SECTION ON UROLOGY
SCHEDULE
SATURDAY, OCTOBER 9,1999 SectiononUrology
8:00 am-4:45pm
Room 38,Washington Convention Center Session 1-ReconstructionI
Moderators: Ricardo Gonzalez, MD, and DavidThomas,MD
8:00am Podium 1
Decreased Linear GrowthAssociatedWith Intestinal Bladder Augmentation In Chil-dren WithBladderExstrophy
JenniferL. Dodson, MD; David-Alexandre C. Gros, MD; UriA. Lopatin,John P. Gearhart, MD,FAAP;Richard I. Silver, MD; Steven G. Docimo, MD, FAAP. The Johns Hopkins Hospital, Baltimore, MD
ClinicalResearchPrize Finalist 8:05am Poster2
Long Term Follow-up of the Hematuria-Dysuria Syndrome
J.ChadwickPlaire, MD; Warren T. Snodgrass, MD,FAAP; Michael E. Mitchell, MD, FAAP. Children'sHospital, Seattle, WA
8:08am Poster 3
SeromuscularSigmoidcystoplasty F. de Badiola, E. Ruiz, J. Puigdevall, D. Car-amutti,J. Moldes, A. Sosa. Cirurgia Pediat-rica,Hospital Italiano, Buenos Aires 8:11am Poster 4
Colocecal Bladder Augmentation with a
Tapered Continent Ileal Limb: Use in the Neuropathic Bladder
D.A.Husmann, MD, FAAP;MarkCain, MD, FAAP.Mayo Clinic, Rochester, MN 8:14am Poster 5
Stomal Stenosis: Is Ileum The Ideal Sub-strateForEfferentLimb Construction? Martin Kaefer, MD; Richard C. Rink, MD, FAAP; MarkP.Cain, MD, FAAP; AnthonyJ. Casale,MD, FAAP; Riley Hospital for Chil-dren,Indianapolis, IN
8:17am Podium 6
Augmentation Ureterocystoplasty Could BePerformed MoreFrequently
Sava V. Perovic, MD, PhD, FAAP; Vojkan Vukadinovic, MD; Miroslav Lj. Djordjevic, MD. Univeristy Children's Hospital, Bel-grade,Yugoslavia
8:22am 8:38 am
Discussion
Podium7
"Co-Culture" of Bladder Smooth Muscle and Urothelial Cells on Small Intestinal Submucosa (SIS): Evaluation of the Best Culture Method forInVitroTissue Engi-neeringTechniques
Y.Y. Zhang, MD; Bradley P. Kropp, MD, FAAP;PeterMoore, BS, MS; Rick Cowan, BS; EarlY.Cheng,MD.UniversityofOklahoma, OklahomaCity,OK
BasicResearch Prize Finalist
8:43 am Podium8
Regeneration of Functional Bladder Sub-stitutes Using Large Segment (>44cm2) Acellular Matrix Allografts In A Porcine Model: LongTermResults
Pramod Reddy, MD; Diego J. Barrieras MD; DariusJ. Bagli, M.D.C.M., FAAP;Gordon A. McLorieMD,FAAP;AntoineE.KhouryMD, FAAP;andPaul A. Merguerian, MD, FAAP. Hospital for Sick Children, Toronto, ON Canada
Basic ResearchPrize Finalist 8:48 am Podium 9
Enhancement Of Angiogenesis To Engi-neeredTissuesUsing VEGF Secreting En-capsulated Cells
Marcelle Machluf PhD; Gilad E. Amiel,MD; Shay Soker, PhD; Anthony Atala, MD, FAAP. Children's Hospital, Boston,MA
Basic ResearchPrizeFinalist
8:53 am Poster10
Comparison of the In Vitro Contractile Characteristics ofNeuropathic and Normal Bladder Smooth Muscle Cells: Implica-tions forTissue Engineering
Earl Y. Cheng, MD; Rick Cowan, BS, Pete Moore, BS, MS; Y.Y. Zhang, MD; James J. Tomasek, PhD;BradleyP.Kropp,MD, FAAP. University of Oklahoma, Oklahoma City, OK
8:56 am Discussion Session2-Bladder-Neurogenic
Moderators: Stuart Bauer, MD, and Thomas
dejong,
MD 9:10 am Podium11Transection of Filum Terminale Remits Urinary and StoolContinenceinChildren with NeuropathicBladder And Spina Bi-fida Occulta
Jeffrey S. Palmer, MD; Max Maizels, MD, FAAP; JohnA. Grant, MD; Ingrid Richards, RN; William E. Kaplan, MD, FAAP. Chil-dren's MemorialHospital,Chicago,IL
9:15 am Podium12
ErectileDysfunction is aTreatable Condi-tion in theSpina Bifida Male
Jeffrey S. Palmer, MD; WilliamE.Kaplan, MD, FAAP; Casimir F. Firlit, MD, PhD, FAAP. Children's MemorialHospital,Chicago,IL Clinical Reasearch Prize Finalist
9:20 am Poster 13
Sexuality Of The Spina Bifida Male And Female: Anonymous Questionnaires Of Function AndKnowledge
Jeffrey S. Palmer, MD; William E. Kaplan, MD, FAAP; Casimir F. Firlit, MD, PhD, FAAP.Children's MemorialHospital, Chi-cago, IL
9:23am 9:32 am
Discussion
Poster14
Luis M. Perez, MD, FAAP; John T. Wilbanks, MD; David B. Joseph, MD, FAAP; W. Jerry Oakes,MD, FAAP. The Children'sHospital ofAlabama, Birmingham,AL
9:35 am Poster 15
Intravesical Bladder Stimulation In Pedi-atric PatientsWithSpinal Cord Defects JeffL. Pugach, MD; Louisa Salvin, RN; Vir-giniaStalnaker, RN; George F. Steinhardt, MD, FAAP.CardinalGlennon Children's Hospi-tal, St.Louis,MO
9:38 am Poster 16
Electrically Stimulated Detrusor Myo-plasty
John G. Van Savage,MD; Gustavo Perez-Aba-dia, MD; Lucio G. Palanca, MD; Richard W. Stremel, PhD; Bruce L. Slaughenhoupt, MD, FAAP; Martin Palacio, MD, FAAP; Gordon Tobin,MD;andClaudio Maldonado, PhD. Uni-versityof Louisville, KY
9:41am Poster 17
Urodynamic Profile Of Myelodysplastic Children With Spinal ClosureInUtero Jeffrey Holzbeierlein, MD; John C. Pope IV, MD; Mark C.Adams,MD;JosephBruner, MD; Noel Tulipan, MD; John W. Brock III, MD, FAAP. Vanderbilt Children's Hospital, Nashville,TN
10:48 am Podium 22
AProspective Randomized Clinical Trial To Evaluate Methods Postoperative Care InHypospadias
GordonA. McLorie,MD, FAAP; ByronD. Joy-ner, MD, FAAP; Darius J. Bagli,M.D.C.M., FAAP; JacquiMcCallum,RN;PaulA. Mergue-rian MD FAAP, Antoine E. Khoury MD FAAP.HospitalForSickChildren,Toronto, Ontario,Canada
10:53 am Poster23
Prospective Randomized Trial of Dress-ings Versus NoDressings inHypospadias Repair
John G. Van Savage,MD; L. G.Palanca,MD; BruceL. Slaughenhoupt,MD, FAAP. Univer-sityofLouisville, Louisville,KY
10:56 am Poster 24
Uretheral Seam Formation and Hypospa-dias
Priya Jagatheesan, MD; Laurence S. Baskin, MD, FAAP; Simon W. Hayward, Ph.D. and Gerald R.Cunha, PhD. University of Califor-nia,SanFrancisco,CA
11:00 am Discussion
11:10 am AAPUROLOGY SECTIONLECTURE
11:50 am LUNCH
Discussion
CoffeeBreakand PosterViewing Session 4-BladderFunctionModerators: Ellen Shapiro, MD, and Anne-MarieHoule,MD
Session3-Hypospadias I
Moderators: A.Barry Belman, MD,and
War-renSnodgrass, MD 10:25am Podium18
Modification of the Koyanagi Technique forSingleStage Repairof Proximal Hypo-spadias: LongTermResults
Haluk Emir, MD; Venkata R. Jayanthi, MD; Ken Nitarahara, MD; Nur Danismend, MD; Stephen Koff, MD,FAAP. Children's Hospi-tal, Columbus,OH
10:30am Poster 19
Radical Mobilization of the Bulbar Urethra to Lengthen Urethral Plane and Correct Chordee in Proximal Hypospa-dias
Linda A. Baker,MD;RanjivI.Mathews, MD; Steven G. Docimo, MD, FAAP. The Johns HopkinsHospital, Baltimore,MD
10:33 am Poster20
Results ofPreputial Reconstruction in 77 Boys with Distal Hypospadias
AartJ.
Klijn,
MD;PieterDik, MD; TomP.V.M. Dejong, MD, FAAP. Wilhelmina Kinder Ziekenhuis,Utrecht,TheNetherlands 10:36am Discussion10:45am Poster21
Anatomy of theNeurovascular Bundle: Is Safe Mobilization Possible?
