Abstract:
INTRODUCTION:Recurrent urinary tract infections (UTIs) are common in patients with neurogenic bladder (NGB) performing clean intermittent catheterization (CIC) treated with or without oral antibiotic prophylaxis. OBJECTIVE:The authors aim to determine if daily neomycin-polymyxin or gentamicin bladder instillations reduce the rate of symptomatic UTIs, the need for oral antibiotic prophylaxis, emergency department (ED) visits for UTI, and inpatient hospitalizations for UTI in patients with NGB on CIC. The authors also aim to investigate resistance patterns in urine microorganisms in patients treated with antibiotic bladder instillations. STUDY DESIGN:The authors retrospectively reviewed the records of all-age patients cared for in the pediatric urology clinic with NGB on CIC having symptomatic UTIs and on daily intravesical instillations of neomycin-polymyxin or gentamicin between 2013 and 2017. Symptomatic UTIs were defined as a positive urine culture with greater than 10,000 colony forming units/mL associated with one or more of the following patient complaints: cloudy/foul-smelling urine, fevers, chills, increase in bladder spasms, pain, urinary leakage, or physician decision for antibiotic treatment. Multidrug-resistant organisms were resistant to two or more classes of antibiotics. RESULTS:Fifty-two patients with a median age of 14.5 years and 192 distinct urine cultures were identified. 90.4% and 9.6% of patients received neomycin-polymyxin and gentamicin instillations, respectively. After initiation of intravesical antibiotics, the rate of symptomatic UTIs was reduced by 58% (incidence rate ratio [IRR]: 0.42, 95% confidence interval [CI]: 0.31-0.56; P < 0.001), the rate of ED visits was reduced by 54% (IRR: 0.46, 95% CI: 0.30-0.71; P < 0.001), and the rate of inpatient hospitalizations for UTI was reduced by 39% (IRR: 0.61, 95% CI: 0.37-0.98; P = 0.043). Fewer patients received oral antibiotic prophylaxis after initiation of antibiotic instillations (odds ratio: 0.12, 95% CI: 0.02-0.067; P = 0.016). There was a trend toward a decrease in multidrug resistance and no change in gentamicin resistance in urine microorganisms. DISCUSSION:This study describes a feasible alternative treatment for patients with NGB on CIC who have persistent UTIs despite oral antibiotic prophylaxis, and for some patients, it may suggest a possibility of discontinuing oral prophylaxis. Limitations include a retrospective design with a small cohort of patients and varying dosages of neomycin-polymyxin. CONCLUSIONS:Antibiotic bladder instillations appear to decrease frequency of symptomatic UTIs, ED visits for UTI, inpatient hospitalizations for UTI, and the need for oral antibiotic prophylaxis in patients with NGB on CIC. There was no increase in multidrug resistance or gentamicin resistance in UTI organisms with use of intravesical antibiotic instillation.
journal_name
J Pediatr Uroljournal_title
Journal of pediatric urologyauthors
Huen KH,Nik-Ahd F,Chen L,Lerman S,Singer Jdoi
10.1016/j.jpurol.2018.12.001subject
Has Abstractpub_date
2019-04-01 00:00:00pages
178.e1-178.e7issue
2eissn
1477-5131issn
1873-4898pii
S1477-5131(18)30431-5journal_volume
15pub_type
杂志文章abstract:OBJECTIVES:To undertake a baseline audit of our pediatric urodynamic service, identifying areas for improvement, and to determine whether clinical management was affected by urodynamic results. PATIENTS AND METHODS:All pediatric urodynamic studies during one calendar year were reviewed to determine the quality of repo...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2004.11.004
更新日期:2005-02-01 00:00:00
abstract:INTRODUCTION:A urogenital sinus (US) and an anorectal malformation (ARM) are a rare constellation of anomalies, and the optimal surgical approach is unclear. Open and laparoscopic approaches have been described for US and ARM, but no data exist to support robotic assistance in children. CASE:A 20-month-old Amish femal...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2019.08.001
更新日期:2019-10-01 00:00:00
abstract::Although some centres have successfully integrated remote clinics into their paediatric urological practice, for many, remote clinics have developed due to the COVID-19 pandemic. One UK-based institution has integrated remote clinics in their practice for over two years and has developed guidelines considering which c...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2021.01.001
更新日期:2021-01-06 00:00:00
abstract:INTRODUCTION:Urethral injuries and trauma-related strictures (UITSs) in children are rare. The treatment is challenging but crucial to avoid life-long urinary complications such as recurrent stricture formation, urinary incontinence, and impotence. OBJECTIVE:The aim was to report on the surgical and functional outcome...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2018.11.014
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVE:Postoperative hydrocele development is a frustrating complication of varicocele surgical repair. To avoid this complication, we began to offer percutaneous embolization as a treatment option. We present our initial experience with this technique. METHODS:A retrospective review of all patients who underwent p...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2010.01.003
更新日期:2010-12-01 00:00:00
abstract:OBJECTIVE:Large bladder diverticulae, i.e. with a diameter measuring at least one-third of the bladder diameter on voiding cystourethrography, constitute an unusual but serious cause of obstructive uropathy in childhood. Their operative management entails meticulous reconstruction of the lower urinary tract. We report ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2005.01.005
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVE:Beckwith-Wiedemann syndrome (BWS) is a constellation of congenital anomalies that classically presents with macroglossia, abdominal wall defects and gigantism. Although renal and adrenal pathology are the most commonly associated urologic findings of BWS, we report a case of a girl with BWS and symptomatic cl...
