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Artibani W, Carmignani L, Carrieri G, Castagnetti M, Cretì G, De Gennaro M, Manzoni G, Masieri L, Porpiglia F, Scarpa RM. The Discipline of Pediatric Urology: Prerogatives and Necessities. Arch Ital Urol Androl 2022; 94:515-518. [PMID: 36576478 DOI: 10.4081/aiua.2022.4.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
To the Editor, The aim of this "position paper" is to describe the discipline of Pediatric Urology with its clinical and cultural competencies, represent the reasons for legitimizing its existence, and reinforce its importance in the "scenario" of the National Italian Healthcare System. The requisites and the educational requirements were defined by both the Italian Ministry of Health with the State-Regions Conference, and the European Union [...].
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Affiliation(s)
| | - Luca Carmignani
- Comitato Esecutivo SIU 2018-2021, Responsabile Ufficio Ricerca.
| | - Giuseppe Carrieri
- Comitato Esecutivo SIU 2018-2021, Responsabile Ufficio Educazionale.
| | - Marco Castagnetti
- GdL SIU Urologia Pediatrica 2018-2021 e Consiglio Direttivo SIUP 2020-21.
| | | | | | | | - Lorenzo Masieri
- GdL SIU Urologia Pediatrica 2018-2021 e Consiglio Direttivo SIUP 2020-21.
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Esposito C, Masieri L, Castagnetti M, Pelizzo G, De Gennaro M, Lisi G, Cobellis G, Gamba P, Di Benedetto V, Escolino M. Current Status of Pediatric Robot-Assisted Surgery in Italy: Epidemiologic National Survey and Future Directions. J Laparoendosc Adv Surg Tech A 2020. [DOI: 10.1089/lap.2019.0516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
| | - Lorenzo Masieri
- Pediatric Urology Unit, Meyer Children Hospital, Florence, Italy
| | | | - Gloria Pelizzo
- Pediatric Surgery Unit, Children's Hospital G. Di Cristina, ARNAS Civico-Di Cristina-Benfratelli, Palermo, Italy
| | - Mario De Gennaro
- Pediatric Urology Unit, Bambin Gesù Children Hospital, Rome, Italy
| | - Gabriele Lisi
- Pediatric Surgery Unit, G. D'Annunzio University of Chieti, Pescara, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Azienda Ospedaliero-Universitaria, Ancona, Italy
| | | | | | - Maria Escolino
- Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy
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Rosier PFWM, Kuo HC, De Gennaro M, Gammie A, Finazzi Agro E, Kakizaki H, Hashim H, Toozs-Hobson P. International Consultation on Incontinence 2016; Executive summary: Urodynamic testing. Neurourol Urodyn 2018; 38:545-552. [PMID: 30576004 DOI: 10.1002/nau.23903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/01/2018] [Indexed: 11/10/2022]
Abstract
AIMS The International Consultation on Incontinence has published an update of the recommendations for the diagnosis and management of urine incontinence (ICI2016). This manuscript summarizes the consultations committee-recommendations with regard to urodynamic assessment. METHODS Expert consensus on the basis of structured evidence assessment has been the basis of the consultations publication and has been summarized by the committee for this manuscript. RESULTS Patients that are not satisfied with their initial management on the basis of their reported signs and symptoms of urinary incontinence, as well as all patients with neurological abnormalities that are potentially relevant for the function of the lower urinary tract, may very likely profit from objective diagnosis and staging and grading of their dysfunction, with urodynamic testing, regardless their age, vulnerability and/or comorbidities. The principles and technical innovations as well as the principal recommendations for the utilization of (invasive) urodynamic assessment for women, men, children, and vulnerable elderly, with or without neurogenic lower urinary tract dysfunction with urinary incontinence are provided in this abbreviated ICI recommendations-document. CONCLUSIONS The ICI2016 committee on urodynamics presents an executive summary of the most important reasons and recommendations for the use of urodynamic investigations for patients with urinary incontinence.
