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PURPOSE: Accurate diagnosis of urinary tract infection in children is essential because children left untreated can experience permanent renal injury. We aimed to assess the diagnostic value of clinical features of pediatric urinary tract infection. METHODS: We performed a systematic review and meta-analysis of diagnostic test accuracy studies in ambulatory care. We searched the PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Health Technology Assessment, and Database of Abstracts of Reviews of Effects databases from inception to January 27, 2020 for studies reporting 2 × 2 diagnostic accuracy data for clinical features compared with urine culture in children aged

Erik Kindgren,1,2 Antonia Quiñones Perez,1 Rajna Knez1,3 1Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden; 2Division of Pediatrics, Department of Biomedical and Clinical Sciences (BKV), Medical Faculty, Linköping University, Linköping, Sweden; 3Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, SwedenCorrespondence: Erik KindgrenDepartment of Pediatrics, Skaraborg Hospital, Lövängsvägen, Skövde, 541 42, SwedenTel +46104739222Fax +46500478356Email erik@kindgren.orgIntroduction: Hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are both characterized by generalized hypermobility, in combination with pain, affected proprioception, and pronounced fatigue. Clinical observation indicates that behavioral problems, hyperactivity, and autistic traits are overrepresented in children with those conditions. The purpose of this retrospective study was to establish the prevalence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) among children with HSD and hEDS treated in our clinic since 2012.Subjects and Methods: Since Ehlers-Danlos syndrome (EDS) diagnostic criteria and international classification were changed in 2017, we equate the older diagnosis EDS hypermobility type with the newer hEDS and the older hypermobility syndrome with HSD. A registry search from the computerized medical record system found 201 children (88 boys, 113 girls) aged 6– 18 years who were treated at our pediatrics department with the diagnoses HSD or EDS. All medical records (113 with HSD, 88 with EDS) were reviewed, and key symptoms such as fatigue and pain, as well as diagnosis of ADHD/ASD, were recorded.Results: All EDS cases could be classified as hEDS. Of the entire study cohort, 16% had a verified ADHD diagnosis and a further 7% were undergoing ADHD diagnostic investigation. Significantly more children with hEDS had ADHD compared to children with HSD (p=0.02). In the age group 15– 16 years, 35% of those with hEDS had ADHD and, among those aged 17– 18 years, ADHD was present in 46%. Children with coexisting ADHD showed a significantly higher proportion of associated symptoms such as fatigue, sleep-problems, and urinary tract problems. ASD had been verified in 6% of the children. Of those with ASD, 92% had sleep problems.Conclusion: This study shows a strong association between HSD or hEDS and ADHD or ASD. Therefore, children with HSD or hEDS may need to be routinely screened for neuropsychiatric symptoms.Keywords: ADHD, autism spectrum disorder, children, hypermobility spectrum disorder, Ehlers-Danlos syndrome

Enuresis (bedwetting) is common in school-aged children and can impact health, psychosocial well-being and quality of life. Although effective treatment is available, treatment resistance is encountered in about 50%. This paper discusses the management of treatment-resistant enuresis from a multidisciplinary perspective. Causes of treatment resistance include lower urinary tract problems, constipation, incorrect alarm training techniques, sleep disorders including sleep apnoea and psychological comorbidities. Practical suggestions to address treatment resistance are offered utilising expertise from clinicians from different disciplines.

Indonesia is one of the wealthiest countries in biological resources that have potential as medicinal plants. Medicinal plants can be an alternative in treating diseases such as urinary tract problems by the people of eastern Indonesia. The study aims to evaluate the use of medicinal plants for various urinary tract problems in east Indonesia, including their efficacy and safety based on the literature review. This research was conducted by interview method and field survey. The data were collected from traditional health practitioners in eastern Indonesia. Data were analyzed using Frequency of Citation (FC) and the Use value (UV). The results showed a total of 222 plants species belonging to 78 families were identified for treating urinary tract problems in east Indonesia. The most prevalent of these was theEuphorbiaceaefamily. The species which had the highest value wereOrthosiphon aristatus(FC 12.52%, UV 0.31),Sericocalyx crispus(FC 7.80%; UV 0.19),Phyllanthus niruri(FC 6.35%; UV 0.16) were the vast majority commonly used plant species in the treatment of urinary tract problems. The most common parts used were leaves (44.87%) and herbs (10.66%). The ethnomedicinal flora in east Indonesia is quite diverse for treating urinary tract problems.

