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Meier KM, Mata C, Kaar JL, Rensing AJ, Dudley AG, Carrasco A, Drzewiecki BA, VanderBrink BA, Streur CS, Bagli DJ, Chalmers DJ, Wilcox DT, Yerkes EB, Lau GA, Vricella GJ, Hecht SL, Copp HL, Pohl HG, Franco I, Ahn J, Wiener JS, Singer JS, Long CJ, Keays MA, Daugherty MR, Fuchs ME, Austin PF, Wu CQ, Zee RS, Misseri R, Tanaka ST, Bauer SB, Rove KO. Expert Consensus on Pediatric Urodynamics Reporting Using Modified Delphi Technique. J Urol 2024:101097JU0000000000004000. [PMID: 38700226 DOI: 10.1097/ju.0000000000004000] [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] [Received: 03/05/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Affiliation(s)
| | - Claudia Mata
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jill L Kaar
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Adam J Rensing
- Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Anne G Dudley
- Connecticut Children's Hospital, Hartford, Connecticut
| | | | | | | | | | - Darius J Bagli
- The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | | | | | | | - Glen A Lau
- University of Utah Health, Salt Lake City, Utah
| | | | - Sarah L Hecht
- OHSU Doernbecher Children's Hospital, Portland, Oregon
| | - Hillary L Copp
- UCSF Benioff Children's Hospitals, San Francisco, California
| | - Hans G Pohl
- Children's National Hospital, Washington, District of Columbia
| | | | - Jennifer Ahn
- Seattle Children's Hospital, Seattle, Washington
| | - John S Wiener
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | | | - Charlotte Q Wu
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca S Zee
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Rosalia Misseri
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | | | | | - Kyle O Rove
- Children's Hospital Colorado, Aurora, Colorado
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Kelly MS, Liu T, Routh JC, Castillo H, Tanaka ST, Smith K, Krach LE, Zhang A, Sherburne E, Castillo J, David J, Wiener JS. Comparing binary & ordinal definitions of urinary & stool continence outcomes: Data from the National Spina Bifida Patient Registry. J Pediatr Urol 2024:S1477-5131(24)00070-6. [PMID: 38368164 DOI: 10.1016/j.jpurol.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/20/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The National Spina Bifida Patient Registry (NSBPR) assesses bladder and bowel incontinence using ordinal categories, but prior NSBPR analyses employed binary classification. Our aims were to 1) perform the first NSBPR analysis of bladder and bowel incontinence as ordinal outcomes to compare to the binary definition and subject variables; 2) explore the correlation of incontinence with undergarment usage, and 3) assess incontinence status following continence surgeries. METHODS Data from NSBPR participants' most recent clinic visit from 2013 to 2020 were analyzed. Ordinal categories of incontinence were compared to previously used binary definitions. Incontinence surgical outcomes were analyzed for those with data at least three months post-operatively. Chi-square tests evaluated associations among categorical variables. Univariate and ordinal logistic regression models were used to test associations of ordinal incontinence status with patient and condition factors. Statistical tests were 2-sided; p values < 0.05 were considered significant. RESULTS Analysis of 7217 individuals using ordinal incontinence outcomes showed little difference from previously used binary outcomes. The final multivariable logistic regression models with ordinal multinomial outcomes showed that associations of incontinence with age, sex, race/ethnicity, health insurance, level of lesion, and continence management technique were similar to prior studies. Among those reporting never being incontinent of both bladder and bowel, 14% reported using protective undergarments. Of the 500 individuals who had bladder outlet surgery, 38% reported never being incontinent of urine. Of 1416 individuals who had appendicostomy (ACE) bowel surgery, 48% reported never being incontinent of stool. DISCUSSION Our current analysis showed that ordinal continence outcome classification had similar continence findings as previous studies using the binary definition of continence. Expanding the binary definition of continence to include monthly episodes of incontinence did not greatly increase the proportion of continent individuals and, therefore, would have not likely made meaningful differences in continence outcomes in prior NSBPR analyses. However, it is known that even mild incontinence can affect quality of life, therefore, capturing any level of incontiennce is of clinical importance. Confirmation of the association of continence outcomes with sociodemographic, condition-related, and interventional factors with both approaches further validates previous analyses using the binary definition of continence. CONCLUSION The previously used binary definition of bladder and bowel continence appears robust. Undergarment choice was a poor surrogate for reported incontinence. After bladder and bowel continence surgeries, 38% and 48%, respectively, reported never being incontinent.
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Affiliation(s)
- Maryellen S Kelly
- Division of Healthcare of Women and Children, Duke University School of Nursing, Durham NC, USA; Division of Pediatric Urology, Department of Urology, Duke University School of Medicine, Durham NC, USA.
| | - Tiebin Liu
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Jonathan C Routh
- Division of Pediatric Urology, Department of Urology, Duke University School of Medicine, Durham NC, USA.
| | - Heidi Castillo
- Division of Developmental and Behavioral Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
| | - Stacy T Tanaka
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Kathryn Smith
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Linda E Krach
- Physical Medicine and Rehabilitation, Gillette Children's Specialty Healthcare, St. Paul, MN, USA.
| | - Amy Zhang
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA; Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Eileen Sherburne
- Children's Hospital and Health System, Inc., Milwaukee, WI, USA.
| | - Jonathan Castillo
- Division of Developmental and Behavioral Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, TX, USA.
| | - Joseph David
- Section of Pediatric Urology, University of Alabama Medical Center, Birmingham, AL, USA.
| | - John S Wiener
- Division of Pediatric Urology, Department of Urology, Duke University School of Medicine, Durham NC, USA.
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Liu T, Ouyang L, Walker WO, Wiener JS, Woodward J, Castillo J, Wood HM, Tanaka ST, Adams R, Smith KA, O'Neil J, Williams TR, Ward EA, Bowman RM, Riley C. Education and employment as young adults living with spina bifida transition to adulthood in the USA: A study of the National Spina Bifida Patient Registry. Dev Med Child Neurol 2023; 65:821-830. [PMID: 36385606 PMCID: PMC10415865 DOI: 10.1111/dmcn.15456] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022]
Abstract
AIM To describe the education and employment transition experience of young adults with spina bifida (YASB) and investigate factors associated with employment. METHOD We queried education and employment data from the US National Spina Bifida Patient Registry from 2009 to 2019. We applied generalized estimating equations models to analyze sociodemographic and disease-related factors associated with employment. RESULTS A total of 1909 participants (850 males, 1059 females) aged 18 to 26 years contributed 4379 annual visits. Nearly 84% had myelomeningocele and, at last visit, the median age was 21 years (mean 21 years 5 months, SD 2 years 10 months). A total of 41.8% had at least some post-high school education, and 23.9% were employed. In a multivariable regression model, employment was significantly associated with education level, lower extremity functional level, bowel continence, insurance, and history of non-shunt surgery. This large, national sample of YASB demonstrated low rates of post-secondary education attainment and employment and several potentially modifiable factors associated with employment. INTERPRETATION Specific sociodemographic, medical, and functional factors associated with employment are important for clinicians to consider when facilitating transition for YASB into adulthood. Additional research is needed to understand the impact of cognitive functioning and social determinants of health on transition success in YASB. WHAT THIS PAPER ADDS There were low education attainment and employment rates in a large sample of young adults with spina bifida. Specific sociodemographic, medical, and functional factors are associated with employment. Some employment-associated factors, such as continence and self-management skills, are modifiable.
