Multicenter survey of endoscopic treatment of vesicoureteral reflux using polyacrylate-polyalcohol bulking copolymer (Vantris).

OBJECTIVE: To evaluate an outcome of endoscopic correction of vesicoureteral reflux (VUR) using Vantris (Promedon, Cordoba, Argentina) in terms of its effectiveness and morbidity in a multicenter study. MATERIALS AND METHODS: From 2009 to 2013, 611 patients (210 boys and 401 girls) with a mean age of 3.56 years (range, 1 month-18 years) were treated at 7 centers worldwide endoscopically with Vantris injection. VUR was unilateral in 413 and bilateral in 198 patients comprising 809 renal refluxing units (RRUs). Of these, primary VUR was present in 674 RRUs (83.3%) and 135 (16.7%) were complex cases. Reflux was grades I-V in 24 (2.96%), 123 (15.2%), 451 (55.8%), 158 (19.5%), and 53 (6.6%) RRUs respectively. The follow-up continued from 6 to 54 months. RESULTS: Reflux resolved in 759 RRUs (93.8%) after first Vantris injection, in 26 (3.1%) after second, and in 6 (0.7%) after third injection, respectively. VUR improved to grade I after 1 or 2 injections in 5 ureters (0.6%), which needed no further treatment. Thirteen ureters (1.6%) failed endoscopic correction and required ureteral reimplantation. Vesicoureteral junction obstruction requiring ureteral reimplantation developed in 6 ureters (0.7%) and in 4 (0.5%) required stent insertion. Twenty-three patients (3.8%) suffered afebrile urinary tract infection. Seven (1.2%) developed febrile urinary tract infection. None of the studied patients demonstrated VUR recurrence on voiding cystourethrography. CONCLUSION: The results of this multicenter survey confirm that endoscopic subureteral Vantris injection is a simple, safe, and effective outpatient procedure for treating all grades of VUR.

Endoscopic correction of complex cases of vesicoureteral reflux utilizing Vantris as a new non-biodegradable tissue-augmenting substance.

PURPOSE: We aimed to evaluate prospectively the efficacy of Vantris as a new non-biodegradable tissue-augmenting substance in children with complex cases of VUR. MATERIALS AND METHODS: Over the last 4 years, 37 children (28 female and 9 male) with a mean age of 5.8 ± 3.1 years (mean ± SD) underwent endoscopic correction of complex VUR. A total of 38 renal refluxing units (RRU) was treated as 5 had persistent reflux after open surgery, 16 had duplication, 4 had Hutch diverticulum, 6 had small poorly functioning kidneys (less than 20% of relative renal function) with grade V VUR, 2 had ureterocele after puncture, 3 had persistent stump reflux, 1 had prune belly syndrome, and 1 had urogenital sinus. VUR was Grade I in 2, Grade II in 9, Grade III in 11, Grade IV in 10, and Grade V in 6 RRU, respectively. RESULTS: The reflux was corrected in 34 (89.4%) RRU after a single injection, after second injection in 2 (5.3%) RRU. In 2 (5.3%) RRU, VUR downgraded to Grade I (1RRU) and Grade II (1RRU) and they were taken off antibiotic prophylaxis. VCUG was performed in 11 (73.3%) of 15 children who completed 1 year and in 3 (33.3%) of 9 who completed 3 years of follow up as a part of the routine protocol. None showed VUR recurrence. US demonstrated normal appearance of kidneys in all patients. CONCLUSION: Our data show that Vantris injection provides a high level of reflux resolution in complex cases of VUR.

Why I cannot find the prostate? Behind the subjectivity of rectal exam.

Background. Most physicians use digital rectal examination (DRE) to help detect prostate cancer and to estimate the prostates' size. The accuracy of DRE is known to be limited. We evaluate the ability of doctors to palpate the whole prostate with DRE. Methods. At time of transrectal ultrasound (TRUS) the distances from the anus to the apex and base of prostates were measured. The TRUS's distances were compared to the mean index finger length of our clinic doctors. Results. The ability of the urologist to reach and examine the apex, half, three quarters and the whole prostate was in 93.7%, 66.3%, 23.2% and 3.2% of cases respectively. Conclusions. In most cases it was impossible to palpate the whole prostate. Anatomical location and volume of the examined prostate, as well as the length of his own index finger limit DRE and allow the examination of only a small portion of the prostate.

