European Journal of Nuclear Medicine and Molecular Imaging, Mar 12, 2005
Prostate cancer is the second leading cause of death from cancer among US men. Positron emission ... more Prostate cancer is the second leading cause of death from cancer among US men. Positron emission tomography (PET) with [(11)C]choline has been shown to be useful in the staging and detection of prostate cancer. The background of the increased uptake of choline in human prostate cancer is not completely understood. The aim of this study was to prospectively investigate the relationship between the [(11)C]choline uptake and the cell proliferation in human prostate cancer. Prostate cancer tissue from 18 patients who had undergone a radical prostatectomy for histologically proven disease was studied. An [(11)C]choline PET scan was performed prior to surgery. Post-prostatectomy specimens were prepared and stained with the antibody MIB-1 for Ki-67, which depicts proliferation. Two independent observers counted the amount of stained nuclei per specimen. Prostate cancer showed Ki-67 staining and high uptake of [(11)C]choline. Statistical analysis showed no significant correlation between [(11)C]choline uptake and Ki-67 staining (R=0.23; P=0.34). No significant relationships were found between the uptake of [(11)C]choline (SUV) and either preoperative PSA (R=0.14; P=0.55) or Gleason sum score (R=0.28; P=0.25). In vivo uptake of [(11)C]choline does not correlate with cell proliferation in human prostate cancer as depicted by Ki-67. Our results suggest that a process other than proliferation is responsible for the uptake of [(11)C]choline in prostate cancer.
ABSTRACT Purpose This study was designed to evaluate sexual (dys)function in adult myelomeningoce... more ABSTRACT Purpose This study was designed to evaluate sexual (dys)function in adult myelomeningocele patients. Furthermore to evaluate the influence of the sex, and of the neurological level. Material and methods 169 adult patients with spina bifida were included . A validated questionnaire on sexual function and the medical records were studied. So far 74 patients have returned the questionnaire (32 men and 42 women).We also divided patients into groups according to their neurological level. Results About half the group had a partner and 83.3 % had a desire for sexual contact. 75% had had sexual contact of some form and 60 % had had intercourse. 30 to 45 % of patients experienced problems with arousal, orgasm and sensitivity of the genital area when having sexual contact. 50 % of the men experienced erectile dysfunction. 6 % of the female patients had problems with lubrication. Besides this, many patients mention incontinence (20 of 54) and difficulties with positions and pain (23 of 54) during sexual contact. In this study women had more sexual contacts than men. Genital sensitivity problems were more frequently encountered in the male group and men also stated more often that their condition had a major impact on their sexual lives. The group with neurological level S1 or lower, more often had a partner and sexual contact compared with their peers with higher neurological levels. For other sexual functions the level of the lesion did not seem to cause relevant differences. Conclusions Myelomeningocele patients are in general sexually active, but sexual dysfunction is frequently encountered . Overall the level of neurological deficit is of less importance than expected. From this study it is evident that the pediatric urologist has to actively enquire about sexual function and provide a special forum for these patients to address these issues.
The objective of this document created by the ICCS standardization subcommittee is to provide a u... more The objective of this document created by the ICCS standardization subcommittee is to provide a uniform guideline on measurement, quality control and documentation of urodynamic studies in children. Methods: This guideline was created using expert opinion and critical review of the published literature on urodynamic studies in children. Currently no standardized guideline or level 1 data exists on the proper technique for this subject matter. Results: The document provides a throughout explanation on how to approach a child who presents with lower urinary tract dysfunction, whether it be of neurogenic, anatomic or functional origin. Formation of an urodynamic question after a comprehensive history and physical examination is paramount in selecting the urodynamic study(ies) that will be most appropriate for each child. Appropriate application of each test with careful consideration of the needs of the child and family will provide the most accurate and reproducible results. Recommendations on how to execute each of the components of an urodynamic study as well as interpretation are included in the document. Conclusions: Urodynamic studies have become a major tool in evaluating lower urinary tract dysfunction in children. There are many subtleties in performing these studies in children in juxtaposition to adults; therefore, adaptations specific to children must be made to achieve accurate and reproducible results. Uniformity in how the studies are conducted from center to center will allow for healthier transparency and enhanced comparison of results in both clinical and research situations. Neurourol.
