Single-center experience with botulinum toxin endoscopic detrusor injection for the treatment of congenital neuropathic bladder in children: effect of dose adjustment, multiple injections, and avoidance of reconstructive procedures.

OBJECTIVE: Since 2007, intra-detrusor OnabotulinumtoxinA (OnabotA) injections have been selectively offered at our institution for cases in which maximal anticholinergic therapy failed or was not tolerated. Herein we present our experience with this approach. MATERIALS AND METHODS: We prospectively obtained data on 17 patients who underwent OnabotA injections over a 4-year period. Demographic information, number of injections, and dose delivered were captured. Children were monitored with baseline and post-injection renal ultrasound, urodynamics, and assessed for side effects, satisfaction, and symptom improvement. RESULTS: Forty-three sessions were performed with injections given every ∼ 6 months. Mean patient age was 10.7 years (range, 3-17). Compared with baseline, after the first injection, mean bladder capacity adjusted for age and compliance improved by 27% (p = 0.039) and 45.2% (p = 0.041), respectively. After subsequent injections, these values increased to 35.7% (p = 0.043) and 55.1% (p = 0.091), respectively. Out of 13 symptomatic patients, ≥ 50% improvement was reported in ten (76.9%) and complete resolution in seven (53.8%). However, all three patients in whom the maximum dose of OnabotA was reduced from 300 to 200 units complained of recurrent symptoms. Fourteen children avoided surgical reconstruction as a second line of treatment. Overall patient/parental reported satisfaction rate was 70.6% (12/17). CONCLUSIONS: Intra-detrusor OnabotA injection is a promising intervention for management of neuropathic bladder in selected patients. Our data demonstrate improvement in symptoms and urodynamic parameters. Although an optimal dose has not been determined for children, we found optimal response with a maximum administration of OnabotA up to 300 units.

Comparison between laparoscopic and open radical nephrectomy for the treatment of primary renal tumors in children: single-center experience over a 5-year period.

OBJECTIVES: To compare the outcomes of laparoscopic nephrectomy (LN) with open radical nephrectomy (ORN) in the management of consecutive pediatric neoplasms. PATIENTS AND METHODS: Retrospective cohort study of consecutive children treated for primary renal tumors between 2006 and 2011, segregated based on surgical modality (LN/ORN). Pre-, intra- and postoperative data and outcomes were collected. RESULTS: Demographics from the 45 patients (13 LN, 32 ORN) were similar, and tumors in the LN group were smaller [6.59 ± 1.8 cm vs. 10.99 ± 2.99 cm ORN (p < 0.05)]. Six patients had preoperative chemotherapy (two LN, four ORN). No tumor ruptures occurred with either technique. Wilms tumor (seven LN, 24 ORN) was the most common diagnosis, followed by renal cell carcinoma (four LN, four ORN). Procedure length was similar between groups (282 ± 79 LN, 263 ± 81 min ORN). Mean length of stay was significantly shorter for LN (2.9 vs. 5.9 days; p = 0.002). Postoperative narcotic requirements and use of nasogastric tube were higher in the ORN group. After a median follow-up of 18 (LN) and 33 months (ORN), 1 and 4 recurrences occurred, respectively. CONCLUSIONS: LN is an attractive alternative to open surgery in carefully selected cases of pediatric renal tumors. Procedure length and incidence of intra-operative rupture were not increased, while post-operative recovery and hospital stay were shorter for LN. Longer follow-up is mandatory to confirm comparable oncological outcomes to ORN.

Analysis of duplicate presentations accepted at two top international pediatric urology meetings.

OBJECTIVE: Meetings of the European Society for Pediatric Urology (ESPU) and American Academy of Pediatrics (AAP) are held annually to promote dissemination of new research findings among practitioners. We conducted an observational study determining the rate of duplicate research presentations at the two meetings. METHODS: A systematic, in-year, cross reference analysis of all clinical and basic research presentations at the ESPU and AAP meetings, for the years 2006-2009, was conducted. The search strategy included abstract title, authorship, country of origin, institution, study design, significance, and sample size. Three reviewers independently abstracted all data. Discrepancies were resolved by consensus. RESULTS: In total, 566 abstracts were presented at the four ESPU meetings. Of these, 23 (4.1%) were also presented at an AAP meeting: 2 of 137 (1.5%) were represented in 2006, 6 of 139 (4.3%) in 2007, 6 of 126 (4.8%) in 2008, and 9 of 164 (5.5%) in 2009. Duplicate presentations were altered by changing the title (57%), adding or removing authors (48%), or changing authorship order (63%) or sample size (22%). Agreement between reviewers was above 90% (kappa = 0.913). CONCLUSIONS: Although there was only a 4% duplicate presentation rate between the studied ESPU and AAP meetings, our results suggest a trend toward increasing duplication over the past 4 years.

Quiste del colédoco en niños: experiencia en 15 casos / Choledocal cyst in children: 15 years experience

Presentamos la experiencia del Servicio de Cirugía Pediátrica del Hospital de Clínicas de la universidadFederal de Minas Gerais en quistes colédoco,con 19 niños tratados en el período de 1984 a 1998,ocho eranmenores de 2 años de edad,7 de los cuales presentaban ictericia obstructiva y acolia.A partir de los dosaños solamente 3 de los 11 niños manifestaban la tríada sintomática de ictericia,dolor y masa abdominal.En 18 pacientes se realizó la estirpación de la vesícula,del quiste y una hepaticoyeyunostomía en Y de Roux.En dos de ellos con severa inflamación periquística,fue realizada la resección intramural del quistey en otro paciente,con inflamación periquística se realizó una quisteyeyunostomía en Y de Roux y colecistectomía

Quiste del colédoco en niños: experiencia en 15 casos / Choledocal cyst in children: 15 years experience

Presentamos la experiencia del Servicio de Cirugía Pediátrica del Hospital de Clínicas de la universidadFederal de Minas Gerais en quistes colédoco,con 19 niños tratados en el período de 1984 a 1998,ocho eranmenores de 2 años de edad,7 de los cuales presentaban ictericia obstructiva y acolia.A partir de los dosaños solamente 3 de los 11 niños manifestaban la tríada sintomática de ictericia,dolor y masa abdominal.En 18 pacientes se realizó la estirpación de la vesícula,del quiste y una hepaticoyeyunostomía en Y de Roux.En dos de ellos con severa inflamación periquística,fue realizada la resección intramural del quistey en otro paciente,con inflamación periquística se realizó una quisteyeyunostomía en Y de Roux y colecistectomía '