Imperforate hymen is very rare in the neonatal period and may be associated with urinary tract problems, such as urinary retention and hydronephrosis. This report presents a case of a 4-day-old neonate with a marked interlabial swelling causing urinary retention. Radiological imaging studies revealed hydrocolpos, hydrosalpinx, and unilateral hydronephrosis. Her symptoms resolved after hymenectomy.

Ethnopharmacological relevance Crinum macowanii is a deciduous bulbous plant which grows in east, central and southern Africa. Crinum macowanii has been used as herbal medicine by the indigenous people of east and southern Africa has for several centuries. The bulb, leaves and roots of C. macowanii are reported to possess diverse medicinal properties and used to treat or manage various human and animal diseases and ailments throughout its distributional range. Crinum macowanii is used traditionally as a remedy for boils, diarrhoea, fever, inflammation, respiratory system problems, skin rashes, tuberculosis, wounds and urinary tract problems. Aim of the review The present review aims to summarize comprehensively the research that has been done on the ethnomedicinal uses, botany, phytochemistry and pharmacology of C. macowanii in different locations throughout its geographical range in east, central and southern African region so as to highlight research gaps and provide a foundation for further investigations on the plant species. Materials and methods A review of the literature was undertaken and an in-depth analysis of previous research on ethnobotany, therapeutic value, phytochemistry and pharmacology of C. macowanii throughout its distributional range in east, central and southern Africa. Literature sources included papers published in international journals, reports from international, regional and national organizations, conference papers, books, theses, websites and other grey literature. Electronic search engines such as Google, Google scholar, publishing sites such as Elsevier, scienceDirect, BMC, PubMed and other scientific database sites such as ChemSpider, PubChem were used as well as searching the library collections of the National Herbarium and Botanic Gardens (SRGH), Harare, Zimbabwe and the University of Fort Hare, South Africa. Results A total of 32 ethnomedicinal uses of C. macowanii are documented in literature, which can be grouped into seven major ethnomedicinal general purpose usages, namely “fever”, “wounds, sores and skin rashes”, “boils and inflammation”, “respiratory system problems”, “blood cleansing”, “urinary tract problem” and “veterinary uses”. The chemical composition of C. macowanii is dominated by various isoquinoline alkaloids, which have been isolated from the bulbs, flowering stalks, leaves and roots. Major biological activities demonstrated by C. macowanii include antifungal, antiviral and antiplasmodial activities, cardiovascular effects as well as effects on the central nervous system. The population of C. macowanii is declining in the wild as the bulbs are over-collected for sale in medicinal (muthi) markets in southern Africa. Conclusion A literature search revealed that C. macowanii has a lot of potential as a possible source of pharmaceutical products for the treatment of a wide range of human and animal diseases and ailments. Some of the alkaloids isolated from C. macowanii have demonstrated various biological activities when investigated in in vitro assays. However, some of the ethnomedicinal uses of C. macowanii still require pharmacological investigations. Therefore, further studies are required to improve our knowledge about the mechanisms of action, efficacy, toxicity and clinical relevance of the plant species as well as its bioactive compounds.

Mucopolysaccharidosis type II (MPS II) is caused by deficiency of lysosomal enzyme iduronate-2-sulfatase. Insufficient activity of the enzyme results in accumulation of glycosaminoglycans leading to progressive multisystem pathologies. MPS II is less likely to be complicated by kidney and urinary tract problems. We report a boy with MPS II, who developed left hydronephrosis. His hydronephrosis improved after starting enzyme replacement therapy. It was suggested that MPS II was closely associated with the pathogenesis of hydronephrosis.