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Affiliation(s)
- Tiebin Liu
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
| | - Lijing Ouyang
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
| | - William O. Walker
- Division of Developmental Medicine, Seattle Children's Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - John S. Wiener
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jason Woodward
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jonathan Castillo
- Division of Developmental Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Hadley M. Wood
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Stacy T. Tanaka
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard Adams
- University of Texas Southwestern Medical Center; Scottish Rite for Children, Dallas, Texas, USA
| | - Kathryn A. Smith
- Children's Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joseph O'Neil
- Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Tonya R. Williams
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
| | - Elisabeth A. Ward
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
- Universal Consulting Services, Inc, Consultant to Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robin M. Bowman
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Catharine Riley
- Birth Defects Monitoring and Research Branch, Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Georgia, Atlanta, USA
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Tanaka ST. This Month in Pediatric Urology. J Urol 2023; 209:1041-1042. [PMID: 37157795 DOI: 10.1097/ju.0000000000003427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
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Szymanski KM, Adams CM, Alkawaldeh MY, Austin PF, Bowman RM, Castillo H, Castillo J, Chu DI, Estrada CR, Fascelli M, Frimberger DC, Gargollo PC, Hamdan DG, Hecht SL, Hopson B, Husmann DA, Jacobs MA, MacNeily AE, McLeod DJ, Metcalfe PD, Meyer T, Misseri R, O'Neil J, Rensing AJ, Routh JC, Rove KO, Sawin KJ, Schlomer BJ, Shamblin I, Sherlock RL, Slobodov G, Stout J, Tanaka ST, Weiss DA, Wiener JS, Wood HM, Yerkes EB, Blount J. Causes of death among people with myelomeningocele: A multi-institutional 47-year retrospective study. J Pediatr Rehabil Med 2023; 16:605-619. [PMID: 38073338 PMCID: PMC10789326 DOI: 10.3233/prm-220086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/20/2022] [Accepted: 10/31/2023] [Indexed: 01/01/2024] Open
Abstract
PURPOSE This study aimed to analyze organ system-based causes and non-organ system-based mechanisms of death (COD, MOD) in people with myelomeningocele (MMC), comparing urological to other COD. METHODS A retrospective review was performed of 16 institutions in Canada/United States of non-random convenience sample of people with MMC (born > = 1972) using non-parametric statistics. RESULTS Of 293 deaths (89% shunted hydrocephalus), 12% occurred in infancy, 35% in childhood, and 53% in adulthood (documented COD: 74%). For 261 shunted individuals, leading COD were neurological (21%) and pulmonary (17%), and leading MOD were infections (34%, including shunt infections: 4%) and non-infectious shunt malfunctions (14%). For 32 unshunted individuals, leading COD were pulmonary (34%) and cardiovascular (13%), and leading MOD were infections (38%) and non-infectious pulmonary (16%). COD and MOD varied by shunt status and age (p < = 0.04), not ambulation or birthyear (p > = 0.16). Urology-related deaths (urosepsis, renal failure, hematuria, bladder perforation/cancer: 10%) were more likely in females (p = 0.01), independent of age, shunt, or ambulatory status (p > = 0.40). COD/MOD were independent of bladder augmentation (p = >0.11). Unexplained deaths while asleep (4%) were independent of age, shunt status, and epilepsy (p >= 0.47). CONCLUSION COD varied by shunt status. Leading MOD were infectious. Urology-related deaths (10%) were independent of shunt status; 26% of COD were unknown. Life-long multidisciplinary care and accurate mortality documentation are needed.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Cyrus M Adams
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | | | - Paul F Austin
- Division of Urology, Texas Children's Hospital, Houston, TX, USA
| | - Robin M Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Heidi Castillo
- Section of Developmental Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Jonathan Castillo
- Section of Developmental Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Carlos R Estrada
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Michele Fascelli
- Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Dominic C Frimberger
- Department of Urology, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | | | - Dawud G Hamdan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah L Hecht
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Betsy Hopson
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Micah A Jacobs
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew E MacNeily
- Division of Pediatric Urology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Daryl J McLeod
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Joseph O'Neil
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Adam J Rensing
- Department of Urology, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | | | - Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Bruce J Schlomer
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Isaac Shamblin
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Gennady Slobodov
- Department of Urology, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | - Jennifer Stout
- Surgery Office of Clinical Research, Duke University, Durham, NC, USA
| | - Stacy T Tanaka
- Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John S Wiener
- Division of Urologic Surgery, Duke University, Durham, NC, USA
| | - Hadley M Wood
- Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jeffrey Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Yerkes EB, Cheng EY, Wiener JS, Austin JC, Tu DD, Joseph DB, Routh JC, Tanaka ST. Translating pediatric urodynamics from clinic into collaborative research: Lessons and recommendations from the UMPIRE study group. J Pediatr Urol 2021; 17:716-725. [PMID: 34412976 DOI: 10.1016/j.jpurol.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/04/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
Pediatric patients present unique challenges in the performance and interpretation of urodynamic studies. Interpretation of urodynamics to guide clinical management at an institutional level is accepted as reliable. Challenges arise however when multi-site collaborations incorporate urodynamics into study design to determine primary or secondary outcomes or to direct decision-making. Although standardized terminology has been established by ICCS, the application of this shared language to performance and interpretation of pediatric urodynamics to across multiple sites may not be intuitive or reliable. With a primary goal of defining the care necessary to protect future renal function, the UMPIRE protocol (Urologic Management to Preserve Initial REnal function) utilizes a urodynamics-based risk stratification to determine medical management for infants with myelomeningocele. Iterative changes in the protocol are based upon the clinical progress of the enrolled children. Despite a team experienced in subtleties of urodynamics and despite efforts to minimize variability across sites, the UMPIRE study group identified several areas in which the language of urodynamics required additional clarification or creation of more explicit definitions to standardize performance and interpretation across sites. This article reviews the foundations of current urodynamics practice, describes limitations and challenges unique to pediatric studies, and the shares the humble lessons learned by the UMPIRE study group on their journey toward standardized urodynamic language for management of infants and children with myelomeningocele.
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Affiliation(s)
- Elizabeth B Yerkes
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Pediatric Urology #24, Chicago, IL, 60611, USA.
| | - Earl Y Cheng
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Pediatric Urology #24, Chicago, IL, 60611, USA
| | - John S Wiener
- Duke University Medical Center, Box 3831, Durham, NC, 27710, USA
| | | | - Duong D Tu
- Texas Children's Hospital / Baylor College of Medicine, 6701 Fannin St, Suite 620, Houston, TX, 77030, USA
| | - David B Joseph
- Children's of Alabama, 1600 7th Ave South, Lowder 318, Birmingham, AL, 35233, USA
| | - Jonathan C Routh
- Duke University Medical Center, Box 3831, Durham, NC, 27710, USA
| | - Stacy T Tanaka
- Vanderbilt University Medical Center, 2200 Children's Way. 4102 DOT, Nashville, TN, 37232, USA
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Tanaka ST, Yerkes EB, Routh JC, Tu DD, Austin JC, Wiener JS, Vasquez E, Joseph DB, Ahn JJ, Wallis MC, Williams T, Rose C, Baum MA, Cheng EY. Urodynamic characteristics of neurogenic bladder in newborns with myelomeningocele and refinement of the definition of bladder hostility: Findings from the UMPIRE multi-center study. J Pediatr Urol 2021; 17:726-732. [PMID: 34011486 PMCID: PMC11008495 DOI: 10.1016/j.jpurol.2021.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Infants with myelomeningocele are at risk for chronic kidney disease caused by neurogenic bladder dysfunction. Urodynamic evaluation plays a key role to risk stratify individuals for renal deterioration. OBJECTIVE To present baseline urodynamic findings from the Urologic Management to Preserve Initial Renal function for young children with spina bifida (UMPIRE) protocol, to present the process that showed inadequacies of our original classification scheme, and to propose a refined definition of bladder hostility and categorization. STUDY DESIGN The UMPIRE protocol follows a cohort of newborns with myelomeningocele at nine children's hospitals in the United States. Infants are started on clean intermittent catheterization shortly after birth. If residual volumes are low and there is no or mild hydronephrosis, catheterization is discontinued. Baseline urodynamics are obtained at or before 3 months of age to determine further management. Based on protocol-specific definitions, urodynamic studies were reviewed by the clinical site in addition to a central review team; and if necessary, by all site urologists to achieve 100% concurrence. RESULTS We reviewed 157 newborn urodynamic studies performed between May 2015 and September 2017. Of these 157 infants, 54.8% were boys (86/157). Myelomeningocele closure was performed in-utero in 18.4% (29/157) and postnatally in 81.5% (128/157) of newborns. After primary review, reviewers agreed on overall bladder categorization in 50% (79/157) of studies. Concurrence ultimately reached 100% with further standardization of interpretation. We found that it was not possible to reliably differentiate a bladder contraction due to detrusor overactivity from a volitional voiding contraction in an infant. We revised our categorization system to group the "normal" and "safe" categories together as "low risk". Additionally, diagnosis of detrusor sphincter dyssynergia (DSD) with surface patch electrodes could not be supported by other elements of the urodynamics study. We excluded DSD from our revised high risk category. The final categorizations were high risk in 15% (23/157); intermediate risk in 61% (96/157); and low risk in 24% (38/157). CONCLUSION We found pitfalls with our original categorization for bladder hostility. Notably, DSD could not be reliably measured with surface patch of electrodes. The effect of this change on future renal outcomes remains to be defined.
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Affiliation(s)
- Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way. 4102 DOT, Nashville, TN, 37232,, USA.
| | - Elizabeth B Yerkes
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Pediatric Urology #24, Chicago, IL, 60611,, USA
| | - Jonathan C Routh
- Division of Urology, Box 383, Duke University Medical Center, Durham, NC, 27710,, USA
| | - Duong D Tu
- Division of Urology, Texas Children's Hospital/Baylor College of Medicine, 6701 Fannin St, Suite 620. Houston, TX, 77030,, USA
| | - J Christopher Austin
- Department of Urology, Oregon Health Sciences University, Pediatric Urology, CDW6, 3181 SW Sam Jackson Park Road. Portland, OR, 97239,, USA
| | - John S Wiener
- Division of Urology, Box 383, Duke University Medical Center, Durham, NC, 27710,, USA
| | - Evalynn Vasquez
- Division of Urology, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS#114. Los Angeles, CA, 90027,, USA
| | - David B Joseph
- Department of Urology, Children's of Alabama. 1600 7th Ave South, Birmingham, AL, 35233,, USA
| | - Jennifer J Ahn
- Division of Pediatric Urology, Seattle Children's Hospital, 4800 Sand Point Way NE OA.9.220. Seattle, WA, 98105,, USA
| | - M Chad Wallis
- Division of Urology, Primary Children's Hospital, 100 N. Mario Capecchi Drive, Suite 3550. Salt Lake City, UT, 84113-1100, USA
| | - Tonya Williams
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS S106-3, 4700 Buford Hwy. Atlanta, GA, 30341-3717,, USA
| | - Charles Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-87. Atlanta, GA, 30329-4018,, USA
| | - Michelle A Baum
- Division of Nephrology, Boston Children's Hospital, 300 Longwood Avenue, BCH 3038. Boston, MA, 02115,, USA
| | - Earl Y Cheng
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Pediatric Urology #24, Chicago, IL, 60611,, USA
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Tanaka ST. This Month in Pediatric Urology. J Urol 2020. [DOI: 10.1097/ju.0000000000001204] [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: 11/25/2022]
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Joseph DB, Baum MA, Tanaka ST, Frimberger DC, Misseri R, Khavari R, Baillie S, Yerkes EB, Wood H. Urologic guidelines for the care and management of people with spina bifida. J Pediatr Rehabil Med 2020; 13:479-489. [PMID: 33252091 PMCID: PMC7838970 DOI: 10.3233/prm-200712] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The life expectancy for people with spina bifida has increased, thus resulting in greater need for guidelines in urologic care in order to protect normal renal function, to develop strategies for urinary continence, and to advance independence through adult years. METHODS The English literature was assessed from 2002-2015; greater than 300 publications identified. Case reports and opinion pieces were eliminated leaving 100 for in depth review. Clinical questions were then established for each age group that allowed for focused assessment. RESULTS There was no Level 1 evidence for any of the defined clinical questions. This resulted in group consensus for all questions throughout all age groups. Guidelines were provided for identifying a symptomatic urinary infection, the role of urodynamic bladder testing and identification of bladder hostility, determining methods of renal function assessment and surveillance, the initiation of continence control, and transitioning to self-care through the teen and adult years. CONCLUSION Urologic guidelines continue to be based on clinical consensus due to the lack of high level evidence-based research. Further research is required in all aspects of urologic management. While not the "Standard of Care," these guidelines should be considered "Best Practice".
