A novel alternative for renal replacement therapy: 2-year successful colonic dialysis via a Malone antegrade continent enema stoma.

This study is a case report of home-based colonic dialysis (CD) for treating end-stage renal disease in a 20-year-old woman. She had a history of Malone antegrade continence enema (MACE) for treating neuropathic bowel at the age of 11 years. The patient refused any type of renal replacement therapy. However, she agreed to CD through the MACE stoma by changing the colonic irrigation solution to the peritoneal dialysis solution. The patient was discharged with a plasma creatinine (Cr) level of 1.7 mg/dL and blood urea nitrogen (BUN) level of 8 mg/dL. She has continued CD on a regular basis at home. The patient's serum Cr and BUN has remained in the steady low state during 24 months of follow-up (mean Cr level = 2.8 mg/dL and mean BUN level = 10.7 mg/dL).

Long-term ultrasound appearance of concomitant autologous blood and dextranomer/hyaluronic acid copolymer implants: is it associated with successful correction of vesicoureteral reflux?

OBJECTIVE: To find the association between mound appearance on ultrasound imaging and successful correction of vesicoureteral reflux (VUR). METHODS: We retrospectively reviewed the ultrasound and voiding cystourethrogram (VCUG) results of patients who underwent dextranomer/hyaluronic acid injection via the hydrodistention injection technique (HIT) or HIT with concomitant autologous blood injection (HABIT) for 5 years postoperatively. VUR resolution at postoperative VCUG was considered as a success. Retained volumes of implants were measured and compared between HABIT and HIT and successful and failed treatments. Presence of mound on ultrasound imaging was also evaluated as a predictor of VUR resolution on VCUG. RESULTS: Measured mound volume was significantly higher in treatments that were successful than in those that were failures (P <.05). During 5-year follow-up, measured mound volumes in the HABIT group were significantly higher than in the HIT group (P <.05). Sensitivity, specificity, positive predictive value, and negative predictive value of mound visualization on the first-month sonography to predict success were 97.7%, 21.5%, 89.6%, and 60%, respectively. These results were dramatically changed for the 50 patients with further VCUG after 1 year of follow-up, with 95.7% sensitivity, 37.0% specificity, 54.0% positive predictive value, and 90.9% negative predictive value. CONCLUSION: Reduction or absence of the mound after implantation is more frequent among failed treatments in which visualization of the mound on postoperative sonography can predict VUR resolution. Autologous blood injection concomitant with dextranomer/hyaluronic acid implantation results in better immediate and long-term mound preservation, which could possibly be the reason for the higher success rate in HABIT group.

Factors that impact the outcome of endoscopic correction of vesicoureteral reflux: a multivariate analysis.

PURPOSE: To identify independent factors that may predict vesicoureteral reflux (VUR) resolution after endoscopic treatment using dextranomer/hyaluronic acid copolymer (Deflux) in children free of anatomical anomalies. MATERIALS AND METHODS: A retrospective study was conducted in our pediatric referral center from 1998 to 2011 on children with primary VUR who underwent endoscopic injection of Deflux with or without concomitant autologous blood injection (called HABIT or HIT, respectively). Children with secondary VUR or incomplete records were excluded from the study. Potential factors were divided into three categories including preoperative, intraoperative and postoperative. Success was defined as no sign of VUR on postoperative voiding cystourethrogram. Univariate and multivariate logistic regression models were constructed to identify independent factors that may predict success. Odds ratio (OR) and 95 % confidence interval (95 % CI) for prediction of success were estimated for each factor. RESULTS: From 485 children received Deflux injection, a total of 372 with a mean age of 3.10 years (ranged from 6 months to 12 years) were included in the study and endoscopic management was successful in 322 (86.6 %) of them. Of the patients, 185 (49.7 %) underwent HIT and 187 (50.3 %) underwent HABIT technique. On univariate analysis, VUR grade from preoperative category (OR = 4.79, 95 % CI = 2.22-10.30, p = 0.000), operation technique (OR = 0.33, 95 % CI = 0.17-0.64, p = 0.001) and presence of mound on postoperative sonography (OR = 0.06, 95 % CI = 0.02-0.16, p = 0.000) were associated with success. On multivariate analysis, preoperative VUR grade (OR = 4.85, 95 % CI = 2.49-8.96, p = 0.000) and identification of mound on postoperative sonography (OR = 0.07, 95 % CI = 0.01-0.18, p = 0.000) remained as independent success predictors. CONCLUSION: Based on this study, successful VUR correction after the endoscopic injection of Deflux can be predicted with respect to preoperative VUR grade and presence of mound after operation.

