Biji Sreedhar

Differences in characteristics of nocturnal enuresis between children and adolescents : a critical appraisal from a large epidemiological study

To evaluate any differences in the characteristics of primary nocturnal enuresis (PNE) between younger enuretic children and adolescents.

Characteristics of primary nocturnal enuresis in adults: an epidemiological study

To evaluate the prevalence and characteristics of primary nocturnal enuresis (PNE) in adults in Hong Kong, as there are currently limited epidemiological data in adults.

Cortical arousal in children with severe enuresis.

To the Editor: Children with nocturnal enuresis are generally believed to be deep sleepers with impaired arousability.1 However, there are conflicting data with regard to sleep patterns in children...

Correlation between ultrasonographic bladder measurements and urodynamic findings in children with recurrent urinary tract infection

Authors from Hong Kong evaluated the role of ultrasonographically measured bladder variables in assessing bladder dysfunction in children with UTI. In a relatively large study, they confirmed the finding that the bladder volume and wall thickness index is a sensitive method for diagnosing bladder dysfunction in children.

Nomograms of total renal volume, urinary bladder volume and bladder wall thickness index in 3,376 children with a normal urinary tract

BackgroundWe have previously shown that urinary bladder volume index (BVI = length × width × depth of bladder) and bladder volume wall thickness index (BVWI = BVI at full bladder/average bladder wall thickness) are useful indicators of bladder dysfunction in children with enuresis and urinary tract infection. These indices show a good correlation with urodynamic studies. We have expanded the study to include normal paediatric subjects with a wide age range. We illustrate a simple sonography protocol with nomograms of different parameters, which provide useful references for functional assessment in children with urological abnormalities.ObjectiveTo construct nomograms of total renal volume, maximum BVI and BVWI based on a Chinese paediatric population with age range from newborn to adolescence.Materials and methodsSonography was performed in consecutive children with normal urinary tracts on imaging, using a standardized protocol. Data were collected for construction of nomograms for different parameters.ResultsNomograms of total renal volume, BVI and BVWI were constructed based on 3,376 consecutive paediatric subjects. All parameters consistently increased with age.ConclusionNomograms of total renal volume, BVI and BVWI could provide useful references for studying bladder dysfunction in children using noninvasive dynamic sonography.

Ultrasound Bladder Measurements in Children With Severe Primary Nocturnal Enuresis: Pretreatment and Posttreatment Evaluation and its Correlation With Treatment Outcome

PURPOSE Results from our previous study demonstrated a high predictive value using ultrasound bladder measurements to identify abnormal bladder function in children with enuresis or urinary tract infection. We prospectively evaluated the role of ultrasound measured bladder parameters for the assessment of bladder dysfunction and posttreatment bladder functional changes (if any), and their correlation with treatment outcome in children with primary nocturnal enuresis. MATERIALS AND METHODS Patients presenting with severe primary nocturnal enuresis (more than 3 wet nights weekly) were prospectively recruited. At study entry each patient underwent ultrasound, and natural and conventional filling cystometric studies. Bladder volume and wall thickness index was calculated based on ultrasound studies and classified as thick (less than 70), normal (70 to 130) or thin (more than 130). The criteria for diagnosing urodynamic patterns included normal, overactive and underactive detrusor activity. Correlation between the ultrasound measured parameters and urodynamic findings was then evaluated. Patients were treated based on our standardized treatment protocol. Bladder measurements were repeated in those children who had completed treatment. The McNemar test was used for comparing posttreatment changes in bladder measurements corresponding to treatment outcome in different groups, and p values less than 0.05 were regarded as statistically significant. RESULTS A total of 35 children (23 males, 12 females; mean age 9.03 years) were prospectively recruited. At study entry bladder volume and wall thickness index was normal in 8 patients, less than 70 in 24 and more than 130 in 3. When bladder volume and wall thickness index was correlated with ultrasound 87.5% of the patients with a normal index exhibited a normal bladder pattern on imaging. In addition, 96% of the patients with an index of less than 70 exhibited bladder overactivity on ultrasound. All of the children with a normal index had either a complete or good response to treatment, whereas 62.5% of those with an index of less than 70 did not respond to treatment. On followup bladder dysfunction had resolved in 37.5% of the children with an initial index of less than 70, all of whom had a good response to the treatment. Bladder dysfunction persisted in 62.5% of the patients, all of whom had partial or no response to treatment (p <0.001). CONCLUSIONS Ultrasound measured bladder parameters correlated well with ultrasound findings, changes in bladder function and treatment outcome in children with primary nocturnal enuresis. This study further confirms that this specially designed ultrasound protocol can provide useful predictive clues that may be helpful in differentiating between various treatment subtypes, guiding clinical management and minimizing the need for invasive urodynamic studies.

Laparoscopy in the management of pediatric vesicoureteral reflux.

The prevalence of vesicoureteral reflux (VUR) has been estimated as. 4 to 1.8% among the pediatric population. In children with urinary tract infection the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of this review article is to highlight the use of laparoscopy and robot-assisted techniques to perform ureteric reimplantation for the management of pediatric VUR. A detailed review of recent literature on the subject is performed to find out various aspects of minimally invasive surgery in the treatment of VUR, highlighting evolution of management approaches, operative steps, complications, results and the current status in clinical practice. We also share our experience on the subject.

Dynamic Ultrasound Study on Urinary Bladder in Infants With Antenatally Detected Fetal Hydronephrosis

To evaluate bladder function in infants with antenatally diagnosed hydronephrosis (ANH) using dynamic ultrasound protocol. Forty consecutive male infants (mean, 0.25 y) with ANH and 33 age-matched normal controls (mean, 0.49 y) were recruited. Anteroposterior (AP) diameter of renal pelvis (RP) and hydronephrosis index [HI = anteroposterior diameter of RP of kidney divided by urinary bladder volume (BV)] were calculated. Maximum BV (MaxBV) was determined just before voiding. Residual volume (RV) and bladder wall thickness (BWT) were measured after spontaneous voiding. Thirty-one infants (77.5%) showed persistently dilated RP postnatally in which 12 (39%) showed significantly high HI. In general, ANH infants had smaller MaxBV (30.71 versus 52.45 mL), larger residual volume (2.47 versus 1.93 mL), and larger BWT (4.4 versus 3.7 mm) than normal (p < 0.05, Mann-Whitney test). Infants with abnormally high HI had significantly more disturbed bladder parameters [smaller MaxBV (23.33 versus 33.49 mL) and larger BWT (4.67 versus 3.79 mm)] than the normal HI group (p < 0.05, Mann-Whitney test). Abnormal functional bladder parameters were evident in ANH infants. We postulated that immature function in the pelviureteric junction was associated with bladder dysfunction in these infants. Dynamic ultrasound protocol might help to understand the underlying pathophysiology of urinary system in ANH infants.

Minimally Invasive Management for Vesicoureteral Reflux in Infants and Young Children

Minimally invasive ureteral reimplantation is an attractive and useful tool in the armamentarium for the management of complicated vesicoureteral reflux (VUR). Subureteric dextranomer/hyaluronic acid injection, laparoscopic extravesical ureteric reimplantation and pneumovesicoscopic intravesical ureteral reimplantation with or without robotic assistance are established minimally invasive approaches to management of VUR. The high cost and the limited availability of robotics have restricted accessibility to these approaches. Laparoscopic and/or robotic ureteral reimplantation continues to evolve and will have a significant bearing on the management of complicated VUR in infants and young children.