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Author(s): Neamatollah Ataei [sup.1] , Abbas Madani [sup.1] , Seyed Taher Esfahani [sup.1] , Alireza Sina [sup.2] , Abdolmohammad Kajbafzadeh [sup.2] , Maryam Monajemzadeh [sup.3] , Fatemeh Ataei [sup.1] Author [...]

Objectives In the present study, a new engineered bulking agent called lyophilized micronized prepuce was examined as a natural scaffold to compare its safety and efficacy with the Urodex®. Methods For an in vivo study, 12 rabbits were divided into two groups. In the first group (n = 6), 0.2 cc of lyophilized and micronized prepuce, and in the second group, 0.2 cc of Urodex® was injected into the seromuscular wall of the bladder. The biopsy was provided from all animals for histological evaluation in 3 and 6 months' post-surgery and for each timeline 12 animals were assigned. The biopsies were stained with H&E and trichrome Masson. IHC staining was also performed with anti-LCA+, anti-CD34+, and anti-CD68+ antibodies. Resluts Microscopic examination of acellular prepuce compared with normal tissue demonstrated the success of this process, and ECM and collagen fibers were preserved with no evidence of cellular remnants in the acellular tissue, Immunohistochemistry staining with CD68 and LCA revealed a higher inflammation grade in Urodex as compared with Prepuce. However, no significant difference was detected in CD34 staining between Prepuce and Urodex experimental groups SEM analysis detected the micronized particle size varying between 2-5 µm. MTT assay revealed that cell proliferation was similar in the presence of control group and acellular prepuce. Conclusion The results of this study disclosed that lyophilized and micronized prepuce could be an operative alternative to Urodex® as a natural and non-synthetic bulking agent in the treatment of children with vesicoureteral reflux (VUR). [ABSTRACT FROM AUTHOR]

Background: Inhalatory anesthetics may impact spermatogenesis and sexual behavior. Comprehensive evaluation should be conducted to screen the effect of inhalatory anesthetics on the sperm and semen quality. This experimental research was organized to assess the impacts of sevoflurane during the period of neonatal spermatogenesis. Materials and methods: Twenty-one pregnant mice were obtained from the Pasteur Institute. After birth, neonates were categorized based on exposure to Monitored Anesthesia Care (MAC) of sevoflurane into three groups: experimental 1, experimental 2 and control. In order to investigate the testicular condition, a histological evaluation, including apoptosis study and immunohistochemistry, was performed. Not only apoptotic target genes such as Bax and Bcl-2, but also microRNA17-92, were investigated in testicular samples via real-time polymerase chain reaction (real-time PCR). Results: The outcomes of this work indicated the effects of sevoflurane on spermatogonial and germ cells in testicular tissue via stimulating apoptotic target genes and microRNA-17-92. The proportion of Bax/Bcl-2 in the experimental group was 8.318699 ± 1.093, and the proportion of Bax/Bcl-2 in the control group was 2.631 ± 0.079. There was a significant (p ≤ 0.002) difference among the control group and both experimental groups. Conclusion: Sequential sevoflurane exposure during the neonatal period may create testicular dysfunction due to the high level of apoptosis in spermatogonial cells. Also, sevoflurane may affect spermatogenesis by influencing other biomarkers, such as microRNA. [ABSTRACT FROM AUTHOR]

