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Kheir GB, Verbakel I, Wyndaele M, Monaghan TF, Sinha S, Larsen TH, Van Laecke E, Birder L, Hervé F, Everaert K. Lifelong LUTS: Understanding the bladder's role and implications across transition phases, a comprehensive review. Neurourol Urodyn 2024. [PMID: 38289317 DOI: 10.1002/nau.25304] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTSs) are a diverse array of urinary and pelvic dysfunctions that can emerge from childhood, extend through adulthood, and persist into older age. This narrative review aims to provide a comprehensive perspective on the continuum of LUTS and shed light on the underlying mechanisms and clinical implications that span across the lower urinary tract. METHODS A panel of five experts from Belgium, the Netherlands, India, Denmark, and the United States participated in an intensive research to explore and pinpoint existing insights into the lifelong concept of LUTS, particularly at the pelvic level. The experts reviewed the existing literature and held a webinar to discuss their findings. RESULTS Childhood LUTS can persist, resolve, or progress into bladder underactivity, dysfunctional voiding, or pain syndromes. The Lifelong character can be explained by pelvic organ cross-talk facilitated through complex neurological and nonneurological interactions. At the molecular level, the role of vasopressin receptors in the bladder's modulation and their potential relevance to therapeutic strategies for LUTS are explored. Frailty emerges as a parallel concept to lifelong LUTS, with a complex and synergistic relationship. Frailty, not solely an age-related condition, accentuates LUTS severity with insufficient evidence regarding the effectiveness and safety profile of the available therapeutic modalities. CONCLUSION Understanding lifelong LUTSs offers insights into genetic, anatomical, neurological, and molecular mechanisms. Further research could identify predictive biomarkers, elucidate the role of clinically translatable elements in pelvic cross-talk, and uncover molecular signatures for personalized management.
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Affiliation(s)
- George Bou Kheir
- Department of Urology, ERN accredited centrum, Ghent University Hospital, Ghent, Belgium
| | - Irina Verbakel
- Department of Urology, ERN accredited centrum, Ghent University Hospital, Ghent, Belgium
| | - Michel Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas F Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
| | - Tove Holm Larsen
- Department of Urology, ERN accredited centrum, Ghent University Hospital, Ghent, Belgium
| | - Erik Van Laecke
- Department of Urology, ERN accredited centrum, Ghent University Hospital, Ghent, Belgium
| | - Lori Birder
- Departments of Medicine and Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - François Hervé
- Department of Urology, ERN accredited centrum, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN accredited centrum, Ghent University Hospital, Ghent, Belgium
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Van Laecke E. Could cremaster muscle spasticity cause retractile or undescended testis in cerebral palsy? Implications for assessment and management. Dev Med Child Neurol 2024; 66:10-11. [PMID: 37408102 DOI: 10.1111/dmcn.15696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 07/07/2023]
Abstract
This commentary is on the original article by Bortnick et al. on pages 82–86 of this issue.
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Van Der Jeugt J, Jamaer C, Berquin C, Decaestecker K, Hoebeke P, Van Laecke E, Van Praet C, Spinoit AF. Robot-assisted radical nephrectomy for Wilms' tumor in children. J Pediatr Urol 2023:S1477-5131(23)00144-4. [PMID: 37130763 DOI: 10.1016/j.jpurol.2023.04.016] [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: 01/14/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Surgical removal of the tumor is a key step in the management of nephroblastoma. Less invasive surgical approaches such as robot-assisted radical nephrectomy (RARN) has gained momentum over the past few years. This video presents a comprehensive step-by-step video for two cases: one uncomplicated left RARN and one more challenging right RARN. MATERIALS & METHODS Following the UMBRELLA/SIOP protocol, both patients received neoadjuvant chemotherapy. Under general anesthesia, in a lateral decubitus position, four robotic and one assistant port are placed. After mobilization of the colon, the ureter and gonadal vessels are subsequently identified. The renal hilum is dissected, and the renal artery and vein are divided. The kidney is dissected with sparing of the adrenal gland. The ureter and gonadal vessels are divided, and the specimen is removed through a Pfannenstiel incision. Lymph node sampling is performed. RESULTS Patients were 4 and 5 years old. The total surgical time was 95 and 200 min, with an estimated blood loss of 5 and 10 cc. The hospital stay was limited to 3 and 4 days. Both pathological reports confirmed the diagnosis of nephroblastoma, with tumour-free resection margins. No complications were observed 2 months postoperatively. CONCLUSION RARN is feasible in children.
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Affiliation(s)
- Jolien Van Der Jeugt
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre
| | | | - Camille Berquin
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre
| | - Karel Decaestecker
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre
| | - Piet Hoebeke
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre
| | - Erik Van Laecke
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre
| | - Charles Van Praet
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre
| | - Anne-Francoise Spinoit
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre.
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Jamaer C, Berquin C, Claeys T, De Bleser E, Hoebeke P, Van Laecke E, Spinoit AF. Robot-assisted pyeloplasty: How to deal with anatomic variants? A step-by-step video presentation. J Pediatr Urol 2023:S1477-5131(23)00114-6. [PMID: 37055342 DOI: 10.1016/j.jpurol.2023.03.027] [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: 10/18/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Pyeloplasty (open or Robot-assisted) is the gold standard of a symptomatic UPJ stenosis. Sometimes anatomic variants make the procedure challenging. This video describes a step-by-step approach in three settings: a crossing blood vessel and two different presentations of incomplete duplicated system. MATERIALS AND METHODS Under general anesthesia, patient positioned in lateral decubitus, three trocars are placed. After mobilization of the colon, the Gerota's fascia is opened, and the renal pelvis is dissected off the surrounding structures. Ureter and obstructed pyelum were subsequently identified, mobilized, and hinged on a traction stitch. The pyelum and ureter are divided and spatulated according to the Anderson-Hynes technique; anastomosis is achieved. In variants, the drainage is one of the challenging steps, needing custom-made drainage of both moieties. Correct positioning of the drainage is confirmed with reflux of methylene blue from the bladder. RESULTS JJ stent was removed 6 weeks postoperatively in surgical day-clinic, additional drainage was removed 1 week after surgery in the outpatient clinic. All three children remain asymptomatic with over a year of follow-up. CONCLUSION A step-by-step plan for pyeloplasty in case of anatomic variants is presented with a video demonstrating a robot-assisted approach in duplicated systems. Moiety drainage can be challenging.
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Affiliation(s)
- Caroline Jamaer
- Department of Urology, University Hospital Ghent, ERN eUROGEN Accredited Centre, Belgium
| | - Camille Berquin
- Department of Urology, University Hospital Ghent, ERN eUROGEN Accredited Centre, Belgium
| | - Tom Claeys
- Department of Urology, University Hospital Ghent, ERN eUROGEN Accredited Centre, Belgium
| | - Elise De Bleser
- Department of Urology, University Hospital Ghent, ERN eUROGEN Accredited Centre, Belgium
| | - Piet Hoebeke
- Department of Urology, University Hospital Ghent, ERN eUROGEN Accredited Centre, Belgium
| | - Erik Van Laecke
- Department of Urology, University Hospital Ghent, ERN eUROGEN Accredited Centre, Belgium
| | - Anne-Francoise Spinoit
- Department of Urology, University Hospital Ghent, ERN eUROGEN Accredited Centre, Belgium.
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Gong S, Bou Kheir G, Kabarriti A, Khosla L, Gong F, Van Laecke E, Weiss J, Everaert K, Hervé F. 'Nocturomics': transition to omics-driven biomarkers of nocturia, a systematic review and future prospects. BJU Int 2023; 131:675-684. [PMID: 36683403 DOI: 10.1111/bju.15975] [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] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To systematically review studies that investigated different biomarkers of nocturia, including omics-driven biomarkers or 'Nocturomics'. MATERIALS AND METHODS PubMed® , Scopus® , and Embase® were searched systematically in May 2022 for research papers on biomarkers in physiological fluids and tissues from patients with nocturia. A distinction was made between biomarkers or candidates discovered by omics techniques, referred to as omics-driven biomarkers, and classical biomarkers, measured by standard laboratory techniques and mostly thought from pathophysiological hypothesis. RESULTS A total of 13 studies with 18 881 patients in total were included, eight of which focused on classical biomarkers including: atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), C-reactive protein (CRP), aldosterone, and melatonin. Five were 'Nocturomics', including one that assessed the microbiome and identified 27 faecal and eight urinary bacteria correlated with nocturia; and four studies that identified candidate metabolomic biomarkers, including fatty acid metabolites, serotonin, glycerol, lauric acid, thiaproline, and imidazolelactic acid among others. To date, no biomarker is recommended in clinical practice. Nocturomics are in an embryonic phase of conception but are developing quickly. Although candidate biomarkers are being identified, none of them are yet validated on a large sample, although some preclinical studies have shown a probable role of fatty acid metabolites as a possible biomarker of circadian rhythm and chronotherapy. CONCLUSION Further research is needed to validate biomarkers for nocturia within the framework of a diagnostic and therapeutic precision medicine perspective. We hope this study provides a summary of the current biomarker discoveries associated with nocturia and details future prospects for omics-driven biomarkers.
