OBJECTIVE: The purpose of this study was to determine the efficacy of transcutaneous nerve stimulation (TENS) in the treatment of neurogenic bladdder secondary to myelomeningocele (MMC).

MATERIALS AND METHODS: A total of 14 children (7 boys and 7 girls) with neurogenic bladder secondary to MMC who were referred to our clinic between 2009 and 2011 were enrolled in the study. Urodynamic parameters including maximum bladder capacity (MBC) and detrusor leak point pressure (DLPP), maximum detrusor pressure (MDP) and bladder compliance (BC), daily incontinence score, constipation, and subjective improvement were recorded as outcome measures. After the first urodynamic session to get the baseline parameters, a 1 hour dose of TENS once a day for at least 3 months was applied at a certain dermatomal level. This was followed by another urodynamic session to assess its effects.

RESULTS: Out of 14 subjects, 11 (78.5%) had improvement in continence profile and 8 (57%) had improvement in bowel movement. Thirteen out of 14 (92%) had subjective improvements such as higher catheterized and/or voided volume, lesser bedwetting episodes, spontaneous voiding, increased sensation to void, presence of urgency to void, and frequent voiding. One subject had no subjective improvement. The difference in DLLP, MBC, MDP, and BC pre and post treatment was not statistically significant.

CONCLUSION: The efficacy of TENS in treating bladder dysfunction in patients with MMC remains uncertain. It did show slight improvement in urodynamic parameters specifically BC and MBC however, it was not statistically significant.

Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; Infant ; Transcutaneous Electric Nerve Stimulation-Treatment Outcome ; Meningomyelocele

A 9 year old boy presented with painless gross hematuria 1 month prior to admission. Ultrasound and CT scan of the whole abdomen with contrast showed a 2.6cm x 2.0cm papillary mass on the right posterolateral wall. Initial transurethral biopsy result showed negative for malignancy, fibrovascular tissue with mild chronic and acute inflammation. On repeat cystoscopy, a 4cm x 4cm pendunculated lobulated mass was located posterolateral encroaching on the right ureteral orifice. Subsequently a partial cystectomy with distal ureterectomy, right; right-to-left transureteroureterostomy with DJ stent insertion were done. Microscopic and immunostaining results support a diagnosis of rhabdoid tumor. Adjuvant chemotherapy and immunotherapy was given. On follow up, there was no evidence of recurrence.

This case emphasizes the need to follow aggressively children with gross hematuria. Biopsy should include deep biopsies as rhabdoid tumors are infiltrating tumors. Coordination with the pathologist is of extreme importance since special stainings are needed for confirmation.

Human ; Male ; Child ; Rhabdoid Tumor-therapy, treatment, management ; Neoplasms ; Urinary Bladder ; Biopsy ; Ultrasonography ; Tomography Scanners, X-Ray Computed

OBJECTIVE: To identify the possible causes of failure in hypospadias repair and to evaluate the authors' own results in this demanding surgery.

MATERIALS AND METHODS: Seventy-five consecutive boys, 3 months-15 years age underwent tubularized incised plate urethroplasty  with the corpus spongiosum as 3rd layer. Patient-related and surgeon-related factors were recorded preoperatively, intra-operatively, and postoperatively. Complications were recorded prospectively, initially after one week follow up.

RESULTS: Overall complication rate was 41%. Fistula rate was 22.67%. Among the patient-related factors, meatal location (P=0.001), degree of severity of scrotal transposition (P=0.002) and atrophic proximal skin length (P=0.040) were significantly contributing to the risk of failure. The more developed the corpus spongoisum is, the risk of fistula formation decreases by 2.78 times (OR=0.36 P=0.043).

CONCLUSION: Only patient-related factors primarily meatal location, degree of severity of scrotal transposition and presence of atrophic proximal skin are significantly associated with failure. Their presence would increase the risk of complication from 1.13 times to 8.5 times. The association of surgeon-related factors to the outcome of surgery varies from protective to risk.

Human ; Male ; Hypospadias ;

OBJECTIVE: Bladder autoaugmentation with detrusorectomy is done to improve bladder capacity and compliance in neurogenic bladders, to achieve constant low bladder pressure, preventing sequelae such as renal failure. Some reports discourage its application however citing that effects are short term and failure rates are high. We compared the pre and post-operative urodynamic profile of high risk patients undergoing autoaugmentation or enterocystoplasty to determine if it can still be used as a treatment option for neurogenic bladders.