LaurenceBaskin, MD, FAAP; Priya Jathesan, MD;AliErol,MD;WenLiu, MD;Yingwu Li, MD;GeraldCunha, PhD.Universityof Cali-fomia,SanFrancisco,CA
1:15pm Podium 25
The Use Of Radiography, Urodynamic Studies AndCystoscopyIn TheEvaluation OfVoiding Dysfunction
Dipen J. Parekh, MD; John C. Pope IV, MD; MarkC.Adams, MD; John W. Brock III, MD, FAAP. Vanderbilt Children's Hospital, Nashville,TN
1:20pm Poster26
Vasovagal Reactions in Children Suggest Autonomic Dysfunction inDysfunctional EliminationDisorders
AndrewJ. Combs, R.P.A.-C.,Robert P.Weinstein, MD;MarkHorowitz, MD,FAAP and Kenneth I. Glassberg, MD,FAAP.Brooklyn,NY 1:23pm Poster27
Defunctionalized Bladders: Effects Before And After Refunctionalization
Marcos G. Machado, MD; James J. Yoo, MD; Anthony Atala, MD,FAAP. Children's Hos-pital,Boston,MA
1:26pm Podium 28
DiffusableGrowth Factors InduceBladder Smooth MuscleDifferentiation
Laurence Baskin, MD, FAAP; Wen Liu, MD; YingwuLi, MD; Simon Hayward, PhD;Gerald Cunha, PhD. University ofCalifornia, San Francisco,CA
Basic Research Prize Finalist 1:31pm Podium 29
Changing the Urothelial Phenotype: Ab-normal Stromal-EpithelialInteraction LaurenceBaskin, MD, FAAP;Yingwu Li, MD; Wen Liu, MD; Simon Hayward, PhD; Gerald 9:44am
Cunha, PhD. University ofCalifornia, San Francisco, CA
BasicResearchPrize Finalist 1:36 pm Discussion
1:55pm MolecularBiologyfor Clinicians: Reading theLiteratureforFunand Profit
MichaelR.Freeman,PhD-Moderator LaurenceBaskin,MD-San Francisco DariusBagli,MD-Toronto AnthonyAtala,MD-Boston 2:50 pm Coffee Breakand Poster Viewing Session 5-Oncology
Moderators:Michael Ritchey, MD,and Dun-can Wilcox,MD
3:10 pm Podium 30
SurgicalComplications afterNephrectomy for Wilms Tumor: Report from the Na-tional Wilms Tumor Study Group (NWTSG)
M.Ritchey, MD, FAAP;R. Shamberger, MD, FAAP;G.Haase, MD,FAAP;J. Horwitz,MD; T. Bergmann, N. Breslow, PhD. The Univer-sityof Texas Health Science Center, Hous-ton,TX
3:15pm Podium31
Long TermOutcome Of Patients With Bi-lateralWilms TreatedWithRenal Salvage Surgery
RainerKubiak,MD; Duncan T. Wilcox, FRCS; Patrick G. Duffy, FRCS; Philip G. Ransley, FRCS,FAAP.GreatOrmond StreetHospital for SickChildren, London, United Kingdom
3:20 pm Poster 32
A Control Release System OfAngiogenic AntagonistsForPediatricTumorTherapy MarcelleMachluf, PhD; Shay Soker PhD; An-thony Atala,MD, FAAP.Children's Hospital, Boston,MA
3:23pm Poster 33
Interleukin-8 (11-8) and IL-8 Receptor Ex-pression and IL-8 regulation In Human Neuroblastoma
Fernando A. Ferrer, MD; Lauri J. Miller, PatrickH.McKenna, MD, FAAPand Donald L. Kreutzer. Conneticut Children's Medical Center,Hartford, CT
3:26pm Discussion Session 6-Bladder Obstruction
Moderators: EarlCheng,MD,andPaddy De-wan, MD
3:40pm Poster 34
Functional and Structural Changes in Guinea Pig Bladder Upon Urethral Ob-struction
D.J.
Kok, K.P.Wolffenbuttel,
J. Minekus, R. Mastrigt, H. Vloedgraven, J.M. Nijman. SophiaChildren'sHospital,Rotterdam,The Netherlands3:43pm Poster 35
Bladder Outlet Obstruction-Influence on Sarcoplasmic Endoplasmic Reticulum Cal-ciumIonPump(SERCA) Protein andGene Expression
Raimund Stein, MD; Chaoliang Gong, PhD; DouglasA. Canning, MD, FAAP; Stephen A
Zderic, MD, FAAP. Children's Hospital of Philadelphia, Philadelphia,PA
3:46 pm Poster 36
Heparin-Binding Epidermal Growth Factor-Like GrowthFactorExpressionisInducedin Bladder SmoothMuscle Tissue in Response toPassive and Active Contraction
KathyG.Niknejad,MD; Hiep T. Nguyen, MD; Maryrose P. Sullivan,PhD;LarsJ.Cisek,MD, PhD; Yalla V. Subbarao, M.D. and Craig A Peters,MD, FAAP.Children'sHospital, Bos-ton, MA
3:49pm Poster 37
IncreasedSusceptibilityToAnd Evidence OfFreeRadicalMediated Membrane Tox-icityAfterBladder Outlet Obstruction Raimund Stein, MD; Chaoliang Gong, PhD; DouglasA. CanningMD, FAAP; StephenA. Zderic MD, FAAP. Children's Hospital of Philadelphia,Philadelphia,PA
3:52 pm Podium38
Mechanical Signals Activate Diverse MembraneReceptorsInvolvedinGrowth FactorSynthesisinBladder Smooth Mus-cle Cells
Hiep T. Ngyuen, MD; SamuelH. Bride, John M. Park,MD;RosalynM. Adam, PhD; Craig A. Peters, MD, FAAP; Michael R. Freeman, PhD. Children'sHospital, Boston,MA Basic ResearchPrizeFinalist
3:57pm 4:15 pm
Discussion
Poster 39
Neonatal UterineHypertrophyas aCause forTemporaryBladder Outlet Obstruction inInfant Girls
Tom P.V.M. Dejong,MD, FAAP; Jan D.van Gool;PieterDik,MD;AartJ. Klijn,MD. Wil-helmina Kinder Ziekenhuis, Utrecht, The Netherlands
4:18pm Poster 40
Does Neonatal Pyelo-Ureterostomy Worsen Bladden Function in Children WithPosteriorUrethral Valves
E.Jaureguizar,P. LopezPereira,MJ. Martinez Urrutia, R. Lobato, L. Espinosa. Hospital In-fantil "La Paz",Madrid, Spain
4:21pm Poster 41
Improved Bladder Emptying In Posterior Urethral ValvePatientsAfter Selective Al-pha Blocker Therapy
PaulF.Austin, MD;Anthony J. Casale, MD, FAAP; Richard C. Rink, MD, FAAP. Riley Hospital for Children, Indianapolis,IN 4:24pm Discussion
SUNDAY,OCTOBER10,1999 SectiononUrology
6:45am-5:00pm
Room38,WashingtonConventionCenter
Session7-ExstrophyI
Moderators: Michael Mitchell, MD, and Paolo Caione, MD
8:00 am Podium42
The Newborn Exstrophy Bladder Too Small for Primary Closure: Evaluation, Managementand Outcome
Jennifer Dodson,MD;IlhamiSurer, MD;Linda Baker,MD;JohnP.Gearhart,MD, FAAP.The JohnsHopkins Hospital,Baltimore,MD Clinical Reasearch PrizeFinalist
8:05 am Podium43
Peri-Urethral Muscular Complex Identifi-cationand Reassemblyin Exstrophy-Epis-padias Repair: Rationale and Technique PaoloCaione, MD; N. Capozza, MD; A. Lais, MD; E.Matarazzo, MD.Ospedale Pedatrico Bambino Gesu,Rome,Italy
8:10am Podium 44
Preliminary Experience With Neonatal CompletePrimary Closure Of Exstrophy/ Epispadias
DouglasE. Coplen, MD. St. Louis Children's Hospital,St. Louis, MO
8:15 am Podium45
Management of Female Bladder Exstro-phy/Epispadias with Total Urogenital Complex Mobilization
Bradley P. Kropp, MD, FAAP and Earl Y. Cheng,MD. UniversityofOklahoma, Okla-homa City, OK
8:20am 8:32 am
9:06am 9:20 am Discussion
Poster 46
Bladder Matrix Changes in Exstrophy-Epispadias Complex. Developmental
De-Discussion Podium53
IsThere a Riskof Contralateral Reflux After PrimaryObstructiveMegaureterRepair? Paolo Caione, MD;L. Asili, MD;N. Capozza, MD;A.Lais, MD;E.Matarazzo,MD. Osped-ale Pediatrico Bambino Gesu, Rome,Italy fectorAcquiredin Utero?
Alberto Lais, MD; Guido Ciprandi, MD; Ma-rinaFrascarelli,Ennio Matarazzo, MD;Nicola Capozza, MD; Paolo Caione, MD. Ospedale Pediatrico Bambino Gesu,Rome,Italy 8:35 am Poster47
Clinical and Biomechanical Analysis of HipsinAdults with Bladder Exstrophy M. M. Jani, B.A., Paul D. Sponseller, MD, FAAP; John P. Gearhart, MD, FAAP. The JohnsHopkins Hospital,Baltimore, MD 8:38am Poster 48
Determinates ofContinenceAfter Bladder Neck Reconstruction in the Bladder Ex-strophy Population
David Y. Chan, MD; Robert D. Jeffs, MD, FAAP , John P. Gearhart, MD, FAAP. The Johns Hopkins Hospital,Baltimore,MD 8:41 am Poster 49
The ModifiedCantwell-Ransley Repairin Exstrophy and Epispadias:Ten Year Expe-rience
Ilhami Surer, MD; Linda Baker, MD; Robert Jeffs, MD, FAAP; John P. Gearhart, MD, FAAP. The Johns Hopkins Hospital, Balti-more, MD
8:44am Discussion
Session 8-Reflux and Infection I
Moderators: H. Gil Rushton, MD, and An-thonyCasale,MD
8:55 am Podium 50
Tc-99mDMSA Renal ScanAbnormalities inInfantswithSterile, High Grade Vesico-ureteral Reflux
HiepT.Ngyuen,MD;LeonardConnolly,MD; Carol Barnewolt, MD; P.L. Ephraim, S. Ted Treves, MD;Craig Peters, MD, FAAP; Stuart B. Bauer, MD, FAAP. Children's Hospital, Boston,MA
Clinical Reasearch PrizeFinalist 9:00 am Poster 51
Neonatal Vesicoureteral Reflux: Natural History
Walid Farhat, MD; Gordon McLorie, M.D. FAAP;GianPaoloCapolicchioM.D.C.M.,Paul Merguerian MD, FAAP; Darius Bagli M.D.C.M., FAAP; Antoine Khoury MD, FAAP.Hospitalfor Sick Children,Toronto, ON, Canada
9:03 am Poster 52
Treatmentof BladderDysfunctionin In-fants with Dilating Vesicoureteral Re-flux
Ulla Sillen, MD;Marc Bachelard, MD; Einar Hanson, MD; A-L Hellstrom, MD; Ewa Sol-snes, RN.OstraHospital, Goteborg, Sweden
9:25 am Poster 54
Bilateral Extravesical Ureteroneocystos-tomy(Detrusorrhaphy) In Children: Lim-ited RiskForPostoperative Urinary Reten-tion
William R. Strand, MD, FAAP. Children's Medical Center,Dallas,TX
9:28am Podium55
Ketorolac Suppresses Postoperative Blad-derSpasmsAfterIntravesical Ureteral Re-implantation
JohnM.Park, MD;Constance S. Houck, MD, FAAP; NavilF.Sethna, MD;LornaJ. Sullivan, RN;David A.Diamond, MD, FAAP,Anthony Atala,MD,FAAP,JosephG.Borer, MD; Bar-tleyG.Cilento, MD; AlanB.Retik, MD, FAAP; Stuart B.Bauer, MD,FAAP.Children's Hos-pital and Harvard Medical School, Boston, MA
ClinicalReasearch Prize Finalist 9:33am Poster 56
ArePost-operative Studies Justified after ExtravesicalUreteralReimplantation? Diego Barrieras, MD; Steven Lapointe, MD; Pramod P. Reddy, MD; Pierre Williot, MD, FAAP; Gordon McLorie, MD, FAAP; Darius Bagli, MDCM, FAAP;Antoine E.Khoury, MD, FAAP; PaulA.Merguerian, MD,FAAP. Hospi-talfor SickChildren,Toronto, ON, Canada
9:50 am CoffeeBreakand PosterViewing Session9-Laparoscopy
Moderators: AlaaElGhoneimi, MD, and C.K. Yeung, MD
10:10am Podium57
Extraperitoneal Endoscopic Nephrectomy inInfantsandChildren
C.K.Yeung,MD;K.K.Lui,Y.H. Tam, K.H.Lee. PrinceWales Hospital, Hong Kong, China 10:15am Podium 58
Laparoscopic Retroperitoneal Nephrec-tomy inHigh Risk Children
AlaaEl-Ghoneimi,M.D. LouisSauty, MD;Joel Maintenant, MD; Marie-Alice Macher, MD; HenriLottmann,MD;Yves Aigrain,MD. Ho-pital RobertDebr6,Paris,France
10:20am Poster 59
IsRetroperitoneal Renal Biopsy an Alter-native to Percutaneous Needle andOpen Biopsies?
