Adolescent urology: A challenge for adult urologists

Urodynamic profile in posterior urethral valve patients following fulguration: Does age at fulguration matter?

Introduction:

Children with posterior urethral valve (PUV) may develop urinary bladder (UB) dysfunction even after valve fulguration (VF). Using Urodynamics (UDS), we sought to identify whether age at VF and time elapsed since VF contributed to UB dysfunction.

Materials and Methods:

Between January 2009 and July 2016, 39 PUV patients referred to a tertiary care center for UDS were classified into Groups A and B (based on age if <2 or ≥2 years at VF) and subclassified into Group A1/A2 and B1/B2 depending on time duration after VF (TVU). A1 and B1 constituted TVU ≤4 years and A2 and B2 constituted TVU >4 years, respectively.

Results:

Median (range) ages at VF and UDS were 18 (1–108) months and 9 (1–19) years. Median (range) time between VF and UDS was 60 (6–164) months. Reduced compliance was seen in 67%, detrusor overactivity in 38.5%, and leak in 15.4% boys, respectively. Median (range) Q_max was 8 (0–28) ml/s and 25% boys had hypocontractile detrusor at voiding. Statistically significant reduction was found in compliance when comparing Group B versus Group A (P = 0.037) and in bladder capacity (P = 0.002) and compliance (P = 0.043) in Group A2 versus A1.

Conclusions:

Boys with VF at <2 years had better urodynamic profiles than those with fulguration over 2 years of age. As the time period since fulguration increased, there was a higher incidence of bladder dysfunction in both the groups.

Pelvic Organ Prolapse in Female Patients Presenting to Transitional Urology Care Clinic

PURPOSE

Patients with congenital genitourinary abnormalities are growing into adulthood and their expectations, especially in the areas of sexual function and fertility are creating unforeseen challenges for health care providers. We review the incidence and management of pelvic organ prolapse at our Transitional Urology Clinic.

MATERIALS AND METHODS

This study is a retrospective chart review of the presentation and treatment of patients with clinically bothersome pelvic organ prolapse seen at our tertiary Transitional Urology Clinic during 2012 to 2015.

RESULTS

Seven patients with a mean age of 22.8 years presented to our clinic with clinically bothersome prolapse. Four patients had myelomeningocele, 2 had sacral agenesis and 1 had bladder exstrophy. All were on self-catheterization. Three patients were sexually active and 1 had an intact uterus and desired fertility. Bothersome symptoms included vaginal bulge in 6 cases, difficult vaginal intercourse in 1 and difficult catheterization in 1. For the leading edge of Bp (anterior compartment) prolapse the median POP-Q (Pelvic Organ Prolapse Quantification System) stage was 3 (range 1 to 3), for Bp (posterior compartment) prolapse it was 1 (range 0 to 3) and for C (vaginal vault or cervical) prolapse it was 2 (range 1 to 3). Management included pessary in 1 case, hysterectomy with bilateral uterosacral ligament suspension in 4, sacrocolpopexy in 1 and observation in 1. Mean followup was 17.6 months (range 1 to 92). One of the 5 patients treated with surgical intervention had recurrence in the anterior compartment and vaginal vault.

CONCLUSIONS

Females with congenital genitourinary anomalies present with pelvic organ prolapse at a much younger age and a more advanced stage. There is a paucity of literature on the epidemiology, presentation and management of pelvic organ prolapse in this patient population.

The adult urology perspective on management of stress urinary incontinence in pediatric urology: ICI-RS 2011

The modern era of patient-centered, multidisciplinary professional practice comes with the expectation of effective interaction between specialties dealing with closely related clinical areas. Interaction between adult and pediatric urology is generally limited in terms of training, conferences, and joint diagnostic/treatment algorithms. However, in the more complex cases managed by pediatric urologists, long-term medical input is commonly necessary. Accordingly, regular interaction between the relevant specialties would be beneficial for continuity of care of individual patients, achieving best results at transition to adolescence, awareness of long-term outcome of pediatric urological procedures and development of new surgical techniques. This article reviews the discussions at the 2011 International Consultation on Incontinence Research Society meeting in Bristol.