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Affiliation(s)
- Susan Gong
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - George Bou Kheir
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Abdo Kabarriti
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Lakshay Khosla
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Fred Gong
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - François Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Verbakel I, Maenhout T, Petrovic M, Weiss J, Van Laecke E, Delanghe J, Everaert K. Laying the foundation for enhancing safety of desmopressin in older people: Validation of capillary blood sodium levels. Neurourol Urodyn 2023; 42:303-308. [PMID: 36321798 DOI: 10.1002/nau.25084] [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] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/22/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE We aim to make desmopressin a safe treatment option for (older) patients at risk for hyponatremia, by introducing a new way of sodium monitoring. The goal is to reduce the risk of hyponatremia, enhance patient safety and ultimately introduce self-monitoring of sodium levels. The first step in the aforementioned is to validate capillary sodium. MATERIALS AND METHODS 100 randomly selected patients admitted to the urology department received a single finger prick to collect capillary blood (250 µl) in a lithium-heparin tube. Each patient acted as its own control for the capillary and venous blood sample. Venous and capillary plasma sodium were analyzed by indirect ion-selective electrode measurement. The primary outcome was the agreement between capillary and venous sodium measurements, measured by the intra-class correlation coefficient (ICC). RESULTS One hundred paired blood samples were obtained of which four were excluded. There was no significant statistical difference observed between venous and capillary sodium (-0.23 mmol/L, p = 0.374). The ICC for single measures between capillary and venous sodium was 0.82 (95% confidence interval 0.75-0.88). Inter-method differences analyzed by a Bland-Altman plot and a Passing-Bablock regression did not reveal a statistically significant difference between both groups. CONCLUSIONS We demonstrated that venous and capillary sodium levels are interchangeable, taken into account the inter- and intravariability between analyses. We provided the first step towards a simple and safe solution for frequent sodium monitoring through a minimal invasive capillary blood collection. The results are of direct clinical relevance to safely use desmopressin in (older) patients at risk.
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Affiliation(s)
- Irina Verbakel
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Joris Delanghe
- Department of Clinical Laboratory, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Haddad R, Decalf V, Monaghan TF, Van Laecke E, Bower W, Goessaert AS, Petrovic M, Everaert K. Nocturia severely impairs the sleep quality of nursing home residents: results from a multi-center study. Geriatr Nurs 2022; 48:164-168. [PMID: 36257221 DOI: 10.1016/j.gerinurse.2022.09.009] [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] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess the association between self-reported sleep quality and nocturia in nursing home residents. METHODS The association between self-reported poor sleep quality and nocturia was examined in eighty nursing home residents from two nursing facilities using logistic regression analysis. RESULTS Poor sleep quality was reported by 29% of the eighty participants (median age 89±7 years, 77% of women). Nocturia was more frequent in patients with versus without self-reported poor sleep quality (78% vs 47%, p=0.01). Nocturia was independently associated with self-reported poor sleep quality after controlling for age, gender, self-rated health status, cognitive frailty score, antidepressant and hypnosedative use (OR[95%CI] of 6.1[1.8-25.4]). CONCLUSION Nocturia severely impaired sleep quality in nursing home residents. Nocturia should be investigated in nursing home residents to optimize sleep quality.
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Affiliation(s)
- Rebecca Haddad
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
| | - Veerle Decalf
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Thomas F Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Wendy Bower
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Australia; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - An-Sofie Goessaert
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Samijn B, Van den Broeck C, Plasschaert F, Pascal A, Deschepper E, Hoebeke P, Van Laecke E. Incontinence training in children with cerebral palsy: A prospective controlled trial. J Pediatr Urol 2022; 18:447.e1-447.e9. [PMID: 35732572 DOI: 10.1016/j.jpurol.2022.05.014] [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: 12/22/2020] [Revised: 02/04/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Urinary incontinence is the most frequently observed lower urinary tract symptom in children with cerebral palsy (CP). Being continent can positively influence quality of life of the child and the social environment. OBJECTIVE To investigate the effectiveness of incontinence training with urotherapy in children with CP. STUDY DESIGN A population-based case-control study was conducted including 21 children with CP and 24 typically developing children between 5 and 12 years old, both with daytime incontinence or combined daytime incontinence and enuresis. Children received treatment for one year with three-monthly examination by means of uroflowmetry, a structured questionnaire and bladder diaries. Children started with three months of standard urotherapy. After three, six and nine months of training, specific urotherapy interventions (pelvic floor muscle training with biofeedback, alarm treatment or neuromodulation) and/or pharmacotherapy could be added to the initial treatment. Therapy was individualized to probable underlying conditions. Effectiveness was controlled for spontaneous improvement due to maturation and analysed by means of longitudinal linear models, generalized estimating equations and multilevel cumulative odds models. Comparison with typically developing children was assessed by means of Kaplan-Meier survival analysis. RESULTS Results suggest effectivity rate of incontinence training is lower and changes occur more slowly in time in children with CP compared to typically developing children (Figure). Within the group of children with CP, significant changes during one year of training were found for daytime incontinence (p < 0.001), frequency of daytime incontinence (p = 0.002), frequency of enuresis (p = 0.048), storage symptoms (p = 0.011), correct toilet posture (p = 0.034) and fecal incontinence (p = 0.026). DISCUSSION Maximum voided volume and fluid intake at the start of training were significantly lower in children with CP and could explain a delayed effectiveness of urotherapy. Treatment of constipation demonstrated a positive effect on maximum voided volume and should be initiated together with standard urotherapy when constipation is still present after implementation of a correct fluid intake schedule. Future research with a larger sample size is recommended. CONCLUSIONS Incontinence training with urotherapy can be an effective treatment for urinary incontinence in children with cerebral palsy. In the current cohort, effectivity rate of incontinence training was lower and changes occurred more slowly in children with cerebral palsy compared to typically developing children.
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Affiliation(s)
- Bieke Samijn
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | | | - Frank Plasschaert
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Aurelie Pascal
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | | | - Piet Hoebeke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
| | - Erik Van Laecke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium.
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Bou Kheir G, Verbakel I, Hervé F, Bauters W, Abou Karam A, Holm-Larsen T, Van Laecke E, Everaert K. OAB supraspinal control network, transition with age, and effect of treatment: A systematic review. Neurourol Urodyn 2022; 41:1224-1239. [PMID: 35537063 DOI: 10.1002/nau.24953] [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] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/05/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In light of a better understanding of supraspinal control of nonneurogenic overactive bladder (OAB), the prevalence of which increases with age, functional imaging has gained significant momentum. The objective of this study was to perform a systematic review on the transition of supraspinal control of OAB with age, the effect of therapeutic modalities, and a coordinate-based meta-analysis of all neuroimaging evidence on supraspinal OAB control in response to bladder filling. METHODOLOGY We performed a systematic literature search of all relevant libraries in November 2021. The coordinates of brain activity were extracted from eligible neuroimaging studies to perform an activation likelihood estimation (ALE) meta-analysis. RESULTS A total of 16 studies out of 241 were selected for our systematic review. Coordinates were extracted from five experiments involving 70 patients. ALE meta-analysis showed activation of the insula, supplementary motor area, dorsolateral prefrontal cortex, anterior cingulate gyrus, and temporal gyrus with a transition of activation patterns with age, using a threshold of uncorrected p < 0.001. Among young patients, neuroplasticity allows the activation of accessory circuits to maintain continence, as in the cerebellum and temporoparietal lobes. Anticholinergics, pelvic floor muscle training, sacral neuromodulation, and hypnotherapy are correlated with supraspinal changes attributed to adaptability and possibly a substratum of an intrinsic supraspinal component. The latter is better demonstrated by a resting-state functional connectivity analysis, a promising tool to phenotype OAB with recent successful models of predicting severity and response to behavioral treatments. CONCLUSION Future neuroimaging studies are necessary to better define an OAB neurosignature to allocate patients to successful treatments.
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Affiliation(s)
- George Bou Kheir
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Irina Verbakel
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - François Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Wouter Bauters
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Anthony Abou Karam
- Department of Radiology, Yale New Haven Hospital, Yale, Connecticut, USA
| | - Tove Holm-Larsen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Pauwaert K, Bruneel E, Van Laecke E, Depypere H, Everaert K, Goessaert AS. Does hormonal therapy affect the bladder or the kidney in postmenopausal women with and without nocturnal polyuria? Results of a pilot trial. Maturitas 2022; 160:61-67. [DOI: 10.1016/j.maturitas.2022.01.009] [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] [Received: 05/19/2021] [Revised: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
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11
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Tack LJ, Springer A, Riedl S, Tonnhofer U, Weninger J, Hiess M, Van Laecke E, Hoebeke P, Spinoit AF, Cools M, Van Hoecke E. Psychosexual Outcome, Sexual Function, and Long-Term Satisfaction of Adolescent and Young Adult Men After Childhood Hypospadias Repair. J Sex Med 2020; 17:1665-1675. [DOI: 10.1016/j.jsxm.2020.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
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12
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Roggeman S, Weiss JP, Van Laecke E, Vande Walle J, Everaert K, Bower WF. The role of lower urinary tract symptoms in fall risk assessment tools in hospitals: a review. F1000Res 2020; 9. [PMID: 32269762 PMCID: PMC7135676 DOI: 10.12688/f1000research.21581.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/20/2022] Open
Abstract
A large number of falls in hospitals occur on the way to the toilet. Accordingly, a literature search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library to identify fall risk screening and assessment metrics published between 1980 and 2019 and to study the inclusion of lower urinary tract symptoms (LUTS) and their related parameters in these screening tools. In addition, the literature was searched to explore the relationship between toilet-related falls and LUTS. In total, 23 fall risk scales were selected, from which 11 were applicable for in-hospital patients. In nine of the 11 scales for in-hospital patients, a LUTS or LUTS-related parameter was included. In the 12 risk assessment tools for community-dwelling older people, there were no LUTS included. Frequency, urinary incontinence, and nocturia were mostly reported in the literature as a potential fall risk parameter. It is recommended to create greater awareness of nocturia and other LUTS among caregivers of hospitalized patients to prevent falls.
