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Urinary incontinence due to idiopathic hypercalciuria in children
INTERNATIONAL ABSTRACTS
spheres and injected in five of the seven animals. The animals were killed at 1, 3, and 6-month intervals. All major organs were retrieved and processed. After intensive histological evaluation, the remaining tissue underwent dissolution and centrifugation in sodium hypochl0rite. The resulting insoluble pellet was analyzed further. For dogs injected with the radiolabeled paste, tissue samples and insoluble pellets of each organ system were analyzed for "y counts. Smears of the insoluble pellets of all animals were examined on light and phase-contrast microscopy. During autopsy, no gross abnormalities were noted. Tissue reaction at injection sites showed a well-encapsulated foreign body reaction, with predominantly giant cells, flbroblasts, and collagen deposition. Limited local migration of polydimethylsiloxane particles into the periureterat lymphatics of one animal (killed at 1 month) was noted, and a single particle visually indistinguishable from polydimethylsiloxane also was found within the splenic capsule. The endoscopic procedure in this animal was complicated in that two separate injections were required, and histological evaluation confirmed that the injections were performed uniquely deep into the bladder muscularis. Radioactive counts and dissolution of all major organ systems demonstrated no migration in the remaining six animals. Endoscopic subureteral injection of polydimethylsiloxane is technically feasible, and it may prove to be biocompatible and without risk of distant migration if injected correctly.--George W. Holcomb, Jr Nonsurgical Management of Threatened Upper Urinary Tracts and Incontinence in Children With Myelomeningocele, R.D. Hemandez, R.S. Hurwitz, ].E. Foote, et al. J Urol 152:1582-1585, (November), 1994. Two major urologic objectives in treating the child with myelomeningocele are to preserve renal function and achieve continence. The authors report success in managing these cases with nonsurgical therapy. From 1981 to 1991; 45 patients With myelomenigocele (1 to 15 years of age) were evaluated urodynamically, before and after initiating nonsurgical treatment. Pretreatment urodynamics identified two groups. Group 1 consisted of 31 patients with a leak-point pressure of 40 cm H20 or more, 10 of whom had grades II to V/V vesicoureteral reflux, and four had moderate or severe hydronephrosiS. Group 2 consisted of 14 incontinent patieiats with a leak-point pressure of less than 40 cm H20 and no reflux or hydronephrosis. Both groups were treated With intermittent catheterization, anticlaolinergic medications, and fluid restriction. Within a mean follow-up period of 5.5 years, nonsurgical intervention resulted in lowering maximum detrusor pressure at maximum cystometric capacity to less than 40 cm H20 in 22 of 31 group 1 patients (71%) and in resolving vesicoureteral reflux in 7 of 10 (70%) and hydronephrosis in 3 of 4 (75%) group 1 patientS. Of the four patients in group one with persistent high-grade vesicoureteral reflux or severe hydronephrosis, three (10%) required augmentation cystoplasty. With nonsurgical management, 18 patients (40%) were completely continent, 18 (40%) required two or fewer pads daily, and nine (20%) required more than two pads daily. Nonsurgical management alone was effective in preserving the upper urinary tract in 90% of patients and it provided satisfactory continence in 80%. Surgical management Should be reserved for the minority of patients whose upper tract changes do not resolve and for those whose degree of continence is not satisfactory With nonsurgical management.--George W. Holcomb, Jr The Sensitivity Of Pressure Specific Bladder Volume Versus Total Bladder Capacity as a Measure of Bladder Storage
761
Dysfunction, E,H, Landau, B.M. Churchill, V.R. Jayanthi, et aL J Urol 152:1578-1581, (November), 1994. Assessment of bladder storage function requires an accurate measure of bladder capacity and pressure. Pressure-specific bladder volume is the volume that a bladder can accommodate at a specified pressure. Twenty-one consecutively treated children with neurogenic bladders who were candidates for bladder augmentation based on standard clinical criteria (upper urinary tract deterioration, incontinence, and infection) were studied to determine the efficacy of pressure-specific bladder volume as a measure of bladder dysfunction. Urodynamic indexes were compared with previously established nomograms. All 21 patients had bladder volumes at pressures of 30 cm H20 or less, which decreased to below the fifth percentile as determined by the nomogram. In seven patients (33%), normal total bladder capacity was achieved at the expense of elevated storage pressures. Pressure-specific bladder volume provides a better measure of bladder storage function than of total bladder capacity because it relates volume to intravesical pressure, does not rely on a subjective end-point to bladder filling, and is objective and reproducible.