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Van Herzeele C, Dhondt K, Roels SP, Raes A, Hoebeke P, Groen LA, Vande Walle J. Desmopressin (melt) therapy in children with monosymptomatic nocturnal enuresis and nocturnal polyuria results in improved neuropsychological functioning and sleep. Pediatr Nephrol 2016; 31:1477-84. [PMID: 27067081 DOI: 10.1007/s00467-016-3351-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/15/2016] [Accepted: 02/10/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND There is a high comorbidity between nocturnal enuresis, sleep disorders and psychological problems. The aim of this study was to investigate whether a decrease in nocturnal diuresis volume not only improves enuresis but also ameliorates disrupted sleep and (neuro)psychological dysfunction, the major comorbidities of this disorder. METHODS In this open-label, prospective phase IV study, 30 children with monosymptomatic nocturnal enuresis (MNE) underwent standardized video-polysomnographic testing and multi-informant (neuro)psychological testing at baseline and 6 months after the start of desmopressin treatment in the University Hospital Ghent, Belgium. Primary endpoints were the effect on sleep and (neuro)psychological functioning. The secondary endpoint was the change in the first undisturbed sleep period or the time to the first void. RESULTS Thirty children aged between 6 and 16 (mean 10.43, standard deviation 3.08) years completed the study. The results demonstrated a significant decrease in periodic limb movements during sleep (PLMS) and a prolonged first undisturbed sleep period. Additionally, (neuro)psychological functioning was improved on several domains. CONCLUSIONS The study demonstrates that the degree of comorbidity symptoms is at least aggravated by enuresis (and/or high nocturnal diuresis rate) since sleep and (neuro)psychological functioning were significantly ameliorated by treatment of enuresis. These results indicate that enuresis is not such a benign condition as has previously been assumed.
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Affiliation(s)
- Charlotte Van Herzeele
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Karlien Dhondt
- Child Neurology & Metabolism, Pediatric Sleep Center, University Hospital Ghent, Ghent, Belgium
| | - Sanne P Roels
- Department of Data Analysis, University Ghent, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Piet Hoebeke
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Luitzen-Albert Groen
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology/Urology and Safepedrug, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
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Spinoit AF, Decalf V, Ragolle I, Ploumidis A, Claeys T, Groen LA, Van Laecke E, Hoebeke P. Urodynamic studies in children: Standardized transurethral video-urodynamic evaluation. J Pediatr Urol 2016; 12:67-8. [PMID: 26638696 DOI: 10.1016/j.jpurol.2015.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/25/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim was too demonstrate standardized video-urodynamic study (VUDS) in children using a transurethral catheter and pressure transducers. METHODS Data necessary to obtain urodynamic evaluation of bladder sphincter function were gathered by concomitant measurement of bladder, urethral, and abdominal pressure. A 7F transurethral triple-lumen water-filled catheter was used for measuring the bladder and sphincter pressures and a water-filled 8F catheter connected to a pressure transducer was inserted into the rectum for pressure measurement. Cystometry was combined with fluoroscopy, providing simultaneous voiding cystourethrography information. Detrusor activity, bladder sensation, capacity, and compliance were measured during filling cystometry. Voiding cystometry consisted of recording pressures in the bladder sphincter and abdomen with simultaneous urinary flow measurement. RESULTS Transurethral VUDS was safely and easily performed in a clinical setting adapted to children. CONCLUSIONS A good and reproducible UDS is mandatory for correct therapeutic decisions. A standardized study associated with fluoroscopic assessment is presented in this video.
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Affiliation(s)
| | - Veerle Decalf
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Inge Ragolle
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Tom Claeys
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium.
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Van Herzeele C, Dhondt K, Roels SP, Raes A, Groen LA, Hoebeke P, Vande Walle J. Periodic limb movements during sleep are associated with a lower quality of life in children with monosymptomatic nocturnal enuresis. Eur J Pediatr 2015; 174:897-902. [PMID: 25567793 DOI: 10.1007/s00431-014-2474-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/25/2014] [Accepted: 12/09/2014] [Indexed: 01/15/2023]
Abstract
UNLABELLED The study investigates whether cortical arousals and periodic limb movements during sleep are related to daytime psychological functioning in children with monosymptomatic nocturnal enuresis with associated nocturnal polyuria. Psychological functioning is evaluated on five domains: attention deficit hyperactivity disorder-inattentive problems, quality of life, internalizing problems, externalizing problems, and executive functioning. This multi-informant (parents, teachers, and children) and multi-method study included overnight video-polysomnography, questionnaires, and neuropsychological testing. Thirty children (7 girls) 6 to 16 years (mean 10.43 years, SD 3.08) were selected in a tertiary enuresis center. A high index of periodic limb movements during sleep was associated with a lower quality of life, according to the child. No significant correlations were found with attention deficit hyperactivity disorder-inattentive problems, internalizing problems, externalizing problems, and executive functioning. CONCLUSION This study clarifies the relationship between sleep parameters and psychological functioning of the children with monosymptomatic nocturnal enuresis and associated nocturnal polyuria according to the child, the parents, and the teachers. Periodic limb movements during sleep are associated with a lower quality of life of the child.
