Pediatrician, Urologists, Pediatric Specialist
19 years of experience
Video profile
Accepting new patients
Division of Urological Surgery
1 Childrens Pl
Midtown, Saint Louis, MO 63110
314-454-6034
Locations and availability (6)

Education ?

Medical School Score Rankings
University of Kentucky (1991)
Surgery
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Awards  
Recognized as a "Best Doctor in America" in the Aug 2011 issue of St. Louis Magazine.
K08 DK054864-01
ENURESIS RESEARCH GRANT
Castle Connolly's Top Doctors™ (2013)
Appointments
Washington University School Of Medicine
ASSISTANT PROFESSOR OF UROLOGIC SURGERY
Barnes-jewish Hospital
Associations
American Urological Association
Member

Affiliations ?

Dr. Austin is affiliated with 9 hospitals.

Hospital Affilations

Score

Rankings

  • Barnes-Jewish West County Hospital
    12634 Olive Blvd, Saint Louis, MO 63141
    • Currently 4 of 4 crosses
    Top 25%
  • Barnes Jewish Hospital
    Urology
    1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110
    • Currently 4 of 4 crosses
    Top 25%
  • Missouri Baptist Hospital Sullivan
    751 Sappington Bridge Rd, Sullivan, MO 63080
    • Currently 3 of 4 crosses
    Top 50%
  • Saint Louis University Hospital
    3635 Vista Ave, Saint Louis, MO 63110
    • Currently 2 of 4 crosses
  • Missouri Baptist Medical Center
    Urology
    3015 N Ballas Rd, Saint Louis, MO 63131
    • Currently 2 of 4 crosses
  • St. Louis Children's Hospital
    1 Childrens Pl, Saint Louis, MO 63110
  • Siteman Cancer Center
  • Memorial Hermann Hospital
  • BarnesJewish Hospital
  • Publications & Research

    Dr. Austin has contributed to 37 publications.
    Title The Physiological Significance of P27(kip1) Expression in Detrusor Function.
    Date October 2010
    Journal The Journal of Urology
    Excerpt

    Bladder outlet obstruction results in smooth muscle cell hyperplasia, decreased bladder wall compliance, and lower and upper urinary tract pathology. The cyclin-dependent kinase inhibitor p27(KIP1) regulates bladder smooth muscle cell proliferation in response to bladder outlet obstruction but little is known about its physiological role in the bladder. We investigated the role of p27(KIP1) in the structure and function of the detrusor layer of the bladder wall.

    Title Editorial Comment.
    Date February 2010
    Journal The Journal of Urology
    Title Mechanoregulation of Proliferation.
    Date September 2009
    Journal Molecular and Cellular Biology
    Excerpt

    The proliferation of all nontransformed adherent cells is dependent upon the development of mechanical tension within the cell; however, little is known about the mechanisms by which signals regulated by mechanical tension are integrated with those regulated by growth factors. We show here that Skp2, a component of a ubiquitin ligase complex that mediates the degradation of several proteins that inhibit proliferation, is upregulated when increased mechanical tension develops in intact smooth muscle and that its upregulation is critical for the smooth muscle proliferative response to increased mechanical tension. Notably, whereas growth factors regulate Skp2 at the level of protein stability, we found that mechanical tension regulates Skp2 at the transcriptional level. Importantly, we demonstrate that the calcium-regulated transcription factor NFATc1 is a critical mediator of the effect of increased mechanical tension on Skp2 transcription. These findings identify Skp2 as a node at which signals from mechanical tension and growth factors are integrated to regulate proliferation, and they define calcium-NFAT-Skp2 signaling as a critical pathway in the mechanoregulation of proliferation.

    Title Enuresis is a Common and Persistent Problem Among Children and Young Adults with Sickle Cell Anemia.
    Date August 2008
    Journal Urology
    Excerpt

    OBJECTIVES: Enuresis and nocturia are common among children with sickle cell anemia (SCA). The objectives of this study were to describe the prevalence of enuresis and nocturia among children and young adults with SCA and determine the relationship, if any, between these symptoms and SCA-related morbidity. METHODS: A prospective infant cohort of African-American children with SCA was previously established from the Cooperative Study for Sickle Cell Disease. Included in this cohort were children with SCA enrolled before 6 months of age for whom questions about enuresis and nocturia had been completed. RESULTS: A total of 213 participants were included in this analysis. Sixty-nine individuals (33%) experienced enuresis over the course of the study. No children under 6 years of age were asked about enuresis. Thereafter, enuresis was most prevalent between the ages of 6 and 8 years (42%) and continued to be common in young adults ages 18 to 20 years (9%). Seventy-nine percent of individuals reported a history of nocturia. There was no association between enuresis or nocturia and an increased rate of pain or acute chest syndrome (ACS) episodes. CONCLUSIONS: Enuresis and nocturia are common in children with SCA. Among adults with SCA, enuresis and nocturia are more persistent compared with adults in the general population. Enuresis and nocturia are not associated with an increased rate of pain or ACS.

    Title Enuresis and Dysfunctional Elimination.
    Date February 2008
    Journal Missouri Medicine
    Excerpt

    Day and night wetting are common pediatric urological concerns. Isolated nocturnal enuresis is rarely associated with functional or anatomical issues but diurnal wetting after the age of toilet training should be addressed. Different subtypes of diurnal enuresis require different and often specific treatment plans. Constipation is frequently associated and can impair successful therapy. A primary care physician can successfully treat most enuresis but severe dysfunctions or refractory patients need a referral to a specialist.

    Title Prenatal Diagnosis and Neonatal Management of Congenital Urethral Diverticulum.
    Date July 2007
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We present a series of male neonates with prenatally detected anterior urethral diverticula and discuss postnatal management. MATERIALS AND METHODS: We retrospectively reviewed 3 cases of prenatally detected anterior urethral diverticula presenting between 1998 and 2005. RESULTS: An anterior urethral cystic mass was identified prenatally in all 3 patients. One mass spontaneously ruptured prenatally. The patient underwent diverticulectomy and urethroplasty at age 6 months. Two patients had obstructive uropathy with oligohydramnios and were delivered at 32 weeks of gestation. Both cases were managed by urethrostomy and subsequent diverticulectomy and urethroplasty at age 6 months. CONCLUSIONS: Infravesical obstruction from a urethral diverticulum can be accurately identified and differentiated from other causes prenatally. Marsupialization is an excellent option for temporary urinary diversion when the clinical situation precludes primary excision and repair.

