Ubirajara Barroso

Nonpharmacological treatment of lower urinary tract dysfunction using biofeedback and transcutaneous electrical stimulation: a pilot study.

To report a series of children with lower urinary tract dysfunction (LUTD) whose urge syndrome was treated by electrical stimulation, and their voiding dysfunction by biofeedback; none of the children were using anticholinergic drugs during treatment.

Sexual function in teenagers after multimodal treatment of pelvic rhabdomyosarcoma: A preliminary report

OBJECTIVEnThe multimodal approach to treatment of genitourinary rhabdomyosarcoma (RMS) has improved survival rates, but there is now a focus on the effect on quality of life. Our aim was to evaluate erectile function in children with rhabdomyosarcoma (RMS) who underwent chemotherapy, radiotherapy, cystectomy and continent urinary diversion.nnnMATERIAL AND METHODSnWe evaluated four eligible patients (agexa0>xa014 years) from our genitourinary RMS database. In two patients the reservoir was constructed at the same time of the cystectomy and in two after undiversion of an ileal conduit. All patients were treated with chemotherapy and radiation therapy before cystectomy. We used a questionnaire to estimate erectile function in adolescents and young adults. There were four questions, each one to be scored 1-5, assessing capability to masturbate.nnnRESULTSnMean follow up after cystectomy was 9.75 years. We considered that two patients had erections of good quality (scores 18 and 20) and two of moderate quality (scores 8 and 10). One patient had a good response to sildenafil administration.nnnCONCLUSIONnOur data demonstrate that it is possible to keep erectile function during masturbation in children with RMS who have undergone chemotherapy, radiotherapy, cystectomy and continent urinary diversion.

Effects of Urinary Tract Infection in Patients With Bladder Augmentation and Kidney Transplantation

PURPOSEnWe evaluated the rate of function decline of the renal allograft in patients with augmented bladder. We also evaluated the prevalence of asymptomatic bacteriuria and urinary tract infection in these patients, and to demonstrate if these findings are predictors of allograft function decline, comparing children who underwent bladder augmentation with a control group.nnnMATERIALS AND METHODSnAmong 170 children and adolescents undergoing renal transplantation at our institution 23 (14%) had previously undergone bladder augmentation. These patients were retrospectively compared (1:2 ratio) to 42 controls matched for gender, age, race, donor type, weight and immunosuppression protocol. The type of donor (living or cadaver), rate of acute tubular necrosis and cold ischemia time during transplantation were also similar between groups.nnnRESULTSnMean followup was 18.0 +/- 13.9 months and 25.2 +/- 14.1 months for the augmented and nonaugmented bladder groups, respectively (p >0.05). The incidence of acute rejection within the first 12 months of kidney transplantation was 9% in the bladder augmentation group and 26% in controls (p >0.05). The rate of urinary tract infection or asymptomatic bacteriuria in the first 12 months after kidney transplantation was higher in the bladder augmentation group (19 patients, 83%) compared to controls (7 patients, 17%, p <0.001). Patients with augmented bladder had a higher number of hospital admissions (14 patients, 61%) compared to the control group (12 patients, 29%, p = 0.004). Despite the higher incidence of urinary tract infection in the augmented bladder group, there was no statistically significant difference in graft function between the groups at 6 months (1.1 +/- 0.3 mg/dl vs 1.0 +/- 0.3 mg/dl) or 12 months (1.0 +/- 0.2 mg/dl vs 1.2 +/- 0.7 mg/dl) after transplantation.nnnCONCLUSIONSnOur study demonstrated that patients with transplanted kidney and augmented bladder had more asymptomatic bacteriuria and urinary tract infections than those without bladder augmentation. However, the rate of graft survival was similar between the groups.

Transverse testicular ectopia and persistent Mullerian duct syndrome

1477-5131/

Is continent urinary diversion feasible in children under five years of age

34 a 2008 Journal of Pediatric Urology Company. Publishe doi:10.1016/j.jpurol.2008.11.012 unilateral cryptorchidism and a contralateral inguinal hernia. The diagnosis is often made incidentally during surgery. Dean and Shah emphasize the importance of laparoscopy in these cases [3]. Here, we report a case of a young boy with TTE and PMDS preoperatively diagnosed by ultrasound, and in whom treatment was assisted by laparoscopy.

Prenatal diagnosis of bladder exstrophy by fetal MRI

PURPOSEnTo review our clinical experience with urinary continent catheterizable reservoir in children under five years of age.nnnMATERIALS AND METHODSnA total of 23 patients (16 males, 7 females) with a median age of 3.64 years were evaluated. Among these, 6 (26.08%) had a posterior urethral valve, 9 (39.13%) myelomeningocele, 4 (17.39%) bladder exstrophy, 2 (8.69%) genitourinary rabdomyosarcoma, 1 (4.34%) had spinal tumor and 1 (4.34%) an ano-rectal anomaly.nnnRESULTSnPerioperative complications were observed in four patients consisting of one febrile urinary tract infection, one partial operative wound dehiscence, one partial stomal dehiscence and one vesico-cutaneous fistula after a secondary exstrophy repair. The overall long-term complications rate was 40.90% and consisted of two stomal stenoses (9.09%), one neobladder mucosal extrusion (4.54%), three neobladder calculi (13.63%) and persistence of urinary incontinence in three patients (13.63%). The overall surgical revision was 36.36% and final continence rate was 95.45% with mean follow-up of 39.95 monthsnnnCONCLUSIONnContinent urinary diversion is technically feasible even in small children, with acceptable rates of complications.