Extracorpo:real shock wave lithotripsy was performed for treatment of calculi of the upper urinar... more Extracorpo:real shock wave lithotripsy was performed for treatment of calculi of the upper urinary tract in 73 children. All patients were treated with the standard HM3 Dornier lithotriptor. A total of 138 calculi in 86 renal units was treated, requiring ll 1 extracorporeal shock wave lithotripsy sessions. After therapy no serious complications were encountered. Six months after treatment 79 per cent of the patients were free of stones and 17 per cent had small residual fragments (less than 3 mm.), while extracorporeal shock wave lithotripsy was considered to be unsuccessful in 3 children, although disintegration could be obtained in all patients. During a median followup of 24 months (range 13 to 40 months) growth of residual fragments was noted in 33 per cent of the patients and the recurrence rate was 10 per cent.
Hypothesis / aims of study Lower urinary tract dysfunction occurs in at least 5 % of the paediatr... more Hypothesis / aims of study Lower urinary tract dysfunction occurs in at least 5 % of the paediatric population. Children with lower urinary tract symptoms (LUTS) need to be diagnosed, quantification and monitoring of LUTS over time. Scores developed for adults are not suitable for use in children. A study to design a high-validation level instrument to screen LUTS in children is still under way, within the project of the International Conference on Incontinence Questionnaire (ICIQ) Committee. The study, which involves three European Centres, aims to preliminarily test accuracy of the ICIQ screener for LUTS in children (ICIQ-LUTSC).
The aim of this study is to evaluate the importance of a closed bladder neck during videourodynam... more The aim of this study is to evaluate the importance of a closed bladder neck during videourodynamic (VUDE) studies in relation to urinary continence following augmentation ileocystoplasty in myelodysplastic patients. Materials and methods: We retrospectively reviewed the records of 24 myelodysplastic patients who underwent augmentation ileocystoplasty, using a standard technique. All patients had a closed bladder neck during preoperative VUDE studies. Their charts, imaging studies and VUDE data before and after surgery were analyzed. The mean follow-up after augmentation ileocystoplasty was 8.4 years. Results: The overall incidence of urinary incontinence following the augmentation ileocystoplasty was 12.5%. Continence was achieved in 21 of 24 (87.5%) patients without additional outlet procedures. No significant upper tract changes developed. A clinically apparent tethered cord significantly hindered the achievement of continence. No significant correlation was found between the other videourodynamic parameters and obtaining continence. Conclusions: Our study provides evidence that a coexisting cord tethering in this myelodysplastic group can affect bladder neck morphology and function, and subsequent continence.
Gastroenterology Clinics of North America, Sep 1, 2008
The ability to maintain normal continence for urine and stools is not achievable in all children ... more The ability to maintain normal continence for urine and stools is not achievable in all children by a certain age. Gaining control of urinary and fecal continence is a complex process, and not all steps and factors involved are fully understood. While normal development of anatomy and physiology are prerequisites to becoming fully continent, anatomic abnormalities, such as bladder exstrophy, epispadias, ectopic ureters, and neurogenic disturbances that can usually be recognized at birth and cause incontinence, will require specialist treatment, not only to restore continence but also to preserve renal function. Most forms of urinary incontinence are not caused by an anatomic or physiologic abnormality and, hence, are more difficult to diagnose and their management requires a sound knowledge of bladder and bowel function.
