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Objective: To evaluate urologic manifestations of sacral agenesis (SA) and their association with bony defects., Methods: Urological manifestations of SA were investigated in 50 patients referred to the urology or neurosurgery department. Urologenital signs and symptoms were assessed and a complete history of previous surgical procedures was attained. Plain lumbosacral radiography, abdominal/pelvic ultrasound, voiding cystourethrogram and urodynamic study were evaluated if available., Results: The most common urologic complaints were urinary incontinence and/or constant dribbling, seen in 30 (85%) of 35 children aged 4 years and over. Recurrent urinary tract infection, the second most common, was seen in 37 (74%). Vesicoureteral reflux was identified in 32 (65.3%) patients, 19 (59.3%) were found to have high maximal voiding pressures and post-voiding residual urine was notable in 42 (85.7%). Abnormal urodynamic parameters were found to be consistent with a neurogenic bladder in all patients. Cases were divided into upper motor lesions (in 34) and lower motor disorders (in 15). There was no statistically significant correlation for any GU finding with type of bony aplasia or motor neuron lesion (P = 0.338)., Conclusion: Voiding impairment and VUR together with recurrent UTI, especially in children with associated renal anomalies, contribute to renal damage. Urinary incontinence with associated social problems frequently occurs in patients with SA. Considering the devastating consequences of this disease in the urinary tract, timely diagnosis, thorough evaluation and appropriate intervention are essential., (Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

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]

Purpose: We report the evolution of endoscopic treatment of ectopic ureteroceles from the unroofing technique to a novel approach using concomitant ureterocele double puncture and intraureterocele fulguration. We also compare the results of different endoscopic modalities at a single center. Materials and Methods: We reviewed the records of 46 children with ectopic ureteroceles who were treated endoscopically between 1995 and 2005. The patients were divided into 2 main groups. Group 1 included 17 patients who underwent common endoscopic treatments, including ureterocele incision (4 patients), single ureterocele puncture (4), and single puncture with insertion of a Double-J® stent (9). Group 2 included 29 children who underwent ureterocele double puncture and fulguration of the anterior and posterior walls of the collapsed ureterocele after insertion of a Double-J stent into both punctured sites. We also managed concomitant vesicoureteral reflux by endoscopic injection of tricalcium phosphate ceramic into the subureteral region. Results: Total success rates in group 1 were 0%, 25% and 33% in patients who underwent ureterocele incision, single ureterocele puncture and single puncture with insertion of a stent, respectively. Total success rate in group 2 was 90% (p <0.05). New onset vesicoureteral reflux developed in 8 patients (47%) in group 1, of which 6 were in ureterocele moieties, and in 8 patients (28%) in group 2, with none in a ureterocele moiety (p <0.01). A total of 13 patients (76%) in group 1 required open surgical intervention, compared to 3 (10%) in group 2 (p <0.05). Conclusions: This new endoscopic approach is highly effective in the treatment of children with ectopic ureteroceles. [Copyright &y& Elsevier]