    Title Imaging Case Book: Superior Vesical Fissure: Variant Classical Bladder Exstrophy.
    Date April 2007
    Journal Journal of Perinatology : Official Journal of the California Perinatal Association
    Title Bladder Injury from a Shard of Glass.
    Date January 2007
    Journal The Journal of Trauma
    Title The Magnitude of Fetal Renal Pelvic Dilatation Can Identify Obstructive Postnatal Hydronephrosis, and Direct Postnatal Evaluation and Management.
    Date August 2006
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Up to 1% of prenatal ultrasounds will detect fetal renal pelvic dilatation. We sought to evaluate and determine whether fetal renal pelvic measurements may appropriately direct prenatal counseling and postnatal evaluation and management. MATERIALS AND METHODS: We performed a retrospective analysis of prospectively collected measurements of anteroposterior renal pelvic dilatation obtained at a single fetal maternal medicine center between 1990 and 2003. Fetuses with renal pelvic dilatation 4 mm or greater at less than 33 weeks of gestation, or 7 mm or greater at more than 33 weeks of gestation were evaluated postnatally at a single pediatric urology center. Infants with renal pelvic dilatation were evaluated with ultrasound, voiding cystourethrograms and renal scintigraphy. Renal obstruction was the main outcome measure assessed. Obstruction was defined as the need for surgery and was not based on the renal scan drainage time. Indications for surgery included declining function and increasing hydronephrosis. RESULTS: There were 257 neonates with prenatally detected renal pelvic dilatation. A mean maximum prenatal renal pelvic dilatation of 11.8 mm was seen in 195 patients with nonobstructive dilatation. In the 62 patients with obstruction there was a nearly 2-fold increase in the mean renal pelvic dilatation (22.3 mm), which was statistically significant. Receiver operating characteristic analysis revealed that when 15 mm renal pelvic dilatation is used as a threshold it correctly discriminates obstruction in at least 80% of fetuses with a sensitivity of 73% and a specificity of 82%. CONCLUSIONS: The magnitude of fetal renal pelvic dilatation is predictive of obstruction. Our results suggest that 15 mm renal pelvic dilatation represents a significant threshold. Receiver operating characteristic analysis provides a useful guide for prenatal counseling and may help to direct the postnatal evaluation.

    Title Outcome Analysis of Prenatally Detected Ureteroceles Associated with Multicystic Dysplasia.
    Date November 2004
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We assessed the outcome of a nonoperative approach in infants with prenatally detected ureteroceles associated with multicystic dysplasia. MATERIALS AND METHODS: A retrospective analysis of all infants with ureteroceles referred for evaluation of prenatally hydronephrosis was conducted. Ultrasound, cystogram and scintigraphy findings were tabulated. Clinical outcomes including infections and the need for surgical intervention were assessed. RESULTS: We identified 5 female and 3 male infants with prenatally detected ureteroceles and associated multicystic dysplasia. There were 4 cases with renal duplication and 4 with single systems. All infants were treated expectantly. One infant had a single urinary tract infection. The multicystic dysplastic moiety involuted by age 18 months in all children. The ureterocele collapsed in 3 children and remained stable in the remainder. None of the children required surgical intervention with a median and mean followup of 36 months (range 14 to 54). CONCLUSIONS: We identified a subset of prenatally diagnosed ureteroceles that had a benign clinical course and did not require surgical intervention with available followup. Careful evaluation and interpretation of postnatal studies will allow identification and observational management of this unique subset of ureteroceles associated with multicystic dysplasia and absence of hydroureteronephrosis.

    Title Inhibition of Mitogenic Signaling and Induction of Apoptosis in Human Bladder Smooth Muscle Cells Treated with Doxazosin.
    Date November 2004
    Journal The Journal of Urology
    Excerpt

    PURPOSE: The alpha1 antagonist doxazosin is used to treat lower urinary tract symptoms and is believed to function primarily as a smooth muscle relaxant. However, doxazosin has been shown to inhibit proliferation and induce apoptosis in nonbladder smooth muscle. Consequently, we examined the effects of doxazosin on human bladder smooth muscle cell (SMC) proliferation and apoptosis. MATERIALS AND METHODS: Primary human bladder SMCs were cultured in M199 with 10% fetal bovine serum (FBS) until they reached 65% confluency and then they were made quiescent by serum starvation in M199 with 0.4% FBS for 24 hours. The quiescent bladder SMCs were pretreated for 30 minutes with doxazosin or vehicle (dimethyl sulfoxide) and then stimulated with 10% FBS for 24 hours. Measurement of 5'-bromo-2'-deoxyuridine (BrdU) uptake by flow cytometry was used to determine the effect of doxazosin on cell cycle progression. Western immunoblot was used to examine cell cycle protein expression and phosphorylation of the retinoblastoma protein (Rb) and cyclin A, both of which regulate cell cycle progression. RESULTS: Cellular proliferation was inhibited in a dose dependent manner by doxazosin. There was nearly a 50% decrease in BrdU uptake at 10 microM doxazosin and an approximately 90% decrease in BrdU at 25 microM doxazosin. Notably, doxazosin inhibited phosphorylation of Rb and expression of cyclin A, both of which are necessary for cell cycle progression. At concentrations of 25 microM doxazosin or greater apoptosis was induced in the bladder SMCs, as indicated by an increase in subG1 DNA content. CONCLUSIONS: Our study demonstrates that doxazosin inhibits mitogen induced proliferation of human bladder SMC by blocking cell cycle progression at the of G1/S border. Doxazosin induced cell cycle inhibition appears to be at least in part due to an inhibition of mitogen induced Rb phosphorylation and cyclin A expression. At higher concentrations doxazosin induces apoptosis in human bladder SMCs.

