Re: Comprehensive Analysis of the Clinical and Urodynamic Outcomes of Secondary Tethered Spinal Cord before and after Spinal Cord Untethering

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PEDIATRIC UROLOGY

Re: Comprehensive Analysis of the Clinical and Urodynamic Outcomes of Secondary Tethered Spinal Cord before and after Spinal Cord Untethering A. Alzahrani, O. Alsowayan, J. P. Farmer, J. P. Capolicchio, R. Jednak and M. El-Sherbiny Department of Pediatric Surgery, Division of Pediatric Urology and Neurosurgery, Montreal Children’s Hospital and McGill University Health Center, Shriners Hospital of Montreal, Montreal, Quebec, Canada, and Department of Urology, College of Medicine and King Fahd Hospital of the University of Dammam, Dammam, Saudi Arabia J Pediatr Urol 2016; 12: 101.e1ee6. doi: 10.1016/j.jpurol.2015.08.011

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26454453 Editorial Comment: The authors studied 23 children before and after spinal cord untethering at a median age of 8.8 years. Pressure at total cystometric bladder capacity decreased following untethering, as did detrusor leak point pressure, compliance at total cystometric bladder capacity and compliance at 75% capacity. The neurological or orthopedic symptoms that brought the children to the attention of the neurosurgeon improved in 65% postoperatively. Sometimes symptoms of spinal cord tethering are subtle. This series shows that secondary surgery for retethering is effective. It also reminds us to be alert for neuroorthopedic and urodynamic changes in children with spinal dysraphism as they age. Douglas A. Canning, MD

Re: Computer Model Predicting Breakthrough Febrile Urinary Tract Infection in Children with Primary Vesicoureteral Reflux A. M. Arlen, S. E. Alexander, M. Wald and C. S. Cooper Departments of Urology and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa J Pediatr Urol 2016; 12: 288.e1ee5. doi: 10.1016/j.jpurol.2016.03.005

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27072485 Editorial Comment: Vesicoureteral reflux is important only in the context of breakthrough urinary tract infections. The authors expanded on their large series of patients with vesicoureteral reflux and further analyzed variables associated with breakthrough infection. Vesicoureteral reflux that appears early in filling, bilateral reflux, bladder and bowel dysfunction, and a history of multiple urinary tract infections were all associated with an increased risk of breakthrough infection. Since our main reason for treating patients with vesicoureteral reflux is to prevent upper tract infection and the ensuing scarring, this series is important because it helps us to identify those at the greatest risk for recurrent infection. Douglas A. Canning, MD

Re: Continence and Quality of Life with the Modified Heitz-Boyer-Hovelacque Rectal Bladder for Children with Urinary Incontinence following Bladder Exstrophy M. Messina, F. Molinaro, F. Ferrara, R. Angotti, A. L. Bulotta, G. Di Maggio and A. Bianchi Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy, and Neonatal and Paediatric Reconstructive Surgery, Royal Manchester Children’s Hospital, Manchester, United Kingdom J Pediatr Urol 2016; 12: 174.e1ee6. doi: 10.1016/j.jpurol.2015.12.010

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26895609 Editorial Comment: The authors followed 14 children born with bladder exstrophy for 5 to 10 years after they underwent a modified Heitz-Boyer-Hovelacque rectal bladder technique. In their