ObjecEive. To study prospectively the influence of videourodynamic studies on the management of c... more ObjecEive. To study prospectively the influence of videourodynamic studies on the management of children with vesicoureteric reflux. Methods. One hundred one children with reflux were investigated routinely with videourodynamic studies, as well as renal scans, ultrasound studies, and/or intravenous urograms. The studies were repeated at one, three, and five years. If bladder instability was demonstrated, the primary treatment consisted of anticholinergic drugs and antibiotics, regardless of the grade of reflux. In reflux Grades IV and V with instability and renal scars, surgery was performed. In case of a stable bladder, reflux Grades I-III received antibacterial treatment, while surgical correction was used for reflux Grades IV and V. Results. The results of three years of follow-up of 101 children are reported. Bladder instability was found in 39 children. Thirty of them with reflux Grades I-IV and instability could be managed with anticholinergic and antibacterial drugs, while 9 needed surgical correction. Conclusions. A voiding cystourethrogram is only sufficient for the detection of reflux but for correct management of these children a (video)urodynamic study is mandatory. After treatment of frequently found bladder dysfunction, the reflux will disappear in the majority of cases.
PURPOSE We studied the effect of hyperhydration with normal saline and furosemide on renal resist... more PURPOSE We studied the effect of hyperhydration with normal saline and furosemide on renal resistive index in children with obstructive uropathy. MATERIALS AND METHODS 99mTechnetium-mercaptoacetyltriglycine diuretic renography and Doppler ultrasound were done in 27 children (54 renal units) with unilateral or bilateral hydronephrosis. Doppler studies were performed at baseline, and after infusion of normal saline and administration of furosemide. Half-time drainage, considered the gold standard for the diagnosis of renal obstruction, was compared to resistive index. RESULTS There was a positive correlation between half-time and resistive index on both Doppler studies. With a resistive index of 0.70 as the critical value for predicting renal obstruction 82 versus 100% sensitivity (p < 0.006), 63 versus 94% specificity (p < 0.04) and 76 versus 98% overall accuracy (p < 0.0005) were obtained for Doppler studies at baseline and after induced diuresis, respectively. All children with false-positive results were younger than age 4 years. CONCLUSIONS Doppler ultrasonography after hyperhydration with normal saline and furosemide is an accurate method for diagnosing renal obstruction in children. It is more sensitive, specific and accurate than baseline Doppler studies.
As in many subjects of pediatric urology, distinct differences exist between the natural history ... more As in many subjects of pediatric urology, distinct differences exist between the natural history of testicular tumors in children and adults. The attempt to extrapolate the experience in adults creates confusion in the classification, therapy, and prognosis of testis cancer in children.
Objective To study the effect of hyperhydration with normal saline and frusemide on the renal res... more Objective To study the effect of hyperhydration with normal saline and frusemide on the renal resistive index (RI) in children with equivocal obstructive uropathy.Patients and methods Twelve children (24 kidneys) with unilateral or bilateral hydronephrosis underwent isotopic diuretic renography and Doppler ultrasonography. All children had equivocal obstruction of the hydronephrotic kidneys with half‐time drainage (T/2) values of 10–20 min. Doppler studies were carried out both at baseline and after the infusion of normal saline and frusemide.Results Of the 24 kidneys, five were normal and 19 were hydronephrotic; compared with normal kidneys, the hydronephrotic units had a significantly lower glomerular filtration rate (GFR) and longer T/2. At baseline, the mean RI values of normal and hydronephrotic kidneys were not significantly different (0.70, sd 0.03 and 0.71, sd 0.04, respectively). After the infusion of saline and frusemide, the mean RI of hydronephrotic kidneys (0.67, sd 0.07) was significantly (P=0.01) higher than that of normal kidneys (0.60, sd 0.02), but the response of RI in hydronephrotic kidneys was variable. Based on the RI at baseline and after infusion, hydronephrotic kidneys could be categorized into three groups. Group 1 (n=6) had an RI&lt;0.7 before and after infusion, group 2 (n=6) had a baseline RI&gt;0.7 and &lt;0.7 after infusion, and in group 3 (n=7) both RIs were &gt;0.7. Kidneys in group 3 had the lowest GFR and the highest T/2 values. Five of these seven hydronephrotic kidneys eventually had deteriorating GFRs requiring surgical correction; the GFR of the remaining hydronephrotic kidneys remained stable.Conclusion In children with equivocal obstructive uropathy based on diuretic renography, the determination of RI before and after infusion of normal saline and frusemide could be helpful in distinguishing obstructed from non‐obstructed kidneys.