    Title Alpha Blocker Therapy for Children with Dysfunctional Voiding and Urinary Retention.
    Date October 2003
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Alpha blocker therapy has been successfully used to decrease residual urine in children with complex neuropathic and nonneuropathic voiding dysfunction. We evaluated the safety and efficacy of using selective alpha blocker therapy for children with uncomplicated voiding dysfunction and underlying poor bladder emptying. MATERIALS AND METHODS: A total of 55 patients with a mean age of 7.9 years presented with symptoms of urinary incontinence, urgency and urinary tract infection. All patients had increased post-void residual (PVR) on bladder ultrasound, with a mean residual volume of 65 ml (22% of age expected capacity). All patients were treated with doxazosin, a selective alpha-1 adrenergic antagonist, at dosages of 0.5 mg to 2.0 mg daily. Of the patients 38 were treated at presentation with a regimen of anticholinergics, timed voiding and antibiotic prophylaxis before initiating alpha blocker therapy. Patients were reevaluated with post-void ultrasound of the bladder 6 weeks after initiating alpha blocker therapy. RESULTS: After starting doxazosin average PVR decreased to 8 ml (p <0.0001), representing an 88% reduction in residual urine (or reduction to only 2.7% of age expected bladder capacity). Medication was discontinued in 2 patients due to minor side effects. CONCLUSIONS: Selective alpha blocker therapy appears to be effective for improving bladder emptying in children with an overactive bladder, wetting, recurrent infection and increased PVR urine. This therapy may be used as either a replacement or in addition to biofeedback in patients with urinary retention. Further investigation, including a prospective randomized trial of alpha blocker therapy in children with urinary tract dysfunction, is warranted based on the findings of our study.

    Title The Effect of Health Care Coverage on Circumcision Rates Among Newborns.
    Date October 2003
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Social and personal biases are thought to have a role in the decision to circumcise newborns. However, economic factors such as the type of health care coverage may determine which parents are offered circumcision during the newborn period. Therefore, we examined the rates of newborn circumcision among patients with and without insurance at a midwestern community hospital and tertiary care center. MATERIALS AND METHODS: A retrospective analysis of all patients undergoing circumcision at 2 different labor and delivery facilities between January 1997 and December 2001 was performed. Female gender, prematurity and all congenital anomalies comprised exclusion criteria. Circumcision rates were stratified by health care coverage and race. To assess characteristics of patients who did not undergo circumcision during the newborn period the indications for circumcision and insurance status were examined at a children's hospital. RESULTS: Health care coverage differed significantly between the 2 labor and delivery facilities. Medicaid or uninsured patients comprised approximately 72% of the population at the tertiary care facility and slightly less than 10% of the total deliveries at the community hospital. Despite the difference in health care coverage status, there was no statistically significant difference between the rates of circumcision among newborns. The circumcision rates were 81% (4,021 of 4,992 cases) and 82% (8,059 of 9,859) at the community and tertiary care facilities respectively. Similarly, there was no difference between circumcision rates when stratified by health care status or race. At the children's hospital there were 2 distinct populations seeking circumcision. Of Medicaid patients 87% younger than 3 years sought circumcision because they were denied circumcision during the newborn period. In contrast, adoption was cited 90% of the time as the reason for seeking circumcision in the privately insured patients. CONCLUSIONS: Although health care coverage may influence the indications for circumcision in older children, health care coverage does not appear to influence newborn circumcision rates in the Midwest.

    Title Lipopolysaccharide and Inflammatory Cytokines Cause an Inducible Nitric Oxide Synthase-dependent Bladder Smooth Muscle Fibrotic Response.
    Date July 2003
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Bladder wall fibrosis is a sequela of recurrent urinary tract infection (UTI). Inducible nitric oxide synthase (iNOS) has been shown to mediate the fibrotic response to inflammation in other tissues. We determined if iNOS could be involved in the fibrotic response to recurrent UTI. MATERIALS AND METHODS: Human bladder smooth muscle cells (SMC) were treated with bacterial lipopolysaccharides (LPS) and a mixture of inflammatory cytokines. The level of collagen type III, and the levels of iNOS mRNA, protein and activity were determined. The effect of the iNOS inhibitor aminoguanidine on collagen type III expression was then assessed. RESULTS: Expression of collagen type III, iNOS mRNA and iNOS protein as well as iNOS activity were increased in bladder SMC treated with the combination of LPS and cytokines. The increase in collagen type III expression was inhibited by pretreatment of cells with aminoguanidine. CONCLUSIONS: LPS and inflammatory cytokines induce collagen type III expression in an iNOS dependent manner in human bladder SMC. This finding suggests that iNOS may be a critical mediator of the bladder wall fibrotic response to chronic UTI and iNOS inhibitors may be of therapeutic value in patients with chronic UTI.

    Title Vesicoureteral Reflux and Clinical Outcomes in Infants with Prenatally Detected Hydronephrosis.
    Date October 2002
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We evaluate the incidence of vesicoureteral reflux and urinary tract infections in infants with prenatally detected hydronephrosis. MATERIALS AND METHODS: We retrospectively reviewed the charts of children referred to our hospital for evaluation of prenatally detected hydronephrosis between 1992 and 1998. Measured variables included ultrasound and voiding cystourethrogram findings, and infectious and clinical reflux outcomes. RESULTS: Vesicoureteral reflux was identified in 40 of 234 infants (21%), including 24% of males and 13% of females. A significant correlation was found between the degree of hydronephrosis and incidence of reflux. Urinary tract infections were uncommon and identified in 7.5% of children on prevention for reflux and 4% with normal voiding cystourethrogram. In the majority (58%) of cases reflux resolved with medical management. CONCLUSIONS: The incidence of reflux increases with greater degrees of sonographic dilatation but a normal ultrasound does not exclude reflux and, therefore, voiding cystourethrogram is recommended in all children with prenatally detected hydronephrosis. Since urinary tract infections are uncommon with prevention, antibiotics should be continued until reflux resolves and/or hydronephrosis significantly improves.