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Affiliation(s)
- Peter F W M Rosier
- Department of Urology, University Medical Center, Utrecht, The Netherlands
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Mario De Gennaro
- Department of Nephrology-Urology Pediatric Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Andrew Gammie
- Bristol Urological Institute, Bristol, United Kingdom
| | | | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hashim Hashim
- Bristol Urological Institute, Bristol, United Kingdom
| | - Philip Toozs-Hobson
- Department of Gynaecology and Pelvic Floor Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Yang S, Chua ME, Bauer S, Wright A, Brandström P, Hoebeke P, Rittig S, De Gennaro M, Jackson E, Fonseca E, Nieuwhof-Leppink A, Austin P. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children's Continence Society. Pediatr Nephrol 2018; 33:2207-2219. [PMID: 28975420 DOI: 10.1007/s00467-017-3799-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND We present a consensus view from the International Children's Continence Society (ICCS) on the evaluation and management of bladder bowel dysfunction (BBD) in children with urinary tract infection (UTI). The statement aims to highlight the importance of BBD in the development and recurrence of childhood UTI and its management to reduce its associated morbidity and sequelae. METHODS A systematic literature search was done on PubMed, Embase, and Scopus databases until August 15, 2016. Relevant publications concerning BBD and its relationship with UTI among children were reviewed and aggregated for statements of recommendation. Discussion by the ICCS Board and a multi-disciplinary core group of authors resulted in a document available on its website for all ICCS members to review. Insights and feedback were considered with consensus and agreement reached to finalize this position statement. RESULTS BBD in children with UTI is summarized. Details regarding epidemiology, pathophysiology, and recommendations for general and family practitioners and pediatricians relating to the evaluation and management of this condition are presented. CONCLUSIONS This document serves as the position statement from ICCS, based on literature review and expert opinion providing our current understanding of BBD in children with UTI.
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Affiliation(s)
- Stephen Yang
- Department of Urology, Taipei Tzu-Chi Hospital, and Buddhist Tzu Chi University, Taipei, Taiwan.
| | - Michael E Chua
- Department of Urology, Taipei Tzu-Chi Hospital, and Buddhist Tzu Chi University, Taipei, Taiwan
- Department of Urology, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Stuart Bauer
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Anne Wright
- Department of Paediatric Nephrourology, Evelina Children's Hospital, London, UK
| | - Per Brandström
- Department of Pediatrics, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Søren Rittig
- Department of Pediatrics, Aarhus University, Aarhus, Denmark
| | - Mario De Gennaro
- Department of Urology, Bambino Gesù Children's Hospital of Rome, Rome, Italy
| | - Elizabeth Jackson
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eliane Fonseca
- Department of Pediatrics, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Paul Austin
- Department of Urology, St Louis Children's Hospital, St. Louis, MO, USA
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Mosiello G, Lopes Mendes ALDC, Capitanucci ML, Zaccara AM, De Gennaro M. Re: Fertility Preservation for Pediatric Patients: Current State and Future Possibilities: E. K. Johnson, C. Finlayson, E. E. Rowell, Y. Gosiengfiao, M. E. Pavone, B. Lockart, K. E. Orwig, R. E. Brannigan and T. K. Woodruff J Urol 2017;198:186-194. J Urol 2017; 199:308-310. [PMID: 28961423 DOI: 10.1016/j.juro.2017.07.092] [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] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Giovanni Mosiello
- Pediatric Neuro-Urology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | | | - Mario De Gennaro
- Pediatric Neuro-Urology Unit, Bambino Gesù Children's Hospital, Rome, Italy
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Palleschi G, Mosiello G, Iacovelli V, Musco S, Del Popolo G, Giannantoni A, Carbone A, Carone R, Tubaro A, De Gennaro M, Marte A, Finazzi Agrò E. Adolescence transitional care in neurogenic detrusor overactivity and the use of OnabotulinumtoxinA: A clinical algorithm from an Italian consensus statement. Neurourol Urodyn 2017; 37:904-915. [PMID: 28877353 DOI: 10.1002/nau.23391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/26/2017] [Indexed: 01/23/2023]
Abstract