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Affiliation(s)
- David B Joseph
- University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama, USA
| | - Michelle A Baum
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacy T Tanaka
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dominic C Frimberger
- Children's Hospital of Oklahoma, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Rosalia Misseri
- Indiana University School of Medicine, Riley Children's Health, Indianapolis, Indiana, USA
| | | | | | - Elizabeth B Yerkes
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hadley Wood
- Cleveland Clinic, Glickman Urologic and Kidney Institute, Cleveland, Ohio, USA
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Huang A, Delozier S, Lauderdale CJ, Zhao S, Clayton DB, Pope JC, Tanaka ST, Adams MC, Shannon CN, Brock JW, Thomas JC. Do repeat ultrasounds affect orchiectomy rate in patients with testicular torsion treated at a pediatric institution? J Pediatr Urol 2019; 15:179.e1-179.e5. [PMID: 30704855 DOI: 10.1016/j.jpurol.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/15/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Testicular torsion is a urological emergency; as the testicular salvage rate decreases with time, prompt intervention is required to restore the blood flow. Interhospital transfers and ultrasound examinations, while clinically essential to proper treatment and diagnosis, may adversely affect outcomes by delaying surgical intervention. Patients transferred to another institution for treatment of testicular torsion may experience a further time delay by undergoing two ultrasound examinations: one at the initial admitting institution and one at the receiving institution. To the knowledge of the authors, no study has yet explored the time delays and outcomes associated with these repeat ultrasounds. OBJECTIVE The objective was to investigate the impact of repeat ultrasound imaging on time to treatment and patient outcomes in patients with testicular torsion. STUDY DESIGN A retrospective chart review of 133 patients, aged 0-20 years, treated at the authors' institution for testicular torsion was conducted. Neonate patients and patients who did not receive ultrasound were excluded. Demographic and clinical variables were collected from the electronic medical record. Pearson Chi-squared and t-tests were used for univariate comparisons, and multivariate logistic regression analysis was performed to measure the relationships between variables. RESULTS Forty-nine percent of patients were primary patients, and 51% were transfer patients. Fifty-two percent of transfer patients received repeat ultrasounds. In comparison to salvaged patients, those who underwent orchiectomy experienced a greater delay between presentation at the institution and surgical intervention (229 min vs 177 min, p = 0.048). The transfer status does not appear to be related to the outcome, i.e. orchiectomy versus salvage. Patients who underwent orchiectomy were more likely than salvaged patients to have received repeat ultrasounds (p = 0.008). Repeat ultrasound patients had three times the likelihood of orchiectomy of single ultrasound patients. In a subset analysis of transfer patients, repeat ultrasound patients were more likely than single ultrasound patients to receive an orchiectomy (p = 0.03). DISCUSSION In agreement with previous studies, patients who underwent orchiectomy were found to experience greater treatment delays and trend toward transfer. Specifically, repeat ultrasound and time between presentation and intervention appear to influence patient outcomes. The effect of repeat ultrasound on outcomes appears to be independent of the transfer status. The study was limited by its retrospective nature and small sample size. CONCLUSION The analysis suggests that efforts to prevent repeat ultrasounds and minimize the time between presentation and intervention would improve patient outcomes. It is proposed that standardized clinical decision-making procedures, such as the TWIST scoring system, be incorporated into hospital protocols.
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Affiliation(s)
- A Huang
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA.
| | - S Delozier
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA
| | - C J Lauderdale
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA
| | - S Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 1100, Nashville, TN 37203, USA
| | - D B Clayton
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - J C Pope
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - S T Tanaka
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - M C Adams
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - C N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Doctors' Office Tower, Suite 9226, 2200 Children's Way, Nashville, TN 37232-9557, USA
| | - J W Brock
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
| | - J C Thomas
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way Nashville, TN 37232, USA; Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 4102, Nashville, TN 37232-9820, USA
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11
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Affiliation(s)
| | - Peter Hsu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics
| | | | - Stacy T Tanaka
- Division of Pediatric Urology, Department of Urology, and
| | - Emily F Mason
- Division of Hematopathology, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
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12
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Taylor AS, Cabo JJ, Lauderdale C, Maskan N, Thomas JC, Tanaka ST, Pope JC, Adams MC, Brock JW, Shannon CN, Clayton DB. Pelvic floor biofeedback therapy in children: Assessment of symptom scores in responders and non-responders. Neurourol Urodyn 2018; 38:254-260. [PMID: 30350888 DOI: 10.1002/nau.23842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 06/06/2018] [Accepted: 09/17/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Pelvic Floor Biofeedback Therapy (PFBT) can be an effective treatment for pediatric lower urinary tract symptoms (LUTS). Due to differing perceptions of efficacy and practice patterns, we sought to further evaluate PFBT in our practice. We hypothesized that PFBT results in quiescence of EMG activity during voiding and improves questionnaire scores in patients with LUTS. METHODS We retrospectively reviewed all patients undergoing PFBT and refined the analysis to females ≥6 years old with ≥2 sessions with completed voiding questionnaires pre- and post-treatment, active EMG during voiding, with non-neurogenic urinary tract complaints refractory to standard urotherapy. Validated Bladder Bowel Dysfunction (BBD) questionnaires were collected at each visit. Quiescence of EMG activity and changes in BBD score were the primary outcomes. RESULTS 229 patients underwent ≥1 PFBT session, of which 64 females ≥6 years of age with ≥2 PFBT sessions and completed pre and post PFBT voiding questionnaires were identified. In this group, mean age at PFBT start was 10.1 (6.2-17.0). Patients completed 3.1 sessions (2-6). No difference was seen in post-void residual (PVR) between first and last session (23.8 vs 22.6 mL, P = 0.55). Median questionnaire score decreased from 18 (4-42) before to 13 (2-28) following PFBT (P < 0.0001). Responders, characterized by silencing of the EMG after PFBT, occurred in 31% (20/64). Non-responders were younger (P = 0.007) with higher pre-PFBT questionnaire scores. CONCLUSION The use of PFBT appears to result in a significant reduction in symptom scores, though quiescence of EMG was observed following therapy in less than 1/3 of patients.
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Affiliation(s)
- Abby S Taylor
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Jackson J Cabo
- Vanderbilt University Medical School, Nashville, Tennessee
| | - Chelsea Lauderdale
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Narges Maskan
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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13
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Dudley AG, Adams MC, Brock JW, Clayton DB, Joseph DB, Koh CJ, Merguerian PA, Pope JC, Routh JC, Thomas JC, Tu DD, Wallis MC, Wiener JS, Yerkes EB, Lauderdale CJ, Shannon CN, Tanaka ST. Interrater Reliability in Interpretation of Neuropathic Pediatric Urodynamic Tracings: An Expanded Multicenter Study. J Urol 2018; 199:1337-1343. [DOI: 10.1016/j.juro.2017.12.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Anne G. Dudley
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C. Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - John W. Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Douglass B. Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - David B. Joseph
- Department of Urology, University of Alabama Birmingham, Children’s of Alabama, Birmingham, Alabama
| | - Chester J. Koh
- Division of Pediatric Urology, Department of Surgery, Texas Children’s Hospital and Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Paul A. Merguerian
- Division of Urology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - John C. Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Jonathan C. Routh
- Division of Urology, Duke University School of Medicine, Durham, North Carolina
| | - John C. Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Duong D. Tu
- Division of Pediatric Urology, Department of Surgery, Texas Children’s Hospital and Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | - M. Chad Wallis
- Division of Urology, Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - John S. Wiener
- Division of Urology, Duke University School of Medicine, Durham, North Carolina
| | - Elizabeth B. Yerkes
- Division of Urology, Ann and Robert Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chelsea J. Lauderdale
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N. Shannon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
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14
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Kang CL, Taylor AS, Clayton DB, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. MP56-18 COMPARISON OF UROFLOWMETRY WITH AND WITHOUT URETHRAL CATHETERIZATION. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1809] [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: 11/30/2022]
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Wiener JS, Suson KD, Castillo J, Routh JC, Tanaka ST, Liu T, Ward EA, Thibadeau JK, Joseph DB. Bladder Management and Continence Outcomes in Adults with Spina Bifida: Results from the National Spina Bifida Patient Registry, 2009 to 2015. J Urol 2018; 200:187-194. [PMID: 29588216 DOI: 10.1016/j.juro.2018.02.3101] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Most children with spina bifida now survive into adulthood, although most have neuropathic bladder with potential complications of incontinence, infection, renal damage and diminished quality of life. In this study we sought to 1) describe contemporary bladder management and continence outcomes of adults with spina bifida, 2) describe differences from younger individuals and 3) assess for association with socioeconomic factors. MATERIALS AND METHODS We analyzed data on bladder management and outcomes in adults with spina bifida from the National Spina Bifida Patient Registry. A strict definition of continence was used. Results were compared to young children (age 5 to 11 years) and adolescents (12 to 19). Statistical analysis compared cohorts by gender, ethnicity, spina bifida type, lesion level, insurance status, educational attainment, employment status and continence. RESULTS A total of 5,250 patients with spina bifida were included, of whom 1,372 (26.1%) were adults. Of the adult patients 45.8% did not take medication, but 76.8% performed clean intermittent catheterization. Continence was decreased in adults with myelomeningocele (45.8%) vs those with nonmyelomeningocele spina bifida (63.1%, p <0.0001). Continence rates were higher in the older cohorts with myelomeningocele (p <0.0001) but not in those with nonmyelomeningocele spina bifida (p = 0.1192). Bladder management and history of urological surgery varied among age groups. On univariate analysis with spina bifida related or socioeconomic variables continence was significantly associated with educational level but on multivariable logistic regression analysis bladder continence was significantly associated with employment status only. CONCLUSIONS Bladder management techniques differ between adults and children with spina bifida. Bladder continence outcomes were better in adults, with nearly half reporting continence. Continence was significantly associated with employment status in patients age 25 years or older.
