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Gupta A, Bajpai M, Anand S, Ali A. Preoperative and postoperative urinary NGAL levels in children with bladder exstrophy. J Nephrol 2023; 36:1409-1414. [PMID: 36562911 DOI: 10.1007/s40620-022-01548-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Urinary NGAL (neutrophil gelatinase-associated lipocalin) levels have been shown to predict renal damage in various medical conditions. The present study was conducted to study the role of urinary NGAL levels in children with bladder exstrophy-epispadias complex post single-stage total reconstruction (SSTR) as markers of early renal function reduction. METHODS Urine samples were collected from children with bladder exstrophy before SSTR (Group A, n = 11), 5 years post SSTR (Group B, n = 40) and controls (Group C, n = 41) and stored at - 20 °C. NGAL levels were estimated using double antibody sandwich ELISA. RESULTS Mean NGAL levels in Groups A, B and C were 1.39, 34.24 and 2.58 ng/ml, respectively. Mean NGAL levels among Group B subjects with glomerular filtration rate (GFR) ≥ 80 ml/min/1.73 m2 body surface area (BSA) was 29.8 ng/ml, while it was 31.74 ng/ml in those with GFR < 80 ml/min. Urine samples were also evaluated 6 months post SSTR. Mean NGAL at 6 months was 6.76 ng/ml, while at 12 months it was 30.3 ng/ml, remaining > 30 ng/ml at 18 and 24 months. Dimercaptosuccinic acid (DMSA) scans did not show any scarring, and GFR on diethylenetriamine pentaacetate (DTPA) scans remained stable. CONCLUSIONS Increasing levels of urinary NGAL following bladder-exstrophy and epispadias complex repair suggest that NGAL detects the earliest signs of renal damage even before any deterioration is observed in DMSA and/or DTPA-GFR scans. Further studies with an adequate sample size and periodic measurement of NGAL need to be performed before any definitive conclusion can be drawn.
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Affiliation(s)
- Alisha Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Abid Ali
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Sabetkish S, Sabetkish N, Kajbafzadeh AM. Early detection of deep wound infection in bladder exstrophy and hypospadias using a novel intervention. J Wound Care 2019; 27:686-691. [PMID: 30332360 DOI: 10.12968/jowc.2018.27.10.686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To introduce a practical technique for the early detection and prompt management of a probable bladder dehiscence (BD) and glanular dehiscence (GD) in patients with bladder exstrophy epispadias complex (BEEC) and hypospadias. METHOD In this prospective study, paediatric patients with BEEC (group 1) and with proximal hypospadias (group 2) underwent body temperature measurement using a non-contact infrared radiant digital temperature measurement device in four body regions, including the surgical wound, forehead, right hand, and right foot at eight hour intervals, postoperatively. This technique was performed to detect wound temperature rises before whole body temperature rise or visible local wound skin redness, cellulitis or any sign of inflammation or wound dehiscence (WD). RESULTS A total of 24 paediatric patients were recruited. Temperature rise in the surgical wound area was discovered in two patients with BEEC. The temperature reached 39.2°C in the first case (12 days postoperative) and 39.4°C in the second case (16 days postoperative). Urinalysis, urine culture, and clean surgical wound sampling was performed and the presence of Gram-positive microorganisms was detected. Both patients were managed with intravenous imipenem and vancomycin. After changing the antibiotic regimen, wound temperature was gradually decreased to 37.2°C in the first patient by day 16, and to 36.9°C in the second patient by day 21, without rise in body temperature. Other patients in group 1 and all patients in group 2 had normal wound temperature fluctuations within the follow-up period. CONCLUSION Postoperative periodical temperature measurement by a non-contact infrared radiant digital temperature measurement device is a safe and feasible technique that has the ability to detect deep wound infection, and may prevent the occurrence of WD before any visible sign of inflammation.
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Affiliation(s)
- Shabnam Sabetkish
- Nurse; Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Abdol-Mohammad Kajbafzadeh
- Professor of Pediatric Urology; Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
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Sunil K, Gupta A, Chaubey D, Pandey A, Kureel SN, Verma AK. Technique of Antireflux Procedure without Creating Submucosal Tunnel for Surgical Correction of Vesicoureteric Reflux during Bladder Closure in Exstrophy. J Indian Assoc Pediatr Surg 2018; 23:70-73. [PMID: 29681696 PMCID: PMC5898207 DOI: 10.4103/jiaps.jiaps_81_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy. Materials and Methods: Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status. Results: At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one. Conclusions: The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction.
