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Objective: The promise of stem cells is to provide a source of non-diseased material for the generation of patient-specific cells or tissue for replacement and reconstruction. This review will provide a broad perspective on stem cell research, from the sentinel discoveries to recent developments, and also discuss translational implications. Methods: We performed internet-based Pubmed database searches to identify recent articles and review papers pertaining to stem cell research and urologic applications. Results: Depending on their source, stem cells have a varied capacity to self-renew and divide and to differentiate into a desired phenotype. Pluripotent stem cells can potentially be differentiated into any cell type and multipotent stem cells are variably lineage restricted. In the urologic literature, stem cell derived smooth muscles have been produced and may be useful for tissue-engineered constructs. Conclusions: The future of reconstructive surgery will surely incorporate a number of these stem cell based technologies in revolutionary ways that may improve and extend lives. However, the ultimate utility and clinical applicability of the different types of stem cells will depend on a complex synthesis of further basic research, future clinical trials, and ethical and regulatory reconcilement. [Copyright &y& Elsevier]

Objectives: To identify any potentially harmful chemical constituents of the gaseous plume produced from urological endoscopic diathermy. Methods: Chemical analysis was performed on the gaseous plume produced from prostatic resections and vaporizations using gas chromatography with mass spectroscopy and high-performance liquid chromatography using ultraviolet and visible light detection. In addition, carbon monoxide levels were analyzed using a portable catalytic flammable gas sensor. Results: This study identified a cocktail of volatile organic hydrocarbons produced during these procedures, some of which are known carcinogens. The most significant finding being high levels of carbon monoxide. Conclusions: From this preliminary study, we advocate the use of smoke evacuator systems for all urologists regularly performing these procedures, and suggest that further research is required to investigate potential long-term complications to the urologist. [Copyright &y& Elsevier]

Objectives: To examine the outcomes of renal ultrasound studies after subureteral injection of dextranomer/hyaluronic acid copolymer and provide recommendations for postoperative management of vesicoureteral reflux (VUR). Methods: Pediatric patients aged 15 years or younger with uncomplicated primary VUR were recruited for endoscopic treatment with dextranomer/hyaluronic acid gel. After undergoing the procedure, patients were instructed to continue prophylactic antibiotic treatment until a follow-up voiding cystourethrogram was obtained 2 weeks or more after treatment. VUR resolution was defined as grade 0. Repeat endoscopic injection was offered to patients with persistent VUR. Postoperative renal ultrasound scans were obtained on the same day as the voiding cystourethrogram. Results: Of 120 patients treated, 6 were lost to follow-up and 14 had not yet undergone the posttreatment evaluation. The 100 remaining patients (efficacy population) had a mean age of 4.2 years (range 0.5 to 15), and the median reflux grade was 2 (range 1 to 5). The overall VUR resolution rate for the patients was 87% after endoscopic injection. Of 100 patients, 88 achieved complete resolution after a single injection and 19 required a repeat injection. Of the 100 patients who underwent postoperative ultrasound examination, none demonstrated renal ultrasound changes consistent with significant ureteral obstruction or renal parenchymal changes. Conclusions: Renal ultrasound studies after endoscopic treatment with dextranomer/hyaluronic acid gel are unnecessary after determination of reflux resolution by voiding cystourethrography. [ABSTRACT FROM AUTHOR]