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Affiliation(s)
- John S Wiener
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Kristina D Suson
- Department of Urology, Children's Hospital of Michigan, Detroit, Michigan
| | - Jonathan Castillo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Stacy T Tanaka
- Department of Urology, Vanderbilt University, Nashville, Tennessee
| | - Tiebin Liu
- Centers for Disease Control and Prevention, Atlanta Georgia
| | - Elisabeth A Ward
- Centers for Disease Control and Prevention, Atlanta Georgia; Carter Consulting, Inc., Atlanta Georgia
| | | | - David B Joseph
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
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16
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Casella DP, Dudley AG, Clayton DB, Pope JC, Tanaka ST, Thomas J, Adams MC, Brock JW, Caskey CF. Modulation of the rat micturition reflex with transcutaneous ultrasound. Neurourol Urodyn 2017; 36:1996-2002. [DOI: 10.1002/nau.23241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 02/04/2023]
Affiliation(s)
| | - Anne G. Dudley
- Vanderbilt University Medical Center; Nashville Tennessee
| | | | - John C. Pope
- Vanderbilt University Medical Center; Nashville Tennessee
| | | | - John Thomas
- Vanderbilt University Medical Center; Nashville Tennessee
| | - Mark C. Adams
- Vanderbilt University Medical Center; Nashville Tennessee
| | - John W. Brock
- Vanderbilt University Medical Center; Nashville Tennessee
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17
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Affiliation(s)
- Stacy T Tanaka
- Departments of Urologic Surgery and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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18
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Dudley AG, Casella DP, Lauderdale CJ, Zhao S, Chen H, Tanaka ST, Thomas JC, Pope JC, Adams MC, Brock JW, Shannon CN, Clayton DB. Interrater Reliability in Pediatric Urodynamic Tracings: A Pilot Study. J Urol 2016; 197:865-870. [PMID: 27936385 DOI: 10.1016/j.juro.2016.10.053] [Citation(s) in RCA: 14] [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] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Urodynamic studies are crucial to neuropathic bladder management and they often determine surgical intervention. However, current evidence indicates that interpretations show poor agreement across physicians. We sought to determine the interrater reliability of urodynamic interpretation in our practice. We hypothesized that there would be strong correlation among pediatric urologists of similar training in a single academic practice. MATERIALS AND METHODS We retrospectively identified patients with neuropathic bladder who underwent urodynamics at our institution between 2014 and 2015. An anonymous electronic survey (phase I) was developed with 20 clinical scenarios, each containing a brief history, a single urodynamic tracing and an accompanying fluoroscopic image. Faculty members assessed each tracing by an online instrument developed using urodynamic reports and published literature. The primary outcome was statistical correlation across raters as measured by the Spearman correlation coefficient. In a followup study (phase II) we investigated the sources of variability in urodynamic interpretations. RESULTS Six faculty members completed the study with a response rate of 100%. In comparing urodynamic interpretation across raters, the faculty demonstrated a weak to strong correlation (rs 0.39-0.61, p <0.001). A strong correlation was found for fluoroscopic and clinical decision making variables, while electromyography synergy and detrusor overactivity demonstrated weaker correlation across physicians. CONCLUSIONS Faculty interpretations of urodynamic tracings showed only moderate agreement despite a close working relationship and similar training at a single institution. Variability in interpretation can strongly impact patient treatment. Therefore, further work is needed to standardize the reporting and interpretation of urodynamic studies to optimize patient care.
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Affiliation(s)
- Anne G Dudley
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
| | - Daniel P Casella
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chelsea J Lauderdale
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Shilin Zhao
- Center for Quantitative Science, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Heidi Chen
- Center for Quantitative Science, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Chevis N Shannon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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19
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Routh JC, Cheng EY, Austin JC, Baum MA, Gargollo PC, Grady RW, Herron AR, Kim SS, King SJ, Koh CJ, Paramsothy P, Raman L, Schechter MS, Smith KA, Tanaka ST, Thibadeau JK, Walker WO, Wallis MC, Wiener JS, Joseph DB. Design and Methodological Considerations of the Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida. J Urol 2016; 196:1728-1734. [PMID: 27475969 DOI: 10.1016/j.juro.2016.07.081] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Care of children with spina bifida has significantly advanced in the last half century, resulting in gains in longevity and quality of life for affected children and caregivers. Bladder dysfunction is the norm in patients with spina bifida and may result in infection, renal scarring and chronic kidney disease. However, the optimal urological management for spina bifida related bladder dysfunction is unknown. MATERIALS AND METHODS In 2012 the Centers for Disease Control and Prevention convened a working group composed of pediatric urologists, nephrologists, epidemiologists, methodologists, community advocates and Centers for Disease Control and Prevention personnel to develop a protocol to optimize urological care of children with spina bifida from the newborn period through age 5 years. RESULTS An iterative quality improvement protocol was selected. In this model participating institutions agree to prospectively treat all newborns with spina bifida using a single consensus based protocol. During the 5-year study period outcomes will be routinely assessed and the protocol adjusted as needed to optimize patient and process outcomes. Primary study outcomes include urinary tract infections, renal scarring, renal function and bladder characteristics. The protocol specifies the timing and use of testing (eg ultrasonography, urodynamics) and interventions (eg intermittent catheterization, prophylactic antibiotics, antimuscarinic medications). Starting in 2014 the Centers for Disease Control and Prevention began funding 9 study sites to implement and evaluate the protocol. CONCLUSIONS The Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida began accruing patients in 2015. Assessment in the first 5 years will focus on urinary tract infections, renal function, renal scarring and clinical process improvements.
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Affiliation(s)
- Jonathan C Routh
- Division of Urology, Duke University Medical Center, Durham, North Carolina.
| | - Earl Y Cheng
- Division of Urology, Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Michelle A Baum
- Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Richard W Grady
- Department of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Adrienne R Herron
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven S Kim
- Division of Urology, Children's Hospital Los Angeles, Los Angeles, California
| | - Shelly J King
- Department of Urology, Riley Hospital for Children, Indianapolis, Indiana
| | - Chester J Koh
- Division of Urology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Pangaja Paramsothy
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa Raman
- Spina Bifida Association, Arlington, Virginia
| | - Michael S Schechter
- Division of Pediatric Pulmonary Medicine, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Kathryn A Smith
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Judy K Thibadeau
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William O Walker
- Division of Developmental Medicine, Seattle Children's Hospital, Seattle, Washington
| | - M Chad Wallis
- Division of Urology, Primary Children's Hospital, Salt Lake City, Utah
| | - John S Wiener
- Division of Urology, Duke University Medical Center, Durham, North Carolina
| | - David B Joseph
- Department of Urology, University of Alabama-Birmingham, Birmingham, Alabama
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20
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Mason MD, Stephany HA, Casella DP, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC. Prospective Evaluation of Sacral Neuromodulation in Children: Outcomes and Urodynamic Predictors of Success. J Urol 2016; 195:1239-44. [DOI: 10.1016/j.juro.2015.11.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew D. Mason
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Heidi A. Stephany
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Daniel P. Casella
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Douglass B. Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - John C. Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - Mark C. Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - John W. Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
| | - John C. Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
- Division of Pediatric Urology, Children's Hospital of Pittsburgh (HAS), Pittsburgh, Pennsylvania
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Abstract
PURPOSE Literature pertaining to surgical disclosure to the pediatric patient is lacking. We hypothesized parents would find it difficult to disclose urologic surgery to a child. MATERIALS AND METHODS Parents of patients <5 years old undergoing urologic surgery were contacted for telephone survey. Parents were asked about future plans of surgical disclosure, comfort with disclosure, and any support received. RESULTS 98 parents consented to study participation. 87% of surgeries were on the genitalia with 62% being minor genitalia surgery (i.e. circumcision). 70% of parents would tell their child about minor genital surgery while 84% would tell about major genital surgery (p=0.07). 4 of 20 parents of children undergoing hypospadias repair (major genital surgery) did not plan to tell their child about surgery. All parents of children undergoing non-genital surgery would tell. Of all parents planning to tell their children about surgery, only 14% were nervous. 34% of parents would find guidance in talking to their child helpful despite the majority (90%) stating no guidance had ever been provided. CONCLUSIONS Parents seem comfortable discussing urologic surgeries with a child but about 1/3 would appreciate further counseling. 20% of parents of children undergoing hypospadias repair hope to avoid telling their child.
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Affiliation(s)
- Christina B Ching
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Mark C Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
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Ching CB, Hays SR, Luckett TR, Mason MD, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC. Interdisciplinary pain management is beneficial for refractory orchialgia in children. J Pediatr Urol 2015; 11:123.e1-6. [PMID: 26059527 DOI: 10.1016/j.jpurol.2014.12.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/20/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Idiopathic testicular/groin pain can be a difficult entity for children, their families, and caregivers. The role of interdisciplinary pain management has previously been demonstrated in treating chronic orchialgia at the present pediatric pain clinic. OBJECTIVE To evaluate the role of interdisciplinary pain management in managing refractory orchialgia. It was hypothesized that children with refractory orchialgia might respond well. Interdisciplinary care was defined as that which crosses two medical disciplines such as a surgical specialty and specialist in analgesia. SUBJECTS AND METHODS Pediatric patients were identified who were: ≥ 10 years old; evaluated in the pediatric urology clinic between 2002 and 2012; were diagnosed wtih ICD code 608.9 or had the diagnosis of male genital disorder NOS. Children were included if they presented with orchialgia without an identifiable cause and failed conservative management (rest, scrotal support, Sitz bath, timed voiding, constipation avoidance) including conventional anti-nociceptive analgesics (acetaminophen, non-steroidal anti-inflammatory drugs, opioids). Patient electronic medical records were reviewed retrospectively. RESULTS Twenty-two children met inclusion criteria. Mean age was 13.7 years (range 10-17). Nearly half (45%) of the children had chronic medical conditions such as asthma, allergies, and obesity. Twenty-one of the 22 children were referred to the pediatric pain clinic; 15 were evaluated, and one refused treatment. All children evaluated in the pediatric pain clinic were initially offered an empiric anti-neuropathic anti-convulsant (i.e. gabapentin) and/or an anti-depressant (i.e. amitriptyline) before being offered a nerve block. Of the 14 children accepting treatment in the pediatric pain clinic, six were treated solely with an empiric anti-neuropathic anti-convulsant and/or anti-depressant; eight received medications followed by nerve block (seven ilioinguinal-iliohypogastric blocks, one spinal and ilioinguinal-iliohypogastric block) (see Fig. 1). A total of eight of the 14 children (57%) treated by the pain clinic had resolution of pain, with 50% of those treated with medications alone (three out of six children) responding (two responding to gabapentin and a tricyclic antidepressant, one to gabapentin alone); and five out of eight (63%) treated with medications and then nerve block (ilioinguinal-iliohypogastric block) responding. Of the eight children undergoing nerve block, five required more than one block. The time between each block ranged from 4 to 22.6 weeks. Response to nerve block required an average of 1.4 procedures (range 1-2); mean follow-up after nerve block was 2.4 months (range 0.1-4.8). DISCUSSION Children with refractory orchialgia often have comorbidities that suggest a multidisciplinary approach would be useful for treating them. The present study found that the majority of children with refractory orchialgia treated in the pediatric pain clinic responded to management. Major limitations, however, included small cohort size and short follow-up, particularly in those children undergoing nerve block. There was also no objective assessment of pain improvement or improvement in quality of life, which could be rectified with a prospective study. CONCLUSION Collaboration and early referral for interdisciplinary pain management as one of these multidisciplinary approaches may help to coordinate care and ease patient suffering.