PaoloCaione,MD;S.Micali,MD; A.Lais, MD; E.Matarazzo, MD; N.Capozza, MD. Osped-alePedatrico Bambino Gesu, Rome, Italy
10:23am Podium 60
Laparoscopic Surgery In Children With Ventriculoperitoneal ShuntsIs Not Asso-ciated With Consequences Of Increased Intracranial Pressure
SteveG.Docimo, MD,FAAP.TheJohns Hop-kinsHospital, Baltimore,MD
10:28 am Poster 61
Nonpalpable Undescended Testis: Does the Order of Procedure Affect Outcome and Cost? A Prospective Randomized Analysis ofLaparoscopyandGroin Explo-ration
AnthonyJ.Casale, MD, FAAP; PaulF.Austin, MD; MarkP.Cain, MD, FAAP;MartinKaefer, MD;Richard C. Rink,MD, FAAP.Riley Hos-pital for Children, Indianapolis, IN 10:31 am
10:50 am
Discussion
AmericanUrological AssociationLecture Dr.DavidBostwick, MD, Richmond, Virginia 11:30 am AAP Section onUrology Medal
Presenta-tion
Dr. RobertD.Jeffs, MD,FAAP 11:45 am
12:15pm
BusinessMeeting LUNCH
Session10-Reflux and InfectionII
Moderators: SaulGreenfield, MD,and Francis Schneck,MD
1:30 pm Poster 62
Variability of Significance of Nuclear Medicine Cystogram
Khalid Fouda-Neel, M.D. and J.F. Shillinger, MD.Children'sHopsital of Eastem Ontario, Ottawa,Ontario, Canada
1:33pm Poster 63
Should thePerformance of the VCUGbe BasedonRaceinthe Evaluation of Prena-talHydronephrosis?
Bartley G. Cilento, Jr., MD; Anthony Atala, MD,FAAP; Craig Peters, MD, FAAP; Stuart Bauer, MD,FAAP; Joseph Borer, MD; RobertL.
Lebowitz,MD, FAAP; P.L. Ephraim; Naiwen Tu; Alan B. Retik MD, FAAP. Children's Hospital
1:36 pm Podium64
Prediction of Outcome in theManagement of Vesicoureteral Reflux: Role of Neural Networks
Satbir Singh, MD; Umesh Patil, MD, FAAP; Steven Docimo, MD,FAAP; Ranjiv Mathews, MD,FAAP. UniversityHospital, Syracuse, NYand The Johns Hopkins Hospital, Balti-more, MD
Clinical Reasearch Prize Finalist
1:41pm Podium65
Vesicoureteral Reflux Dysregulates the Renin-Angiotensin System in the Fetal Sheep Kidney
Samuel H. Bride, Hiep T. Nguyen, MD; Rita Gobet, MD; CraigA.Peters,MD, FAAP. Chil-dren's Hospital, Boston,MA
BasicResearch PrizeFinalist
1:46pm Poster 66
Congenital Vesicoureteral Reflux in Sheep is Associated with Reduced Expression Levels ofAquaporin-1 andAquaporin-2 in KidneyInnerMedulla
RitaGobet,MD; LarsCisek, MD,Ph.D.,Craig A. Peters, MD, FAAP; Soren Nielsen, MD, PhD; J0rgen Fr0kiaer, MD. University Chil-dren's Hospital, Zurich, Switzerland and Children's Hospital, Boston, MA
1:49pm 2:04pm
Discussion Podium67
Expression Array"GeneChip" Analysis of InVitroUrotheliumExposedto Uropatho-genic Escherichia coli PDC1
R. W.Grady, MD;M. E.Mitchell, MD, FAAP, A.Mahmoudi,A. E.Stapleton,MD.Children's Hospital, Seattle,WA
BasicResearchPrizeFinalist 2:09pm Poster 68
The Induction Of Nitric OxideSynthaseIn HumanBladder Smooth Muscle Cells By Inflammation:APotential MechanismFor Fibrosis
PaulF.Austin, MD; Juan Wang,MS;Anthony J. Casale, MD, FAAP; Mark P. Cain, MD, FAAP; Martin
Kaefer,
MD; Richard C. Rink, MD, FAAP;MarcioChedid, PhD.Riley Hos-pital forChildren,Indianapolis,IN 2:12pm Poster 69Growth Inhibition ofE.coliby theUrine of Children withUrinaryTractAnomalies UnderProphylactic Antibiotics
0. Kessler, A. El-Khayam, L. Godfrey, B. Wolach, I. Nissenkorn, A. Pomeranz. Meir Hospital, Kfar-Saba, Israel
2:15pm 2:30pm
3:10pm 3:30pm
Discussion
Vesicoureteral Reflux: Point-Counter-point (Jointly with the Section on Ne-phrology)
Pediatric Nephrolithiasis: Evaluation and Medical Management-Dawn Milliner,MD New Horizons in Endourologic Manage-mentofPediatric Nephrolithiasis Minipercutaneous Nephrolithotomy-StevenDocimo,MD
Pediatric Ureteroscopy for Nephrolithia-sis-Michael Erhard,MD
Session11-Stone/Ureterocele
Moderators: Gregory Dean, MD, and Isreal Franco,MD
4:15 pm Podium70
Management of Distal Ureteral Stones in Children-Similarities to AUAGuidelines inAdults.
John G. Van Savage, MD; Lucio G. Palanca, MD; RobertD.Andersen, MD; Ganesh S. Rao, MD; Bruce L. Slaughenhoupt, MD, FAAP. Universityof Louisville, Louisville,KY Clinical Reasearch Prize Finalist
4:20 pm Poster 71
The UreteroscopicTreatment of Proximal Ureteral and Intrarenal Collecting System Calculiinthe PediatricPopulation Michael Erhard, MD; Mark A. Barraza, MD, FAAP. NemoursChildren's Clinic, Jackson-ville, FL
4:23pm Poster 72
Ureteropyeloscopy And Holmium Laser Lithotripsy For Upper Tract Calculi In Children
Mark A. Cabelin, MD; David Hoenig, MD; Gregory E. Dean, MD. Cooper Hospital, Camden, NJ
4:26pm Podium73
Hypercalciuria and Stone Recurrence in PediatricUrolithiasis
H. NormanNoe, MD,FAAP.Memphis,TN 4:31pm
4:45 pm
Discussion Podium74
Long-TermFollow-up of Endoscopic Inci-sion of Ureteroceles: Intravesical Versus Extravesical
ChristopherS.Cooper, MD; Giacomo Passerini-Glazel,MD;Joel C.Hutcheson,MD; Massimo Iafrate, MD; Cristina Camuffo, MD; Claudio Milani, MD; Howard M. Snyder, III, MD, FAAP.Children'sHospital of Pennsylvania, Philadelphia,PA
4:50pm Podium75
Natural History of Reflux in Patients with Ureteroceles
R. Wayne Hatfield,MD; Martin Kaefer, MD; Richard C.Rink, MD, FAAP; John C. Pope, IV, MD;JohnW. Brock, III, MD, FAAP; Mark C. Adams. Vanderbilt Children's Hospital, Nashville,TN andRileyHospital for Chil-dren,Indianapolis, IN
4:55pm Poster 76
Endoscopic Puncture of Ureterocele as Minimal Invasive andLong-termEffective Procedure in Children
BorisChertin, MD; Alon Fridmans, MD; Irit Hadas-Halperin, MD; Wail Abu-Arafeh, MD;
Moshe Zilberman, MD;AmicurFarkas, MD, FAAP.ShaareZederMedical Center, Jerusa-lem,Israel
4:58 pm Discussion
MONDAY, OCTOBER 11, 1999 SectiononUrology
6:45am-4:15pm
Room32/33, Washington Convention Center 6:45am-7:45 am MasterClass
Seniorprofessorsdiscussingcases,andfocusing ontheresident,fellow, and junior faculty level audience
DougCanning, MD,FAAP,Moderator. Howard Synder, MD, FAAP
AlanRetik,MD,FAAP EdmondGonzales, MD, FAAP John Woodard, MD, FAAP
Session12-Kidney Obstruction
Moderators: GeorgeSteinhardt, MD, and Jor-ganFrokiaer,MD
8:00 am Podium77
Symptomatic Ureteropelvic Junction Ob-struction inChildrenintheEraofPrenatal Sonography-IsthereaHigher Incidence of Crossing Vessels?
MarkP. Cain, MD, FAAP; Adam C. Thomas, Paul F. Austin, MD; MartinKaefer, MD; An-thony J. Casale, MD, FAAP; Richard C. Rink, MD, FAAP.RileyHospitalforChildren, In-dianapolis,IN
8:05am Podium78
The Long Term Follow-up of Newborn Hydronephrosis Initially Managed Non-Operatively.
Ibrahim Ulman, MD; VenkataR.
Jayanthi,
MD, FAAP; Stephen A. Koff, MD, FAAP. Chil-dren'sHospital,Columbus, OH8:10am Podium79
Renal Pelvis Histopathology Correlates with Radiologic Outcome Following Py-eloplasty in Children with UPJ Obstruc-tion.
Peter D.FurnessIII,MD; SangWonHan,MD; Max Maizels,MD, FAAP; PaulineM. Chou, MD; Sandra K. Fernbach, M.D. and Earl Y. Cheng,MD.YonseiUniversity,Seoul,Korea and University of Oklahoma, Oklahoma City, OK
8:15am 8:24 am
Discussion
Poster 80
Renal Expression of HB-EGF Inhibits Me-chanical Stretch-Induced Apoptosis in CollectingDuctCells
HiepT.Ngyuen, MD;SamuelH. Bride, B.A., Rosalyn M. Adam,PhD; JianquinLin, CraigA. Peters,MD, FAAP; MichaelR.Freeman,PhD. Children'sHospital,Boston,MA
8:27 am Poster 81
FAAP, Valentina Kon, MD. Vanderbilt Chil-dren's Hospital,Nashville, TN
8:30 am Poster 82
Renal Functionand Morphologyin Exper-imental Unilateral Hydronephrosis: Are Early MRI Morphology or Renography Predictorsofthe Outcome?
AnniEskild-Jensen,MD;Jorgen Frokiaer,MD; D.M.Sci., Hans Todkilde Jorgensen, MD, D. M.Sci., Jens Christian
Djurhuus,
MD, D.M.Sci; Troels Munch Jorgensen, MD, D.M.Sci. Aarhus University Hospital, Aar-hus,Denmark8:33 am Poster 83
Comparison Of Surgical (UUO) Versus Congenital Obstruction Of The Urinary Tract In AnAnimal Model:AreThey The Same?