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Affiliation(s)
- Saskia Roggeman
- NOPIA research group, Urology Department, Ghent Universtity Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Jeffrey P Weiss
- NOPIA research group, Urology Department, Ghent Universtity Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Erik Van Laecke
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- 5. Faculty of Medicine and Health Sciences, Department of internal Medicine and Pediatrics, Ghent University, Ghent, 9000, Belgium.,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- NOPIA research group, Urology Department, Ghent Universtity Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Wendy F Bower
- NOPIA research group, Urology Department, Ghent Universtity Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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13
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Ringoir A, Dhondt B, De Bleser E, Van Laecke E, Everaert K, Groen LA, Hoebeke P, Spinoit AF. Intradetrusor onabotulinum-a toxin injections in children with therapy-resistant idiopathic detrusor overactivity. A retrospective study. J Pediatr Urol 2020; 16:181.e1-181.e8. [PMID: 31964616 DOI: 10.1016/j.jpurol.2019.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/11/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE The use of intravesical onabotulinum-A toxin (BoNT-A) injections in the treatment of idiopathic detrusor overactivity has been widely studied in adults [2-5]. However, in pediatric populations, study groups are small, and results are not yet sufficient to support this treatment as a standard practice. The aim of this study is to determine the effectiveness and safety of this treatment in children with non-neurogenic detrusor overactivity, resistant to conservative therapy. MATERIAL AND METHODS We retrospectively evaluated the effect and safety of the intradetrusor injection of 100 Units (U) of BoNT-A in 257 children with therapy-resistant non-neurogenic detrusor overactivity between May 2003 and August 2017. Outcome parameters were the number of daytime incontinence and enuresis episodes per week and bladder capacity (BC). Treatment outcomes were classified into complete response, partial response, or no response. RESULTS The database includes 257 children, of which are 102 girls and 155 boys. Median age of first BoNT-A injection was 8 years (range 4-18 years). Of the patients with enuresis, daytime incontinence or both, a complete response was seen in 50%, 45.7%, and 17%, respectively. BC was significantly higher after the first, second, and third injection of 100 U BoNT-A. We estimated that the mean duration of the effect of an injection with a dose of 100 U is around 12 months. After the first injection, one girl (0.4%) developed urinary retention, which required temporary clean intermittent catheterization (CIC). Seventeen patients (6.6%) developed a urinary tract infection. In three patients (1.2%), postoperative vesicoureteral reflux was seen. DISCUSSION A distinction between the effect on daytime incontinence and enuresis was made. A poorer effect on enuresis in children who suffered from both conditions was observed. Drawbacks of this study are its retrospective design and the lack of anticholinergic treatment standardization before and after BoNT-A injection. CONCLUSION BoNT-A injection is a potentially effective adjuvant therapy in the treatment of children with therapy-resistant overactive bladder (OAB). Bladder capacity increases significantly after the first, second, and third injections. A better effect on daytime incontinence than on enuresis was seen. Prospective randomized trials with standardization of conservative treatment and symptoms questionnaires are necessary to confirm the beneficial effect of BoNT-A injections on BC and incontinence.
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Affiliation(s)
- Annelies Ringoir
- Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium.
| | - Bert Dhondt
- Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - Elise De Bleser
- Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - Erik Van Laecke
- Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | - Karel Everaert
- Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | | | - Piet Hoebeke
- Ghent University Hospital, Corneel Heymanslaan 10, 9000, Gent, Belgium
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14
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Alwis US, Monaghan TF, Haddad R, Weiss JP, Roggeman S, Van Laecke E, Vande Walle J, Wein AJ, Everaert K. Dietary considerations in the evaluation and management of nocturia. F1000Res 2020; 9. [PMID: 32185022 PMCID: PMC7059782 DOI: 10.12688/f1000research.21466.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 03/03/2020] [Indexed: 12/24/2022] Open
Abstract
Aim: This narrative review investigates the effect of dietary intake on nocturnal voiding severity. The primary aims of this review are to provide a framework for future research and ultimately contribute to more comprehensive, lifestyle-centered guidelines for the management of nocturia. Methods: A literature search was conducted in Web of Science, PubMed, and Google Scholar databases using the keywords “nocturia”, “diuresis”, “natriuresis”, “food”, “diet”, and “nutrients”. Results: High fruit and vegetable consumption was negatively associated with nocturia. High intake of tea and dietary sodium showed a positive association with nocturia. Several foods have also been directly linked to changes in diuresis rate, glycemic control, and endogenous serum melatonin concentration, offering potential mechanisms for this observed effect. Overall quality of the evidence was low. Conclusion: At present, there is limited evidence to suggest that certain foods, electrolytes, and specific compounds may contribute to the pathogenesis of nocturia. A greater understanding of the impact of food and nutrients on body fluid metabolism is needed to further refine the evaluation and treatment of nocturia.
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Affiliation(s)
- Upeksha S Alwis
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Thomas F Monaghan
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Rebecca Haddad
- Sorbonne Université, UPMC Univ Paris 06, AP-HP, GRC 01, Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Rééducation Neurologique, AP-HP, Paris, France.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Saskia Roggeman
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Erik Van Laecke
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Alan J Wein
- Department of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Karel Everaert
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
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15
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De Ruysscher C, Pien L, Tailly T, Van Laecke E, Vande Walle J, Prytuła A. Risk factors for recurrent urolithiasis in children. J Pediatr Urol 2020; 16:34.e1-34.e9. [PMID: 31759903 DOI: 10.1016/j.jpurol.2019.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/07/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To identify risk factors associated with recurrent kidney stones in a paediatric cohort in a Belgian tertiary centre. STUDY DESIGN AND METHODS Medical records of children with the first episode of urolithiasis between 1998 and 2016, followed at Ghent University Hospital initially and at least one-year follow-up were retrospectively reviewed. Patient characteristics, past medical history, presenting symptoms, the results of laboratory investigations and the applied management strategy were analysed. The significant variables from the univariate analysis were integrated into a backward conditional multivariate model. RESULTS Ninety-seven children were included in the analysis, of which 33 (34%) presented with at least one episode of stone recurrence. In the univariate analysis, body mass index (BMI) > 85th percentile and asymptomatic stones at initial presentation were associated with 1.8 and 0.1 times lower risk of recurrent stones, respectively (p = 0.020, 95% confidence interval (CI):0.368-8.749 and p = 0.017, 95% CI:0.014-0.921). In contrast, immobilization resulted in a 10-times higher risk (p = 0.002, 95% CI:1.968-50.005) and the need for technical intervention was associated with a 3.2- times higher risk (p = 0.017, 95% CI:1.297-8.084) of developing recurrent stones. On multivariate analysis only BMI >85th percentile was associated with a 15 times lower risk of stone recurrence (p = 0.030, 95% CI:0.006-0.739). DISCUSSION A possible explanation of reduced risk in patients with a BMI > 85th percentile may lie in a different metabolic profile. Immobilization as a risk factor can be explained by calcium metabolism, which is influenced by immobilization due to fractures, paralysis or motor disability because it causes resorption of the skeleton resulting in elevated blood calcium levels. This study showed that patients who presented without symptoms when the stones first occurred were less likely to have recurring kidney stones compared with patients with symptoms at initial presentation. When technical intervention was needed, we believe this is partly due to a larger stone burden, however we could not find an evidence-based explanation. The institutional protocol, which allowed to create a database with a limited number of patients, was lost to follow-up. Despite the retrospective setting some data were missing. There might also be a bias because the patients were followed-up at a tertiary centre. Possibly, our conclusions cannot be generalized toward the entire paediatric population. CONCLUSION Of all the factors investigated in our cohort, BMI >85 th percentile and asymptomatic stones are associated with a lower risk of stone recurrence. Conversely, immobilized patients and those who require technical intervention at initial presentation may benefit from an intense follow-up after the first episode of urolithiasis.