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Affiliation(s)
- C B Ching
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - S R Hays
- Department of Anesthesiology, Vanderbilt University School of Medicine and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University School of Medicine and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - T R Luckett
- Perioperative Services and Pediatric Pain Service, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - M D Mason
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - D B Clayton
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - S T Tanaka
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - J C Thomas
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - M C Adams
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - J W Brock
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - J C Pope
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
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Stephany HA, Ching CB, Kaufman MR, Squiers A, Trusler L, Clayton DB, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Transition of Urologic Patients From Pediatric to Adult Care: A Preliminary Assessment of Readiness in Spina Bifida Patients. Urology 2015; 85:959-63. [DOI: 10.1016/j.urology.2014.12.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 12/02/2014] [Accepted: 12/10/2014] [Indexed: 10/23/2022]
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Ching CB, Lee H, Mason MD, Clayton DB, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Bullying and Lower Urinary Tract Symptoms: Why the Pediatric Urologist Should Care about School Bullying. J Urol 2015; 193:650-4. [DOI: 10.1016/j.juro.2014.08.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Christina B. Ching
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Haerin Lee
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Matthew D. Mason
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Douglass B. Clayton
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Thomas
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Pope
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C. Adams
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - John W. Brock
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
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Ching CB, Hays SR, Kaffenberger SD, Stephany HA, Luckett TR, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC. Pediatric chronic orchialgia: patient population and patterns of care. J Pediatr Urol 2014; 10:799-803. [PMID: 24768521 DOI: 10.1016/j.jpurol.2014.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/13/2013] [Accepted: 01/06/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A major hurdle in management of any chronic pain syndrome is understanding the population in which it occurs. We describe our pediatric population of patients with peripubertal and postpubertal chronic orchialgia. PATIENTS AND METHODS Pediatric patients ≥ 10 years of age seen between 2002 and 2012 were identified by ICD code 608.9, Male Genital Disorder NOS. Patients were included if they had orchialgia without identifiable cause lasting >3 months. Patient history, diagnostic evaluations, treatments, and outcomes were assessed. RESULTS Seventy-nine pediatric patients were identified. The mean age was 13.3 years (range 10-18); mean duration of orchialgia was 16.3 months (range 3-85). Thirty-three of 79 (42%) had concomitant medical conditions and/or psychiatric-behavioral issues. The mean follow-up was 7.1 months (range 0-70.4) with 41/79 (52%) having more than one office visit follow-up. Eleven patients were referred to a pediatric pain clinic; 10 out of 11 (91%) were evaluated there. Overall, 16 out of 41 (39%) had resolution of pain: nine out of 41 (22%) responding to conservative management vs seven of 10 (70%) responding to pain clinic management (3 to anti-neuropathic medications, 4 to nerve block). CONCLUSION Many pediatric patients with chronic orchialgia have co-morbidities amenable to multidisciplinary collaborative coordination of care. Referral to pediatric pain clinic can be of significant benefit.
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Affiliation(s)
- Christina B Ching
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Stephen R Hays
- Department of Anesthesiology, Vanderbilt University School of Medicine & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University School of Medicine & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Samuel D Kaffenberger
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Heidi A Stephany
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Twila R Luckett
- Perioperative Services & Pediatric Pain Service, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Douglass B Clayton
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Stacy T Tanaka
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John C Thomas
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Mark C Adams
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John W Brock
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - John C Pope
- Division of Pediatric Urology, Vanderbilt University Medical Center & Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
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Fraumann SA, Stephany HA, Clayton DB, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Long-term follow-up of children who underwent severe hypospadias repair using an online survey with validated questionnaires. J Pediatr Urol 2014; 10:446-50. [PMID: 24582083 DOI: 10.1016/j.jpurol.2014.01.015] [Citation(s) in RCA: 26] [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: 10/03/2013] [Accepted: 01/21/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Few studies of hypospadias repair in childhood have used validated questionnaires to investigate outcomes of cosmesis, urinary function, and sexual function in adulthood. We sought to investigate long-term outcomes in adult patients who had undergone severe hypospadias repair as children using an existing web-based application available to multiple institutions in order to develop an online patient survey of previously validated questionnaires. MATERIALS AND METHODS Patients aged 18 years or older who underwent severe hypospadias repair between 1992 and 1997 at our institution were contacted to complete an online survey. Through medical chart reviews, we analyzed the location of meatus, type of repair, and complications. The online survey included questions about penile appearance, and validated questionnaires to assess urinary and sexual function. RESULTS Of 58 patients who met the inclusion criteria, we contacted 19, and 13 completed the survey. Fifty-nine percent had complications, with an average of 2.2 procedures per patient. Most (85.0%) were satisfied with penile appearance, although 38.0% had residual penile curvature. Hypospadias patients had mean lower orgasmic function than normal controls. Mean scores for urinary function and other domains of sexual function were similar to normal controls. CONCLUSIONS Although the majority of adult patients were satisfied with the outcomes of penile appearance, urinary function, and sexual function, our online survey suggests decreased lower orgasmic function as measured by validated questionnaire. An online survey accessible to multiple institutions with validated questionnaires may facilitate assessment of long-term hypospadias results.
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Affiliation(s)
- Sarah A Fraumann
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - Heidi A Stephany
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - Mark C Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 4012 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA.
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Joshi SS, Clayton DB, Pope JC, Adams MC, Tanaka ST, Brock JW, Thomas JC. MP26-02 SPONTANEOUS DESCENT RATE OF CRYPTORCHID TESTES: A PLEA FOR EARLY REFERRAL. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.890] [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: 10/25/2022]
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Clayton DB, Stephany HA, Ching CB, Rahman SA, Tanaka ST, Thomas JC, Pope JC, Adams MC, Brock JW, Clark PE, Hayward SW, Matusik RJ, Milne GL. F2-isoprostanes as a biomarker of oxidative stress in the mouse bladder. J Urol 2014; 191:1597-601. [PMID: 24679873 DOI: 10.1016/j.juro.2013.09.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE We theorized that progressive bladder dysfunction due to clinical diagnoses such as outlet obstruction occurs as a result of cyclical oxidative stress events. We hypothesized that measurement of F2-isoprostane, a marker of lipid peroxidation, could serve as a biomarker of oxidative stress in the murine bladder. MATERIALS AND METHODS At age 5 to 6 weeks oophorectomized female mice were subjected to 1 of 2 bladder injury models, that is partial bladder outlet obstruction or acute bladder distension. The time points studied after injury included 4, 8 and 16 weeks after obstruction, and 0 to 48 hours after acute bladder distension. In a separate group short-term repetitive acute bladder distension was performed every other day for 14 days. Bladder samples were analyzed for F2-isoprostane using gas chromatography and mass spectroscopy. Mean tissue F2-isoprostane levels were compared. RESULTS F2-isoprostane increased significantly after 4 weeks of partial bladder outlet obstruction from 1.46 ng/gm in controls to 2.31 ng/gm at 4 weeks (p = 0.01). Eight and 16 weeks after partial bladder outlet obstruction F2-isoprostane remained significantly elevated (2.39 and 2.48 ng/gm, respectively). Acute bladder distension resulted in a significant increase in F2-isoprostane immediately after distension compared to controls (1.6 vs 0.75 ng/gm, p = 0.04). In mice that underwent repetitive acute bladder distension F2-isoprostane did not change. CONCLUSIONS Measurement of tissue F2-isoprostane in the bladder reflects the progression of oxidative stress, primarily in chronic injury models such as partial bladder outlet obstruction. The usefulness of F2-isoprostane measurements in shorter term injury models requires further study.
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Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
| | - Heidi A Stephany
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Christina B Ching
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Shareena A Rahman
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Peter E Clark
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Simon W Hayward
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert J Matusik
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ginger L Milne
- Eicosanoid Core Laboratory and Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Lachenmyer LL, Anderson JJ, Clayton DB, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Analysis of an intervention to reduce parental anxiety prior to voiding cystourethrogram. J Pediatr Urol 2013; 9:1223-8. [PMID: 23769752 DOI: 10.1016/j.jpurol.2013.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 02/28/2013] [Accepted: 05/18/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The voiding cystourethrogram (VCUG) is a common imaging test in pediatric urology that can be associated with anxiety in the child and parent. We hypothesized that education by mailed brochure would decrease pre-procedure parental anxiety. METHODS Families of children scheduled for VCUG were randomized into an experimental group that was mailed an educational brochure about the VCUG and a control group. Immediately prior to the procedure, parental anxiety was assessed with the self-administered State-Trait Anxiety Inventory (STAI). The parent repeated the STAI at home after the VCUG and answered brief questions about educational resources used to prepare for the VUCG. RESULTS We enrolled 105 families (47 experimental, 58 control). Parental state anxiety was higher before the procedure than after the procedure (p < 0.001). Younger parents had greater pre-procedure state anxiety (p = 0.007). Contrary to our expectations, pre-procedure state anxiety did not differ between control and experimental groups. However, parents in the experimental group demonstrated less anxiety with some individual items in the questionnaire. CONCLUSION An educational brochure mailed to families prior to VCUG did not decrease pre-procedure parental state anxiety. However, the educational brochure can ensure accurate dissemination of information to help families prepare for this potentially distressing procedure.