AIMS OnabotulinumtoxinA (onaBNTa) for treating neurogenic detrusor overactivity (NDO) is widely used after its regulatory approval in adults. Although the administration of onaBNTa is still considered off-label in children, data have already been reported on its efficacy and safety. Nowadays, there is a lack of standardized protocols for treatment of NDO with onaBNTa in adolescent patients in their transition from the childhood to the adult age. With the aim to address this issue a consensus panel was obtained. METHODS A panel of leading urologists and urogynaecologists skilled in functional urology, neuro-urology, urogynaecology, and pediatric urology participated in a consensus-forming project using a Delphi method to reach national consensus on NDO-onaBNTa treatment in adolescence transitional care. RESULTS In total, 11 experts participated. All panelists participated in the four phases of the consensus process. Consensus was reached if ≥70% of the experts agreed on recommendations. To facilitate a common understanding among all experts, a face-to-face consensus meeting was held in Rome in march 2015 and then with a follow-up teleconference in march 2017. By the end of the Delphi process, formal consensus was achieved for 100% of the items and an algorithm was then developed. CONCLUSIONS This manuscript represents the first report on the onaBNTa in adolescents. Young adults should be treated as a distinct sub-population in policy, planning, programming, and research, as strongly sustained by national public health care. This consensus and the algorithm could support multidisciplinary communication, reduce the extent of variations in clinical practice and optimize clinical decision making.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Andrea Tubaro
- Urology Unit, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | | | - Antonio Marte
- Paediatric Surgery, II University of Naples, Naples, Italy
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Mosiello G, Lopes Mendes AL, Capitanucci ML, Zaccara AM, De Gennaro M. Button Cystostomy: Is it Really a Safe and Effective Therapeutic Option in Pediatric Patients With Neurogenic Bladder? Urology 2016; 101:73-79. [PMID: 27693876 DOI: 10.1016/j.urology.2016.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To define safety and effectiveness of cystostomy button in the management of bladder drainage in pediatric patients with neurogenic bladder, and report our personalized surgical technique. MATERIALS AND METHODS This study is a retrospective analysis of patients undergoing cystostomy button placement for bladder drainage from October 2009 to December 2015. Endoscopic and open surgical techniques and medium-term complication were analyzed and indications were recorded. RESULTS Thirty-five patients, 16 (45.7%) females and 19 (54.3%) males, underwent cystostomy button placement for bladder drainage with a mean age of 8.6 ± 4.8 years (standard deviation) and a mean follow-up time of 37 months. There were 91.4% of patients who had a neurogenic bladder; a nonobstructive urinary retention was diagnosed in the remainder of cases. A medium-term complication was mostly represented by urinary tract infection observed in 10 of 35 patients that was the most representative cause of button removal (4 of 35). Other observed complications were button leakage (n = 2), decubitus (n = 1), and bladder stone (n = 1). No postoperative complication was observed and no differences were found in terms of complications in the two surgical approaches performed. CONCLUSION Cystostomy button is a safe and effective treatment for bladder drainage in neurogenic pediatric patients and it is also well accepted by patients and caregivers. Cystostomy button, which may avoid mechanical concerns and most of the social discomfort, should be considered an alternative method to other bladder drainage modalities.
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Affiliation(s)
- Giovanni Mosiello
- Neuro-Urology Clinical and Research Unit, Paediatric Hospital Bambino Gesù, Rome, Italy; Robotic Surgery and Urodynamic Unit, Paediatric Hospital Bambino Gesù, Rome, Italy
| | - Ana Ludy Lopes Mendes
- Neuro-Urology Clinical and Research Unit, Paediatric Hospital Bambino Gesù, Rome, Italy; Robotic Surgery and Urodynamic Unit, Paediatric Hospital Bambino Gesù, Rome, Italy.
| | | | | | - Mario De Gennaro
- Robotic Surgery and Urodynamic Unit, Paediatric Hospital Bambino Gesù, Rome, Italy
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Mosiello G, Torino G, De Gennaro M. Re: Laparoscopic Mitrofanoff procedure in children, surgery alone is not effective for the treatment of bladder dysfunction. J Pediatr Urol 2015; 11:301-2. [PMID: 26248684 DOI: 10.1016/j.jpurol.2015.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Giovanni Mosiello
- Neuro-Urology Unit, Department of Nephro-Urology, Bambino Gesù Pediatric Hospital, Piazza S Onofrio 4, 00165, Rome, Italy.
