Pediatrics

Chad Wallis, MD, pediatric urology fellow at the Hospital for SickChildren, Toronto, accepts congratulations from Catherine R.deVries, MD, president of International Volunteers in Urology, atthe IVU Traveling Urology Resident Scholar Reception Mondayevening.

Urologists attending the 2006 AUA annual meeting can look forwardto hearing about promising new reconstructive techniques for malegenital disorders. Studies will spotlight a number of approachesthat are at various stages of maturity, including some that arebeing reported for the very first time.

Slow, steady, and encouraging are the most appropriate terms todescribe recent changes in the treatment of renal cell carcinoma.Breakthroughs are on the horizon, and two new drugs andevolutionary advances in surgical technique add up to a hopefulpicture.

Pediatric urologists trained solely in traditional surgical methodswould be well advised to use their CME credits for courses inlaparoscopic and robotic surgery techniques. That, says Howard M.Snyder, III, MD, is inevitably the direction in which thesubspecialty is headed.

Clearwater Beach, FL-In children with incontinence,urodynamic studies are warranted in a small minority of cases,according to pediatric urology experts.

The first human recipients of laboratory-grown organs were reported this week by Anthony Atala, MD, of the Institute of Regenerative Medicine at Wake Forest University School of Medicine, Winston-Salem, NC.

Washington--Even after surgical ablation, posterior urethral valves (PUVs) in boys can cause bladder and kidney problems in later years. But now, for the first time, a team of pediatric urologists has shown that PUVs also can affect sex accessory glands and, ultimately, fertility. Justine M. Schober, MD, a pediatric urologist at Hamot Medical Center, Erie, PA, reported the group's findings here at the 2005 American Academy of Pediatrics Section on Urology annual meeting.

San Francisco--A never-before-seen virus associated with prostate cancer suggests that infection may play a role in the development of the disease in genetically susceptible individuals. The new virus, XMRV, is 25 times more likely to be present in prostate cancer patients with a specific genetic mutation than it is in the general male population, researchers reported at the American Society of Clinical Oncology 2006 Prostate Cancer Symposium here.

Most adolescent cancer patients who have been offered fertility preservation are able to bank sperm, according to a study published in the Archives of Disease in Childhood (2006; 91:149-52).

Baltimore--As the focus on pelvic pain syndromes moves away from the organs to the nervous system, researchers such as Ursula Wesselmann, MD, PhD, are trying to find out how acute pain develops into chronic pain.

Risk management is high on the list of concerns for busy urologists, and for good reasons. Start with patients: They are less loyal, less trustful, and more demanding than they were in the past. These attitudes increase your risk for a frivolous medical liability suit. Add to this the looming medical liability crisis and escalating premiums, and the focus on controlling risk takes center stage.

Montreal--The anti-estrogen agent clomiphene citrate (Clomid, Milophene, Serophene) may provide an easier, less expensive treatment for infertility among some men with hypogonadotropic hypo-gonadism [HH], according to a small retrospective study. The agent may be worth trying before the more expensive and difficult-to-administer gonadotropins are employed.

New York--When a teenager complains of erectile dysfunction, do not assume that the problem is psychogenic, advises John P. Mulhall, MD.

Washington--For children with ambiguous genitalia at birth, surgical techniques have improved vastly, but deciding when and whether to do surgery hasn't gotten easier. That was apparent from the lively and sometimes contentious panel and audience discussion here at the American Academy of Pediatrics Section on Urology annual meeting.

Washington--Long-term experience with bladder augmentation in children is now giving pediatric urologists and parents a true picture of the risks and benefits of different bowel segments. No single segment was the obvious winner in two experimental studies presented here at the American Academy of Pediatrics Section on Urology annual meeting, but the maintenance and surveillance required has become clearer. Other than technical considerations, metabolic, rather than urodynamic considerations, may prove more important in deciding which segment to use.

Washington--The most common anomaly detected on prenatal ultrasound is hydronephrosis. Up to 38% of those patients will have vesicoureteral reflux in early life. What to do about it, however, isn't always clear.

I predict that we will find that MR urography will rapidly develop and eventually come to be the imaging technique of choice in adult and pediatric urology.

Washington--When hydronephrosis is diagnosed antenatally in an infant, is pyeloplasty needed? More often than not, the indication is not clear.

If bedwetting does not upset a child, treatment probably isn't necessary, and the child will outgrow it, according to a new position statement from the Canadian Pediatric Society (CPS).

Leo Fung, MD, chief of pediatric urology at the University of Minnesota's Medical School, died of cancer on Dec. 10 at the age of 42

As the only nonprofit organization dedicated to teaching urology in developing countries, International Volunteers in Urology (IVU) provides a number of opportunities for residents and practicing urologists alike. Volunteers offer their teaching and clinical skills and learn about resourcefulness and compassion in return, IVU President Catherine deVries, MD, says in this exclusive interview. She was interviewed by UT Editorial Consultant Richard D. Williams, MD, professor and chairman of the department of urology at the University of Iowa, Iowa City. Dr. Williams also leads a volunteer surgical team that travels to Haiti each year.

New data from The National Birth Defects Prevention Study provide additional evidence that pregnancy-related intake of progestins is associated with increased hypospadias risk.

New data from The National Birth Defects Prevention Study provide additional evidence that pregnancy-related intake of progestins is associated with increased hypospadias risk.

Data from a 13-week British study add to the mounting evidence of the efficacy of botulinum toxin (Botox) for the treatment of overactive bladder.

Across a spectrum of indications, minimally invasive procedures are having a major impact on the practice of pediatric urology, said Howard Snyder, MD, professor of surgery in urology, University of Pennsylvania School of Medicine and Children's Hospital of Philadelphia. This observation was evident in a number of papers presented at the AUA annual meeting.

San Antonio--Although it may be routine at any number of tertiary care institutions and centers of excellence, the practice of automatically reviewing pathology slides that accompany referred bladder cancer patients nets little gain for either physicians or patients. In an overwhelming majority of instances, the practice does little more than add unnecessary dollars to the cost of treatment, according to a study presented at the 2005 AUA annual meeting here.

The most important factor in predicting a successful prostatectomy appears to be the overall experience of the surgeon, not the frequency of using a specific approach.

Nearly every practice is increasing the use of technology to improve office efficiency, enhance reimbursement, and increase patient satisfaction. Nearly every practice has or is considering implementing an electronic medical record, creating a robust interactive web site, networking their computers, and using electronic claims submission and a claims scrubber to ensure that claims are processed more quickly to increase your practice's cash flow.

This year, you have a unique opportunity to improve your income by providing more services in the office.

Atlanta--Children treated with endoscopic intervention for vesicoureteral reflux continue to demonstrate cures that approach those of open surgery and have a high resolution rate after initial failure. In addition, incidence of febrile and non-febrile urinary tract infection after treatment is lower than after surgery, according to data presented here at the State-of-the-Art Symposium on Pediatric UTI, Reflux, Antibiotic Resistance, and Endoscopy.