Paweł Kroll

An Evaluation of the Efficacy of Selective Alpha-Blockers in the Treatment of Children with Neurogenic Bladder Dysfunction--Preliminary Findings.

The aim of this study was to assess the usefulness of selective α1-blockers in children with neurogenic urinary tract dysfunctions and increased leak point pressure (LPP). 14 children from age 6 to 16 years with neurogenic urinary tract dysfunctions (neurogenic bladder) and LPP > 40 cm H2O were enrolled in the study. All patients received a selective α1-blocker (doxazosin) for 6–8 weeks with an initial dosage of 0.03 mg/kg. During the observation period the continuation of oral anticholinergics, Clean Intermittent Catheterization (CIC), observation of “urinary dryness” and urinary incontinence periods were recommended. Patients were scheduled for a follow-up visit and urodynamic investigation after 6–8 weeks after the doxazosin therapy was started. In 4 patients, urine leakage occurred at lower pressures; in 9 patients, no significant changes in urine leak point pressures were detected; in 3 patients, there was a significant increase in the bladder capacity; in one patient, deterioration in continence was noted. The differences both in LPP and LPV before and after the treatment were not statistically significant. Our observations are consistent with the conclusions from other studies and showed no evident efficacy of doxazosin in children with neurogenic bladder.

Pharmacotherapy for Pediatric Neurogenic Bladder

Neurogenic bladder (NB) is a nonspecific term that may describe conditions ranging from areflectic noncontractile bladder to detrusor overactivity. The most common cause of NB in children is the presence of dysraphic malformations. Urodynamic evaluations make it possible to describe bladder dysfunctions and to plan a therapeutic strategy for each patient. In a child with NB there are two major dangerous functional problems seen in urodynamic investigations: high intravesical pressure in the storage phase and high pressure during urination. The basic goals of urologic treatment for a child with NB are the protection of the urinary tract from complications and improvement of continence. Treatment for a child with NB is usually conservative, and focuses on achieving safe bladder pressures during storage with reliable emptying, via voiding or catheterization. The two most important forms of conservative treatment are clean intermittent catheterization and pharmacological treatment of functional disorders. Some drugs are used in the treatment of functional disorders in children with NB, but none of the drugs are officially approved for small children and babies.

Outcomes of Continuous Renal Replacement Therapy With Regional Citrate Anticoagulation in Small Children After Cardiac Surgery: Experience and Protocol From a Single Center.

Patients after a cardiac surgery in cardiopulmonary bypass often present an acute kidney failure. Continuous renal replacement therapy (CRRT) is often required. The aim of this study was to present effectiveness and safety of CRRT with regional citrate anticoagulation (RCA‐CRRT) in small children after cardiac surgery. A retrospective analysis was conducted on 15 patients after cardiac surgery and who had RCA‐CRRT performed in 2014. The established protocol was followed. Mean time on the RCA‐CRRT was 192 h 40 min with the circuit mean lifetime of 43 h 33 min. Clotting was found to be a cause of shutdown in 29% of circuits. No severe electrolyte and metabolic disorders were observed. The RCA‐CRRT is a safe procedure for critically ill children with contraindications to the CRRT with heparin anticoagulation. To avoid adverse effects related to metabolic disorders a proper procedure protocol has to be followed.

The endoscopic Botulinum toxin-A injections in equally efficient in the treatment of neurogenic bladder dysfunctions in children in different age groups. Single centre experience after more than 550 procedures.

To evaluate the usefulness of cystoscopic injections of Botulinum-A toxin (BTX) in the detrusor wall in the treatment of children with decreased bladder capacity due to the neurogenic bladder. A prospective, randomized non placebo controlled trial has been conducted in our institution since 2006 with the approval of the local Ethics Committee. 556 cystoscopic injections of BTX were performed in 141 children aged 1 to 18 with a neurogenic bladder. In all cases decreased bladder capacity and bladder overactivity with urine incontinence were estimated. The pre-and post-treatment evaluations included determination of the urinary continence status, the bladder function in a frequency/volume chart of catheterized urine and in urodynamic studies. Parameters measured in urodynamic investigations included the maximum cystometric capacity, the detrusor reflex volume, the maximum detrusor pressure. Parameters were analyzed before the cystoscopy and during follow-up examinations. Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 23 July 2018 doi:10.20944/preprints201807.0424.v1

Does fibrin sealant applied to the kidney wound of a young rat affect the development of this organ? A comparative study

Abstract Objective: The aim of the study was to compare the results of the application of fibrin sealant and absorbable interrupted sutures and to evaluate the impact of the kidney wound closure method on the further development of the organ in young rats. Materials and methods: In 140 rats, a longitudinal bipolar incision of the renal parenchyma was made. In the study group the wound was closed using a fibrin sealant, whereas in the control group single absorbable sutures were applied to the renal parenchyma. Intravenous pyelography, postmortem and histopathological examinations were carried out 4 weeks and 6 months after the surgery. Results: The blood loss was smaller and the time of procedure shorter in the study group than in controls, and the differences were statistically significant. Both 4 weeks and 6 months after the surgery, the differences in the kidney dimensions and kidney weight between the two groups were statistically significant. The differences increased after a longer period of time following the surgery. The histopathological examination revealed that in the case of animals with surgical sutures applied to the wound, the rate of resorptive granulomas and abscess formation was higher, whereas kidneys with fibrin sealant applied to the wound featured a high number of lymphocytic infiltrations of minor severity. Conclusions: The application of the fibrin sealant simplified the surgical procedure, shortened its duration, and provided hemostasis and permanent closure of the wound. The fibrin sealant facilitates the process of wound healing. The application of a fibrin sealant, compared to surgical sutures, improved the growth of rat kidneys without impairing their functions.

Erratum to: Normal-range albuminuria does not exclude nephropathy in diabetic children

Erratum to: Pediatr NephrolDOI 10.1007/s00467-010-1443-zIt has come to our attention that the reported NGAL levelsare 10-fold higher than those reported by other researchers.This is best seen from the normal values reported inTable 1. Inaccurate data is due to a decimal mistake. Allreported serum and urine values for NGAL have to bedivided by 10.