journal_title:Journal of pediatric urology
pub_type: 杂志文章,评审
doi:10.1016/j.jpurol.2010.06.003
更新日期:2011-04-01 00:00:00
abstract:INTRODUCTION:Established criteria to assist surgeons in deciding between a one- or two-stage operation for severe hypospadias are lacking. While anatomical features may preclude some surgical options, the decision to approach severe hypospadias in a one- or two-stage fashion is generally based on individual surgeon pre...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2016.11.022
更新日期:2017-06-01 00:00:00
abstract:INTRODUCTION:Bladder calculi are a known complication of bladder augmentation. Open cystolithotomy remains the preferred option for treating large or multiple stones. Increasingly, however, minimal access techniques have been used. Reports of Mitrofanoff cystolitholapaxy are rare and have been limited to adults. This s...
journal_title:Journal of pediatric urology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jpurol.2018.02.024
更新日期:2018-10-01 00:00:00
abstract::We report on a child with hypertension secondary to MCDK who underwent an elective retroperitoneoscopic nephrectomy and is normotensive on follow up. We looked at the pathological correlation with respect to the hypertension caused by a non-functioning kidney. ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2011.03.019
更新日期:2011-10-01 00:00:00
abstract:PURPOSE:The literature on small intestinal submucosa for chordee correction in children is scarce. We reviewed our experience with 1 ply SIS for ventral corporal body grafting in cases of severe ventral penile curvature associated with proximal hypospadias in children. MATERIALS AND METHODS:From 04-2001 to 12-2007, 58...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2011.03.008
更新日期:2011-06-01 00:00:00
abstract:INTRODUCTION:Recent studies have suggested contradictory trends in the incidence of undescended testis (UDT) and hypospadias (HYP), partly because of methodological issues and ascertainment bias. The recently described association of "testicular dysgenesis syndrome" links concomitant UDT and HYP, with decreasing sperm ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2018.07.003
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:To report our experience with laparoscopic transperitoneal (TP) heminephrectomy for duplicated pyeloureteral systems in children under 2 years old. PATIENTS AND METHODS:We retrospectively reviewed the intraoperative evolution and patient outcome of 10 laparoscopic partial ureteronephrectomies (7 upper and 3 ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2009.06.012
更新日期:2010-04-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to determine if later toilet training is associated with urge incontinence in children. METHODS:We used a case-control study design to yield level 2 evidence. RESULTS:Initiation of toilet training after 32 months of age was associated with urge incontinence (P=0.02). CONCLUS...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2009.05.012
更新日期:2009-12-01 00:00:00
abstract:INTRODUCTION/BACKGROUND:The Monti ileovesicostomy provides an excellent substitution for an appendicovesicostomy when the appendix is unavailable or suitable for use. The spiral Monti is a useful modification to the traditional Monti as it allows creation of a longer channel when needed. In 2007, the short-term outcome...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2014.12.013
更新日期:2015-06-01 00:00:00
abstract:INTRODUCTION:Complications remain the top evaluation priority subsequent to hypospadias repair. Complications vary in further management, and usually require one or more reoperations. Patients and/or their parents concern not only with the success rate of reoperation, but also with the risk of numerous reoperations. O...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2020.11.010
更新日期:2020-11-12 00:00:00
abstract:INTRODUCTION:Primary nocturnal enuresis is one of the sleep related phenomena characterized by disruption in the relationship between arousal and urination. Corticotropin-releasing factor (CRF) is a neurohormone released from the paraventricular nucleus of the hypothalamus into the median eminence to elicit release of ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2016.08.030
更新日期:2017-02-01 00:00:00
abstract:INTRODUCTION:Cloacal exstrophy (CE) is the most severe manifestation of the epispadias-exstrophy spectrum. Previous studies have indicated an increased rate of renal anomalies in children with classic bladder exstrophy (CBE). Given the increased severity of the CE defect, it was hypothesized that there would be an even...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2016.04.008
更新日期:2016-08-01 00:00:00
abstract::Ureteropelvic junction (UPJ) stenosis is the most common cause of pathological neonatal hydronephrosis. UPJ obstruction may be treated conservatively in some cases, but surgery is indicated if symptoms occur or renal function deteriorates. Pyeloplasty is the procedure of choice for UPJ stenosis. Pyeloplasty can be per...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2019.03.022
