Goedele M.A. Beckers

Urological and Nephrological Findings of Renal Ectopia

PURPOSE Urological characteristics of renal ectopia have been addressed previously but little is known about the functional consequences. We sought to study renal function, blood pressure, proteinuria and urological abnormalities in children with renal ectopia. As a secondary objective, we compared these parameters between simple and crossed ectopia. MATERIALS AND METHODS For this retrospective, single center, observational study we reviewed case documents and radiological records. We also analyzed longitudinal data on blood pressure, proteinuria and kidney function. RESULTS Renal ectopia was diagnosed in 41 cases, of which 26 (63%) were simple renal ectopia, ie unilateral pelvic kidney. In 32% of patients the diagnosis was made during prenatal screening. Median patient age was 0.24 years at diagnosis and 7.7 years at the most recent control visit. Associated urological abnormalities were found in 66% of patients. Voiding cystourethrography was performed in all patients, with vesicoureteral reflux shown in 13. In 8 of 10 cases with unilateral reflux the condition manifested in the orthotopic kidney. The relative function of the ectopic kidney on dimercapto-succinic acid scan was 38%, and in 22% of patients glomerular filtration rate was less than 90 ml per minute per 1.73 m(2). Albuminuria and proteinuria were absent in most cases. Longitudinal analysis of blood pressure, glomerular filtration rate and albuminuria revealed a stable course for all parameters. No substantial difference was observed between simple and crossed renal ectopia. CONCLUSIONS Our data suggest no adverse effects on blood pressure or kidney function in children with renal ectopia. However, periodic followup seems warranted, at least until young adulthood.

Value of an Immediate Intravesical Instillation of Mitomycin C in Patients with Non–muscle-invasive Bladder Cancer: A Prospective Multicentre Randomised Study in 2243 patients

BACKGROUND The efficacy of an immediate single chemotherapy instillation after transurethral resection of a bladder tumour (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC) remains a topic of debate. Evidence is even more scarce when an immediate instillation is followed by adjuvant instillations. OBJECTIVE To compare the effect of a mitomycin C (MMC) instillation within 24h to an instillation 2 wk after TURBT in patients with NMIBC with or without adjuvant instillations. DESIGN, SETTING, AND PARTICIPANTS Between 1998 and 2003, 2844 NMIBC patients were randomised for immediate versus delayed MMC instillation after TURBT. Patients were categorised in low-risk (LOR), intermediate-risk (IMR), and high-risk (HIR) groups. Total numbers of instillations in these groups were 1, 9, and 15, respectively. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary end point was 3-yr recurrence risk for the IMR and HIR groups and 5-yr risk for the LOR group. Secondary outcomes were time to recurrence and incidence of adverse events. Analyses were performed with the log-rank test, Cox-regression, and χ2 test in SPSS. RESULTS AND LIMITATIONS A total of 2243 patients were eligible on an intention-to-treat basis. Recurrence risks were 43% and 46% in the LOR group (5-yr follow-up, p=0.11), 20% and 32% in the IMR group (3-yr follow-up, p=0.037), and 28% and 35% in the HIR group (3-yr follow-up, p=0.007), for an immediate and a delayed instillation, respectively. For all patients, the recurrence risk was 27% (95% confidence interval [CI], 24-30) in the immediate and 36% (95% CI, 33-39) in the delayed instillation group (p<0.001) with a 27% reduction in relative recurrence risk (hazard ratio: 0.73, 95% CI, 0.63-0.85, p<0.001). The incidence of adverse events did not differ significantly between treatment groups (immediate instillation 25%, delayed instillation 22%, p=0.08). The risk groups in our study differ slightly from the current guidelines, which is a limitation of our study. CONCLUSIONS An immediate, single instillation after TURBT reduces the recurrence risk in NMIBC patients, independent of the number of adjuvant installations. PATIENT SUMMARY A single instillation of chemotherapy after the resection of non-muscle-invasive bladder cancer reduces the recurrence risk, even if patients are treated with an adjuvant schedule of instillations.

Posterior urethral valves in three siblings: a case report and review of the literature.