John C. Pope IV, MD; Keisuke Oshima, MD; MatthewHassen, MD; MarkC.Adams, MD; Agnes Fogo, MD; John W. Brock III, MD, FAAP,IekuniIchikawa,MD.Vanderbilt Chil-dren'sHospital, Nashville,TN
8:36am 8:46 am
Discussion Poster 84
PrimaryObstructiveMegaureterManaged By Ureteric Stenting: Experience And Long-Term Outcome
Michaela Kohler, MD; Duncan Wilcox, Isky Gordon, Getta Dhillon, Philip G. Ransley, FAAP. Great Ormond Street Hospital for SickChildren, London, United Kingdom
8:49am Poster 85
Ureteroscopic Endopyelotomy for Recur-rentUPJObstruction in Children Ravi Rajan, MD; Richard I. Silver, MD; T. Ernesto Figueroa, MD, FAAP; Demetrius H. Bagley,MD. A.I. DupontHospital for Chil-dren, Wilmington, DE
8:52am Poster86
Lessons Learned from LaserWelding and Fibrin Glue Pyeloplasties in an In Vivo ChronicPorcineModel
Diego Barrieras, MD;PramodP. Reddy,MD; Gordon A. McLorie, MD, FAAP; Darius J. Bagli, M.D.C.M., FAAP; Antoine E. Khoury, MD,FAAP; LotharLilge, PhD; Paul A. Mer-guerian, MD,FAAP. Hospital for Sick Chil-dren, Toronto, ON Canada
8:55 am Poster87
UltrasonographicReevaluation ofaCohort of Children withPrenatally-Detected Mul-ticysticDyplastic Kidney (MDK) and Eval-uationofFirstDegree Relatives
Rachel A. Belk, BSc; David F. M. Thomas, FRCPFRCS; RobertF.Mueller, FRCP; Adrian D.Joyce,FRCS; Michael J. Weston,FRCR. St. James's UniversityHospital, Leeds, United Kingdom
8:58am Discussion
Session 13-Reconstruction II
Moderators: Henri Lottmann, MD, and Gor-donMcLorie,MD
9:10am Podium88
Long TermResultsofGenitoplastyfor Pe-nile Agenesis, Dysgenesisand Microphal-lia
PeterPinto, MD;MichaelDesautel,MD;Jeffrey Stock, MD, FAAP; Moneer Hanna, MD, FAAP.SchneiderChildren's Hospital, Long Hyde Park, NYand Children's Hospital of NJ, Livingston, NJ
9:15 am Poster 89
CorporalTissue For Penile Reconstruction GermanFalke,MD; James J. Yoo, MD; Marcos G.Machado,MD;RobertMoreland, PhD; An-thony Atala, MD, FAAP.Children'sHospital, Boston, MA
9:18 am Poster 90
Construction of Female Urethra Using Buccal MucosaGraft
John M. Park,MD; W. Hardy Hendren, MD, FAAP, FACS, FRCS(I).Children'sHospital, Boston, MA
9:21 am Poster 91
Results of ReconstructionofChildrenwith High UrogenitalSinus
Moneer Hanna, MD, FAAP; Salima Al-Ra-madan, MBBCh, FRCS, Ibrahim Bassiouny, MBBCh, FAAP; Jeffrey Stock, MD, FAAP. NewYorkHospital-Cornell Medical Center, NewYork, NY, Children'sHospital ofNew Jersey, Livingston, NJ
9:24 am Podium92
Initial Experience With the Transurethral Self Detachable Balloon System For Uri-naryIncontinence
David A. Diamond, MD, FAAP; Anthony Atala, MD, FAAP; Stuart B. Bauer, MD, FAAP.Children's Hospital, Boston,MA 9:29 am
9:45am
Session14-Testis
Discussion
Coffee BreakandPosterViewing
Moderators: DavidDiamond, MD,and Stan-ley Kogan,MD
10:10 am Podium93
Placental Estradiol: APurported Etiologic FactorofHumanCryptorchidism F. Hadziselimovic, MD, FAAP; Geneto L.R. Emmons, PhD; Kinderarzt FMH, Liestal, Switzerland
10:15am Podium94
Pretreatment Testicular Location: No Dif-ference InPaternity Of Undescended Tes-tisAfter Unilateral Cryptorchidism Peter A.Lee,MD, PhD; Michael T.Coughlin, PhD; Mark F. Bellinger, MD, FAAP. Chil-dren's Hospital of Pittsburgh, Pittsburgh, PA
10:20am Poster 95
DNAOrganizationinPatientswitha His-toryofCryptorchidism
Joseph G. Barone, MD, FAAP; Kenneth B. Cummings, MD; Steven W. Ward, PhD. Uni-versity of Medicine and Dentistry ofNew Jersey,NewBrunswick, NJ
Inhibin B: An Indicator of Seminiferous Tubule Impairment in Children with Cryptorchidism
Francis X. Schneck, MD; Mark F. Bellinger, MD,FAAP;JulianFagerli, MD; Peter A. Lee, MD,PhD.Children's Hospital of Pittsburgh, Pittsburgh, PA
10:26 am Poster 97
Impaired Gonocyte Transformation Due ToAndrogenReceptorDefect
Faruk Hadziselimovic,MD, FAAP,HowardM. Snyder III, MD, FAAP, Dale S. Huff, MD. InstituteofAndrology, Liestal,Switzerland 10:29 am Discussion
10:45 am Poster 98
How Well Does Contralateral Testis Hy-pertrophy Predict the Absence ofthe Non-palpable Testis?
Richard S. Hurwitz, MD, FAAP. Southern CaliforniaPermanente MedicalGroup,Los Angeles, CA
10:48 am Poster 99
ComparativeAssessmentOf Pediatric Tes-ticular Volume: OrchidometerVersus Ul-trasound
DavidA.Diamond,MD,FAAP,Harriet J. Pal-tiel, MD; James Dicanzio, David Zurakowski, PhD; Stuart B. Bauer, MD, FAAP, CraigA. Peters, MD, FAAP, Anthony Atala, MD, FAAP, P. L. Ephraim, Alan B. Retik, MD, FAAP.Children'sHospital, Boston,MA 10:51 am Poster 100
Microsurgical LigationInAdolescent Var-icocele: Much Ado AboutNothing? F.Ferro,A.Zaccara, M. DeGennaro,A. Spag-noli, M. Silveri. Ospedale Pediatrico Bam-binoGesu,Rome,Italy
10:54 am Poster 101
MaleSelf HealthAwareness
PhillipF.Nasrallah,MD, FAAP;GijuR.Nair, MD; Cynthia Bennett, MSN, Joseph Congeni, MD; DanielR.McMahon,MD,FAAP.Akron, OH
10:57 am Discussion
11:10 am AAP Section on Urology Research Prize Presentations
11:25 am NATIONAL KIDNEY FOUNDATION Lecture
Dr.CharlesBerde, MD, PhD, Children's Hos-pital,Boston
12:15pm LUNCH
1:30 pm Video Forum: Endoscopic and Laparo-scopic SurgeryinPediatricUrology Hock Tan, MD-Laparoscopic Pyeloplastyin Children AlaaElGhoneimi, MD-Retroperi-toneal Laparoscopic Nephrectomy Steven Docimo, MD-Laparoscopic Assisted Pediat-ricUrologic Reconstruction David Diamond, MD and Paddy Dewan, MD-Laparoscopic Orchiopexy:PointCounterpoint
RichardSchlussel, MD-Transurethral Inci-sion ofUreterocele
Paddy Dewan, MD-Endoscopic Aspects of PosteriorUrethral Valves: WhenisaValve aValve?
2:45 pm Coffee Breakand Poster Viewing Session 15-Hypospadias II
Moderators: Mark Zaontz, MD, and Edward Reda, MD
3:00pm Podium102
HowEfficient is the Prenatal Diagnosisof Ambiguous Genitalia
Y.Aigrain, MD; A.Cheikhelard,MD; E. Vuil-lard, MD; J. Leger, MD; M. Polak, MD; A. ElGhoneimi, MD. Hopital Robert Debre, Paris, France
3:05 pm 3:08pm
Discussion Podium 103
AComprehensive Analysis ofa TIP Hypo-spadias Repair
D. PrestonSmith,MD,FAAP.TheUniversity ofTennesseeMedical Center, Knoxville,TN 3:13 pm Podium 104
Snodgrass Hypospadias Repair Without Circumcision
FranciscodeBadiola,MD;Alejandro Sosa,Juan Moldes, Juan C. Puigdevall, Eduardo Ruiz. Hospital Italiano,Buenos Aires, Argentina 3:18pm Poster 105
Histology Of The UrethralPlate: Implica-tionsForHypospadias Repair
Warren Snodgrass, MD, FAAP; Kathleen Patterson, MD; Chad Plaire, MD; Richard Grady, MD; Michael Mitchell, MD, FAAP. Children'sHospital, Seattle,WA
3:21pm Poster 106
TheGitup(Glanuloplasty andinSitu Tu-bularizationOf The Urethral Plate) Hypo-spadias Repair: A Simple Technique For DistalHypospadias Repairs
Andrew K. Chung, MD; Evan J. Kass MD, FAAP. William Beaumont Hopsital, Royal Oak,MI
3:24pm Poster 107
Outcome Analysis of Tubularized Incised PlateHypospadias Repair
Antoine E. Khoury, MD, FAAP; Alpana Prasad,MD; Paul A.Merguerian,MD,FAAP; Gordon A. McLorie, MD, FAAP; Darius J. Bagli, MDCM,FAAP.Hospital for Sick Chil-dren,Toronto,ON Canada
3:27pm Poster 108
Management of Penoscrotal Transposi-tion: ANovelApproach
Israel Franco, MD, FAAP; Mark Kolligian, MD; EdwardF.Reda, MD,FAAP. Westches-terMedical Center.Valhalla, NY
3:30pm Discussion Session16-ExstrophyII
Moderators: CurtisSheldon, MD,andEnrique Jaureguizar,MD
3:50pm Podium109
Cloacal Exstrophy: Managment Of The 46XYGenotype
J. ChadwickPlaire, MD; MichaelE. Mitchell, MD, FAAP. Children's Hospital, Seattle, WA
Adult ClinicalPsychosocial Adaptation in PatientsBornwith Bladder Exstrophy H.Jaureguizar,MD; M. J. Martinez Urrutia, P. LopezPereira, C. Soto, M. Diaz.Hospital In-fantil "LaPaz",Madrid, Spain
4:00pm Poster 111
TheUseofPelvicOsteotomyinRepairof Bladder Exstrophy
Paul D. Sponseller, MD, FAAP; M. M. Jani, BA;JohnP. Gearhart,MD, FAAP.TheJohns HopkinsHospital,Baltimore,MD
4:03pm Poster 112
Results of Umbilicoplasty for Bladder Ex-strophy
Christian Pavlovich, MD; Jeffrey Stock, MD, FAAP; MoneerHanna, MD,FAAP. NewYork Hospital-Cornell Medical Center, New York, NYand Children's Hospital of New Jersey,Livingston, NJ
4:06 pm Discussion
4:15 pm ADJOURN
UNMODERATED POSTERS
1 The Role ofIdiopathic Hypercalciuriain a Sub Group Of Dysfunctional Voiding Syndromes of Childhood
Dipen J.Parekh, M.Ch., John C.PopeIV,MD; Mark C.Adams,MD;John W.BrockIII, MD, FAAP. Vanderbilt Children's Hospital, Nashville, TN
2 The Dysfunctional Voiding Scoring Sys-tem(DVSS):Objective Criteria Evaluation OfVoiding DysfunctioninChildren Walid Farhat,MD; Darius J Bagli, MDCM, FAAP; GianPaolo Capolicchio, MDCM, Sheila O' Reilly, RN, Paul A. Merguerian, MD, FAAP; Antoine Khoury, MD, FAAP; Gordon A. McLorie MD, FAAP. Hospital for Sick Kids, Toronto, Ontario, Can
3 Structual Changes InThe Bladder Walls Of Pregnant And Hormone TreatedRats: CorrelationToBladder Dynamics Larissa V.Rodriguez, Bingyin Wang, StevenP. Lapointe, LindaM.DairikiShortliffe. Stanford University,Stanford,CA
