Jose de Bessa

Antibiotic Prophylaxis for Prevention of Febrile Urinary Tract Infections in Children with Vesicoureteral Reflux: A Meta-Analysis of Randomized, Controlled Trials Comparing Dilated to Nondilated Vesicoureteral Reflux

PURPOSEnThe followup and treatment of children with vesicoureteral reflux has been debated for many years. Antibiotic prophylaxis has a role for preventing urinary tract infection in these children. Recent studies and guidelines suggested that prophylaxis has little or no role in preventing urinary tract infection in those children, especially those with low grades (I and II) of reflux.nnnMATERIALS AND METHODSnWe analyzed all published randomized, controlled trials comparing antibiotic prophylaxis vs no prophylaxis or placebo in children with vesicoureteral reflux. The children were divided into those with nondilated (grades I and II) and dilated (grades III and IV) vesicoureteral reflux. After data were analyzed the RIVUR study was published and, therefore, it was added to the analyzed data.nnnRESULTSnAfter analyzing the first published studies we found that antibiotic prophylaxis would be beneficial only in children with high grade vesicoureteral reflux. With the addition of the data in the RIVUR study these results changed. The new pooled data support antibiotic prophylaxis in all children with vesicoureteral reflux.nnnCONCLUSIONSnVesicoureteral reflux management is still controversial. In contrast to recently published studies and guidelines, this meta-analysis supports antibiotic prophylaxis in all children with vesicoureteral reflux regardless of reflux grade. More studies are needed to support this finding.

Contemporary Trends in the Epidemiology of Traumatic Spinal Cord Injury: Changes in Age and Etiology

Background: Epidemiological features of spinal cord injury (SCI) have been changing over the last decades. We evaluated the contemporary trends in the epidemiology of traumatic SCI patients from a rehabilitation center. Methods: In a cross-sectional study, a consecutive series of 348 patients with traumatic SCI were evaluated. Variables were collected through an epidemiological form, which included gender, age at injury, duration and cause of SCI. We investigated SCI epidemiological trends over time including the association between gender and age at injury with SCI features such as etiology, injury severity and level. Results: The mean age at SCI has increased from 26.0 ± 11.8 in patients with SCI before 2003 to 37.9 ± 15.7 in those with SCI after 2009 (p < 0.001). Gunshot wounds were the main cause of injury in patients with SCI before 2003, dropping from 40.6 to 16.9% after 2009 and being surpassed by road traffic injuries (38.6%) and falls (31.4%) after 2009 (p < 0.001). Gender, SCI severity and level have not changed significantly over the time. Conclusions: There was a major increase in the average age of patients as well as changes in the etiology of SCI over the past fifteen years, including a significant decrease in gunshot wounds and an increase in the frequency of road traffic injuries and falls. These changes and accompanying risk factors must be taken into consideration when planning measures to prevent SCI.

Comparative analysis of the frequency of lower urinary tract dysfunction among institutionalised and non-institutionalised children

To evaluate the level of symptoms of lower urinary tract dysfunction (LUTD) in orphans in institutions, and compare these data with schoolchildren of the same age group who were not institutionalised, as LUTD in children is related to factors such as social isolation and low self‐esteem, with other psychological changes also being cited, although it is unknown whether these problems are primary or secondary to the symptoms of LUTD.

Lower urinary tract dysfunction in children: what do pre-school teachers know about it?

OBJECTIVEnTo evaluate the basic knowledge of pre-school teachers who deal with children between the ages of 4 and 7 years, who present signs of lower urinary tract dysfunction (LUTD).nnnMATERIALS AND METHODSnWe performed a survey with 50 teachers from 9 private schools working with pre-school children. The criteria for selection were if teachers were certified or non-certified elementary school teachers - NCEST and the amount of professional experience.nnnRESULTSnThirty-three teachers considered that the normal daily urinary frequency should be from 4 to 7 times. Two of the 50 teachers considered it normal to urinate less than 4 times per day and 15 teachers considered more than 7 times per day as normal. There was no difference between the 2 categories of certified or NCEST nor between those with more or less than five years of professional experience. Thirty-three percent believed that to urinate more than 4 times during a class period (4-5 hours) could indicate a urinary problem. There was a statistically significant difference among the certified and NCEST but not in terms of time of professional experience. If during this period the child would not ask to urinate, only 18% considered that as an indication of urinary problem. When asked about the symptoms that would indicate urinary urgency and urge incontinence, only 24% of the teachers connected it with urinary problem. There was no difference in terms of professional background or professional experience in these 2 last analyses.nnnCONCLUSIONnOur data shows evidences that private pre-schools teachers are not well informed of the clinical manifestation of LUTD.