Although many authors have doubted that "feline urological syndrome" (FUS) describes a real pathogenetic entity, because it subsumes such a large variety of signs, Sumner's recent finding that urethral obstruction occurs most frequently in springtime adds to a large body of evidence that lower urinary tract problems occur most commonly in late winter and spring. This suggests that FUS may be a unitary disorder, with a hormonal basis, driven by increasing day length. We argue that rising adrenal androgens (AA) in neutered cats induce stress, and other more concrete manifestations of FUS through androgen-driven mechanisms.

Introduction: Hydrocotyl verticillata Thunb. is a shady creeping medicinal herb with therapeutic properties and is commonly used for fevers, wounds, boils, abscesses, colds, coughs, hepatitis, influenza, purities, sore throat, headaches, and urinary tract problems. However, it is not standardized to date. So, the study aims to standardize H. verticillate as it is used as a primary medicine for human ailments . Materials and Methods: The plant was collected from Mahatma Gandhi Ayurved College Hospital and Research Centre, herbal garden and authenticated by the pharmacognosy department of IPGT&RA, Jamnagar, Gujarat. A pharmacognostic study with microscopic and preliminary phytochemical analysis was carried out. Result: Microscopy study showed some characteristics of stomata, palisade, and surface, which is useful for the identification and standardization of H. verticillata.

Prevalence of congenital abnormalities varies from 3.5% up to 43% in pediatrics.This wide interval is due to limited numbers of research. Limitation of data on recurrent urinary tract infection in CAKUT infants as well as symptoms which resemble other diseases makes it quite a challenge. A study of the prospective cohort was established to analyze the prevalence of recurrent UTI among CAKUT in children at Neonatal and Nephrology Paediatric Department of H.Adam Malik Hospital from 2016 to 2017.Urinalysis and urine culture were used to assess the presence of UTI. The result showed that the prevalence of UTI in CAKUT patients reached 64% in which 52% is the obstructive type and 12% non-obstructive type. Pelvic ureteric junction obstruction is the most common cause. Children with known urinary tract problems such as CAKUT are very prone to developing recurrent UTI. Due to a low survival rate of children with ESKD, new strategies are needed to prevent CAKUT, preserve renal function, and reduce associated cardiovascular morbidity. Meanwhile, children with CAKUT requires a multi-disciplinary and longer follow up.

Summary Urinary tract abnormalities are more common in spina bifida cystica than has been appreciated in the past. After meningitis and hydrocephalus, renal failure is an important cause of chronic ill health or death. Early and accurate assessment of urinary tract function will, I hope, prevent later and intractable renal disease, which causes a high rate of morbidity and mortality. This problem must be considered almost as urgent as the associated neurological and orthopaedic problems of spina bifida. In general, contrary to popular thought, the baby with partial bladder control is in more immediate danger than his fellow with dribbling incontinence. Much work remains to be done to understand the basic physiology of normal and abnormal bladder and ureteral function. Through this unique society we have the opportunity to assess the incidence and investigate the many problems of spina bifida; not the least of these are the urinary ones. A prospective study is now under way.

Despite substantial evidence to the contrary, it is still generally assumed that prostatic enlargement, obstruction, and infection are the causes of essentially all lower urinary tract problems in men. In fact, bladder problems of all types are prevalent in men, generally to a similar degree found in women. Yet men continue to be misdiagnosed, underdiagnosed, mistreated, and undertreated. This may be due in part to residual prejudices in the medical community, but it also relates to reluctance of men to discuss these problems. Bladder problems are simply not “manly.”

