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Study design:Retrospective chart review.Objective:To evaluate the clinical outcomes and factors influencing patient satisfaction with Malone antegrade continence enema (MACE) in patients with spina bifida.Setting:Japan.Methods:We performed retrospective analysis of 21 patients with spina bifida who underwent surgical creation of an MACE stoma. Clinical outcomes were evaluated by medical records, operative notes and mailed questionnaires. Patient satisfaction scores (SSs) were measured on a modified visual analog scale (VAS) from 1 to 10, and the factors influencing the SS were analyzed.Results:A 100% return rate for the mailed questionnaires was achieved. All patients underwent in situ appendicocecostomy with cecal plication. There was only one complication that required surgical revision. Regarding fecal continence, the overall success rate was 90%. Although 4 patients (19%) had severe irrigation pain and 4 patients (19%) found the washout time intolerably long, 18 (85%) of them were satisfied with the MACE procedure. Age at operation, experience of retrograde colonic enema (RCE), experience of stomal leakage, increased comfort at school or workplace and increased comfort at sleepovers significantly influenced SSs.Conclusion:MACE is a valuable option in achieving fecal continence in patients with spina bifida, with most patients being satisfied with the procedure. In our analysis, younger age at operation, previous experience of RCE, no stomal leakage and improvement of quality of life (enhanced comfort at school, workplace and sleepovers) significantly influenced the high satisfaction after MACE. [ABSTRACT FROM AUTHOR]

Purpose: We investigated whether bladder wall thickness measured at specifically defined bladder volumes could predict videourodynamic findings in children with spina bifida., Materials and Methods: We prospectively investigated patients with spina bifida on intermittent catheterization who underwent ultrasound examination simultaneously with videourodynamics. We evaluated the association between bladder wall thickness measured at maximum cystometric capacity and parameters including age, maximum detrusor pressure during filling or at leak and bladder compliance. Differences in bladder wall thickness measured at each percent maximum cystometric capacity were compared between patients with and without unfavorable videourodynamic findings. Maximum detrusor pressure 40 cm H2O or greater during filling or at leak, bladder compliance less than 10 ml/cm H2O, detrusor overactivity, bladder trabeculation and vesicoureteral reflux were defined as unfavorable videourodynamic findings., Results: A total of 23 males and 30 females with spina bifida (median age 7.8 years) underwent measurement of bladder wall thickness at maximum cystometric capacity. Mean ± SD bladder wall thickness measured at maximum cystometric capacity was 1.7 ± 0.5 mm. Only age had a weak correlation with bladder wall thickness measured at maximum cystometric capacity (p <0.05). In 31 patients bladder wall thickness was measured at each percent maximum cystometric capacity. Regarding unfavorable videourodynamic findings, there were no significant differences in bladder wall thickness measured at each percent maximum cystometric capacity, except for bladder trabeculation., Conclusions: Even if bladder wall thickness is measured at specifically defined bladder volumes, it cannot predict videourodynamic findings other than bladder trabeculation in children with spina bifida., (Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To assess whether the winter season in Japan is associated with failure in the alarm treatment of nocturnal enuresis (NE)., Patients and Methods: Consecutive patients with NE referred to our center between June 2009 and May 2010 were treated with the enuresis alarm (EA). The EA was used for 16 weeks with each child. Patients were divided into a success group and a treatment failure group. Pretreatment variables were collected, including age, sex, night-time urine volume, severity of enuresis, presence of nocturnal polyuria, presence of daytime incontinence, and treatment initiation season. These variables and initial success rates were retrospectively compared between the two groups. Chi-square, Student t tests, and multivariate regression analysis were used for statistical analysis., Results: A total of 67 children with NE were evaluated, 37 (55%) in the success group and 30 (45%) in the failure group. None of the pretreatment variables differed significantly between groups except for season; winter season initiation was an independent risk factor for failure in multivariate regression analysis., Conclusions: Winter was associated with failure in the EA treatment. We recommend that EA be introduced in the summer season in Japan to achieve an optimal success rate., (Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: There is an ongoing debate about whether initial laparoscopy is as efficient as initial extra-abdominal exploration for unilateral nonpalpable testis. The aim of this study was to clarify whether the finding of a closed internal ring on laparoscopy accurately predicts extra-abdominal findings in unilateral nonpalpable testis., Methods: Both laparoscopy and subsequent extra-abdominal exploration were prospectively performed in consecutive patients with unilateral nonpalpable testis. Laparoscopic findings were reviewed with respect to the status of the vas deferens, spermatic vessels, and the appearance of the internal ring. Except for patients with an abdominal testis, all patients underwent subsequent open exploration regardless of the laparoscopic findings. Open explorations were primarily performed by scrotal incision. During open exploration, any testicular remnants were removed and evaluated histologically., Results: A total of 100 patients with unilateral nonpalpable testis were evaluated, of whom 15 had an abdominal testis. Of the 85 patients without an abdominal testis, an open internal ring was recognized in only 8. Of the remaining 77 with a closed internal ring, subsequent open exploration revealed testicular nubbins in all patients (100%), regardless of the laparoscopic findings of the vessels and vas. Nine nubbins were associated with intra-abdominal vanishing vessels above the closed internal ring. All nubbins were confirmed by histological findings, and the incidence of viable germ cell elements was 7.4%., Conclusions: When laparoscopy demonstrates no abdominal testis in patients with unilateral nonpalpable testis, the finding of a closed internal ring on laparoscopy is always associated with the presence of an extra-abdominal nubbin, regardless of the status of the vessels and the vas at the internal ring. Subsequent extra-abdominal exploration can be obviated in this circumstance if nubbin excisions are skipped. Initial diagnostic laparoscopy for unilateral nonpalpable testis provides not only the intra-abdominal findings, but also exact prediction of the extra-abdominal findings in patients with a closed internal ring., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: At present, autologous intestinal segments are often used for bladder reconstruction. However, the gastrointestinal mucosa often causes various complications., Methods: Oral mucosal tissues were obtained from the buccal cavity of beagle dogs. Primary oral mucosal epithelial cells were cultured on temperature-responsive culture dishes with a mitomycin C-treated 3T3 feeder layer for 2 weeks. Cultured epithelial cells were harvested as contiguous sheets by reducing the temperature to 20°C. The study consisted of three groups. In group 1, oral mucosal epithelial cell sheets were autografted on demucosalized gastric flaps. Next, the gastric flaps with the oral mucosal epithelial cell sheets were used for bladder reconstruction. Bladder reconstruction was once immediately and then 5 days after epithelial cell sheet grafting in groups 2 and 3, respectively. Three weeks after bladder reconstruction, the gastric flaps with the oral mucosal epithelial cell sheets were examined by immunohistology., Results: Flaps grafted with oral mucosal epithelial cell sheets showed epithelial regeneration in groups 1 and 3. Regenerated epithelia were stratified and similar to native oral mucosa. However, the regenerated epithelium was absent from the reconstructive segment, and urothelial ingrowth was observed in group 2. Macroscopically, all reconstructive segments showed contracture., Conclusions: We successfully performed a bladder reconstruction using oral mucosal epithelial cell sheet-grafted flaps that exhibited epithelial regeneration. Further study should consider shrinkage prevention.