4 Is Proactive Clean Intermittent Catheter-ization Safe and Practical in Newboms withSpinalDysraphism?
Jose M. B. Netto, MD; Luis M. Perez, MD, FAAP; David B. Joseph, MD, FAAP. Chil-dren's Hospital of Alabama, Birmingham, AL
5
6
Outcome ofGastrocystoplasty inTertiary PediatricUrology Practice
Michael P. Leonard, MD, FAAP; Nafisa Dharamsi, MD; PierreE.Williot,MD.Hopital Sainte-Jusinte, Montreal and Children's Hospital, Winnipeg, Canada
In vitro engineering of human stratified urothelium: analysis of its morphology andfunctionality
Sita Sugasi, Yannick Lesbros, Isabelle Bisson, Pavel Kucera, MD; Peter Frey, MD, Bsc, FAAP. Centre Hospitalier Universitaire Vaudois and University Institutefor Physi-ology,Lausanne, Switzerland
7
8
9
10
11
12
13
14
15
16
The Microbiology Of Bladder Augmenta-tion InChildren
AnthonyJ. Casale,MD, FAAP;Ronald S. Suh, Romano T.DeMarco,MD;MarkP.Cain,MD, FAAP; Richard C. Rink, MD, FAAP. Riley Children'sHospital, Indianapolis,IN Laparoscopic ACE (Antegrade Conti-nence Enema) In Situ Appendix Proce-dure forRefractory Constipation and Fe-calIncontinence in Children with Spina Bifida.
John G. Van Savage, MD; Paulos Yohannes, MD; Bruce L. Slaughenhoupt, MD, FAAP. Universityof Louisville, Louisville,KY Umbilicus ReconstructioninPatientswith Bladder Exstrophy
FranciscodeBadiola, MD; Juan C. Puigdevall, Alejandro Sosa, Juan Moldes, Eduardo Ruiz. Hospital Italiano.Buenos Aires, Argentina HowWellDoExstrophyPatientsActually Void?
ElizabethB.Yerkes,MD;Mark C.Adams, MD; John C. Pope, IV, MD;Richard C.Rink, MD; John W. Brock, III, MD, FAAP. Vanderbilt Children'sHospital, Nashville,TN Avoidanceof Inguinal Incision in Cases of Laparoscopically Confirmed Vanishing Testicle.
John G. VanSavage,MD; Bruce L. Slaughen-houpt, MD,FAAP.Universityof Louisville, Louisville,KY
PelvicFractureUrethral InjuriesInFemale Children
MiguelL.Podesta, MD; RicardoMedel,MD; RobertoCastera, MD; Marcela Herrera. Cen-troMedico San Luis, Buenos Aires, Argen-tina
Ureterocele Disproportion (Non-Obstruc-tiveUreterocele) Revisited
John M. Park, MD; Stuart B. Bauer, MD, FAAP, DavidA.Diamond, MD, FAAP, Craig A. Peters, MD, FAAP, Anthony Atala, MD, FAAP, AlanB.Retik, MD,FAAP.Children's Hospital, Boston,MA
The Use of Computerized Tomography (CT) in the Evaluation of Duplication Anomalies
MarkHorowitz, MD, FAAP;IvanColon,MD. Downstate MedicalCenter, Brooklyn,NY Lower Urinary Tract Reconstruction for Non-Functioning Renal Moieties Associ-ated with Ureterovesical Junction Pathol-ogy:AReviewof Three Institutions' Expe-rience
Andrew C. Roberts, MD; Bradley P. Kropp, MD,FAAP;Earl Y. Cheng, MD;Kenneth A. Kropp, MD, FAAP; Thomas S. Parrott, MD, FAAP. University ofOklahoma, Oklahoma City,OK
CostAndOutcomeTrendsInOpen Pyelo-plasty:A Single Institution Five-Year Re-view
Ischemia-Reperfusion Injury Induces Re-nalTubular Cell Production ofTNF-ci Kirstan K. Donnahoo, MD; Daniel R. Mel-drum,MD;ZianzhongMeng, MD;LihuaAo, Alfred Ayala, Ph.D., Brian D. Shames,MD; MarkP.Cain, MD, FAAP; AldenH.Harken, MD. RileyChildren's Hospital, Indianap-olis, IN
A Modified Extravesical Ureteral Reim-plantation Technique Using an "Invert-ed-Y" Detrusor Dissection
James 0. L'Esperance, MD; Yegappan Laksh-manan; Leo C.T. Fung, MD. University of Massachusetts Medical Center, Worcester, MA
Double Onlay Preputial Flap For Hypos-padias Repair. Experience With A New Technique in 46Patients
Roman
Jednak,
MD;UbirajaraBarrosoJr., MD; Julia Spencer Barthold, MD, FAAP, Ricardo Gonzalez, MD, FAAP. Children's Hospital of Michigan, Detroit, MILong-Term Evaulationof Hypospadias Re-pair: Patient and Family Perspective of Functional andAesthesticResults Umesh Patil, MD, FAAP; Elan Salzhauer, Manjula Subramanian, RanjivMathews, MD, FAAP. Syracuse, NY
FreeGrafts for Penile Curvature
RichardE.Caesar, MD;AnthonyJ.Caldamone, MD. Hasbro Children's Hospital, Provi-dence,RI
BovinePericardium asaCorporal Cavern-osal PatchMaterialinthe Repair of Penile Chordee
Vernon M. Pais, MD; Yegappan Lakshmanan, MD;LeoC.T. Fung,MD.Universityof Mas-sachusetts MedicalCenter, Worcester, MA Ring Around ThePenis: A Technique To Correct Severe Hypospadias And Lower The Risk Of Urethral Stricture Or Meatal Stenosis, Initial Results
Ross M.Decter, MD,FAAP.Hershey Medical Center,Hershey, PA
Hypospadias Failure: Outcome Of Ure-thralReconstruction In 36Patients GianantonioManzoni, Giacinto Marrocco, Os-pedale di Circolo; S. Camillo Hospital, Rome,Italy
Management of Recalcitrant and Fulmi-nantVenerealWartInfectionsinChildren withHighDoseCimetidine
Israel Franco, MD, FAAP.Westchester Med-ical Center, Valhalla,NY
Uroplakin And Androgen Receptor Ex-pressionInTheHumanFetal Female Gen-italTract:InsightsIntoTheDevelopment Of TheVaginaInNormal Females AndIn Congenital Adrenal Dyperplasia
EllenShapiro, MD, FAAP; Hong-Ying Huang, MD;Xue-RuWu,MD. NewYorkUniversity MedicalCenter,NewYork, NY
Consensus OnThe ApproachTo Antena-tally Detected Urologic Abnormalities C.D.AnthonyHerndon, MD; PatrickH. McK-enna,MD,FAAP; AndrewL.Freedman, MD,
28
FAAP; Fernando A. Ferrer, MD. Connecticut Children's MedicalCenter, Hartford, CT
Outcome Analysis of Vesicoamniotic Shunt Insertion for Suspected Bladder Outlet Obstruction
Gordon A.McLorie, MD, FAAP;Mohammad Abdul-Aaly, MD; Antoine E. Khoury, MD, FAAP;DariusBagli, M.D.C.M., FAAP;Paul A.Merguerian, MD, FAAP;GregRyan,MD; Denis Geary, MD. Hospital for Sick Kids, Toronto, Ontario, Canada
1
DECREASEDLINEARGROWTHASSOCIATEDWITH INTESTINAL BLADDERAUGMENTATIONINCHILDREN WITHBLADDEREXSTROPHY.
JenniferL.Dodson, MD, David-Alexandre C. Gros, MD, Uri A. Lopatin, BA, John P. Gearhart, MD, FAAP, Richard I. SilverMD, Steven G. Docimo, MD, FAAP. Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Hospital, Balti-more, MD.
Background: While some case series have suggested delayed linear growth after enterocystoplasty, none of these were case-controlled and the series did not necessarily include patients whosebladders were augmented for identical reasons.Therefore, the presentstudywasperformedtoexaminethehypothesis that intestinal bladder augmentationisassociated with reduced linear growth.
Methods: Fifty patients who hadundergone bladder augmen-tation for incontinence resulting from bladder exstrophy were randomly selected from our institution's patient data-base and matched for gender, age and type of exstrophy with 50 non-augmented bladderexstrophy patients. Patients werethen con-tacted and asked to permit their pediatricians to release their growth charts. Once consent was obtained, the charts were re-quested from thepediatricians.Evaluable data(definedas atleast oneheight pre and post augmentation)wereobtainedfor 20 (40%) augmented and 14 (28%) non augmented patients. Results: The meanageatoperationwas 7.7years.Delayed growth definedby apostoperativedropinpercentile height occurredin18(90%) of augmented patients, withameanloss of 17percentile points.In thecontrol group,delayedgrowth after7.7yearsof age occurred in 4 (29%) patients, with the control group as a wholegaining average of 8 percentile points. A Shapiro-Wilk test found the heightstobenormally distributed (p=0.19 and0.93respectively) and a t-testshowed the mean heightchangetobe significantly different between thetwogroups (p=0.006). The average follow up periods of6 and 7.4 years in the augmented and non-aug-mented groups, respectively, were not significantly different (p=0.19).Conclusion: Intestinal bladder augmentationisassociated withanearly universal decreaseinpercentileheight.Analysis of subtle metabolic alterations mayprovide informationtohelp min-imizeorpreventgrowth impedimentinthefuture. Altemativesto intestinal augmentation shouldcontinuetobepursued.
2
LONG TERMFOLLOW-UPOF THE HEMATURIA-DYSURIA SYNDROME.