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Affiliation(s)
- Charlotte Van Herzeele
- Department of Pediatric Nephrology/Urology, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium,
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Spinoit AF, Poelaert F, Van Praet C, Groen LA, Van Laecke E, Hoebeke P. Grade of hypospadias is the only factor predicting for re-intervention after primary hypospadias repair: a multivariate analysis from a cohort of 474 patients. J Pediatr Urol 2015; 11:70.e1-6. [PMID: 25797860 DOI: 10.1016/j.jpurol.2014.11.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 11/11/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is an ongoing quest on how to minimize complications in hypospadias surgery. There is however a lack of high-quality data on the following parameters that might influence the outcome of primary hypospadias repair: age at initial surgery, the type of suture material, the initial technique, and the type of hypospadias. OBJECTIVES The objective of this study was to identify independent predictors for re-intervention in primary hypospadias repair. STUDY DESIGN We retrospectively analyzed our database of 474 children undergoing primary hypospadias surgery. Univariate and multivariate logistic regression was performed to identify variables associated with re-intervention. A p-value <0.05 was considered statistically significant and therefore considered as a prognostic factor for re-intervention. RESULTS Distal penile hypospadias was reported in 77.2% (n = 366), midpenile in 11.4% (n = 54) and proximal in 11.4% (n = 54) of children. Initial repair was based on an incised plate technique in 39.9% (n = 189), meatal advancement in 36.0% (n = 171), an onlay flap in 17.3% (n = 82) and other or combined techniques in 5.3% (n = 25). In 114 patients (24.1%) re-intervention was required (n = 114) of which 54 re-interventions (47.4%) were performed within the first year post-surgery, 17 (14.9%) in the second year and 43 (37.7%) later than 2 years after initial surgery. The reason for the first re-intervention was fistula in 52 patients (46.4%), meatal stenosis in 32 (28.6%), cosmesis in 35 (31.3%) and other in 14 (12.5%). The median time for re-intervention was 14 months after surgery [range 0-114]. Significant predictors for re-intervention on univariate logistic regression (polyglactin suture material versus poliglecaprone, proximal hypospadias, lower age at operation and other than meatal advancement repair) were put in a multivariate logistic regression model. Of all significant variables, only proximal hypospadias remained an independent predictor for re-intervention (OR 3.27; p = 0.012). DISCUSSION The grade of hypospadias remains according to our retrospective analysis the only objective independent predicting factor for re-intervention in hypospadias surgery. This finding is rather obvious for everyone operating hypospadias. Curiously midpenile hypospadias cases were doing slightly better than distal hypospadias in terms of re-intervention rates. Our study however has also some shortcomings. First of all, data was gathered retrospectively and follow-up time was ill-balanced for several variables. We tried to correct this by applying sensitivity analysis, but possible associations between some variables and re-intervention might still be obscured by this. Standard questionnaires to analyze surgical outcome were not available. Therefore, we focused our analysis on re-intervention rate as this is a hard and clinically relevant end point. CONCLUSIONS This retrospective analysis of a large hypospadias database with long-term follow-up indicates that the long-lasting debate about factors influencing the reoperation rate in hypospadias surgery might be futile: in experienced hands, the only variable that independently predicts for re-intervention is the severity of hypospadias, the only factor we cannot modify. This retrospective multivariate analysis of a large hypospadias database with long-term follow-up suggests that the only significant independent predictive factor for re-intervention is proximal hypospadias. In our series, technique did not influence the re-intervention rate.
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Affiliation(s)
| | - Filip Poelaert
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | | | | | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Gent, Belgium.