Objectives: The aim of this study was to evaluate the efficacy of the retrograde colonic enema relative to the Malone antegrade continence enema., Methods: We retrospectively investigated 25 children with spina bifida and fecal incontinence. Thirteen children had started retrograde colonic enema and twelve had started Malone antegrade continence enema. Fecal continence, water volume, time to washout, procedure frequency, pain during procedure, performance independence and demographical data were compared between the two groups., Results: Fecal continence was achieved for 10 of 13 (76.9%) in the retrograde group and 9 of 12 (75.0%) in the antegrade group. In the antegrade group 8 of 12 (66.7%) performed procedure independently, while 3 of 13 (23.1%) did so in the retrograde group. Achievement of fecal continence did not differ between the groups, but procedure independence was significantly better in the antegrade group., Conclusions: Our results suggest that retrograde colonic enema was not inferior to Malone antegrade continence enema on fecal continence. We recommend considering retrograde colonic enema prior to introduction of Malone antegrade continence enema in children with spina bifida.

Objectives: To determine whether a scrotal nubbin is present in children with unilateral non-palpable testis when diagnostic laparoscopy demonstrates blind-ending vessels and a normal vas deferens entering a closed internal ring., Methods: Eighty consecutive patients with a unilateral nonpalpable testis were retrospectively reviewed. Patients underwent initial diagnostic laparoscopy, and, if needed, subsequent inguinal exploration was performed. On inguinal exploration, any testicular remnant or nubbin-like tissue was removed and evaluated histologically. Patients with a patent processus vaginalis were excluded from this analysis., Results: Overall, 60 of the 80 patients had neither an abdominal testis nor a patent processus vaginalis. Of these 60, 34 patients had both a vas deferens and spermatic vessels entering a closed internal ring, and all of these underwent inguinal exploration. A total of 17 patients had both a blind-ending vas deferens and blind-ending spermatic vessels; no inguinal exploration was attempted. In nine patients, laparoscopy revealed blind-ending vessels with a normal vas deferens entering the closed internal ring. Of these nine, six underwent inguinal exploration, and a scrotal nubbins was found in three. At histological examination, hemosiderin deposit and calcification were seen in the nubbin tissue. No viable germ cell was detected in these specimens., Conclusions: A laparoscopic finding of blind-ending vessels above the closed internal ring does not mean intra-abdominal vanished testis, regardless of the appearance of the vas deferens.