J.ChadwickPlaire,MD, WarrenT.Snodgrass,MD, FAAP, and Michael E. Mitchell, MD, FAAP Children's Hospital and Re-gional Medical Center,Seattle,WA
Background: In pediatric bladder reconstruction, gastrocysto-plasty has both advantages anddisadvantages. Aunique disad-vantage is the Hematuria-Dysuria Syndrome (HDS). We previ-ously described thissyndromeasanyof thefollowingsymptoms: bladder spasm; suprapubic, penile or periurethral pain; coffee 17
18
19
20
21
22
23
24
25
26
brown or gross hematuria without infections; skin excoriation; and dysuria without infections. Our initial enthusiasm for the routine use of stomach tissue in urinaryreconstruction waned primarilybecause of theconcernsregarding HDS. Asafollow-up to our initial study, we evaluated the long term incidence and severityof HDSinalarge group of patients.
Methods: The medical records of78patients whounderwent gastrocystoplasty, withaminimumof 5 yearsoffollow-up, were reviewed.Follow-up data within the past year was availablein 72 patients. Thecharts were examined to determine which patients currently have symptoms of HDS and any therapy required. Di-agnosis includedmyelomeningocele (28), bladder exstrophy (21), cloacalexstrophy (8), posterior urethral valves (6), sacral agenesis (3),pelvic tumor (2), bilateral ectopic ureters (2), non-neurogenic neurogenic bladder (1) andpersistent cloaca (1). The average age at the time of gastrocystoplasty was 8.75 years and follow-up rangedfrom 5 years to 10 years.
Results: When using thebroadest criteria of HDS, 17(23%) patients wereidentified who had at least1 of the above symp-toms.However, only3patients(2bladder exstrophy,1cloacal exstrophy) require medications on a daily basis to control symptomsofthe HDS. One patient, who had posterior urethral valves, required removal of the gastric patch secondary to suprapubic pain and parental concern. Four patients require medications intermittently to control symptoms and the other 9 patients'symptoms aremild andself-limiting. The diagnosis of the patients with symptoms included bladder exstrophy (10), myelomeningocele (2), posterior urethral valves (2), sacral agenesis (1),pelvictumor(1), and cloacalexstrophy (1). Of the 17patientswith symptoms, 10 described suprapubicdiscomfort ordysuria alone,5described hematuriaalone, and2described bothdysuria and hematuria.
Conclusion: HDS is a unique disadvantage seen in patients undergoing gastrocystoplasty.Inthis large group of patients, with aminimumof 5 yearsfollow-up, 23% describe some component of HDS. However, in only 5.5% (4/72) of patients the symptoms weresevereenough to require constant medical therapy or surgi-cal removal. A higher percentage of the patients with bladder exstrophy (10/21 or 47%) demonstrated symptoms when com-paredtotheother groups of patients. Eventhoughweraised the initialconcernswithHDS,wefeel thatgastrocystoplasty contin-ues tobeanexcellentalternativeinpediatric bladder reconstruc-tion.The severity of HDS does not appeartobeamajorproblem inthemajority of patientsinthelong term andtherefore should notdeter onefrom using gastric tissue.
3
SEROMUSCULARSIGMOIDCYSTOPLASTY
F.de Badiola,E.Ruiz, J.Puigdevall, D. Caramutti, J. Moldes and A. Sosa. PediatricUrology, HospitalItaliano, BuenosAires, Ar-gentina.
Background and Objectives: Intestinal bladder augmentations have wellrecognizedcomplications includingmucusproduction, metabolic abnormalities and perforations. These complications might be avoided if the intestinalmucosa is notincorporatedinto theurinarytract. Here wereportourexperience with seromuscu-larsigmoidcystoplasty(SSC) includingclinical,urodynamic and histological results.
Materials and Methods:WeperformedSSCin19of130patients undergoing bladder augmentation. There were 10 males. The meanagewas 8.7years(2-19). Fourteen patients hadneurogenic bladder, 2 anorectal malformations, 2 bladder extrophy and 1 posterior urethral valves. The indications for augmentationwere poorbladder compliance with urinaryincontinence and/or hy-dronephrosis.Complete follow upurodynamicdataareavailable for16patients(mean 8 months).In 10patients,endoscopic biop-sies of the augmented segment were obtained. The operation consisted of opening the bladder sagittally and adding to it a
reconfigured segment ofsigmoid colon from which the mucosa hadbeen removed preserving the muscularismucosa.
Results: Allpatients are dry on intermittent catheterizationat four hour intervalsorgreater. There werenoclinical urinarytract infections. Mucus production was not a problem and bladder irrigations were not necessary in any case. Capacity and compli-ance improved in all cases. Three patients presented peristaltic contractions. Capacity increased from 87.3ml (30-300) to 333ml (200-400). Mean postoperative compliance was 17.4ml/cm (8-40). There was little orno mucus present in centrifuged urine specimens. Biopsies from 10 patients obtained1year after surgery revealed that the seromuscular layer of the sigmoid was now coveredwithpseudostratifiedepitheliumwithcolonicglandsbut withoutcrypts, probably representing metaplasia of the regrown colonicepithelium. Theonlycomplication seen in somepatients has beenprolonged hematuria, not clinically significant. This has been avoided inthe last three cases by treating the demucosalized segment with the argon beamlaser,a procedure that appearsto furthereliminate residual colonicglands.
Conclusion:Theprocedure described is simpler to perform than other similar ones that preserve the urothelial lining. The clinical and urodynamic resultshave been very satisfactory.
4
COLOCECAL BLADDER AUGMENTATION WITHA TAPEREDCONTIENT ILEAL LIMB: USE IN THE NEUROPATHICBLADDER
DA Husmann MD, FAAP, Rochester, MN and Mark CainMD, FAAP,Indianapolis, IN
Background: In pts with a neurogenic bladder (NGB) needing a bladder augmentation use of a detubulerized colocecal patch with a tapered ileal segment as a continent catheterizable stoma has generally been disregarded as a option due to concerns regarding fecal continence.
Methods: A retrospective reviewof pts with a NGB managed by acolocecal bladder augmentation using a continent tapered ileal limb was performed. All pts included in this study had failed conservative management with anticholinergic medications and intermittent catheterization. To be considered for this procedure all patients had to havedocumented fecalcontinencepriortothe operation.
(58%) pts, duringamedianfollow-up interval of 6 years, range 1-9 yrs. The need for additional surgery was, removal of bladder calculi in 16 (26%), stomal procedure for continence 8 (14%), stomalstenosis 4(6%) rupture of the augment4(6%), SBO2(3%), parastomalhernia 1 (1.5%), and ureteral obstruction 1(1.5%).
Conclusion:In selected pts withaNGB colocecal bladder aug-mentations withatapered ileal stoma willprovide excellent uri-nary continence, preserve the upper tracts and does notroutinely resultinfecal incontinence.
5
STOMAL STENOSIS:IS ILEUM THE IDEAL SUBSTRATE FOR EFFERENT LIMB CONSTRUCTION?
MartinKaefer, MD, Richard C. Rink, MD, FAAP, Mark P. Cain, MD,FAAP and Anthony J. Casale, MD, FAAP. Department of Urology, Indiana University Medical Center, Indianapolis,IN.
Background: Construction of the efferent conduit can be the most challenging aspect of continent urinary diversion (CUD). Complications involving the catheterizable channel have been reported in up to 30%of patients, with stomal stenosis being one of themost common.We report theincidenceof stomalstenosis relative to the biomaterial used forefferent limb construction.
Methods:Weretrospectively reviewed the recordsof all patients undergoing thecreationofa continentcatheterizable channel from 1985 to 1997.Incases where appendix (N=46),Bladder-continent vesicostomy (N=22), or reconfigured ileum-Monti technique (N=14)wasutilized, the stomalsite wascreated usingalaterally basedV-flap of skin.Incaseswheretapered ileumwasemployed (N= 10), thestoma wasbrought flushtothe skin.Allileal conduits wereconstructed overa 12-14 Fr.catheter. Presentingdiagnosis, dateof operation, interval to stomal stenosis and other complica-tions involving the CUD construction were recorded. Patients with less than one yearof follow up were excluded from further analysis (N=11).
Results: Stomalstenosisoccurredin 19of92patients(20%) with the majority occurringduring the first year of follow up (11/19= 58%). Stenosis requiring surgical revision occurred most fre-quently when appendixor abladderflapwereutilized(10/46 and 9/22, respectively: average intervaltostenosis = 1.4years,range: 2 months-6 years).Incontrast, this complication was not appre-ciated inpatients withefferent conduits constructed from recon-figured ileum (Monti or Tapered) (p<0.0001). Stomal location was not a predictor of stomalstenosis (Umbilicus 10/49 = 20% vs. LowerQuadrant7/34= 20%vs.Neoumbilicus2/9 = 20%).
Conclusion: Efferent conduitsconstructed from ileum have had a significantly lower incidence of stomal stenosis in our series whencomparedtoappendicovesicostomy andcontinent vesicos-tomy. We would strongly recommend the use of ileum when utilizing strategies that require a bowel anastomosis (i.e. ileal augmentation). Wewould tendtofavoraMontiileovesicostomy over appendicovesicostomy in all other situations although the Montifollow upisrelatively short.
Biomaterial Incidence Timeto Follow-up Stenosis (avg.)
(avg.)
Appendicovesicostomy 10/46=22% 19months 3.4years ContinentVesicostomy 9/22=41% 13months 3.0years Ileum-Tapered 0/10=0% NA 8.1years
Ileum-Monti 0/14=0% NA 1.3years
6
AUGMENTATIONURETEROCYSTOPLASTY COULD BE PERFORMED MORE FREQUENTLY
Sava V. Perovic, MD, PhD, FAAP (Affiliate), Voikan Vukadi-novic,MD and Miroslav Li. Djordjevic, MD. Dept.of Urology, UniversityChildren'sHospital, Belgrade, Yugoslavia.
Background: Gastrointestinal segments are most often used for bladder augmentation. However, there are numerous complica-tions related to their incorporation into the urinary tract. Mega-uretersrepresenttheideal tissue, but ureterocystoplasty has been used onlyinselected cases up to now. Oureffort was to show that itcould be used more frequently by using the distal part of the megaureterfor augmentation and proximal one for reinplantation. Methods: From November 1995 to September 1998 ureterocys-toplasty was performed in16 patients,aged 3 to 12years(mean 6.6). In9 pts with impaired renal function loop ureterocutanos-tomy was previously done to preserve and improve renal func-tion.Distal part ofureterswas dilatedby balloon catheters.Inthe remaining 7 pts bladder augmentation and simultaneous uretero-neocystostomy were performed without ureterocutanostomy. Ureterocystoplasty was done extraperitoneally. Distal part of megaureter wasused for augmentation. For constructing the blad-der of adequate shape, bladder expander was inserted during surgery and removed two weeks later. Proximal part of the megaureterwasmobilized and implantedintothe bladder using extravesical detrusortunneling ureteroneocystostomy.
