Ramnath Subramaniam

Making the diagnosis of biliary atresia using the triangular cord sign and gallbladder length.

Abstract.Background. To evaluate the accuracy and utility of the triangular cord sign and gallbladder length in diagnosing biliary atresia by sonography.¶Materials and methods. Sixty fasted infants with cholestatic jaundice aged 2–12 weeks were examined sonographically using a 5–10 MHz linear array transducer, focusing on the triangular cord sign (as described by Choi et al. [1]), the gallbladder, and ducts. The triangular cord is defined as a triangular or tubular echogenic density seen immediately cranial to the portal vein bifurcation; it represents the fibrotic remnant of the obliterated cord in biliary atresia. The findings were blinded to blood chemistry, 99 mTc-DISIDA hepatobiliary scintigraphy, and liver biopsy. Diagnosis of biliary atresia was confirmed at surgery and histology. Non-biliary atresia infants resolved medically. Comparative charges of the various investigations was made.¶Results. Twelve infants had biliary atresia, and ten demonstrated a definite triangular cord. The two false-negatives had small or nonvisualized gallbladders. No false-positives were recorded. Gallbladder length ranged from 0–1.45 cm with a mean of 0.52 cm in biliary atresia compared to a mean of 2.39 cm in nonbiliary atresia infants. 99 mTc-DISIDA hepatobiliary scintigraphy showed no excretion (false-positive) in 23 % of nonbiliary atresia cases. Scintigraphy and liver biopsy charges were 2 and 6 times that of sonography, respectively.¶Conclusion. The triangular cord sign and gallbladder length together are noninvasive, inexpensive, and very useful markers for biliary atresia.

Tissue engineering potential of urothelial cells from diseased bladders.

PURPOSE We examined the suitability of urothelium from patients with abnormal bladders for use in surgical reconstruction using a tissue engineering approach that would require autologous urothelium to be expanded by propagation in cell culture. MATERIALS AND METHODS Resection specimens from 8 children (median age 9.8 years) with abnormal bladders (neuropathic in 4, posterior urethral valves in 2, epispadias in 1, nonneurogenic in 1) were collected with informed parental consent during planned urological procedures. Six patients had recurrent urinary tract infections and 7 underwent frequent intermittent catheterization. A representative sample was immunohistologically processed to assess urothelial proliferation and differentiation status, and the remaining 7 cases were processed for urothelial cell culture. Five normal adult urothelial samples were included as controls. RESULTS Immunohistological assessment indicated that 3 of 8 samples lacked urothelial differentiation associated expression of UPK3a or CK20. Four of 7 samples resulted in successful primary culture, with 1 sample lost to underlying infection and 2 not surviving in culture. All 4 cultures grew beyond passage 3 before senescence but all showed reduced proliferation capacity and a compromised ability to form a barrier urothelium compared to controls. CONCLUSIONS While normal human urothelium is highly regenerative and derived cells are highly proliferative in culture, our results with urothelium from abnormal pediatric bladders indicate a reduced capacity for proliferation and differentiation in vitro. This finding may indicate a need to identify alternative cell sources for engineered bladder reconstruction.

Sutureless circumcision: a prospective randomised controlled study

Our aim was to study the advantages of glue versus sutures for circumcision in children. A randomised prospective controlled study was conducted with 152 boys; glue was used on 80 and sutures on 72). The procedures were quicker and the duration and severity of postoperative pain were significantly less (p<0.001) in the cases in which glue was used. The tissue glue is a perfectly feasible alternative to sutures for circumcision in children and has potentially significant advantages.

Paediatric sutureless circumcision: a systematic literature review

Circumcision can be undertaken using a variety of techniques. For the technique to be successful, it should be easy to perform, avoid excessive haemorrhage and achieve a good cosmetic and functional result with minimal postoperative care. Naturally, there are differences between circumcision in the paediatric and adult populations and here we review the literature on recent advances that have been made in paediatric circumcision and the use of a sutureless technique with tissue glue for wound approximation.

Metastatic Crohn's disease: Two cases of penile Crohn's and literature review

Crohns disease is a chronic granulomatous inflammatory bowel disorder, often associated with cutaneous manifestations, termed metastatic Crohns. Here we present two cases of paediatric metastatic Crohns disease involving the penis, focusing on clinical presentation, histological diagnosis and treatment.