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Groen LA, Spinoit AF, Van Laecke E, Everaert K, Hoebeke P, Subramaniam R. 485 THE ADVANCE MALE SLING FOR INTRINSIC SPHINCTER DEFICIENCY IN PAEDIATRIC UROLOGY: 5 YEAR EXPERIENCE IN TWO REFERRAL CENTRES. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Spinoit AF, Poelaert F, Groen LA, Van Laecke E, Hoebeke P. Hypospadias repair at a tertiary care center: long-term followup is mandatory to determine the real complication rate. J Urol 2013; 189:2276-81. [PMID: 23306089 DOI: 10.1016/j.juro.2012.12.100] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE The field of reconstructive surgery for hypospadias is lacking standard techniques and followup. Most published series include complication rates after a short followup. We report and analyze the long-term outcome of primary hypospadias repair at a single tertiary care center. MATERIALS AND METHODS We reviewed 1,061 operations performed at our institution between 1997 and 2010 and registered as hypospadias repair. The operations were performed in 543 patients born between June 1997 and June 2005. A retrospective database was created with information about hypospadias characteristics, surgery and followup. RESULTS A total of 474 primary repairs were selected, excluding incomplete/incorrect files. Distal penile hypospadias was reported in 366 patients (77.2%), mid penile hypospadias in 54 (11.4%) and proximal hypospadias in 54 (11.4%). Initial repair technique was based on incised plate in 189 patients (39.9%), meatal advancement in 171 (36%), onlay flap in 82 (17.3%) and other or combined techniques in 25 (5.3%). Insufficient information was reported for 7 patients (1.5%). Mean age at first operation was 22.6 months (range 4 to 134) and mean followup after first operation was 34.0 months (0 to 145). Of the children 360 (75.9%) had a good long-term outcome and required only 1 procedure. Reoperation was needed in 114 patients (24.1%), of whom 54 (47.4%) underwent reoperation in the first year of followup. CONCLUSIONS Overall a good long-term outcome without further complication was achieved in 75.9% of our cases. Of the 24.1% of patients who needed reoperation only 47.4% presented within the first year postoperatively, indicating the need for long-term followup when reporting outcomes of hypospadias repair.
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Spinoit AF, De Prycker S, Groen LA, van Laecke E, Hoebeke P. New Surgical Technique for the Treatment of Buried Penis: Results and Comparison with a Traditional Technique in 75 Patients. Urol Int 2013; 91:134-9. [DOI: 10.1159/000351944] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 04/23/2013] [Indexed: 11/19/2022]
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Groen LA, Hoebeke P, Loret N, Van Praet C, Van Laecke E, Ann R, Vande Walle J, Everaert K. Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms: 15-year experience. J Urol 2012; 188:1313-7. [PMID: 22902022 DOI: 10.1016/j.juro.2012.06.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Sacral nerve modulation with an implantable pulse generator is not an established treatment in children. This therapy has been described for dysfunctional elimination syndrome and neurogenic bladder. We report 2 new indications for this approach in children, ie bladder overactivity and Fowler syndrome. The aim of this study was to improve the results of future treatment for sacral neuromodulation in children by describing factors favorable for good outcomes with this method. MATERIALS AND METHODS A total of 18 children 9 to 17 years old were studied. Mean ± SD followup was 28.8 ± 43.8 months. Of the patients 16 underwent S3 sacral neuromodulation and 7 underwent pudendal stimulation (5 as a revision, 2 from the beginning). RESULTS Initial full response was achieved in 9 of 18 patients (50%) and partial response in 5 (28%). In patients presenting with incontinence mean ± SD number of incontinence episodes weekly improved significantly from 23.2 ± 12.4 to 1.3 ± 2.63 (p <0.05). In patients requiring clean intermittent catheterization there was a significant decrease in mean ± SD daily frequency of catheterization from 5.2 ± 1.6 to 2.0 ± 1.9 (p <0.05). At the end of the study 6 of 15 patients (40%) had a full response and 5 (33%) had a partial response, while 4 implantable pulse generator devices (27%) were explanted because of failure. CONCLUSIONS Sacral neuromodulation is feasible in the pediatric population, with good short-term (78% full or partial response) and satisfactory long-term results (73%). Sacral neuromodulation can offer good results for overactive bladder, dysfunctional elimination syndrome and Fowler syndrome. Pudendal nerve stimulation is a feasible salvage treatment that can be useful in cases when S3 implantation is impossible or unsuccessful.
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Affiliation(s)
- Luitzen-Albert Groen
- Pediatric Urologic Nephrologic Center, Ghent University Hospital, Ghent, Belgium.
