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Introduction Non-neurogenic detrusor overactivity in children leads to varying degrees of functional impairments (urinary urgency, pollakiuria, urge incontinence, nocturia). Botulinum toxin has shown its effectiveness in the management of detrusor overactivity in neurological patients. Objectives To evaluate the relevance of intravesical Botulinum toxin injections for the treatment of non-neurogenic overactive bladders in children. These pediatric patients were resistant to all the usual therapeutics (e.g. bladder/bowel rehabilitation, anticholinergic drugs, management of diet/hygiene habits and constipation, percutaneous posterior tibial nerve stimulation). Materials and methods 8 children (mean age: 12.5years), 5 girls, 3 boys with daytime and/or nighttime incontinence and non-neurogenic detrusor overactivity validated by urodynamic testing. Urodynamic testing was conducted before the injections as well as 6weeks and 1year post injections. We used Dysport® 8 Speywood Units/kg injected via cystoscopy into 25 different sites. Results We noted improvements without any complaints during bladder voiding for all patients, in 6 patients the overactivity disappeared after 1 injection. Compliance was improved early-on in half the cases and at 1year for all cases (from 12% to 61%, p=0.01). Noninhibited contractions decreased constantly in both frequency and intensity. Clinical symptoms improved: mean of 7.75 daytime urinary incontinence episodes (IE) per week before the injection vs. 3 after the procedure (p=0.04). For nighttime IE the improvement was even more noticeable with 7.38 nighttime IE episodes per week before the injection vs. 2.06 after the procedure (p=0,02). Conclusion Intradetrusor Botulinum toxin injections are a potential therapeutic option for the management of non-neurogenic detrusor overactivity in children resistant to the usual treatments.

We present the results of a new technique using a pedicled cutaneous flap for continent cystostomy.A total of 15 boys and 8 girls (mean +/- SD age 13.4 +/- 6.4 years) underwent continent cystostomy for neurogenic bladder (20), bladder exstrophy (2) and sequelae of hypospadias (1) between 1999 and 2008. In this procedure a rectangular pedicled flap is surgically elevated from a hairless area on the abdomen. The flap is tubularized and passed through the anterior abdominal wall directly into the bladder. A submucosal detrusor incision is made to expose the bladder mucosa, and the distal part of the flap is anastomosed to the bladder mucosa in a circular manner. The tube is positioned along the incised detrusor, which is closed over. Viability of the flap, self-catheterization management and continence status are then evaluated.Mean +/- SD followup was 4.5 +/- 3.1 years. There was 1 case of distal necrosis of the flap, which required a secondary surgery using the Mitrofanoff technique. The 22 remaining flaps were initially viable, although 2 patients were eventually lost to followup and 3 subsequently presented with false-passage incidents requiring a few days of calibration using a balloon catheter. Dryness was achieved immediately in 73% of the cases. After adding a complementary bulking agent the dryness rate reached 77%.We present a novel approach to continent cystostomy that is safe and easy to perform. This technique is a less invasive and more efficient alternative to other commonly used approaches.

This paper is about an optimization method which has been developed to deal with trajectory optimization and mission analysis of an aeroassisted orbital transfer vehicle (OTV), in the context of preliminary design studies. Although this kind of trajectory can already be computed with existing trajectory optimization tools, we need a faster and robust tool which can be integrated as a “black box” in a multidisciplinary design process, in order to study rapidly many different OTV concepts and missions. In this context, our objective is not to get a very precise “optimal trajectory”, as existing “heavy” optimization tools do, but a solution precise enough to give a good insight of the performance (namely, the apogee altitude variation) and the mechanical and thermal loads. Incidentally, the solution obtained may also be used as an initial guess for a more precise trajectory optimization tool. To achieve this goal, we have studied parametric formulations of the control law, with optimization of the switching times. This development has been done considering a low lift-to-drag ratio vehicle (controlled only with the bank angle), like the aerocapture-designed version of the Mars Sample Return Orbiter. The cost function to be minimized is the heat flux, which is a key parameter for the multidisciplinary design of this kind of vehicle. The parametric formulation eventually chosen yields a good level of precision and robustness. Also, the study has been pushed further with the optimization of some mission parameters in the same process, in order to get directly preliminary answers to some trade-off issues in the mission analysis, like the choice of the initial perigee altitude.