Israel Franco

The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society.

The impact of the original International Childrens Continence Society (ICCS) terminology document on lower urinary tract (LUT) function resulted in the global establishment of uniformity and clarity in the characterization of LUT function and dysfunction in children across multiple healthcare disciplines. The present document serves as a stand‐alone terminology update reflecting refinement and current advancement of knowledge on pediatric LUT function.

Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: A standardization document from the International Children's Continence Society

PURPOSE This document represents the consensus guidelines recommended by the ICCS on how to evaluate and treat children with nonmonosymptomatic nocturnal enuresis (NMNE). The document is intended to be clinically useful in primary, secondary and tertiary care. MATERIALS AND METHODS Discussions were held by the board of the ICCS and a committee was appointed to draft this document. The document was then made available to the members of the society on the web site. The comments were vetted and amendments were made as necessary to the document. RESULTS The main scope of the document is the treatment of NMNE with drugs other than desmopressin-based therapy. Guidelines on the assessment, and nonpharmacologic and pharmacologic management of children with NMNE are presented. CONCLUSIONS The text should be regarded as an expert statement, not a formal systematic review of evidence-based medicine. It so happens that the evidence behind much of what we do in the care of enuretic children is quite weak. We do, however, intend to present what evidence there is, and to give preference to this rather than to experience-based medicine, whenever possible.

Laparoscopic orchiopexy : report of 203 cases with review of diagnosis, operative technique, and lessons learned

BACKGROUND AND PURPOSE Proper management of the nonpalpable testicle requires an accurate diagnosis. Laparoscopic orchiopexy (LO) has become the standard for diagnosis and treatment. We classified the location of nonpalpable testicles, reviewed the technique of LO in detail, and report the results of our series, the largest described to date. PATIENTS AND METHODS We compiled the records of all cryptorchid patients seen between 1994 and 2002. Those with testicles located near the internal inguinal ring and those with nonpalpable testicles underwent laparoscopy and LO in the same session. The 173 patients underwent 203 procedures, all performed by the senior authors. RESULTS The undescended testicles were right-sided in 33% of patients, left-sided in 53%, and bilateral in 14%. Six testicles were excluded because of hypotrophy (N=4) or agenesis of the vas deferens (N=2). At laparoscopy, 58% of the testicles were at the iliac vessels or higher (high intra-abdominal), 22% were between the iliac vessels and the internal ring (low intra-abdominal), 16% were peeping, 3% were intracanicular, and 1% were retrovesical. Standard LO was performed in 70.5% of the patients, with the remainder being treated by laparoscopic Fowler-Stephens orchiopexy. There have been four cases of testicular atrophy, all after Fowler-Stephens procedures. Two were virgin gonads, and the other two had previously been subjected to extensive orchiolysis. Only 3% of the patients required repeat surgery because of an unsatisfactory testicular location. CONCLUSION The reported success rate for LO of intra-abdominal testicles has far exceeded that of open repair (95% v 76%). It is our belief that minimal manipulation of the testicle during dissection, a wider peritoneal window, and sparse use of electrocautery will result in adequate testicular position even for high intra-abdominal gonads with minimal risk of atrophy.

International Children's Continence Society's recommendations for therapeutic intervention in congenital neuropathic bladder and bowel dysfunction in children.

We present a consensus view of members of the International Childrens Continence Society on the therapeutic intervention in congenital neuropatic bladder and bowel dysfunction in children.

International Children's Continence Society's recommendations for initial diagnostic evaluation and follow-up in congenital neuropathic bladder and bowel dysfunction in children.

The objective of this ICCS standardization document is to report the initial diagnostic evaluation and subsequent work‐up of children with neuropathic bladder dysfunction.