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Groen LA, Spinoit AF, Hoebeke P, Van Laecke E, De Troyer B, Everaert K. The AdVance male sling as a minimally invasive treatment for intrinsic sphincter deficiency in patients with neurogenic bladder sphincter dysfunction: a pilot study. Neurourol Urodyn 2012; 31:1284-7. [PMID: 22847896 DOI: 10.1002/nau.21256] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 11/28/2011] [Indexed: 11/10/2022]
Abstract
AIMS The aim of the study was to evaluate feasibility, efficacy, and safety of the AdVance male sling in neuropathic male patients with intrinsic sphincter deficiency. METHODS We evaluated 20 consecutive male neuropathic patients (12 menigomyelocele and 8 lower spinal cord injured), age 23 ± 13 years (range 6-52 years) with urodynamically proven sphincter deficiency and stress urinary incontinence. In all patients an AdVance male sling was implanted from June 2007 to September 2009. Patients were evaluated with the number of pads per day (PPD), visual analogue scale (VAS) for continence and the International Consultation on Incontinence-Short Form (ICIQ-SF). Cure was defined as a 10 on VAS or using no pads for urinary leakage, improvement as >5 and failure as ≤5. RESULTS Positive effect in 13 of 20 patients (65%) at 1-year follow-up: 8 patients were cured, 5 improved, and 7 failed. VAS score increased from baseline 2.6 (SD 2.0) to 7.2 (SD 3.5) at 12 months (P < 0.001). ICIQ-SF decreased from 14 (SD 4.2) to 4 (SD 4.1) (P < 0.001). Friedman and Wilcoxon tests revealed at 1, 3, 6, 9, and 12 months significant improvement compared to baseline (P = 0.008). CONCLUSIONS Implantation of the AdVance male sling is feasible in both adult and pediatric patients. A promising cure/improvement rate was achieved as well as a low complication rate.
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Abstract
Fatty acid amides are a class of compounds with newly discovered biological activity. The ion trap mass spectrometric characteristics of silylated fatty acid amides were examined. Silylation of primary fatty acid amides is required prior to gas chromatography owing to thermal instability of the underivatized compound. The trimethylsilylated amides do not yield a molecular ion under normal electron ionization conditions (70 eV). With methane as a chemical ionization gas, the [M+H]+ ion appears. The [M+H]+ ion also appears when the helium buffer gas pressure is increased in the ion trap. There are three fragments other than the [M+H]+ peak that are predominant in the ion trap mass spectra of these compounds. Two of the fragments have been reported previously, namely the m/z 59 and the [M-71]+ fragments. The fragment of m/z 72 was identified and is the result of a rearrangement. Isotopic labeling was used to confirm fragment identity and the composition of the rearrangement products. Fragmentation patterns were affected by the amide chain length and concentration.
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Affiliation(s)
- A J Gee
- Duquesne University, Department of Chemistry and Biochemistry, Pittsburgh, Pennsylvania 15282-1530, USA
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Gee AJ, Groen LA, Johnson ME. Determination of fatty acid amides as trimethylsilyl derivatives by gas chromatography with mass spectrometric detection. J Chromatogr A 1999; 849:541-52. [PMID: 10457449 DOI: 10.1016/s0021-9673(99)00609-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Fatty acid amides are a newly emerging class of compounds with biological activity. The amides are formed enzymatically in vivo. Analysis of fatty acid amides has been accomplished by gas chromatography coupled with mass spectrometry. Fatty acid amides required derivatization prior to analysis at high temperatures due to thermal instability. Trimethylsilylation of fatty acid amides has been accomplished under optimum reaction conditions. The limit of detection for the silylated amides is approximately 1 pmol, with the lowest detected level being 700 fmol for the lauramide derivative. Quantitation of fatty acid amide derivatives can be accomplished by monitoring m/z 59 or m/z M-71, the only two major fragments formed in the ion trap mass spectrometer with electron impact ionization. The smaller fragment is the result of a newly reported, McLafferty-type rearrangement; M-71 resulted from loss of an n-pentyl fragment. Either peak gave four-five orders of magnitude linear dynamic range. Numerous trimethylsilylamides from C7 to C20 were separated under standard conditions. Elution was linear with the number of carbons and was systematically affected by the number and position of the double bonds.
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Affiliation(s)
- A J Gee
- Duquesne University, Department of Chemistry and Biochemistry, Pittsburgh, PA 15282, USA
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