Outcomes of seromuscular bladder augmentation versus standard ileocystoplasty: A single institution experience over 14 years.

INTRODUCTION: Ileocystoplasty is the standard technique used for bladder augmentation, and has been used widely for decades. However, it is known to be associated with complications such as stone formation, mucus production, metabolic acidosis, urinary tract infections, intestinal obstruction, and a long-term risk of bladder cancer. Seromuscular bladder augmentation (SMBA) is an alternative to the standard ileocystoplasty, and has been associated with a lower incidence of bladder stones. Few reports have been published on intermediate outcomes of SMBA. Herein, we report long-term outcomes of SMBA from a single institution compared with standard ileocystoplasty. METHODS: After Institutional Review Board approval, a retrospective chart review of all patients who underwent bladder augmentation at our institution over a 14-year period was performed. The status of patients after SMBA (10 patients) was compared according to age, sex, and diagnosis with patients who underwent traditional ileocystoplasty (30 patients). Parameters such as demographic information, pre- and postoperative bladder capacity as assessed by urodynamic studies, urinary tract infections (UTIs), bladder calculi, incontinence, need for secondary surgical procedures, and spontaneous bladder perforation were compared in the two groups. All the patients were on a clean intermittent catheterization (CIC) regimen. RESULTS: Over the study period, 10 patients underwent SMBA and 30 patients (according to age, sex, and diagnosis) underwent standard ileocystoplasty; the average age at surgery was 10.3 and 10 years respectively, with a mean follow up of 6.7 years in the SMBA group and 6 years in the ileocystoplasty group. There were no statistically significant differences in the rate of UTIs, urinary incontinence, subsequent surgery, or spontaneous bladder perforation. The mean bladder capacity increased significantly for both groups as assessed by pre- and postoperative urodynamic studies, although the difference in the rate of bladder calculi between the two groups (0 [0%] vs. 8 [27%], p = 0.06) did not reach statistical significance (Table). CONCLUSIONS: SMBA is safe and efficacious and may result in a lower rate of stone formation than standard ileocystoscopy. SMBA should be considered as a viable alternative to standard ileocystoplasty.

Congenital Uterine Anomalies and Uterine Rupture.

Congenital uterine anomalies are more common than previously recognized. While many women will have no symptoms or problems, some women with congenital uterine anomalies have increased risks of adverse outcomes during pregnancy. This article presents a case study of a woman with a congenital uterine anomaly leading to spontaneous rupture of her unscarred uterus remote from term. The most common types of congenital uterine anomalies and their associated reproductive risks are reviewed. Evaluation of congenital uterine anomalies and management alternatives are discussed.

Sacral nerve stimulation is a valuable diagnostic tool in the management of anorectal and pelvic malformations.

BACKGROUND: We hypothesize that the current practice of sphincter assessment in anorectal malformations (ARMs) by direct muscle stimulation can be improved by sacral nerve stimulation (SNS). Focusing on the specific adjustments for infants, we highlight the anatomical and neurophysiologic basis of SNS and its further diagnostic and therapeutic implications. PATIENTS AND METHODS: We examined 20 patients: 12 patients with ARM, 3 with Hirschsprung disease, 3 with sacrococcygeal teratoma, and 2 with cloacal exstrophies. Under general anesthesia and ultrasound guidance, percutaneous needle electrodes were placed within the sacral neural foramina. Electrical stimulation was applied to assess the presence, pattern, and extent of the neuromuscular response of the external anal sphincter. RESULTS: We successfully modified the traditional method used in adults replacing radiographic controls by ultrasound guidance. In 20 SNS procedures with no complications, we found a muscle response on stimulation of the third and/or fourth sacral nerves in 18 of 20 patients (anal sphincter contraction and/or ipsilateral plantar flexion). CONCLUSION: We demonstrated the feasibility of SNS for intraoperative sphincter mapping and detection of primary innervation abnormalities in ARM as well as for the assessment of secondary deficits in postoperative follow-up. Sacral nerve stimulation broadens the spectrum of intraoperative information concerning the sacral innervation pattern by a direct assessment of the sacral nerves. Furthermore, electrophysiologic data may allow prospective criteria for sphincter function to be established. These may improve the accuracy of the present classification-based prognosis as well as the understanding of sphincter physiology in general.

Association between maternal prenatal vitamin use and congenital abnormalities of the genitourinary tract in a developing country.

OBJECTIVE: To determine the association between prenatal multivitamin supplementation and congenital genitourinary tract anomalies in a group of Colombian newborn babies included in the Latin-American surveillance program (ECLAMC). STUDY DESIGN: We included all neonates born between January 2004 and August 2007 registered in the ECLAMC database. Maternal prenatal multivitamin use was assessed for 122 newborns with congenital genitourinary tract anomalies and then compared to 271 non-malformed controls. RESULTS: 46,850 births were registered and 122 (26/10,000) of them were identified to have a genitourinary tract anomaly. Prenatal multivitamin supplementation during the first, second, and third trimesters of pregnancy was associated with a reduction in the risk of these anomalies: OR 0.16 (0.08-0.31), OR 0.31 (0.19-0.52), and OR 0.38 (0.23-0.63) respectively. CONCLUSIONS: Maternal prenatal multivitamins may reduce the risk of congenital genitourinary tract anomalies, not only during the first 8 weeks of gestation but also later in pregnancy, in developing countries.