| | - Giovanni Torino
- Neuro-Urology Unit, Department of Nephro-Urology, Bambino Gesù Pediatric Hospital, Piazza S Onofrio 4, 00165, Rome, Italy
| | - Mario De Gennaro
- Neuro-Urology Unit, Department of Nephro-Urology, Bambino Gesù Pediatric Hospital, Piazza S Onofrio 4, 00165, Rome, Italy
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Zaccara A, Silveri M, Capitanucci ML, Mosiello G, De Gennaro M, Bizzarri C, Cappa M, Orazi C. Prenatal hydrocolpos in a male. Journal of Pediatric Surgery Case Reports 2015. [DOI: 10.1016/j.epsc.2014.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Colombo GL, Di Matteo S, Vinci M, Gatti C, Pascali MP, De Gennaro M, Macrellino E, Mosiello G, Redaelli T, Schioppa F, Dieci C. A cost-of-illness study of spina bifida in Italy. Clinicoecon Outcomes Res 2013; 5:309-16. [PMID: 23861590 PMCID: PMC3704355 DOI: 10.2147/ceor.s42841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Spina bifida (SB) is a congenital malformation of the spinal cord, nerves, and adjacent covering structures, with different levels of severity and functional disability. The economic cost of spina bifida and its prevention using folic acid have never been estimated in Italy. This study was conducted to define the cost of illness of SB in Italy. Methods A retrospective multicenter observational study on the social cost of patients with SB was carried out in three SB centers in Italy. Cost data were collected relating to the 12 months preceding the enrollment time (T0), and subsequently 3 months after the T0 time (±20 days) through a case report form designed to collect the relevant information on the costs incurred during the period considered. The data for all patients were analyzed through multivariate analysis on the main parameters. Results We enrolled 128 patients equally divided between males and females, with a mean age of 13 years (minimum, 0; maximum, 29). Diagnosis was mostly postnatal, with 64 cases diagnosed at birth and 33 cases diagnosed subsequently. The lesion severity levels, as defined in the inclusion criteria, were walking (52 patients); walking with simple orthoses (33 patients); walking with complex orthoses (16 patients); and nonwalking, (25 patients). The anatomic type identified is open SB in most cases (84 patients), followed by closed SB (37 patients) and SB occulta (3 patients). The most significant cost per year was for assistive devices, for a total of 4307.00 €, followed by hospitalization (907.00 €), examinations (592.00 €), and drug therapy (328.00 €). Cost breakdown by age range shows that the highest costs are incurred in the 0–4 age range. The highest cost was for cases of open SB (12,103.00 €). The cost/degree of severity ratio showed that the highest cost was for nonwalking patients (14,323.00 €), followed by patients walking with complex orthoses (13,799.00 €). Conclusion The data from this study show that the mean total cost for a patient with SB was 11,351.00 € per year. Based on data provided by the Italian Institute of Health, we can estimate a total annual social cost of about 60 million Euros per year for SB in Italy. Cost of illness was correlated with age and degree of severity of SB.
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Affiliation(s)
- Giorgio L Colombo
- University of Pavia, Department of Drug Sciences, School of Pharmacy, Pavia, Italy ; S.A.V.E. Studi Analisi Valutazioni Economiche, Milan, Italy
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Franco I, von Gontard A, De Gennaro M. Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: a standardization document from the International Children's Continence Society. J Pediatr Urol 2013; 9:234-43. [PMID: 23260268 DOI: 10.1016/j.jpurol.2012.10.026] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [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: 02/27/2012] [Accepted: 10/31/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE This document represents the consensus guidelines recommended by the ICCS on how to evaluate and treat children with nonmonosymptomatic nocturnal enuresis (NMNE). The document is intended to be clinically useful in primary, secondary and tertiary care. MATERIALS AND METHODS Discussions were held by the board of the ICCS and a committee was appointed to draft this document. The document was then made available to the members of the society on the web site. The comments were vetted and amendments were made as necessary to the document. RESULTS The main scope of the document is the treatment of NMNE with drugs other than desmopressin-based therapy. Guidelines on the assessment, and nonpharmacologic and pharmacologic management of children with NMNE are presented. CONCLUSIONS The text should be regarded as an expert statement, not a formal systematic review of evidence-based medicine. It so happens that the evidence behind much of what we do in the care of enuretic children is quite weak. We do, however, intend to present what evidence there is, and to give preference to this rather than to experience-based medicine, whenever possible.
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Affiliation(s)
- Israel Franco
- Section of Pediatric Urology, Maria Fareri Children's Hospital and New York Medical College, Valhalla, NY 10595, USA.