    Title The Relationship Between Müllerian Inhibiting Substance and Androgens in Boys with Hypospadias.
    Date October 2002
    Journal The Journal of Urology
    Excerpt

    PURPOSE: The etiology of hypospadias is probably multifactorial and disruption of androgen production may have a role. Müllerian inhibiting substance (MIS), a hormone produced by Sertoli cells, has been shown to suppress androgen biosynthesis in Leydig cells by inhibiting cytochrome P450c17 hydroxylase/lyase (CYP17) gene expression. We investigated the relationship between serum MIS and androgens in boys with isolated hypospadias compared with normal boys. MATERIALS AND METHODS: Serum levels of MIS, testosterone and androstenedione were measured in 29 boys with distal hypospadias (midshaft or less) and 21 normal boys undergoing circumcision. The subjects were stratified according to age 12 months or younger (group 1) and 13 to 24 months old (group 2). Statistical evaluation was performed by Student's t test. RESULTS: Mean age plus or minus standard error of mean of normal boys and their respective age matched groups with hypospadias were not significantly different. Within each respective age group serum müllerian inhibiting substance levels in boys with hypospadias were significantly higher compared with those of normal boys (129.6 +/- 1.8 and 96.1 +/- 1.8, p <0.03 for group 1 and 143.2 +/- 2.0 and 77.2 +/- 2.3, p <0.005 for group 2). Serum MIS levels were not statistically different when normal boys or boys with hypospadias were compared across age groups. In group 1 serum testosterone levels in boys with hypospadias were not significantly different from those of normal boys (0.36 +/- 0.20 and 0.56 +/- 0.32 pg./ml., respectively). In group 2 normal boys serum testosterone levels were higher than these in boys with hypospadias (2.36 +/- 0.47 and 0.35 +/- 0.23 pg./ml., p <0.01). Serum androstenedione levels in group 1 boys with hypospadias were significantly lower compared with those of normal boys of similar age (0.29 +/- 0.1 and 0.64 +/- 0.16 ng./ml., respectively, p <0.003). Androstenedione levels among older boys were not different (0.49 +/- 0.25 and 0.32 +/- 0.11 ng./ml., respectively. CONCLUSIONS: The association between elevated serum MIS levels and lower testosterone concentrations in boys with hypospadias suggests that MIS may have some role in the development of hypospadias, possibly mediated by MIS inhibition of CYP17 gene expression.

    Title Multi-institutional Experience with the Gastrointestinal Composite Reservoir.
    Date June 2001
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We evaluated multi-institutional experience with the gastrointestinal composite reservoir in patients with metabolic acidosis, the short bowel syndrome, severe pelvic radiation and/or renal insufficiency. MATERIALS AND METHODS: At 4 institutions 33 patients underwent construction of a gastrointestinal composite reservoir, including 19 with the short bowel syndrome, 13 with metabolic acidosis and 7 who also had renal insufficiency. A total of 16 patients underwent conversion of a previous diversion and the remaining 17 received new urinary diversion. Charts were reviewed for the metabolic impact of the gastrointestinal reservoir as well as any long-term sequelae. RESULTS: At a mean followup of 54 months there was a significant (p < or =0.05) improvement in mean preoperative and postoperative serum chloride (106 versus 102 mEq./l.), serum bicarbonate (23.3 versus 25 mEq./l.) and serum pH (7.36 versus 7.4). Mean serum creatinine did not significantly differ during followup in patients with normal renal function or renal insufficiency. Complications were not different than those of standard intestinal or gastric reservoirs. CONCLUSIONS: The gastrointestinal reservoir has provided an excellent metabolic balance in a large series of compromised patients with few side effects. We believe that the gastrointestinal composite reservoir represents the urinary diversion of choice when standard intestinal urinary reservoirs cannot be created in the setting of metabolic acidosis, the short bowel syndrome and severe pelvic radiation. However, the value of the gastrointestinal composite in the setting of renal insufficiency remains undetermined.

    Title Advantages of Rectus Fascial Slings for Urinary Incontinence in Children with Neuropathic Bladders.
    Date June 2001
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Many surgical procedures to improve outlet resistance in children with neuropathic bladders are obstructive and increase the detrusor leak point pressure. In contrast, fascial slings are designed to achieve continence by increasing the Valsalva or stress leak point pressure without altering the detrusor leak point pressure. We evaluate the effectiveness of fascial slings in achieving continence in pediatric patients with neuropathic bladder. MATERIALS AND METHODS: From October 1994 until February 1999, 10 females and 8 males with neuropathic bladder secondary to myelodysplasia or traumatic spinal cord injury underwent fascial sling procedures. Mean patient age was 14 years (range 8 to 18) and all were incontinent despite aggressive medical management. Urodynamic evaluation was performed preoperatively and postoperatively. Specific urodynamic measurements included detrusor leak point pressure, stress leak point pressure and detrusor compliance. Compliance was only compared in the 12 nonaugmented cases. RESULTS: With a mean followup of 21.2 months (range 6 to 57), preoperative and postoperative urodynamics revealed little change in mean detrusor leak point pressure (23.2 versus 23.22 cm. H2O) but a substantial increase in mean stress leak point pressure (41.6 versus 64.5 cm. H2O). Mean compliance was unchanged in the nonaugmented group (22.00 versus 26.78 ml/cm. H2O). Four patients (22.22%) remained wet after surgery, of whom 2 were successfully treated with a repeat sling procedure and 1 with collagen injection for an overall continence rate of 94.44%. CONCLUSIONS: Fascial slings can be effectively used in pediatric patients for neuropathic incontinence. Furthermore, stress urinary incontinence is corrected by increasing the Valsalva or stress leak point pressure with preservation of the detrusor leak point pressure. Preservation of detrusor leak point pressure is particularly advantageous because other forms of bladder outlet procedures achieve continence at the expense of increasing detrusor pressures, thus placing the upper tracts at risk for damage.

    Title Symptomatic Ureteropelvic Junction Obstruction in Children in the Era of Prenatal Sonography-is There a Higher Incidence of Crossing Vessels?
    Date April 2001
    Journal Urology
    Excerpt

    OBJECTIVES: To determine whether prenatal sonography and early detection and correction of ureteropelvic junction obstruction (UPJO) has changed the incidence of crossing vessels as the etiology of obstruction in older children presenting with symptomatic UPJO. METHODS: We reviewed the medical records of all children and adolescents who underwent pyeloplasty for symptomatic UPJO between 1986 and 1999, during the era of widespread use of prenatal sonography. Operative notes were used to determine which patients had obstruction due to lower pole crossing vessels. RESULTS: Thirty-eight patients were identified who underwent pyeloplasty for symptomatic UPJO. Lower pole vessels were identified in 22 (58%) of 38 patients (P <0.0001 compared with historical controls). All patients underwent dismembered pyeloplasty and remained asymptomatic after surgery, with renal scans demonstrating excellent drainage and preservation of function. CONCLUSIONS: Prenatal ultrasonography has increased the incidence of crossing vessels as the etiology of UPJO in young children and adolescents presenting with symptomatic UPJO compared with the historical incidence of 11% to 15%. This finding may impact treatment recommendations with respect to endourologic management of the obstruction in this patient population. Currently, we recommend open dismembered pyeloplasty for young children and adolescents presenting with symptomatic UPJO.