Laparoscopic Renal Surgery in Infants and Children: Is it a Feasible and Safe Procedure for all Pediatric Age Groups?

PURPOSEnAlthough laparoscopy is considered the mainstay for most renal procedures in adults, its role in the pediatric population is still controversial, especially for smaller children. We reviewed our experience in pediatric renal laparoscopic surgery in three pediatric age groups in an attempt to identify if age has an impact on feasibility and surgical outcomes.nnnMATERIALS AND METHODSnFrom November 1995 to May 2006, 144 pediatric laparoscopic renal procedures were performed at our institution. The charts of these patients were reviewed for demographic data, urologic pathology and surgical procedure, as well as perioperative complications and post-operative outcomes. The findings were stratified into 3 groups, according to patient age (A: < 1 year, B: 1 to 5 years and C: 6-18 years).nnnRESULTSnMedian age of the patients was 4.2 years (42 days - 18 years). We performed 54 nephrectomies, 33 nephroureterectomies, 19 upper pole nephrectomies, 11 radical nephrectomies, 22 pyeloplasties and 4 miscellaneous procedures. The 3 age groups were comparable in terms of the procedures performed. Conversion rates were 0%, 1.4% and 1.9% for groups A, B and C, respectively (p = 0.72). Incidence of perioperative complications was 5%, 8.2% and 7.8% for age groups A to C, respectively (p = 0.88).nnnCONCLUSIONSnMost renal procedures can be performed safely by laparoscopy in the pediatric population, with excellent aesthetic and functional outcomes. The morbidity related to the procedure was minimal irrespective of the age group.

About the article: Prevalence of lower urinary tract symptoms in individuals with down syndrome

In the study published by our group, titled ‘Prevalence of lower urinary tract symptoms in individuals with Down syndrome’ (Mrad FCC, et al. J Pediatr Urol 2014; 10:844e9), we found a 27.3% (23/84) prevalence of lower urinary tract symptoms (LUTS) and higher frequency in young males with Down syndrome (DS), and a strong association between LUTS and functional constipation. Four years after collecting the data for that study, we decided to review these 23 patients with DS and LUTS by reapplying the Dysfunctional Voiding Symptom Score (DVSS) [1] adapted and validated for the Brazilian population [2]. We observed that 47.83% (11/23) of these individuals improved their DVSS score and 45.45% (5/11) showed improvement in constipation, using the Rome III criteria [3]. Of these 11 patients, 54.54% (6/11) were male and 45.46% (5/11) female, and all of them were older than 10 years of age at the time of re-evaluation. Therefore, in this reassessment, we observed a reduction in symptoms with an increase in age. These findings are compatible with those of Rihtman et al. [4] who showed that in individuals with DS aged from 6 to 16 years, there is an improvement in motor and cognitive skills, which could therefore lead to a better voiding pattern. Although all families were instructed to seek a pediatric urologist for evaluation and treatment of dysfunctional voiding after the first assessment, none of them did so. Despite this advice, when responding to the DVSS for the second time, many caregivers stated that after participation in the study they began to pay more attention and were more aware of their child’s urinary problem. This was

Impact of the route of clean intermittent catheterization on quality of life in children with lower urinary tract dysfunction

To compare the impact of the different routes for clean intermittent catheterization on the quality of life of children with lower urinary tract dysfunction.

Periurethral muscle-derived mononuclear cell injection improves urethral sphincter restoration in rats

Investigate the effect of a novel cell‐based therapy with skeletal muscle‐derived mononuclear cells (SMDMCs) in a rat model of stress urinary incontinence.