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Affiliation(s)
- Charlotte De Ruysscher
- Ghent University Hospital, Department of Paediatric Nephrology and Rheumatology, Belgium
| | - Lynn Pien
- Ghent University Hospital, Department of Paediatric Nephrology and Rheumatology, Belgium
| | - Thomas Tailly
- Ghent University Hospital, Department of Paediatric Urology, Belgium
| | - Erik Van Laecke
- Ghent University Hospital, Department of Paediatric Urology, Belgium
| | - Johan Vande Walle
- Ghent University Hospital, Department of Paediatric Nephrology and Rheumatology, Belgium
| | - Agnieszka Prytuła
- Ghent University Hospital, Department of Paediatric Nephrology and Rheumatology, Belgium.
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16
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Spinoit AF, Moreels N, Raes A, Prytula A, De Groote R, Ploumidis A, De Bleser E, Randon C, Vanpeteghem C, Walle JV, Van Laecke E, Vermassen F, Decaestecker K. Single-setting robot-assisted kidney transplantation consecutive to single-port laparoscopic nephrectomy in a child and robot-assisted living-related donor nephrectomy: initial Ghent experience. J Pediatr Urol 2019; 15:578-579. [PMID: 31519482 DOI: 10.1016/j.jpurol.2019.08.005] [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: 01/29/2019] [Accepted: 08/04/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Kidney transplantation (KT) is the gold-standard treatment for end-stage renal disease (ESRD) in children. Robot-assisted kidney transplantation (RAKT) in adults is becoming increasingly common with potentially improved morbidity compared with open KT. The study objective was to evaluate feasibility and outcomes of RAKT in children. PATIENTS & METHODS An 8-years-old boy with ESRD received a kidney transplant from his mother. Simultaneously in two operation theatres, the boy underwent single-port (GelPOINT®) right laparoscopic nephro-ureterectomy (LNU), and his mother underwent robot-assisted left donor nephrectomy (RADN).Two full surgical teams were operating at the same time. Subsequently, the boy underwent RAKT, introducing the graft through the GelPOINT®. RESULTS Total operative time for LNU, RADN, and RAKT was 180, 140, and 195 min, respectively, with warm, cold, and rewarming ischemia times 1.5, 200, and 47 min, respectively. Blood loss was 300, 20, and 50 cc, respectively. No intraoperative complications were noted. Convalescence of both donor and recipient was uneventful, with good kidney function at 1-year follow-up. CONCLUSION RAKT in children is technically feasible and safe, resulting in excellent graft function. Concomitant nephrectomy can be done laparoscopically through the single-site GelPOINT®. An experienced RAKT team with the full support of pediatric nephrologists is mandatory.
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Affiliation(s)
| | - Nathalie Moreels
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ann Raes
- Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | | | - Ruben De Groote
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Elise De Bleser
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Caren Randon
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | | | | | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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17
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Ferong K, Waterschoot M, Sinatti C, Van Laecke E, Cools M, Hoebeke P, Spinoit AF. Rare and special robotic surgery indications in the pediatric population: ectopic organs and differences of sexual development. World J Urol 2019; 38:1865-1868. [PMID: 31440805 DOI: 10.1007/s00345-019-02913-5] [Citation(s) in RCA: 3] [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: 12/17/2018] [Accepted: 08/14/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Differences of sexual development (DSD) affect the development of internal reproductive organs and external genitalia. Ectopic kidney is a rare and challenging pathology causing amongst others incontinence and recurrent urinary tract infections. Those pathologies may in certain cases be an indication for surgery. This manuscript aims to evaluate the role of robot-assisted laparoscopy in the surgical treatment of patients with ectopic kidneys or DSD. MATERIALS AND METHODS A prospective database is maintained in a tertiary referral center with all robotic surgeries performed in children. From this database, a prospective series of robot-assisted resection of embryologic remnants located in the pelvis was extracted: resection of a prostatic utricle cyst, removal of ectopic non-functional kidneys, and resection of a hemi-uterus. RESULTS From an initial database including 72 patients, six patients met the inclusion criteria. Three male patients presenting with utricle cysts, two young girls presenting with ectopic kidneys, and one young boy with pelvic embryological remnants of the uterus, were further evaluated. CONCLUSION Surgical treatment of patients with DSD is safe, feasible, and a good indication for robot-assisted laparoscopic surgery, as both deep dissection and reconstruction in a limited surgical field are requested.
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Affiliation(s)
- Kristel Ferong
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Céline Sinatti
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Martine Cools
- Department of Pediatric Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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18
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Samijn B, Van Laecke E, Vande Walle J, Pascal A, Deschepper E, Renson C, Van den Broeck C. Uroflow measurement combined with electromyography testing of the pelvic floor in healthy children. Neurourol Urodyn 2018; 38:231-238. [PMID: 30311676 DOI: 10.1002/nau.23836] [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: 03/15/2018] [Accepted: 08/23/2018] [Indexed: 11/11/2022]
Abstract
AIMS To investigate if the standard protocol for uroflowmetry, recommended by the International Children's Continence Society, remains accurate when integrating EMG measurement by means of superficial electrodes. METHODS A cross-sectional study was conducted including healthy children. Group A performed two direct repetitions of uroflowmetry in combination with electromyography (uroflow/EMG). Group B performed a preceding measurement of isolated uroflowmetry, followed by two randomized measurements of uroflowmetry with and without EMG. Interpretation of uroflow curve was assessor blinded by a pediatric urologist and secondly performed using the flow index methodology. Statistical analysis compared different voids within each group and between group A and B. RESULTS Eighty-three children were included and 206 uroflow measurements were obtained. In both groups statistical findings confirmed the hypothesis that it is preferable to perform an additional measurement before the use of uroflow/EMG. Although both groups showed improvement between voids, the group with initial uroflow measurement followed by uroflow/EMG measurement showed more improvement in concern of curve pattern. An initially better first void in group A, but no statistical difference between the second void in group A and uroflow/EMG testing in group B further demonstrates a higher improvement in group B. This suggests the use of a precedent uroflowmetry without EMG is preferable to immediate testing with EMG. CONCLUSIONS It should be mandatory to perform one measurement in advance to ensure the reliability of the results. It is suggested to initiate the procedure with a single uroflowmetry measurement followed by one measurement of uroflow with EMG testing.
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Affiliation(s)
- Bieke Samijn
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Erik Van Laecke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium.,Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Aurelie Pascal
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | - Catherine Renson
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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19
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Daeze C, Van Biervliet S, Van Laecke E, Van Winckel M, De Bruyne R, De Guchtenaere A, Hoebeke P, Vande Velde S. The predictive value of colon transit time and anorectal manometry in the approach of faecal continence in children with spina bifida. Acta Gastroenterol Belg 2018; 81:277-282. [PMID: 30024699] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study is to analyse colon transit time (CTT) and anorectal manometry (ARM) in children with spina bifida (SB) as a predictor for achieving spontaneous faecal continence. METHODS SB patients (2.5-7 years old) followed at the SB Reference Centre Ghent University Hospital underwent CTT and/or ARM before starting bowel management. A standardized questionnaire about the presence of constipation and faecal incontinence was completed. CTT was measured using a 6-day pellet abdominal X-ray method. ARM was performed in nonsedated children using a latex-free catheter. RESULTS Twenty-two patients were studied, with a median age of 4.57 years. They all underwent a CTT study, 17 (77%) also agreed to ARM. 10/22 patients (45.5%) were constipated. 5/22 patients (22.7%) became spontaneously continent, 10/22 (45.5%) became pseudocontinent with bowel management, the others remained incontinent. SB patients had a significant prolonged CTT compared to healthy controls. In the group with an abnormal CTT study (12 patients), none of the patients developed faecal continence spontaneously, irrespective of the ARM result. In case of a normal CTT study (10 patients), 7 agreed to ARM. All children with normal resting pressure (4 patients) gained continence spontaneously. The 3 children with abnormal low resting pressure remained incontinent. CONCLUSIONS This prospective study confirms the predictive value of normal CTT and normal resting pressure, in the evolution towards spontaneous faecal continence. If CTT is abnormal, irrespective of the ARM, bowel management will be necessary to obtain pseudo-continence. In these cases, ARM is not a designated examination.