    Title Dysfunctional Voiding.
    Date October 2000
    Journal Pediatrics in Review / American Academy of Pediatrics
    Title Nephrostomy Tube Drainage with Pyeloplasty: is It Necessarily a Bad Choice?
    Date May 2000
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Despite continued controversy regarding the optimal method of urinary diversion after dismembered pyeloplasty in children, we have treated the majority of our patients with postoperative nephrostomy tubes and no stents. We report our experience. MATERIALS AND METHODS: The records of all patients who underwent surgery for ureteropelvic junction obstruction from August 1985 to October 1998 and were treated only with a nephrostomy tube after pyeloplasty were reviewed for hospital course, complications and postoperative followup. All patients had a perinephric Penrose drain as well as a Foley catheter placed for bladder drainage. RESULTS: A total of 137 pyeloplasties were performed in 132 patients, including 5 with bilateral ureteropelvic junction obstruction, using only nephrostomy tube drainage with an average followup of 2.1 years. Initial nephrostograms demonstrated good drainage across the repair with no extravasation in 91% of patients. Subsequent nephrostograms revealed a widely patent anastomosis in the remaining cases. No patient had postoperative obstruction, or required secondary pyeloplasty or nephrectomy. Urinary tract infection developed in 2 patients (1.5%). Mean hospitalization was 4.4 days. There was a significant difference in length of stay in the last 5 years compared to that in previous years (3.4 versus 5.8 days, p <0.05) and hospital stay continues to decrease. CONCLUSIONS: Use of only a nephrostomy tube after pyeloplasty resulted in few complications and an open anastomosis in 100% of cases. Nephrostomy drainage not only serves as a protective mechanism, but also allows easy access for radiographic studies before removal of the tube. In addition, nephrostomy tube drainage does not prolong hospitalization and the tube may be easily removed on an outpatient basis without further anesthesia.

    Title Alpha-adrenergic Blockade in Children with Neuropathic and Nonneuropathic Voiding Dysfunction.
    Date September 1999
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Inadequate bladder emptying is a common urinary dysfunction in children. The role of alpha-blockers for managing bladder outlet obstruction remains relatively unexplored in children. Because of the well established impact of alpha-blocker therapy in men, we investigated its use for treating inadequate bladder emptying in the pediatric population. MATERIALS AND METHODS: We treated 17 children 3 to 15 years old with documented poor bladder emptying of various etiologies, including dysfunctional voiding, the Hinman syndrome, the lazy bladder syndrome, posterior urethral valves, myelomeningocele and the prune-belly syndrome, using the alpha-1 adrenergic receptor antagonist, doxazosin. The initial dose of 0.5 to 1.0 mg. nightly was increased according to patient response and as tolerated. Patients were followed weekly to monthly by symptomatic history, and urine flow and/or post-void residual urine volume measurement. Two patients with neurogenic bladder were also followed with cystometrography and leak point pressure determination. RESULTS: Bladder symptomatology and/or emptying improved in 14 patients (82%). Ten patients had decreased post-void residual urine during treatment and in 3 uroflowmetry showed increased maximum flow. Two patients with neuropathic bladder secondary to myelomeningocele had decreased leak point pressure on alpha-blocker therapy and in 2 with a history of posterior urethral valves new onset bilateral hydronephrosis completely resolved. Only 1 patient had mild postural hypotension, which resolved with dose reduction. CONCLUSIONS: Selective alpha-blocker therapy seems to be well tolerated in children and appears effective for improving bladder emptying in various pediatric voiding disorders at short-term followup. Long-term followup and further investigation are warranted to validate the potential role of alpha-blocker therapy in pediatric urinary dysfunction.

    Title The Gastrointestinal Composite Urinary Reservoir in Patients with Myelomeningocele and Exstrophy: Long-term Metabolic Followup.
    Date September 1999
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We investigated the long-term metabolic effects of gastrointestinal composite urinary reservoirs in patients with myelomeningocele or exstrophy. MATERIALS AND METHODS: Seven patients with myelomeningocele or exstrophy who required complex urinary reconstruction in the setting of metabolic acidosis or the short bowel syndrome underwent construction of a gastrointestinal composite reservoir, including a staged and a single procedure in 3 and 4, respectively. Preoperatively and postoperatively serum electrolytes were measured, and urinalysis and urine cultures were performed in all patients. In 5 patients serum pH was compared preoperatively and postoperatively, and in all serum gastrin was measured postoperatively. RESULTS: At an average followup of 62 months (range 52 to 87) serum chloride and bicarbonate significantly normalized (p <0.05) in all 7 patients with bladder exstrophy or myelomeningocele. Serum pH also significantly normalized (p <0.05) in 5 patients at long-term followup. Serum gastrin and creatinine were normal and urinary pH fluctuated insignificantly throughout followup. None of the patients had urolithiasis or symptoms of the hematuria-dysuria syndrome. Periodic symptomatic urinary tract infections developed but none required chronic antibiotic therapy. CONCLUSIONS: Gastrointestinal composite urinary reservoirs appear to be beneficial for patients with myelomeningocele or exstrophy who have preexisting metabolic acidosis or the short bowel syndrome. Serum electrolyte neutrality is achieved during long-term followup. No patient had the hematuria-dysuria syndrome or urolithiasis.

    Title Predictability of Psa Failure in Prostate Cancer by Computerized Cytometric Assessment of Tumoral Cell Proliferation.
    Date May 1999
    Journal Urology
    Excerpt

