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Severe kidney dysfunction in a child who presented with constipation: Answers. Pediatr Nephrol 2021; 36:4079-4082. [PMID: 34331130 DOI: 10.1007/s00467-021-05189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
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Sulkowski JP, Nacion KM, Deans KJ, Minneci PC, Levitt MA, Mousa HM, Alpert SA, Teich S. Sacral nerve stimulation: a promising therapy for fecal and urinary incontinence and constipation in children. J Pediatr Surg 2015; 50:1644-7. [PMID: 25858097 DOI: 10.1016/j.jpedsurg.2015.03.043] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/07/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study describes our series of children with bowel and bladder dysfunction (BDD) treated with sacral nerve stimulation in order to begin to identify characteristics associated with better outcomes and guide future therapies. METHODS Between May 2012 and February 2014, 29 patients were evaluated before and after sacral nerve stimulator (SNS) placement. A prospective data registry was developed that contains clinical information and patient-reported measures: Fecal Incontinence Qualify of Life Scale, Fecal Incontinence Severity Scale, PedsQL Gastrointestinal Symptom Scale, and Vancouver DES Symptom Scale. RESULTS The median age of patients was 12.1 (interquartile range: 9.4, 14.3) years and the median follow-up period was 17.7 (12.9, 36.4) weeks. 93% had GI complaints and 65.5% had urinary symptoms while 7% had urologic symptoms only. The most common etiologies of BBD were idiopathic (66%) and imperforate anus (27%). Five patients required reoperation due to a complication with battery placement. Six of 11 patients (55%) with a pre-SNS cecostomy tube no longer require an antegrade bowel regimen as they now have voluntary bowel movements. Ten of eleven patients (91%) no longer require anticholinergic medications for bladder overactivity after receiving SNS. Significant improvements have been demonstrated in all four patient-reported instruments for the overall cohort. CONCLUSIONS Early results have demonstrated improvements in both GI and urinary function after SNS placement in pediatric patients with bowel and bladder dysfunction.
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Affiliation(s)
- Jason P Sulkowski
- Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH; Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH
| | - Kristine M Nacion
- Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH; Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH; Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH
| | - Hayat M Mousa
- Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Seth A Alpert
- Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH; Division of Pediatric Urology, Department of Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Steven Teich
- Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH.
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Dwyer ME, Reinberg YE. The Dysfunctional Elimination Syndrome in Children—Is Sacral Neuromodulation Worth the Trouble? J Urol 2012; 188:1076-7. [PMID: 22901582 DOI: 10.1016/j.juro.2012.07.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Al Badr W, Al Bader S, Otto E, Hildebrandt F, Ackley T, Peng W, Xu J, Li J, Owens KM, Bloom D, Innis JW. Exome capture and massively parallel sequencing identifies a novel HPSE2 mutation in a Saudi Arabian child with Ochoa (urofacial) syndrome. J Pediatr Urol 2011; 7:569-73. [PMID: 21450525 PMCID: PMC3157539 DOI: 10.1016/j.jpurol.2011.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
We describe a child of Middle Eastern descent by first-cousin coupling with idiopathic neurogenic bladder and high-grade vesicoureteral reflux at 1 year of age, whose characteristic facial grimace led to the diagnosis of Ochoa (urofacial) syndrome at age 5 years. We used homozygosity mapping, exome capture and paired-end sequencing to identify the disease causing mutation in the proband. We reviewed the literature with respect to the urologic manifestations of Ochoa syndrome. A large region of marker homozygosity was observed at 10q24, consistent with known autosomal recessive inheritance, family consanguinity and previous genetic mapping in other families with Ochoa syndrome. A homozygous mutation was identified in the proband in HPSE2: c.1374_1378delTGTGC, a deletion of 5 nucleotides in exon 10 that is predicted to lead to a frameshift followed by replacement of 132 C-terminal amino acids with 153 novel amino acids (p.Ala458Alafsdel132ins153). This mutation is novel relative to very recently published mutations in HPSE2 in other families. Early intervention and recognition of Ochoa syndrome with control of risk factors and close surveillance will decrease complications and renal failure.