Surgical outcome of different types of primary hypospadias repair during three decades in a single center.

OBJECTIVE: To evaluate the surgical outcome of different techniques of primary hypospadias repair in a single department. METHODS: We retrospectively evaluated the medical files of all patients who had undergone primary hypospadias repair at our department during the past 3 decades (1978-2009). RESULTS: A total of 820 patients were divided into 3 groups. The first group of 309 patients (37.7%) had glanular hypospadias, the second group of 398 patients (48.5%) had distal hypospadias, and the third group of 113 patients (13.8%) had proximal hypospadias. Of these 820 patients, 67 (8.2%) required corpoplasty to straighten the penis. In the first group, 67 (21.7%) children underwent meatal advancement or meatoplasty, 211 (68.3%) underwent meatal advancement and glanduloplasty, 8 (2.6%) underwent tubularized incised plate hypospadias repair, and 23 (7.4%) underwent Mathieu flap hypospadias repair. In the second group, 196 (49.2%) underwent Mathieu hypospadias repair, 38 (9.5%) underwent tubularized incised plate repair, 142 (35.7%) underwent meatal advancement and glanduloplasty, and 22 (5.5%) underwent onlay-type hypospadias repair. In the third group, 28 (24.8%) underwent 2-stage hypospadias repair, 85 (75.2%) underwent single-stage surgery (including 68 [60.2%] onlay and 11 [9.7%] tubularized island flap), and 6 (5.3%) underwent tubularized incised plate hypospadias repair. Immediate complications developed in 46 (14.9%) in the first, 123 (30.9%) in the second, and 66 (58.4%) in the third group; 38 (4.6%) required additional surgery during or after adolescence. CONCLUSION: Our data have shown that despite the numerous techniques used for hypospadias surgery, the incidence of complications is still high in patients who undergo hypospadias repair.

Treatment of nocturnal enuresis in children with attention deficit hyperactivity disorder.

PURPOSE: Children with attention deficit hyperactivity disorder disproportionately experience voiding dysfunction and persistent nocturnal enuresis due to a combination of sphincter and detrusor overactivity and nocturnal polyuria. The different treatment approaches to nocturnal enuresis often fail in these patients. Therefore, we performed a prospective study to compare the efficacy of combination therapy with desmopressin and oxybutynin vs the tricyclic antidepressant imipramine in patients with attention deficit hyperactivity disorder who have nocturnal enuresis. MATERIALS AND METHODS: A total of 54 patients with attention deficit hyperactivity disorder and nocturnal enuresis were randomly stratified into 2 groups. Demographic data on patient age and gender were identical in the 2 groups. Functional bladder symptoms were judged using the dysfunctional voiding symptoms survey. The initial dysfunctional voiding symptoms survey score was similar in the 2 groups. The total survey score was compared between the 2 groups in aggregate as well as specifically regarding the incidence of nocturnal enuresis following treatment. RESULTS: The first group consisted of 27 patients who received desmopressin and oxybutynin, and the second group of 27 was treated with imipramine. Of the 27 children in each group 23 (85%) received methylphenidate for attention deficit hyperactivity disorder. The mean +/- SD initial dysfunctional voiding symptoms survey score in groups 1 and 2 was 20.5 +/- 3.3 and 20.9 +/- 4.1, respectively. Following treatment the mean survey score decreased significantly in groups 1 and 2 (6.5 +/- 2.5 and 9.4 +/- 2.1, respectively, p <0.001). However, between groups analysis showed that the dysfunctional voiding symptoms survey score was significantly lower in group 1 than in group 2 (mean 6.5 +/- 0.5 vs 9.6 +/- 0.4, p <0.001). There was also a statistically significant decrease in the incidence of nocturnal enuresis in group 1 (survey question 2 score 0.9 +/- 0.2 vs 2.9 +/- 0.2). CONCLUSIONS: Our data show that there is a high incidence of voiding dysfunction in children with attention deficit hyperactivity disorder. Combination therapy with desmopressin and oxybutynin is a feasible, safe and effective treatment for nocturnal enuresis in these children.