European Journal of Nuclear Medicine and Molecular Imaging, Mar 12, 2005
Prostate cancer is the second leading cause of death from cancer among US men. Positron emission ... more Prostate cancer is the second leading cause of death from cancer among US men. Positron emission tomography (PET) with [(11)C]choline has been shown to be useful in the staging and detection of prostate cancer. The background of the increased uptake of choline in human prostate cancer is not completely understood. The aim of this study was to prospectively investigate the relationship between the [(11)C]choline uptake and the cell proliferation in human prostate cancer. Prostate cancer tissue from 18 patients who had undergone a radical prostatectomy for histologically proven disease was studied. An [(11)C]choline PET scan was performed prior to surgery. Post-prostatectomy specimens were prepared and stained with the antibody MIB-1 for Ki-67, which depicts proliferation. Two independent observers counted the amount of stained nuclei per specimen. Prostate cancer showed Ki-67 staining and high uptake of [(11)C]choline. Statistical analysis showed no significant correlation between [(11)C]choline uptake and Ki-67 staining (R=0.23; P=0.34). No significant relationships were found between the uptake of [(11)C]choline (SUV) and either preoperative PSA (R=0.14; P=0.55) or Gleason sum score (R=0.28; P=0.25). In vivo uptake of [(11)C]choline does not correlate with cell proliferation in human prostate cancer as depicted by Ki-67. Our results suggest that a process other than proliferation is responsible for the uptake of [(11)C]choline in prostate cancer.
ABSTRACT Purpose This study was designed to evaluate sexual (dys)function in adult myelomeningoce... more ABSTRACT Purpose This study was designed to evaluate sexual (dys)function in adult myelomeningocele patients. Furthermore to evaluate the influence of the sex, and of the neurological level. Material and methods 169 adult patients with spina bifida were included . A validated questionnaire on sexual function and the medical records were studied. So far 74 patients have returned the questionnaire (32 men and 42 women).We also divided patients into groups according to their neurological level. Results About half the group had a partner and 83.3 % had a desire for sexual contact. 75% had had sexual contact of some form and 60 % had had intercourse. 30 to 45 % of patients experienced problems with arousal, orgasm and sensitivity of the genital area when having sexual contact. 50 % of the men experienced erectile dysfunction. 6 % of the female patients had problems with lubrication. Besides this, many patients mention incontinence (20 of 54) and difficulties with positions and pain (23 of 54) during sexual contact. In this study women had more sexual contacts than men. Genital sensitivity problems were more frequently encountered in the male group and men also stated more often that their condition had a major impact on their sexual lives. The group with neurological level S1 or lower, more often had a partner and sexual contact compared with their peers with higher neurological levels. For other sexual functions the level of the lesion did not seem to cause relevant differences. Conclusions Myelomeningocele patients are in general sexually active, but sexual dysfunction is frequently encountered . Overall the level of neurological deficit is of less importance than expected. From this study it is evident that the pediatric urologist has to actively enquire about sexual function and provide a special forum for these patients to address these issues.
The objective of this document created by the ICCS standardization subcommittee is to provide a u... more The objective of this document created by the ICCS standardization subcommittee is to provide a uniform guideline on measurement, quality control and documentation of urodynamic studies in children. Methods: This guideline was created using expert opinion and critical review of the published literature on urodynamic studies in children. Currently no standardized guideline or level 1 data exists on the proper technique for this subject matter. Results: The document provides a throughout explanation on how to approach a child who presents with lower urinary tract dysfunction, whether it be of neurogenic, anatomic or functional origin. Formation of an urodynamic question after a comprehensive history and physical examination is paramount in selecting the urodynamic study(ies) that will be most appropriate for each child. Appropriate application of each test with careful consideration of the needs of the child and family will provide the most accurate and reproducible results. Recommendations on how to execute each of the components of an urodynamic study as well as interpretation are included in the document. Conclusions: Urodynamic studies have become a major tool in evaluating lower urinary tract dysfunction in children. There are many subtleties in performing these studies in children in juxtaposition to adults; therefore, adaptations specific to children must be made to achieve accurate and reproducible results. Uniformity in how the studies are conducted from center to center will allow for healthier transparency and enhanced comparison of results in both clinical and research situations. Neurourol.