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Affiliation(s)
- Kanoujia Sunil
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Archika Gupta
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Digamber Chaubey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anand Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shiv Narain Kureel
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar Verma
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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Arab HO, Helmy TE, Abdelhalim A, Soltan M, Dawaba ME, Hafez AT. Complete Primary Repair of Bladder Exstrophy: Critical Analysis of the Long-term Outcome. Urology 2018; 117:131-136. [PMID: 29649545 DOI: 10.1016/j.urology.2018.03.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/16/2018] [Accepted: 03/24/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To demonstrate the long-term outcome of a contemporary series of 64 children who underwent complete primary repair of bladder exstrophy (CPRE) in a single tertiary referral center. MATERIALS AND METHODS Between 1998 and 2012, 64 children, 47 boys and 17 girls, were identified. Only 60 of the 64 cases were available for follow-up. The follow-up was done by renal bladder ultrasound and serum creatinine every 3 months and voiding cystourethrogram from 6 to 12 months postoperatively. Continence was defined as dryness ≥3 hours. RESULTS Median (range) follow-up is 14 years (from 5 to 19 years). Voided continence was achieved in 14 children (23%) after CPRE only. Additionally, 6 children were continent after bladder neck reconstruction (BNR) and 2 after bladder neck injection (BNI), raising the percentage of voided continence to 36%. The remaining 38 (64%) patients were using clean intermittent catheterization. All cases were continent at last assessment. The results of BNR or BNI were better in de novo than in redo cases (P <.05). The percentage of cases that needed augmentation ileocystoplasty in combination with multiple bladder neck procedures was lower in both female and de novo cases (P <.05). CONCLUSION The percentage of children with classic bladder exstrophy who underwent CPRE who will achieve continence with volitional voiding via the urethra is 36%. The continence results after BNR and BNI are better in de novo cases than in redo ones. Continence in female and de novo cases is more likely to be achieved with lower number of continence procedures.
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Affiliation(s)
- Hesham O Arab
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Tamer E Helmy
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Abdelhalim
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Soltan
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed E Dawaba
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ashraf T Hafez
- Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Sabetkish N, Sabetkish S, Kajbafzadeh AM. Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size. Int Braz J Urol 2018; 44:591-599. [PMID: 29368874 PMCID: PMC5996800 DOI: 10.1590/s1677-5538.ibju.2017.0196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/12/2017] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the role of high-barrier plastic wrap in reducing the number and size of polyps, as well as decreasing the inflammation and allergic reactions in exstro- phy cases, and to compare the results with the application of low-barrier wrap. Materials and Methods Eight patients with bladder exstrophy-epispadias complex (BEEC) that had used a low density polyethylene (LDPE) wrap for coverage of the exposed polypoid bladder in preoperative care management were referred. The main complaint of their parents was increase in size and number of polyps. After a period of 2 months using the same wrap and observing the increasing pattern in size of polyps, these patients were recommended to use a high-barrier wrap which is made of polyvinylidene chloride (PVdC), until closure. Patients were monitored for the number and size of polyps before and after the change of barriers. The incidence of para-exstrophy skin infection/inflammation and skin allergy were assessed. Biopsies were taken from the polyps to identify histopathological characteristics of the exposed polyps. Results The high barrier wrap was applied for a mean ± SD duration of 12±2.1 months. Polyps' size and number decreased after 12 months. No allergic reaction was detected in patients after the usage of PVdC; three patients suffered from low-grade skin allergy when LDPE was applied. Also, pre-malignant changes were observed in none of the patients in histopathological examination after the application of PVdC. Conclusion Polyps' size and number and skin allergy may significantly decrease with the use of a high-barrier wrap. Certain PVdC wraps with more integrity and less evaporative permeability may be more “exstrophy-friendly”.