Superselective α-adrenergic blockers versus transurethral resection of the prostate: a prospective comparison of health-related quality of life outcome after treating patients with benign prostatic hyperplasia.

PURPOSE: We prospectively evaluated the impact of transurethral resection of the prostate (TURP) versus superselective α-adrenergic blocker treatment on health-related quality of life (HRQOL) in men with clinically diagnosed benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: A total of 219 patients with lower urinary tract symptoms (LUTS) caused by BPH were recruited in this study. Treatment modalities consisted of standard TURP (n = 104) and tamsulosin medical treatment (n = 115). HRQOL was assessed by SF-36-Item Health Survey 1.0. LUTS were estimated by The International Prostate Symptom Score. Patients' outcome 4 weeks after treatment was compared to pre-treatment status and to that of the other group. Statistically significant changes in each HRQOL scale from baseline to follow-up period were investigated. RESULTS: Baseline characteristics were similar in both groups except for the duration of disease before treatment that was longer in TURP group. Both treatments resulted in statistically significant improvements from pre-treatment in all scales of QOL after 4 weeks, with no significant differences observed between the two groups. In medical treatment group, there was a significant association between higher educational level and better QOL in all 8 scales. Our outcomes revealed a significant decrease in the IPSS in both groups but this improvement was more evident in TURP group. CONCLUSION: All scales concerning HRQOL were favorably improved 4 weeks after both surgical and medical treatment, and no significant differences were observed between these two treatment modalities for patients with symptomatic BPH. This information may aid patients when deciding which treatment option to take.

Usefulness of concomitant autologous blood and dextranomer/hyaluronic acid copolymer injection to correct vesicoureteral reflux.

PURPOSE: We present the long-term results of a new modification of endoscopic treatment of vesicoureteral reflux involving concomitant injection of autologous blood following the standard hydrodistention injection technique to prevent bulking agent leakage immediately after the procedure. MATERIALS AND METHODS: A total of 341 children underwent endoscopic implantation of dextranomer/hyaluronic acid for vesicoureteral reflux. A subset of 171 patients underwent hydrodistention autologous blood injection, while 170 underwent classic hydrodistention injection. Frequency of symptomatic urinary tract infection after endoscopic treatment was recorded. Success was defined as absence of vesicoureteral reflux on postoperative voiding cystourethrography. RESULTS: A total of 523 ureters in 214 girls and 127 boys were treated. In patients undergoing hydrodistention autologous blood injection mean age was 39.48 months, mean maximal reflux grade was 3.02 and success rate was 93.6% after the first injection (98.0% in patients with grade II, 92.1% with grade III, 93.3% with grade IV and 85.7% with grade V reflux). In patients who underwent classic hydrodistention injection mean age was 36.12 months, mean maximal reflux grade 3.05 and success rate was 81.8% after the first injection (91.5% in patients with grade II, 89.4% with grade III, 74.4% with grade IV and 44.4% with grade V reflux). The success rate was significantly higher (p = 0.001) in patients undergoing hydrodistention autologous blood injection vs classic hydrodistention injection. Of the patients 1.7% in the hydrodistention autologous blood injection group and 2.9% in the classic hydrodistention injection group reported symptomatic urinary tract infection during followup. CONCLUSIONS: Immediate injection of autologous blood following dextranomer/hyaluronic acid injection to create a blood clot and barricade against bulking agent leakage is more effective than pure dextranomer/hyaluronic acid implantation. This novel modification stabilizes the subureteral implant mount and may affect the antireflux outcome.