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Introduction: Debris within the bladder is commonly seen on ultrasound. The etiology of bladder debris is varied and the likelihood that urinary debris represents positive urine culture is under investigation. We hypothesize that bladder debris will increase the likelihood that a urine culture is positive compared to those without bladder debris., Methods: We performed a retrospective review on children aged 0-17 years who had a voiding cystourethrogram with a catheterized urinalysis or urine culture, and who also had a renal and bladder ultrasound up to 1 week prior, the day of, or up to 2 days after their urine studies. Presence of bladder debris and debris severity was recorded. Positive urine culture was defined as a single bacterial strain ≥50,000 cfu/mL. Demographic information, including findings of reflux and hydronephrosis were compared. Sensitivity, specificity, and risk ratios were calculated for predicting positive urine culture in patients with urinary debris on ultrasound., Results: A total of 445 patients met inclusion criteria between January and December 2014. The positive urine culture rate was 20%, and the rate of bladder debris was 22%. The mean age for those with and without bladder debris was 6.6 and 5.5 years, respectively (p = 0.02). 23% of girls had bladder debris, compared to 12% of boys (p = 0.04, see results table). The sensitivity and specificity for bladder debris in detecting positive urine cultures was 52% and 86%, respectively. Forty-seven percent of those with bladder debris had positive cultures, compared with 12% of those without debris (p < 0.01). The relative risk of positive urine culture if debris is present is 3.90 (95% CI 2.73-5.55). Hydronephrosis or vesicoureteral reflux did not affect the relationship between bladder debris and positive urine cultures., Conclusions: Nearly half of pediatric patients undergoing urological evaluation found to have bladder debris on ultrasound will have a positive urine culture. Debris is noted more commonly in girls and at a slightly higher age. The presence of debris is associated with a fourfold increase in detecting a positive urine culture, regardless of debris severity, hydronephrosis, or vesicoureteral reflux. Given this, it is of value to routinely document and look for the presence of any amount of bladder debris seen on ultrasound, as this finding can be used to augment clinical decision-making and warrants strong consideration for obtaining urine culture., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: Enterocystoplasty is an important procedure in the management of children with difficult neurogenic bladder. We report on short-term complications as captured by National Surgical Quality Improvement Program (NSQIP) Pediatric., Methods: We analyzed NSQIP Pediatric 30-day perioperative data on 114 patients who underwent enterocystoplasty in 2012 and compared those with and without complications., Results: Neurogenic bladder was the most common diagnosis. The proportion of the children who underwent two or more procedures was 71.9%, in addition to enterocystoplasty, most commonly appendicovesicostomy. Median length of hospital stay was 8 days (mean 9.7 days, range 2 to 46 days). Thirty-day complication rate was 33.3%, and the most common complications were urinary tract infections (9.6%), wound complications (8.7%), blood transfusions (6.1%), and sepsis (3.5%). Reoperation rate and readmission rate were 9.6% and 13.2%, respectively. No statistically significant differences in perioperative characteristics were found between children with and without postoperative complications. Addition of appendicovesicostomy or bladder neck continence procedures was not associated with significantly increased complications., Conclusion: Enterocystoplasty is associated with significant perioperative morbidity, and reasonable expectations should be set during preoperative counseling., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To investigate the use of a microelectrode array with a high spatial density of penetrating intrafascicular electrodes for selective recording of pudendal nerve activity evoked by a variety of genitourinary stimuli., Materials and Methods: Felines were anesthetized with alpha-chloralose and high-density Utah slanted electrode arrays (48 microelectrodes; 200-μm spacing) were implanted into the pudendal nerve for acute experimentation. Neural activity was recorded during bladder filling, spontaneous reflexive distention-evoked bladder contractions, and tactile somatosensory stimulation., Results: The intrafascicularly implanted pudendal nerve electrodes were able to selectively record neural activity that corresponded to various genitourinary stimuli. Across all seven experimental animals, a total of 10 microelectrodes recorded neural units that were selectively driven by bladder filling or distention-evoked bladder contractions. Twenty-two electrodes were selectively driven by tactile stimulation., Conclusion: Microelectrode arrays implanted intrafascicularly into the pudendal nerve can be used to selectively record the neural responses that reflect bladder status and urogenital tactile stimulation. This work sets the stage for developing future implantable closed-loop neuroprosthetic devices for restoration of bladder function., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: The voiding cystourethrogram (VCUG) is a commonly employed radiographic test used in the management of vesicoureteral reflux (VUR). Recently, the reliability of VCUG to accurately grade VUR has been questioned. The purpose of this study is to examine reliability of the VCUG for the grading of VUR in a setting mimicking daily practice in a busy pediatric hospital., Materials and Methods: Two-hundred consecutive VCUGs were independently graded by two pediatric urologists and two pediatric radiologists according to the International Classification of Vesicoureteral Reflux. A weighted kappa coefficient was calculated to determine inter-rater agreement and a modified McNemar test was performed to assess rater bias. Further assessment for impact on clinical and research decision-making was made for disagreement between grades II and III., Results: Weighted kappa values reflect strong reliability of VCUG for grading VUR between and among urologists and radiologists ranging from 0.95 to 0.97. There was statistically significant bias with radiologists reporting higher grades. Despite high kappa values, disagreement between raters was not infrequent and most common for grades II-IV., Conclusions: VCUG is reliable for grading VUR, but small differences in grading between raters were detected and may play an important role in clinical decision-making and research outcomes., (Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: Enterocystoplasty provides needed improvement in bladder storage parameters in many patients but it also generates significant morbidity. We evaluated the unusual potential alternative of using the capsule that forms around a standard silicone tissue expander placed perivesically to augment the bladder in dogs., Materials and Methods: Six mongrel dogs underwent baseline videourodynamics and assessment of serum electrolytes, followed by placement of a 250 to 500 cc perivesical silicone tissue expander. Four months after implantation the tissue expander was removed and the fibrous capsule around the expander was biopsied. The capsule was opened and anastomosed to the bladder to augment storage. Serum electrolytes were determined 2 and 4 weeks after augmentation. Videourodynamics were repeated after 3 to 5 months, that is at sacrifice. The harvested bladders underwent histological evaluation., Results: Five dogs underwent augmentation as described, while in an additional dog that underwent intraperitoneal placement of the tissue expander a fibrous capsule failed to form. Of the 5 augmented dogs 4 underwent repeat urodynamic and electrolyte evaluation with harvesting of the lower urinary tract, while 1 died of undetermined causes 3 weeks after augmentation. A distinct capsule formed in all dogs and augmentation was technically achievable. Anastomosis calcification in 3 dogs limited filling the augmenting capsule for cystography. Bladder capacity and compliance improved in all animals but it varied in degree. Histological examination of the capsule biopsies showed collagen rich connective tissue without epithelium or smooth muscle. After augmentation the capsular segment revealed urothelium in all cases with squamous metaplasia in 1. The subepithelial region had dense fibrosis and a thin band of osseous metaplasia occupied the lamina propria in all cases. Disorganized smooth muscle bundles were noted in all augmented bladders within the collagen of the capsule wall., Conclusions: Bladder augmentation with the collagenous capsule formed over a perivesical tissue expander is technically feasible. There was evidence of epithelial and smooth muscle ingrowth from the native bladder with improved bladder capacity and compliance in all dogs. Osseous metaplasia of the luminal surface of the collagen based capsule that developed in all animals may have been responsible for anastomotic narrowing and limited filling on cystography.

