Volume of the normal prostate gland in polish boys, aged 1-17 years: Based on transabdominal ultrasound - Prospective study

BACKGROUND

Until now, there are no established norms for prostate size in children. Prostate volume during development has been analyzed in small study groups. In diagnostic imaging, transabdominal ultrasound and magnetic resonance imaging are used.

AIMS

To establish prostate volume norms for individuals aged 1-17 years using transabdominal ultrasound.

STUDY DESIGN

Between 2021 and 2023, transabdominal prostate ultrasound was performed on 482 Caucasian boys, aged 1-17 years, who were patients of the urology clinic. Normative data were based on results of 345 boys with normal lower urinary tract, urethral and penile structures. Patients with abnormal external genitalia, Prune Belly Syndrome, Myelomeningocele, chromosomal disorders, or prostate abnormalities found in ultrasound were excluded from the study. Patient eligibility was determined based on medical records and physical examinations. During ultrasound, height, anterior-posterior dimension, and width of prostate were assessed. Prostate volume was calculated using the ellipsoid formula VH x L(AP) x W x 0.523. Measurements were correlated with age, weight, and height. Results were analyzed using descriptive statistics, statistical significance tests for means, and correlation methods. After estimating preliminary results, taking into account the development periods, patients were divided into age groups: 1-4 years (n = 70), 5-10 years (n = 124), 11-12 years (n = 43), 13-15 years (n = 65), and 16-17 years (n = 43).

RESULTS

The table and nomogram shows prostate volumes based on age. Prostate size remains stable up to the age of 8. We noticed a transitional phase at the age of 8-11 years. A significant increase in volume occurs over 11 years of age. There was a statistically significant relationship between prostate size, age, height, and weight.

DISCUSION

Established norms can serve as a reference for prostate analysis in patients with defects of the genitourinary system. An interesting analysis would be a prostate size assessment in relation to stage of development on Tanner scale.

CONCLUSION

Transabdominal ultrasound, being a non-invasive, painless, and readily accessible examination, allows assessment of prostate size even in boys aged 1 year old. A statistically significant relationship was found between prostate size, weight, and height. Norms for prostate size in boys were established according to age.

Bladder autoaugmentation in myelodysplastic children

OBJECTIVE

To present the long-term results of bladder autoaugmentation in myelodysplastic children with low compliance neurogenic bladders who failed attempts at medical management, including clean intermittent catheterization (CIC) and pharmacological bladder relaxation.

PATIENTS AND METHODS

Twenty-one patients with a neurogenic bladder after myelomeningocele operations (mean age 9.5 years, range 3-16) underwent autoaugmentation; 12 children were paraplegic and hydrocephalic, and were treated by insertion of a ventriculoperitoneal valve. All patients had low-compliance neurogenic bladders confirmed urodynamically. Ten patients had vesico-ureteric reflux (VUR) and eight had dilated upper urinary tracts with no reflux. All patients had been treated pre-operatively using CIC and anticholinergic agents, with no success.

RESULTS

Of 21 children treated surgically, 17 were assessed urodynamically and examined to determine the condition of the upper and lower urinary tract. The follow-up ranged from 3 months to 8 years (mean 6 years). In 13 patients the bladder capacity increased by approximately 60 mL and in 14 the intravesical pressure decreased by approximately 65 cmH2O. Fourteen children were continent using CIC (from 3- to 4-hourly); in the six patients with VUR the reflux resolved in two, decreased in two and remained unchanged in two. Of eight patients with dilated upper tracts but no reflux, seven improved. There was no improvement in bladder capacity in four patients and no reduction in intravesical pressure in three. Two patients underwent enterocystoplasty (one ileocystoplasty and one colocystoplasty) with good results. Two children needed anticholinergic agents after autoaugmentation.

CONCLUSIONS

Autoaugmentation effectively reduces high intravesical pressure and provides a sufficient increase in bladder capacity with a concomitant improvement in urodynamic values. The present method allows the extent of the surgical procedure to be limited to the extraperitoneal space and thus maintains all of other options. Bladder autoaugmentation is a reasonable alternative to enterocystoplasty in selected patients.