Ten male Finnish Landrace goat kids and 10 male Finnish Landrace lambs raised under similar stall-feeding conditions were compared for feed intake, feed efficiency, growth rate and slaughter results. The animals were housed individually from 2 months old to slaughter in grated metal pens and offered timothy/meadow fescue hay ad libitum and a concentrate at800 g/ animal/day. In their daily ration lambs and kids received on average 14.98 and 9.55 MJ metabolizable energy (ME), 186 and 136 g crude protein (CP) and 125 and 81 g amino acids absorbed in the small intestine (AAT), respectively. Mean total dry matter (DM) intake (98 vs. 75 g/kgW 0.75 ) and mean growth rate (245 vs. 174 g animal/day) were higher for lambs than for kids. All these differences between the two species were significant (p

Objective The aim was to determine the prevalence of voiding dysfunction and its related risk factors in Turkish schoolchildren. Materials and methods A randomly selected, cross-sectional study was conducted using a self-administered and previously validated questionnaire. The questionnaire consisted of two parts. The first part included personal demographic and familial information, and the second part included the Dysfunctional Voiding and Incontinence Scoring System (DVISS). The questionnaires were given to 4668 children between 6 and 15 years of age, which were completed by the parents and children together. The children with a score of ≥9 were accepted as having lower urinary tract dysfunction (LUTD). Results The data were collected from 4016 children (the response rate was 86.0%), including 48.6% boys and 51.4% girls. The mean age was 10.5 ± 2.2 years. The overall frequency of LUTD was 9.3%. While the 6-year-old children had the highest frequency (23.1%) of LUTD, this rate was 7.9% at the age of 10, and the children aged 14 years had the lowest frequency (4.9%), (p < 0.001). Lower urinary tract symptoms were significantly more common in girls (7.6%) than in boys (3.2%) only for the older age group (between 12 and 15 years of age). Compared with normal children, those with LUTD (with a score of ≥9) had the following risk factors: less educated parents, a parent that had lower urinary tract symptoms when he or she was a child, more persons per room (≥2 persons), more siblings (≥4 siblings) at home, past medical history of urinary tract infections, and squatting position (in girls). Conclusions Lower urinary tract problems are one of the most important and ongoing health problems in childhood. Determining the prevalence of lower urinary tract problems in children and their related risk factors is the first step to managing and reducing the number of children suffering from voiding problems. © 2014 Journal of Pediatric Urology Company.

Precise measurement of postvoid residual (PVR) urine volume is a key factor in assessing patients with voiding dysfunction, including those with lower urinary tract problems. The safe and noninvasive ultrasound bladder scan is the preferred mode to measure PVR volume. However, this procedure has a false-positive rate up to 9%, in the presence of ovarian cysts, renal cysts, ascites, or uterine myoma with cystic degeneration. Until now, cystic lesions are known to cause false positivity in ultrasound bladder scanner. However, we encountered falsely-elevated PVR in two cases of non-cystic uterine myomas. We present these cases with detailed radiologic images and volume measurement data.

UI in women is a highly prevalent condition. It affects women of all ages, domicile, or health status. UI is highly correlated with several medical conditions, including physical mobility problems, neurologic conditions, bowel problems, respiratory problems, and lower urinary tract problems. It also affects negatively the social and psychologic well-being of the affected individual. Many of the urodynamic parameters commonly tested showed no significant difference between continent and incontinent subjects. The few parameters that showed significant difference between the two groups have values that are overlapping. Lastly, the incidence and remission rates of urinary incontinence in elderly women are available and are significant.

The aim of the study was to describe patterns of morbidity, as reflected by reimbursed claims for veterinary care among cats covered by a Swedish insurance company during 1999–2006. The annual incidence rates of having at least one veterinary care event were calculated overall and stratified by sex, age, breed, diagnosis and urban/other location. The total rate was 875 (95% CI 858–892) cats with claims per 10,000 cat-years at risk. The Siamese, Burmese, and the Abyssinians had high rates of claims, compared to the Norwegian Forest cat, the Maine Coon, the European Shorthair and domestic cats. The most common causes for insurance claims were trauma, gastrointestinal and lower urinary tract problems and there was substantial breed, sex and age variation for certain problems. For example, among cats under 9 years of age, the rate for lower urinary tract problems was 2–3 times higher in males than females.

