Ureterocystoplasty: videourodynamic assessment.

PURPOSE: We evaluated bladder function outcome in children who underwent ureterocystoplasty based on preoperative and postoperative videourodynamic studies. MATERIALS AND METHODS: Between 1977 and 2003, 8 patients with a median age of 6 years who had severe bladder dysfunction underwent ureterocystoplasty as a single surgical procedure. Augmentation was performed in 1 refluxing ureter in 7 patients and with a nonrefluxing megaureter in 1. All patients were evaluated urodynamically before and after augmentation using videourodynamic studies. Preoperative bladder capacity was estimated subtracting the volume trapped inside the refluxing ureter from the total amount of contrast fluid infused into the bladder. Controls included 8 patients matched in age (median 7.8 years) and diagnosis who had undergone ileocystoplasty and were studied with the same urodynamic methodology. Median age in patients with ureterocystoplasty and controls at postoperative urodynamic testing was 7.3 and 11.2 years, respectively. RESULTS: Median cystometric bladder capacity for age before and after ureterocystoplasty was 75% (range 10% to 92%) and 94% (range 49% to 100%), respectively. In the ileocystoplasty group cystometric bladder capacity increased significantly after augmentation (median 44% vs 118, p <0.0005). Comparison of postoperative cystometric bladder capacity between the 2 treatment groups showed significantly higher bladder volumes in the ileocystoplasty group (median 217 vs 290 ml, p <0.02). When we analyzed compliance before and after ureterocystoplasty, no statistically significant difference was found (4.09 vs 10.5 ml/cm water). The same parameter in the ileocystoplasty group was statistically significant (1.6 vs 22.5 ml/cm water, p <0.016). CONCLUSIONS: Our retrospective study suggests that, although ureterocystoplasty is a useful method for improving bladder storage abnormalities in properly selected patients, enterocystoplasty is associated with a better storage function outcome.

The assessment of the hematopoietic reservoir after immunosuppressive therapy or bone marrow transplantation in severe aplastic anemia.

We investigated the hematopoietic reservoir in 43 severe aplastic anemia (SAA) patients following immunosuppression (IS) (n = 15) or bone marrow transplantation (BMT) (n = 28), at a median interval of 5 years (range, 2-20) from treatment. All patients had normal blood counts, good marrow cellularity, and normal numbers of colony forming unit-granulocyte macrophages (CFU-GM). Burst forming unit-erythroid (BFU-E) and colony forming unit-granulocyte erythroid megakaryocyte macrophages (CFU-GEMM) numbers were reduced when compared with normal controls. However, the most pronounced defect was observed at the level of long-term culture-initiating cells (LTC-IC), which significantly differed from controls (P < .00001) both for IS and BMT patients. Their number did not improve with time and was not affected by transplant or treatment-related variables. When IS patients were compared with BMT we found comparable numbers of CFU-GEMM (P = .8) and LTC-IC (P = .9), but lower numbers of BFU-E and CFU-GM (P = .05 and P = .004, respectively), suggestive of a persistent suppressive mechanism. These data indicate that LTC-IC numbers are severely reduced in BMT and IS patients, contradicting the common belief that the former are fully reconstituted as compared with the latter. In addition, the number of mature cells and committed progenitors does not seem to reflect the real size of the hematopoietic reservoir and few stem cells may be sufficient to guarantee normal hematopoiesis long term.