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Pascali MP, De Gennaro M, Mosiello G. Re: Intradetrusor botulinum neurotoxin A (BoNT-A) injections decrease bladder fibrosis secondary to partial urethral obstruction in the male rat model. Neurourol urodyn 2012;31:564-70. Neurourol Urodyn 2012; 31:571. [DOI: 10.1002/nau.21245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/07/2011] [Indexed: 11/09/2022]
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Laterza RM, De Gennaro M, Tubaro A, Koelbl H. Female pelvic congenital malformations. Part I: embryology, anatomy and surgical treatment. Eur J Obstet Gynecol Reprod Biol 2011; 159:26-34. [DOI: 10.1016/j.ejogrb.2011.06.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/30/2011] [Accepted: 06/09/2011] [Indexed: 11/15/2022]
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Pascali MP, Mosiello G, Marciano A, Capitanucci ML, Zaccara AM, De Gennaro M. A Simplified Technique for Botulinum Toxin Injections in Children With Neurogenic Bladder. J Urol 2011; 185:2558-62. [DOI: 10.1016/j.juro.2011.01.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Maria Paola Pascali
- Department of Nephro-Urology, Urodynamics and NeuroUrology Unit, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Giovanni Mosiello
- Department of Nephro-Urology, Urodynamics and NeuroUrology Unit, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Armando Marciano
- Department of Nephro-Urology, Urodynamics and NeuroUrology Unit, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Maria Luisa Capitanucci
- Department of Nephro-Urology, Urodynamics and NeuroUrology Unit, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Antonio Maria Zaccara
- Department of Nephro-Urology, Urodynamics and NeuroUrology Unit, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Mario De Gennaro
- Department of Nephro-Urology, Urodynamics and NeuroUrology Unit, Bambino Gesù Pediatric Hospital, Rome, Italy
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Pascali MP, Mosiello G, Boldrini R, Salsano ML, Castelli E, De Gennaro M. Effects of botulinum toxin type a in the bladder wall of children with neurogenic bladder dysfunction: a comparison of histological features before and after injections. J Urol 2011; 185:2552-7. [PMID: 21527192 DOI: 10.1016/j.juro.2011.01.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Botulinum toxin type A has gained popularity in urology. Most reported studies have been in adults at urology centers and most have addressed long-term safety. Since botulinum toxin type A treatment for neurogenic bladder dysfunction requires repeat injections, verifying that such treatment does not induce fibrosis in children seems essential. MATERIALS AND METHODS The study was approved by the institutional review board and patients were enrolled after we obtained written consent. Patients with neurogenic bladder dysfunction not responding to conventional treatment (anticholinergics and clean intermittent catheterization) were treated with 10 IU/kg botulinum toxin type A up to a maximum of 300 IU. Endoscopic cold cup biopsies were obtained from the posterolateral bladder wall 1.5 to 2 cm above the ureteral orifice. Bladder wall findings were categorized into 3 groups, including inflammatory infiltration, edema and fibrosis. Each criterion was then graded as mild or severe and analyzed by Fisher's exact test (p <0.05). RESULTS A total of 46 bladder wall biopsies were obtained from 40 patients 2 to 18 years old. Biopsies were evaluated in groups 1 and 2, including group 1-20 from patients with no botulinum toxin type A injection and group 2-20 after botulinum toxin type A injection. Group 2 was subdivided into group 3-10 biopsies after 1 injection and group 4-10 after multiple injections. Six patients underwent biopsy twice, that is before the first and second treatments. Histological changes were present in all biopsies. When comparing groups 1 and 2, there was no statistically significant difference in inflammation and edema. However, there was a significant difference in fibrosis between groups 1 and 4 (p <0.05) with apparently decreased fibrosis after multiple injections. CONCLUSIONS In our experience repeat botulinum toxin type A injections into the detrusor in children do not lead to increased fibrosis in the bladder wall. This study confirms the long-term safety of botulinum toxin type A in the pediatric population.