Objective: To determine the prevalence of health issues among hajj pilgrims and the factors associated with them.Method:An observational study conducted during hajj (Year 2011) using a questionnaire which was filled by pilgrims on their visit to the health clinics conducted by the Imamia Medics International.Results:During the period, pilgrims presented complaints related to the respiratory system 52.5%(n=394) followed by musculoskeletal system 29.6%(n=222), gastrointestinal system 15.5%(n=116), skin problems 5.9%(n=44), central nervous system 3.1%(n=23), cardiovascular system 2.9%(n=22), reproductive system 2.7%(n=20), urinary tract problems 2.3%(n=17) were dealt with. Out of 750, 17.9% (n=134) were diabetic and 26.4% (n=198) were hypertensive. Amongst the total, 24.8% (n=186) were vaccinated against hepatitis while 35.7% (n=268) were vaccinated against pneumonia. An astonishingly high percentage of the pilgrims had no prior immunization to both hepatitis and pneumonia.Conclusion:This data tries to emphasize awareness regarding the importance of vaccination and the potential problems which are faced by diabetic, hypertensive and older population which can help to improve the health condition of hajj pilgrims and can lessen the burden faced by concerned authorities. Link: http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/90/379

Genetic hypercalciuria, one of the most common mineral disorders in childhood, is frequently associated with a variety of urinary tract problems. Identifying and treating genetic hypercalciuria alleviates urinary tract problems and optimizes peak bone mass growth in affected children. Advanced practice pediatric nurses play a key role in identifying and coordinating care for children with genetic hypercalciuria.

H Zappel, A Leenen and F Seseke, pp. xii+251, 2003 (Springer-Verlag, Berlin, Heidelberg, Germany), £98.00 ISBN 3-540-43348-1 This book written by specialists in urology, radiology and nuclear medicine provides a comprehensive review of this subject. The early chapters deal with embryology of the urinary tract and then a description of the more common congenital abnormalities of the upper and lower urinary tract. There are chapters dealing with the clinical problems of urinary tract infection and stone formation with further chapters dealing with the imaging of and treatment of common urinary tract problems such as vesicoureteric reflux, megaureter, obstructive uropathy and urinary tract tumours. The imaging investigations are separate from the clinical chapters and nuclear medicine is provided in a separate chapter from the other imaging modalities. The book is completed with a series of case studies of some common and some not so common urinary tract problems. This layout has certain advantages for the authors but for the reader the separation of the clinical from the imaging seems a rather artificial one. The quality of the book is, however, very high and for those involved in imaging an insight into the management strategies for various urinary tract pathology is very interesting. It seems likewise the very clear description of the imaging strategy would be of great interest to those involved clinically in paediatric urology. Because the book deals extensively with the common problems as well as the less common this book should be very welcome in all departments dealing with children’s urinary tract problems. The views on difficult subjects such as follow up of antenatally diagnosed hydronephrosis and the imaging of urinary tract infection are dealt with in a well reasoned fashion giving pragmatic advice. This book can be strongly recommended. D W PILLING Book reviews

Urologic complications related to renal transplantation may be difficult to treat and can be serious threats to life or to function of the transplanted kidney. Successful experience with omentum for non-transplant and transplant-related reconstructive procedures recommends its further use. Herein are reported 4 patients in whom pedicled flaps of omentum were used to treat transplant-related urologic problems.

Real-time renal ultrasonographic scans were obtained of 204 subjects, comprising 159 pregnant and 45 control subjects. A classification of hydronephrosis based on calyceal diameters was established, and the overall incidence of hydronephrosis was found to be 90% on the right side and 67% on the left side. Calyceal diameters for both kidneys were found to increase gradually throughout pregnancy, the right more rapidly than the left. Neither parity nor a history of urinary tract problems was found to be relevant to the degree of dilatation.

