X3 receptor complex may explain the lack of significant pathological findings in children with overactive bladder. Nonetheless, the inconsistent expression of P2X3 receptors in fetuses and infants may permit new therapeutic concepts.

Urodynamic changes in patients with anterior urethral valves: Before and after endoscopic valve ablation

Purpose To retrospectively review a series of children with anterior urethral valves (AUV), with emphasis on patterns of urodynamic change and long-term outcome of endoscopic treatment. Patients and methods We reviewed the medical records of eight patients who had undergone thorough radiological and urodynamic exams before and after treatment. The diagnosis of AUV was based on radiological imaging and confirmed by urethrocystoscopy. The valves were ablated through either transurethral fulguration or resection. The upper urinary tracts were studied by renal scan and ultrasonography before and after the procedure. Bladder function was assessed urodynamically 3 months after surgery. Uroflowmetry was performed as soon as the children were toilet trained. Results Endoscopic ablation of AUV was successful in all cases and no surgical complications occurred. The initial symptoms resolved in all boys. VUR disappeared in two out of three patients, and five children had bladder trabeculation that was resolved after surgery. The final outcome was successful in seven patients (88%). The major urodynamic dysfunction was bladder hypercontractility that resolved following valve ablation. The mean maximum voiding detrusor pressure ( P detmax) decreased from 213.2 ± 17.9 cmH 2O to 80.7 ± 9.9 cmH 2O, 6 months after treatment ( P < 0.001). None of the patients had low-compliant bladder, detrusor instability or myogenic failure. The voiding pattern in all toilet-trained patients was staccato and of an interrupted shape prior to surgery, but changed to a normal bell-shaped voiding pattern following valve ablation. Conclusion AUV should be considered in the differential diagnosis of patients presenting with infravesical obstruction. We recommend endoscopic valve ablation as the treatment of choice.

Single system ectopic ureter in females: A single center study

The purpose of this study was to inquire into the clinical features and methods for the diagnosis and management of single-system ectopic ureters associated with renal dysplasia. Materials and Methods: A total of 13 female patients were studied. Main stay of diagnosis was ultrasonography of KUB region and intravenous urography and renal scan was used to confirm the diagnosis. Histopathological evaluation was done in all cases for documentation of renal dysplasia. Result: In eight cases ectopic ureter with dysplastic kidney was seen on left side and in five it was on right side. All the patients were treated with nephroureterectomy of the affected side because of poor functioning of ipsilateral dysplastic kidney. Conclusion: Continuous urinary incontinence in females with a normal voiding pattern should prompt an evaluation for ureteric ectopia and when initial evaluation yields diagnosis of solitary kidney the clinician should be aware of the possibility of a hypoplastic and/or dysplastic on one side and normally functioning kidney on opposite side. Nephroureterectomy is the treatment of choice for unilateral single system ectopic ureter with renal dysplasia of affected side.

A Multicenter Evaluation of Urinary Incontinence Management and Outcome in Spina Bifida

We describe urinary continence management and outcome in patients with spina bifida to identify the procedures that are most successful. In a multicenter retrospective cohort study medical charts were studied. At the same time in a cross-sectional survey sociodemographic characteristics, orthopedic features and urinary continence were described based on the frequency of leakage from the viewpoint of patients or close relatives using a Likert scale of 5 items, namely 1-leakage permanent to 5-leakage never. A total of 421 patients were included, of whom 191 (45%) had been medically treated with a normal voiding pattern according to the patient viewpoint in 21%, clean intermittent catheterization in 61% and no specific bladder emptying method in 18%. The mean leakage score +/- SD was 2.74 +/- 1.55. On the other hand, 230 patients (55%) were surgically treated. Except for 23 patients who underwent noncontinent urinary diversion 207 were considered for treatment and continence description. The mean leakage score was 3.45 +/- 1.60. An artificial urinary sphincter in male and females, and a sling or Kropp technique in females were satisfactory when bladder enlargement was not required. In cases of bladder augmentation without continent diversion an artificial urinary sphincter in males and a bladder neck sling or cinch, Kropp and Young-Dees procedures in females have provided the best results. In cases of bladder enlargement with continent urinary diversion bladder neck closure or a wrap have provided the best results whatever the patient sex. Many factors may influence the choice of a technique, such as patient sex, bladder characteristics or orthopedic conditions. However, since to our knowledge no randomized, controlled study has been yet performed, definitive conclusions on the best way to achieve urinary continence in patients with spina bifida cannot be established.