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Affiliation(s)
- Lisa L Lachenmyer
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Stephany HA, Juliano TM, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC. Prospective Evaluation of Sacral Nerve Modulation in Children with Validated Questionnaires. J Urol 2013; 190:1516-22. [DOI: 10.1016/j.juro.2013.01.099] [Citation(s) in RCA: 11] [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] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Heidi A. Stephany
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Trisha M. Juliano
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Douglass B. Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C. Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W. Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Ching CB, Stephany HA, Juliano TM, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC. Outcomes of incontinent ileovesicostomy in the pediatric patient. J Urol 2013; 191:445-50. [PMID: 23954583 DOI: 10.1016/j.juro.2013.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Ileovesicostomy is a reconstructive option in complex urological cases but pediatric specific outcomes are lacking. We report our results with pediatric ileovesicostomy. MATERIALS AND METHODS We retrospectively evaluated patients younger than 18 years undergoing incontinent ileovesicostomy at Vanderbilt University. History, urinary tract management and operative course were reviewed in the electronic medical record. Particular attention was given to immediate and long-term postoperative complications. RESULTS Nine patients underwent incontinent ileovesicostomy between 2000 and 2013 at a mean age of 10.3 years (range 1.4 to 15.5). Surgical indication was sequelae of neurogenic or nonneurogenic neurogenic bladder (such as infection or worsening hydronephrosis) in 5 patients, reversal of vesicostomy in 3 and closure of cloacal exstrophy in 1. All 9 patients were thought incapable of reliable clean intermittent catheterization due to family unwillingness, poor social support or patient refusal. Median followup was 11.5 months (mean 48.2, range 1.3 to 144.8). Immediate postoperative complications included ileus requiring total parenteral nutrition and a wound infection in 1 patient. Long-term complications included urinary tract infection in 2 patients (febrile in 1 and positive culture for foul smelling urine in 1), stomal issues in 2 and temporary urethral leakage in 1. Constipation affected 3 children in long-term followup (all with neurogenic bowel preoperatively). Postoperative creatinine was stable or improved in all patients. CONCLUSIONS Ileovesicostomy is a viable approach in children left with few other options, particularly those who are noncompliant or physically/socially unable to handle catheterization. This operation can help keep such patients out of diapers.
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Affiliation(s)
- Christina B Ching
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Heidi A Stephany
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Trisha M Juliano
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Douglass B Clayton
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
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Ching CB, Stephany HA, Tanaka ST, Thomas JC, Pope JC, Adams MC, Brock JW, Clayton DB. 479 BLADDER OUTLET OBSTRUCTION GENERATES OXIDATIVE STRESS. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1871] [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: 11/28/2022]
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Stephany HA, Strand DW, Ching CB, Tanaka ST, Milne GL, Cajaiba MM, Thomas JC, Pope JC, Adams MC, Brock JW, Hayward SW, Matusik RJ, Clayton DB. Chronic cyclic bladder over distention up-regulates hypoxia dependent pathways. J Urol 2013; 190:1603-9. [PMID: 23429070 DOI: 10.1016/j.juro.2013.02.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Bladder over distention secondary to anatomical or functional obstruction can eventually lead to pathological changes, including decreased elasticity and contractile dysfunction. We hypothesized that chronic bladder distention in a murine model would activate hypoxia dependent signaling pathways despite intermittent relief of distention. MATERIALS AND METHODS Female C57Bl/6 mice were oophorectomized at age 5 to 6 weeks and underwent urethral catheterization and 90-minute bladder distention. Acute and chronic time points were evaluated. Bladder tissue was harvested for hematoxylin and eosin, and immunohistochemical staining with the hypoxia markers Glut-1 (EMD Millipore, Merck, Darmstadt, Germany) and Hypoxyprobe™-1. Bladder tissue was also harvested for real-time polymerase chain reaction and oxidative stress measurement. Hypoxia polymerase chain reaction arrays were done to determine changes in gene expression. Oxidative stress was measured using F2-IsoP. Functional bladder changes were evaluated using voided urine blots. RESULTS After acute distention and 5 consecutive distentions, bladders showed marked inflammatory changes on hematoxylin and eosin staining, and evidence of tissue hypoxia on immunohistochemistry. Quantitative real-time polymerase chain reaction revealed up-regulation of hypoxia and oxidative stress related genes, including Hif1a, Arnt2, Ctgf, Gpx1 and Hmox1. Measurements of oxidative stress with F2-IsoP did not change. Voided urine blots before and after bladder distention showed marked changes with an overactive voiding pattern. CONCLUSIONS Chronic bladder distention is possible in the female mouse. It generates hypoxic injury, as characterized functionally by increased voiding patterns. This bladder injury model might more closely replicate bladder dysfunction in patients with poor bladder emptying due to neurological disease, including those noncompliant with intermittent catheterization.
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Affiliation(s)
- Heidi A Stephany
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Juliano TM, Stephany HA, Clayton DB, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Incidence of abnormal imaging and recurrent pyelonephritis after first febrile urinary tract infection in children 2 to 24 months old. J Urol 2013; 190:1505-10. [PMID: 23353046 DOI: 10.1016/j.juro.2013.01.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The AAP (American Academy of Pediatrics) no longer recommends voiding cystourethrogram in children 2 to 24 months old who present with a first urinary tract infection if renal-bladder ultrasound is normal. We identified factors associated with abnormal imaging and recurrent pyelonephritis in this population. MATERIALS AND METHODS We retrospectively evaluated children diagnosed with a first episode of pyelonephritis at age 2 to 24 months using de-identified electronic medical record data from an institutional database. Data included age at first urinary tract infection, gender, race/ethnicity, need for hospitalization, intravenous antibiotic use, history of abnormal prenatal ultrasound, renal-bladder ultrasound and voiding cystourethrogram results, urinary tract infection recurrence and surgical intervention. Risk factors for abnormal imaging and urinary tract infection recurrence were analyzed by univariate logistic regression, the chi-square test and survival analysis. RESULTS We identified 174 patients. Of the 154 renal-bladder ultrasounds performed 59 (38%) were abnormal. Abnormal prenatal ultrasound (p = 0.01) and the need for hospitalization (p = 0.02) predicted abnormal renal-bladder ultrasound. Of the 95 patients with normal renal-bladder ultrasound 84 underwent voiding cystourethrogram. Vesicoureteral reflux was more likely in patients who were white (p = 0.003), female (p = 0.02) and older (p = 0.04). Despite normal renal-bladder ultrasound, 23 of 84 patients (24%) had dilating vesicoureteral reflux. Of the 95 patients with normal renal-bladder ultrasound 14 (15%) had recurrent pyelonephritis and 7 (7%) went on to surgical intervention. CONCLUSIONS Despite normal renal-bladder ultrasound after a first pyelonephritis episode, a child may still have vesicoureteral reflux, recurrent pyelonephritis and the need for surgical intervention. If voiding cystourethrogram is deferred, parents should be counseled on these risks.
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Affiliation(s)
- Trisha M Juliano
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Drzewiecki BA, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Use of Validated Bladder/Bowel Dysfunction Questionnaire in the Clinical Pediatric Urology Setting. J Urol 2012; 188:1578-83. [DOI: 10.1016/j.juro.2012.02.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Indexed: 12/31/2022]
Affiliation(s)
- Beth A. Drzewiecki
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Thomas
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John C. Pope
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Mark C. Adams
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - John W. Brock
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Drzewiecki BA, Anumanthan G, Penn HA, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC, Matusik RJ, Hayward S, Clayton DB. Modulation of the hypoxic response following partial bladder outlet obstruction. J Urol 2012; 188:1549-54. [PMID: 22910264 DOI: 10.1016/j.juro.2012.02.037] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE Tissue level hypoxia has been noted in animal models of partial bladder outlet obstruction. The key mechanisms linking hypoxia and obstruction induced bladder dysfunction remain unknown. 2-Methoxyestradiol is a natural derivative of 17β-estradiol and is currently used as an oncologic agent for its ability to regulate the hypoxia pathway. We investigated the ability of 2-methoxyestradiol to modulate the hypoxia response in a mouse model of bladder obstruction. MATERIALS AND METHODS A group of 5 to 6-week-old female C57BL/6 mice underwent oophorectomy and partial bladder outlet obstruction. Obstructed animals received a subcutaneous pellet of cholesterol placebo (7) or 2-methoxyestradiol plus cholesterol (7). Age matched controls underwent oophorectomy only (8). After 4 weeks the bladders of mice with partial bladder outlet obstruction and of unobstructed animals were harvested. Bladder sections (5 μm) were immunostained for Hypoxyprobe™-1, glucose transporter 1 and hypoxia inducible factor-1α. Real-time polymerase chain reaction was performed for hypoxia inducible factor-1α and lysyl oxidase. Statistical analysis was performed using 1-way ANOVA and the Wilcoxon rank sum test. RESULTS Immunostaining for glucose transporter 1 and Hypoxyprobe-1 revealed the presence of tissue hypoxia after partial bladder outlet obstruction. Immunostaining and real-time polymerase chain reaction demonstrated the up-regulation of hypoxia inducible factor-1α in mice after partial bladder outlet obstruction compared to controls (p = 0.0394). Although not statistically significant, a trend toward lower gene expression of hypoxia inducible factor-1α was seen in mice receiving 2-methoxyestradiol compared to placebo (p = 0.0625). Compared to placebo, 2-methoxyestradiol treatment increased lysyl oxidase expression (p = 0.007). CONCLUSIONS Murine partial bladder outlet obstruction resulted in hypoxia and up-regulation of the hypoxia inducible factor-1 pathway. Subcutaneous 2-methoxyestradiol administration attenuated this response and may be a viable tool to study the role of hypoxia after partial bladder outlet obstruction.