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Affiliation(s)
- Maria Paola Pascali
- Department of Nephro-Urology, Bambino Gesù Pediatric and Research Hospital, Piazza S. Onofrio 4, Rome, Italy
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De Gennaro M, Capitanucci ML, Mosiello G, Zaccara A. Current state of nerve stimulation technique for lower urinary tract dysfunction in children. J Urol 2011; 185:1571-7. [PMID: 21419450 DOI: 10.1016/j.juro.2010.12.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE A variety of electrical nerve stimulation methods has been used through the years to treat lower urinary tract dysfunction. Relevant literature was reviewed to analyze techniques and available biomedical devices, technique applicability, indications and usefulness in pediatrics. MATERIALS AND METHODS An extensive search was performed on PubMed® and MEDLINE® for scientific publications on intravesical, transcutaneous, sacral spine and root, and tibial nerve stimulation in children with lower urinary tract dysfunction of nonneurogenic and neurogenic origin. Relevant articles and controlled studies in adult patients were also considered. The search covered the period 1990 to 2009 and we found approximately 400 articles, of which 29 related to pediatrics. RESULTS Due to feasibility problems with placebo studies the majority of the studies were noncontrolled, some of them clinical trials on acute urodynamic changes during electrical stimulation or experimental research in animals. Overall only a few randomized trials were found. Regarding types of electrostimulation and indications in children the recent literature emphasizes stimulation far from the anal-genital region, such as sacral transcutaneous electrical nerve stimulation, mainly for refractory overactive bladder. Intravesical stimulation is the procedure of choice to enhance sensation in patients with incomplete neurogenic lesions. Percutaneous tibial nerve stimulation is tolerated by children but has been poorly studied. Sacral neuromodulation using implanted devices remains questionable and needs further clarification of its indications. Magnetic stimulation has rarely been used in children to date. More experimental studies are needed to assess the method of action and refine the parameters of stimulation. CONCLUSIONS Clinical controlled trials vs sham devices and predictable variables for successful response are urgently needed to address an apparently renewed focus on the use of nerve stimulation in the treatment of pediatric lower urinary tract symptoms.
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Affiliation(s)
- Mario De Gennaro
- Urodynamic Unit, Department of Nephrology and Urology, Children's Hospital Bambino Gesu, Rome, Italy.
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De Gennaro M, Niero M, Capitanucci ML, von Gontard A, Woodward M, Tubaro A, Abrams P. Validity of the International Consultation on Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms: A Screening Questionnaire for Children. J Urol 2010; 184:1662-7. [DOI: 10.1016/j.juro.2010.03.075] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Mario De Gennaro
- Urodynamic Unit, Department of Nephrology and Urology, Children's Hospital Bambino Gesù, Rome, Italy
| | - Mauro Niero
- Department of Methodology, University of Verona, Verona, Italy
| | - Maria Luisa Capitanucci
- Urodynamic Unit, Department of Nephrology and Urology, Children's Hospital Bambino Gesù, Rome, Italy
| | - Alexander von Gontard
- Department of Pediatric Neuropsychiatry, Saarland University Hospital, Homburg, Germany
| | - Mark Woodward
- Department of Paediatric Surgery, Bristol Children's Hospital, Bristol, United Kingdom
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
| | - Paul Abrams
- Department of Urology, Southmead Hospital, Bristol, United Kingdom
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Pascali MP, Mosiello G, Boldrini R, Salsano ML, Marciano A, Castelli E, De Gennaro M. 746 HISTHOLOGICAL FEATURES IN BLADDER WALL IN CHILDREN WITH NEUROGENIC BLADDER DYSFUNCTION AFTER BOTULINUM TOXIN TYPE A INJECTIONS. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1272] [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: 10/19/2022]
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Camanni D, Zaccara A, Capitanucci ML, Mosiello G, Iacobelli BD, De Gennaro M. Bladder After Total Urogenital Mobilization for Congenital Adrenal Hyperplasia and Cloaca—Does it Behave the Same? J Urol 2009; 182:1892-7. [DOI: 10.1016/j.juro.2009.02.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Indexed: 10/20/2022]
Affiliation(s)
- Daniela Camanni
- Urodynamic Unit, Department of Nephrology and Urology and Newborn Surgery Unit (BDI), Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Zaccara
- Urodynamic Unit, Department of Nephrology and Urology and Newborn Surgery Unit (BDI), Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Luisa Capitanucci
- Urodynamic Unit, Department of Nephrology and Urology and Newborn Surgery Unit (BDI), Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Mosiello
- Urodynamic Unit, Department of Nephrology and Urology and Newborn Surgery Unit (BDI), Bambino Gesù Children's Hospital, Rome, Italy