Initial experience with ‘inverted U’ staged buccal mucosa graft (bracka) for hypospadias repair

PURPOSEnTo review our experience with prenatal diagnosis of bladder exstrophy by fetal magnetic resonance imaging (MRI). Bladder exstrophy can be diagnosed by ultrasonography (US) evaluation of the fetus based on absence of bladder filling, low-set umbilicus, small genitalia and lower abdominal mass, although in some instances more accurate anatomical information is desired.nnnMATERIAL AND METHODSnWe studied three patients at mean gestational age of 27.3 weeks. The fetal MRI exam was performed on axial, sagittal, coronal planes and echo gradient in the best plan for acquisition of fetus. Images were analyzed by a group of three radiologists with experience in fetal MRI.nnnRESULTSnThe MRI defined a lower abdominal mass prolapsing below the umbilical vessels, having the ureters ending on it in an anterior position. A cloacal malformation or a cloacal exstrophy could be excluded, as well as other accompanying spinal abnormalities. The renal system and oligohydramnios could be well documented.nnnCONCLUSIONSnThe MRI showed a detailed scenario of the abnormality with advantages over the US evaluation in regard to excluding cloacal anomalies. MRI allowed accurate sexual differentiation and may be indicated after suspected bladder exstrophy on US evaluation.

The buccal mucosa fenestrated graft for Bracka first stage urethroplasty: experimental study in rabbits

OBJECTIVEnTo describe a modification of the Bracka procedure (inverted U), used to enlarge the graft and diminish the risk of graft contracture compromising the subsequent urethral reconstruction.nnnMATERIAL AND METHODSnInverted U Bracka procedure was performed in 10 children in whom previous hypospadias correction had failed. The surgical steps are identical to the original Bracka procedure. The only modification is reconfiguration to enlarge the graft.nnnRESULTSnSignificant contraction of the graft was not seen in any patient and the second stage was performed uneventfully. After the second surgery there were two complications: one fistula and one wound infection.nnnCONCLUSIONnIn this preliminary study, the modification avoided significant contracture of the graft giving a more predictable size of the neourethra for the second-stage procedure. An amplified series is necessary to confirm this initial result.

Simplified upper pole nephrectomy: initial experience

OBJECTIVEnTo histologically evaluate, in an experimental study in rabbits, the integration process of the buccal mucosa fenestrated graft applied in the corpora cavernosa for Bracka first stage urethroplasty.nnnMATERIALS AND METHODSnA urethral defect was surgically created in 16 male rabbits of the New Zealand breed through the excision of the penile urethra. The urethral defect was corrected by applying buccal mucosa fenestrated graft through two cruciform incisions in the distal portions of its longitudinal axis. The animals were sacrificed at 2, 4, 8 and 12 weeks post surgery and their genitals were subjected to clinical and histological assessment.nnnRESULTSnThe buccal mucosa fenestrated graft showed complete uptake in all groups, with keratinization squamous metaplasia and mucosal proliferation of the fenestrated areas. The fenestrated graft area represented an increase in length of 25 % in length in relation to the original standard graft.nnnCONCLUSIONSnThe fenestrated buccal mucosa graft presented total integration to the adjacent epithelia with re-epithelization of the incision areas of the graft (fenestrations) and no significant inflammatory or scarring reactions when compared to other mucosa transplanted areas; therefore its application is viable in cases of extensive urethral defect whenever the donating area might be insufficient.

Elective appendicovesicostomy in association with monfort abdominoplasty in the treatment of prune belly syndrome

OBJECTIVEnTo assess the results of an upper pole nephrectomy technique on 5 children.nnnMATERIALS AND METHODSnUpper pole nephrectomy was performed on 5 children, including 4 females and 1 male. Age ranged from 3 to 6 years old. The technique was performed without initial dissection of the renal pedicle. The upper pole is incised and removed. Upon its complete dissection, the segment that drains the upper pole is easily identified, clamped and sectioned.nnnRESULTSnThree children with ureterocele and 2 with ectopic ureter underwent this procedure. There was no intra- or postoperative complication with this technique. DSMA scintigraphy showed no decrease in renal function in the remaining kidney following the procedure.nnnCONCLUSIONnThe polar nephrectomy technique is simple, and has the advantage of not approaching the renal hilum, which makes surgery less laborious and prevents risk of renal damage, hemorrhage and decreased function in the remaining renal portion.