    OBJECTIVES: To evaluate the relationship of DNA ploidy and cell proliferation (CP) with Gleason score (GS) and clinical outcome in prostate cancer. METHODS: Sixteen patients with benign prostatic hyperplasia (BPH) and 65 patients with prostate cancer classified by GS (four groups: 2 to 4, 5 to 6, 7, and 8 to 10) were studied. All patients with carcinoma underwent prostatectomy and were separated into prostate-specific antigen (PSA) failure and nonfailure groups (failure if PSA 0.1 ng/mL or more three times after surgery). Tumoral CP (Ki-67 inmunostaining and SG2M phase) and DNA ploidy were evaluated by computerized cytometry. RESULTS: BPH were diploid with low CP (8% SG2M cells or less). Carcinomas were either diploid with high CP (greater than 8% SG2M cells) or aneuploid. CP was significantly higher (P <0.001) in tumors with GS 7 or greater than in tumors with GS less than 7 (mean percent Ki-67 cells 18.3% versus 7.8%, respectively). PSA failure increased with GS (7.1% in GS 2 to 4, 21% in GS 5 to 6, 28.6% in GS 7, and 50% in GS 8 to 10), as well as with aneuploidy (18.5% in diploid tumors versus 72.7% in aneuploid tumors). Those experiencing PSA failure had significantly higher (P <0.001) CP than those not failing (mean percent Ki-67 cells 24% and mean percent SG2M 30.4% versus 8.7% and 13.5%, respectively). Cox regression analysis showed GS, DNA ploidy, Ki-67, and SG2M to each be univariately prognostic for time to PSA failure; however, Ki-67 and SG2M were more highly significant (P <0.0001 for both) than GS (P = 0.007) or DNA ploidy (P = 0.002). After adjusting for either SG2M or Ki-67 measures of CP, neither ploidy nor GS contained additional prognostic value. CONCLUSIONS: Tumor CP and DNA ploidy can be reliably determined in prostate cancer by computerized cytometry. On the basis of our preliminary results, CP correlates well with GS and predicts PSA failure better than DNA ploidy or GS.

    Title Evaluation of Flap Valve As an Alternative Continence Mechanism in the Florida Pouch.
    Date April 1999
    Journal Urology
    Excerpt

    OBJECTIVES: To evaluate urodynamic findings in a successful flap valve (FV) continence mechanism in association with a continent colonic urinary reservoir (Florida pouch) and to compare the urodynamic findings of the FV mechanism with the doubly plicated (PI) standard anti-incontinence segment in the same reservoir. METHODS: Thirteen patients who successfully received the Florida pouch between 1988 and 1996 agreed to undergo urodynamic evaluation as part of a pilot study. Eight patients had a PI continence mechanism and a mean time from surgery of 51 months; 5 had a FV continence mechanism and a mean time from surgery of 14 months. Enterocystometry was performed with a trans-stomal Bard triple channel 7F catheter. Volume and pressure at first desire to empty (VFDE, PFDE), as well as maximal enterocystometric capacity and pressure (VMEC, PMEC), were recorded. Maximal outlet pressure (MOP) was recorded using the catheter withdrawal technique. RESULTS: PI and FV groups demonstrated the following mean values respectively: VFDE, 692.7 and 403 mL; PFDE, 19.5 and 19.2 cm H2O; VMEC, 876.5 and 515 mL; PMEC, 25.9 and 24.6 cm H2O; MOP, 57.5 and 51.2 cm H2O (reservoir empty) and 50.5 and 52.6 cm H2O (reservoir full); and functional length of outlet, 24.3 and 24.6 cm. MOP measurement demonstrated greater variability in the PI than in the FV group. CONCLUSIONS: Urodynamic comparison of these mechanisms reveals that MOP measurement was closer to the mean among FV than PI patients. In addition, the mean VFDE (692.7 mL for PI versus 403 mL for FV, P < 0.05) and the mean VMEC (876.5 mL for PI versus 515 mL for FV, P < 0.05) were significantly less in the FV group. Lower VMEC and less variability in MOP indicate that continence may be more dependent on MOP in the FV mechanism. A longer follow-up time and a larger number of patients will be of assistance in clarifying these findings.

    Title Prenatal Bladder Outlet Obstruction Secondary to Ureterocele.
    Date December 1998
    Journal Urology
    Excerpt

    We present 2 cases of prenatal hydroureteronephrosis and bladder outlet obstruction due to an obstructing ureterocele. Both neonates were stabilized and managed with early endoscopic decompression. Neither infant demonstrated significant function in the kidney ipsilateral to the ureterocele either before or after ureterocele puncture. There have been few cases reported of prenatal bladder outlet obstruction due to a ureterocele. Our limited experience has been poor with regard to salvaging the affected upper tract. Future definitive management will be tailored as more of these cases are documented.

    Title Testicular Serous Papillary Cystadenomatous Tumor of Low Malignant Potential in a Child.
    Date December 1998
    Journal The Journal of Urology
    Title The Prenatal Diagnosis of Cloacal Exstrophy.
    Date September 1998
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We assess and clarify diagnostic features for making the prenatal diagnosis of cloacal exstrophy. MATERIALS AND METHODS: We evaluated 9 patients born with cloacal exstrophy at our institutions (2 prospectively and 7 retrospectively) for diagnostic features on prenatal ultrasound studies. We also thoroughly reviewed the literature on 13 previous prenatally diagnosed cloacal exstrophy cases. Diagnostic criteria were assessed by combining the findings in our patients and those in previous reports. RESULTS: Of the 22 patients with prenatal ultrasound studies and cloacal exstrophy whom we analyzed 1 of our 9 and 2 in the literature had a cloacal membrane that persisted at 22 weeks of gestation. Major ultrasound criteria for diagnosing cloacal exstrophy prenatally are nonvisualization of the bladder, a large midline infraumbilical anterior wall defect or cystic anterior wall structure (persistent cloacal membrane), omphalocele and lumbosacral anomalies. Seven less frequent or minor criteria include lower extremity defects, renal anomalies, ascites, widened pubic arches, a narrow thorax, hydrocephalus and 1 umbilical artery. CONCLUSIONS: We propose major and minor criteria to assist in the prenatal diagnosis of cloacal exstrophy. Despite these major and minor criteria the certainty of establishing a prenatal diagnosis remains challenging. Persistence of the cloacal membrane beyond the first trimester in 1 patient was an exception to the classic concept of cloacal exstrophy embryogenesis. An accurate prenatal diagnosis requires validation of these criteria by further correlation of prenatal and postnatal observations.