Objective: To present our experience in a single pediatric urology practice over a 10-year period with bladder tumors in the pediatric population in an effort to add to the relatively small amount of existing data. We hope to expand the community's knowledge of presentations, management and natural history of pediatric bladder tumors.Methods: We retrospectively queried our electronic medical records for International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology (CPT) codes relevant for bladder tumors. Patients with underlying bladder pathology, such as neurogenic bladder, history of bladder exstrophy, and history of bladder augmentation, were excluded.Results: We identified 30 patients with bladder tumors from 2011 to 2021. There were 21 males and 9 females. Age at diagnosis ranged from 16 months to 19 years. Tumors identified were: 11 of various inflammatory subtypes; 4 papillomas; 4 rhabdomyosarcomas; 3 papillary urothelial neoplasms of low malignant potential and 8 of other types. Treatment included transurethral resection of bladder tumor, chemoradiation and laparoscopic partial cystectomy. Twenty nine patients had disease limited to the bladder and 1 had disease outside the bladder. Follow-up ranged from 2 weeks to 13 years (median 19 months). All patients had no evidence of disease at most recent follow-up.Conclusion: Pediatric bladder tumors range from aggressive rhabdomyosarcomas to more benign urothelial lesions. Fortunately, the latter type of tumor is the more prevalent lesion. Knowledge of the treatment options and natural history of these tumors will hopefully be of benefit to clinicians and parents alike. [ABSTRACT FROM AUTHOR]

Objective: To report the first exclusively pediatric series of robot-assisted urachal remnant excisions in children.Methods: We reviewed the medical records of all children who underwent robot-assisted excision of urachal remnants from 2010 to 2016. For the procedure, a 3-port approach was performed in all cases. Excision of the urachus was performed, along with partial cystectomy if there was clear or suspected bladder involvement. Outcomes and complications were reviewed.Results: Sixteen cases of robotic urachal excision were performed during the study period in patients aged 0.8-16.5 years. Complete excision was accomplished in all cases with no conversions. Partial cystectomy was performed in 11 cases, in which a urinary catheter was left for 1 day in all cases (no catheter was left in the absence of partial cystectomy). The only complication was a bladder leak requiring open surgical repair. There were no bowel injuries or hernias. The median operative time was 107 minutes. The length of stay was 2 days with partial cystectomy and 1 day without partial cystectomy. All patients were well at follow-up.Conclusion: We report the largest known series of robot-assisted urachal remnant excisions in children, demonstrating this minimally invasive approach to be safe and effective. [ABSTRACT FROM AUTHOR]

Objective: To examine trends in the number of cases of primary vesicoureteral reflux managed by ureteral reimplantation nationally over the last decade. Substantial changes have occurred in management of vesicoureteral reflux (VUR) over time, but trends in use of ureteral reimplantation have yet to be investigated on a national scale with annualized data.Materials and Methods: Using the Premier Healthcare Database, we extracted hospital discharge data for pediatric patients (age ≤ 18 years) with a procedure code for ureteroneocystostomy (International Classification of Diseases, Ninth Revision, 56.74) between January 1, 2003 and December 31, 2013. We excluded patients with secondary VUR. The presence of a temporal trend in reimplantation was examined via regression using generalized estimating equations.Results: In 4301 cases of primary VUR (23,602 weighted), there was a substantial decrease in the number of reimplantations performed, with an estimated decline in the rate of 0.239 cases per attending per year (P = .006). Average patient age declined 1.2 months in each year (P < .0001) due largely to a decline in reimplantation in those over age 2, which fell by 0.15 reimplantations per attending per year (P = .026). There was no difference between rates of decline in reimplantation for children with and without reflux nephropathy (P = .21) CONCLUSION: Nationally there has been a marked decrease in the incidence of ureteral reimplantation among children with primary VUR. The potential factors contributing to this are broad, including changes in diagnostic patterns, treatment recommendations, and the rise of endoscopic intervention. [ABSTRACT FROM AUTHOR]

We present the case of a 9 year old boy with hemorrhagic cystitis and urinary clot retention in the setting of chemotherapy refractory pre-B cell acute lymphocytic leukemia. The patient was undergoing palliative care which was complicated by severe discomfort from urinary clot retention. The decision was made to perform a cutaneous vesicostomy for clot removal and urinary drainage given the goals of care. The patient tolerated the procedure well and was comfortable with no further urinary tract symptoms until he expired. Cutaneous vesicostomy should be considered as an effective surgical option for severe clot retention in children. [Copyright &y& Elsevier]