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Affiliation(s)
- Wisam Al Badr
- Division of Nephrology, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
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Cameron A, Fenner DE, DeLancey JOL, Morgan DM. Self-report of difficult defecation is associated with overactive bladder symptoms. Neurourol Urodyn 2011; 29:1290-4. [PMID: 20127839 DOI: 10.1002/nau.20839] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS The association of dysfunctional bowel elimination with lower urinary tract symptoms is well known in children, but not in adults. It was our objective to assess lower urinary tract symptoms (LUTS) in women who report difficult defecation (DD). METHODS This is a secondary analysis of 2,812 women, aged 35-64, who participated in a telephone interview. All subjects were asked "When you move your bowels, does the stool come out easily?" DD was considered present in those answering "no." All subjects were queried regarding LUTS, urinary infections in the past year, self-perceived health status, medical history, and demographics. Symptoms of stress incontinence (five items), urge incontinence (five items), and the impact of these symptoms on their quality of life were solicited from subjects reporting more than 12 episodes of incontinence in 1 year. RESULTS DD was reported by 10.4% (290/2,790) of women. Women with DD had higher LUTS than those who did not: nocturia (mean 1.8 ± 0.1 vs. 1.3 ± 0.0), urgency (47.6% vs. 29.2%), increased daytime frequency (mean 8.2 ± 0.3 vs. 7.2 ± 0.1), dysuria (22.9% vs. 13.7%), and a sensation of incomplete bladder emptying (55.6% vs. 28.2%). DD women were more often menopausal, reported a fair or poor self-reported health status, and had a higher number of comorbidities, less formal education, and lower annual household income. CONCLUSIONS Women with symptoms of DD have an increased rate of LUTS, consistent with the diagnosis of overactive bladder without incontinence. The pathophysiology underlying this association is worthy of future research.
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Affiliation(s)
- Anne Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-5330, USA.
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Derbent M, Melek E, Arman A, Uçkan S, Baskin E. Urofacial (ochoa) syndrome: can a facial gestalt represent severe voiding dysfunction? Ren Fail 2010; 31:589-92. [PMID: 19839856 DOI: 10.1080/08860220903003370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Urofacial (Ochoa) syndrome is a rare autosomal-recessive disorder that features an unusual "inverted" facial expression, such that patients appear to be crying when they smile. This syndrome also involves serious urinary tract disorders, though the diagnosis may be missed because of variability of these problems and failure to recognize the characteristic facial grimacing. The urinary issues usually result in enuresis, urinary tract infection, and hydronephrosis, and some severely affected patients become hypertensive and progress to end-stage renal disease. Early diagnosis is very important for management of urinary problems and best prognosis in these patients. We report the first published case of urofacial syndrome in Turkey. The patient was diagnosed at 16 years of age, after having been followed with the diagnosis of recurrent urinary tract infection and vesico-ureteral reflux. Physicians should keep this syndrome in mind for any patient who presents with dysfunctional voiding, particularly in countries with high rates of consanguineous marriage.
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Affiliation(s)
- Murat Derbent
- Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey.
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Roth TJ, Vandersteen DR, Hollatz P, Inman BA, Reinberg YE. Sacral Neuromodulation for the Dysfunctional Elimination Syndrome: A Single Center Experience With 20 Children. J Urol 2008; 180:306-11; discussion 311. [DOI: 10.1016/j.juro.2008.03.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Pam Hollatz
- Pediatric Urology, Pediatric Surgical Associates, Minneapolis, Minnesota
| | - Brant A. Inman
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Yuri E. Reinberg
- Pediatric Urology, Pediatric Surgical Associates, Minneapolis, Minnesota
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Affiliation(s)
- Abiodun A Omoloja
- Nephrology Department, The Children's Medical Center, Dayton, Ohio, USA
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Humphreys MR, Vandersteen DR, Slezak JM, Hollatz P, Smith CA, Smith JE, Reinberg YE. Preliminary Results of Sacral Neuromodulation in 23 Children. J Urol 2006; 176:2227-31. [PMID: 17070300 DOI: 10.1016/j.juro.2006.07.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Indexed: 10/24/2022]
Abstract
PURPOSE Sacral nerve stimulation with InterStim is approved in the United States for use in adults. Limited data on the effectiveness of sacral nerve stimulation in children are available. We report our experience with patients who underwent InterStim placement for the treatment of severe dysfunctional elimination syndrome, which is defined as a constellation of functional urinary and gastrointestinal symptoms in patients without anatomical anomalies or obvious neurological disease, in whom intensive medical and behavioral therapies have failed to improve symptoms. MATERIALS AND METHODS A total of 23 patients 6 to 15 years old with presenting symptoms of dysfunctional voiding, enuresis, incontinence, urinary tract infections, bladder pain, urinary retention, urgency, frequency, constipation and/or fecal soiling were followed for a mean of 13.3 months after InterStim placement. RESULTS Of the 19 patients with urinary incontinence 3 (16%) had complete resolution, 13 (68%) had improvement, 2 (11%) were unchanged and 1 (5%) was worse (sign test, p = 0.002). Among the 16 patients with nocturnal enuresis 2 (13%) had resolution, 9 (56%) improved, 4 (25%) were unchanged and 1 (6%) was worse (sign test, p = 0.0063). Of the 15 patients with urinary retention requiring intervention 9 (60%) had improvement and 1 had worsening symptoms (sign test, p = 0.022), while 2 of 6 patients (33%) on intermittent catheterization were able to stop. One patient had development of new incontinence and enuresis. Bladder pain, urgency, frequency and constipation improved in 67% (8 of 12), 75% (12 of 16), 73% (11 of 15) and 80% (12 of 15) of the patients, respectively. Medications required postoperatively decreased by an average of 3 per patient (p < 0.001). The overall patient satisfaction rate was 64%, while that of the caregiver was 67%. Two leads were explanted from the 23 patients. Complications encountered included 1 seroma, 1 episode of skin sensitivity, 2 device failures and 1 lead revision. CONCLUSIONS Sacral nerve stimulation in children is an option for carefully selected patients who have failed other therapies. Our results show that sacral nerve stimulation was effective in the majority of patients with the dysfunctional elimination syndrome. However, longer followup is needed.