    Title Daytime Functional Bladder Capacity As a Predictor of Response to Desmopressin in Monosymptomatic Nocturnal Enuresis.
    Date July 1998
    Journal European Urology
    Excerpt

    OBJECTIVE: The objective of this study was to identify a cost-effective method of predicting a therapeutic response to desmopressin (DDAVP) by correlating daytime functional bladder capacity, age and urine osmolalities in patients with monosymptomatic nocturnal enuresis. MATERIALS AND METHODS: Thirty-five children out of 51 who initially presented to our institutions were included in the study. The remainder was excluded for lack of complete data. Constipation was actively addressed and was managed by administration of evening enemas for 3 consecutive days and dietary adjustment prior to initiating the study. Each micturition as measured throughout the day and the maximal daytime functional bladder capacity was determined as the largest void over a 2-day period. Urine samples were collected at home at 08:00, 16:00 and 22:00 (times that would best reflect the fluctuations in plasma vasopressin levels). Intranasal DDAVP was then administered, titrating the dose over a 2-week period. The initial dose was 10 micrograms and the dose was increased 10 micrograms every 3 days. RESULTS: The response to DDAVP was then evaluated and of the 35 children, 27 demonstrated a complete response to DDAVP (all at doses between 10 and 30 micrograms). These were then related to the possible predictive factors. There was a significant correlation between a high maximum daytime functional bladder capacity and response to DDAVP (p = 0.006). Similarly, age was also predictive of a good response to DDAVP treatment (p = 0.008). However, spot urine osmolalities were not predictive of a response to DDAVP (p > 0.1). CONCLUSIONS: Functional bladder capacity is a reliable predictor of response to desmopressin; children with larger capacities are more likely to exhibit a successful response. Older children have a better response rate than younger ones. Spot urine osmolality measured on specimens collected in the home setting is not predictive of response to desmopressin.

    Title Long-term Metabolic Advantages of a Gastrointestinal Composite Urinary Reservoir.
    Date November 1997
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We investigated the long-term metabolic impact of gastrointestinal composite reservoirs. MATERIALS AND METHODS: Nine patients underwent construction of a gastroileal (7) or gastrocolonic (2) reservoir for continent urinary diversion. Four cases of metabolic acidosis were converted from a preexisting conduit and the other 5 patients had diversion for either preexisting metabolic acidosis or the short bowel syndrome. All were reconstructed using a medium sized gastric segment (8 x 4 cm.) from the greater curvature of the stomach. The anti-incontinence segment was constructed from a tapered and reimplanted ileal segment. All patients underwent preoperative and postoperative measurements of serum pH, serum electrolytes, and urinalysis. Serum gastrin was measured in all patients postoperatively. Followup from surgery ranged from 47 to 61 months (mean 54.4). RESULTS: All 9 patients demonstrated electrolyte neutrality in serum on long-term followup. Postoperative serum pH (mean 7.40) was significantly different (p < 0.01) from preoperative serum pH (mean 7.36) and serum bicarbonate was also significantly different (p < 0.01) preoperatively versus postoperatively (mean 22.3 versus 25.14). Urine pH values were not significantly different throughout the study. One patient with mildly acidic urinary pH (6.0 to 6.5) had ulcerative skin changes at the stoma site. Three patients had elevated serum gastrin levels on short-term followup but all patients had normal serum gastrin levels on long-term followup. One patient, with persistent alkaline urine, had urolithiasis and symptomatic urinary tract infections. CONCLUSIONS: Our results demonstrate that a composite urinary reservoir constructed using gastric and intestinal segments achieved serum electrolyte neutrality on long-term followup. These results indicate a long-term metabolic advantage over other intestinal reservoirs associated with hyperchloremic metabolic acidosis and may be beneficial in patients compromised by either preexisting metabolic acidosis or the short bowel syndrome.

    Title Spot Urine Osmolality, Age and Bladder Capacity As Predictors of Response to Desmopressin in Nocturnal Enuresis.
    Date July 1997
    Journal Scandinavian Journal of Urology and Nephrology. Supplementum
    Excerpt

    The objective of the current study was to find a cost-effective way of correlating spot urine osmolalities, bladder capacity and age in patients with monosymptomatic nocturnal enuresis with response to treatment with desmopressin (Minirin, DDAVP). A total of 35 children fulfilled the entry criteria and were included in the study. Constipation was eliminated in these children by appropriate enema treatment and diet adjustment prior to enrollment. Urine samples were collected at home at times that would best reflect fluctuations in plasma vasopressin levels (08:00, 16:00 and 22:00) over three consecutive 24-hour periods. Maximal functional bladder capacity was determined from the largest voided volume. A 2-week dose-titration treatment period with intranasal desmopressin was then conducted. With doses of desmopressin being increased by 10 micrograms every 3 days. Response to desmopressin treatment was then assessed and factors that were observed to be markers of a favourable response were noted. Of the 35 children, 27 demonstrated a complete response to desmopressin treatment, at doses of 10-30 micrograms. Spot urine osmolalities were not predictive of the response to desmopressin (P > 0.1). In contrast, there was a significant correlation between a high maximum functional bladder capacity and response to desmopressin (P = 0.006). Age was also predictive of a good response to desmopressin treatment (P = 0.008).

    Title Age As a Prognostic Factor in the Malignant Melanoma Population.
    Date March 1995
    Journal Annals of Surgical Oncology
    Excerpt

    BACKGROUND: The incidence of malignant melanoma is increasing faster than any other cancer, and the state of Florida has one of the highest incidence of melanoma in the United States. This increased incidence is thought to be due to the intense sunlight exposure and ultraviolet radiation exposure in the elderly population. With the increased emphasis on issues of aging, it is appropriate to study the role of age as a prognostic factor for malignant melanoma in the Florida population. METHODS: A retrospective, computer-aided search identified 442 consecutively registered patients with malignant melanoma at the Cutaneous Oncology Program. All patients had stage 1 or 2 disease (cutaneous disease only) at diagnosis. Prognostic variables analyzed included the most powerful factors for stage 1 and 2 melanoma, tumor thickness, ulceration, and Clark level of invasion. Other prognostic variables included in the analysis were the clinical variables of sex and primary site (axial vs. extremity). The population was divided into patients < or = 65 and > 65 years of age. RESULTS: Significant disease-free survival differences were encountered in the older population, with only 55% of the elderly population being disease free at 5 years compared with 65% for the younger population (p = 0.0073). However, a greater percentage of patients with melanoma who were > 65 years of age had ulcerated lesions (17.5% vs. 12.9%) and a greater percentage of thick lesions at diagnosis (67.2% vs. 62.7%). Both of these prognostic factors would bias the older population with a poorer survival. A stepwise regression analysis of the entire population was performed, treating age as a continuous variable. Surprisingly, increasing age along with tumor thickness were the only significant predictors for disease-free survival. After inclusion of these two prognostic variables, none of the other prognostic factors, including Clark level, ulceration, sex, and primary site, added to the prognostic model. CONCLUSIONS: From this analysis, it is apparent that geriatric patients with melanoma have a worse prognosis than a younger control population, even after the correction for the more commonly cited prognostic factors. This information should be used in mathematical modeling to identify high-risk populations who are candidates for perhaps more aggressive primary or adjuvant therapies.