BACKGROUND Posterior urethral valves (PUVs), the most common congenital cause of lower urinary tract obstruction, have been described to occur in families. Until now, reports have been published on 10 cases of PUVs in two siblings and 13 cases of PUVs in identical and nonidentical twins, of which we provide an overview. CASES We report for the first time on three siblings with PUVs, with a different presentation and course in the three brothers. This within-family variability is well noted and is even present in identical twins. CONCLUSIONS This finding suggests that both genetic and environmental factors play a role in the presence and severity of PUVs. As brothers of patients with PUVs seem to be at increased risk of having PUVs, we suggest antenatal ultrasound screening in brothers of patients with PUVs in order to guide early and optimal care.

The BladderScan BVI 6200® is not accurate enough for use in a bladder retraining program

OBJECTIVE Bladder scans are used extensively in adult urology to estimate urinary volumes. For children, smaller devices have been developed. Scarce literature shows conflicting results regarding the accuracy of measurements in children. The BladderScan(®) BVI 6200 has been developed to overcome some of the inaccuracies. We tested this device to see whether it can replace conventional ultrasound in a bladder retraining program. PATIENTS AND METHODS 84 children (mean age 7.8 years) were included. Measurements with the BVI 6200 were compared to measurements with a graduated cylinder or with conventional ultrasound before and after micturition. All volumes were expressed in milliliters. The measured volumes were compared to each other in a Bland-Altman analysis. RESULTS Mean (bias) of the different measurements fell within 10% difference of measurements. The spread of the different measurements around the mean was however very large, with a broad spread of over- and under-estimations of different measured volumes. CONCLUSION The BVI 6200 is not reliable enough to replace conventional ultrasound for measurements of bladder volumes. It is not advisable to use it in a bladder retraining program.

The effect of timing of an immediate instillation of mitomycin C after transurethral resection in 941 patients with non‐muscle‐invasive bladder cancer

To investigate whether the timing of an immediate instillation of mitomycin C (on the day of transurethral resection of bladder tumour [TURBT] or 1 day later) has an impact on time to recurrence of non‐muscle‐invasive bladder cancer (NMIBC).

An immediate, single intravesical instillation of mitomycin C is of benefit in patients with non–muscle-invasive bladder cancer irrespective of prognostic risk groups

BACKGROUND In a recent meta-analysis, subgroups of patients were defined that may not benefit from a single, immediate instillation with chemotherapy. This led to a change in the European Association of Urology bladder cancer guidelines. In a previous paper, our group confirmed the efficacy of an immediate instillation of mitomycin C (MMC). However, prognostic groups in that study differ from those in the meta-analysis. Therefore, we performed a reanalysis using contemporary risk groups. OBJECTIVES To validate whether specific subgroups of patients with non-muscle-invasive bladder cancer (NMIBC) benefit from an immediate instillation with MMC. PATIENTS AND METHODS All 2,243 NMIBC patients enrolled in our randomized controlled trial between 1998 and 2003 were analyzed. Treatment effect was investigated for all subgroups, including subgroups that did not benefit from an immediate instillation according to the meta-analysis. Time to recurrence was assessed using Kaplan-Meier curves and multivariable Cox regression. Differences in treatment effect between subgroups was tested using the variable treatment by covariate interactions in a Cox regression model. RESULTS The difference in time to recurrence was statistically significant in favor of an immediate instillation with MMC (P < 0.001) which corresponds to a 25% risk reduction (hazard ratio: 0.75, 95% confidence interval, 0.64-0.88, P < 0.001). Treatment effect of an immediate instillation with MMC did not differ significantly between any of the subgroups. CONCLUSIONS In contrast to the recommendations in the European Association of Urology guidelines, we could not identify any subgroup of patients with NMIBC who do not benefit from an immediate instillation with MMC after transurethral resection.

Case Presentation: Neurogenic Bladder in a Girl After Surgery for Cloacal Malformation

A girl born in 2006 has been under close surveillance in our pediatric urology unit since birth. Besides cloacal malformation, she has associated spinal cord dysraphism, uterus didelphys, and a vaginal septum.