Extracorpo:real shock wave lithotripsy was performed for treatment of calculi of the upper urinar... more Extracorpo:real shock wave lithotripsy was performed for treatment of calculi of the upper urinary tract in 73 children. All patients were treated with the standard HM3 Dornier lithotriptor. A total of 138 calculi in 86 renal units was treated, requiring ll 1 extracorporeal shock wave lithotripsy sessions. After therapy no serious complications were encountered. Six months after treatment 79 per cent of the patients were free of stones and 17 per cent had small residual fragments (less than 3 mm.), while extracorporeal shock wave lithotripsy was considered to be unsuccessful in 3 children, although disintegration could be obtained in all patients. During a median followup of 24 months (range 13 to 40 months) growth of residual fragments was noted in 33 per cent of the patients and the recurrence rate was 10 per cent.
Hypothesis / aims of study Lower urinary tract dysfunction occurs in at least 5 % of the paediatr... more Hypothesis / aims of study Lower urinary tract dysfunction occurs in at least 5 % of the paediatric population. Children with lower urinary tract symptoms (LUTS) need to be diagnosed, quantification and monitoring of LUTS over time. Scores developed for adults are not suitable for use in children. A study to design a high-validation level instrument to screen LUTS in children is still under way, within the project of the International Conference on Incontinence Questionnaire (ICIQ) Committee. The study, which involves three European Centres, aims to preliminarily test accuracy of the ICIQ screener for LUTS in children (ICIQ-LUTSC).
The aim of this study is to evaluate the importance of a closed bladder neck during videourodynam... more The aim of this study is to evaluate the importance of a closed bladder neck during videourodynamic (VUDE) studies in relation to urinary continence following augmentation ileocystoplasty in myelodysplastic patients. Materials and methods: We retrospectively reviewed the records of 24 myelodysplastic patients who underwent augmentation ileocystoplasty, using a standard technique. All patients had a closed bladder neck during preoperative VUDE studies. Their charts, imaging studies and VUDE data before and after surgery were analyzed. The mean follow-up after augmentation ileocystoplasty was 8.4 years. Results: The overall incidence of urinary incontinence following the augmentation ileocystoplasty was 12.5%. Continence was achieved in 21 of 24 (87.5%) patients without additional outlet procedures. No significant upper tract changes developed. A clinically apparent tethered cord significantly hindered the achievement of continence. No significant correlation was found between the other videourodynamic parameters and obtaining continence. Conclusions: Our study provides evidence that a coexisting cord tethering in this myelodysplastic group can affect bladder neck morphology and function, and subsequent continence.
Gastroenterology Clinics of North America, Sep 1, 2008
The ability to maintain normal continence for urine and stools is not achievable in all children ... more The ability to maintain normal continence for urine and stools is not achievable in all children by a certain age. Gaining control of urinary and fecal continence is a complex process, and not all steps and factors involved are fully understood. While normal development of anatomy and physiology are prerequisites to becoming fully continent, anatomic abnormalities, such as bladder exstrophy, epispadias, ectopic ureters, and neurogenic disturbances that can usually be recognized at birth and cause incontinence, will require specialist treatment, not only to restore continence but also to preserve renal function. Most forms of urinary incontinence are not caused by an anatomic or physiologic abnormality and, hence, are more difficult to diagnose and their management requires a sound knowledge of bladder and bowel function.