--Geoi'ge W. Holcomb, Jr Urinary Incontinence Due to Idiopathic Hypercalciuria in Children. P. Vachvanichsanong, M. Malagon, and E.S. Moore. J Urol 152:1226-1228, (October), 1994. Idiopathic hypercalciuria is known to cause many nonstone urinary tract disorders in childhood. In addition to being the most common cause of microhematuria in children, this study demonstrates that idiopathic hypercalciuria is also frequently associated with urinary incontinence of all types. Of 124 children evaluated for idiopathic hypercalciuria, 28 (23%) had urinary incontinence. Of the 28, 15 (54%) had nocturnal, six (21%) diurnal, and seven (25%) nocturnal and diurnal incontinence. The random urinary calcium-creatinine ratio, which was used to screen for hypercalcluria, should be part of the initial evaluation for urinary incontinence in children. Diagnosis may be confirmed by quantitative urinary calcium excretion. Most urinary incontinence in children that is caused by idiopathic hypercalciuria responds to a combination of general treatment for hypercalciuria or thiazide diuretics.-George 141..Holeomb, Jr Transurethral Puncture of Ectopic Ureteroceles in Neonates and Infants. C. Smith, R. Gosalbez, T.S. Parrott, et al. J Urol 152:2110-2112, (December), 1994. Ten neonates and infants with a total of 11 ectopic ureteroceles prospectively underwent transurethral puncture as the primary form of therapy. Six of the 10 patients had a prenatal diagnosis of uropathy, and four presented postnatally with a urinary tract infection. One patient had bilateral single-system ectopic ureteroceles, and nine had a single ectopic ureterocele in a duplex system. Significant associated ipsilateral and/or contralateral urologic pathology was noted in addition to the ectopic ureterocele in seven patients. Transurethral puncture adequal.ely decompressed 10 of the 11 ectopic ureteroceles (91%) and improved drainage of nonureterocele moieties in three cases. Iatrogenic reflux was found in three of the 11 ureterocele ureters. Urinary tract infection developed in six infants (four with fever). Of the 10 patients, eight (80%) eventually required secondary surgical intervention because of recurrent urinary tract infections, persistent or iatrogenic reflux, or unresolving hydronephrosis. Although transurethral puncture rarely constitutes definitive treatment for ectopic ureterocele, there appears to be immediate benefit in cases of bilateral hydronephrosis or significant ipsilateral lower pole hydronephr0sis. Decompres-
spheres and injected in five of the seven animals. The animals were killed at 1, 3, and 6-month intervals. All major organs were retrieved and processed. After intensive histological evaluation, the remaining tissue underwent dissolution and centrifugation in sodium hypochl0rite. The resulting insoluble pellet was analyzed further. For dogs injected with the radiolabeled paste, tissue samples and insoluble pellets of each organ system were analyzed for "y counts. Smears of the insoluble pellets of all animals were examined on light and phase-contrast microscopy. During autopsy, no gross abnormalities were noted. Tissue reaction at injection sites showed a well-encapsulated foreign body reaction, with predominantly giant cells, flbroblasts, and collagen deposition. Limited local migration of polydimethylsiloxane particles into the periureterat lymphatics of one animal (killed at 1 month) was noted, and a single particle visually indistinguishable from polydimethylsiloxane also was found within the splenic capsule. The endoscopic procedure in this animal was complicated in that two separate injections were required, and histological evaluation confirmed that the injections were performed uniquely deep into the bladder muscularis. Radioactive counts and dissolution of all major organ systems demonstrated no migration in the remaining six animals. Endoscopic subureteral injection of polydimethylsiloxane is technically feasible, and it may prove to be biocompatible and without risk of distant migration if injected correctly.--George W. Holcomb, Jr Nonsurgical Management of Threatened Upper Urinary Tracts and Incontinence in Children With Myelomeningocele, R.D. Hemandez, R.S. Hurwitz, ].E. Foote, et al. J Urol 152:1582-1585, (November), 1994. Two major urologic objectives in treating the child with myelomeningocele are to preserve renal function and achieve continence. The authors report success in managing these cases with nonsurgical therapy. From 1981 to 1991; 45 patients With myelomenigocele (1 to 15 years of age) were evaluated urodynamically, before and after initiating nonsurgical treatment. Pretreatment urodynamics identified two groups. Group 1 consisted of 31 patients with a leak-point pressure of 40 cm H20 or more, 10 of whom had grades II to V/V vesicoureteral reflux, and four had moderate or severe hydronephrosiS. Group 2 consisted of 14 incontinent patieiats with a leak-point pressure of less