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Affiliation(s)
- Charlotte Daeze
- Department of paediatric Gastroenterology, Ghent University Hospital, Belgium
| | | | - Erik Van Laecke
- Department of paediatric Urology, Ghent University Hospital, Belgium
| | - Myriam Van Winckel
- Department of paediatric Gastroenterology, Ghent University Hospital, Belgium
| | - Ruth De Bruyne
- Department of paediatric Gastroenterology, Ghent University Hospital, Belgium
| | | | - Piet Hoebeke
- Department of paediatric Urology, Ghent University Hospital, Belgium
| | - Saskia Vande Velde
- Department of paediatric Gastroenterology, Ghent University Hospital, Belgium
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20
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Waterloos M, Claeys T, Sempels M, Van Laecke E, Hoebeke P, Spinoit AF. Genitoplasty in newborn females with adrenogenital syndrome: Focus on the reconstruction technique and its outcomes. J Pediatr Urol 2018; 14:198-199. [PMID: 29551555 DOI: 10.1016/j.jpurol.2018.02.011] [Citation(s) in RCA: 1] [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: 06/15/2017] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
The adrenogenital syndrome is an autosomal recessive disorder in which an enzyme defect in the steroid pathway leads to excessive prenatal exposure of androgens. In the female fetus, masculinization of the external genitalia is observed. Surgery aims for functional and aesthetical reconstruction. Many techniques have been described. A video of our modified pull-through reconstruction technique is hereby presented. A retrospective descriptive database was created with patients who underwent genitoplasty for a CAH-associated genital condition. A video demonstrating the reconstructive technique was recorded while operating on a 9-month-old girl. Prior to surgery a cystoscopy is performed to evaluate the length of the urogenital sinus. Surgery starts with creating a reversed U-flap, after which the urogenital sinus is mobilized. The corpora cavernosa are released and the neurovascular bundle is isolated. To create vaginal space the urogenital sinus is subsequently separated. The vaginal introitus is anchored to the perineal skin flap. Labia minora are created by splitting the preputial skin. Finally excessive skin tissue is resected. Twenty-two female patients underwent reconstructive surgery for the adrenogenital syndrome in a tertiary referral centre over 16 years. Median age at surgery was 3 months (0-190). Median follow-up was 36 months (0-108) after surgery. A good functional and aesthetical outcome was observed. The modified pull-through technique, illustrated by this video, provided satisfactory results with a low complication rate. Follow-up until adulthood is needed to evaluate long-term outcomes.
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Affiliation(s)
- Marjan Waterloos
- University Hospital Ghent, Department of Pediatric Urology, De Pintelaan 185, 9000 Gent, Belgium.
| | - Tom Claeys
- University Hospital Ghent, Department of Pediatric Urology, De Pintelaan 185, 9000 Gent, Belgium
| | - Maxime Sempels
- University Hospital Ghent, Department of Pediatric Urology, De Pintelaan 185, 9000 Gent, Belgium
| | - Erik Van Laecke
- University Hospital Ghent, Department of Pediatric Urology, De Pintelaan 185, 9000 Gent, Belgium
| | - Piet Hoebeke
- University Hospital Ghent, Department of Pediatric Urology, De Pintelaan 185, 9000 Gent, Belgium
| | - Anne-Françoise Spinoit
- University Hospital Ghent, Department of Pediatric Urology, De Pintelaan 185, 9000 Gent, Belgium
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21
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Samijn B, Van den Broeck C, Deschepper E, Renson C, Hoebeke P, Plasschaert F, Vande Walle J, Van Laecke E. Risk Factors for Daytime or Combined Incontinence in Children with Cerebral Palsy. J Urol 2017; 198:937-943. [PMID: 28533005 DOI: 10.1016/j.juro.2017.05.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE We identify risk factors for daytime or combined urinary incontinence in children with cerebral palsy. MATERIALS AND METHODS A cross-sectional case-control study was conducted including children with cerebral palsy with or without daytime or combined urinary incontinence from the CP-Reference Center at Ghent University Hospital and 2 associated special education schools. Factors were subdivided in 3 clusters of demographic and general medical data, cerebral palsy classification, and bladder and bowel dysfunction. Data were obtained using uroflowmetry with electromyography testing, a nonvalidated questionnaire and bladder diaries. Univariate and multivariate analyses were performed for variables and clusters, respectively. A final associative logistic model including all clusters was developed. RESULTS The study included 34 incontinent children and 45 continent children. Daytime or combined urinary incontinence was associated with intellectual disability (OR 7.69), swallowing problems (OR 15.11), use of external aids (OR 27.50) and use of laxatives (OR 13.31). Daytime or combined urinary incontinence was positively associated with dyskinesia (OR 5.67) or combined spasticity and dystonia (OR 4.78), bilateral involvement (OR 4.25), Gross Motor Function Classification System level IV (OR 10.63) and V (OR 34.00), and severe impairment in manual (OR 24.27) or communication skills (OR 14.38). Lower maximum voided volume (OR 0.97) and oral fluid intake (OR 0.96) influenced daytime or combined urinary incontinence negatively. Pathological uroflow curves were not significantly associated with incontinence. The final model defined functional impairment, intellectual disability and oral fluid intake as predictive factors for daytime or combined urinary incontinence. CONCLUSIONS Risk analysis revealed functional impairment, intellectual disability and fluid intake as important factors influencing continence in a child with cerebral palsy.
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Affiliation(s)
- Bieke Samijn
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | | | | | - Catherine Renson
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Piet Hoebeke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Frank Plasschaert
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Erik Van Laecke
- Department of Uro-gynaecology, Ghent University, Ghent, Belgium; Department of Urology, Ghent University Hospital, Ghent, Belgium
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22
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Samijn B, Van Laecke E, Renson C, Hoebeke P, Plasschaert F, Vande Walle J, Van den Broeck C. Lower urinary tract symptoms and urodynamic findings in children and adults with cerebral palsy: A systematic review. Neurourol Urodyn 2016; 36:541-549. [DOI: 10.1002/nau.22982] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/05/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Bieke Samijn
- Department of Uro-Gynaecology; Ghent University; Ghent Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Ghent University; Ghent Belgium
| | - Erik Van Laecke
- Department of Uro-Gynaecology; Ghent University; Ghent Belgium
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | | | - Piet Hoebeke
- Department of Uro-Gynaecology; Ghent University; Ghent Belgium
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Frank Plasschaert
- Department of Orthopaedic Surgery; Ghent University Hospital; Ghent Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology and Rheumatology; Ghent University Hospital; Ghent Belgium
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23
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Spinoit AF, Decalf V, Ragolle I, Ploumidis A, Claeys T, Groen LA, Van Laecke E, Hoebeke P. Urodynamic studies in children: Standardized transurethral video-urodynamic evaluation. J Pediatr Urol 2016; 12:67-8. [PMID: 26638696 DOI: 10.1016/j.jpurol.2015.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 08/11/2015] [Accepted: 08/25/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim was too demonstrate standardized video-urodynamic study (VUDS) in children using a transurethral catheter and pressure transducers. METHODS Data necessary to obtain urodynamic evaluation of bladder sphincter function were gathered by concomitant measurement of bladder, urethral, and abdominal pressure. A 7F transurethral triple-lumen water-filled catheter was used for measuring the bladder and sphincter pressures and a water-filled 8F catheter connected to a pressure transducer was inserted into the rectum for pressure measurement. Cystometry was combined with fluoroscopy, providing simultaneous voiding cystourethrography information. Detrusor activity, bladder sensation, capacity, and compliance were measured during filling cystometry. Voiding cystometry consisted of recording pressures in the bladder sphincter and abdomen with simultaneous urinary flow measurement. RESULTS Transurethral VUDS was safely and easily performed in a clinical setting adapted to children. CONCLUSIONS A good and reproducible UDS is mandatory for correct therapeutic decisions. A standardized study associated with fluoroscopic assessment is presented in this video.
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Affiliation(s)
| | - Veerle Decalf
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Inge Ragolle
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Tom Claeys
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium.