MATERIALS AND METHODS: A retrospective study using the database of our spina bifida foundation was performed. Out of 382 patients, 45 underwent augmentation cystoplasty. Twenty seven (27) had followed evaluation protocol and were included in the study. The median age was 8.6 years at the time of surgery and the median years of follow up was 3.5 years. Urodynamic parameters, as well as symptom and bladder/sphincter profiles, pre- and post-operatively were compared between the two groups.

RESULTS: In the autoaugmentation group there was a 42.45% mean increase in capacity, and mean increase in compliance of 181.1% versus a 190.3% increase in capacity, and 479% increase in compliance in the enterocystoplasty group. The difference is statistically significant. There was no difference in the end filling pressure, leak point pressures, reflux, number of postoperative UTIs and incontinence. One patient in the autoaugmentation needed redo with an enterocystoplasty. Complication rates were comparable in both groups.

CONCLUSION: Autoaugmentation cystoplasty is still a viable option for surgical management of neurogenic bladders. Our data showed that in patients who underwent detrusorectomy, there was improvement of urodynamic parameters, bladder and upper tract profiles, UTIs and incontinence, which were comparable to the gold standard.

Human ; Male ; Female ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Urinary Bladder, Neurogenic

OBJECTIVE: Neurogenic bladder dysfunction (NBD) in myelomeningocele (MMC) remains a major cause of renal decline. We evaluate the initial presentation, ultrasonographic, urodynamic and VCUG findings in search of indicators that can guide in early decisions in treatment to avoid poor long-term outcomes.

MATERIALS AND METHODS: From 1989 to 2013, 178 patients with neurogenic bladder due to MMC had records accessible for review. The median follow up was 10.4 years (0.9 - 25.0). Parameters reviewed were: patients' initial presentation; Ultrasonography: hydronephrosis grade and bilaterality, bladder wall thickness, and kidney size; Urodynamics: compliance, Detrusor Leak Point Pressure (DLPP), bladder activity and sphincter synergy; VCUG: grade of reflux, bladder pattern, and bladder neck appearance. Endpoints to which all parameters were compared were: 1. need for surgery, 2. continence 3. renal status, and 4. follow-up urodynamics

RESULTS: Recurrent UTI at presentation was associated with 3.1 times [OR = 3.1 (95% CI: 1.3 - 8.5)] need for surgery and incontinence at presentation was 11 times [OR=11.0 (95% CI: 3.8 - 33.4)] more likely to be incontinent in the long term. Hydronephrosis was associated with 4.4 times [OR= 4.4 (95% CI: 1.3 - 19.0)] risk for renal deterioration and 6 times [OR = 6.3, (95% CI: 3.8- 14.7)] need for surgery. Those with thickened bladder were 6 times [0R=6.0 (95% CI: 2.9 - 12.5)] more likely to have needed surgery. Patients with urodynamic findings of low compliance are 2.7 times [OR 2.7(95% CI: 1.2 - 6.3)] more likely to have needed surgery and high DLLP on initial consultation are 5.6 times [OR=5.6 (95% CI: 1.2 - 51.6)] more likely to have renal deterioration and 2.1 times [OR 2.1(95% CI: 1.1 - 4.4)] more likely needing surgery. On VCUG, those with "Christmas tree" pattern of bladder have 90% [0R=0.9 (95% CI: 0.01 - 0.70)] more risk for renal deterioration, 5 [0R=5 (95% CI: 2.5 - 10.2)] times more likely to need surgery and 70% [0R=0.7 (95% CI: 0.1 - 0.9)] more likely to have urodynamic deterioration. Finally, reflux, specifically bilateral, was associated with 4 times [OR = 4.0 (95% CI: 1.2 - 14.3)] risk renal deterioration as compared to those with no reflux findings and 9.6 times [OR=9.6 (95% CI: 4.1 - 23.8)] more likely to need surgery, while high-grade reflux had 90% more risk [OR = 0.9 (95% CI: 0.1 - 0.8)] to have urodynamic deterioration.