Purpose: A procedure was designed to correct vesicoureteral reflux with minimally invasive technology., Materials and Methods: A total of 22 children 14 months to 18 years old underwent percutaneous endoscopic trigonoplasty between January and June 1995. Followup ranges from 4 to 11 months. In 32 ureters reflux was grade 2 in 13, grade 3 in 13, grade 4 in 5 and grade 5 in 1., Results: All patients had normal sonography of the kidneys after surgery. On followup voiding cystourethrography at 2 or 6 months there was resolution of reflux in 20 of the 32 ureters (62.5%). The probability of resolution was unrelated to patient age, laterality of reflux, initial grade, operative sequence or preoperative bladder instability. The 3 major complications were vesicovaginal fistula, hyponatremia and perivesical fluid collection., Conclusions: Percutaneous endoscopic trigonoplasty is technically feasible but it involves a distinct learning curve. It offers significant advantages related to more rapid recovery with less discomfort. The success rate is modest at present. If it were to be improved with technical modifications, percutaneous endoscopic trigonoplasty may change the basic approach to treating children with vesicoureteral reflux.

Autoaugmentation has proved effective in many patients in lowering bladder pressures, increasing bladder capacity, and improving their related symptoms. Patients with sever bladder hyperreflexia, uncontrolled with medications, have also benefited greatly from autoaugmentation procedures. Only patients who failed conventional medical management have undergone autoaugmentation at the authors' institution.

A surgical technique of partial detrusorectomy (autoaugmentation) for creation of a diverticular bulge of the dog bladder is described. The method is designed to serve as a bladder augmentation without using bowel. We describe the technique, results with dogs and its clinical application. Partial detrusorectomy appears to function as an autoaugmentation that can be performed reliably in dogs, offers potential advantages over bowel segments, and is a potential alternative to enterocystoplasty in selected patients.

A surgical technique is described in which detrusor muscle over the entire dome of the bladder is excised while leaving the bladder epithelium intact. A large epithelial bulge is created, which functions to augment the storage properties of the bladder without using bowel, and it is referred to as "autoaugmentation". Seven patients have undergone autoaugmentation of whom 5 have excellent clinical results while 1 has modest improvement. The remaining patient was a technical failure. Postoperative urodynamics in 5 patients demonstrated improved bladder capacity in 3 and markedly improved bladder storage pressures in 4 compared to preoperative studies. The technical aspects of the procedure and patient management are discussed. Autoaugmentation offers potential advantages over enterocystoplasty, is simple to perform, does not preclude future enterocystoplasty if needed and may be a reasonable alternative to conventional augmentation in selected patients.