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:To present our experience with infant pyeloplasty, comparing outcomes between robotic-assisted laparoscopic pyeloplasty (RALP) and open pyeloplasty (OP). MATERIALS AND METHODS:A retrospective review was performed of all children <1 year of age who underwent unilateral dismembered pyeloplasty at a single pedi...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2013.10.016
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Urinary tract infection (UTI) is a frequent disorder of childhood, yet the proper approach for a child with UTI is still a matter of controversy. The objective of this study was to critically compare current guidelines for the diagnosis and management of UTI in children, in light of new scienti...
journal_title:Journal of pediatric urology
pub_type: 杂志文章,评审
doi:10.1016/j.jpurol.2017.07.018
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:Overuse of computed tomography (CT) in the initial evaluation of children with upper urinary tract calculi (UUTC) has been well documented. Follow-up imaging patterns, however, remain undefined. Sequential imaging following an acute episode of UUTC represents additional opportunity for enacting good imaging ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2018.04.019
更新日期:2018-12-01 00:00:00
abstract:INTRODUCTION:Ultrasound (US) imaging is preferred in the initial evaluation for children with suspected nephrolithiasis; however, computed tomography (CT) continues to be used in this setting with resultant unnecessary ionizing radiation exposure. The study institution implemented a standardized clinical pathway to red...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2019.06.014
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Predicting the fate of a unilateral non-palpable testis based on its scrotal counterpart has been recommended by some, yet disputed by others, and the question remains open. OBJECTIVE:To investigate the accuracy of contralateral testis hypertrophy in predicting the absence of a unilateral non-palpable testi...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2016.12.013
更新日期:2017-06-01 00:00:00
abstract:OBJECTIVE:Testicular torsion is one of the most common diagnoses involved in lawsuits in the pediatric patient. Missed diagnosis and diagnostic delays put patients at risk for testicular loss and have resulted in malpractice litigation. Using a national database, we sought to describe testicular torsion malpractice cas...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2016.03.008
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To determine the effectiveness of gabapentin as an add-on therapy in children presenting with overactive bladder (OAB) not responding to conventional anticholinergics. MATERIALS AND METHODS:Children with refractory OAB were included prospectively from March 2009 to February 2010. The inclusion criterion was ...
journal_title:Journal of pediatric urology
pub_type: 临床试验,杂志文章
doi:10.1016/j.jpurol.2011.10.022
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the emotional and behavioral functioning of children with bladder exstrophy-epispadias complex (BEEC), taking into account developmental and gender considerations. This study also sought to overcome methodological limitations of previous studies evaluating psychological well-being of children with...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2013.07.013
更新日期:2014-02-01 00:00:00
abstract:INTRODUCTION AND BACKGROUND:Elective circumcision is a common procedure, known to be safe and associated with minimal morbidity. There are few data reporting the rates of readmission and reoperation following elective circumcision. OBJECTIVE:We sought to define the rates of readmission and reoperation in the first 7 d...
journal_title:Journal of pediatric urology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jpurol.2015.10.006
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Perioperative antibiotics prevent infections after surgery. Guidelines for antibiotic use allow the surgeon to balance the risks of adverse events and drug resistance with the benefit of reduced infection rates. However, due to a lack of evidence-based guidelines within pediatric urology, antibiotic practice...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2020.05.148
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:The ICCS defines OAB by the subjective symptom of urgency; detrusor overactivity (DO) is only implied. While no other symptom is required, OAB can also be associated with urinary frequency, decreased functional bladder capacity, and incontinence. OBJECTIVE:We sought to determine how often these associated f...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2017.02.010
更新日期:2017-06-01 00:00:00