| | - Barbara D. Iacobelli
- Urodynamic Unit, Department of Nephrology and Urology and Newborn Surgery Unit (BDI), Bambino Gesù Children's Hospital, Rome, Italy
| | - Mario De Gennaro
- Urodynamic Unit, Department of Nephrology and Urology and Newborn Surgery Unit (BDI), Bambino Gesù Children's Hospital, Rome, Italy
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Affiliation(s)
- Mario De Gennaro
- Division of Urodynamics and Neurourology, Department of Nephrology and Urology, Bambino Gesù Children Hospital, Rome, Italy
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Capitanucci ML, Camanni D, Demelas F, Mosiello G, Zaccara A, De Gennaro M. Long-term efficacy of percutaneous tibial nerve stimulation for different types of lower urinary tract dysfunction in children. J Urol 2009; 182:2056-61. [PMID: 19695611 DOI: 10.1016/j.juro.2009.03.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Indexed: 12/18/2022]
Abstract
PURPOSE We evaluated the efficacy of percutaneous tibial nerve stimulation for different types of pediatric lower urinary tract dysfunction. MATERIALS AND METHODS A total of 14 children with idiopathic overactive bladder, 14 with dysfunctional voiding, 5 with underactive bladder, 4 with underactive valve bladder and 7 with neurogenic bladder resistant to conventional therapy underwent percutaneous tibial nerve stimulation weekly for 12 weeks. The stimulation effect was evaluated by comparing bladder diary, flowmetry and urinalysis before and after treatment. Improved patients were followed by bladder diary and urinalysis. Followup data at 1 and 2 years were compared with those obtained after stimulation. Data were analyzed using Fisher's exact test. RESULTS Symptom improvement was significantly greater in nonneurogenic than in neurogenic cases (78% vs 14%, p <0.002). Of patients 18% with underactive bladder and 50% with underactive valve bladder were unresponsive. Of 14 overactive bladder cases 12 and all 14 of dysfunctional voiding were improved (p not significant). Of improved patients 5 of 12 with overactive bladder and 12 of 14 with dysfunctional voiding were cured (p <0.01). On uroflowmetry voided volume and post-void residual urine became normal in a greater number of dysfunctional voiding than overactive bladder cases (57% vs 20% and 57% vs 25%, each p not significant). At 1 year of followup the cure rate was greater in dysfunctional voiding than in overactive bladder cases (71% vs 41%) and it remained the same at the 2-year evaluation. Chronic stimulation was necessary to maintain results in 29% of dysfunctional voiding and 50% of overactive bladder cases. CONCLUSIONS Percutaneous tibial nerve stimulation is reliable and effective for nonneurogenic, refractory lower urinary tract dysfunction in children. Efficacy seems better in dysfunctional voiding than in overactive bladder cases. There is evidence that percutaneous tibial nerve stimulation should be part of the pediatric urology armamentarium when treating functional incontinence.
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De Gennaro M, Capitanucci ML, Di Ciommo V, Adorisio O, Mosiello G, Orazi C, Tubaro A. Reliability of bladder volume measurement with BladderScan® in paediatric patients. ACTA ACUST UNITED AC 2009; 40:370-5. [PMID: 17060082 DOI: 10.1080/00365590600679137] [Citation(s) in RCA: 10] [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: 10/24/2022]
Abstract
OBJECTIVE To evaluate the reliability of estimates of bladder volume (BV) in children made with the BladderScan BVI 2500 (BS) and their agreement with standard ultrasound (US) measurements. MATERIAL AND METHODS BV was measured using both US and BS in 92 children (41 females, 51 males; age range 3 months to 16 years) who underwent standard US measurements for various reasons. Patients were stratified into three groups according to age (3-35, 36-83 and > 83 months) and BV (< 20%, 20-50% and > 50% of expected bladder capacity for age). US and BS measurements were compared by means of the percentage difference and Pearson's correlation coefficient (r); limits of clinical agreement were evaluated by means of Bland-Altman analysis. RESULTS Overall, a difference of -12.9% and a correlation coefficient of r = 0.98 were found between US and BS. The percentage difference was higher in younger patients (-27.8%) and for low volumes (-24.8%). Correlation analysis confirmed this trend in different age (3-35 months, r = 0.74; 36-83 months, r = 0.93; > 83 months, r = 0.97) and BV (< 20%, r = 0.70; 20-50%, r = 0.94; >50%, r = 0.97) groups. Bland-Altman analysis showed large limits of clinical agreement between the two methods in terms of overall measurements (-45 to 29.3 ml) and in both age (-25.3 to 56.9 ml) and BV (-27.5 to 52.5 ml) groups. CONCLUSIONS A good correlation between US and BS measurements of BV was found in children aged > 7 years and in those with a BV > 20% of expected bladder capacity. Thus, BS avoids the need for standard US equipment to assess BV for schoolchildren with voiding dysfunction. Nevertheless, a dedicated BS instrument should be used in younger children.