ObjecEive. To study prospectively the influence of videourodynamic studies on the management of c... more ObjecEive. To study prospectively the influence of videourodynamic studies on the management of children with vesicoureteric reflux. Methods. One hundred one children with reflux were investigated routinely with videourodynamic studies, as well as renal scans, ultrasound studies, and/or intravenous urograms. The studies were repeated at one, three, and five years. If bladder instability was demonstrated, the primary treatment consisted of anticholinergic drugs and antibiotics, regardless of the grade of reflux. In reflux Grades IV and V with instability and renal scars, surgery was performed. In case of a stable bladder, reflux Grades I-III received antibacterial treatment, while surgical correction was used for reflux Grades IV and V. Results. The results of three years of follow-up of 101 children are reported. Bladder instability was found in 39 children. Thirty of them with reflux Grades I-IV and instability could be managed with anticholinergic and antibacterial drugs, while 9 needed surgical correction. Conclusions. A voiding cystourethrogram is only sufficient for the detection of reflux but for correct management of these children a (video)urodynamic study is mandatory. After treatment of frequently found bladder dysfunction, the reflux will disappear in the majority of cases.
PURPOSE We studied the effect of hyperhydration with normal saline and furosemide on renal resist... more PURPOSE We studied the effect of hyperhydration with normal saline and furosemide on renal resistive index in children with obstructive uropathy. MATERIALS AND METHODS 99mTechnetium-mercaptoacetyltriglycine diuretic renography and Doppler ultrasound were done in 27 children (54 renal units) with unilateral or bilateral hydronephrosis. Doppler studies were performed at baseline, and after infusion of normal saline and administration of furosemide. Half-time drainage, considered the gold standard for the diagnosis of renal obstruction, was compared to resistive index. RESULTS There was a positive correlation between half-time and resistive index on both Doppler studies. With a resistive index of 0.70 as the critical value for predicting renal obstruction 82 versus 100% sensitivity (p < 0.006), 63 versus 94% specificity (p < 0.04) and 76 versus 98% overall accuracy (p < 0.0005) were obtained for Doppler studies at baseline and after induced diuresis, respectively. All children with false-positive results were younger than age 4 years. CONCLUSIONS Doppler ultrasonography after hyperhydration with normal saline and furosemide is an accurate method for diagnosing renal obstruction in children. It is more sensitive, specific and accurate than baseline Doppler studies.
As in many subjects of pediatric urology, distinct differences exist between the natural history ... more As in many subjects of pediatric urology, distinct differences exist between the natural history of testicular tumors in children and adults. The attempt to extrapolate the experience in adults creates confusion in the classification, therapy, and prognosis of testis cancer in children.
Objective To study the effect of hyperhydration with normal saline and frusemide on the renal res... more Objective To study the effect of hyperhydration with normal saline and frusemide on the renal resistive index (RI) in children with equivocal obstructive uropathy.Patients and methods Twelve children (24 kidneys) with unilateral or bilateral hydronephrosis underwent isotopic diuretic renography and Doppler ultrasonography. All children had equivocal obstruction of the hydronephrotic kidneys with half‐time drainage (T/2) values of 10–20 min. Doppler studies were carried out both at baseline and after the infusion of normal saline and frusemide.Results Of the 24 kidneys, five were normal and 19 were hydronephrotic; compared with normal kidneys, the hydronephrotic units had a significantly lower glomerular filtration rate (GFR) and longer T/2. At baseline, the mean RI values of normal and hydronephrotic kidneys were not significantly different (0.70, sd 0.03 and 0.71, sd 0.04, respectively). After the infusion of saline and frusemide, the mean RI of hydronephrotic kidneys (0.67, sd 0.07) was significantly (P=0.01) higher than that of normal kidneys (0.60, sd 0.02), but the response of RI in hydronephrotic kidneys was variable. Based on the RI at baseline and after infusion, hydronephrotic kidneys could be categorized into three groups. Group 1 (n=6) had an RI&lt;0.7 before and after infusion, group 2 (n=6) had a baseline RI&gt;0.7 and &lt;0.7 after infusion, and in group 3 (n=7) both RIs were &gt;0.7. Kidneys in group 3 had the lowest GFR and the highest T/2 values. Five of these seven hydronephrotic kidneys eventually had deteriorating GFRs requiring surgical correction; the GFR of the remaining hydronephrotic kidneys remained stable.Conclusion In children with equivocal obstructive uropathy based on diuretic renography, the determination of RI before and after infusion of normal saline and frusemide could be helpful in distinguishing obstructed from non‐obstructed kidneys.
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