Purpose: We identified independent factors predicting recurrent urinary tract infection within 1 year after the first urinary tract infection in pretoilet trained children with vesicoureteral reflux., Materials and Methods: We retrospectively reviewed the records of infants younger than 2 years with primary vesicoureteral reflux and a history of febrile urinary tract infection. Patients were divided into 2 groups based on the presence or absence of recurrent febrile urinary tract infection. Analysis included age, gender, reflux laterality and grade, abnormalities on dimercapto-succinic acid renal scan and prophylactic antibiotic type. Univariate and multivariate analyses were performed to identify risk factors for recurrent febrile urinary tract infection., Results: From 2004 to 2007, 78 children met study inclusion criteria. Mean age at the first urinary tract infection was 4 months (range 1 week to 16 months). None of the males were circumcised. Of 78 children 25 (32%) had a recurrent febrile urinary tract infection during 1 year of followup. Univariate analysis showed that bilateral reflux, high grade reflux (IV-V) and abnormal dimercapto-succinic acid scan were statistically significant predictors of early recurrent urinary tract infection (p <0.05). However, on multivariate analysis only an abnormal dimercapto-succinic acid scan showed a significant association with early recurrent urinary tract infection (OR 8.01, 95% CI 2.10-30.51, p = 0.002)., Conclusions: Abnormal dimercapto-succinic acid renal scan is an important predictor of early recurrent urinary tract infection in pretoilet trained children with vesicoureteral reflux. Whether the explanation lies in congenital or infection related damage, in this patient subgroup careful clinical followup or early surgical management for reflux should be considered.

Purpose: (99m)Technetium dimercapto-succinic acid renal scans are ideal for demonstrating renal scarring in children with spina bifida. However, doubt persists about the need for routine application. We assessed the associations among abnormal (99m)technetium dimercapto-succinic acid renal scans, vesicoureteral reflux and urodynamic findings in patients with spina bifida during long-term followup., Materials and Methods: We retrospectively reviewed the records of 64 patients with spina bifida followed at our center. All patients were older than 10 years (mean 15.8, range 10 to 23). Dimercapto-succinic acid renal scans were considered abnormal with differential function of less than 40% or focal defects. Patient age, gender, previous febrile urinary tract infections, positive vesicoureteral reflux history, timing of clean intermittent catheterization initiation and the latest urodynamic findings were noted. Patients were grouped based on normal/abnormal scan results. Statistical analysis included univariate and multivariate regression analyses and chi-square tests., Results: A total of 16 patients (25%) had abnormal scans. Mean patient age, male-to-female ratio, leak point pressure, bladder compliance and timing of clean intermittent catheterization initiation did not differ between groups. Rates of previous febrile urinary tract infections differed significantly (11 of 16 in the abnormal group vs 9 of 48 in the normal group, p <0.01), as did positive reflux history (100% vs 31%, p <0.01). No patient with a negative reflux history had an abnormal dimercapto-succinic acid renal scan. Multivariate analysis identified previous febrile urinary tract infections as a significant risk factor for an abnormal scan., Conclusions: A positive vesicoureteral reflux history and febrile urinary tract infections were associated with abnormal dimercapto-succinic acid renal scan in followup of patients older than 10 years with spina bifida. Thus, these factors are indicators of proactive evaluation of renal function using dimercapto-succinic acid renal scanning.

We report a case of asymmetric development of tumor-like cysts in a child with autosomal dominant polycystic kidney disease (ADPKD). The preliminary considerations were renal cell carcinoma and Wilms' tumor. After open biopsy, the patient was diagnosed with ADPKD with atypical renal cyst development. The development pattern of renal cysts in children with ADPKD is varied, and open biopsy is sometimes needed.

Olmesartan, a novel angiotensin II AT1-receptor antagonist, is excreted into both bile and urine, with minimal metabolism. Because olmesartan is a hydrophilic anionic compound, some transporters could be involved in its hepatic and renal clearance. In this study, we characterized the role of human drug transporters in the pharmacokinetics of olmesartan and determined the contribution of each transporter to the overall clearance of olmesartan. Olmesartan was significantly taken up into human embryonic kidney 293 cells expressing organic anion-transporting polypeptide (OATP) 1B1, OATP1B3, organic anion transporter (OAT) 1, and OAT3. We also observed its saturable uptake into human hepatocytes and kidney slices. Estimated from the relative activity factor method and application of specific inhibitors, the relative contributions of OATP1B1 and OATP1B3 to the uptake of olmesartan in human hepatocytes were almost the same, whereas OAT3 was predominantly involved in its uptake in kidney slices. The vectorial transport of olmesartan was observed in OATP1B1/multidrug resistance-associated protein (MRP) 2 double transfectants, but not in OATP1B1/multidrug resistance (MDR) 1 and OATP1B1/breast cancer resistance protein (BCRP) transfectants. ATP-dependent transport into membrane vesicles expressing human MRP2 and MRP4 was clearly observed, with K(m) values of 14.9 and 26.2 microM, respectively, whereas the urinary excretion of olmesartan in Mrp4-knockout mice was not different from that of control mice. We also investigated the transcellular transport of olmesartan medoxomil, a prodrug of olmesartan. Vectorial basal-to-apical transport was observed in OATP1B1/MRP2, OATP1B1/MDR1 double, and OATP1B1/BCRP double transfectants, suggesting the possible involvement of MRP2, MDR1, and BCRP in the limit of intestinal absorption of olmesartan medoxomil. From these results, we suggest that multiple transporters make a significant contribution to the pharmacokinetics of olmesartan and its prodrug.