Pediatrics

The absence of guidelines for appropriate management of stones in children is clearly a major problem that has resulted in great variability.

Researchers enumerate the benefits of LESS as improved cosmesis, reduction in iatrogenic bowel injury, reduced risk of visceral and vascular injuries associated with port placement, lower risk of wound infections and incisional hernias, and possible cost reductions derived from the use of a single port.

Testicular sperm extraction can be successfully performed in adolescents with Klinefelter's syndrome.

Physician attitudes, actions at odds over preserving fertility in adolescent men with cancer.

Pediatric urologists have confirmed that environmental pollutants can impair male sexual development and fertility and that reinnervation of the bladder after spinal cord injury may be within reach.

In the office and the operating room, urologists are finding an array of more palatable approaches to managing pediatric cases.

Children who do not respond to treatment for urgency frequency syndrome may have underlying neuropsychiatric disorders that need treatment before UFS symptoms can be resolved.

Video urodynamic studies found serious underlying pathology in a majority of cerebral palsy children who had urinary incontinence.

Studies of vesicoureteral reflux in children show steady progress in treatment modalities and outcomes.

It appears that ureteroscopy and other minimally invasive techniques, such as laser lithotripsy, are safe and effective in managing pediatric nephrolithiasis, including ureteric calculi, renal pelvic stones, and lower-pole stones.

The FDA has approved new labeling for sunitinib malate (Sutent) to include first-line treatment of advanced renal cell carcinoma. The labeling change is based on results of a large phase III trial that showed prolonged progression-free survival.

Atlanta-Tissue engineering research has grown by leaps and bounds in the past decade and a half, yielding findings that may someday have a profound impact on the field of pediatric urology. At the 2006 American Academy of Pediatrics Section on Urology annual meeting here, several groups presented cutting-edge data on novel systems for organ generation, including research demonstrating the feasibility of generating a functioning bladder from stem cells.

Atlanta-The impact of environmental toxins on male sexual development has become a topic of keen interest among pediatric urologists, who have released a growing body of data suggesting environmental links to hypospadias, cryptorchidism, and other urinary tract anomalies and diseases. At the 2006 American Academy of Pediatrics Section on Urology annual meeting, several groups presented data on the effect of in utero exposure to endocrine disrupters on the developing fetus.

Atlanta-A study funded by the National Institutes of Health and a new registry promise to provide needed information on the incidence, prevalence, and consequences of two important urologic conditions in children: vesicoureteral reflux and prenatal hydronephrosis. Both the study and the registry were highlighted at the American Academy of Pediatrics Section on Urology annual meeting here.

Atlanta-For a number of urologic conditions in adult patients, pure laparoscopic and robot-assisted laparoscopic procedures have taken urology by storm. Pediatric urology has been somewhat slower to adopt laparoscopic approaches, but many of the same questions arise in pediatric circles when arguing the relative merits and shortcomings of current laparoscopic and open surgical options: How do postoperative pain scores, operative times, and return to activities compare? What is the learning curve for laparoscopy, and does robotic assistance shorten it? In which patients, and for which indications, is one approach preferred over another?

Atlanta-Shifting patient and physician demographics, a rapidly changing medical marketplace, and evolving national health policies will create unique challenges for pediatric urology in the next decade, according to William J. Cromie, MD, MBA, a pediatric urologist who is CEO of Capital District Physicians' Health Plan, Inc.

Atlanta-Secondary testicular ascent (acquired cryptorchidism) remains a relatively rare condition, occurring in 3.2% to 6.9% of patients in a recent cohort study of boys with retractile testes. The diagnosis of ascent is becoming more commonplace, and ,therefore, boys with questionable testicular exams should have follow-up through adolescence, according to re-searchers from the Vanderbilt University Children's Hospital, Nashville, TN.

Atlanta-Magnetic resonance imaging has exciting new applications in diagnosing and evaluating of pediatric urologic conditions, according to several studies presented here at the 2006 American Academy of Pediatrics Section on Urology annual meeting.

As part of a new policy statement, the American Academy of Pediatrics recommends that television ads for erectile dysfunction products be confined to after 10 pm.

Chicago-With the evolving definition of advanced prostate cancer that now includes a number of clinical states not previously defined, treatment has also evolved into a multimodal approach. This mandates close cooperation among urologists and medical and radiation oncologists to ensure optimal patient care, according to leading oncologists.

Three new staff members have joined the Cleveland Clinic Glickman Urological Institute: Jeffrey Palmer, MD, is the director of minimally invasive surgery, pediatric urology; Courtenay K. Moore, MD, is a specialist in female urology; and Edmund Sabanegh, MD, is head of the section of male infertility.

Cleveland-A Mayo Clinic study published earlier this year raised more than a few eyebrows when its authors concluded that treatment of renal stones with shockwave lithotripsy appears to heighten the risk of diabetes mellitus and hypertension. More recently, researchers from Northwestern University reported a similar finding in patients with pancreatic stones-that SWL used in these patients may be associated with an increased risk of diabetes.

Atlanta-Urologists can add one more alternative, plant-based medication to the list of intriguing possibilities for treating urologic disease. This one is a rye-pollen extract called Cernilton that showed promising results in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in a preliminary, placebo-controlled study from Germany.

Atlanta-Direct medical costs are nearly twice as much for men with chronic prostatitis as men without, and those costs are definitely because of the disease, an analysis of an HMO's cost data showed.

The take-home messages on infection/inflammation at the AUA annual meeting covered a spectrum of urological conditions, including stone disease, urinary tract infection, urethritis, and interstitial cystitis. Results from both clinical studies and laboratory research have potential implications for urologists in their evaluation and management of patients with these disorders, said Anthony J. Schaeffer, MD, Herman L. Kretschmer professor and chairman, department of urology, Feinberg School of Medicine, Northwestern University, Chicago.

Many urologists are in the process of trying to transition their practices from the hospital to the office, and are looking for opportunities for ancillary income. A number of ancillary services are being explored.

Chicago-Two measures derived from an assay being used in research by the U.S. Environmental Protection Agency may add an indicator for the genetic health of sperm to those that already measure sperm count and sperm motility, according to a poster presented at the American Society of Andrology annual meeting here.

Among the more than 1,700 scientific papers presented at the 2006 AUA annual meeting, the focus was less on new medical or procedural innovations than on the benefits and risks of current tests and therapies.

Three or four no-shows per day add up to as much as $1,000 per month, with no resulting revenue to the practice.

Spectrum Laboratory Products, Inc., is initiating a voluntarynationwide recall of the active pharmaceutical ingredienttacrolimus after learning some lots are sub-potent.