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Affiliation(s)
- Mario De Gennaro
- Department of Nephrology and Urology, Urodynamic Unit, Ospedale Pediatrico Bambino Gesu, Piazza Sant'Onofrio, Rome, Italy
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Mosiello G, Salsano ML, Pascali MP, Camanni D, De Gennaro M. A Minimally Invasive Approach in the Treatment of Vesicoureteral Reflux in Neurogenic Bladder in Children. Eur Urol 2009; 55:254-6. [DOI: 10.1016/j.eururo.2008.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
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Affiliation(s)
- Mario De Gennaro
- Urodynamics and Neurourology Unit, Department of Nephrology Urology, Bambino Gesù Children Hospital of Rome, Rome, Italy
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Mosiello G, Capitanucci ML, Gatti C, Adorisio O, Lucchetti MC, Silveri M, Schingo PSM, De Gennaro M. How to Investigate Neurovesical Dysfunction in Children With Anorectal Malformations. J Urol 2003; 170:1610-3. [PMID: 14501674 DOI: 10.1097/01.ju.0000083883.16836.91] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [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: 11/26/2022]
Abstract
PURPOSE Neurovesical dysfunction (NVD) is common in children with anorectal malformation (ARM). NVD is mainly related to tethered cord or iatrogenic injury but how to investigate it is still debated. We evaluate the usefulness of routine magnetic resonance imaging (MRI) and urodynamics (UDS) for ARM. MATERIALS AND METHODS A total of 89 children were screened for sacral, spinal or urological anomalies using sacrum x-ray, MRI, renal and spinal ultrasound, uroflowmetry and/or 4-hour voiding observation. UDS was performed in 60 patients with suspected NVD. Mean +/- SD followup was 9.8 +/- 5.2 years. RESULTS Of the 89 patients 29 presented with urinary tract anomalies. The prevalence of sacral (53 cases) and spinal cord (54) anomalies was no different between patients with low, intermediate and high ARM. Spinal cord tethering was present in 13 patients with a normal sacrum x-ray. NVD was found in 31 of the 89 patients (hyperreflexia 21 and hypo-areflexia 10), and was associated with sacral and spinal anomalies in 23, occult spinal dysraphism without bone lesion in 3 and sacral anomalies in 5. The incidence of NVD was 40% of cases with low and 51% with high ARM. CONCLUSIONS Because tethered cord occurs in children without sacral anomalies as well as in those with low ARM, we recommend evaluation of all patients using MRI. When MRI is positive UDS should be performed. We agree with a previous suggestion to evaluate all males with rectourethral fistula and females with cloaca malformations. Finally we recommend a noninvasive evaluation for all other children and UDS when neurogenic dysfunction is suspected.
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Affiliation(s)
- Giovanni Mosiello
- Department of Pediatric Surgery and Radiology, Urodynamic Unit, Bambino Gesù Children's Hospital, Rome, Italy.
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Silveri M, Capitanucci ML, Capozza N, Mosiello G, Silvano A, Gennaro MD. Occult spinal dysraphism: neurogenic voiding dysfunction and long-term urologic follow-up. Pediatr Surg Int 1997; 12:148-50. [PMID: 9156844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
From 1976 to 1994, we followed 55 children with occult spinal dysraphism (OSD). The average age at diagnosis was 4.5 years (range: 24 days - 21 years). In 13 cases the OSD was associated with anorectal anomalies. Urologic symptoms were present at diagnosis in 24 children (43%), but urinary incontinence affected all patients in the evolution of the OSD. At diagnosis, all children underwent complete neurourologic and urodynamic evaluation. Nine required early neurosurgical correction, before 3 years of age. During follow-up, intermittent clean catheterization was started in all patients. Vesicoureteral reflux was present or developed in 17 patients: 15 underwent endoscopic procedures and 2 required bladder augmentation because of upper-tract and renal-function deterioration. Endoscopic treatment for urinary incontinence was performed in 3 children. At long-term follow-up (6 to 18 years), socially acceptable continence was achieved in 78% of the children; renal failure occurred in 8. The long-term results were analyzed in order to compare the evolution of urinary continence and renal function in children with OSD with or without neurosurgery.
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Affiliation(s)
- M Silveri
- Divisione di Chirurgia Pediatrica, Ospedale "Bambino Gesù", P.zza S. Onofrio 4, I-000165, Rome, Italy
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