Results: Follow up wasfrom 6 to41months(mean23months). Thenewincreased bladder capacityranged from 296mlto442ml (mean 371ml) for both groups. Compliance was improvedin all cases with decrease of number of CIC per day. There was no further worsening of the renal function. Transitory VUR was notedinthree patientswithout clinical symptoms.
Conclusion: Megaureter presents the ideal tissue for bladder augmentation.Divisionof theureterandusingitsdistal part for augmentation is always possible. Augmentation ureterocysto-plasty performedinthis way could be donemorefrequently.
7
"CO-CULTURE"OF BLADDER SMOOTHMUSCLEAND UROTHELIAL CELLS ON SMALL INTESTINAL
SUBMUCOSA(SIS): EVALUATIONOF THEBEST CULTUREMETHODFORINVITROTISSUE ENGINEERING TECHNIQUES
Y.Y.Zhang, MD, BradleyP.Kropp, MD, FAAP,Peter MooreBS, MS, RickCowan, BS, and Earl Y. Cheng, MD. Department of Urology, Children's Hospital of Oklahoma and University of Oklahoma, Oklahoma City, OK.
Background: Small intestinal submucosa (SIS) is a xenogenic, acellular, collagen rich membrane with inherentgrowth factors previously shown to promotein vivo bladder regeneration and supportthe individual3dimensionalgrowth of bladder smooth muscle cells(SMC) and urothelial cells (UC).It is currently un-knownwhetherinvitroseeding of SISwithcellswillenhancethe regeneration process and what the best methodofseedingisfor usewith thistechnique.Thisstudywasconductedtoevaluate the combinedinvitrogrowthof SMC and UConSIS andtodetermine the best culture methodforin vitro tissueengineeringuse.
SMCseeded onserosal surfacefollowed by seeding of UConthe mucosal surface 24 hours later. TheSIS-cell constructs were formalin fixed at the time of harvesting and processed for routine histology including Masson's trichrome staining. The specificcell growth char-acteristicswerestudied with special attention tocell morphology, cell proliferation, cell adherence, and 3 dimensional patterns of growth. Tohelpintheidentification of cells in the groups where cells were seededtogether, immunohistochemical analysiswasperformedwith antibodiestosmooth musclea-actinandcytokeratinsAE1/AE3.
Results: Both human and dogcells grew similarly on SIS. When seeded alone, SMC and UC grewinseveral layers withminimal matrix penetration. When cells were seeded on the SIS in "co-culture", there appeared to beasynergisticeffect with respect to enhancedgrowth and penetration of the SIS membrane. Both SMC and UC layered morereadily and had greater adherence to the SIS. Cells formedathick stratified layer that was organized such that SMCwerebasally located withmatrixpenetrancewhile the UC grew in multiple layers with early polarity on top of the proliferating SMC. With the "sandwich technique" there was also enhancement of growth and penetrance, however this wasless pronounced when compared to the "co-culture" technique. Cell growth was progressive over the 28 day period of observation with the majority of proliferation occurring in the first 14 days. Immunohistochemical studies demonstrated that both SMC and UCmaintainthe expressionof the phenotypic markersof differ-entiation(smooth muscle a-actin andcytokeratins AE1/AE3).
Conclusions: SIS is capable of supporting the differentiated growthof human and dog bladder cellsinvitro.The present study suggeststhatthe co-culture method ofseeding provides the best bladdergraft material forinvitro tissueengineeringtechniques. Additionally, this study demonstrates that there are important smooth muscle-epithelial cell interactions involved in the en-hancementofinvitrogrowthof bladdercells.Thisinvitromodel will beavaluable toolfor the future study of these critical inter-actions and the cellularsignals involved inthe processoftissue regeneration. These results alsohave important implications for the future clinical use of tissue engineered bladder grafts for urinarytract reconstruction.
8
REGENERATION OF FUNCTIONAL BLADDER SUBSTITUTES USING LARGE SEGMENT(>44CM2) ACELLULARMATRIXALLOGRAFTS IN APORCINE MODEL: LONG TERM RESULTS
Pramod P.Reddy MD, Diego J. Barrieras MD, DariusJ.Bagli MDCM, FAAP, Gordon A. McLorie MD, FAAP, Antoine E. Khoury MD, FAAP and Paul A. MerguerianMD, FAAP. The Hospital for Sick Children, University of Toronto, Toronto, On-tario,Canada.
Introduction and Objectives: Wehavepreviously presented the short-term(4wks)results ofamorphometric analysisofabladder acellular matrix allograft (BAMA) bioprosthesis using segments >24cm2.WedemonstratedBAMArepopulationofnativebladder cellphenotypes throughoutthe entirethicknessof theallograft. We now present longterm (12 wks) morphometric as well as functionaloutcomes ofBAMAintegrationintoporcinebladders, utilizing largesegmentsmeasuring >44cm2 (meansurfacearea). Methods: BAMA was prepared by detergent and enzymatic extraction of porcine bladders, to achieve an acellular matrix. Eighteen pigs had partial
(.
50%) cystectomies performed and thenBAMAsegmentswereimplanted ontotheirbladders, aver-agesize 44cm2 (maxsize 72cm2,n=6). No urinary diversionwas employed.The animalswerethen sacrificedat1wk(n=2),2wks (n=2),4wks(n=2), 8 wks (n=3) and12wks(n=9). Thenative bladder andrepopulatedBAMAsegmentwerestained with He-matoxylin-Phloxine-Saffron and immunohistochemistry staining forCollagenI&III, a-actin,Cytokeratin-7,Protein geneproduct 9.5andAcetyl-Choline (to demonstratein vivofunctional nerveendings). The sampleswereanalyzed morphometrically withlight and con-focal microscopyto evaluatecellular repopulation and matrixre-organization.Videourodynamic studieswereperformed atmonthly intervalsinthe 8 and12wkpreps,toevaluate bladder capacity,compliance and emptyingability,aswellasradiographic morphology.
Results: Allanimals survived the surgical procedure and there were no urinaryleaks. None of the animals developed urinary calculiorhydronephrosis.At 1wk therewas adiffuse infiltration with acuteinflammatory cells.Isolated areasof smooth muscle cell (SMC) infiltration of theBAMA werenoted.At 2wks theluminal BAMAsurfacewaslined withasingle layer ofurothelium, stro-malinfiltration with non-organized SMC and evidence of angio-genesisinthedeeperBAMAregions.At 4wks the urotheliumwas multi-layered with organizing groupsof SMC and discrete blood vessel lumens noted. By 8 and 12 wks, the SMC formed well-defined musclebundles, and therewas acellularrepopulationof nervesheaths extending throughout the entire thickness of the BAMAallograft. Upto4wks the regenerationofBAMAoccurred withacentripetal decreaseincelldensity. However by 8-12 wks aconsiderable(catch-up) increase incentralcelldensitywas ob-served.Videourodynamicstudies demonstrated that the regener-ated bladders hadcapacity (max300cc)andcompliance compa-rableto nativebladders, withoutdemonstratinganyuninhibited contractions orpersistent elevationsof bladderfillingpressures. Moreover,BAMAallograft bladders showed gross structural sym-metry, without anyadynamic segments visualized radiographi-cally.
Conclusions:Wepresentevidence thatlarge patchBAMA allo-graft implantation is technically feasible. The advantages of BAMAinclude thepotentialforcellularandfunctional regenera-tionofabladdersubstitute, includingneuralregeneration, while avoidingthecomplicationsassociated withconventional bladder augmentation strategies. Bladder acellular matrix allograft (BAMA) may provetobeaviablesurgicalalternativetobladder augmentationwithintestinal segments.
9
ENHANCEMENT OF ANGIOGENESIS TO ENGINEERED TISSUES USING VEGF SECRETING ENCAPSULATED CELLS
MarcelleMachluf,PhD, GiladE.Amiel,MD,Shay Soker, PhD, Anthony Atala, MD, FAAP.Department ofUrology,Children's Hospital and Harvard MedicalSchool,Boston,MA.
Introduction:Oneof the major obstaclesfacingtissueengineered organsandtissuesisinadequatevascularization of theimplants. Poorvascularizationlimits the transport ofnutrientsand oxygen tothe seededcells,and may resultintissue necrosis. Angiogene-sis, the process ofnewblood vessel formation, is regulated by different molecules, such asvascular endothelial growth factor (VEGF). Inthe presentstudyrenal cellsseededonacellular ma-trices were implanted inmicefollowedbyinjection of alginate-PLLencapsulatedChinese hamster ovary(CHO) cells,expressing VEGF (CHO/VEGF). Theencapsulation ofCHO/VEGF enables the long term release of VEGF while isolatingtheCHO/VEGF cells from the hostimmunesystem.
cells were injected to 12 mice, near the area of implantation. Renal unitsof the study and control groups (i.e. with and without the injected alginate) were harvested 3, 7 and 20 days after implanta-tion.
Results:Western blot analyses performed on conditioned media takenfrom encapsulatedcells revealed extended amount of VEGF proteinwhen compared to non encapsulated cells. High levels of VEGF were maintained for 6 weeks in culture. Macroscopic ex-aminationof mice injected with encapsulated cells together with the implant, revealed a progressive increase in vascularization at the implanted sites. In contrast, the control group which was not injected with CHO/VEGF cells, did not demonstrate enhanced vascularization. Immunohistochemical analysis of VEGF and VEGF receptors showed positive stainingof vessels.Anincreased number of capillaries and blood vessels was observed when com-pared to the control group.
Conclusions: These resultsindicate that extensiveamountsof VEGF are releasedfrom encapsulated CHO/VEGF cellsin vitro and in vivo. The release of VEGF in vivo greatly stimulated vascularizationinthe area of the implant. This new approach can be used to enhance vascularization of tissue engineered implants.
10
COMPARISON OFTHE INVITROCONTRACTILE CHARACTERISTICS OF NEUROPATHICAND NORMAL BLADDER SMOOTH MUSCLE CELLS: IMPLICATIONSFOR TISSUE ENGINEERING
Earl Y. Cheng, MD, Rick Cowan, BS, Pete Moore, BS,MS,Y.Y. Zhang, MD, James J. Tomasek, PhD, and BradleyP.Kropp MD, FAAP.Departmentof Urology, Children's Hospital of Oklahoma and Universityof Oklahoma, Oklahoma City, OK.
Background: It has recently been demonstrated that cellscanbe cultured from the normal animal bladder in vitro, seeded on a biodegradable matrix, and then placed back into the hosttoinduce regeneration of near normal bladder. Clinically,cells utilizedin tissue engineeringtechniques suchasthis willnotbe derived from a normal bladder. They will usually come from a neuropathic bladder with abnormal contractile properties. It is unknown whetherneuropathic bladder cellsin vitrowillretaintheir abnor-malcontractilecharacteristics or whether theywillrevertback to anormalpattern.Thisstudy compares theinvitrocontractilityof neuropathic bladder smooth muscle cells (SMC) andcellscultured from the normal bladder.