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Chang SJ, Van Laecke E, Bauer SB, von Gontard A, Bagli D, Bower WF, Renson C, Kawauchi A, Yang SSD. Treatment of daytime urinary incontinence: A standardization document from the International Children's Continence Society. Neurourol Urodyn 2015; 36:43-50. [DOI: 10.1002/nau.22911] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/01/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Shang-Jen Chang
- Division of Urology; Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; New Taipei Taiwan
- Medical College of Buddhist Tzu; Chi University; Hualien Taiwan
| | - Erik Van Laecke
- Department of Urology; Section of Pediatric Urology; Ghent University; Ghent Belgium
| | - Stuart B. Bauer
- Department of Urology; Boston Children's Hospital; Harvard Medical School; Boston Massachusetts
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry; Saarland University Hospital; Germany
| | - Darius Bagli
- Division of Urology; Hospital for Sick Children and Department of Surgery; University of Toronto; Toronto Ontario
| | - Wendy F. Bower
- Department of Rehabilitation; The Royal Melbourne Hospital; Melbourne Australia
| | - Catherine Renson
- Department of Urology; Section of Pediatric Urology; Ghent University; Ghent Belgium
| | - Akihiro Kawauchi
- Department of Urology; Shiga University of Medical Science; Otsu Japan
| | - Stephen Shei-Dei Yang
- Division of Urology; Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; New Taipei Taiwan
- Medical College of Buddhist Tzu; Chi University; Hualien Taiwan
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Spinoit AF, Poelaert F, Van Praet C, Groen LA, Van Laecke E, Hoebeke P. Grade of hypospadias is the only factor predicting for re-intervention after primary hypospadias repair: a multivariate analysis from a cohort of 474 patients. J Pediatr Urol 2015; 11:70.e1-6. [PMID: 25797860 DOI: 10.1016/j.jpurol.2014.11.014] [Citation(s) in RCA: 23] [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: 03/06/2014] [Accepted: 11/11/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is an ongoing quest on how to minimize complications in hypospadias surgery. There is however a lack of high-quality data on the following parameters that might influence the outcome of primary hypospadias repair: age at initial surgery, the type of suture material, the initial technique, and the type of hypospadias. OBJECTIVES The objective of this study was to identify independent predictors for re-intervention in primary hypospadias repair. STUDY DESIGN We retrospectively analyzed our database of 474 children undergoing primary hypospadias surgery. Univariate and multivariate logistic regression was performed to identify variables associated with re-intervention. A p-value <0.05 was considered statistically significant and therefore considered as a prognostic factor for re-intervention. RESULTS Distal penile hypospadias was reported in 77.2% (n = 366), midpenile in 11.4% (n = 54) and proximal in 11.4% (n = 54) of children. Initial repair was based on an incised plate technique in 39.9% (n = 189), meatal advancement in 36.0% (n = 171), an onlay flap in 17.3% (n = 82) and other or combined techniques in 5.3% (n = 25). In 114 patients (24.1%) re-intervention was required (n = 114) of which 54 re-interventions (47.4%) were performed within the first year post-surgery, 17 (14.9%) in the second year and 43 (37.7%) later than 2 years after initial surgery. The reason for the first re-intervention was fistula in 52 patients (46.4%), meatal stenosis in 32 (28.6%), cosmesis in 35 (31.3%) and other in 14 (12.5%). The median time for re-intervention was 14 months after surgery [range 0-114]. Significant predictors for re-intervention on univariate logistic regression (polyglactin suture material versus poliglecaprone, proximal hypospadias, lower age at operation and other than meatal advancement repair) were put in a multivariate logistic regression model. Of all significant variables, only proximal hypospadias remained an independent predictor for re-intervention (OR 3.27; p = 0.012). DISCUSSION The grade of hypospadias remains according to our retrospective analysis the only objective independent predicting factor for re-intervention in hypospadias surgery. This finding is rather obvious for everyone operating hypospadias. Curiously midpenile hypospadias cases were doing slightly better than distal hypospadias in terms of re-intervention rates. Our study however has also some shortcomings. First of all, data was gathered retrospectively and follow-up time was ill-balanced for several variables. We tried to correct this by applying sensitivity analysis, but possible associations between some variables and re-intervention might still be obscured by this. Standard questionnaires to analyze surgical outcome were not available. Therefore, we focused our analysis on re-intervention rate as this is a hard and clinically relevant end point. CONCLUSIONS This retrospective analysis of a large hypospadias database with long-term follow-up indicates that the long-lasting debate about factors influencing the reoperation rate in hypospadias surgery might be futile: in experienced hands, the only variable that independently predicts for re-intervention is the severity of hypospadias, the only factor we cannot modify. This retrospective multivariate analysis of a large hypospadias database with long-term follow-up suggests that the only significant independent predictive factor for re-intervention is proximal hypospadias. In our series, technique did not influence the re-intervention rate.
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Affiliation(s)
| | - Filip Poelaert
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | | | | | - Erik Van Laecke
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Gent, Belgium.
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Baetens D, Mladenov W, Delle Chiaie B, Menten B, Desloovere A, Iotova V, Callewaert B, Van Laecke E, Hoebeke P, De Baere E, Cools M. Extensive clinical, hormonal and genetic screening in a large consecutive series of 46,XY neonates and infants with atypical sexual development. Orphanet J Rare Dis 2014; 9:209. [PMID: 25497574 PMCID: PMC4271496 DOI: 10.1186/s13023-014-0209-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/05/2014] [Indexed: 01/22/2023] Open
Abstract
Background One in 4500 children is born with ambiguous genitalia, milder phenotypes occur in one in 300 newborns. Conventional time-consuming hormonal and genetic work-up provides a genetic diagnosis in around 20-40% of 46,XY cases with ambiguous genitalia. All others remain without a definitive diagnosis. The investigation of milder cases, as suggested by recent reports remains controversial. Methods Integrated clinical, hormonal and genetic screening was performed in a sequential series of 46, XY children, sex-assigned male, who were referred to our pediatric endocrine service for atypical genitalia (2007–2013). Results A consecutive cohort of undervirilized 46,XY children with external masculinization score (EMS) 2–12, was extensively investigated. In four patients, a clinical diagnosis of Kallmann syndrome or Mowat-Wilson syndrome was made and genetically supported in 2/3 and 1/1 cases respectively. Hormonal data were suggestive of a (dihydro)testosterone biosynthesis disorder in four cases, however no HSD17B3 or SRD5A2 mutations were found. Array-CGH revealed a causal structural variation in 2/6 syndromic patients. In addition, three novel NR5A1 mutations were found in non-syndromic patients. Interestingly, one mutation was present in a fertile male, underlining the inter- and intrafamilial phenotypic variability of NR5A1-associated phenotypes. No AR, SRY or WT1 mutations were identified. Conclusion Overall, a genetic diagnosis could be established in 19% of non-syndromic and 33% of syndromic cases. There is no difference in diagnostic yield between patients with more or less pronounced phenotypes, as expressed by the external masculinisation score (EMS). The clinical utility of array-CGH is high in syndromic cases. Finally, a sequential gene-by-gene approach is time-consuming, expensive and inefficient. Given the low yield and high expense of Sanger sequencing, we anticipate that massively parallel sequencing of gene panels and whole exome sequencing hold promise for genetic diagnosis of 46,XY DSD boys with an undervirilized phenotype. Electronic supplementary material The online version of this article (doi:10.1186/s13023-014-0209-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorien Baetens
- Center for Medical Genetics, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - Wilhelm Mladenov
- Department of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Building 3K12D, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Pediatrics and Medical Genetics, Medical University of Varna, University Hospital "Sveta Marina", Varna, Bulgaria.
| | - Barbara Delle Chiaie
- Center for Medical Genetics, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - Björn Menten
- Center for Medical Genetics, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - An Desloovere
- Department of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Building 3K12D, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Violeta Iotova
- Department of Pediatrics and Medical Genetics, Medical University of Varna, University Hospital "Sveta Marina", Varna, Bulgaria.
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - Erik Van Laecke
- Department of Pediatric Urology, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - Piet Hoebeke
- Department of Pediatric Urology, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - Elfride De Baere
- Center for Medical Genetics, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - Martine Cools
- Department of Pediatric Endocrinology, Ghent University Hospital and Ghent University, Building 3K12D, De Pintelaan 185, 9000, Ghent, Belgium.
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Callens N, De Cuypere G, T’Sjoen G, Monstrey S, Lumen N, Van Laecke E, Hoebeke P, Cools M. Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study. World J Urol 2014; 33:137-43. [DOI: 10.1007/s00345-014-1283-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/17/2014] [Indexed: 11/29/2022] Open
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De Bruyne P, De Guchtenaere A, Van Herzeele C, Raes A, Dehoorne J, Hoebeke P, Van Laecke E, Vande Walle J. Pharmacokinetics of desmopressin administered as tablet and oral lyophilisate formulation in children with monosymptomatic nocturnal enuresis. Eur J Pediatr 2014; 173:223-8. [PMID: 23989967 DOI: 10.1007/s00431-013-2108-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 04/03/2013] [Accepted: 07/16/2013] [Indexed: 11/25/2022]
Abstract
Desmopressin 120 μg oral lyophilisate and 200 μg tablet are considered bioequivalent, based on extrapolation of studies in a limited number of adults and on one dose-finding study of desmopressin oral lyophilisate in children. However, no comparative pharmacokinetic study in children was executed confirming this statement. No data are available on the influence of food intake on the bioavailability of desmopressin tablet in a pediatric setting, although studies in adults have documented that food intake results in a significantly lower desmopressin plasma concentration. In this study, we analyzed plasma concentrations of desmopressin oral lyophilisate and tablet with concomitant food intake. Twenty-three children with monosymptomatic nocturnal enuresis (mean age, 12.7 years) were recruited. Two tests were performed on two separate days in identical conditions with a standardized food and fluid intake. Desmopressin was administered as desmopressin tablet or desmopressin oral lyophilisate immediately after a meal. Desmopressin plasma concentration was measured at 1 h, 2 h, and 6 h postdosing. No significant difference in plasma concentration of 120 μg desmopressin oral lyophilisate and 200 μg tablet was demonstrated, even with concomitant food intake. A significant difference in variability was found, identifying a smaller variance for desmopressin oral lyophilisate plasma concentrations at all time points. This study demonstrates comparable plasma levels for desmopressin oral lyophilisate, despite the lower dose. The dosage for desmopressin oral lyophilisate is more predictable due to the significantly smaller variance. Therefore, desmopressin oral lyophilisate seems more suitable, especially in the younger age group for which time interval between dinner and drug administration is limited.
