A potpourri of paediatric urology

      In the News

      My technique for the treatment of an ureterocele has evolved over the years and I now make multiple punctures of the cyst to achieve decompression. The end result of this procedure resembles a tea bag, so I refer to it as “tea bagging”. I could never understand why this description caused so much amusement amongst the theatre staff until our urology fellow took me aside to explain what it implied. I will leave the reader to discover the true meaning of this expression, but would suggest that they do not “google” the phrase on a work computer. At the suggestion of my fellow I now refer to the technique as “pepper potting”!
      Antenatal steroids and ADHD. Antenatal steroids are hugely beneficial to the pulmonary function of premature babies, but there are concerns about their long-term affects on brain development. A study from Imperial College London found that the incidence of ADHD at 8 years of age was higher in the children whose mothers had received antenatal steroids as compared with case matched controls.
      BBC News 23rd November 2013.
      Germany sanctions third sex. Germany has become the first country in Europe to allow babies to be registered as neither male nor females on their birth certificate. It will also give its citizens the option of choosing, between M for Male, F for Female or X for indeterminate on their passports. The aim of this change is to remove pressure on parents of a child with “indeterminate sex”. It would appear that Europe is way behind the rest of the world; India, Nepal, Pakistan and Bangladesh all have this third option.
      BBC News 1st November 2013.
      Children are slowing down. It would appear that moaning about the fitness of ones children is now evidence based. Looking at the data from 25 million children in 28 (mainly Western) countries has confirmed that children now run a mile 90 s slower than they did 30 years. Apparently every decade children's cardiovascular fitness has dwindled by around 5%, which is worryingly similar to what has happened to me over that time. Not surprisingly the majority of this decline is down to an increase in the incidence on obesity, but I am sure we can drag electronic games into the equation.
      BBC News 20th November 2013.
      Urinating on a North/South axis. Researchers from the Czech republic have documented a bizarre effect of the earth's magnetic field on dogs. It would appear that in the absence of any major magnetic fluctuation, dogs line themselves up in a North South axis to urinate and defecate. Having worked extensively in biological behaviours and magnetic fields, the authors were quite excited to spot this affect in a relatively large mammal. I am concerned that if this extends to humans I may have orientated the toilets in my house incorrectly.
      Hart et al. Dogs are sensitive to small variations of the Earth's magnetic field. Front Zool (2013) vol. 10 (1) pp. 80.

      In the Journals

      Enuresis and Military exposure. As a paediatric urologist I will always look for a physical cause for urinary incontinence and down play the role of stress and life events. However there is not always a structural cause for these symptoms, Vaughan et al. looked at the incidence of urinary incontinence in American men who had prior military exposure. They found that men below the age of 55 were over 3 times more likely to suffer moderate or severe incontinence if they had served in the military. Interestingly this increased risk was not present in the older group of patients.
      Vaughan et al. Military exposure and urinary incontinence among American men. J Urol (2014) vol. 191 (1) pp. 125–9.
      Successful sperm retrieval from atrophic testes. I have often wondered whether there is any benefit in bringing a small testicle down into the scrotum. A recent report from Bryson et al. has made me think again. They report their institution's success rate with microdissection testicular sperm extraction and intracytoplasmic sperm injection. They report that in their patients with testicular volumes less than 2 ml they had a sperm retrieval rate of 55%, which was no different to their patients who had testicular volumes greater than 10 ml. There was also no difference in the resulting pregnancy and life birth rate, which were 55% and 47% respectively. It would appear that with modern techniques even an atrophic testis has fertility potential.
      Bryson et al. Severe testicular atrophy does not affect the success of micro dissection testicular sperm extraction. J Urol (2014) vol. 191 (1) pp. 175–8.
      Does carbon dioxide insufflation of the bladder cause kidney damage? Ureteric reimplantation utilising a “pneumovesicum” has become a popular minimally invasive technique. However, there have been concerns raised about whether there would be any adverse effects on the kidneys from this technique. Kilincaslan et al. looked at the effects of carbon dioxide insufflation on the kidneys of 30 New Zealand rabbits. They cannulated and insufflated the right ureter with pressures of 10 mmHg and 12 mmHg for 2 h and 4 h. The study demonstrated histological changes in the right kidney, which became more progressive with longer periods of insufflation. The question is does this happen in children with this technique and are the histological changes permanent.
      Kilincaslan et al. Carbon dioxide insufflation causes upper urinary tract injury in the early period of an experimental vesicoureteral reflux model. Pediatr Surg Int (2013) vol. 29 (12) pp. 1311–20.
      Hydration and ultrasound appearances of the kidney. As a paediatric urologist we rely heavily on the ultrasound appearance of the kidney. A study by Peerboccus et al. has highlighted the marked variation in kidney appearance based on the hydration of patients. They studied a group of 31 children prior to oral hydration and at 30 and 60 min after hydration. Hydrating the children prior to the scan made their kidneys 10% larger, their renal pelvis volume increased by 20% and their parenchyma became more echogenic. The authors concluded that we consider standardising the level of hydration in our patients before their routine scans.
      Peerboccus et al. The impact of hydration on renal measurements and on cortical echogenicity in children. Pediatr Radiol (2013) vol. 43 (12) pp. 1557–65.
      Anabolic steroids and hypogonadism. As part of my mid life crisis I have been trying to either swim or cycle before work each morning. The swimming involves a trip to the local health club close to my hospital, which has been a bit of a culture shock. It would appear that there is an increasing obsession with muscle development amongst the younger generation. I therefore read with interest the report by Coward et al. that documented the very high percentage of men under 50 who were presenting with hypogonadism secondary to anabolic steroid use. This paper not only clarified the reason for the muscle bulk, but also explained why the club felt they needed to provide a sharps container in the changing room.
      Coward et al. Anabolic steroid induced hypogonadism in young men. J Urol (2013) vol. 190 (6) pp. 2200–5.