Methods: Primary cultures of bladder SMC were established utilizingstandardexplant techniques from patients witha neuro-pathic bladder (n=3, urodynamically with poor bladder compli-anceand poorcontractility) undergoing augmentation and from patientswithanormal bladder (n=5) undergoing ureteral reim-plantation. Cells from passage 5 were seeded on 1% collagen lattices (150,000 cells/lattice) and cultured for 5 days in M199 media with 10%serum.Contractility of theSMC-latticeconstructs werethenanalyzedfollowingexposure toapanelofwellknown contractile agonists including: 10% serum, Ca-Ionophore (1 ,um), andlysophospatidic acid (LPA) (1 ,uM). Totalcontraction(mean% reductionof the original lattice diameter) and relativecontraction (%reduction of the latticeascompared to reduction obtained with 10%serum)weremeasuredatthe 10 minute time point.
Results: Neuropathic bladder SMC had significantly less total contractionto10%serum(20% lessascomparedtothecontraction
75 m
1~~~~~
60j
serum serumfree LPA
* Normal =Neuropathic
.p<o.05
-Lt
lonophore
obtained with normal bladderSMC, p s .05),Ca-lonophore (50% less thannormal, p ' .05), andLPA(47%less than normal, p s .05) (seefigure 1). There was nosignificant difference in the total contraction obtainedinserumfree conditions betweenneuropathic and normal bladder SMC (p >0.05). Interestingly, the relative contraction to all of the agonists was not significantly different when neuropathic and normal bladder SMC were compared (p >0.05).
Conclusions: These results demonstrate that cultured neuro-pathic bladder SMC promote a significantly weaker contractile responsewhen compared to cultured normalbladder SMC. How-ever,both types of cultured cellsmaintain asimilar agonistprofile. Theclinicalimplications of these findings with respecttowhether these cells will continue to retain these functional differences whenutilized in tissue engineering techniques to promotebladder regeneration requiresfurther investigation.
11
TRANSECTION OF FILUMTERMINALEREMITS URINARY ANDSTOOL CONTINENCEINCHILDRENWITH
NEUROPATHICBLADDER ANDSPINABIFIDAOCCULTA Jeffrey S. Palmer, MD,MaxMaizels, MD, FAAP,John A. Grant, MD,Ingrid Richards, RN, and WilliamE.Kaplan, MD,FAAP. Divisionof Urology, Children's Memorial Medical Center, North-western University Medical School, Chicago,IL.
Background: Children withday\night wetting, urineinfection, and encopresis are difficult to treat. In children with spina bifida occulta (SBO), recent evidence suggests that traction of the filum terminaleonthe caudalspinalcord may be causing this dysfunction. Transection of the filum terminale has been reported to improve continence. Herein we report our experience with transection of the filum terminale for such children.
Methods:From agroupof about500childrenwho have been evaluated since 1994 for a combination of day and\or night wetting, urinary tractinfection, and encopresis,weidentifieda cohortof 8 children (girls=5, boys=3)who:1) didnotrespond toconventionaltreatment (enuresis alarms,pharmacotherapy, diet, and psychological treatment); 2) manifested SBO; 3) showed neurogenic bladderdespiteanormalneurological ex-aminationand MRI; and 4) normal urologicalexamination in-cluding cystoscopy. The effectiveness of the procedure was determinedby assessing the postoperative resolution of enure-sisand stoolincontinence.
Results: There were 8 children (mean age of 9.5 years) who fulfilled the criteria and had filum terminale transection. By 6 months postoperatively, allchildren had complete resolution of the nocturnal enuresis and stool incontinence; diumal enuresis was completely resolved (57%) or markedly improved (43%). Complicationsfrom the operation occurredinonlyonegirlwho experiencesback pain.
Conclusion: Transection of the filumterminaleis aneffective treatment modalityfor select children withrefractoryurinary and/or bowel incontinence, namely those who show spina bifida occulta and abnormalurodynamictestingdespitea nor-malMRI.
12
ERECTILE DYSFUNCTION ISATREATABLECONDITION IN THESPINABIFIDA MALE
Jeffrey S. Palmer, MD, William E. Kaplan, MD, FAAP, and Casimir F. Firlit, MD, PhD, FAAP. Division of Urology, Chil-dren's Memorial MedicalCenter,Northwestern University Med-icalSchool, Chicago,IL.
aC
10
Background: Nowthat individuals with spinabifida live well into adulthood, erectile dysfunction has become a recognized associated medical disorder. Surprisingly, nostudy has dealt specifically with the treatment of erectile dysfunction inspina bifida males. Therefore, we conducted a prospective, blinded, randomized, placebo-controlled, dose-escalation, crossover study to determinethe ability to treat erectile dysfunction in spina bifida men withsildenafil citrate (Viagra).
Methods: Fourteenmales (18 yearsof age and older) with spina bifida and a clinical diagnosis of erectile dysfunction were as-signed totake 4 sets of tablets (5 tablets per set)inarandom order. All mentook 25mg and 50mgof sildenafil citrate and2 identical-looking sets of corresponding placebos 1 hour before planned sexual activity. Efficacy was assessed by the effect of treatment comparedtobaseline (i.e. before treatment) on: 1) ratingof erec-tions (scored from 0 to 10); 2) duration of erections; and, 3) frequency of erections and confidence to obtain an erection based onresponsetoquestions1and 15(scoredfrom 0 to 5 and1to5, respectively) of the International Index of Erectile Function, re-spectively. Statistical analysis wasperformed withap-value <0.05 consideredstatistically significant. The Food and Drug Adminis-trationexempted this protocolfrom the requirementsof Part 312 of theINDregulations.
Results: Eleven men (79%) reported improved erectile func-tion whileonsildenafil compared tobothbaseline and place-bos. There was a significant dose-dependent improvement of erectile function with both 25mg and 50mg of sildenafil com-paredtobaseline (p<0.05): 1)meanerectile score increased by 54% and 89%, respectively; 2) mean duration oferections in-creasedby 199% and 271%, respectively; 3) meanfrequency of erections increased by 65% and 100%, respectively; and, 4) mean level of confidence increased by 33% and 67%, respec-tively. Furthermore, 50mg of sildenafil provided greater im-provementin all 4parameters compared to 25mg. In compari-son, the placebo results were not significantly different comparedtobaseline for anyof the parameters.
Conclusion: This is the first study specifically demonstrating that erectiledysfunction in the spina bifida maleis a medically treatable condition. Sildenafil citrate(Viagra) canbeaneffective therapyinthis patientpopulation and itimprovestheir level of sexualconfidence. Fundedbyaresearch grantfromPfizer,Inc.
13
SEXUALITY OFTHESPINA BIFIDA MALE:ANONYMOUS QUESTIONNAIRES OFFUNCTIONANDKNOWLEDGE Jeffrey S. Palmer, MD, William E. Kaplan, MD, FAAP, and Casimir F. Firlit, MD, PhD, FAAP. Division ofUrology, Chil-dren'sMemorial Medical Center,NorthwesternUniversity Med-icalSchool, Chicago,IL.
Background: Major advances have markedly increased the life expectancyof spina bifida individuals wellintoadulthood. Asa result, erectile dysfunction has becomeawell-recognized associ-ated medical disorder. The purpose of this study wastoconduct the first anonymousevaluation of the sexual function and knowl-edgeof these males.
Methods: Allmale patients18yearsof age andolder fromour SpinaBifida Centerweremailed both: 1) the International Index of Erectile Function (IIEF) questionnaire; and, 2) a question-nairedesigned by this study group. IIEFaddresses the erectile function, orgasmicfunction,sexualdesire,intercourse satisfac-tion, and overall satisfaction. Our questionnaire evaluates: 1) rating oferections on a scale from 0 to 10;2) duration of the erections; and 3) knowledge of the sexual and reproductive capabilities of individuals with spina bifida. Both question-nairesweremailed backtothe investigatorsanonymously. The protocolwas approved byourinstitutionalreviewboard. Sta-tisticalanalysiswasperformedwithap-value<0.05considered statistically significant.
Results: 57 men(range: 18-61 yearsold) completed the ques-tionnaires (32% response rate). The median erectile score was6 (range: 0-10) with a median duration of rigidity of 5 minutes (range: 0-60 minutes). Only 9 (16%) had ever had a health pro-fessional initiate a conversation about sex. None of the 26 patients with erectile dysfunction had ever been treated for this condition. There was an inverserelationship (p<0.05) between the level of physical disability and: 1) the importance of sex to them; 2) level of sexualactivity;3) total score, erectile function score, orgasmic function score, sexual desire score, intercoursesatisfaction score, and overallsatisfaction score of the IIEF; and, 4) knowledge of the reproductive capabilities of individuals with spina bifida. In ad-dition, significant racial differences were noted on the IIEF (p<0.05), with non-white males reporting a lower: 1) total score; 2) orgasmic function score; 3) sexual desire score; and, 4) overall satisfaction score than white males.
Conclusion: The resultsof these anonymous questionnaires re-flect the need to educate, initiate conversations on sex, and treat spina bifida males with erectiledysfunction, with special attention paid to differences in physical disability and race Funded by re-searchgrantsfrom PfizerInc.andMentorMedicalInc.
14
UROLOGIC OUTCOME OF PATIENTS WITH CERVICAL AND UPPERTHORACIC MENINGOMYELOCELES
Luis M P6rez, MD, FAAP, John T Wilbanks, MD, David B Joseph, MD, FAAP, W. Jerry Oakes, MD,FAAP. University of Alabama atBirmingham. Birmingham,AL.
Background: Little information exists concerning the voiding dysfunction and risk for upper tract deterioration of patients born with cervical or upper thoracic meningomyeloceles (MMC). The spinal level of the vast majority of children born with meningo-myeloceles occursinthe lower thoracic and lumbo-sacral regions. Children born withacervical or upper thoraciclevel meningomy-elocele constitute 1to 5 percentof theentire meningomyelocele population. Thesechildren aretypically ambulatory, andintheory they have a less hostile dynamicsof their neurogenicbladder and lower risk to upper tract deterioration than children with lower level MMC.
Methods:Wereviewed theneurosurgical andurological presen-tation, evaluation and management of 14 consecutive patients who had cervical (n = 11) orupper thoracic (n=3) meningomy-eloceles. There were 10female and4male patients ages 10months to 39 yearsof age (mean12years). All patientswereambulatory, and 8 of14(57%) hadhydrocephalus.Although all patients hada voidinghistoryobtained byaneurosurgeon, only9patients had formal urological evaluation includinghistory, physical examina-tion, and renal-bladderimaging studies. Six patients underwent video-urodynamicstudies.
Results:Voiding dysfunction (mildincontinence)wasnotedin 2of the9patients 5 yearsof ageorolder. No patient hadincreased post voidresiduals andnonehadeverbeenplacedonintermittent cath-eterization. Only1patient hadahistory of urinarytractinfections and thissamepatient wastheonlyintheseries onanticholinergic pharmacotherapy.Imagingstudies of the uppertracts wasnormalin all 9 patients. Video-urodynamics wasnormalin5of6patients.One patient hadmildhyperreflexia. One of10patientshad vesicoureteral reflux despite normal urodynamic parameters. No patient has re-quiredurologic surgical intervention.