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Nicanor FA, Cook A, Pippi-Salle JL. Early diagnosis of the urofacial syndrome is essential to prevent irreversible renal failure. Int Braz J Urol 2006; 31:477-81. [PMID: 16255797 DOI: 10.1590/s1677-55382005000500012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Accepted: 07/25/2005] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The urofacial or Ochoa syndrome is a rare disease characterized by the presence of functional obstructive uropathy associated with peculiar facial features when patients attempt to smile or laugh. Unfortunately, many of these patients remain without proper diagnosis or adequate treatment due to lack of recognition of the disease. This can ultimately result in upper tract deterioration and eventual renal failure. We present our experience with this rare syndrome. MATERIALS AND METHODS We identified 3 patients who presented initially with acute renal failure, urinary tract infection (UTI) and severe dysfunctional elimination. All patients were thoroughly evaluated, including screening for spinal cord anomalies, and were subsequently diagnosed with urofacial syndrome. RESULTS At the outset, the two older patients (aged 4 and 9 years) presented with the typical facial features when attempting to smile or laugh. One patient in the newborn period presented with urinary and fecal retention and septicemia and, to our knowledge, represents the youngest case of urofacial syndrome reported so far. All patients were evaluated with ultrasonography, renal scan, voiding cystourethrogram (VCUG) and urodynamics. Findings included hydronephrosis and a thick-walled, trabeculated bladder with poor compliance and detrusor hypereflexia respectively in each patient. All were subsequently treated with clean intermittent catheterization (CIC), antibiotic prophylaxis and anticholinergic therapy. One patient required appendicovesicostomy for CIC due to discomfort secondary to a sensate urethra. CONCLUSIONS Our series demonstrates that early recognition of this rare syndrome is necessary to adequately treat and prevent upper tract deterioration in these unique individuals. Although the urofacial is difficult to diagnose in infants, cognizance must be maintained in order to prevent severe subsequent sequalae.
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Affiliation(s)
- Francisco A Nicanor
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Abstract
Several neuromodulatory options are available for selected children who have voiding dysfunction resistant to conventional therapy. Integral to all types of treatment is an educated team that reinforces progress rather than cure and encourages long-term behavioral changes.
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Affiliation(s)
- Ahmad H Bani-Hani
- Department of Urology, Mayo Graduate School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55901, USA
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Abstract
The practicing urologist commonly sees children with lower-urinary tract dysfunction who wet or have recurrent urinary tract infections. This article identifies the proposed etiologies of such behavior in children in whom there are no anatomic or neuropathic causes, outlines the approach to evaluating affected children, and describes a stepwise,interdisciplinary approach to treatment.
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Affiliation(s)
- Seth L Schulman
- Dysfunctional Outpatient Voiding Center, Division of Urology, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Affiliation(s)
- Linda S Nield
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
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Balat A, Sarica K, Cekmen M, Yürekli M, Yağci F, Erbağci A. Adrenomedullin and nitric oxide in children with detrusor instability. Pediatr Nephrol 2003; 18:422-5. [PMID: 12687457 DOI: 10.1007/s00467-003-1125-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2002] [Revised: 01/06/2003] [Accepted: 01/07/2003] [Indexed: 11/26/2022]
Abstract
Detrusor instability (DI) and detrusor-external sphincter dyssynergia lead to poor bladder emptying and high bladder pressure. Recent results indicate that nitric oxide (NO) is an important transmitter or messenger molecule in autonomic neurotransmission. Adrenomedullin (AM) is a potent vasodilator and natriuretic peptide, originally purified from human pheochromocytoma. Since NO and AM have vasodilatory effects on smooth muscles, we considered them to be of interest in children with DI. We determined the tissue levels of NO and AM in 14 children with DI, and compared these with 6 children with normal bladder activity. Bladder biopsy total nitrite levels (nmol/g tissue) were decreased in children with DI (10.69+/-0.91 vs. 12.83+/-0.98, P<0.01). However, AM levels (pmol/g tissue) were increased in the same patients (48.84+/-3.52 vs. 28.79+/-1.53, P<0.001). According to our results, decreased NO production probably has a role in the pathophysiology of DI, although increased AM appears to be compensatory. NO may provide a therapeutic target in clinical situations related to DI. However, the functional significance of AM and NO in bladder smooth muscle remains to be determined by further detailed studies.
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Affiliation(s)
- Ayşe Balat
- Department of Pediatric Nephrology, Medical Faculty, Gaziantep University, Turkey.
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