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Affiliation(s)
- Beth A Drzewiecki
- Department of Urologic Surgery, Division of Pediatric Urology, Vanderbilt University, Nashville, Tennessee 37232, USA
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Drzewiecki BA, Thomas JC, Pope JC, Adams MC, Brock JW, Tanaka ST. Observation of patients with vesicoureteral reflux off antibiotic prophylaxis: physician bias on patient selection and risk factors for recurrent febrile urinary tract infection. J Urol 2012; 188:1480-4. [PMID: 22906676 DOI: 10.1016/j.juro.2012.02.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/28/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Observation off continuous antibiotic prophylaxis is an option for vesicoureteral reflux. We evaluated the characteristics of patients observed off continuous antibiotic prophylaxis and risk factors for febrile urinary tract infection. MATERIALS AND METHODS We identified children 1 to 18 years old with primary vesicoureteral reflux between January 1, 2010 and December 31, 2010. We excluded patients with prior surgical correction from analysis. We recorded age, gender, race/ethnicity, primary language, insurance carrier, age at vesicoureteral reflux diagnosis, initial presentation and vesicoureteral reflux severity. We quantified bladder and bowel dysfunction with a validated questionnaire if toilet trained. We compared patients off vs on continuous antibiotic prophylaxis with the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables. We used a univariate Cox proportional hazards model to assess predictors of febrile urinary tract infection during observation off continuous antibiotic prophylaxis. RESULTS Of 529 eligible patients 224 were observed off continuous antibiotic prophylaxis. Patients off continuous antibiotic prophylaxis tended to be older (p <0.001), to be older at diagnosis (p <0.001), to have an initial presentation other than febrile urinary tract infection (p = 0.05), to have nondilating vesicoureteral reflux on most recent cystogram (p <0.001) and to have lower bladder/bowel dysfunction scores if toilet trained (p <0.001). Of the patients off continuous antibiotic prophylaxis a febrile urinary tract infection developed in 19 (8.5%). Risk factors associated with febrile urinary tract infection included initial presentation of multiple febrile urinary tract infections (p = 0.03), older age at diagnosis (p = 0.03) and older age starting observation off continuous antibiotic prophylaxis (p = 0.0003). CONCLUSIONS Criteria to select patients with vesicoureteral reflux for observation off continuous antibiotic prophylaxis remain poorly defined in the literature. Observation will fail in a subset of patients with vesicoureteral reflux. Physician biases regarding patient selection for observation off continuous antibiotic prophylaxis should be considered when interpreting studies that evaluate treatment strategies.
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Affiliation(s)
- Beth A Drzewiecki
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9820, USA.
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Anderson CB, Tanaka ST, Pope JC, Adams MC, Brock JW, Thomas JC. Acute pain crisis as a presentation of primary megaureter in children. J Pediatr Urol 2012; 8:254-7. [PMID: 21700498 DOI: 10.1016/j.jpurol.2011.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 04/14/2011] [Accepted: 05/24/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Congenital ureteropelvic junction obstruction may present with flank pain, commonly referred to as a Dietl's crisis. We report on a similar presentation of primary megaureter. METHODS AND MATERIALS We identified all patients with any diagnosis of megaureter treated at our institution between 1993 and 2009 (n = 465). We included 103 patients with primary megaureter and, of these, identified patients presenting with pain. All patients with secondary megaureter were excluded. RESULTS Seventeen patients (20 megaureters) presented with pain and 10 (13 megaureters) presented with an acute pain crisis. Median age at presentation was 77 months. Seven children initially presented to the emergency department for evaluation and two of them required urgent stent placement for intractable pain. Obstruction was diagnosed in 8 patients. Six patients underwent ureteral reimplantation. Four patients were initially observed: one failed observation at 12 months due to worsening hydronephrosis and required surgery, one was lost to follow up, and two are still successfully being followed. All patients who underwent surgery had pain resolution. CONCLUSION In this contemporary cohort, approximately 17% of patients with primary megaureter presented with pain and 10% presented with an acute pain crisis. Most presenting in acute pain required surgery, which resolved presenting symptoms.
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Affiliation(s)
- Christopher B Anderson
- Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232, USA.
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Clayton DB, Tanaka ST, Trusler L, Thomas JC, Pope JC, Adams MC, Brock JW. Long-Term Urological Impact of Fetal Myelomeningocele Closure. J Urol 2011; 186:1581-5. [DOI: 10.1016/j.juro.2011.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Douglass B. Clayton
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Lisa Trusler
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - John C. Thomas
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - John C. Pope
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Mark C. Adams
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
| | - John W. Brock
- Division of Pediatric Urology, Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
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Broughton GJ, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC. The usefulness of lumbosacral magnetic resonance imaging in the management of isolated dysfunctional elimination. J Urol 2011; 186:1715-20. [PMID: 21855914 DOI: 10.1016/j.juro.2011.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Magnetic resonance imaging is sometimes used to rule out spinal pathology in patients with dysfunctional elimination, although its usefulness in this setting is unclear. We determined the usefulness of magnetic resonance imaging in children with isolated dysfunctional elimination, and normal cutaneous, neurological and orthopedic examinations. MATERIALS AND METHODS We reviewed the records of children with dysfunctional elimination who underwent lumbosacral magnetic resonance imaging and identified those who were neurologically normal and who had normal cutaneous back examinations. Our primary goal was to determine the rate at which magnetic resonance imaging identified a spinal abnormality in this population. Univariate analysis was performed to assess the association of several clinical variables with a radiographic abnormality on magnetic resonance imaging. RESULTS Between 2000 and 2009 a total of 49 lumbosacral magnetic resonance imaging studies were performed in 29 females and 18 males with a mean age of 8.5 years (range 2.1 to 17). Four of the 49 imaging studies (8%) revealed a radiographic abnormality but in only 1 (2%) was clinically significant spinal pathology identified, that is filum lipoma causing cord tethering. Findings on the 3 remaining abnormal imaging studies were considered unrelated to bladder dysfunction. No clinical, demographic or videourodynamic findings were associated with a radiographic abnormality on magnetic resonance imaging. CONCLUSIONS In children with isolated dysfunctional elimination complaints, and normal neurological, orthopedic and back examinations the diagnostic yield of lumbosacral magnetic resonance imaging is low but not zero. We suggest that spinal magnetic resonance imaging be used judiciously and as a test of last resort in these children.
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Affiliation(s)
- Gregory J Broughton
- Department of Urologic Surgery, Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
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Tanaka ST. Commentary to "History and physical examination findings predictive of testicular torsion: an attempt to promote clinical diagnosis by house staff". J Pediatr Urol 2011; 7:475. [PMID: 21256810 DOI: 10.1016/j.jpurol.2010.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 12/16/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Stacy T Tanaka
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Division of Pediatric Urology, 4102 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232, USA.
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Woo LL, Tanaka ST, Anumanthan G, Pope JC, Thomas JC, Adams MC, Brock JW, Bhowmick NA. Mesenchymal stem cell recruitment and improved bladder function after bladder outlet obstruction: preliminary data. J Urol 2011; 185:1132-8. [PMID: 21255803 DOI: 10.1016/j.juro.2010.10.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Indexed: 12/15/2022]
Abstract
PURPOSE Mesenchymal stem cells have various therapeutic benefits in various organ injury models. Bladder outlet obstruction causes smooth muscle hypertrophy and fibrosis, leading to lowered compliance, increased storage pressures and renal injury. Decreased blood flow and hypoxia may contribute to obstruction related bladder decompensation. We used a mouse model to determine whether mesenchymal stem cell recruitment occurred after bladder outlet obstruction and whether this was associated with changes in bladder hypoxia, histology and function. We also identified potential chemokines involved in mesenchymal stem cell recruitment. MATERIALS AND METHODS A total of 20 female mice underwent bladder outlet obstruction. Three days later 2 million green fluorescent protein labeled mesenchymal stem cells were intravenously administered. After 4 weeks urodynamic and histological evaluation was performed. Quantitative reverse transcriptase-polymerase chain reaction was done to determine relative expression of the chemokines CCL2, CCL20, CCL25, CXCL9 and CXCL16. We simultaneously studied mice with bladder outlet obstruction only without mesenchymal stem cell injection and a control group. RESULTS In 10 of 15 surviving mesenchymal stem cell injected mice mesenchymal stem cells were identified in the detrusor, and decreased hypoxia, hypertrophy and fibrosis was seen. Nine of 10 mice with mesenchymal stem cell engraftment had improved compliance compared to those without engraftment (mean±SD 9.6±5.1 vs 3.9±2.6 μl/cm H2O, p=0.012). Polymerase chain reaction revealed a 2-fold increase in CCL2 expression but there were no significant changes in other chemokine levels. CONCLUSIONS Mesenchymal stem cell recruitment to the bladder after bladder outlet obstruction appears to be associated with increased blood flow and decreased tissue hypoxia, which may contribute to improvement in histopathological and functional parameters. Mesenchymal stem cell recruitment may be related to CCL2 over expression. Additional studies in larger samples are needed but these initial results suggest a potential role for mesenchymal stem cell based therapy for bladder outlet obstruction related bladder injury.
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Affiliation(s)
- Lynn L Woo
- Division of Pediatric Urology, Vanderbilt University Medical Center, Monroe Carell, Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9820, USA
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Drzewiecki BA, Thomas JC, Tanaka ST. Bone marrow-derived mesenchymal stem cells: current and future applications in the urinary bladder. Stem Cells Int 2011; 2010:765167. [PMID: 21253479 PMCID: PMC3022195 DOI: 10.4061/2010/765167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 12/14/2010] [Indexed: 12/22/2022] Open
Abstract
Mesenchymal stem cells can be isolated from almost any adult tissue. In this paper we focus on bone marrow-derived mesenchymal stem cells which have captured the interest of researchers since their introduction because of the promising potential of tissue regeneration and repair. They are known for their ability to self-renew and differentiate into diverse lineages while maintaining low immunogenicity. The exact mechanisms behind how these cells work still remain unclear, and there is a continuing shift in the paradigms that support them. There has been extensive research in multiple organ systems; however, the genitorurinary system has been vastly underrepresented. This article discusses the background behind bone marrow-derived mesenchymal stem cells and they are currently being applied to the urinary bladder in the realm of tissue engineering. We also postulate on their future applications based on the current literature in other organ systems.