than 40 cm H20 and no reflux or hydronephrosis. Both groups were treated With intermittent catheterization, anticlaolinergic medications, and fluid restriction. Within a mean follow-up period of 5.5 years, nonsurgical intervention resulted in lowering maximum detrusor pressure at maximum cystometric capacity to less than 40 cm H20 in 22 of 31 group 1 patients (71%) and in resolving vesicoureteral reflux in 7 of 10 (70%) and hydronephrosis in 3 of 4 (75%) group 1 patientS. Of the four patients in group one with persistent high-grade vesicoureteral reflux or severe hydronephrosis, three (10%) required augmentation cystoplasty. With nonsurgical management, 18 patients (40%) were completely continent, 18 (40%) required two or fewer pads daily, and nine (20%) required more than two pads daily. Nonsurgical management alone was effective in preserving the upper urinary tract in 90% of patients and it provided satisfactory continence in 80%. Surgical management Should be reserved for the minority of patients whose upper tract changes do not resolve and for those whose degree of continence is not satisfactory With nonsurgical management.--George W. Holcomb, Jr The Sensitivity Of Pressure Specific Bladder Volume Versus Total Bladder Capacity as a Measure of Bladder Storage
761
Dysfunction, E,H, Landau, B.M. Churchill, V.R. Jayanthi, et aL J Urol 152:1578-1581, (November), 1994. Assessment of bladder storage function requires an accurate measure of bladder capacity and pressure. Pressure-specific bladder volume is the volume that a bladder can accommodate at a specified pressure. Twenty-one consecutively treated children with neurogenic bladders who were candidates for bladder augmentation based on standard clinical criteria (upper urinary tract deterioration, incontinence, and infection) were studied to determine the efficacy of pressure-specific bladder volume as a measure of bladder dysfunction. Urodynamic indexes were compared with previously established nomograms. All 21 patients had bladder volumes at pressures of 30 cm H20 or less, which decreased to below the fifth percentile as determined by the nomogram. In seven patients (33%), normal total bladder capacity was achieved at the expense of elevated storage pressures. Pressure-specific bladder volume provides a better measure of bladder storage function than of total bladder capacity because it relates volume to intravesical pressure, does not rely on a subjective end-point to bladder filling, and is objective and reproducible.--Geoi'ge W. Holcomb, Jr Urinary Incontinence Due to Idiopathic Hypercalciuria in Children. P. Vachvanichsanong, M. Malagon, and E.S. Moore. J Urol 152:1226-1228, (October), 1994. Idiopathic hypercalciuria is known to cause many nonstone urinary tract disorders in childhood. In addition to being the most common cause of microhematuria in children, this study demonstrates that idiopathic hypercalciuria is also frequently associated with urinary incontinence of all types. Of 124 children evaluated for idiopathic hypercalciuria, 28 (23%) had urinary incontinence. Of the 28, 15 (54%) had nocturnal, six (21%) diurnal, and seven (25%) nocturnal and diurnal incontinence. The random urinary calcium-creatinine ratio, which was used to screen for hypercalcluria, should be part of the initial evaluation for urinary incontinence in children. Diagnosis may be confirmed by quantitative urinary calcium excretion. Most urinary incontinence in children that is caused by idiopathic hypercalciuria responds to a combination of general treatment for hypercalciuria or thiazide diuretics.-George 141..Holeomb, Jr Transurethral Puncture of Ectopic Ureteroceles in Neonates and Infants. C. Smith, R. Gosalbez, T.S. Parrott, et al. J Urol 152:2110-2112, (December), 1994. Ten neonates and infants with a total of 11 ectopic ureteroceles prospectively underwent transurethral puncture as the primary form of therapy. Six of the 10 patients had a prenatal diagnosis of uropathy, and four presented postnatally with a urinary tract infection. One patient had bilateral single-system ectopic ureteroceles, and nine had a single ectopic ureterocele in a duplex system. Significant associated ipsilateral and/or contralateral urologic pathology was noted in addition to the ectopic ureterocele in seven patients. Transurethral puncture adequal.ely decompressed 10 of the 11 ectopic ureteroceles (91%) and improved drainage of nonureterocele moieties in three cases. Iatrogenic reflux was found in three of the 11 ureterocele ureters. Urinary tract infection developed in six infants (four with fever). Of the 10 patients, eight (80%) eventually required secondary surgical intervention because of recurrent urinary tract infections, persistent or iatrogenic reflux, or unresolving hydronephrosis. Although transurethral puncture rarely constitutes definitive treatment for ectopic ureterocele, there appears to be immediate benefit in cases of bilateral hydronephrosis or significant ipsilateral lower pole hydronephr0sis. Decompres-