The Use of an Antegrade Continence Enema Stopper in Catheterizable Channels Virtually Eliminates the Incidence of Stomal Stenosis: Preliminary Experience

PURPOSE We report the effectiveness of an antegrade continence enema stopper device in preventing stomal stenosis in catheterizable channels. MATERIALS AND METHODS All cases in which a channel was created for clean intermittent catheterization during a 5-year period beginning in May 2002 were included in the analysis. For the first 31 months the catheterizable channels were used for clean intermittent catheterization but were not kept patent between catheterizations (group 1, 19 patients). For the next 29 months we began to use an antegrade continence enema stopper in the stoma between catheterizations for a period of 3 to 6 months postoperatively (group 2, 14 patients). RESULTS A total of 33 catheterizable channels were studied. Six catheterizable channels in group 1 (32%) had to be revised within 6 months of reconstruction. No catheterizable channel in group 2 had to be revised. This difference is statistically significant (p = 0.02). CONCLUSIONS An antegrade continence enema stopper inserted into the catheterizable channel for 3 to 6 months postoperatively effectively eliminates the incidence of stomal stenosis.

Orchidopexy patterns in Austria from 1993 to 2009

OBJECTIVE To evaluate orchidopexy patterns in Austria. MATERIAL AND METHODS All boys with cryptorchidism who underwent orchidopexy (n = 19.998) in Austria between 1993 and 2009 were analyzed using the database Austrian Health Information System at the Austrian Federal Research and Planning Institute for Health Care. Regression models were constructed to examine associations between the probability of orchidopexy before 24 months of life and the following parameters: year of birth, federal state of residence, character of area of living (rural/urban) and hospital type. RESULTS Average age at operation dropped from 6 to 4.3 years (mean 5.2 years, SD 3.8 years). Total incidence of orchidopexy was continuously rising throughout the study period (p < 0.0001), with an OR of 1.007 (95% C.I.: 1.004; 1.0100) per year. The rate of operations between 0 and 2 years (p < 0.001) and 3-7 years (p < 0.001) increased, while the rate in boys older than 7 years decreased (p < 0.001). Year of birth (p < 0.0001) and place of residence (p < 0.0001 and p < 0.024) are significant predictors for having early orchidopexy. CONCLUSION In Austria the total incidence of orchidopexy is significantly rising. Moreover, the incidence of orchidopexies performed before 24 months of life is constantly rising with significant geographic differences.

Nonobstructive urinary tract dilatation in children with diabetes insipidus

We report 4 boys with diabetes insipidus associated with renal impairment and hydroureteronephrosis. The high flow states caused the bladder to become trabeculated in the absence of infravesical obstruction. Urodynamics have shown the bladder itself to be compliant, but drainage is poor leading to further renal impairment and overflow incontinence. All 4 boys have been managed with cystostomy button drainage and have done well on close follow-up.

Management of high-flow priapism in paediatric patients: a case report and review of the literature.

Priapism is rare in the paediatric population and hence there is little consensus as to appropriate management strategies. This is a report of a case of high-flow priapism in a 9-year-old boy managed expectantly. A review of the literature found 52 previously published cases. This report highlights the diagnostic problems and examines the safety and effectiveness of expectant management in the paediatric population.

Abstracts presented at the European Society for Pediatric Urology (ESPU) meetings (2003–2010): Characteristics and outcome

OBJECTIVE To determine the characteristics and outcome of abstracts presented to the meetings of the European Society for Pediatric Urology (ESPU). MATERIAL AND METHODS Abstract books from 2003 to 2010 were reviewed and subsequent publication of presented abstracts determined by MEDLINE/PubMed search. RESULTS Of 1194 abstracts, 50-78% per year originated from 15 to 20 European countries and 50-22% from 8 to 13 non-European countries; 233 (19%) were basic science and 961 (81%) clinical. Clinical abstracts included 135 (14%) multicenter/prospective/randomized trials. These figures did not change significantly over time. A total of 564 (47%) abstracts were subsequently published, 65% within 1 year of the meeting, mostly in the Journal of Urology (33%) and the Journal of Pediatric Urology (21%). Multicenter/prospective/randomized trials studies (OR 2.03; 95% CI 1.37-2.96) and abstracts originating from outside Europe (OR 1.61; 95% CI 1.26-2.05) were significantly more likely to be subsequently published in full. CONCLUSION The ESPU meetings are a true occasion for international exchange of scientific endeavors. Almost half of the abstracts are subsequently published. The Journal of Urology and the Journal of Pediatric Urology are consistently the two major target journals for publication. Non-European countries, irrespective of whether English-speaking or not, seem significantly more likely to publish their abstracts.