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Affiliation(s)
- Beth A. Drzewiecki
- Division of Pediatric Urology, Monroe Carell, Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - John C. Thomas
- Division of Pediatric Urology, Monroe Carell, Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Stacy T. Tanaka
- Division of Pediatric Urology, Monroe Carell, Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Abstract
Genitourinary complaints are common in children, and the busy primary care provider must determine initial treatment and assess need for specialty referral. Many complaints are self-limited, but some represent disorders that can threaten organ function. In this article, an initial approach in the primary care office and a guide to specialty referral for pediatric urologic conditions of the urinary tract, male genitalia, and female genitalia are suggested.
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Affiliation(s)
- Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell Jr Children's Hospital at Vanderbilt, 4102 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9820, USA.
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Tanaka ST, Thangappan R, Eandi JA, Leung KN, Kurzrock EA. Bladder Wall Transplantation—Long-Term Survival of Cells: Implications for Bioengineering and Clinical Application. Tissue Eng Part A 2010; 16:2121-7. [DOI: 10.1089/ten.tea.2009.0557] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stacy T. Tanaka
- Department of Urology, University of California–Davis School of Medicine, Sacramento, California
| | - Ravikumar Thangappan
- Department of Urology, University of California–Davis School of Medicine, Sacramento, California
| | - Jonathan A. Eandi
- Department of Urology, University of California–Davis School of Medicine, Sacramento, California
| | - Karen N. Leung
- Department of Medical Microbiology and Immunology, University of California–Davis School of Medicine, Davis, California
| | - Eric A. Kurzrock
- Department of Urology, University of California–Davis School of Medicine, Sacramento, California
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Tanaka ST, Ishii K, Demarco RT, Pope JC, Brock JW, Hayward SW. Endodermal origin of bladder trigone inferred from mesenchymal-epithelial interaction. J Urol 2010; 183:386-91. [PMID: 19914648 DOI: 10.1016/j.juro.2009.08.107] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE In the classic view of bladder development the trigone originates from the mesoderm derived wolffian ducts while the remainder of the bladder originates from the endoderm derived urogenital sinus. Recent molecular developmental studies have questioned the veracity of this received wisdom, suggesting an endodermal origin for the trigone. To shed further light on this issue we observed mesenchymal-epithelial interactions between trigone epithelium and fetal urogenital sinus mesenchyma to infer the trigonal germ layer of origin. MATERIALS AND METHODS Mouse trigone epithelium was recombined with fetal rat urogenital sinus mesenchyma in tissue recombinant grafts that were placed beneath the renal capsule of athymic mouse hosts. Grafts were harvested at 4 weeks. Control grafts with bladder dome and ureteral epithelium were also examined. Tissues were evaluated with hematoxylin and eosin, and Hoechst dye 33258 to confirm cell species origin. Immunohistochemistry was done with androgen receptor, broad spectrum uroplakin, dorsolateral prostate secretions and seminal vesicle secretions to differentiate prostatic and seminal vesicle differentiation. RESULTS Grafts of mouse trigone epithelium with fetal rat urogenital sinus mesenchyma yielded epithelial tissue that stained for dorsolateral prostate secretions but not for seminal vesicle secretions. Control grafts of bladder dome epithelium yielded the expected endodermal prostate differentiation. Control grafts of ureteral epithelium yielded the expected mesodermal seminal vesicle differentiation. CONCLUSIONS The consistent finding of prostatic epithelium in tissue recombinants of trigone epithelium and fetal urogenital sinus mesenchyma reinforces the hypothesis that the trigone is derived from the endoderm and not from the mesoderm, as commonly accepted.
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Affiliation(s)
- Stacy T Tanaka
- Department of Urologic Surgery, Monroe Carell, Jr Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9820, USA.
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Tanaka ST, Martinez-Ferrer M, Makari JH, Wills ML, Thomas JC, Adams MC, Brock JW, Pope JC, Bhowmick NA. Recruitment of bone marrow derived cells to the bladder after bladder outlet obstruction. J Urol 2009; 182:1769-74. [PMID: 19692058 DOI: 10.1016/j.juro.2009.02.081] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE Bladder fibrosis is an undesired end point of partial bladder outlet obstruction. In fibrotic disease of the lung, kidney, skin and heart chemokines recruit bone marrow derived cells to injured tissue. Blockade of chemokines like CCL2 results in decreased fibrosis in other organs. To our knowledge we present the first report of bone marrow derived cell recruitment to the bladder in a murine bladder outlet obstruction model. MATERIALS AND METHODS We lethally irradiated WT female mice and reconstituted their bone marrow using fetal liver cells from transgenic mice ubiquitously expressing green fluorescent protein. Periurethral collagen injection was used for bladder outlet obstruction. Obstruction was assessed by urodynamics, and bladder and kidney histological changes. Bladders were harvested 1 to 12 weeks after bladder outlet obstruction and compared to those in nonobstructed controls. The chemokine CCL2 was compared between obstructed and nonobstructed mice with reverse transcriptase-polymerase chain reaction. Green fluorescent protein expressing bone marrow derived cells were identified with immunohistochemistry and fluorescence activated cell sorting. RESULTS Bladders showed histological and urodynamic changes consistent with obstruction. CCL2 induction increased after obstruction compared to that in controls. After obstruction bone marrow derived cells were present in the urothelial and stromal layers. Activated epidermal growth factor receptor was found in cells associated with bone marrow derived cells. CONCLUSIONS Bone marrow derived cells are recruited to the bladder by bladder outlet obstruction and are present in the urothelial and stromal layers. Stromal bone marrow derived cells may have a role in hypertrophy and fibrosis. Further study of the recruitment and function of bone marrow derived cells in the bladder may provide potential targets for antifibrotic therapy.
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Affiliation(s)
- Stacy T Tanaka
- Division of Pediatric Urology, Monroe Carell, Jr. Vanderbilt Children's Hospital, Nashville, Tennessee 37232-9820, USA.
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Anumanthan G, Tanaka ST, Adams CM, Thomas JC, Wills ML, Adams MC, Hayward SW, Matusik RJ, Bhowmick NA, Brock JW, Pope JC. Bladder stromal loss of transforming growth factor receptor II decreases fibrosis after bladder obstruction. J Urol 2009; 182:1775-80. [PMID: 19692014 DOI: 10.1016/j.juro.2009.05.126] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE Transforming growth factor-beta is a potent stimulator of extracellular matrix production. Several studies show that loss of transforming growth factor-beta signaling decreases kidney, liver and lung fibrosis. However, the role of transforming growth factor-beta signaling in bladder fibrosis is not entirely understood. We investigated the effect of stromal loss of such signaling in mice after partial bladder outlet obstruction. MATERIALS AND METHODS We performed partial bladder outlet obstruction by urethral ligation in 5-week-old female Tgfbr2(colTKO) mice. These mice were compared to WT mice with partial bladder outlet obstruction and to WT nonobstructed controls. After 4 weeks and before sacrifice urodynamics were performed. Bladder tissue was harvested, and p-Smad2 and collagen (Masson's trichrome) staining were performed. RESULTS Bladder compliance was increased in partially obstructed Tgfbr2(colTKO) mice and decreased in partially obstructed WT mice. The latter had increased smooth muscle hypertrophy and increased collagen deposition between smooth muscle bundles compared to those in Tgfbr2(colTKO) mice and nonobstructed controls. Transforming growth factor-beta responsive collagen promoter activity was significantly decreased in Tgfbr2 knockout bladder stromal cells vs WT stromal cells. CONCLUSIONS Stromal loss of transforming growth factor-beta signaling decreased collagen deposition after partial bladder outlet obstruction. In contrast to collagen production by recruited macrophages, stromal transforming growth factor-beta signaling appears to be the primary source of fibrosis after partial bladder outlet obstruction. These findings further support the hypothesis that manipulating transforming growth factor-beta signaling in bladder stromal cells would provide a future avenue for neuropathic bladder and bladder fibrosis treatment.
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Affiliation(s)
- Govindaraj Anumanthan
- Department of Urologic Surgery, Division of Pediatric Urology, Vanderbilt Children's Hospital, Nashville, Tennessee 37232-2765, USA
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Yap SA, DeLair SM, Tanaka ST, Kurzrock EA. Current perceptions of resident training in laparoscopic nephrectomy. Urology 2009; 73:1067-71. [PMID: 19394507 DOI: 10.1016/j.urology.2008.08.520] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 07/02/2008] [Accepted: 08/11/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the perceived degree of training of residents in laparoscopic nephrectomy. Laparoscopic nephrectomy is well established in the field of urology and has seen increasing penetrance in urologic practice. The degree to which this recent technical shift has been integrated into urologic training at the residency level has not been characterized. METHODS An electronic survey was sent to 518 urology residents and recent graduates and to 85 laparoscopic specialists at academic medical centers. Both residents and practicing urologists were queried regarding the level of resident participation for each step of laparoscopic nephrectomy and opinions on the necessity of fellowship training. The data were analyzed using the Wilcoxon rank-sum and chi(2) tests. RESULTS Attending surgeons perceived a significantly greater level of resident involvement in performing all aspects of laparoscopic nephrectomy, with the exception of hilar dissection and port closure. To perform laparoscopic nephrectomy, 12.5% of attending physicians and 5% of residents reported that a fellowship is necessary. CONCLUSIONS Significant disagreement exists between attending surgeons and residents on the perceived degree of resident involvement in most aspects of laparoscopic nephrectomy. This could have significant implications on resident education for a procedure that is arguably the standard of care for treatment of uncomplicated renal masses. Most attending physicians and residents were in agreement that fellowship is not necessary to perform this procedure. These results raise questions regarding the future of laparoscopic training and bring to light the need for better regulation of laparoscopic training.
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Affiliation(s)
- Stanley A Yap
- Department of Urology, University of California, Davis, Children's Hospital, Sacramento, California 95817, USA.
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Abstract
Urinary stone disease is less common in children than adults. Although many aspects of pediatric stone disease are similar to that of adults, there are unique concerns regarding the presentation, diagnosis, and management of stone disease in children. We present a review of the increasing prevalence of pediatric stone disease, the diagnostic concerns specific to children, recent results from pediatric series regarding the expectant management and surgical treatment of stones, metabolic evaluation, and current research on the genetics of nephrolithiasis.
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