CONCLUSIONS: Prognostication early in the course of NBD in MMC is possible. It is recommended that patients with risk factors for deterioration be provided a more intensive regimen of treatment and follow-up to prevent further morbidity.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Urinary Bladder, Neurogenic ; Meningomyelocele

OBJECTIVE: There are no standard ways and guidelines in uroflowmetry and post void residual (PVR) measurements in children. We assessed the repeatability and consistency of uroflowmetry and PVR determination in children at a bladder volume of 50-100% of the estimated bladder capacity (EBC).
METHODS: Twenty-five children, ages 3-8 years, underwent uroflowmetry and post void urine measurements. Values were taken for 3 consecutive micturitions at a bladder volume of 50-1 00% ofthe EBC, as measured by transabdominal ultrasound. Uroflowmetry parameters and PVR were analyzed and recorded.
RESULTS: There were no significant differences in the measurements across three trials for maximum flow rate (Qmax) and prevoid urine volume. There were significant differences in the measurements of PVR and uroflowmetry curves. PVR urine volumes were not related to prevoid urine volumes. Age, height and weight were related to the prevoid volumes.
CONCLUSION: Uroflowmetry and PVR tests will give informative and reliable values at a volume of 50-100% of EBC. In cases of any abnormal flow pattern at this bladder capacity, a repeat examination is prude

Human ; Child ; Urination ; Urinary Bladder ; Urologic Surgical Procedures ; Body Weight

The objective of this paper was to describe the bladder and sphincter urodynamic profiles and the upper tract status of patients with myelomeningocoele. This was correlated with the patients age when initially evaluated. Patients from the Spina Bifida Support Group of the Philippines who underwent initial videourodynamics when first seen were included in the study. The procedure was performed using a Laborie Avanti 4.1 model urodynamic machine. The hostile profile included bladder-sphincter dyssynergia, dyssynergic bladder neck/sphincter or leak point pressure greater than 35 cm H2O. The non-hostile picture included areflexic bladder and sphincter, open or areflexic sphincter or leak point pressure less than 35 cm H2O. The upper tracts were also assessed for the presence of hydronephrosis or vesicoureteral reflux There were 83 myelomeningocoele patients who underwent screening videourodynamics. Their ages ranged from 2 months to 19 years. Fifty one patients presented with hostile bladder sphincter profile while 32 patients presented with non-hostile features. Among the patients with hostile features, 37 manifested with hydronephrosis and/or vesicoureteral reflux. Three patients already presented with renal failure. Beyond 2 years old, 34 patients showed hostile bladder sphincter profile. Sixteen patients already presented with hydronephrosis and/or reflux after the age of 5 years. Renal failure was manifested by older children, all exhibited hostile bladder sphincter features and upper tract deterioration. These data showed a positive correlation of age, hostile profile and upper tract changes in patients with myelomengocoele

Human ; Male ; Female ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Urodynamics ; Vesico-ureteral Reflux ; Meningomyelocele ; Spinal Dysraphism ; Hydronephrosis ; Urinary Bladder Diseases ; Renal Insufficiency ; Self-help Groups ; Ataxia

OBJECTIVE: Urolithiasis, a common problem in medicine, poses a significant burden with prevalenceof 1-15%. Potassium citrate therapy has become one of the cornerstones of medical stone managementwith hypocitraturia being the most common metabolic problem in stone formers. The authorsdetermined the effects of potassium citrate on urinary metabolic profiles and its impact on stoneburden among Filipino stone formers. PATIENTS AND METHODS: This is a prospective, cohort study in patients seen at the UST Hospital between2016 and 2018. Twenty-four hour urine citrate levels, stone sizes and urine pH pre-therapy and post-therapy were analyzed. RESULTS: Significant changes in urinary citrate, pH and stone sizes were noted as soon as 3 months afterthe onset of therapy. These changes included increase in urinary pH (6.1 to 6.7; p=0.001), increase inurinary citrate (109.1 to 253.4mg/day; p<0.001) and decrease in stone size (0.56 to 0.37cm; p=0.037).The changes in the urine citrate and the changes in the stone size were not correlated using the Pearsoncorrelation scatter plot. CONCLUSION Potassium citrate therapy provides a significant alkali and citraturic treatment among Filipino stone formers. However, there is no significant correlation between changes in stone size and changes in urine citrate level.