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Affiliation(s)
- Pauline De Bruyne
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, 3K12D, De Pintelaan 185, 9000, Ghent, Belgium,
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Groen LA, Spinoit AF, Van Laecke E, Everaert K, Hoebeke P, Subramaniam R. 485 THE ADVANCE MALE SLING FOR INTRINSIC SPHINCTER DEFICIENCY IN PAEDIATRIC UROLOGY: 5 YEAR EXPERIENCE IN TWO REFERRAL CENTRES. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1877] [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: 10/27/2022]
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Spinoit AF, Poelaert F, Groen LA, Van Laecke E, Hoebeke P. Hypospadias repair at a tertiary care center: long-term followup is mandatory to determine the real complication rate. J Urol 2013; 189:2276-81. [PMID: 23306089 DOI: 10.1016/j.juro.2012.12.100] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/21/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE The field of reconstructive surgery for hypospadias is lacking standard techniques and followup. Most published series include complication rates after a short followup. We report and analyze the long-term outcome of primary hypospadias repair at a single tertiary care center. MATERIALS AND METHODS We reviewed 1,061 operations performed at our institution between 1997 and 2010 and registered as hypospadias repair. The operations were performed in 543 patients born between June 1997 and June 2005. A retrospective database was created with information about hypospadias characteristics, surgery and followup. RESULTS A total of 474 primary repairs were selected, excluding incomplete/incorrect files. Distal penile hypospadias was reported in 366 patients (77.2%), mid penile hypospadias in 54 (11.4%) and proximal hypospadias in 54 (11.4%). Initial repair technique was based on incised plate in 189 patients (39.9%), meatal advancement in 171 (36%), onlay flap in 82 (17.3%) and other or combined techniques in 25 (5.3%). Insufficient information was reported for 7 patients (1.5%). Mean age at first operation was 22.6 months (range 4 to 134) and mean followup after first operation was 34.0 months (0 to 145). Of the children 360 (75.9%) had a good long-term outcome and required only 1 procedure. Reoperation was needed in 114 patients (24.1%), of whom 54 (47.4%) underwent reoperation in the first year of followup. CONCLUSIONS Overall a good long-term outcome without further complication was achieved in 75.9% of our cases. Of the 24.1% of patients who needed reoperation only 47.4% presented within the first year postoperatively, indicating the need for long-term followup when reporting outcomes of hypospadias repair.
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Groen LA, Hoebeke P, Loret N, Van Praet C, Van Laecke E, Ann R, Vande Walle J, Everaert K. Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms: 15-year experience. J Urol 2012; 188:1313-7. [PMID: 22902022 DOI: 10.1016/j.juro.2012.06.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Sacral nerve modulation with an implantable pulse generator is not an established treatment in children. This therapy has been described for dysfunctional elimination syndrome and neurogenic bladder. We report 2 new indications for this approach in children, ie bladder overactivity and Fowler syndrome. The aim of this study was to improve the results of future treatment for sacral neuromodulation in children by describing factors favorable for good outcomes with this method. MATERIALS AND METHODS A total of 18 children 9 to 17 years old were studied. Mean ± SD followup was 28.8 ± 43.8 months. Of the patients 16 underwent S3 sacral neuromodulation and 7 underwent pudendal stimulation (5 as a revision, 2 from the beginning). RESULTS Initial full response was achieved in 9 of 18 patients (50%) and partial response in 5 (28%). In patients presenting with incontinence mean ± SD number of incontinence episodes weekly improved significantly from 23.2 ± 12.4 to 1.3 ± 2.63 (p <0.05). In patients requiring clean intermittent catheterization there was a significant decrease in mean ± SD daily frequency of catheterization from 5.2 ± 1.6 to 2.0 ± 1.9 (p <0.05). At the end of the study 6 of 15 patients (40%) had a full response and 5 (33%) had a partial response, while 4 implantable pulse generator devices (27%) were explanted because of failure. CONCLUSIONS Sacral neuromodulation is feasible in the pediatric population, with good short-term (78% full or partial response) and satisfactory long-term results (73%). Sacral neuromodulation can offer good results for overactive bladder, dysfunctional elimination syndrome and Fowler syndrome. Pudendal nerve stimulation is a feasible salvage treatment that can be useful in cases when S3 implantation is impossible or unsuccessful.
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Affiliation(s)
- Luitzen-Albert Groen
- Pediatric Urologic Nephrologic Center, Ghent University Hospital, Ghent, Belgium.
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Groen LA, Spinoit AF, Hoebeke P, Van Laecke E, De Troyer B, Everaert K. The AdVance male sling as a minimally invasive treatment for intrinsic sphincter deficiency in patients with neurogenic bladder sphincter dysfunction: a pilot study. Neurourol Urodyn 2012; 31:1284-7. [PMID: 22847896 DOI: 10.1002/nau.21256] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 11/28/2011] [Indexed: 11/10/2022]
Abstract
AIMS The aim of the study was to evaluate feasibility, efficacy, and safety of the AdVance male sling in neuropathic male patients with intrinsic sphincter deficiency. METHODS We evaluated 20 consecutive male neuropathic patients (12 menigomyelocele and 8 lower spinal cord injured), age 23 ± 13 years (range 6-52 years) with urodynamically proven sphincter deficiency and stress urinary incontinence. In all patients an AdVance male sling was implanted from June 2007 to September 2009. Patients were evaluated with the number of pads per day (PPD), visual analogue scale (VAS) for continence and the International Consultation on Incontinence-Short Form (ICIQ-SF). Cure was defined as a 10 on VAS or using no pads for urinary leakage, improvement as >5 and failure as ≤5. RESULTS Positive effect in 13 of 20 patients (65%) at 1-year follow-up: 8 patients were cured, 5 improved, and 7 failed. VAS score increased from baseline 2.6 (SD 2.0) to 7.2 (SD 3.5) at 12 months (P < 0.001). ICIQ-SF decreased from 14 (SD 4.2) to 4 (SD 4.1) (P < 0.001). Friedman and Wilcoxon tests revealed at 1, 3, 6, 9, and 12 months significant improvement compared to baseline (P = 0.008). CONCLUSIONS Implantation of the AdVance male sling is feasible in both adult and pediatric patients. A promising cure/improvement rate was achieved as well as a low complication rate.
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Snauwaert E, Vande Walle J, Renson C, Vandaele J, Raes A, Roels S, Van Laecke E, Debruyne E, Deguchtenaere A, Mauel R, Hoebeke P. 591 A 10-YEAR RETROSPECTIVE STUDY OF AN IN CENTRE TRAINING PROGRAM FOR CHILDREN WITH REFRACTORY OVERACTIVE BLADDER. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.668] [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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De Guchtenaere A, Dehoorne J, Raes A, Van Laecke E, Groen A, Vande Walle J, Hoebeke P. 590 DESMOPRESSIN ORAL LYOPHYLISATE FORMULATION (MELT): AMELIORATING DESMOPRESSIN RESPONSE IN MONOSYMPTOMATIC NOCTURNAL ENURESIS? J Urol 2012. [DOI: 10.1016/j.juro.2012.02.667] [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: 10/28/2022]
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Affiliation(s)
- Erik Van Laecke
- Department of Pediatric Urology, University Hospital Ghent, Ghent, Belgium
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Lumen N, Hoebeke P, Deschepper E, Van Laecke E, De Caestecker K, Oosterlinck W. Urethroplasty for failed hypospadias repair: a matched cohort analysis. J Pediatr Urol 2011; 7:170-3. [PMID: 20965140 DOI: 10.1016/j.jpurol.2010.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 04/09/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the outcome of urethroplasty for failed hypospadias repair and to compare this with a matched cohort of patients treated with urethroplasty for other reasons. PATIENTS AND METHODS Between January 2000 and August 2007, 25 patients with a failed hypospadias repair were treated with urethroplasty (A). This cohort of patients was matched with a cohort of 25 patients who underwent urethroplasty for other reasons (B). The patients were matched for stricture location, stricture length, duration of follow up and type of urethroplasty. The outcomes were analysed and compared. A P-value < 0.05 was considered statistically significant. RESULTS There were no significant differences between the two cohorts in stricture location, stricture length, follow up and previous interventions. Patients in cohort A however were significantly younger. The surgical technique used was exactly the same in A and B. Failure was observed in 7 patients (28%) in A compared to 4 patients (16%) in B (P = 0.45). CONCLUSIONS Although a higher failure rate was observed after failed hypospadias repair, this is not proof of a worse outcome for urethroplasty after failed hypospadias repair due to the lack of statistical significance.
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Affiliation(s)
- Nicolaas Lumen
- Department of Urology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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De Troyer B, Van Laecke E, Groen LA, Everaert K, Hoebeke P. A comparative study between continent diversion and bladder neck closure versus continent diversion and bladder neck reconstruction in children. J Pediatr Urol 2011; 7:209-12. [PMID: 20488754 DOI: 10.1016/j.jpurol.2010.03.011] [Citation(s) in RCA: 7] [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: 01/23/2010] [Accepted: 03/30/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the long-term outcome of continent diversion in children with structural or neurogenic cause of incontinence, with special interest in differences between closed and open bladder neck procedures. PATIENTS AND METHODS A cohort of 63 children with intractable incontinence treated with continent diversion between January 1998 and January 2008 were reviewed for underlying disease, type of surgery, complications and outcome. RESULTS Forty patients had a continent diversion with open bladder neck (group 1) and 23 patients had their bladder neck closed (group 2: 11 primarily closed; 12 secondarily closed). There was no difference between the two groups in terms of patient characteristics, surgical re-interventions and stone formation. The continence rate however was significantly better in group 2 (95.6% vs 77.5%). CONCLUSION Bladder neck closure with continent diversion as primary or salvage procedure in children with intractable incontinence does not result in extra morbidity and has a high success rate. Thorough urodynamic evaluation of bladder function is the key to success in therapy planning for these children, to minimize the need for re-intervention.
