A 15-year retrospective review of urodynamic studies in children at Red Cross War Memorial Children's Hospital, Cape town, South Africa.

BACKGROUND: Despite the undeniable diagnostic benefits of urodynamic studies (UDS), their adoption into clinical practice in Africa has been slow. This study aimed to review the use of invasive UDS in children at a tertiary paediatric hospital in South Africa. METHODS: A retrospective analysis of 1108 UDS was conducted. Patient demographic characteristics, primary diagnosis, indication and urodynamic outcomes were reviewed. Presence of urodynamic high-risk features were documented, and a comparison was made between the first study and follow-up study. RESULTS: This study revealed increasing trends in the use of UDS from 2015. Referrals were from Urology (37.7%), Spinal defects clinic (34.4%), Nephrology (20.8%) and other departments (7.0%). The most common reason for referral was review of medical treatment (36.5%). Spinal dysraphism (58.3%) accounted for the majority of conditions seen. Majority (59.1%) of the patients were receiving more than one type of bladder treatment at the time of their first study, with clean intermittent catheterisation (46.5%) being the most common form of bladder management. 97.5% of studies were performed using transurethral bladder catheterization. Urodynamic diagnosis was neurogenic in 74.0%, anatomical (12.2%), functional (8.8%) and normal (5.0%). There was statistically significant improvement in bladder compliance, detrusor leak point pressure and detrusor sphincter dyssynergia between the first study and a subsequent study following therapeutic intervention. CONCLUSIONS: The unique ability of UDS to demonstrate changes in detrusor pressures, which is a common reason for therapy failure, makes UDS an invaluable tool in the diagnosis and management of children with lower urinary tract dysfunction.

Long-term urological outcomes in six sets of conjoined twins.

AIM: To review the long-term urological outcomes of six sets of ischiopagus and pygopagus conjoined twins. Emphasis is placed on the particular genitourinary challenges of separation, reconstruction and monitoring of these patients. PATIENTS AND METHODS: We performed a longitudinal, retrospective analysis of six sets of conjoined twins who presented to a single center and describe their long-term urological outcomes. RESULTS: Six sets of ischiopagus (4) and pygopagus (2) conjoined twins presented from 1993 to 2003 and have been followed up for a mean of 12 years (range 7-17 years). Separation was achieved in 5/6 cases; the remaining one died of intestinal perforation and resultant sepsis. One further child died of malaria after separation. Patterns of genitourinary anatomy found in these conjoined twins are described. Urinary continence was achieved in 2/6 ischiopagus and 3/4 pygopagus twins. Renal failure has developed in one child. Urinary tract infections have been common. Secondary urological surgery has been required in 3/6 ischiopagus twins, usually to perform an incontinent urinary diversion. CONCLUSION: Complex urological problems occur in ischiopagus and pygopagus conjoined twins. Beyond the challenge of surgical separation, they continue to provide management challenges requiring secondary reconstructive surgery and close urological monitoring.