    Title Correlation of Prenatal and Postnatal Ultrasound Findings with the Incidence of Vesicoureteral Reflux in Children with Fetal Renal Pelvic Dilatation.
    Date
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Up to 1% of prenatal ultrasounds detect renal pelvic dilatation. This dilatation is associated with vesicoureteral reflux but its clinical significance and the necessity for vesicoureteral reflux detection have been questioned. We report an evaluation of fetal renal pelvic dilatation and postnatal sonographic features with the incidence of vesicoureteral reflux. MATERIALS AND METHODS: Maximum fetal renal pelvic dilatation was prospectively measured at a single center between 1990 and 2003. Dilatation 4 mm or greater at less than 33 weeks of gestation, or 7 mm or greater at more than 33 weeks was the threshold for inclusion in the study. Postnatal evaluation included ultrasound and voiding cystourethrogram. Postnatal data included vesicoureteral reflux incidence and grade, and caliceal and ureteral dilatation on ultrasound. RESULTS: Of 215 neonates 46 (21%) had vesicoureteral reflux. Mean renal pelvic dilatation was 14.4 mm in those with reflux, which was not statistically different than the mean of 11.8 mm in 169 with a normal voiding cystourethrogram. ROC analysis revealed that fetal renal pelvic dilatation was a poor discriminator of reflux. Reflux was identified in a significantly greater number of neonates with vs without postnatal calicectasis (20% vs 9%, p <0.05). When fetal renal pelvic dilatation was combined with postnatal calicectasis, only 5% of infants with dilatation less than 10 mm and isolated renal pelvic dilatation had reflux, whereas reflux was identified in 25% with fetal renal pelvic dilatation 10 mm or greater and calicectasis (p <0.02). CONCLUSIONS: The magnitude of fetal renal pelvic dilatation is not reliably predictive of reflux and this measure alone cannot be used to direct postnatal cystography. However, postnatal calicectasis appears to be an important predictor of vesicoureteral reflux in children with fetal renal pelvic dilatation. Expectant management can be considered in the subset of newborns with minimal dilatation (less than 10 mm) and absent calicectasis.

    Title The Incidence of Disorders of Sexual Differentiation and Chromosomal Abnormalities of Cryptorchidism and Hypospadias Stratified by Meatal Location.
    Date
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Routine karyotype analysis has been recommended for patients with cryptorchidism and hypospadias. However, it is unclear whether karyotyping should be obtained in all patients, or tailored to the severity or degree of hypospadias. Therefore, we analyzed the incidence of chromosomal abnormalities in patients with distal or proximal hypospadias and concomitant cryptorchidism. MATERIALS AND METHODS: We reviewed the records of patients with cryptorchidism and hypospadias treated at a pediatric hospital between 1994 and 2006. Data collected included karyotype analysis, gonad palpability, and meatal and testes location at time of surgery. Patients with retractile testes and congenital adrenal hyperplasia were excluded from analysis. RESULTS: We identified 44 patients with hypospadias and cryptorchidism (26 with proximal and 18 with distal hypospadias). Karyotype information was available in 25 patients (19 with proximal and 6 with distal hypospadias). None of the patients with distal hypospadias and cryptorchidism had an abnormality of a sex chromosome. In contrast, chromosomal abnormalities were present in 6 of 19 individuals (32%) with proximal hypospadias and cryptorchidism. The most common abnormality was mixed gonadal dysgenesis in 3 patients, followed by autosomal translocations in 2 and 48XY aneuploidy in 1. CONCLUSIONS: When karyotype information was stratified by meatal location with cryptorchidism we found no significant chromosomal abnormalities in distal hypospadias and cryptorchidism, whereas a third of patients with proximal hypospadias and cryptorchidism had an abnormal karyotype. Karyotype analysis appears to be important in individuals with cryptorchidism and proximal hypospadias but of little benefit in patients with distal hypospadias and palpable undescended testes.

    Title Combination Therapy with Desmopressin and an Anticholinergic Medication for Nonresponders to Desmopressin for Monosymptomatic Nocturnal Enuresis: a Randomized, Double-blind, Placebo-controlled Trial.
    Date
    Journal Pediatrics
    Excerpt

    OBJECTIVE: Desmopressin is an approved medical therapy for the treatment of monosymptomatic primary nocturnal enuresis. In cases of limited response to desmopressin, we have added anticholinergic therapy to desmopressin (combination therapy). To evaluate this treatment strategy, we examined the efficacy of combination therapy for primary nocturnal enuresis in desmopressin-nonresponders. METHODS: Only patients with primary nocturnal enuresis refractory to the maximal dosage of desmopressin were enrolled. Children with lower urinary tract symptoms or bowel dysfunction were excluded, on the basis of a 3-day, 24-hour, frequency-volume chart and elimination record. Children continued to take desmopressin and were assigned randomly, in a double-blind manner, to receive either extended-release anticholinergic medication or placebo. Patients were reassessed after 1 month of therapy, with a 1-week nocturnal record. RESULTS: Forty-one desmopressin-nonresponders were enrolled, and 7 patients were excluded because of noncompliance. The treatment groups were equally matched with respect to age, gender, functional bladder capacity, and number of wet nights per week. After 1 month of treatment, there was a significant reduction in the mean number of wet nights in the combination therapy group, compared with the placebo group. With a generalized estimating equation approach, there was a significant 66% decrease in the risk of a wet episode, compared with the placebo group. CONCLUSIONS: This study represents the first prospective, placebo-controlled trial examining the effect of desmopressin in combination with long-acting, anticholinergic, bladder-relaxing therapy for monosymptomatic primary nocturnal enuresis.

    Title Is Neonatal Circumcision Clinically Beneficial? Argument in Favor.
    Date
    Journal Nature Clinical Practice. Urology
    Title Circumcision.
    Date
    Journal Current Opinion in Urology
    Excerpt

    Recent randomized control trials have demonstrated the efficacy of male circumcision in reducing the incidence of HIV infection in geographic areas epidemic with AIDS. Ancillary studies from these trials and others have emerged with more data on further public health benefits. We review the findings of these new trials as well as new studies pertaining to male circumcision.

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