Functional Bladder Problems in Children: Pathophysiology, Diagnosis, and Treatment

Functional lower urinary tract problems, bladder and bowel problems, or dysfunctional elimination syndrome are all terms that describe the common array of symptoms that include overactive bladder syndrome, voiding postponement, stress incontinence, giggle incontinence, and dysfunctional voiding in children. This article discusses the nomenclature and looks at the pathophysiology of functional bladder disorders from a different perspective than has been the norm in the past. Some standard medical treatments as well as some newer forms of treatment are outlined. Treatment algorithms for urinary frequency and urinary incontinence have been created to help the practitioner manage the patient.

Fibroepithelial Polyp Associated with Congenital Ureteral Diverticulum: Report of 2 Cases

We report 2 cases of a single fibroepithelial polyp in conjunction with ureteral diverticula. Ureterorenoscopy is valuable in the identification of the benign nature of these lesions preoperatively to avert unnecessary nephroureterectomy. The etiology of fibroepithelial polyps remains unknown, although many theories have been proposed. Recent evidence has suggested that these lesions may be a developmental anomaly. Congenital ureteral diverticula also are thought to be of developmental origin. We hypothesize that fibroepithelial polyps and congenital diverticula of the ureter are part of a spectrum of the same developmental anomaly.

Accessory and ectopic scrotum with VATER association

Scrotal ectopia or accessory scrotum are both rare conditions. This report describes a neonate with both abnormalities, who also has elements of the VATER association. This constellation of anomalies has not been previously described.

The Central Nervous System and its Role in Bowel and Bladder Control

Bowel and bladder issues have been noted to be coexistent in children, and treatment of bladder symptoms without concomitant targeting of bowel issues generally leads to failure. This article explores the potential roots for this persistent connection between bowel and bladder and the role that the central nervous system plays in affecting both. An ever-increasing pool of knowledge drawn from multiple medical disciplines has provided us with a wealth of functional imaging information that is allowing us to map the areas of the brain better with regards to bowel and bladder function. We explore these new findings and attempt to connect the dots between the central nervous system bladder and bowel dysfunction.

Pediatric overactive bladder syndrome: pathophysiology and management.

Detrusor overactivity, also known as the overactive bladder syndrome (OAB), urge syndrome, hyperactive bladder syndrome, persistent infantile bladder, and detrusor hypertonia, is the most common voiding dysfunction in children. Until recently, the concepts that had been used to dictate the management of this problem in children were based on the foundation that this was a primary bladder problem and or a delay in maturation in the nervous system of children. The expectation that children would outgrow their problems led many pediatric urologists and other practitioners to tell the parents of these children ‘that they would not be wetting themselves on their wedding day.’ However, it has become apparent from recent studies in adult patients with voiding dysfunctions that they had symptoms present as children. Recent findings of associations between lower urinary tract symptoms and sexual dysfunction and between voiding dysfunctions and neuropsychiatric problems have opened up a new frontier into the possible mechanisms of OAB in children that would explain these problems, link them together, and explain the continued problems that adult patients face. These findings point to OAB as a symptom of a more centrally located dysfunction that affects multiple systems.The objective of this review was to evaluate the neuroanatomy and neurophysiology of voiding and neuropharmacologic effects. We considered not only the available research and clinical data within the urologic field but also outside the field so that these data could be combined to generate a unified theory that could possibly explain many of the associated symptoms that are commonly found in pediatric OAB. Treatment modalities that are currently available for managing OAB were also explored.Currently available data indicate that pediatric OAB and many pediatric voiding dysfunctions may be part of a more generalized problem that affects multiple systems: notably bowels, bladder, sexual and ejaculatory function, control of blood pressure, and even mood and behavior. We explain the relationship that the bowel has with pediatric OAB and also the link that other neuropsychiatric problems have with OAB. This article describes which drug may be best suited to treat OAB in children and what treatment modalities are available when first-line drugs fail.In conclusion, the movement away from a vesicocentric way of thinking to a more corticocentric mode of thinking along with new imaging modalities that can examine the brain as it works will be of great value in determining future treatments of OAB. Medications generated from these evidence-based studies will hopefully treat the underlying disease process and not just the symptoms.