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Introduction: Hyponatremia is the most common electrolyte disorder in patients following surgical interventions (19-50%). Hospital acquired hyponatremia is often due to using hypotonic solution s and can be lethal. Materials and Methods: Between January and December 2014, 190 children (1 month to 12 years) who were admitted in the urology department of Children's Hospital Medical Center for elective surgical procedures were enrolled in the study. The patients were randomly divided into two groups: group I received 50 mEq/L sodium and 20 mEq/L potassium in D/W 5% and group II received 154 mEq/l sodium and 20 mEq/L potassium in D/W 5% at the maintenance dose for a period of 6 hours following the operation. The patients did not have any oral fluid intake 6 hours postoperatively. The incidence of hyponatremia before and after maintenance IV fluid therapy was analyzed. Other characteristics of the patients such as age, gender, duration of hospitalization, other concomitant electrolyte disturbances, and symptoms of hypervolemia were also evaluated. The incidence of fluid-IV therapy-induced hyponatremia was investigated and analyzed in different categories of patients. Results: One hundred and ninety patients were enrolled. The mean age was 3.75 years (ranging from 1 month to 12years). One hundred and thirty-three patients (70%) were boys. The incidence of hyponatremia before and after maintenance IV fluid therapy was 9.5% and 36%, respectively. After the therapy, the incidence of hyponatremia was 54% and 17% in hypotonic and isotonic groups, respectively. Final multivariate logistic analysis showed that hyponatremia was common in patients that received hypotonic solution after surgery. Conclusions: Hyponatremia was markedly induced in patients receiving hypotonic solution after surgery. It seems isotonic fluid therapy after surgery protects the patients from hyponatremia. [ABSTRACT FROM AUTHOR]

Aphallia (total absence of penis) is an extremely rare abnormality that can be part of the urorectal septum malformation sequence. We are reporting a 40-day-old boy who was referred to our nephrology clinic due to the absence of the penis and urinating through the rectum. He was born to a 17-year-old mother and a 24-year-old father, and was delivered term via normal vaginal delivery. The pregnancy was uncomplicated with no maternal toxin or medication exposure. Both parents were healthy and there was no family history of congenital abnormality. The parents were also unrelated. Physical examination revealed agenesis of the penis, a normal scrotum, and bilateral normally positioned testises. Moreover, the heart, lungs, abdomen, head and neck, and spinal column were all normal on examination. The karyotype was 46XY and the gender was male. Initial ultrasonography one week after birth revealed moderate bilateral hydronephrosis but the last ultrasonography 45 days later revealed only mild fullness of both kidneys. [ABSTRACT FROM AUTHOR]

Human endometrium contains mesenchymal stem cells (eMSC) which have the ability to differentiate into three cell lineages and the potential in therapeutic applications. We hypothesize that using environmental induction in culture media such as dexamethasone, human recombinant insulin and human epidermal growth factor (hEGF) can differentiate endometrial stem cells into myoblast. These agents have a broad range of effects in myoblast differentiation in-vitro. We used immunohystochemistry analysis and RT -PCR to evaluate the presence of skeletal muscle - specific proteins some of which are expressed in the early stage of differentiation including myoD and Desmin which expressed at later stages of differentiation. In conclusion eMSC can differentiate in culture media which contains above mentioned factors and use for therapeutic purpose in muscular degenerative disease. [ABSTRACT FROM AUTHOR]

OBJECTIVE To report our experience of treating bladder and bowel dysfunction in children with myelomeningocele, with simultaneous laparoscopic antegrade continence enema (LACE) and repeated intravesical injection of botulinum toxin-type A (BTX-A). PATIENTS AND METHODS Six girls and 14 boys (mean age, 8.7 years) with myelomeningocele were included in this study. All patients had received one or two intravesical injection(s) of BTX-A, but had persistent fecal incontinence or constipation despite improved urinary symptoms. We performed a two-port laparoscopic appendicostomy, immediately after repeated intravesical injection of BTX-A, through a V-shaped skin flap at McBurney’s point. The stoma was finally covered by a quadrilateral skin flap, using the ‘VQ’ technique. The degree of urinary incontinence and bowel dysfunction were determined in each patient, and conventional urodynamic studies were performed 4 months after each injection. RESULTS All patients were followed-up for a mean (range) of 19.1 (14–33) months. Urinary continence improved significantly after the first injection, and remained constant after repeat injections. The maximum detrusor pressure, bladder compliance and capacity improved significantly ( P < 0.001) compared with baseline. Interestingly, the simultaneous intravesical BTX-A injection/LACE procedure significantly improved all urodynamic variables compared with the values obtained after the last BTX-A injection alone. The laparoscopic procedure was well tolerated, and 19 (95%) children were nappy-free at the final follow-up. Only two patients had stoma stenosis, and one patient had minor stoma leakage. CONCLUSION Concomitant repeat intravesical injection of BTX-A and LACE can effectively manage bladder and bowel dysfunction in children with myelomeningocele. The procedure may further contribute to improve bladder urodynamic function, as effective evacuation of the bowel provides more room for bladder distension. [ABSTRACT FROM AUTHOR]