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Affiliation(s)
- Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Shabnam Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
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Panda SS, Bajpai M, Singh A, Chand K. Intra thoracic migration of ureteric stent after exstrophy bladder closure: Unusual complication. Afr J Paediatr Surg 2015; 12:98-9. [PMID: 25659564 PMCID: PMC4955482 DOI: 10.4103/0189-6725.151006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Classic bladder exstrophy is a rare malformation of the genitourinary tract requiring surgical intervention either one-staged or staged fashion. Premature stent dislodgement is a well-known reported complication. We are reporting an unusual case of migration of ureteric stent to thoracic cavity leading to the pleural effusion and respiratory distress in early post-operative period.
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Affiliation(s)
| | - Minu Bajpai
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Elsayed ER, Alam MN, Sarhan OM, Elsayed D, Eliwa AM, Khalil S. Closure of bladder exstrophy with a bilateral anterior pubic osteotomy: Revival of an old technique. Arab J Urol 2011; 9:203-6. [PMID: 26579298 PMCID: PMC4150575 DOI: 10.1016/j.aju.2011.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/18/2011] [Accepted: 08/25/2011] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the results of simple closure using bilateral anterior pubic osteotomy to achieve a tension-free approximation of the pubis and abdominal wall in patients with bladder exstrophy. Patients and methods A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3–47 months). Of these patients, three had recurrent exstrophy while 10 were operated primarily. An elective surgical technique was used for all patients, which included dissection of the exstrophic bladder from the abdominal wall, closure of the bladder and reconstruction of the urethra, then dissection of the rectus muscle and sheath lateral to the attachment of muscle to pubic bone, which makes osteotomy of the superior pubic ramus easy, thus facilitating closure. Results For closure of the bladder and anterior abdominal wall the results were excellent for all patients soon after surgery, but there was soft-tissue infection in two patients. Of all 15 patients, one had incomplete bladder dehiscence and another had a vesico-cutaneous fistula; both needed surgical intervention later. Conclusions Simple closure with anterior pubic osteotomy is a feasible and effective means to facilitate both bladder and abdominal closure for patients with bladder exstrophy. It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.
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Affiliation(s)
- Ehab R Elsayed
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed N Alam
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Osama M Sarhan
- Urology and Nephrology Centre, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Diab Elsayed
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M Eliwa
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Salem Khalil
- Urology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Orsola A, Estrada CR, Nguyen HT, Retik AB, Freeman MR, Peters CA, Adam RM. Growth and stretch response of human exstrophy bladder smooth muscle cells: molecular evidence of normal intrinsic function. BJU Int 2005; 95:144-8. [PMID: 15638913 DOI: 10.1111/j.1464-410x.2004.05267.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To establish primary cultures of smooth muscle cells (SMC) from human exstrophic bladders (E-SMC), and determine their in vitro growth dynamics and responses to mechanical stretch. MATERIALS AND METHODS Primary cultures of E-SMC from three patients were established from exstrophic bladder tissue using an explant method. Growth dynamics were assessed using tetrazolium-dye uptake. The DNA synthesis rate in response to cyclic stretch-relaxation was determined with thymidine-incorporation assays. Expression of the SMC mitogen heparin-binding epidermal growth factor-like growth factor (HB-EGF) mRNA in response to mechanical stretch was determined using semiquantitative reverse transcription-polymerase chain reaction. RESULTS The approximate doubling time of the E-SMC grown in the presence of serum was 4 days, consistent with growth rates of SMC reported previously. E-SMC exposed to stretch had greater DNA synthesis, albeit to a lesser extent than previously seen with non-exstrophic SMC. The expression of HB-EGF was also increased in cells exposed to mechanical stimuli, consistent with our previous finding of stretch-regulated HB-EGF gene expression in bladder SMC. CONCLUSIONS E-SMC had growth characteristics similar to those previously reported in non-exstrophic cells. E-SMC also had stretch-induced expression of HB-EGF mRNA. These observations provide evidence that despite development in an abnormal defunctionalized state, E-SMC retain the potential for normal growth, and may modulate this response through mechanisms similar to those operating in normal bladder SMC.
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Affiliation(s)
- Anna Orsola
- Urological Diseases Research Center, Department of Urology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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