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Affiliation(s)
- Bart De Troyer
- Department of Urology & Paediatric Urology, Ghent University Hospital, Ghent 9000, Belgium
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Hoebeke P, Renson C, Van Laecke E, Van Den Broeck C, Vande Walle J. 740 PROSPECTIVE EVALUATION OF CLINICAL VOIDING RE-EDUCATION OR VOIDING SCHOOL FOR LOWER URINARY TRACT CONDITIONS IN CHILDREN. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1266] [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: 11/25/2022]
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Van Laecke E, Raes A, Vande Walle J, Hoebeke P. Adequate Fluid Intake, Urinary Incontinence, and Physical and/or Intellectual Disability. J Urol 2009; 182:2079-84. [DOI: 10.1016/j.juro.2009.05.125] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Indexed: 12/01/2022]
Affiliation(s)
- Erik Van Laecke
- Departments of Paediatric Urology and Nephrology (AR, JVW), Ghent University Hospital, Gent, Belgium
| | - Ann Raes
- Departments of Paediatric Urology and Nephrology (AR, JVW), Ghent University Hospital, Gent, Belgium
| | - Johan Vande Walle
- Departments of Paediatric Urology and Nephrology (AR, JVW), Ghent University Hospital, Gent, Belgium
| | - Piet Hoebeke
- Departments of Paediatric Urology and Nephrology (AR, JVW), Ghent University Hospital, Gent, Belgium
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Hoebeke P, De Pooter J, De Caestecker K, Raes A, Dehoorne J, Van Laecke E, Vande Walle J. Solifenacin for therapy resistant overactive bladder. J Urol 2009; 182:2040-4. [PMID: 19695608 DOI: 10.1016/j.juro.2009.05.100] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Indexed: 02/06/2023]
Abstract
PURPOSE With the availability of the once daily oral antimuscarinic agent solifenacin (5 mg), we started to use it for therapy resistant overactive bladder. We evaluate side effects and efficacy. MATERIAL AND METHODS We reviewed the charts of children treated with solifenacin succinate between August 2005 and August 2008 for therapy resistant OAB. Incontinence was compared at study entry and study end. RESULTS During the study period 84 boys and 54 girls with a mean age of 9 years 2 months received solifenacin. Mean followup was 22.59 months. While on solifenacin, side effects were observed in 9 of 138 patients (6.5%). Efficacy evaluation included only 99 patients after 3 months of therapy. Mean voided volume after treatment was 253.5 ml, showing a significant 25% increase compared to the mean value before therapy (50.5 vs 203.0 ml, p <0.01). Of the patients 84 (85%) were considered responders, including 45 who were completely dry (full response) and 39 who had fewer nocturnal enuresis or diurnal incontinence symptoms (partial response). Of these 39 patients 17 became dry during the day, 1 became dry during the night and 21 had more than a 50% decrease in nocturnal enuresis and diurnal incontinence symptoms. In 15 patients the outcome was unchanged or worse (no response). CONCLUSION In this group of children with OAB we noted favorable results with solifenacin with few side effects. Despite the uncontrolled, retrospective study design the effect is attributable to solifenacin intake.
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Affiliation(s)
- Piet Hoebeke
- Division of Pediatric Urology, Department of Urology, Ghent University Hospital, Ghent, Belgium.
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De Guchtenaere A, Raes A, Vande Walle C, Hoebeke P, Van Laecke E, Donckerwolcke R, Vande Walle J. Evidence of partial anti-enuretic response related to poor pharmacodynamic effects of desmopressin nasal spray. J Urol 2008; 181:302-9; discussion 309. [PMID: 19013601 DOI: 10.1016/j.juro.2008.09.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE Desmopressin is an evidence-based medicine level I, category A therapy for monosymptomatic nocturnal enuresis. However, in up to 40% of patients only partial desmopressin response is obtained. While the poor pharmacokinetic characteristics of the different available formulations may have a role in apparent therapy resistance, there are limited data available to support this theory. We sought to identify pharmacodynamic factors involved in partial desmopressin response or desmopressin resistance in children with monosymptomatic nocturnal enuresis, with special emphasis on concentrating performance, and time to reach and duration of maximal urine concentration. MATERIALS AND METHODS We evaluated 64 children with monosymptomatic nocturnal enuresis and proved nocturnal polyuria lacking full response to desmopressin treatment. The study involved 2 separate home based test days (A and B), each consisting of 9 timed urine collections starting in the evening 1 hour before desmopressin administration and continuing for 16 hours following desmopressin administration. Test A was done during fluid restriction, and test B was done during an oral fluid load. RESULTS Under fluid restriction 16 patients failed to achieve urine concentration greater than 850 mOsmol/l at the midnight collection following desmopressin administration. After an oral fluid load given at the start of the test the majority of patients failed to reach maximal concentration of urine as voided during hydropenia, and 45 patients failed to regain appropriate dilution of urine even when an oral water load of 15 ml/kg (urine osmolality less than 750 mOsmol/l) was given in the morning at the end of the test. This finding is suggestive of a prolonged duration of action of the drug. CONCLUSIONS Pharmacodynamic tests reveal a suboptimal effect of desmopressin on urine concentration in a significant percentage of patients, which worsens when fluid is not restricted before desmopressin administration. Also the time to reach maximal antidiuretic effect and the duration of pharmacodynamic action show a wide range, requiring individualization of mode and time of administration. Our data demonstrate that a simple pharmacodynamic test as described may give important information on time of dosing, duration of action and influence of oral fluid intake, allowing individualization of therapy. Data also reveal that desmopressin should be administered at least 1 hour before bedtime, and that in case of therapy resistance a longer interval, up to 2 hours, might further reduce diuresis rate in the early night. Because of the documented prolonged action of desmopressin in some patients, increasing the dose without performing pharmacodynamic testing is no longer acceptable.
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Vande Walle J, Van Laecke E. Pitfalls in studies of children with monosymptomatic nocturnal enuresis. Pediatr Nephrol 2008; 23:173-8. [PMID: 18057964 DOI: 10.1007/s00467-007-0688-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 07/08/2007] [Revised: 10/02/2007] [Accepted: 10/02/2007] [Indexed: 01/13/2023]
Abstract
In this issue Ferrara et al. present an important placebo-controlled, three-arm, double-blind, double-dummy, study on the treatment of nocturnal enuresis, demonstrating that homotoxicology is superior to placebo but less effective than desmopressin. Nocturnal enuresis is a disease with a heterogeneous aetiology and complex pathophysiology. The fact that different therapies may result in a wide range of responses is, therefore, not surprising. Differences in success rate can, therefore, be largely attributed to selection bias in the sub-populations. This consideration must be taken into account for every study design, to avoid premature interpretation of the results. Positive results in a paper are only not subject for discussion if both methodology and study population fulfil the highest standards, because negative results are not likely to be reported. Several points of weakness are present in the majority of studies, such as (a) inappropriate subtyping of the patients (terminology) or (b) epidemiological data, (c) insufficient documentation of patients' characteristics, (d) lack of plausible explanation as to why the placebo effect might be absent, (e) the heterogeneity of the severity of bedwetting. All these may lead to false positive and/or false negative results. In this commentary we try to tackle these different issues which might be relevant for the interpretation even of placebo-controlled studies like that of Ferrara et al.
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Affiliation(s)
- Johan Vande Walle
- Paediatric Nephrology, UZ Gent, DePintelaan 185, 9000, Gent, Belgium.
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Hoebeke P, Van Laecke E, Renson C, Raes A, Dehoorne J, Vermeiren P, Vande Walle J. Pelvic floor spasms in children: an unknown condition responding well to pelvic floor therapy. Eur Urol 2005; 46:651-4; discussion 654. [PMID: 15474278 DOI: 10.1016/j.eururo.2004.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE During a study period of 4 years, 21 children are seen for night time pelvic pain. These children typical wake up in the middle of the night with severe lower abdominal or perineal pain. During day some of them suffer urge syndrome. During urodynamic investigation extremely high pelvic floor activity as recorded by high urethral pressure was observed in these children. We therefore started pelvic floor relaxation biofeedback in these children. METHODS All children diagnosed with pelvic floor spasms underwent biofeedback pelvic floor relaxation therapy in order to learn them to counteract pelvic pain due to these spasms. In those girls in whom detrusor hyperactivity was seen on urodynamics concomitant anticholinergic treatment was given (oxybutynin). RESULTS Between January 1998 and January 2002 symptomatic pelvic floor spasms were diagnosed in 21 children (19 girls/2 boys). Pelvic floor relaxation biofeedback was successful for treatment of this condition in 17 of 21 children. Mean duration of therapy was 3 months (12 weekly sessions) and on long term follow-up relapse was seen in 3 of 17 successfully treated children. 10 of 17 successfully treated children received anticholinergics. CONCLUSION Pelvic floor spasms in children (which can be secondary to detrusor overactivity) respond well to pelvic floor relaxation therapy.
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Affiliation(s)
- Piet Hoebeke
- Department of Paediatric Urology, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
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