The effectiveness of oxybutynin in the treatment of primary enuresis was evaluated in a double-blind study. A total of 30 children (25 boys, five girls), at least 6 years of age, with primary enuresis and no daytime incontinence or history of other urinary tract problems were selected at random from an enuresis clinic population. The study was explained to the families and they were told how to keep records of nocturnal bed-wetting episodes and side effects. The patients were treated with a 10 mg of oxybutynin at suppertime for 28 days. Before or after the treatment period, all children received an identical placebo for 4 weeks. Two-sided paired t tests were used to compare frequency of nocturnal enuresis. Frequency during the drug regimen did not differ significantly from that during the placebo study. There were no differences in findings between boys and girls or between children who had previously taken imipramine and those who had not. The study showed no evidence that oxybutynin is effective in treating primary enuresis.

This excellent monograph offers practical management of all the difficult problems encountered in the care and, most important of all, the rehabilitation of patients who have had spinal cord injury. The first two chapters discuss in simple, but concise and thorough terms the anatomy of the bladder and the physiology of micturition, with excellent, lucid diagrams. Next are discussed the changes that occur as a result of spinal cord injury: the disturbances of micturition in the upper motor neuron and lower motor neuron; incomplete mixed lesions; and the pathological changes that occur in the bladder. Diagnosis and treatment are excellently presented. This is followed by the bacteriological investigation and then the treatment of urinary tract problems. The second half of the book is devoted to the following: the techniques of catheterization, which are presented very well, with many photographs; the staffing, design, and organization of a spinal unit; and lastly

To evaluate the changing patterns of complications of surgery for intersex, the records of 58 patients operated on for ambiguous genitalia over the last two decades were reviewed. Patients with 21-hydroxylase deficiency constitute the largest group. These patients required the fewest operations and had the fewest complications. Surgery for all other diagnoses was accompanied by a high incidence of multistaged procedures and a high complication rate. The operations associated with the highest complication rate were those for vaginal reconstruction and severe hypospadias. Stenosis of the vagina and urinary tract problems accounted for most of the problems. Before 1975, the management of intersex was associated with a later age at diagnosis and initial operation, and a higher incidence of multistaged procedures performed by multiple surgeons from different specialties. These factors contributed to a higher complication rate than that observed after 1975, when patients were diagnosed and operated on earlier and had fewer complications.

In Reply .—Dr Mimouni highlights two important points that I and my colleagues addressed in our report: (1) He indicates that there is no need to perform renal ultrasonography if a supernumerary nipple is identified in an otherwise normal individual without a history of urinary tract problems. (2) He believes that the presence of a supernumerary nipple in an infant or child with multiple congenital anomalies is an indication for an ultrasound examination of the kidneys. In his editorial, Dr Hoyme agreed with this approach. Recently, a follow-up study from Hungary 1 again demonstrated an increased incidence of renal malformations in infants and children with a supernumerary nipple who were otherwise normal. Renal abnormalities were found in six (8%) of 78 patients hospitalized for illnesses unrelated to the urinary tract and healthy newborn infants; the authors believed this reinforced the original recommendation by Mehes 2 to perform roentgenographic studies of

• We assessed the safety of Hartmann's procedure in terms of postoperative morbidity and mortality associated not only with the original operation, but also with reestablishment of colorectal continuity and long-term survival. We studied 107 consecutive patients in whom Hartmann's procedure was performed either electively (96) or as an emergency (11) between 1970 and 1975. In 87, the resection extended below the peritoneal reflection. The mean age of the patients was 67 years. The principal indication for Hartmann's procedure was palliation (53%), obstruction (42%) either alone or with perforation, and technical difficulties (5%). Four patients died (3.7%) in the immediate postoperative period, two after elective surgery (2.1%). Complications were observed in 35 patients, including wound infection or dehiscence (22), urinary tract problems (seven), and pelvic abscess (three). Colorectal continuity was reestablished in ten patients without mortality or morbidity. The mean five-year survival for Dukes' B, C, and D lesions was 54%, 23%, and 3%, Hartmann's procedure, when performed for complicated carcinomas of sigmoid colon and rectum, including subsequent restoration of bowel continuity, is safe and can be associated with long-term survival. ( Arch Surg 1981;116:630-633)