OBJECTIVES: The objectives of this study were to compare the voiding pattern of toilet-trained patientswith and without recurrent UTI, to describe the voiding pattern of toilet-trained patients withoutUTI aged 2 to 15 years old and to describe the voiding pattern of toilet trained patients with recurrentUTI aged 2 to 15 years old. MATERIALS AND METHODS: A total of 80 toilet-trained Filipino children divided into two groups with 40each were included. R-UTI group consisted of patients aged 2 to 15 years old who presented withrecurrent UTI. The control (No-UTI) group consisted of children aged 2 to 15 years old without anyurinary symptoms and without history of urinary tract infection. Parents completed a 72-hour bladderchart at home. All participants answered Farhat's DVSS. Patients underwent uroflowmetry,uroflowmetry with EMG and post void residual assessment (PVR). Qmax, uroflowmetry pattern,bladder wall thickness and PVR were recorded and analyzed using independent t-test. RESULTS: The mean age of subjects with UTI was 6.32 ± 2.77 years and those in the control group havea mean age 6.67 ± 2.77 years old. Of patients of R-UTI group the following were statisticallysignificant compared to No-UTI : Constipation (48% vs 15%), mean frequency of voiding volumesgreater than 125% of the estimated bladder capacity (EBC) at daytime (0.8 ± 0.22 vs 0.05 ± 1.20p=0.0002), frequency (45% vs 5%), mean average voided volume (126.54 ± 56.05 mL vs 84.34 ±34.26 mL p=0.0001), mean daytime average voided volume (121.33 ± 59.59 mL vs 87.90 ± 36.41mL p =0.0033), mean maximum voided volume (232.25 ± 113.99 mL vs 130.85 ± 49.99 mLp<0.0001), mean bladder thickness (3.83 ± 0.68 mm vs 3.38 ± 0.62 mm p = 0.0030), mean PVR(12.96 ± 10.54 mL vs 5.21 ± 5.68 mL p=0.0001). PVR was significant in 45% of cases compared to3% significant PVR (when 4-6 years old defined as >10ml or >10%of EBC, and if >7 years old >20mlor >15% of EBC). When mean PVR was computed as percentage of EBC, R-UTI group had astatistically higher percentage compared to the no-UTI group (6.27 ± 2.52 % vs 2.52 ± 2.75 %p=0.0001). Mean observed bladder capacity (OBC) was found to be more than the EBC in 35% ofcases in the R-UTI group compared to 12% of No-UTI group (p=0.018). Uroflow-EMG in the R-UTI group were, 85% synergic, 12% dyssynergic and 3% interrupted pattern. EMG in the No-UTIgroup were, 38% synergic, 55% dyssynergic, 2% delayed relaxation, 5% interrupted. The EMGpatterns were statistically significant between the groups (p<0.0001). Uroflow patterns werecomparable between the two groups (p=1.000). CONCLUSION Constipation was more frequent in the R-UTI group. R-UTI group had a higher meanfrequency of EBC > 125% during daytime, frequency, mean average voided volume, mean averagevoided volume during daytime, mean maximum voided volume, mean bladder thickness, mean PVRcompared to the without UTI group. Mean observed bladder capacity was observed to be greater thanthe EBC in the R-UTI group compared to the No-UTI group. R-UTI group was synergic compared toNo-UTI group which were dyssynergic.

: Transurethral incision of ureterocele (TUI-U) is a simple, quick, less invasive, and less expensive,and an effective procedure for the management of ureteroceles. Several studies have already shownits utility for primary management of ureteroceles but it has also been associated with the need foradditional surgery. The authors reviewed charts of patients from their database to describe the outcomesof TUI-U done in ureteroceles associated with the upper pole moiety of a duplex system. They alsolooked into preoperative patient characteristics and post TUI-U outcomes that could influence theneed for subsequent surgeries. MATERIALS AND METHODS: The authors identified patients from their duplex system database who presentedwith a ureterocele and underwent TUI-U. They reviewed the patient records of 25 patients who wereincluded in the study to determine the outcomes of TUI-U in duplex system ureteroceles. Chi squareand Mann Whitney U tests were used to determine whether preoperative patient features and postTUI-U outcomes were associated with secondary surgery. RESULTS: Out of 65 patients who had duplex system ureteroceles, 25 patients (38.4%) underwent TUI-U at a mean age of 1.51 years old. TUI-U alone was successful in improving the prevalent signs andsymptoms of 15 patients (60%) in this group, while 10 patients (40%) had to undergo subsequentsurgical procedures. Breakthrough urinary tract infection (UTI) post TUI-U was the only patientfactor noted to be significantly associated with a secondary surgery for duplex system ureterocele(p=0.027). CONCLUSION TUI-U as primary treatment for duplex system ureteroceles is not yet widely accepteddue to reported rates of morbidities and need for secondary surgery. Present data however show thatTUI-U can be used as a primary procedure and even as a definitive procedure for this subset ofpatients with remarkable results in terms of symptoms resolution and improvement of upper tract profiles.