Abstract: Cerebrovascular accident and renal hypertension secondary to ureteropelvic junction obstruction (UPJO) are extremely rare. A 6-year-old girl presented with intracranial hemorrhage because of hypertension secondary to the bilateral UPJO. This was successfully treated with craniotomy and subsequent percutaneous nephrostomy placement and bilateral pyeloplasty. Brain computerized tomography revealed right-sided intracranial hemorrhage, and renal ultrasonography confirmed bilateral severe hydronephrosis. Craniotomy with evacuation of intracerebral hematoma and bilateral nephrostomy under ultrasound guidance were performed. One week later, she underwent bilateral pyeloplasty in 2 stages. The patient has been well with normalized renal function and is completely cured of her hypertension in long-term follow-up. [Copyright &y& Elsevier]

Abstract: PURPOSE: The application of muscle derived stem cells is an area of active research that may represent an improved alternative for the treatment of urinary incontinence. We investigated the effectiveness of autologous muscle precursor cell transplantation as a treatment option for urinary incontinence due to sphincter incompetence in children with the bladder exstrophy/epispadias complex (BEEC). MATERIAL AND METHODS: Twelve patients with BEEC (11 boys and 1 girl) with persistent urinary incontinence entered the study. All patients had undergone staged bladder repair and bladder neck reconstruction and all of them (except 1) had received 1-3 transurethral injections of bulking agents with minimal effects. Muscle precursor cells were isolated from each patient''s abdominal skeletal muscle, and cultured before endourethral injection. The effectiveness of treatment was evaluated with particular emphasis on clinical outcome (based on a 24-hour voiding diary), cystometric and urodynamic studies. RESULTS: Eight Patients had a mean follow-up of 11.3 (from 8 to 14 months), The remaining 4 cases with less than 6 months follow-up are not presented in this data. There was a significant time-dependent improvement in patients'' urinary continence. At the final follow-up, all 7 (88%) boys were socially dry (day-time dryness >3 hours) – including 3 (38%) completely dry. Urodynamic studies revealed an increase in mean bladder capacity (p < 0.001) and leak point pressure (p < 0.001). Six months after injection, all 7 boys (versus 2 cases preoperatively) had normal micturition with demonstrable voiding detrusor contraction in presence of compliant, stable bladders (p < 0.05). These changes were accompanied by an increment in the average maximum urinary flow (p < 0.01). CONCLUSIONS: Autologous myoblast transplantation may be a safe, effective and attractive alternative treatment option for structural urinary incontinence, with possible ability for functional regeneration of urethral sphincter. [Copyright &y& Elsevier]

Fish scale is rich in collagen type I and hydroxyapatite, resembling bone structure. It is readily available, cost effective and can compensate for the limitations of grafting methods such as unavailability, zoonotic disease transmission, and high cost. The aim of this study was to evaluate in vivo the fish scale potential and the possible synergistic effect of platelet rich plasma (PRP) with this scaffold in bone regeneration. Fifteen male white New Zealand rabbits were randomly divided into six groups, each involving 5 limbs. Full thickness bicortical defects were created in the proximal tibia of both pelvic limbs of rabbits. The defect was left untreated in the negative control group. In experimental groups the defect was filled with PRP (group 1), cellular fish scale (group 2), combination of cellular fish scale and PRP (group 3), acellular fish scale (group 4), and a combination of acellular fish scale and PRP (group 5). Fresh fish scales were decellularized to increase biocompatibility and reduce immunity reactions. Decellularization was confirmed by DAPI (4',6-diamidino-2-phenylindole) staining. The microstructure and surface characteristics of fish scales were assessed by scanning electron microscopy (SEM). Histopathological evaluation of bone healing was performed on day 56. Although there was no significant difference in the bone union among experimental groups, the union was superior in all experimental groups compared to control. Spongiosa and cortex formation were superior in the acellular groups. Furthermore, PRP promoted bone marrow formation. We concluded that fish scale is a biocompatible scaffold with a high regenerative potential. [ABSTRACT FROM AUTHOR]